Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting

F. Driehuis; N.L.W. Keijsers; M.W.G. Nijhuis-van der Sanden; R.A. De Bie; J.B. Staal; T.J. Hoogeboom

doi:10.1080/10669817.2020.1746896

Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting

F. Driehuis^*, N.L.W. Keijsers, M.W.G. Nijhuis-van der Sanden, R.A. De Bie, J.B. Staal, T.J. Hoogeboom

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: In infants with indications of upper cervical dysfunction, the Flexion-Rotation-Test and Lateral-Flexion-Test are used to indicate reduced upper cervical range-of-motion (ROM). In infants, the inter-rater reliability of these tests is unknown.Objective: To assess the inter-rater reliability of subjectively and objectively measured ROM by using the Flexion-Rotation-Test and Lateral-Flexion-Test.Methods: 36 infants (<6 months) and three manual therapists participated in this cross-sectional observational study. Pairs of two manual therapists independently assessed infants' upper cervical ROM using the Flexion-Rotation-Test and Lateral-Flexion-Test, blinded for each other's outcomes. Two inertial motion sensors objectively measured cervical ROM. Inter-rater reliability was determined between each pair of manual therapists. For subjective outcomes, Cohen's kappa (kappa) and the proportion of agreement (Pra)were calculated. For objectively measured ROM, Bland Altman plots were conducted and Limits of Agreement and Intraclass Correlation Coefficients (ICC) were calculated.Results: The inter-rater reliability of the Flexion-Rotation-Test and Lateral-Flexion-Test for subjective (kappa: 0.077-0.727; Pra: 0.46-0.86) and objective outcomes (ICC: 0.019-0.496) varied between pairs of manual therapists.Conclusion: Assessed ROM largely depends on the performance of the assessment and its interpretation by manual therapists, leading to high variation in outcomes. Therefore, the Flexion-Rotation-Test and Lateral-Flexion-Test cannot be used solely as a reliable outcome measure in clinical practice and research context.

Original language	English
Pages (from-to)	40-50
Number of pages	11
Journal	Journal of Manual and Manipulative Therapy
Volume	29
Issue number	1
DOIs	https://doi.org/10.1080/10669817.2020.1746896
Publication status	Published - 2 Jan 2021

Keywords

diagnostic
flexion-rotation-test
infants
lateral-flexion-test
manual therapy
reliability
upper cervical dysfunction
Manual therapy
Lateral-Flexion-Test
Flexion-Rotation-Test

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Driehuis, F., Keijsers, N. L. W., Nijhuis-van der Sanden, M. W. G., De Bie, R. A., Staal, J. B., & Hoogeboom, T. J. (2021). Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting. Journal of Manual and Manipulative Therapy, 29(1), 40-50. https://doi.org/10.1080/10669817.2020.1746896

Driehuis, F. ; Keijsers, N.L.W. ; Nijhuis-van der Sanden, M.W.G. et al. / Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting. In: Journal of Manual and Manipulative Therapy. 2021 ; Vol. 29, No. 1. pp. 40-50.

@article{23180c166f054d8f853c16a8c4d07057,

title = "Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting",

abstract = "Background: In infants with indications of upper cervical dysfunction, the Flexion-Rotation-Test and Lateral-Flexion-Test are used to indicate reduced upper cervical range-of-motion (ROM). In infants, the inter-rater reliability of these tests is unknown.Objective: To assess the inter-rater reliability of subjectively and objectively measured ROM by using the Flexion-Rotation-Test and Lateral-Flexion-Test.Methods: 36 infants (<6 months) and three manual therapists participated in this cross-sectional observational study. Pairs of two manual therapists independently assessed infants' upper cervical ROM using the Flexion-Rotation-Test and Lateral-Flexion-Test, blinded for each other's outcomes. Two inertial motion sensors objectively measured cervical ROM. Inter-rater reliability was determined between each pair of manual therapists. For subjective outcomes, Cohen's kappa (kappa) and the proportion of agreement (Pra)were calculated. For objectively measured ROM, Bland Altman plots were conducted and Limits of Agreement and Intraclass Correlation Coefficients (ICC) were calculated.Results: The inter-rater reliability of the Flexion-Rotation-Test and Lateral-Flexion-Test for subjective (kappa: 0.077-0.727; Pra: 0.46-0.86) and objective outcomes (ICC: 0.019-0.496) varied between pairs of manual therapists.Conclusion: Assessed ROM largely depends on the performance of the assessment and its interpretation by manual therapists, leading to high variation in outcomes. Therefore, the Flexion-Rotation-Test and Lateral-Flexion-Test cannot be used solely as a reliable outcome measure in clinical practice and research context.",

keywords = "diagnostic, flexion-rotation-test, infants, lateral-flexion-test, manual therapy, reliability, upper cervical dysfunction, Manual therapy, Lateral-Flexion-Test, Flexion-Rotation-Test",

author = "F. Driehuis and N.L.W. Keijsers and {Nijhuis-van der Sanden}, M.W.G. and {De Bie}, R.A. and J.B. Staal and T.J. Hoogeboom",

note = "Funding Information: This work was supported by the Dutch Association for Manual Therapy (NVMT). We gratefully thank the parents and infants for their willingness to participate in this study and the participating manual therapists E. Saedt, K. Giesen and S. Roode for their dedication and active participation in this study. We thank the Dutch Association for Manual Therapy (NVMT) for their support and funding. We thank E. Saedt and B. van der Woude for their continuous dedication to this study. At last, we thank A.T.M. van de Water for reviewing our manuscript thoroughly. Publisher Copyright: {\textcopyright} 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.",

year = "2021",

month = jan,

day = "2",

doi = "10.1080/10669817.2020.1746896",

language = "English",

volume = "29",

pages = "40--50",

journal = "Journal of Manual and Manipulative Therapy",

issn = "1066-9817",

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Driehuis, F, Keijsers, NLW, Nijhuis-van der Sanden, MWG, De Bie, RA, Staal, JB & Hoogeboom, TJ 2021, 'Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting', Journal of Manual and Manipulative Therapy, vol. 29, no. 1, pp. 40-50. https://doi.org/10.1080/10669817.2020.1746896

Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting. / Driehuis, F.; Keijsers, N.L.W.; Nijhuis-van der Sanden, M.W.G. et al.
In: Journal of Manual and Manipulative Therapy, Vol. 29, No. 1, 02.01.2021, p. 40-50.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting

AU - Driehuis, F.

