Anarte-Lazo Ernesto, Rodriguez-Blanco Cleofas, Bernal-Utrera Carlos
Doctoral Program in Health Sciences, University of Seville, Seville, Spain; Faculty of Health, UNIE University, 28015, Madrid, Spain.
Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain.
Braz J Phys Ther. 2024 Nov-Dec;28(6):101134. doi: 10.1016/j.bjpt.2024.101134. Epub 2024 Nov 6.
Headache is common in people with whiplash-associated disorders (WAD). Upper-cervical structures may be involved in the presence of headache, and the flexion-rotation test (FRT) has been widely studied to assess cervicogenic headaches.
To evaluate the diagnostic accuracy of the FRT for the presence of headache in people with WAD, and its cut-off value.
In this secondary analysis from a previously published study 47 people with WAD were consecutively recruited, 28 with and 19 without headache. FRT was assessed by a single blinded evaluator, with production of headache during the test as the reference standard. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were assessed through cross-tabulation. The cut-off value was calculated based on the Youden's Index. The positivity of the test was defined based on: a) range of motion (ROM) <32°; and ROM <32° combined with headache provocation.
Differences between groups were significant for both most and least restricted sides of FRT in terms of ROM (p < 0.001). For the most restricted side, moderate sensitivity and specificity was found (82.1% [95%CI = 68.4%, 95.8%] and 63.2% [95%CI = 40.8%, 85.6%], respectively) when only ROM was considered. When headache provocation was included, sensitivity and specificity were 78.6% (95%CI = 63.1%, 93.7%) and 68.4% (95%CI = 47.5%, 88.5%), respectively. A cut-off value of 31.5° was found.
Moderate diagnostic accuracy through both ways of assessing the FRT was found for this test to detect the presence of whiplash-associated headache from upper cervical origin. The FRT may be considered positive if ROM is less than 31.5°.
头痛在挥鞭样损伤相关疾病（WAD）患者中很常见。上颈椎结构可能与头痛的发生有关，并且屈曲旋转试验（FRT）已被广泛研究用于评估颈源性头痛。
评估FRT对WAD患者头痛存在情况的诊断准确性及其截断值。
在这项对先前发表研究的二次分析中，连续招募了47例WAD患者，其中28例有头痛，19例无头痛。由一名单盲评估者评估FRT，以测试期间出现头痛作为参考标准。通过交叉表评估敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比。基于约登指数计算截断值。根据以下定义测试的阳性结果：a）活动范围（ROM）<32°；以及ROM<32°并伴有头痛激发。
就ROM而言，FRT最受限侧和最不受限侧的组间差异均具有显著性（p<0.001）。对于最受限侧，仅考虑ROM时，发现中等敏感性和特异性（分别为82.1%[95%CI=68.4%，95.8%]和63.2%[95%CI=40.8%，85.6%]）。当包括头痛激发时，敏感性和特异性分别为78.6%（95%CI=63.1%，93.7%）和68.4%（95%CI=47.5%，88.5%）。发现截断值为31.5°。
通过两种评估FRT的方式均发现该测试对于检测源自上颈椎的挥鞭样损伤相关头痛的存在具有中等诊断准确性。如果ROM小于31.5°，则FRT可被视为阳性。
