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Upper cervical instability: are clinical tests reliable?

E. Cattrysse1, R. A.H.M. Swinkels, R. A.B. Oostendorp

  • 1Faculty of Medicine and Pharmacology, Free University of Brussels, Brussels; Practice of Physical Therapy and Manual Therapy, Wuustwezel, Belgium

Manual Therapy
|May 1, 1997
PubMed
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This study found the upper cervical flexion test to be reliable for assessing upper cervical instability in children with Down syndrome. However, other manual tests showed inconsistent reliability among examiners.

Area of Science:

  • Orthopedics
  • Pediatrics
  • Manual Therapy

Background:

  • Instability of the upper cervical region is a concern in children with Down syndrome.
  • Manual tests are commonly used to assess this instability.
  • Reliability of these tests is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To evaluate the intra- and interobserver reliability of specific manual tests for upper cervical instability.
  • To assess the reliability of the lateral displacement test, Sharp-Purser test, and upper cervical flexion test.
  • To determine the consistency of findings across different examiners with varying experience levels.

Main Methods:

  • Eleven children with Down syndrome participated in the study.
  • Four independent examiners with different manual therapy experience levels conducted the tests.

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  • Three specific manual tests were performed: lateral displacement, Sharp-Purser, and upper cervical flexion.
  • Test-retest scores were analyzed using percentage agreement, Brennan and Prediger's modified kappa, and the binomial test.

    • Main Results:

    • The upper cervical flexion test demonstrated significant test-retest agreement in three out of four examiners.
    • Interobserver agreement for the upper cervical flexion test was significant in four out of six examiner combinations.
    • The lateral displacement test and Sharp-Purser test showed no consistent significant intra- or interobserver reliability.

    Conclusions:

    • The upper cervical flexion test appears to be a reliable method for assessing upper cervical instability in children with Down syndrome.
    • Other manual tests investigated may not provide consistent results, highlighting the need for careful interpretation.
    • Further research is warranted to establish reliable manual assessment protocols for this population.