Evaluating Commercial Cervical Immobilization Devices for Prehospital Use: Identifying the Most Comfortable Model for Adults

Abstract

Cervical Immobilization Devices (CIDs) are a routinely used intervention in the prehospital and in hospital care of patients with suspected cervical spinal injury. However, there is limited evidence regarding the comfort of CIDs, especially given the increasing number of commercially available immobilization devices on the market. This study aimed to address the current literature gap by evaluating comfort levels, pain and perceived movement restriction in various commercially available CIDs. Descriptive and statistical analysis were used to compare the results, and linear regression was performed to examine the effects of various covariates. A convenience sample of fifty subjects (18 Female, and 32 Male) were recruited. Mean age 35.9 years old (SD) 1.85 years. Results showed that the relative risk (RR) of a participant an abnormal positioning while wearing a collar was lowest with Collar C (SipQuik Cervical Collar, Soft Collar) (RR 0.25, 95% CI 0.09 - 0.70) (Table 2 & Figure 3). Although the remaining collars (A, D, and E) also had lower RR values, these were not statistically significant. The RR of experiencing pain or tenderness after three minutes collar application, was similar across all models (Table 2 & Figure 4). None of the results reached statistical significance, indicating that no collar was definitively superior in reducing discomfort. Results also showed that the more rigid collar types (A and B) showed the highest number of participants (n=14 and n=12) respectively reporting an inability to move their head in any direction. On the other side, Collar C had the highest number of participants stating that they could fully move their head in any direction. There were no statistically significant effects from the covariates, except for one instance, Collar D, where a positive correlation was found between weight and movement restriction (p < 0.05). While the current study gives valuable insights on the preferred model cervical collar when healthy adults are the sole participants, more research into subjective experiences while wearing cervical collars is still needed. The study findings show that the chosen collar type may be more dependent on specific aspects such as correct application and immobilization capabilities than on the participants physical attributes such as weight, height, and age. With the ongoing controversy, further research on collar comfort preference is still required. This study highlights variations in comfort and movement restriction among different commercially available cervical collars. While many studies have examined the biomechanical effectiveness of cervical collars, limited research has focused on their impact on patient comfort, a crucial factor influencing compliance and tolerance in both prehospital and in-hospital settings. This study contributes to the broader conversation about best practices in prehospital trauma care. If certain collars are found to cause significant discomfort without offering superior stabilization benefits, reconsideration of current immobilization protocols may be warranted. Ultimately, this research supports a more evidence-based approach to cervical spine immobilization, prioritizing both patient safety and experience in trauma management.