Assessment of published reliability studies for cervical spine range-of-motion measurement tools

Objective: To assess the reliability of tools to measure cervical spine ran ge of motion in clinical settings and discuss the necessary components for reliability studies. Data Sources: Database searches included Bandolier; Bath Information and Da ta Services including Index of Scientific and Technical Proceedings, Britis h Nursing Index, Cumulative Index to Nursing and Allied Health Literature, English National Health Care Database, MEDLINE, Occupational Therapy Index; Physiotherapy Index, and Rehabilitation Index for English language article s from 1966. In addition, citations were searched. Study Selection: Studies were selected that assessed the tool for intraobse rver or interobserver reliability, evaluated it on movements of flexion/ext ension. lateral flexion, or rotation, and measured range of motion of the w hole cervical spine. Data Extraction: All papers were read by one nonclinical researcher with a data extraction sheet. A consultant rheumatologist and a physiotherapist we re each asked to read a sample of the papers to give a clinical viewpoint. Data Synthesis: Evidence for the reliability of measurement tools was asses sed qualitatively based on the quality of the study designs, appropriatenes s of analysis, and strength of the reliability based on reported intraclass correlation coefficients (the most appropriate analysis technique for reli ability studies of this nature). Measurement tools were found to have not b een fully tested for reliability, particularly in terms of adequate sample size and appropriate analysis techniques. There were also wide variations i n the research design, including the protocol for movement, the characteris tics of observers and study population, whether warm-ups were allowed, whet her the movement was active or passive, and time intervals between repeated measurements. Conclusion: Although a range-of-motion device has shown promise in reliabil ity and has many advocates, its practicality for clinical use is questionab le. Further work must be pet-formed on all measurement tools. Researchers n eed to produce more rigorous studies and consider the issues discussed here .