Weinschenk Stefan, Göllner Richard, Hollmann Markus W, Hotz Lorenz, Picardi Susanne, Hubbert Katharina, Strowitzki Thomas, Meuser Thomas
Outpatient Practice Drs. Weinschenk, Scherer & Co., Karlsruhe, Germany.
Forsch Komplementmed. 2016;23(4):223-9. doi: 10.1159/000447506. Epub 2016 Jun 23.
Neck reflex points (NRP) are tender soft tissue areas of the cervical region that display reflectory changes in response to chronic inflammations of correlated regions in the visceral cranium. Six bilateral areas, NRP C0, C1, C2, C3, C4 and C7, are detectable by palpating the lateral neck. We investigated the inter-rater reliability of NRP to assess their potential clinical relevance.
32 consecutive patients with chronic neck pain were examined for NRP tenderness by an experienced physician and an inexperienced medical student in a blinded design. A detailed description of the palpation technique is included in this section. Absence of pain was defined as pain index (PI) = 0, slight tenderness = 1, and marked pain = 2. Findings were evaluated either by pair-wise Cohen's kappa (ĸ) or by percentage of agreement (PA).
Examiners identified 40% and 41% of positive NRP, respectively (PI > 0, physician: 155, student: 157) with a slight preference for the left side (1.2:1). The number of patients identified with >6 positive NRP by the examiners was similar (13 vs. 12 patients). ĸ values ranged from 0.52 to 0.95. The overall kappa was ĸ = 0.80 for the left and ĸ = 0.74 for the right side. PA varied from 78.1% to 96.9% with strongest agreement at NRP C0, NRP C2, and NRP C7. Inter-rater agreement was independent of patients' age, gender, body mass index and examiner's experience.
The high reproducibility suggests the clinical relevance of NRP in women.
颈部反射点（NRP）是颈部区域的压痛软组织区域，对颅内脏器相关区域的慢性炎症会产生反射性变化。通过触诊颈部外侧可检测到六个双侧区域，即NRP C0、C1、C2、C3、C4和C7。我们研究了NRP的评分者间可靠性，以评估其潜在的临床相关性。
采用盲法设计，由一名经验丰富的医生和一名经验不足的医学生对32例连续的慢性颈部疼痛患者进行NRP压痛检查。本节包含触诊技术的详细描述。无痛定义为疼痛指数（PI）=0，轻度压痛=1，明显疼痛=2。结果通过成对的科恩kappa系数（ĸ）或一致率（PA）进行评估。
检查者分别识别出40%和41%的阳性NRP（PI>0，医生：155个，学生：157个），略倾向于左侧（1.2:1）。检查者识别出>6个阳性NRP的患者数量相似（分别为13例和12例）。ĸ值范围为0.52至0.95。左侧总体kappa系数为ĸ = 0.80，右侧为ĸ = 0.74。PA从78.1%到96.9%不等，在NRP C0、NRP C2和NRP C7处一致性最强。评分者间的一致性与患者的年龄、性别、体重指数和检查者的经验无关。
高再现性表明NRP在女性中具有临床相关性。
