Inter-rater-reliability, intra-rater-reliability and validity of clinical tests to assess cervical spine motor control abilities: A systematic review of diagnostic accuracy studies

Background: Research into the aetiology of spinal pain has shown a clear tendency towards a sensorimotor control perspective. In contrast to the lumbar spine, the available motor control tests for the cervical spine are extremely varied, little studied and sometimes very costly. Objective: Review the quality and choice of the available cervical spine motor control tests. The diagnostic accuracy of the current low technology motor control tests was evaluated in a systematic review. Method: A search for reliability and discriminative validity studies was conducted in the Pubmed MEDLINE (R) database (NCBI) and the Cochrane Central Register of Controlled Trials, according to the PRISMA-DTA protocol. Quality Appraisal for Reliability Studies (QAREL) and Standards for Reporting Diagnostic accuracy studies (STARD) were conducted to assess the quality of the included studies. The statistical parameters of ICC, kappa-value, sensitivity, specificity, Diagnostic Odds Ratio, Area Under the Curve, mean, standard deviation and/or the confidence interval were extracted. Results: Two movement control test batteries, one head-eye-coordination test battery and the craniocervical flexion test were found to be standing out in terms of reliability, validity, applicability and cost-effectiveness (Kappa and ICC scores >0.8 for reliability and AUC 0,83 for validity.) Discussion: To date only one study was published for each of the test batteries. Nevertheless, the risk of bias compared to all other cervical motor control tests found was significantly lower. Moreover, the application is possible completely without technical equipment, which makes the findings of the present work accessible to the majority of healthcare professionals.