Reliability of the Joint Position Sense Error Test for Women With Neck Pain and Asymptomatic Men and Women

Published:September 30, 2022DOI:



      The purpose of this study was to evaluate the intra-rater between-days reliability of the joint position sense error (JPSE) test in asymptomatic men and women, as well as in women with neck pain.


      Fourteen asymptomatic men and 27 women (14 asymptomatic and 13 with neck pain) participated. The JPSE test was performed during right and left cervical rotation (10 trials for each side) in 2 sessions, with at least 7 days between them. The head repositioning error during the JPSE test (in degrees) was measured and used to calculate the intra-rater between-days reliability of the test, evaluated through the intraclass correlation coefficient and Bland-Altman analyses. Independent t tests were calculated to compare the head repositioning errors of asymptomatic women and men. The minimal detectable change was also calculated.


      The neck pain group showed higher intraclass correlation coefficient values (0.866 and 0.773, good reliability) compared to the asymptomatic men (0.478 and 0.403, poor reliability) and to the asymptomatic women (-0.161 and 0.504, poor and moderate reliability, respectively) for both right and left cervical rotation, respectively. Considering Bland-Altman analyses, the neck pain group showed better agreement between the measurements for right cervical rotation than the asymptomatic groups.


      The results indicate that the methodology used to perform the JPSE test in this study may be a reliable way to assess the proprioception of women with neck pain in clinical settings.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Manipulative & Physiological Therapeutics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • de Vries J
        • Ischebeck BK
        • Voogt LP
        • et al.
        Joint position sense error in people with neck pain: a systematic review.
        Man Ther. 2015; 20: 736-744
        • Proske U
        • Gandevia SC.
        The proprioceptive senses: their roles in signaling body shape, body position and movement, and muscle force.
        Physiol Rev. 2012; 92: 1651-1697
        • Proske U
        • Wise AK
        • Gregory JE.
        The role of muscle receptors in the detection of movements.
        Prog Neurobiol. 2000; 60: 85-96
        • Lephart SM
        • Jari R.
        The role of proprioception in shoulder instability.
        Oper Tech Sports Med. 2002; 10: 2-4
        • Malmström EM
        • Karlberg M
        • Fransson PA
        • Lindbladh J
        • Magnusson M.
        Cervical proprioception is sufficient for head orientation after bilateral vestibular loss.
        Eur J Appl Physiol. 2009; 107: 73-81
        • Rix GD
        • Bagust J.
        Cervicocephalic kinesthetic sensibility in patients with chronic, nontraumatic cervical spine pain.
        Arch Phys Med Rehabil. 2001; 82: 911-919
        • Roren A
        • Mayoux-Benhamou M-A
        • Fayad F
        • Poiraudeau S
        • Lantz D
        • Revel M.
        Comparison of visual and ultrasound-based techniques to measure head repositioning in healthy and neck-pain subjects.
        Man Ther. 2009; 14: 270-277
        • Kristjansson E
        • Dall'Alba P
        • Jull G
        A study of five cervicopephalic relocation tests in three different subject groups.
        Clin Rehabil. 2003; 17: 768-774
        • Hoy DG
        • Protani M
        • De R
        • Buchbinder R.
        The epidemiology of neck pain.
        Best Pract Res Clin Rheumatol. 2010; 24: 783-792
        • Fejer R
        • Kyvik KO
        • Hartvigsen J.
        The prevalence of neck pain in the world population: A systematic critical review of the literature.
        Eur Spine J. 2006; 15: 834-848
        • Vos T
        • Allen C
        • Arora M
        • et al.
        Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015.
        Lancet. 2016; 388: 1545-1602
        • Alahmari K
        • Reddy RS
        • Silvian P
        • Ahmad I
        • Nagaraj V
        • Mahtab M.
        Intra- and inter-rater reliability of neutral head position and target head position tests in patients with and without neck pain.
        Brazilian J Phys Ther. 2017; 21: 259-267
        • Pinsault N
        • Fleury A
        • Virone G
        • Bouvier B
        • Vaillant J
        • Vuillerme N.
        Test-retest reliability of cervicocephalic relocation test to neutral head position.
        Physiother Theory Pract. 2008; 24: 380-391
        • Kristjansson E
        • Dall'alba P
        • Jull G
        Cervicocephalic kinaesthesia: reliability of a new test approach.
        Physiother Res Int. 2001; 6: 224-235
        • Tierney R
        • Sitler M
        • Swanik C
        • Swanik K
        • Higgins M
        • Torg J.
        Gender differences in head-neck segment dynamic stabilization during head acceleration.
        Med Sci Sport Exerc. 2005; 37: 272-279
        • Vafadar AK
        • Côté JN
        • Archambault PS.
        Sex differences in the shoulder joint position sense acuity: a cross-sectional study Rehabilitation, physical therapy and occupational health.
        BMC Musculoskelet Disord. 2015; 16: 273
        • Vernon H.
        The Neck Disability Index: state-of-the-art, 1991-2008.
        J Manipulative Physiol Ther. 2008; 31: 491-502
        • Aguiar AS
        • Carrer HCN
        • Lira MR
        • Silva GZM
        • Chaves TC.
        Patient-reported outcome measurements in temporomandibular disorders and headaches: summary of measurement properties and applicability.
        J Clin Med. 2021; 10: 3823
        • Yap AU
        • Zhang MJ
        • Lei J
        • Fu K.
        Accuracy of the Fonseca Anamnestic Index for identifying pain-related and /or intra-articular Temporomandibular Disorders.
        Cranio. 2021; 14: 1-8
      1. Silveira A, Therapist P, Services AH, et al. Masticatory and cervical muscle tenderness and pain sensitivity in a remote area in subjects with a temporomandibular disorder and neck disability. 2014;28(2):138-146.

