title: Simulation tests for cervical nonorganic signs: a study of face validity.
abstract: OBJECTIVE
  The purpose of this study was to develop and determine the face validity of additional cervical nonorganic simulation tests.
  
  
  METHODS
  Four simulation tests were either selected from the literature or newly designed: simulated sitting trunk/shoulder rotation (SR; test no. 1), active vs passive cervical rotation (CR; test no. 2), Libman's test (LT; test no. 3) of pressure over the mastoid process, and side-lying passive shoulder abduction (SA; test no. 4). Three groups, 1 without neck pain (n = 44) and 2 with neck pain (n = 43 and 27), were formed. Outcome measures consisted of questions on provocation of pain (Yes/No) and appropriateness (Yes/No) as well as measurements of cervical rotation (goniometric) and pressure pain threshold (pressure algometer). Group test responses were evaluated and scored. A threshold of acceptance was established at 80% agreement for face validity. Ranges of rotation and pressure threshold values were analyzed with the Student t test.
  
  
  RESULTS
  In nonneck pain subjects, all 4 tests were rated as nonpainful and 3 were rated as "appropriate" for neck pain examination (not SR). In neck pain subjects, this test and SA were rated as nonpainful, whereas LT was rated as painful in 26% of subjects. Only CR and LT were rated as "appropriate." In neck pain subjects, passive rotations exceeded actives by 10% to 14% (P = .000). On a second round of testing with a slightly modified method, SR and SA achieved acceptable "appropriateness."
  
  
  CONCLUSIONS
  Once 2 tests were slightly modified, all 4 tests were found to have acceptable face validity. Further research into the reliability of these tests as well as into the combinations of these tests is warranted.
authors.affiliation: Canadian Memorial Chiropractic College, Graduate Education and Research, Toronto, Ontario, Canada M2H 3J1. hvernon@cmcc.ca
authors.forename: Howard
authors.initials: H
authors.lastname: Vernon
authors.forename: Dan
authors.initials: D
authors.lastname: Proctor
authors.forename: Dianna
authors.initials: D
authors.lastname: Bakalovski
authors.forename: Jesse
authors.initials: J
authors.lastname: Moreton
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid; D008875:Middle Aged; D009038:Motion; D019547:Neck Pain / Q000175:diagnosis*; D010147:Pain Measurement / Q000379:methods*; D010173:Palpation; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012399:Rotation; D012782:Shoulder; D055815:Young Adult