Intertester-Reliabilität des kraniozervikalen Flexionstests

Zusammenfassung

Der kraniozervikale Flexionstest (CCFT) ist als Assessment der motorischen Kontrolle der HWS bekannt. Während dessen Validität ausreichend bewiesen wurde, existieren nur wenige Publikationen zu seiner Reliabilität.

Das Ziel dieser Studie bestand darin, die Intertester-Reliabilität von 2 unabhängigen und verblindeten Testerinnen und mithilfe einer Pressure Biofeedback Unit (PBU) an asymptomatischen Probanden zu untersuchen. Die Datenanalyse umfasste eine prozentuale Einschätzung der Testerinnenübereinstimmung (gewichteter Kappa) und die Berechnung in der eigentlichen Messeinheit der PBU (mmHg) mittels 95 % Limits of agreement.

Die Resultate ergaben eine moderate bis beachtliche Übereinstimmung. In der eigentlichen Messeinheit bestanden trotz guter mittlerer Differenz zwischen den Testerinnen jedoch große Streuungen in der Datenverteilung, die den Test derzeit eher unzuverlässig erscheinen lassen.

Abstract

The craniocervical flexion test (CCFT) is an assessment for cervical spine motor control. While its validity has been well proven there exist only few publications concerning its reliability.

This study aims to investigate the intertester reliability of 2 independent and blinded testers and by means of a pressure biofeedback unit (PBU) in asymptomatic subjects. Data analysis included percentual evaluation of intertester reliability (weighted kappa) and calculation of the real unit of measurement used by the PBU (mmHg) by 95% limits of agreement.

The results showed a moderate to respectable agreement. However, despite good mean deviation between the testers, the real unit of measurement showed a large statistical spread so that the test seems to be unreliable to date.

Schlüsselwörter

kraniozervikaler Flexionstest - Intertester-Reliabilität - Nackenbeschwerden - HWS

Key words

craniocervical flexion test - intertester reliablitiy - neck pain - cervical spine

Literatur

• 1 Bland J M, Altman D G. Statistical Methods for Assessing Agreement between two Methods of Clinical Measurement.  The Lancet. 1986;  8 307-310
• 2 Bland J M. Measuring Health and Disease: Cohen’s Kappa. York; University of York, Department of Health Science 2005
• 3 Chattanooga Group .Stabilizer Pressure Bio-Feedback Operating Instructions. Hixson/USA; Chattanooga Group 2002
• 4 Chiu T T, Law E Y, Chiu T H. Performance of the Craniocervical Flexion Test in Subjects with and without Chronic Neck pain.  J Orthop Sports Phys Ther. 2005;  35 567-571
• 5 De Koning C HP, Heuvel S P, Staal J B. et al . Clinimetric evaluation of methods to measure muscle functioning in patients with non-specific neck pain: a systematic review.  BMC Musculoskeletal Disorders. 2008;  9 142 , www.biomedcentral.com/ 1471 – 2474 / 9 / 142
• 6 Falla van den D. Unravelling the complexity of muscle impairment in chronic neck pain.  Manual Therapy. 2004;  9 125-133
• 7 Falla D, Bilenkij G, Jull G A. Patients with Chronic Neck Pain Demonstrated Altered Patterns of Muscle Activation during Performance of a Functional Upper Limb Task.  Spine. 2004;  29 1436-1440
• 8 Falla D, Jull G A, Hodges P W. Feedforward activity of the cervical flexor muscles during voluntary arm movements is delayed in chronic neck pain.  Exp Brain Res. 2004;  157 43-48
• 9 Falla D, Jull G A, Hodges P W. Patients with Neck Pain Demonstrate Reduced Electromyographic Activity of the Deep Cervical Flexor Muscles during Performance of the Craniocervical Flexion Test.  Spine. 2004;  29 2108-2114
• 10 Hudswell S, Mengersen von M, Lucas N. The cranio-cervical flexion test using pressure biofeedback: A useful measure of cervical dysfunction in the clinical setting?.  International Journal of Osteopathic Medicine. 2005;  8 98-105
• 11 Jull G A, Barrett C, Magee R. et al . Further clinical clarification of the muscle dysfuntion in cervical headache.  Cephalagia. 1999;  19 179-185
• 12 Jull G. Deep cervical flexor muscle dysfunction in whiplash.  Journal of Muskuloskeletal Pain. 2000;  8 143-154
• 13 Jull G A. Management of Cervicogenic Headache. Grant R Physical Therapy of the Cervical and Thoracic Spine New York; Elsevier 2002
• 14 Jull G A, Falla D, Treleaven J. et al .A therapeutic exercise approach for cervical disorders. Boyling JD, Jull GA Grieve’s Modern Manual Therapy Edinburgh; Elsevier 2004
• 15 Jull G, Falla D. Rehabilitation of Cervical Spine Disorders – A Research-Based Approach. Kursskript Pre-course Manual Therapy Congress. Rom; 2005
• 16 Jull G A, O’Leary S P, Falla D. Clinical Assessment of the Deep Cervical Flexor Muscles: The Craniocervical Flexion Test.  J Manipulative Physiol Ther. 2008;  31 525-533
• 17 Landis J R, Koch G G. The measurement error of observer agreement for categorical data.  Biometrics. 1977;  33 159-174
• 18 O’Leary S, Falla D, Jull G. et al . Muscle specificity in tests of cervical flexor muscle performance.  J Electromyogr Kinesiol. 2007;  17 35-40
• 19 O’Leary S, Jull G, Kim M. et al . Cranio-cervical flexor muscle impairment at maximal, moderate, and low loads is a feature of neck pain.  Manual Therapy. 2007;  12 34-39
• 20 Sim J, Wright C C. The Kappa Statistic in Reliability Studies: Use, Interpretation, and Sample Size Requirements.  Phys Ther. 2005;  85 257-268