Cervical: Studies into assessment, diagnosis and procedures

Bybee RF, Dionne CP, Interater agreement on assessment, diagnosis, and treatement for neck pain by trained physical therapist students., J Phys Ther Edu, 21;2:39-47, 2007

17 students who had completed parts A and B viewed a video recording of assessment of 20 patients with neck pain and recorded classification and classification-treatment link. There reliability was compared to that of post-graduate physical therapists from a previous study. Reliability was kappa 0.5 for initial classification, 0.55 for initial treatment, and 0.58 for classification-treatment link; for clinicians the latter kappa was 0.46. The students were significantly more reliable.

Chaniotis SA, Clinical reasoning for a patient with neck and upper extremity symptoms: a case requiring referral., J Bodywork Movement Ther, 16:359-363, 2012

A case report of a patient with neck and arm pain referred to an MDT clinician with cervical radiculopathy, but whose history suggested serious pathology and so the therapist referred the patient to an oncologist. A bone scan revealed multiple metastases in the spine.

Clare HA, Adams R, Maher CG, Reliability of McKenzie classification of patients with cervical and lumbar pain, J Manipulative Physiol Ther, Feb;28(2):122-7, 2005

25 lumbar and 25 cervical patients were assessed simultaneously by pairs of credentialed therapists; 14 in total. Prevalence of derangement was 88%/84%, dysfunction 0%/4%, posture 0%/0%, and _x0018_other_x0019_ 12%/12% for the 2 therapists. Kappa values for lumbar syndromes and sub-syndromes was 1.0 and 0.89, and for cervical syndromes and sub-syndromes 0.63 and 0.84 respectively.

 

Clare HA, Adams R, Maher CG, Reliability of the McKenzie spinal pain classification using patient assessment forms., Physiotherapy, 90:114-119, 2004

50 completed neck and back assessment forms were sent to 50 credentialed McKenzie therapists to classify - kappa values of 0.56 were recorded for syndromes and 0.68 for sub-syndromes.

 

Dionne C, Bybee RF, Tomaka J, Correspondence of diagnosis to initial treatment for neck pain., Physiotherapy, 93:62-68, 2006

54 trained clinicians viewed videotapes of the assessment of 20 patients with neck pain to determine the reliability of MDT diagnosis to management link and derangement classification and directional preference (DP) link. For derangement-DP link kappa values were 0.46, and for extension, lateral flexion DP 0.4, 0.45, and 0.04 respectively.

 

Dionne CP, Bybee RF, Tomaka J, Inter-rater-reliability of McKenzie assessment in patients with neck pain., Physiotherapy, 92:75-82, 2006

54 physical therapists with a range of MDT training reviewed 20 video-taped examinations and offered a MDT classification, sub-classification and directional preference if relevant. The majority classification was derangement (16), then dysfunction (2) and postural syndrome (1). The majority decision on directional preference for derangement was extension (15) and lateral (1). Reliability statistics (kappa) were: classification, 0.55; sub-classification, 0.47; directional preference, 0.46.

 

Hahn T, Kelly C, Murphy E, Whissell P, Brown M, Schenk R., Clinical decision-making in the management of cervical spine derangement: a case study survey using a patient vignette., J Man Manip Ther, 22:213-219, 2014

Survey via Survey Monkey was sent to 714 therapists with credentialed or diploma (MDT) or Fellowship in Orthopaedic Manual Physical Therapy (FAAOMPT), of whom 77 and 6 provided adequate data. All therapists chose posture analysis and active range of movement as their initial examination procedures, but the MDT clinicians then chose end-range active cervical repeated movements as their next examination procedure and then discontinued the examination. The FAAOMPT group used a much more varied examination process.

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Hegedus E, Cook, C Lewis J, Wright A, Park J, Combining orthopedic special tests to improve diagnosis of shoulder pathology , Physical Therapy in Sport, 87-92, 2015

This review looked at the 'best' combinations of shoulder orthopedic tests to help rule in or out different pathologies. It found there were significant issues and limitations with the studies looking at clusters of tests, but outlined a case study to illustrate how the clinical reasoning process can be guided by current findings.

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Horton S, Johnson G, and Skinner M, Changes in Head and Neck Posture Using Office Chair With and Without Lumbar Roll Support, Spine, Vol. 35(12): 542-548, 2010

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Reiman M, Goode A, Hegedus E, Cook C, Wright A, Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis , BR J Sports, 47,893-902, 2013

This systematic review found that there were few quality studies to assist in clionical decision making. Only one test is supported by the data for the hipe physical examination

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Takasaki H, Hall T, Kaneko S, Ikemoto Y, Jull G, A radiographic analysis of the influence of initial neck posture on cervical segmental movement at end-range extension in asymptomatic subjects., Man Ther, 16:74-79, 2011

Comparison of the effect of different starting positions on range of extension. There was a significant difference in the pattern of extension, but no difference in the total range. Starting from protraction produced significantly more extension at C1-2, and starting from retraction produced significantly more extension at C6-7.

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