Identifiers suggestive of clinical cervical spine instability: a Delphi study of physical therapists.
OBJECTIVE
Clinical cervical spine instability (CCSI) is controversial and difficult to diagnose. Within the literature, no clinical or diagnostic tests that yield valid and reliable results have been described to differentially diagnose this condition. The purpose of this study was to attempt to obtain consensus on symptoms and physical examination findings that are associated with CCSI.


METHODS
One hundred seventy-two physical therapists who were Orthopaedic Certified Specialists (OCS) or Fellows of the American Academy of Orthopaedic Manual Physical Therapists (FAAOMPT) participated in the survey.


METHODS
This study was a 3-round Delphi survey designed to obtain consensual symptoms and physical examination findings for CCSI.


RESULTS
The symptoms that reached the highest consensus among respondents were "intolerance to prolonged static postures," "fatigue and inability to hold head up," "better with external support, including hands or collar," "frequent need for self-manipulation," "feeling of instability, shaking, or lack of control," "frequent episodes of acute attacks," and "sharp pain, possibly with sudden movements." The physical examination findings related to cervical instability that reached the highest consensus among respondents included "poor coordination/neuromuscular control, including poor recruitment and dissociation of cervical segments with movement," "abnormal joint play," "motion that is not smooth throughout range (of motion), including segmental hinging, pivoting, or fulcruming," and "aberrant movement."


CONCLUSIONS
The Delphi method is useful in situations where clinical judgments are encountered but empirical evidence to provide evidence-based decision making does not exist. Findings of this study may provide beneficial clinical information, specifically when the identifiers are clustered together, because no set of clinical examination and symptom standards for CCSI currently exists. Diagnosis of CCSI is challenging; therefore, appropriate clinical reasoning is required for distinctive physical therapy assessment using pertinent symptoms and physical examination findings.
Cook
Chad
C
Duke University Medical Center 3907, Durham, NC 27710, USA. chad.cook@duke.edu
Brismée
Jean-Michel
JM
Fleming
Robert
R
Sizer
Phillip S
PS
D000328:Adult; D002574:Cervical Vertebrae / Q000503:physiopathology*; D003697:Delphi Technique; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D026761:Physical Therapy Specialty; D014481:United States