The interexaminer reproducibility of physical examination of the cervical spine

J Manipulative Physiol Ther. 2004 Feb;27(2):84-90. doi: 10.1016/j.jmpt.2003.12.002.


Objective: To assess the interexaminer reproducibility of physical examination of the cervical spine.

Methods: Two physiotherapists independently judged the general mobility and the intersegmental mobility (segments C0-T2) of the neck and the pain that was provoked. Percentage agreement and Cohen's kappa expressed agreement of dichotomous variables; limits of agreement expressed agreement of continuous variables; and intraclass correlation coefficients (ICCs) expressed the reliability of continuous variables.

Results: Agreement for general mobility showed kappa between 0.05 and 0.61, and for the intersegmental mobility, it showed kappa values between -0.09 and 0.63. Agreement for provoked neck pain within 1 point of an 11-point numerical rating scale (NRS) varied between 46.9% and 65.7% for general mobility and between 40.7% and 75.0% for intersegmental mobility. The ICCs varied between 0.36 and 0.71 for general mobility and between 0.22 and 0.80 for intersegmental mobility.

Conclusions: Despite the use of a standardized protocol to assess general mobility and intersegmental mobility of the cervical spine, it is difficult to achieve reasonable agreement and reliability between 2 examiners. Likewise, the patients are not able to score the same level of provoked pain in 2 assessments with an interval of 15 minutes.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cervical Vertebrae / physiopathology*
  • Chiropractic* / methods
  • Chiropractic* / standards
  • Clinical Competence*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neck Pain / physiopathology*
  • Netherlands
  • Observer Variation
  • Physical Examination* / methods
  • Physical Examination* / standards
  • Range of Motion, Articular
  • Reproducibility of Results
  • Time Factors