An investigation of intraexaminer and interexaminer reliability in the measurement of cervical active range of motion using the cervical measurement system (CMS)

Nicholas P. Burns                                                                                            Supervisor: Mary Penn

Abstract: 
Producing accurate measurements of joint ranges of motion is important for reliable interpretation of research studies. For clinical validity, the aim of this investigation is to explore the intra-examiner and inter-examiner reliability in the measurement of cervical active range of motion using the Cervical Measurement System (CMS). 

Methods
In the outpatient clinic at the London School of Osteopathy, non-symptomatic subjects from the student body (n=8) were randomly assessed in a test, re-test design study using a standardized measurement protocol. Measurements were taken in the order of: left lateral flexion, right lateral flexion, flexion, extension, left rotation and right rotation, in accordance with the manufacturers guidelines. Subjects were deemed suitable for selection if they were non-symptomatic, i.e. did not presently suffer from neck pain or dizziness, and had not experienced whiplash, neck trauma / injury, or dizziness in the past year.

Results
Reliability of this study results were poor statistically, although certain trends of increasing ranges is expressed by the Intra-examiner Correlation Coefficient, for lateral flexion was (0.8) and above, with variable 95% limits of agreement. It has been made clear that thorough training is necessary in the use of an appropriate cervical measuring device to reduce examiner error and therefore better quality results, a more thorough subject selection questionnaire, a full case history should be taken for all who pass the initial selection process, as this will add to the safety and professionalism of the study.

Left Lateral Flexion
The Correlation Coefficient was used to assess for Intra-examiner reliability, for examiner A, in Left Lateral Flexion, the Correlation coefficient (r) = 0.7370, the one-tailed P value is 0.0185, considered significant.
For intra-examiner B reliability, Correlation coefficient. (r) = 0.8809, the one-tailed P value is 0.0019, considered very significant.
Inter-Examiner A-B reliability, the Correlation coefficient (r) = 0.7241, The one-tailed P value is 0.0211, considered significant.