Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2014

Open Access 01-12-2014 | Research article

Reliability, construct and discriminative validity of clinical testing in subjects with and without chronic neck pain

Authors: René Jørgensen, Inge Ris, Deborah Falla, Birgit Juul-Kristensen

Published in: BMC Musculoskeletal Disorders | Issue 1/2014

Login to get access

Abstract

Background

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. Moreover, construct and between-group discriminative validity of the tests were examined.

Methods

Twenty-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.

Results

Intraclass 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.

Conclusions

The majority of the tests evaluated showed satisfactory reliability and construct validity supporting their use in the clinical evaluation of patients with chronic neck pain.
Appendix
Available only for authorised users
Literature
1.
National Institute of Public Health: Folkesundhedsrapporten. 2007, Denmark
2.
Huisstede BM, Wijnhoven HA, Bierma-Zeinstra SM, Koes BW, Verhaar JA, Picavet S: Prevalence and characteristics of complaints of the arm, neck, and/or shoulder (CANS) in the open population. Clin J Pain. 2008, 24 (3): 253-259. 10.1097/AJP.0b013e318160a8b4.CrossRefPubMed
3.
4.
Fejer R, Kyvik KO, Hartvigsen J: The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006, 15 (6): 834-848. 10.1007/s00586-004-0864-4.CrossRefPubMed
5.
Jull G, Kristjansson E, Dall’Alba P: Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Man Ther. 2004, 9 (2): 89-94. 10.1016/S1356-689X(03)00086-9.CrossRefPubMed
6.
Falla DL, Jull GA, Hodges PW: Patients with neck pain demonstrate reduced electromyographic activity of the deep cervical flexor muscles during performance of the craniocervical flexion test. Spine (Phila Pa 1976). 2004, 29 (19): 2108-2114. 10.1097/01.brs.0000141170.89317.0e.CrossRef
7.
Elliott J, Jull G, Noteboom JT, Darnell R, Galloway G, Gibbon WW: Fatty infiltration in the cervical extensor muscles in persistent whiplash-associated disorders: a magnetic resonance imaging analysis. Spine (Phila Pa 1976). 2006, 31 (22): 847-855. 10.1097/01.brs.0000240841.07050.34.CrossRef
8.
Schomacher J, Farina D, Lindstroem R, Falla D: Chronic trauma-induced neck pain impairs the neural control of the deep semispinalis cervicis muscle. Clin Neurophysiol. 2012, 123 (7): 1403-1408. 10.1016/j.clinph.2011.11.033.CrossRefPubMed
9.
Woodhouse A, Vasseljen O: Altered motor control patterns in whiplash and chronic neck pain. BMC Musculoskelet Disord. 2008, 9: 90-10.1186/1471-2474-9-90.CrossRefPubMedPubMedCentral
10.
Treleaven J, Jull G, Sterling M: Dizziness and unsteadiness following whiplash injury: characteristic features and relationship with cervical joint position error. J Rehabil Med. 2003, 35 (1): 36-43. 10.1080/16501970306109.CrossRefPubMed
11.
Feipel V, Salvia P, Klein H, Rooze M: Head repositioning accuracy in patients with whiplash-associated disorders. Spine (Phila Pa 1976). 2006, 31 (2): 51-58. 10.1097/01.brs.0000194786.63690.54.CrossRef
12.
Treleaven J, Jull G, Grip H: Head eye co-ordination and gaze stability in subjects with persistent whiplash associated disorders. Man Ther. 2011, 16 (3): 252-257. 10.1016/j.math.2010.11.002.CrossRefPubMed
13.
Grip H, Sundelin G, Gerdle B, Karlsson JS: Variations in the axis of motion during head repositioning--a comparison of subjects with whiplash-associated disorders or non-specific neck pain and healthy controls. Clin Biomech (Bristol, Avon). 2007, 22 (8): 865-873. 10.1016/j.clinbiomech.2007.05.008.CrossRef
14.
Sjostrom H, Allum JH, Carpenter MG, Adkin AL, Honegger F, Ettlin T: Trunk sway measures of postural stability during clinical balance tests in patients with chronic whiplash injury symptoms. Spine (Phila Pa 1976). 2003, 28 (15): 1725-1734.
15.
Madeleine P, Nielsen M, Arendt-Nielsen L: Characterization of postural control deficit in whiplash patients by means of linear and nonlinear analyses - A pilot study. J Electromyogr Kinesiol. 2011, 21 (2): 291-297. 10.1016/j.jelekin.2010.05.006.CrossRefPubMed
