Reliability of a seated three-dimensional passive intervertebral motion test for mobility, end-feel, and pain provocation in patients with cervicalgia

J Man Manip Ther. 2012 Aug;20(3):135-41. doi: 10.1179/2042618611Y.0000000023.


Objectives: Neck pain can be evaluated with passive intervertebral motion (PIVM). No study has evaluated the reliability of three-dimensional (3D) segmental PIVM testing of the cervical spine in symptomatic subjects in a functional, seated position. The purpose of this study was to evaluate inter-rater reliability of such 3D PIVM technique for pain provocation, hypomobility, and end-feel detection.

Methods: Subjects (n = 63), age 44±15·6 years, neck pain 3·4±1·6 cm with visual analog scale, were evaluated by two of three raters with varied manual therapy education and experience. To perform the test, the rater passively invoked side-bending motion at each cervical joint from C2-C3 to C6-C7, allowing segmental synkinetic rotation and extension to occur. Each joint was assessed for hypomobility, hard end-feel, and pain provocation. Kappa statistics were used to determine the inter-rater reliability for each variable for joints C2-C3 through C6-C7 for both the most painful and least painful sides.

Results: Percent agreements for pain provocation, hypomobility, and end-feel ranged 65-83%, 62-84%, and 68-87%, respectively. Kappa values for pain provocation, hypomobility, and end-feel on the most painful side were fair to moderate (0·29-0·53, 0·21-0·48, and 0·25-0·50, respectively), and on the least painful side were fair to substantial (0·43-0·65, 0·33-0·58, and 0·28-0·60, respectively).

Discussion: This is the first investigation to assess reliability of 3D cervical segmental testing in sitting and to assess reliability of end-feel. The seated 3D PIVM test has sufficient clinical reliability for use in patients with cervicalgia for the assessment of hypomobility, end-feel, and pain provocation.

Keywords: Cervicalgia; Manual therapy; Passive motion; Reliability.