Abstract
ObjectiveThe objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess the cervical spine.Materials:Reliability study that used a convenience sample of 51 patients between the ages of 16–70 years presenting with a chief complaint of neck pain. Two physical therapists independently performed the same series of cervical physical examination procedures on each of the participant. The clinicians were blinded to each other’s findings and the clinical status of the patient. Kappa coefficients (κ) were calculated for levels of agreement between the clinicians for each procedure.ResultsWhen assessing for asymmetrical motion, excellent levels of reliability (κ range: 0.88–0.96) were observed for the Bilateral Modified Lateral Shear (asymmetry criterion), Bilateral C2 Spinous Kick (asymmetry criterion) and Flexion-Rotation Tests. When pain provocation was used as the indicator of a positive test during palpation of the cervical facet joints, moderate to substantial levels of reliability (κ range: 0.53–0.76) were observed. When patients were instructed not to provide feedback to the clinicians about pain provocation during facet joint palpation and clinicians relied solely on their qualitative assessment of segmental mobility, the level of reliability was lower (κ range: 0.45–0.53). Due to 100 % prevalence of negative findings, Kappa values could not be calculated for the Sharp-Purser test or the Unilateral C2 Spinous Kick Test.ConclusionsMost physical examination procedures examined in this study demonstrated moderate to excellent levels of inter-examiner reliability. Palpation for segmental mobility without pain provocation demonstrated a lower level of reliability compared to palpation for pain provocation. Correlation with clinical findings is necessary to establish validity and the applicability of these procedures in clinical practice.
Highlights
Neck pain is a common musculoskeletal disorder with an annual prevalence exceeding 30 % and is considered the fourth leading cause of disability worldwide [1, 2]
Most physical examination procedures examined in this study demonstrated moderate to excellent levels of inter-examiner reliability
Palpation for segmental mobility without pain provocation demonstrated a lower level of reliability compared to palpation for pain provocation
Summary
Neck pain is a common musculoskeletal disorder with an annual prevalence exceeding 30 % and is considered the fourth leading cause of disability worldwide [1, 2]. There are many “mechanical” assessments used by chiropractors and physical therapists to determine localized areas of musculoskeletal pain and dysfunction in the cervical spine [6] These procedures involve two components: (1) pain provocation and (2) qualitative assessments by the clinician about the perceived amount of joint motion and muscle tone [7]. A recent systematic review found little evidence to support the reliability and validity of most clinical tests used by physical therapists and chiropractors to assess head posture, pain location and cervical mobility in patients with neck pain [11] Another recent systematic review found inconsistent levels of reliability for movement and pain testing procedures ranging from poor to almost perfect, with the overall conclusion that passive intervertebral tests had poor reliability [12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
