Fit for purpose? A cross-sectional study to evaluate the acceptability and usability of HeadUp, a novel neck support collar for neurological neck weakness

Figures & data

Figure 1. HeadUp collar (previously known as Sheffield Support Snood). The A-frame and supports (far left), the HeadUp collar (middle) and the HeadUp collar with selection and placement customized for the participant (far right). Available sizes include small (33–40 cm/13–16 inches), medium (38–44 cm/15–17.5 inches) and large (43–51 cm/17–20 inches).

Table 1 Distribution of participant by diagnosis.

Diagnosis	Number of Participants	Neck Flexion Score		Neck Extension Score
		Mean	SD	Mean	SD
Motor Neuron Disease	117	3.0	1.1	2.7	1.1
Post Radiation Myopathy	11	3.5	1.0	3.0	1.0
Multiple Sclerosis	3	3.0	1.0	3.3	0.6
Fascioscapulohumeral dystrophy	1	4	n/a	2	n/a
Kennedy’s Disease	1	4	n/a	4	n/a
Duchenne Muscular Dystrophy	1	4	n/a	3	n/a
Mitochondrial Myopathy	1	2	n/a	2	n/a
Multiple System Atrophy	1	4	n/a	2	n/a
Myasthenia Gravis	1	4	n/a	3	n/a
Spinal Muscular Atrophy	1	2	n/a	3	n/a
Progressive Supranuclear Palsy	1	4	n/a	2	n/a
Total	139	3.1	1.2	2.8	1.2

Neck flexion and extension scores; mean and standard deviation (SD) from MRC scoring (0–5). N.B. Standard deviation (SD) not available (n/a) for those disorders in which only one participant was recruited.

Table 2 Distribution of different collar types between participants.

Collar Name	Type of Collar	Frequency	Percentage
Headmaster	Semi-rigid	47	33.8
Soft collar	Soft	18	12.9
Foam collar	Soft	12	8.6
Hereford	Soft	9	6.5
Strio II	Soft	4	2.9
Oxford	Rigid	4	2.9
Miami J	Rigid	2	1.4
Adams	Semi-rigid	2	1.4
Aspen Vista	Rigid	2	1.4
Philadelphia Adjustable	Rigid	1	0.7
Hensinger	Soft	1	0.7
Hard collar	Rigid	1	0.7
Saratoga	Rigid	1	0.7
Trulife airflow	Rigid	1	0.7
Other	Homemade	4	2.9
Information not available	N/A	30	21.4

Table 3. Neck collar questionnaire responses.

Questions	Previous collar mean rating (Mean and SD)	HeadUp collar mean rating (Mean and SD)	Wilcoxon signed rank test for paired samples
1. This collar causes no restriction to my natural breathing	n = 91	n = 97	n = 67
	2.98	2.42	z= −1.951^P
	1.921	1.707	p = 0.051
2. I experience no additional difficulties eating a meal due to wearing this collar.	n = 69	n = 81	n = 48
	5.00	3.65	z= −3.3563^P
	2.149	2.075	p < 0.0005*
3. I experience no additional problems drinking due to wearing this collar.	n = 74	n = 87	n = 54
	4.38	3.03	z= −3.886^P
	2.194	1.926	p < 0.0005*
4. This collar causes no restriction to my natural swallowing	n = 84	n = 91	n = 60
	3.57	2.86	z= −2.001^P
	2.180	1.912	p = 0.045*
5. I feel that this collar offers support.	n = 92	n = 99	n = 69
	3.27	2.07	z= −4.071*
	1.742	1.342	p < 0.0005*
6. I experience no perspiration around my head, shoulders or neck as a result of wearing this collar	n = 92	n = 98	n = 68
	3.43	3.17	z= −0.712^P
	2.093	2.000	p = 0.476
7. I find this collar visually attractive.	n = 90	n = 97	n = 68
	5.49	3.62	z= −5.857^P
	1.493	1.610	p < 0.0005*
8. I have an acceptable range of head movement wearing this collar	n = 92	n = 94	n = 67
	4.51	2.68	z= −5.046^P
	1.975	1.461	p < 0.0005*
9. I find this collar very easy to fit on my own	n = 86	n = 98	n = 64
	5.47	6.33	z= −3.363^N
	2.022	1.091	p = 0.001*
10. I feel no frustration at all whilst wearing this collar.	n = 92	n = 98	n = 69
	4.93	3.76	z= −3.874^P
	1.932	1.867	p < 0.0005*
11. I am extremely satisfied with this collar	n = 92	n = 99	n = 69
	5.11	3.16	z= −4.722^P
	1.824	1.800	p < 0.0005*

Rating derived from seven-point Likert scale: 1 strongly agree; 2 agree; 3 agree somewhat; 4 neither agree nor disagree; 5 disagree somewhat; 6 disagree; 7 strongly disagree. Rating for pain was categorized as 1 = No discomfort and 7 = Severe pain. ^N based on negative ranks. ^P based on positive ranks. * highlights significant values.

Table 4 Clinician feedback on experience of collar fitting on baseline visit.

Site	Q1. Experience of fitting				Q2. Time taken for first fitting (in minutes)
	VE	E	D	VD	<5	5–10	10–15	15–20	20–25	>25
Site A	0	2	3	0	0	0	0	0	0	5
Site B	0	5	2	0	0	2	3	0	0	2
Site C	2	2	3	0	1	1	2	1	1	1
Site D	1	8	5	3	0	0	1	7	7	2
Site E	1	14	3	0	0	4	4	3	7	0
Site F	2	7	0	0	0	1	1	2	4	1
Site G	0	2	3	0	0	0	0	2	0	3
Site H	3	1	1	0	0	0	2	2	0	1
Site I	2	26	3	2	0	1	2	5	16	9
Site J	3	2	2	0	0	0	0	1	3	3

Q1. Experience of fitting at each site; degree of difficulty of fitting was categorized as: VE; very easy, E; easy, D; difficult, VD; very difficult. The experience for each participant was noted, each site provided totals for each category. Q2. Time taken for first fitting (in minutes); assessed at baseline and categorized into <5; 5–10, 10–15, 15–20, 20–25 and >25 minutes. N.B Line totals for Q1 and Q2 do not match as some sites returned incomplete data.