Interrater reliability of the craniocervical flexion test in asymptomatic individuals--a cross-sectional study

J Manipulative Physiol Ther. 2011 May;34(4):247-53. doi: 10.1016/j.jmpt.2011.04.011. Epub 2011 May 4.


Objective: The objective of this study was to evaluate interrater reliability of the craniocervical flexion test (CCFT) on asymptomatic subjects.

Methods: A cross-sectional repeated-measures study design was used. Thirty asymptomatic subjects (15 men and 15 women; mean age, 33.7 years; range, 22-48 years) were recruited for the study. Subjects were positioned in supine lying with a pneumatic pressure sensor of the pressure biofeedback unit placed under the neck. Subjects performed 3 trials of craniocervical flexion with each trial consisting of 5 incremental stages (22, 24, 26, 28, and 30 mm Hg) guided through feedback from the pressure dial of the pressure biofeedback unit. All the trials were scored simultaneously by 2 raters. The outcome measure was the activation score-the maximum pressure (above baseline 20 mm Hg) that was achieved and held in a steady manner for 10 seconds. Intraclass correlation coefficient (ICC 3,1) was analyzed using the 2 repeated scores out of 3 trials for either rater.

Results: Interrater reliability (ICC) for the CCFT was 0.91 (95% confidence interval, 0.83-0.96). There was a reasonable agreement on the Bland-Altman plot confirming high reliability of the test.

Conclusion: The study has shown high interrater reliability when 2 raters simultaneously scored the CCFT trials in asymptomatic individuals.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neck Muscles / physiology*
  • Observer Variation
  • Physical Examination / methods*
  • Physical Examination / statistics & numerical data*
  • Range of Motion, Articular
  • Reproducibility of Results
  • Young Adult