16.
Scott D, Jull G, Sterling M: Widespread sensory hypersensitivity is a feature of chronic whiplash-associated disorder but not chronic idiopathic neck pain. Clin J Pain. 2005, 21 (2): 175-181. 10.1097/00002508-200503000-00009.CrossRefPubMed
17.
Sterling M, Hodkinson E, Pettiford C, Souvlis T, Curatolo M: Psychologic factors are related to some sensory pain thresholds but not nociceptive flexion reflex threshold in chronic whiplash. Clin J Pain. 2008, 24 (2): 124-130. 10.1097/AJP.0b013e31815ca293.CrossRefPubMed
18.
James G, Doe T: The craniocervical flexion test: intra-tester reliability in asymptomatic subjects. Physiother Res Int. 2010, 15 (3): 144-149. 10.1002/pri.456.CrossRefPubMed
19.
Chiu TT, Law EY, Chiu TH: Performance of the craniocervical flexion test in subjects with and without chronic neck pain. J Orthop Sports Phys Ther. 2005, 35 (9): 567-571. 10.2519/jospt.2005.35.9.567.CrossRefPubMed
20.
Arumugam A, Mani R, Raja K: Interrater reliability of the craniocervical flexion test in asymptomatic individuals–a cross-sectional study. J Manipulative Physiol Ther. 2011, 34 (4): 247-253. 10.1016/j.jmpt.2011.04.011.CrossRefPubMed
21.
Jull G, Barrett C, Magee R, Ho P: Further clinical clarification of the muscle dysfunction in cervical headache. Cephalalgia. 1999, 19 (3): 179-185. 10.1046/j.1468-2982.1999.1903179.x.CrossRefPubMed
22.
de Koning CH, van den Heuvel SP, Staal JB, Smits-Engelsman BC, Hendriks EJ: Clinimetric evaluation of methods to measure muscle functioning in patients with non-specific neck pain: a systematic review. BMC Musculoskelet Disord. 2008, 9: 142-10.1186/1471-2474-9-142.CrossRefPubMedPubMedCentral
23.
Loudon JK, Ruhl M, Field E: Ability to reproduce head position after whiplash injury. Spine (Phila Pa 1976). 1997, 22 (8): 865-868. 10.1097/00007632-199704150-00008.CrossRef
24.
Strimpakos N, Sakellari V, Gioftsos G, Kapreli E, Oldham J: Cervical joint position sense: an intra- and inter-examiner reliability study. Gait Posture. 2006, 23 (1): 22-31. 10.1016/j.gaitpost.2004.11.019.CrossRefPubMed
25.
Kongsted A, Jorgensen LV, Bendix T, Korsholm L, Leboeuf-Yde C: Are smooth pursuit eye movements altered in chronic whiplash-associated disorders? A cross-sectional study. Clin Rehabil. 2007, 21 (11): 1038-1049. 10.1177/0269215507075519.CrossRefPubMed
26.
Grip H, Jull G, Treleaven J: Head eye co-ordination using simultaneous measurement of eye in head and head in space movements: potential for use in subjects with a whiplash injury. J Clin Monit Comput. 2009, 23 (1): 31-40. 10.1007/s10877-009-9160-5.CrossRefPubMed
27.
Clark RA, McGough R, Paterson K: Reliability of an inexpensive and portable dynamic weight bearing asymmetry assessment system incorporating dual Nintendo Wii Balance Boards. Gait Posture. 2011, 34 (2): 288-291. 10.1016/j.gaitpost.2011.04.010.CrossRefPubMed
28.
Walton DM, Macdermid JC, Nielson W, Teasell RW, Chiasson M, Brown L: Reliability, standard error, and minimum detectable change of clinical pressure pain threshold testing in people with and without acute neck pain. J Orthop Sports Phys Ther. 2011, 41 (9): 644-650. 10.2519/jospt.2011.3666.CrossRefPubMed
29.
30.
Enoch F, Kjaer P, Elkjaer A, Remvig L, Juul-Kristensen B: Inter-examiner reproducibility of tests for lumbar motor control. BMC Musculoskelet Disord. 2011, 12: 114-10.1186/1471-2474-12-114.CrossRefPubMedPubMedCentral
31.
Rubinstein SM, Pool JJ, van Tulder MW, Riphagen II, de Vet HC: A systematic review of the diagnostic accuracy of provocative tests of the neck for diagnosing cervical radiculopathy. Eur Spine J. 2007, 16 (3): 307-319. 10.1007/s00586-006-0225-6.CrossRefPubMed
32.
Carter CL, Dacey CM: Validity of the Beck Depression Inventory, MMPI, and Rorschach in assessing adolescent depression. J Adolesc. 1996, 19 (3): 223-231. 10.1006/jado.1996.0021.CrossRefPubMed
33.
Vernon H, Mior S: The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991, 14 (7): 409-415.PubMed
34.
Bjorner JB, Damsgaard MT, Watt T, Groenvold M: Tests of data quality, scaling assumptions, and reliability of the Danish SF-36. J Clin Epidemiol. 1998, 51 (11): 1001-1011. 10.1016/S0895-4356(98)00092-4.CrossRefPubMed
