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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.

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.

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The neck extensor test.
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Figure 5: The neck extensor test.

Mentions: The neck extensor test (NET) is a dynamic clinical test, which targets neck extensor muscle endurance. It was performed with the participant lying prone, with arms at the sides and the head over the edge of the plinth (Figure 5), initially supported by the examiner. The participant wore headgear (a cap) with a 2 cm wide measuring tape applied to the top of the cap. A spirit level laser was placed in front of the plinth (Class 3A Laser product, Wen Zhou Xinke, China). The examiner held the participant’s head in a neutral position, with the laser pointer at the centre of the measuring tape. The test began when the examiner stopped supporting the subject’s head. The participant was instructed to maintain a neutral head posture while performing a small side-to-side head rotation. They were told to perform the rotation at a smooth and slow pace. The rate at which participants performed the movements was not strictly controlled. However, all subjects were instructed to move at a comfortable pace. Participants were allowed one short practice trial. Verbal encouragement was given (e.g., “Hold your head up”), if the participant started to change their head posture. 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 extensor test.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: The neck extensor test.
Mentions: The neck extensor test (NET) is a dynamic clinical test, which targets neck extensor muscle endurance. It was performed with the participant lying prone, with arms at the sides and the head over the edge of the plinth (Figure 5), initially supported by the examiner. The participant wore headgear (a cap) with a 2 cm wide measuring tape applied to the top of the cap. A spirit level laser was placed in front of the plinth (Class 3A Laser product, Wen Zhou Xinke, China). The examiner held the participant’s head in a neutral position, with the laser pointer at the centre of the measuring tape. The test began when the examiner stopped supporting the subject’s head. The participant was instructed to maintain a neutral head posture while performing a small side-to-side head rotation. They were told to perform the rotation at a smooth and slow pace. The rate at which participants performed the movements was not strictly controlled. However, all subjects were instructed to move at a comfortable pace. Participants were allowed one short practice trial. Verbal encouragement was given (e.g., “Hold your head up”), if the participant started to change their head posture. 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