        • Januario LB
        • Oliveira AB
        • Cid MM
        • Madeleine P
        • Samani A.
        The coordination of shoulder girdle muscles during repetitive arm movements at either slow or fast pace among women with or without neck-shoulder pain.
        Hum Mov Sci. 2017; 55: 287-295
        • Childs JD
        • Cleland JA
        • Elliott JM
        • et al.
        Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association.
        J Orthop Sports Phys Ther. 2008; 38: A1-A34
        • Munhoz WC
        • Marques AP
        • Siqueira JTT.
        Evaluation of body posture in individuals with internal temporomandibular joint derangement.
        Cranio. 2005; 23: 269-277
        • Guimarães M
        • Sacco I
        • João S.
        Postural characterization of young female Olympic gymnasts.
        Brazilian J Phys Ther. 2007; 11: 185-190
        • Walter SDSD
        • Eliasziw MM
        • Donner AA.
        Sample size and optimal designs for reliability studies.
        Stat Med. 1998; 17: 101-110
        • Koo TK
        • Li MY.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropr Med. 2016; 15: 155-163
        • Portney LG.
        Foundations of Clinical Research: Applications to Evidence-Based Practice.
        4th ed. F. A. Davis, Philadelphia, PA2020: 696
        • Beckerman H
        • Roebroeck ME
        • Lankhorst GJ
        • Becher JG
        • Bezemer PD
        • Verbeek ALM.
        Smallest real difference, a link between reproducibility and responsiveness.
        Qual Life Res. 2001; 10: 571-578
        • Hall T
        • Briffa K
        • Hopper D
        • Robinson K.
        Long-term stability and minimal detectable change of the cervical flexion-rotation test.
        J Orthop Sports Phys Ther. 2010; 40: 225-229
        • Hesby BB
        • Hartvigsen J
        • Rasmussen H
        • Kjaer P.
        Electronic measures of movement impairment, repositioning, and posture in people with and without neck pain: a systematic review.
        Syst Rev. 2019; 8: 220
        • Meisingset I
        • Woodhouse A
        • Stensdotter AK
        • et al.
        Evidence for a general stiffening motor control pattern in neck pain: a cross sectional study Pathophysiology of musculoskeletal disorders.
        BMC Musculoskelet Disord. 2015; 16: 56
        • Makino H
        • Hwang EJ
        • Hedrick NG
        • Komiyama T.
        Circuit mechanisms of sensorimotor learning.
        Neuron. 2016; 92: 705-721
        • Stanton TR
        • Leake HB
        • Chalmers KJ
        • