Cervical nonorganic signs: a new clinical tool to assess abnormal illness behavior in neck pain patients: a pilot study
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Published on: June 27, 2025
J B Sobel1, P Sollenberger, R Robinson
1Productive Rehabilitation Institute of Dallas for Ergonomics Research Foundation, TX, USA.
Objective:
To develop and assess the reliability of a group of cervical nonorganic physical signs to be used as a simple screening tool for identifying patients with low neck pain who exhibit abnormal illness behavior.
Design:
Survey, consecutive sample.
Data Set:
Double masked.
Setting:
Functional restoration program.
Patients:
Twenty-six consecutive patients with complaints of chronic neck pain (greater than 4 months duration). Each patient was evaluated by a physician and then again by either a physical or occupational therapist, for the presence of specific cervical nonorganic signs. Both of the evaluations occurred on the same day.
Main Outcome Measures:
Five categories consisting of eight tests were appraised: (1) tenderness, (2) simulation, (3) range of motion, (4) regional disturbance, and (5) overreaction.
Results:
The percent agreement between raters ranged from a high of 100% for regional sensory disturbance, to a low of 68% for one of the simulation tests. The average agreement between raters across all of the nonorganic test signs was 84.6%. Likewise, kappa coefficients ranged from 1.00 to .16, reflecting differences in strength of agreement.
Conclusion:
For many years, the lumbar nonorganic signs (developed by Waddell and colleagues) have been a useful screening tool in the assessment of abnormal illness behavior in the low back pain population. For the first time, a group of cervical nonorganic signs have been developed, standardized, and proven reliable.
