Upper cervical instability: are clinical tests reliable?

SUMMARY. The aim of this preliminary study was to investigate the reliability of a selection of manual tests used for the examination of instability of the upper cervical region. Eleven children with Down's syndrome were examined by four independent examiners with different levels of experience in manual therapy. Three tests as described by Van der El (1992) were used: the lateral displacement test, the Sharp-Purser test, and the upper cervical flexion test. Scores of tests and retests were statistically analysed by calculating the percentage of agreement, and Brennan and Prediger's modified kappa, and with the binomial test. The results showed a significant agreement between test and retest for the upper cervical flexion test in three out of four investigators. Agreement between investigators was significant in four out of six combinations between two investigators, and near to significant for this test (P(bin) =.07) in the two remaining combinations. The other two investigated tests and the total score showed no tendancy towards a consistent level of significant intra- or interobserver reliability. Copyright 1997 Harcourt Publishers Ltd.