Inter-examinerreliability study of physical examination procedures to assess the cervical spine

Abstract

Objective The objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess the cervical spine. Materials: Reliability study that used a convenience sample of 51 patients between the ages of 16–70 years presenting with a chief complaint of neck pain. Two physical therapists independently performed the same series of cervical physical examination procedures on each of the participant. The clinicians were blinded to each other’s findings and the clinical status of the patient. Kappa coefficients (κ) were calculated for levels of agreement between the clinicians for each procedure. Results When assessing for asymmetrical motion, excellent levels of reliability (κ range: 0.88–0.96) were observed for the Bilateral Modified Lateral Shear (asymmetry criterion), Bilateral C2 Spinous Kick (asymmetry criterion) and Flexion-Rotation Tests. When pain provocation was used as the indicator of a positive test during palpation of the cervical facet joints, moderate to substantial levels of reliability (κ range: 0.53–0.76) were observed. When patients were instructed not to provide feedback to the clinicians about pain provocation during facet joint palpation and clinicians relied solely on their qualitative assessment of segmental mobility, the level of reliability was lower (κ range: 0.45–0.53). Due to 100 % prevalence of negative findings, Kappa values could not be calculated for the Sharp-Purser test or the Unilateral C2 Spinous Kick Test. Conclusions Most physical examination procedures examined in this study demonstrated moderate to excellent levels of inter-examiner reliability. Palpation for segmental mobility without pain provocation demonstrated a lower level of reliability compared to palpation for pain provocation. Correlation with clinical findings is necessary to establish validity and the applicability of these procedures in clinical practice.

Intramuscular Electrical Stimulation for the Treatment of Trigger Points in Patients with Chronic Migraine: A Protocol for a Pilot Study Using a Single-Case Experimental Design

“…Both are standard clinical devices that are reported to have good reliability for clinical use [ 47 , 48 ]. Segmental mobility will be tested using a lateral gliding [ 49 ] and segmental side-bending maneuvers [ 50 , 51 ] in order to examine patients for hypomobility of the C2–C4 segments. Flexion rotation test (FRT) will be performed bilaterally to assess for pain provocation and impaired mobility of the upper cervical spine at the C1–2 levels [ 46 ], which has been reported in patients with migraine [ 52 ].…”

Analysis of Clinical Pattern of Musculoskeletal Disorders in the Cervical and Cervico—Thoracic Regions of the Spine

“…First of all, in some studies, the repeatability of the manual examination of intersegmental movements is questioned, particularly in patients without pain [30]. However, in a study conducted by Hariharan et al (2021) on inter-examiner reliability of physical examination procedures assessing the cervical spine, PABAK values (Prevalence And Bias Adjusted Kappa) for segmental mobility without pain provocation were moderate for mid-cervical (0.45) and low-cervical (0.53) regions [48]. According to these authors, some tests with obtained lower Kappa values may still be invaluable when making clinical decisions.…”

Performance of key physical tests for temporomandibular disorder via telehealth: Establishing validity and reliability

“…facial muscles), joint sounds with movement, accessory movements, manual screening of the cervical spine and neck flexor muscle endurance test 8 . The majority of these physical tests have been demonstrated to have good to excellent inter‐tester reliability when performed in‐person by post‐graduate musculoskeletal physiotherapists, 9 while they appears to be poor to moderate reliability between assessors for screening tests of the cervical spine 8,10,11 …”

“…8 The majority of these physical tests have been demonstrated to have good to excellent inter-tester reliability when performed in-person by post-graduate musculoskeletal physiotherapists, 9 while they appears to be poor to moderate reliability between assessors for screening tests of the cervical spine. 8,10,11 In response to the COVID-19 global pandemic, many individuals are now seeking healthcare virtually which has led to a significant uptake of telehealth activity. 12 There is, however, no current literature that describes whether the physical examination tests recommended for the assessment of TMD can be adequately modified to a telehealth environment such that findings are consistent with an in-person assessment.…”