title: Assessment of published reliability studies for cervical spine range-of-motion measurement tools.
abstract: OBJECTIVE
  To assess the reliability of tools to measure cervical spine range of motion in clinical settings and discuss the necessary components for reliability studies.
  
  
  METHODS
  Database searches included Bandolier, Bath Information and Data Services including Index of Scientific and Technical Proceedings, British Nursing Index, Cumulative Index to Nursing and Allied Health Literature, English National Health Care Database, MEDLINE, Occupational Therapy Index, Physiotherapy Index, and Rehabilitation index for English language articles from 1966. In addition, citations were searched.
  
  
  METHODS
  Studies were selected that assessed the tool for intraobserver or interobserver reliability, evaluated it on movements of flexion/extension, lateral flexion, or rotation, and measured range of motion of the whole cervical spine.
  
  
  METHODS
  All papers were read by one nonclinical researcher with a data extraction sheet. A consultant rheumatologist and a physiotherapist were each asked to read a sample of the papers to give a clinical viewpoint.
  
  
  RESULTS
  Evidence for the reliability of measurement tools was assessed qualitatively based on the quality of the study designs, appropriateness of analysis, and strength of the reliability based on reported intraclass correlation coefficients (the most appropriate analysis technique for reliability studies of this nature). Measurement tools were found to have not been fully tested for reliability, particularly in terms of adequate sample size and appropriate analysis techniques. There were also wide variations in the research design, including the protocol for movement, the characteristics of observers and study population, whether warm-ups were allowed, whether the movement was active or passive, and time intervals between repeated measurements.
  
  
  CONCLUSIONS
  Although a range-of-motion device has shown promise in reliability and has many advocates, its practicality for clinical use is questionable. Further work must be performed on all measurement tools. Researchers need to produce more rigorous studies and consider the issues discussed here.
authors.affiliation: Research Fellow, Centre for Health Planning and Management and Department of Mathematics, Keele University, United Kingdom. k.p.jordan@keele.ac.uk
authors.forename: K
authors.initials: K
authors.lastname: Jordan
mesh_terms: D002574:Cervical Vertebrae / Q000502:physiology*; D006801:Humans; D020393:Manipulation, Spinal / Q000592:standards*; D015588:Observer Variation; D016059:Range of Motion, Articular; D015203:Reproducibility of Results