A systematic review of reliability and validity studies of methods for measuring active and passive cervical range of motion

J Manipulative Physiol Ther. 2010 Feb;33(2):138-55. doi: 10.1016/j.jmpt.2009.12.009.


Objective: The purpose of this study was to systematically review the literature evaluating the reliability and validity of all available methods for measuring active and passive cervical range of motion (CROM).

Methods: Electronic databases (PubMed, MEDLINE, CINAHL, EMBASE, and AMED) were searched through OVID from their inception to January 2008. Articles were selected according to a priori defined criteria. Data were extracted regarding publication details, type of study, movements and device evaluated, subject and observer characteristics, and measurement protocol including blinding and statistical analysis methods. Quality assessment was undertaken using developed criteria to assess internal validity, external validity, and statistical methods. An estimate of the level of reliability and validity was calculated and used to categorize studies as good, moderate, or poor.

Results: A total of 56 articles fulfilled the selection criteria and were included in the review. Forty-six of these articles described 66 reliability studies and 21 described 21 concurrent criterion validity studies. Twelve different methods were evaluated. Although it was the intention of this review to conduct meta-analysis, this was deemed inappropriate due to studies being too heterogeneous. Most of the reliability and validity studies involved asymptomatic subjects measured by allied health professionals investigating active ROM. Devices that were deemed to have "good" reliability and validity were the CROM device, the Spin-T goniometer, and the single inclinometer.

Conclusions: A considerable number of reliability and concurrent validity studies have been published for CROM. The CROM device has undergone most evaluation and has been shown to be clinimetrically sound. Further research with significantly improved methodology and reporting is warranted for all devices.

Publication types

  • Evaluation Study
  • Review
  • Systematic Review

MeSH terms

  • Cervical Vertebrae / physiology*
  • Humans
  • Physical Therapy Modalities / standards*
  • Range of Motion, Articular*
  • Reproducibility of Results