title: International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study.
abstract: BACKGROUND
  A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests.
  
  
  OBJECTIVE
  To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache.
  
  
  METHODS
  Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache.
  
  
  RESULTS
  Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests.
  
  
  CONCLUSIONS
  Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache.
authors.affiliation: Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: k.luedtke@uke.de.
authors.forename: K
authors.initials: K
authors.lastname: Luedtke
authors.affiliation: University of Wisconsin-Madison, Department of Orthopedics and Rehabilitation, Wisconsin, USA.
authors.forename: W
authors.initials: W
authors.lastname: Boissonnault
authors.affiliation: Danish Headache Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: N
authors.initials: N
authors.lastname: Caspersen
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO+Institute for Health Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Castien
authors.affiliation: Head and Neck Research Group, Research Centre, Akershus University Hospital, 1478, Oslo, Norway; Institute of Clinical Medicine, Akershus University Hospital and University of Oslo, 1474, Nordbyhagen, Norway.
authors.forename: A
authors.initials: A
authors.lastname: Chaibi
authors.affiliation: School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK; Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Falla
authors.affiliation: Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Fernández-de-Las-Peñas
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, P.O. Box U1987, Perth, WA 6845, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Hall
authors.affiliation: Danish Headache Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: J R
authors.initials: JR
authors.lastname: Hirsvang
authors.affiliation: Physiotherapy Practice Jensen & Team, Nienstedtener Marktplatz 29, 22609 Hamburg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Horre
authors.affiliation: Physiotherapy, Birmingham Community Healthcare NHS Trust, Birmingham, England, UK.
authors.forename: D
authors.initials: D
authors.lastname: Hurley
authors.affiliation: Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Jull
authors.affiliation: Danish Headache Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: L S
authors.initials: LS
authors.lastname: Krøll
authors.affiliation: Danish Headache Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: B K
authors.initials: BK
authors.lastname: Madsen
authors.affiliation: Spine Center "Am Michel", Ludwig-Erhard-Str. 18, 20459 Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Mallwitz
authors.affiliation: Physiotherapy Department, University Hospital Birmingham Foundation Trust, Birmingham B15 2TH, UK.
authors.forename: C
authors.initials: C
authors.lastname: Miller
authors.affiliation: Migraine and Headache Clinic Königstein im Taunus, Ölmühlweg 31, 61462 Königstein im Taunus, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schäfer
authors.affiliation: Hochschule für Angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Fakultät Soziale Arbeit und Gesundheit, Studiengang Ergotherapie, Logopädie und Physiotherapie, Goschentor 1, 31134 Hildesheim; Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schöttker-Königer
authors.affiliation: Hochschule für Angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Fakultät Soziale Arbeit und Gesundheit, Studiengang Ergotherapie, Logopädie und Physiotherapie, Goschentor 1, 31134 Hildesheim; Germany.
authors.forename: W
authors.initials: W
authors.lastname: Starke
authors.affiliation: University of Applied Sciences Osnabrueck, Faculty of Business Managment and Social Science, Department Movement and Rehabilitation Science, Caprivistr. 30a, 49076 Osnabrück, Germany.
authors.forename: H
authors.initials: H
authors.lastname: von Piekartz
authors.affiliation: Watson Headache Institute, GPO Box 4714, Sydney, NSW 2001, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Watson
authors.affiliation: Heimlisbergstr. 47, 4513 Langendorf, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Westerhuis
authors.affiliation: Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: May
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003697:Delphi Technique; D005260:Female; D006261:Headache / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000175:diagnosis*; D019547:Neck Pain / Q000175:diagnosis* / Q000503:physiopathology*; D010808:Physical Examination / Q000592:standards*; D059825:Physical Therapists; D011795:Surveys and Questionnaires
keywords: Consensus; Delphi; Examination; Headache; Migraine; Physical therapy