Flexion-rotation test and C0-C2 axial rotation test. Are they equally reliable for novice clinicians?

Abstract

Objective: To analyse the inter- and intra-examiner reliability for the neck flexion-rotation test and the C0-C2 axial rotation test when applied in asymptomatic subjects by two novice physiotherapists.

Design: Repeated measures reliability study design. The study was approved by the Research Ethics Committee of [X], in compliance with the Declaration of Helsinki (CSEULS-PI: 004/2020).

Methods: 32 asymptomatic adults were included, recruited by convenience sampling. Two sessions were scheduled for each subject, with an intersession break of 30 min. Two inexperienced raters blinded to their own previous and peer results performed three movements to both sides using the flexion-rotation test and the C0-C2 axial rotation test in randomised order of rater, test and direction. A third researcher collected the data measured by inertial sensors and displayed to the Pro Motion Capture software.

Results: Both raters showed good-excellent intra-examiner reliability (ICC_(2,3) ranging from 0.88 to 0.94) and moderate to good inter-examiner reliability (ICC_(2,3) ranging from 0.58 to 0.86) to measure the rotation ROM with the FRT. The C0-C2 axial rotation test resulted in poor to moderate intra-examiner reliability (ICC_(2,3) ranging from 0.33 to 0.74) and poor inter-examiner reliability using (ICC_(2,3) ranging from 0.16 to 0.37).

Conclusion: Although performed by novice raters, the FRT showed good to excellent intra and inter-examiner reliability. Results for the C0-C2 axial rotation test were less reliable. We suggest that novice physiotherapists use the FRT instead of the C0-C2 axial rotation test in order to determine C1-C2 dysfunction.

Keywords: Agreement; Flexion-rotation test; Reliability; The C0–C2 axial rotation test; Upper cervical spine.