Interexaminer agreement of clinical examination of the neck in manual medicine.

OBJECTIVES

To assess interexaminer agreement in a structured, manual, clinical examination of the neck. To correlate these data with the score in a functional questionnaire (a validated, French-language version of the neck pain and disability scale).

PATIENTS

Fifty-nine ambulatory patients (26 males and 33 females, mean+/-SD age: 46.3+/-12 yrs) with common neck pain but no radiation below the elbow.

METHODS

Two medical practitioners (a junior and a senior consultant) assessed neck rotation (in degrees) and the presence of pain during maximum neck flexion and extension, muscle palpation trapezius, levator scapulae, splenius cervicis, semispinalis) and cervical spine palpation. Cohen's kappa coefficient was calculated for qualitative variables. Angular rotational values (as a continuous variable) were compared using the p coefficient. Pearson coefficient was used to correlate the number of tender spots to the results of the questionnaire.

RESULTS

There was no significant interexaminer difference (+/-10 degrees) in the neck rotation measurement. Kappa was (i) 0.71 and 0.76 for pain in flexion or extension, respectively, (ii) 0.44 on average for palpation of various muscles and (iii) 0.53 on average for cervical spine palpation. The number of tender spots correlated strongly with the questionnaire score (Pearson's coefficient: 0.35; p=0.007).

CONCLUSION

The interexaminer agreement for our clinical examination was moderate. The number of tender spots correlated strongly with the functional impairment. Pain at the lower attachment of the levator scapulae was associated with dysfunction of the median or upper cervical spine.