A perspective on the use of the cervical flexion rotation test in the physical therapy management of cervicogenic headaches.
Jean-Philippe Paquin, Jean-Pierre Dumas, Thomas Gérard and 1 others
PMID 36476405WHAT IT FOUND
The cervical flexion-rotation test is unreliable for diagnosing cervicogenic headache because its reference standard is flawed.
Use it instead to track upper neck movement loss and guide manual therapy, not to confirm the diagnosis.
Key findings
01The test's diagnostic accuracy is likely overestimated because the manual examination used as the reference standard has poor reliability.
02Pain, age, eyeball estimation of rotation, and migraine are confounding factors that can lead to misinterpretation of the test.
03The authors propose treating the test as a prognostic marker to guide rehabilitation techniques, rather than as a definitive diagnostic tool.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is an expert opinion piece, not a new empirical study. The proposed use of CFRT as a prognostic factor is theoretical and requires future cohort studies to validate. The paper notes that the current evidence base for the test's diagnostic accuracy is flawed due to the lack of a true gold standard.
Declared interests
No funding or conflicts of interest are declared in the provided text.
The easy way to misread this
Do not use the cervical flexion-rotation test to rule in or rule out cervicogenic headache. Its diagnostic accuracy is likely overestimated because the reference standard used in studies is unreliable, and positive results can also occur in patients with migraine.