Intra- and inter-rater reliability, standard error of measurement, and minimal detectable change of the cranio-cervical flexion test in individuals with non-specific chronic neck pain.

Abstract

Background: The cranio-cervical flexion test (CCFT) is used in clinical practice to measure the activation of deep cervical flexor muscles. However, the reliability of the test has not been conducted on an adequate sample size, specifically in individuals with non-specific chronic neck pain (CNP).

Objective: The aim of the present study is to investigate the intra- and inter-rater reliability, standard error of measurement (SEM), and minimal detectable change (MDC) of the CCFT in individuals with non-specific CNP.

Methods: A cross-sectional study of reliability conducted at the UFSCar. Fifty-one individuals (17 men and 31 women) with non-specific CNP and aged over 18 years participated in this study. The CCFT was assessed with the Stabilizer pressure biofeedback device. Two raters conducted the test over two days, with a 5-7-days interval and a 10-min rest between raters. The activation score was determined by the level at which the participant kept activation for 10 s in a single stage (22, 24, 26, 28 and 30 mmHg). Appropriate statistical analysis was performed to calculate the intraclass correlation coefficient (ICC), SEM and MDC.

Results: Both intra-rater (ICC = 0.65; 95% CI = 0.46-0.78) and inter-rater reliability (ICC = 0.72; 95% CI = 0.55-0.83) were considered moderate. The SEM was 1.73 and 1.66 for intra-rater and inter-rater reliability, and the MDC was 4.81 to 4.60, respectively.

Conclusion: The results of the present study indicate that CCFT is a reliable test to evaluate the activation score in individuals with chronic neck pain.