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Comparative Study
. 2014 Dec 4;15:408.
doi: 10.1186/1471-2474-15-408.

Reliability, Construct and Discriminative Validity of Clinical Testing in Subjects With and Without Chronic Neck Pain

Free PMC article
Comparative Study

Reliability, Construct and Discriminative Validity of Clinical Testing in Subjects With and Without Chronic Neck Pain

René Jørgensen et al. BMC Musculoskelet Disord. .
Free PMC article


Background: The reliability of clinical tests for the cervical spine has not been adequately evaluated. Six cervical clinical tests, which are low cost and easy to perform in clinical settings, were tested for intra- and inter-examiner reliability, and two performance tests were assessed for test-retest reliability in people with and without chronic neck pain. Moreover, construct and between-group discriminative validity of the tests were examined.

Methods: Twenty-one participants with chronic neck pain and 21 asymptomatic participants were included. Intra- and inter-reliability were evaluated for the Cranio-Cervical Flexion Test (CCFT), Range of Movement (ROM), Joint Position Error (JPE), Gaze Stability (GS), Smooth Pursuit Neck Torsion Test (SPNTT), and neuromuscular control of the Deep Cervical Extensors (DCE). Test-retest reliability was assessed for Postural Control (SWAY) and Pressure Pain Threshold (PPT) over tibialis anterior, infraspinatus and the C3-C4 segment.

Results: Intraclass Correlation Coefficient (ICC) for intra- and inter-examiner reliability was highest for ROM (range: 0.80 to 0.94), DCE (0.75 to 0.90) and CCFT (0.63 to 0.86). JPE had the lowest ICC (0.02 to 0.66). Intra- and inter-reliability for GS and SPNTT showed kappa ranging from 0.66 to 0.92, and 0.57 to 0.78 (prevalence adjusted), respectively. For the test-retest study, ICC was 0.83 to 0.89 for PPT and 0.39 to 0.79 for SWAY. Construct validity was satisfactory for all tests, except JPE. Significant between group discriminative validity was found for CCFT, ROM, GS, SPNTT and PPT, however, differences were within the limits of the minimal detectable change.

Conclusions: The majority of the tests evaluated showed satisfactory reliability and construct validity supporting their use in the clinical evaluation of patients with chronic neck pain.


Figure 1
Figure 1
Participant flow and retention.
Figure 2
Figure 2
Device for the measurement of rotation ROM.
Figure 3
Figure 3
Test procedure.

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    1. National Institute of Public Health . Folkesundhedsrapporten. 2007.
    1. Huisstede BM, Wijnhoven HA, Bierma-Zeinstra SM, Koes BW, Verhaar JA, Picavet S. Prevalence and characteristics of complaints of the arm, neck, and/or shoulder (CANS) in the open population. Clin J Pain. 2008;24(3):253–259. doi: 10.1097/AJP.0b013e318160a8b4. - DOI - PubMed
    1. Picavet HS, Hazes JM. Prevalence of self reported musculoskeletal diseases is high. Ann Rheum Dis. 2003;62(7):644–650. doi: 10.1136/ard.62.7.644. - DOI - PMC - PubMed
    1. Fejer R, Kyvik KO, Hartvigsen J. The prevalence of neck pain in the world population: a systematic critical review of the literature. Eur Spine J. 2006;15(6):834–848. doi: 10.1007/s00586-004-0864-4. - DOI - PMC - PubMed
    1. Jull G, Kristjansson E, Dall’Alba P. Impairment in the cervical flexors: a comparison of whiplash and insidious onset neck pain patients. Man Ther. 2004;9(2):89–94. doi: 10.1016/S1356-689X(03)00086-9. - DOI - PubMed
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