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.
Femke Driehuis, Noël L W Keijsers, Maria W G Nijhuis-van der Sanden and 3 others
PMID 32282288WHAT IT FOUND
Two manual tests for infant neck stiffness show poor agreement between therapists.
The tests cannot reliably measure reduced mobility. Therapists should not use these tests alone to diagnose or decide on treatment for infants.
Key findings
01Inter-rater reliability for the Flexion-Rotation and Lateral-Flexion tests varied from poor to substantial, and objectively measured range of motion showed large variation between therapists.
02Due to high variation, the tests cannot reliably assess reduced upper cervical mobility in infants with indications of dysfunction.
03Therapists should not use these tests solely as an outcome measure in clinical practice or research.
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
All infants included already had indications of upper cervical dysfunction, so the results do not apply to infants without these signs. The study did not include a control group of infants without dysfunction, limiting the ability to validate the tests. Imaging techniques like MRI were not used to verify the presence of dysfunction, so the tests could not be compared against a gold standard. Sensor data may have been affected by infant movement and crying during the assessment. The study was conducted in private practices in the Netherlands, which may limit generalizability to other healthcare settings.
Declared interests
The work was supported by the Dutch Association for Manual Therapy.
The easy way to misread this
Do not interpret the high agreement on diagnosis and treatment indication as evidence that the physical tests are reliable. The study authors note that this agreement may be influenced by selection bias, as all infants were included specifically because they already had indications of dysfunction.