35.
McCarthy MJ, Grevitt MP, Silcocks P, Hobbs G: The reliability of the Vernon and Mior neck disability index, and its validity compared with the short form-36 health survey questionnaire. Eur Spine J. 2007, 16 (12): 2111-2117. 10.1007/s00586-007-0503-y.CrossRefPubMedPubMedCentral
36.
Cleland JA, Childs JD, Whitman JM: Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain. Arch Phys Med Rehabil. 2008, 89 (1): 69-74. 10.1016/j.apmr.2007.08.126.CrossRefPubMed
37.
Kamper SJ, Ostelo RW, Knol DL, Maher CG, de Vet HC, Hancock MJ: Global Perceived Effect scales provided reliable assessments of health transition in people with musculoskeletal disorders, but ratings are strongly influenced by current status. J Clin Epidemiol. 2010, 63 (7): 760-766. 10.1016/j.jclinepi.2009.09.009.CrossRefPubMed
38.
Jull GA, O’Leary SP, Falla DL: Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipulative Physiol Ther. 2008, 31 (7): 525-533. 10.1016/j.jmpt.2008.08.003.CrossRefPubMed
39.
Hopkins WG: Measures of reliability in sports medicine and science. Sports Med. 2000, 30 (1): 1-15. 10.2165/00007256-200030010-00001.CrossRefPubMed
40.
Fleiss J: Reliability of Measurement. The Design and Analysis of Clinical Experiments. 1986, New York: John Wiley & Sons, 1
41.
Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Tomas M, Mir MA, Cano A, Muriel A, Zamora J, Del Real MT, Gestoso M, Mufraggi N, Spanish Back Pain Research Network: Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskelet Disord. 2008, 9: 43-10.1186/1471-2474-9-43.CrossRefPubMedPubMedCentral
42.
de Vet HC, Terwee CB, Knol DL, Bouter LM: When to use agreement versus reliability measures. J Clin Epidemiol. 2006, 59 (10): 1033-1039. 10.1016/j.jclinepi.2005.10.015.CrossRefPubMed
43.
Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics. 1977, 33 (1): 159-174. 10.2307/2529310.CrossRefPubMed
44.
Sim J, Wright CC: The kappa statistic in reliability studies: use, interpretation, and sample size requirements. Phys Ther. 2005, 85 (3): 257-268.PubMed
45.
Hudswell S, Von Mengersen M, Lucas N: The cranio-cervical flexion test using pressure biofeedback: A useful measure of cervical dysfunction in the clinical setting?. Int J Osteopath Med. 2005, 8: 98-105. 10.1016/j.ijosm.2005.07.003.CrossRef
46.
Juul T, Langberg H, Enoch F, Sogaard K: The intra- and inter-rater reliability of five clinical muscle performance tests in patients with and without neck pain. BMC Musculoskelet Disord. 2013, 14: 339-10.1186/1471-2474-14-339.CrossRefPubMedPubMedCentral
47.
Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986, 1 (8476): 307-310.CrossRefPubMed
48.
Elliott JM, O’Leary SP, Cagnie B, Durbridge G, Danneels L, Jull G: Craniocervical orientation affects muscle activation when exercising the cervical extensors in healthy subjects. Arch Phys Med Rehabil. 2010, 91 (9): 1418-1422. 10.1016/j.apmr.2010.05.014.CrossRefPubMed
49.
O’Leary S, Cagnie B, Reeve A, Jull G, Elliott JM: Is there altered activity of the extensor muscles in chronic mechanical neck pain? A functional magnetic resonance imaging study. Arch Phys Med Rehabil. 2011, 92 (6): 929-934. 10.1016/j.apmr.2010.12.021.CrossRefPubMed
50.
Cleland JA, Childs JD, Fritz JM, Whitman JM: Interrater reliability of the history and physical examination in patients with mechanical neck pain. Arch Phys Med Rehabil. 2006, 87 (10): 1388-1395. 10.1016/j.apmr.2006.06.011.CrossRefPubMed
51.
Hole DE, Cook JM, Bolton JE: Reliability and concurrent validity of two instruments for measuring cervical range of motion: effects of age and gender. Man Ther. 1995, 1 (1): 36-42. 10.1054/math.1995.0248.CrossRefPubMed
52.
Williams MA, McCarthy CJ, Chorti A, Cooke MW, Gates S: A systematic review of reliability and validity studies of methods for measuring active and passive cervical range of motion. J Manipulative Physiol Ther. 2010, 33 (2): 138-155. 10.1016/j.jmpt.2009.12.009.CrossRefPubMed
53.
