Interrater Reliability of the History and Physical Examination in Patients With Mechanical Neck Pain

Abstract

Cleland JA, Childs JD, Fritz JM, Whitman JM. Interrater reliability of the history and physical examination in patients with mechanical neck pain. Objective To examine the interrater reliability of the history and physical examination in patients with mechanical neck pain. Design Single-group repeated measures for interrater reliability. Setting Outpatient physical therapy clinic. Participants Twenty-two patients with mechanical neck pain underwent a standardized history and physical examination by a physical therapist. Intervention Following a 5-minute break, a second therapist who was blind to the findings of examiner 1 performed the second standardized history and physical examination. Main Outcome Measures The Cohen κ and weighted κ were used to calculate the interrater reliability of ordinal level data from the history and physical examination. Intraclass correlation coefficients model 2,1 (ICC 2,1) and the 95% confidence intervals were calculated to determine the interrater reliability for continuous variables. Results The κ coefficients ranged from −.06 to .90 for the variables obtained from the history. Reliability values for categorical data collected during the physical examination ranged from no to substantial agreement depending on the particular test and measure. ICC 2,1 for cervical range of motion (ROM) measurements ranged between .66 and .78. Conclusions We have reported the interrater reliability of the history and physical examination in a group of patients with a primary report of neck pain. The reliability variables varied considerably for manual assessment techniques and were significantly higher for the examination of muscle length and cervical ROM. Ultimately, it will be up to each clinician to determine if a particular test or measure poses adequate reliability to assist in the clinical decision making process.