AU - Keijsers, N.L.W.

AU - Nijhuis-van der Sanden, M.W.G.

AU - De Bie, R.A.

AU - Staal, J.B.

AU - Hoogeboom, T.J.

N1 - Funding Information: This work was supported by the Dutch Association for Manual Therapy (NVMT). We gratefully thank the parents and infants for their willingness to participate in this study and the participating manual therapists E. Saedt, K. Giesen and S. Roode for their dedication and active participation in this study. We thank the Dutch Association for Manual Therapy (NVMT) for their support and funding. We thank E. Saedt and B. van der Woude for their continuous dedication to this study. At last, we thank A.T.M. van de Water for reviewing our manuscript thoroughly. Publisher Copyright: © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

PY - 2021/1/2

Y1 - 2021/1/2

N2 - Background: In infants with indications of upper cervical dysfunction, the Flexion-Rotation-Test and Lateral-Flexion-Test are used to indicate reduced upper cervical range-of-motion (ROM). In infants, the inter-rater reliability of these tests is unknown.Objective: To assess the inter-rater reliability of subjectively and objectively measured ROM by using the Flexion-Rotation-Test and Lateral-Flexion-Test.Methods: 36 infants (<6 months) and three manual therapists participated in this cross-sectional observational study. Pairs of two manual therapists independently assessed infants' upper cervical ROM using the Flexion-Rotation-Test and Lateral-Flexion-Test, blinded for each other's outcomes. Two inertial motion sensors objectively measured cervical ROM. Inter-rater reliability was determined between each pair of manual therapists. For subjective outcomes, Cohen's kappa (kappa) and the proportion of agreement (Pra)were calculated. For objectively measured ROM, Bland Altman plots were conducted and Limits of Agreement and Intraclass Correlation Coefficients (ICC) were calculated.Results: The inter-rater reliability of the Flexion-Rotation-Test and Lateral-Flexion-Test for subjective (kappa: 0.077-0.727; Pra: 0.46-0.86) and objective outcomes (ICC: 0.019-0.496) varied between pairs of manual therapists.Conclusion: Assessed ROM largely depends on the performance of the assessment and its interpretation by manual therapists, leading to high variation in outcomes. Therefore, the Flexion-Rotation-Test and Lateral-Flexion-Test cannot be used solely as a reliable outcome measure in clinical practice and research context.

AB - Background: In infants with indications of upper cervical dysfunction, the Flexion-Rotation-Test and Lateral-Flexion-Test are used to indicate reduced upper cervical range-of-motion (ROM). In infants, the inter-rater reliability of these tests is unknown.Objective: To assess the inter-rater reliability of subjectively and objectively measured ROM by using the Flexion-Rotation-Test and Lateral-Flexion-Test.Methods: 36 infants (<6 months) and three manual therapists participated in this cross-sectional observational study. Pairs of two manual therapists independently assessed infants' upper cervical ROM using the Flexion-Rotation-Test and Lateral-Flexion-Test, blinded for each other's outcomes. Two inertial motion sensors objectively measured cervical ROM. Inter-rater reliability was determined between each pair of manual therapists. For subjective outcomes, Cohen's kappa (kappa) and the proportion of agreement (Pra)were calculated. For objectively measured ROM, Bland Altman plots were conducted and Limits of Agreement and Intraclass Correlation Coefficients (ICC) were calculated.Results: The inter-rater reliability of the Flexion-Rotation-Test and Lateral-Flexion-Test for subjective (kappa: 0.077-0.727; Pra: 0.46-0.86) and objective outcomes (ICC: 0.019-0.496) varied between pairs of manual therapists.Conclusion: Assessed ROM largely depends on the performance of the assessment and its interpretation by manual therapists, leading to high variation in outcomes. Therefore, the Flexion-Rotation-Test and Lateral-Flexion-Test cannot be used solely as a reliable outcome measure in clinical practice and research context.

KW - diagnostic

KW - flexion-rotation-test

KW - infants

KW - lateral-flexion-test

KW - manual therapy

KW - reliability

KW - upper cervical dysfunction

KW - Manual therapy

KW - Lateral-Flexion-Test

KW - Flexion-Rotation-Test

U2 - 10.1080/10669817.2020.1746896

DO - 10.1080/10669817.2020.1746896

M3 - Article

C2 - 32282288

SN - 1066-9817

VL - 29

SP - 40

EP - 50

JO - Journal of Manual and Manipulative Therapy

JF - Journal of Manual and Manipulative Therapy

IS - 1

ER -

Driehuis F, Keijsers NLW, Nijhuis-van der Sanden MWG, De Bie RA, Staal JB, Hoogeboom TJ. Measurement of range-of-motion in infants with indications of upper cervical dysfunction using the Flexion-Rotation-Test and Lateral-Flexion-Test: a blinded inter-rater reliability study in a clinical practice setting. Journal of Manual and Manipulative Therapy. 2021 Jan 2;29(1):40-50. doi: 10.1080/10669817.2020.1746896