Intertester reliability and diagnostic validity of the cervical flexion-rotation test / Toby M. Hall, Kim W. Robinson, Osamu Fujinawa, Kiyokazu Akasaka, and Elizabeth A. Pyne

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Objective: This article evaluates reliability and diagnostic validity ofthe cervical flexion-rotation test (FRT) to discriminate subjects with headache because of Cl/2 dysftinction. In addition, this study evaluates agreement between experienced and inexperienced examiners.
Methods: These were 2 single blind comparative measurement study designs. In study 1. 2 experienced blinded examiners evaluated the FRT in 10 asymptomatic controls, 20 subjects with cervicogenic headache (CeH) where Cl/2 was the primary dysfunctional level, and 10 subjects with CcH hut without Cl/2 as the primary dysfunctional level. In study 2, 2 inexperienced and 1 experienced blinded examiners evaluated the FRT in 12 subjects with CeH and 12 asymptomatic controls. Examiners were required lo slate whether the FRT was positive and also to delenniiic range of rotation using a goniometer. An analysis of variance with planned orthogonal comparison, single measure intraclass correlation coefficient (2.1). and Bland-Altman plot were used to analyze FRT range of rotation between the examiners.
Sensitivity, specitleily, and examiner agreement for test Inteqiretation were analyzed using cross tabulation and K.
Results: In study I, sensitivity and specificity of the FRT was 90% and 88% with 92% agreement for experienced examiners (P < .001). Overall diagnostic accuracy was 89% {P < .001) and K = 0.85. In study 2, for inexperienced examiners, FRT mobility was significantly greater than for experienced examiners, but sensitivity, specificity, agreement, and K values were all within clinically aeeeplable levels.
Conclusions: The FRT can he used aecuratety and reliably by inexperienced examiners and may be a useful aid in CeH evaluation. (J Manipulative Physiol Ther 2008;31:293-300)