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The intra- and inter-rater reliability of five clinical muscle performance tests in patients with and without neck pain.

Juul T, Langberg H, Enoch F, Søgaard K - BMC Musculoskelet Disord (2013)

Bottom Line: However, only slight to fair agreement was found for the neck extensor test (ICC = 0.19-0.25).Intra- and inter-rater reliability ranged from moderate to almost perfect agreement with the exception of a new test (neck extensor test), which ranged from slight to moderate agreement.The significant variability observed suggests that tests like the neck extensor test and the neck flexor muscle endurance test performed in a 45°-upright position are too unstable to be used when evaluating neck muscle performance.

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Affiliation: Institute of Sports Science and Clinical Biomechanics, The University of Southern Denmark, Odense, Denmark. tjsorensen@health.sdu.dk.

ABSTRACT

Background: This study investigates the reliability of muscle performance tests using cost- and time-effective methods similar to those used in clinical practice. When conducting reliability studies, great effort goes into standardising test procedures to facilitate a stable outcome. Therefore, several test trials are often performed. However, when muscle performance tests are applied in the clinical setting, clinicians often only conduct a muscle performance test once as repeated testing may produce fatigue and pain, thus variation in test results. We aimed to investigate whether cervical muscle performance tests, which have shown promising psychometric properties, would remain reliable when examined under conditions similar to those of daily clinical practice.

Methods: The intra-rater (between-day) and inter-rater (within-day) reliability was assessed for five cervical muscle performance tests in patients with (n = 33) and without neck pain (n = 30). The five tests were joint position error, the cranio-cervical flexion test, the neck flexor muscle endurance test performed in supine and in a 45°-upright position and a new neck extensor test.

Results: Intra-rater reliability ranged from moderate to almost perfect agreement for joint position error (ICC ≥ 0.48-0.82), the cranio-cervical flexion test (ICC ≥ 0.69), the neck flexor muscle endurance test performed in supine (ICC ≥ 0.68) and in a 45°-upright position (ICC ≥ 0.41) with the exception of a new test (neck extensor test), which ranged from slight to moderate agreement (ICC = 0.14-0.41). Likewise, inter-rater reliability ranged from moderate to almost perfect agreement for joint position error (ICC ≥ 0.51-0.75), the cranio-cervical flexion test (ICC ≥ 0.85), the neck flexor muscle endurance test performed in supine (ICC ≥ 0.70) and in a 45°-upright position (ICC ≥ 0.56). However, only slight to fair agreement was found for the neck extensor test (ICC = 0.19-0.25).

Conclusions: Intra- and inter-rater reliability ranged from moderate to almost perfect agreement with the exception of a new test (neck extensor test), which ranged from slight to moderate agreement. The significant variability observed suggests that tests like the neck extensor test and the neck flexor muscle endurance test performed in a 45°-upright position are too unstable to be used when evaluating neck muscle performance.

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The neck muscle endurance test performed in 45°-upright position (A) and (B).
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Figure 4: The neck muscle endurance test performed in 45°-upright position (A) and (B).

Mentions: A modified NFME test was performed with the participant sitting in a 45°-upright position. The plinth served as back support (Figure 4A). The participant wore the same headgear, but with a 1.5 cm wide measuring tape applied on the side of the cap, approximately 2 cm above the right ear (Figure 4B). The spirit level laser was placed on the right side of the subject. The laser pointed at the centre of the measuring tape. Participants were allowed one short practice trial. Starting position was set as described above and the same instructions were given. The test was terminated when the laser moved outside either above or below - and thereby exceeded - the measuring tape due to head movement indicating fatigue (i.e., inability to maintain upper cervical flexion, increase in neck flexion or lowering of the head). The examiner recorded time to termination as the holding time in seconds. The participants performed this trial once.


The intra- and inter-rater reliability of five clinical muscle performance tests in patients with and without neck pain.

Juul T, Langberg H, Enoch F, Søgaard K - BMC Musculoskelet Disord (2013)

The neck muscle endurance test performed in 45°-upright position (A) and (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219589&req=5

Figure 4: The neck muscle endurance test performed in 45°-upright position (A) and (B).
Mentions: A modified NFME test was performed with the participant sitting in a 45°-upright position. The plinth served as back support (Figure 4A). The participant wore the same headgear, but with a 1.5 cm wide measuring tape applied on the side of the cap, approximately 2 cm above the right ear (Figure 4B). The spirit level laser was placed on the right side of the subject. The laser pointed at the centre of the measuring tape. Participants were allowed one short practice trial. Starting position was set as described above and the same instructions were given. The test was terminated when the laser moved outside either above or below - and thereby exceeded - the measuring tape due to head movement indicating fatigue (i.e., inability to maintain upper cervical flexion, increase in neck flexion or lowering of the head). The examiner recorded time to termination as the holding time in seconds. The participants performed this trial once.

Bottom Line: However, only slight to fair agreement was found for the neck extensor test (ICC = 0.19-0.25).Intra- and inter-rater reliability ranged from moderate to almost perfect agreement with the exception of a new test (neck extensor test), which ranged from slight to moderate agreement.The significant variability observed suggests that tests like the neck extensor test and the neck flexor muscle endurance test performed in a 45°-upright position are too unstable to be used when evaluating neck muscle performance.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Sports Science and Clinical Biomechanics, The University of Southern Denmark, Odense, Denmark. tjsorensen@health.sdu.dk.

ABSTRACT

Background: This study investigates the reliability of muscle performance tests using cost- and time-effective methods similar to those used in clinical practice. When conducting reliability studies, great effort goes into standardising test procedures to facilitate a stable outcome. Therefore, several test trials are often performed. However, when muscle performance tests are applied in the clinical setting, clinicians often only conduct a muscle performance test once as repeated testing may produce fatigue and pain, thus variation in test results. We aimed to investigate whether cervical muscle performance tests, which have shown promising psychometric properties, would remain reliable when examined under conditions similar to those of daily clinical practice.

Methods: The intra-rater (between-day) and inter-rater (within-day) reliability was assessed for five cervical muscle performance tests in patients with (n = 33) and without neck pain (n = 30). The five tests were joint position error, the cranio-cervical flexion test, the neck flexor muscle endurance test performed in supine and in a 45°-upright position and a new neck extensor test.

Results: Intra-rater reliability ranged from moderate to almost perfect agreement for joint position error (ICC ≥ 0.48-0.82), the cranio-cervical flexion test (ICC ≥ 0.69), the neck flexor muscle endurance test performed in supine (ICC ≥ 0.68) and in a 45°-upright position (ICC ≥ 0.41) with the exception of a new test (neck extensor test), which ranged from slight to moderate agreement (ICC = 0.14-0.41). Likewise, inter-rater reliability ranged from moderate to almost perfect agreement for joint position error (ICC ≥ 0.51-0.75), the cranio-cervical flexion test (ICC ≥ 0.85), the neck flexor muscle endurance test performed in supine (ICC ≥ 0.70) and in a 45°-upright position (ICC ≥ 0.56). However, only slight to fair agreement was found for the neck extensor test (ICC = 0.19-0.25).

Conclusions: Intra- and inter-rater reliability ranged from moderate to almost perfect agreement with the exception of a new test (neck extensor test), which ranged from slight to moderate agreement. The significant variability observed suggests that tests like the neck extensor test and the neck flexor muscle endurance test performed in a 45°-upright position are too unstable to be used when evaluating neck muscle performance.

Show MeSH
Related in: MedlinePlus