Long-Term Stability and Minimal Detectable Change of the Cervical Flexion-Rotation Test

STUDY DESIGN: Reliability of clinical measurements over time. OBJECTIVES: To determine the long-term stability and minimal detectable change (MDC) of the flexion-rotation test (FRT) measurements over days in subjects with cervicogenic headache (CGH). BACKGROUND: The FRT is used by physical therapists to assist in identifying upper cervical movement impairment, as well as to gauge treatment effectiveness. Test-retest reliability for the FRT has been reported, but the stability of range-of-motion measures taken during the FRT over time and the MDC have not been investigated. METHODS: Fifteen subjects with CGH were evaluated on headache-free days using the FRT by a blinded examiner at baseline, 2, 4, and 14 days later. An additional 10 asymptomatic subjects were included for blinding purposes. On each occasion, the examiner measured range of motion and determined whether the FRT was positive or negative. RESULTS: For subjects with CGH, there was no significant change in FRT range of motion over days (P>.05). Intraclass correlation coefficients for intratester reliability were 0.95 (95% CI: 0.90 to 0.98) and 0.97 (95% CI: 0.94 to 0.99) for right and left rotation, respectively. MDC₉₀ was 4.7° for right rotation and 7° for left rotation. Examiner interpretation of the FRT was consistent over time, with κ = 0.92. CONCLUSIONS: This study provides evidence that FRT measurements are stable over time, and the MDC₉₀ indicates that a change in FRT range of motion of at least 7° is required to be confident that a change has occurred due to an intervention rather than measurement error.

J Orthop Sports Phys Ther 2010;40(4):225-229, Epub 12 March 2010. doi:10.2519/jospt.2010.3100

KEY WORDS: cervicogenic headache, neck, psychometrics, ROM, spine

The authors aim to determine the long-term stability and minimal detectable change (MDC) of the flexion-rotation test (FRT) measurements over days in subjects with cervicogenic headache (CGH).

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