Swait G, Rushton AB, Miall RC, Newell D: Evaluation of cervical proprioceptive function: optimizing protocols and comparison between tests in normal subjects. Spine (Phila Pa 1976). 2007, 32 (24): 692-701. 10.1097/BRS.0b013e31815a5a1b.CrossRef
54.
Pinsault N, Fleury A, Virone G, Bouvier B, Vaillant J, Vuillerme N: Test-retest reliability of cervicocephalic relocation test to neutral head position. Physiother Theory Pract. 2008, 24 (5): 380-391. 10.1080/09593980701884824.CrossRefPubMed
55.
Kristjansson E, Dall’Alba P, Jull G: Cervicocephalic kinaesthesia: reliability of a new test approach. Physiother Res Int. 2001, 6 (4): 224-235. 10.1002/pri.230.CrossRefPubMed
56.
Lee HY, Teng CC, Chai HM, Wang SF: Test-retest reliability of cervicocephalic kinesthetic sensibility in three cardinal planes. Man Ther. 2006, 11 (1): 61-68. 10.1016/j.math.2005.03.008.CrossRefPubMed
57.
Treleaven J, Jull G, LowChoy N: Smooth pursuit neck torsion test in whiplash-associated disorders: relationship to self-reports of neck pain and disability, dizziness and anxiety. J Rehabil Med. 2005, 37 (4): 219-223.CrossRefPubMed
58.
Treleaven J, LowChoy N, Darnell R, Panizza B, Brown-Rothwell D, Jull G: Comparison of sensorimotor disturbance between subjects with persistent whiplash-associated disorder and subjects with vestibular pathology associated with acoustic neuroma. Arch Phys Med Rehabil. 2008, 89 (3): 522-530. 10.1016/j.apmr.2007.11.002.CrossRefPubMed
59.
Heikkila HV, Wenngren BI: Cervicocephalic kinesthetic sensibility, active range of cervical motion, and oculomotor function in patients with whiplash injury. Arch Phys Med Rehabil. 1998, 79 (9): 1089-1094. 10.1016/S0003-9993(98)90176-9.CrossRefPubMed
60.
Montfoort I, Van Der Geest JN, Slijper HP, De Zeeuw CI, Frens MA: Adaptation of the cervico- and vestibulo-ocular reflex in whiplash injury patients. J Neurotrauma. 2008, 25 (6): 687-693. 10.1089/neu.2007.0314.CrossRefPubMed
61.
Prushansky T, Dvir Z, Pevzner E, Gordon CR: Electro-oculographic measures in patients with chronic whiplash and healthy subjects: a comparative study. J Neurol Neurosurg Psychiatry. 2004, 75 (11): 1642-1644. 10.1136/jnnp.2003.031278.CrossRefPubMedPubMedCentral
62.
Dispenza F, Gargano R, Mathur N, Saraniti C, Gallina S: Analysis of visually guided eye movements in subjects after whiplash injury. Auris Nasus Larynx. 2011, 38 (2): 185-189. 10.1016/j.anl.2010.08.007.CrossRefPubMed
63.
Clark RA, Bryant AL, Pua Y, McCrory P, Bennell K, Hunt M: Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance. Gait Posture. 2010, 31 (3): 307-310. 10.1016/j.gaitpost.2009.11.012.CrossRefPubMed
64.
Persson AL, Brogardh C, Sjolund BH: Tender or not tender: test-retest repeatability of pressure pain thresholds in the trapezius and deltoid muscles of healthy women. J Rehabil Med. 2004, 36 (1): 17-27. 10.1080/16501970310015218.CrossRefPubMed
Metadata
Title
Reliability, construct and discriminative validity of clinical testing in subjects with and without chronic neck pain
Authors
René Jørgensen
Inge Ris
Deborah Falla
Birgit Juul-Kristensen
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2014
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/1471-2474-15-408

Other articles of this Issue 1/2014

BMC Musculoskeletal Disorders 1/2014 Go to the issue

Correspondence

Evolving guidelines in the use of topical nonsteroidal anti-inflammatory drugs in the treatment of osteoarthritis

Case report

Metal hypersensitivity in patient with posterior lumbar spine fusion: a case report and its literature review

Research article

The biomechanical differences of rotational acetabular osteotomy, Chiari osteotomy and shelf procedure in developmental dysplasia of hip

Research article

The cn/cn dwarf mouse. Histomorphometric, ultrastructural, and radiographic study in mutants corresponding to human acromesomelic dysplasia Maroteaux type (AMDM)

Research article

Lower hamstring extensibility in men compared to women is explained by differences in stretch tolerance

Research article

Low validity of the Sensewear Pro3 activity monitor compared to indirect calorimetry during simulated free living in patients with osteoarthritis of the hip