Physiotherapist observation of head and neck alignment

To determine the reliability of physiotherapists' visual observation of head and neck alignment.

An interrater reliability study with an evaluation of concurrent validity using a gold standard.

Physiotherapy Research Laboratory, Princess Alexandra Hospital.

Three physiotherapist raters, one male model exhibiting 53 test positions.

Assessment of head and neck alignment required rating the direction of deviation (in each of the three planes of movement), and the magnitude of deviation.

All three assessors were correct across all domains of direction and magnitude of deviation for only 10 of the 53 test positions. There was a mean of 2 total errors (out of a possible 12) per position. The more planes of deviation involved in a position, the more total errors there were. Most errors were made in the axial rotation (transverse) plane. Where a lateral flexion (coronal) plane of deviation was involved, there were more total errors; however, this plane itself had the fewest number of errors. Positions with a combination of both lateral flexion and axial rotation deviations were often mistaken for a flexion/extension (sagittal plane) deviation. Fewer errors were recorded for positions of 10-degree deviation compared to 5-degree deviations.

Visual assessment of head and neck alignment by physiotherapists is of questionable validity for identifying deviations in the order of 5 degrees from neutral. For deviations of 10 degrees in a single plane visual, observation is comparable to other clinically available tools.