Abstract
BackgroundThe reliability of clinical tests for the cervical spine has not been adequately evaluated. Six cervical clinical tests, which are low cost and easy to perform in clinical settings, were tested for intra- and inter-examiner reliability, and two performance tests were assessed for test-retest reliability in people with and without chronic neck pain. Moreover, construct and between-group discriminative validity of the tests were examined.MethodsTwenty-one participants with chronic neck pain and 21 asymptomatic participants were included. Intra- and inter-reliability were evaluated for the Cranio-Cervical Flexion Test (CCFT), Range of Movement (ROM), Joint Position Error (JPE), Gaze Stability (GS), Smooth Pursuit Neck Torsion Test (SPNTT), and neuromuscular control of the Deep Cervical Extensors (DCE). Test-retest reliability was assessed for Postural Control (SWAY) and Pressure Pain Threshold (PPT) over tibialis anterior, infraspinatus and the C3-C4 segment.ResultsIntraclass Correlation Coefficient (ICC) for intra- and inter-examiner reliability was highest for ROM (range: 0.80 to 0.94), DCE (0.75 to 0.90) and CCFT (0.63 to 0.86). JPE had the lowest ICC (0.02 to 0.66). Intra- and inter-reliability for GS and SPNTT showed kappa ranging from 0.66 to 0.92, and 0.57 to 0.78 (prevalence adjusted), respectively. For the test-retest study, ICC was 0.83 to 0.89 for PPT and 0.39 to 0.79 for SWAY. Construct validity was satisfactory for all tests, except JPE. Significant between group discriminative validity was found for CCFT, ROM, GS, SPNTT and PPT, however, differences were within the limits of the minimal detectable change.ConclusionsThe majority of the tests evaluated showed satisfactory reliability and construct validity supporting their use in the clinical evaluation of patients with chronic neck pain.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-408) contains supplementary material, which is available to authorized users.
Highlights
The reliability of clinical tests for the cervical spine has not been adequately evaluated
Satisfactory reliability has been reported for the measure of pressure pain threshold (PPT) using a handheld algometer in patients with acute neck pain [28], this has not been replicated in patients with chronic neck pain
Highest Intraclass Correlation Coefficient (ICC) for clinical tests were found for Range of Movement (ROM) (ICC: 0.80 to 0.93), Deep Cervical Extensors (DCE) (0.75 to 0.90) and Cervical Flexion Test (CCFT) (0.63 to 0.86) and lowest for Joint Position Error (JPE) (0.02 to 0.66) (Table 4)
Summary
The reliability of clinical tests for the cervical spine has not been adequately evaluated. Six cervical clinical tests, which are low cost and easy to perform in clinical settings, were tested for intra- and inter-examiner reliability, and two performance tests were assessed for test-retest reliability in people with and without chronic neck pain. Several studies conducted on people with chronic neck pain, cervicogenic headache or asymptomatic controls [18,19,20,21], have found satisfactory intra- and inter examiner reliability of the cranio-cervical flexion test, a low-load test, measuring the patient’s ability to activate the deep cervical flexor muscles. Reliability of measuring repositioning error during tests of relocation accuracy has been examined in people with whiplashinduced neck pain and in asymptomatic controls with advanced equipment only, and the results are conflicting - ranging from high levels of reliability [23], to very low levels [24]. Satisfactory reliability has been reported for the measure of pressure pain threshold (PPT) using a handheld algometer in patients with acute neck pain [28], this has not been replicated in patients with chronic neck pain
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