title: The clinical utility of cervical range of motion in diagnosis, prognosis, and evaluating the effects of manipulation: a systematic review.
abstract: BACKGROUND
  Clinicians commonly assess cervical range of motion (ROM), but it has rarely been critically evaluated for its ability to contribute to patient diagnosis or prognosis, or whether it is affected by mobilisation/manipulation.
  
  
  OBJECTIVE
  This review summarises the methods used to measure cervical ROM in research involving patients with cervical spine disorders, reviews the evidence for using cervical ROM in patient diagnosis, prognosis, and evaluation of the effects of mobilisation/manipulation on cervical ROM.
  
  
  METHODS
  A systematic search of MEDLINE, EMBASE, CINAHL, AMED and ICL databases was conducted, addressing one of four constructs related to cervical ROM: measurement, diagnosis, prognosis, and the effects of mobilisation/manipulation on cervical ROM.
  
  
  METHODS
  Two independent raters appraised methodological quality using the QUADAS-2 tool for diagnostic studies, the QUIPS tool for prognostic studies and the PEDro scale for interventional studies. Heterogeneity of studies prevented meta-analysis.
  
  
  RESULTS
  Thirty-six studies met the criteria and findings showed there is limited evidence for the diagnostic value of cervical ROM in cervicogenic headache, cervical radiculopathy and cervical spine injury. There is conflicting evidence for the prognostic value of cervical ROM, though restricted ROM appears associated with negative outcomes while greater ROM is associated with positive outcomes. There is conflicting evidence as to whether cervical ROM increases or decreases following mobilisation/manipulation.
  
  
  CONCLUSIONS
  Cervical ROM has value as one component of assessment, but clinicians should be cautious about making clinical judgments primarily on the basis of cervical ROM.
  
  
  BACKGROUND
  This collaboration was supported by an internal grant from the Faculty of Health, The University of Newcastle.
authors.affiliation: Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Hunter Building, Callaghan, NSW 2308, Australia. Electronic address: Suzanne.Snodgrass@newcastle.edu.au.
authors.forename: Suzanne J
authors.initials: SJ
authors.lastname: Snodgrass
authors.affiliation: Physical Therapy Program, Franklin Pierce University, 670 N. Commercial St. Suite 301, Manchester, NH 03101, USA. Electronic address: clelandj@franklinpierce.edu.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Cleland
authors.affiliation: Discipline of Physiotherapy, School of Health Sciences, The University of Newcastle, Hunter Building, Callaghan, NSW 2308, Australia. Electronic address: Robin.Haskins@newcastle.edu.au.
authors.forename: Robin
authors.initials: R
authors.lastname: Haskins
authors.affiliation: School of Health Sciences, The University of Newcastle, Hunter Building, Callaghan, NSW 2308, Australia. Electronic address: Darren.Rivett@newcastle.edu.au.
authors.forename: Darren A
authors.initials: DA
authors.lastname: Rivett
mesh_terms: D002574:Cervical Vertebrae / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D020393:Manipulation, Spinal / Q000379:methods*; D019547:Neck Pain / Q000175:diagnosis / Q000534:rehabilitation; D011237:Predictive Value of Tests; D011379:Prognosis; D016059:Range of Motion, Articular / Q000502:physiology*; D018570:Risk Assessment; D013122:Spinal Diseases / Q000175:diagnosis* / Q000534:rehabilitation*; D016896:Treatment Outcome
keywords: Cervical vertebrae; Manipulation (spinal); Measurement; Physical therapy techniques