Reliability of Manual Mobility Testing of the Upper Cervical Spine in Subjects with Cervicogenic Headache

Abstract

The identification of a cervicogenic headache is determined by criteria as stated by the International Headache Society (IHS). One of the criteria involves a finding of abnormal tenderness or resistance to movement in the neck region. The purpose of this study was to examine the inter-examiner and intra-examiner reliability of manual mobility testing of the upper cervical spine in the diagnosis of cervicogenic headaches in symptomatic subjects. Two groups of 20 subjects were required to meet initial criteria for a cervicogenic headache as adapted from the IHS. Subjects were not currently receiving medical treatment for headaches. To determine inter-examiner reliability, two examiners independently examined the 20 subjects (ages 22-48; 5 males and 15 females). Each examiner performed 15 mobility tests in random order on each subject. To establish intra-examiner reliability, a separate group of 20 subjects (ages 21-48; 3 males and 17 females) was evaluated by one examiner on two consecutive days. The Spearman's rho correlation was applied to the total number of abnormal findings recorded across each group of subjects. The Kappa correlation coefficient and percent agreement were used to compare the findings of each of the 15 mobility tests. They were also used to compare the identification of at least one abnormal finding for every subject. For this study, Kappa values ≥0.400 were considered acceptable. The Spearman's rho value for inter-examiner reliability was 0.943. Acceptable inter-examiner reliability was found on 11 out of 15 mobility tests, with Kappa values ranging from –0.053 to 1.000 and percent agreement values ranging from 70 to 100%. There was 100% agreement between examiners on whether the subject met the IHS criteria, resulting in a Kappa value of 1.000. The Spearman's rho value for intra-examiner reliability was also 0.943. Kappa values for intra-examiner reliability were acceptable for 11 out 15 tests and ranged from 0.208 to 1.000. The percent agreement values ranged from 60 to 100%. There was 100% agreement on consecutive days on whether the subject met the IHS criteria, yielding a Kappa value of 1.000. This study found that mobility testing, which includes palpation of the cervical spine, is a reliable tool, specifically in the identification of a cervicogenic headache in symptomatic subjects.