Cervical nonorganic signs: a new clinical tool to assess abnormal illness behavior in neck pain patients: a pilot study

Arch Phys Med Rehabil. 2000 Feb;81(2):170-5. doi: 10.1016/s0003-9993(00)90136-9.


Objective: To develop and assess the reliability of a group of cervical nonorganic physical signs to be used as a simple screening tool for identifying patients with low neck pain who exhibit abnormal illness behavior.

Design: Survey, consecutive sample.

Data set: Double masked.

Setting: Functional restoration program.

Patients: Twenty-six consecutive patients with complaints of chronic neck pain (greater than 4 months duration). Each patient was evaluated by a physician and then again by either a physical or occupational therapist, for the presence of specific cervical nonorganic signs. Both of the evaluations occurred on the same day.

Main outcome measures: Five categories consisting of eight tests were appraised: (1) tenderness, (2) simulation, (3) range of motion, (4) regional disturbance, and (5) overreaction.

Results: The percent agreement between raters ranged from a high of 100% for regional sensory disturbance, to a low of 68% for one of the simulation tests. The average agreement between raters across all of the nonorganic test signs was 84.6%. Likewise, kappa coefficients ranged from 1.00 to .16, reflecting differences in strength of agreement.

Conclusion: For many years, the lumbar nonorganic signs (developed by Waddell and colleagues) have been a useful screening tool in the assessment of abnormal illness behavior in the low back pain population. For the first time, a group of cervical nonorganic signs have been developed, standardized, and proven reliable.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Chronic Disease
  • Disability Evaluation
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neck Pain / diagnosis
  • Neck Pain / etiology
  • Neck Pain / psychology*
  • Pain Measurement*
  • Physical Examination / methods
  • Pilot Projects
  • Psychophysiologic Disorders / diagnosis*
  • Reproducibility of Results
  • Sick Role*