Radiographic Assessment and Reliability Study of the Craniovertebral Sidebending Test

Abstract

Background and Purpose: In orthopaedic manual physical therapy, passive intervertebral joint testing of the upper cervical spine is widely used for clinical assessment. However, the test position has not been standardized and tester reliability has not been well established. The purpose of this study is to determine whether patient positioning affects the degree of reliability of passive motion testing and end-feel assessment when passively testing craniovertebral sidebending.Subjects: Ten subjects participated in both the radiographic and clinical assessment portion of this study with mean age of 32.5 +/− 6.9 years.Methods: Open-mouth position radiographs were used to measure passive craniovertebral sidebending at the “erect” neutral and the “physiological” neutral positions. Intertester and intratester reliability were determined on the same group of subjects using six physical therapists to assess end-feel and mobility grades for passive craniovertebral sidebending in five positions.Results: The mean total sidebending motion for C0C2 was 8.3 degrees for the physiological neutral position and 7.2 degrees for the erect neutral position. In the clinical assessment portion of the study, Kappa scores ranged from − .027 to .182 for intertester reliability and from − .022 to .137 for intratester reliability for mobility grade assessment with minimal difference noted between the five test positions. For end-feel assessment, the Kappa scores ranged from − .043 to .119 for intertester reliability and from .01 to .308 for intratester reliability with the physiological neutral position demonstrating the highest intratester reliability.Conclusion and Discussion: The results of the radiographic assessment portion of this study demonstrate greater passive range of motion in the physiological neutral position for the majority of the subjects offering some support for the use of the physiological neutral position as the standard position of the cervical spine for testing passive craniovertebral sidebending motion. However, all the test positions showed poor intertester reliability for the craniovertebral sidebending passive motion test. Follow-up studies are needed that allow testers an opportunity to correlate clinical findings with the passive craniovertebral motion test in order to establish reliability in using this manual assessment procedure.