Simulation Tests for Cervical Nonorganic Signs: A Study of Face Validity
Received 6 August 2009; received in revised form 28 October 2009; accepted 5 November 2009.
Abstract
Objectives
The purpose of this study was to develop and determine the face validity of additional cervical nonorganic simulation tests.
Methods
Four simulation tests were either selected from the literature or newly designed: simulated sitting trunk/shoulder rotation (SR; test no. 1), active vs passive cervical rotation (CR; test no. 2), Libman's test (LT; test no. 3) of pressure over the mastoid process, and side-lying passive shoulder abduction (SA; test no. 4). Three groups, 1 without neck pain (n = 44) and 2 with neck pain (n = 43 and 27), were formed. Outcome measures consisted of questions on provocation of pain (Yes/No) and appropriateness (Yes/No) as well as measurements of cervical rotation (goniometric) and pressure pain threshold (pressure algometer). Group test responses were evaluated and scored. A threshold of acceptance was established at 80% agreement for face validity. Ranges of rotation and pressure threshold values were analyzed with the Student t test.
Results
In nonneck pain subjects, all 4 tests were rated as nonpainful and 3 were rated as “appropriate” for neck pain examination (not SR). In neck pain subjects, this test and SA were rated as nonpainful, whereas LT was rated as painful in 26% of subjects. Only CR and LT were rated as “appropriate.” In neck pain subjects, passive rotations exceeded actives by 10% to 14% (P = .000). On a second round of testing with a slightly modified method, SR and SA achieved acceptable “appropriateness.”
Conclusions
Once 2 tests were slightly modified, all 4 tests were found to have acceptable face validity. Further research into the reliability of these tests as well as into the combinations of these tests is warranted.
dResearch Assistant, Canadian Memorial Chiropractic College, Graduate Education and Research, Toronto, Ontario, Canada
Submit requests for reprints to: Howard Vernon, DC, PhD, Canadian Memorial Chiropractic College, Graduate Education and Research, 6100 Leslie St. Toronto, Ontario, Canada, M2H 3J1
Canadian Memorial Chiropractic College, Research Ethics Board approval, 0804B01, May 7, 2009.
Presented at: Association of Chiropractic Colleges, Research Conference, March 12-14, 2009, Las Vegas, NV.
ABSTRACT