Intrarater and interrater reliability of select clinical tests in patients referred for diagnostic facet joint blocks in the cervical spine

Abstract

Objective: To measure the intra- and interrater reliability of select standardized clinical tests used for the assessment of patients with axial neck pain referred for diagnostic facet joint blocks.

Design: Single-group, repeated-measures study.

Setting: Tertiary interventional pain management center.

Participants: Consecutive patients with persistent neck pain, referred to a tertiary interventional pain management center, were approached to participate. Fifty-six patients consented to participate in the study.

Interventions: Subjects underwent a standardized clinical testing protocol, performed by 2 physiotherapists, before receiving diagnostic facet joint blocks. Subjects were examined twice by 1 assessor for the determination of the intrarater reliability of the testing protocol, and again by a second assessor for determination of interrater reliability.

Main outcome measures: Intraclass correlation coefficients (ICCs), kappa coefficients, and 95% confidence intervals were calculated to determine the intra- and interrater reliability for cervical range of motion (ROM; 6 directions), extension-rotation (ER) test, manual spinal examination (MSE), and palpation for paraspinal tenderness (PST) from C2 through C7.

Results: For intrarater reliability, kappa coefficients ranged from .51 to .88 for the ER test, MSE, and PST, and ICCs ranged from .91 to .97 for ROM. For interrater reliability, kappa coefficients ranged from .74 to .96 for the ER test, MSE, and PST, and ICCs ranged from .90 to .95 for ROM.

Conclusions: The standardized clinical tests exhibited moderate to substantial reliability in patients with axial neck pain referred for diagnostic facet joint blocks. The data justify the incorporation of these tests into a clinical prediction model to screen patients before referral for diagnostic facet blocks.

Keywords: ER; Facet joint; ICC; MSE; NPRS; Neck; Neck pain; PST; Physical examination; ROM; Rehabilitation; Reliability (epidemiology); SEM; extension-rotation; intraclass correlation coefficient; manual spinal examination; numeric pain rating scale; palpation for segmental tenderness; range of motion; standard error of measurement.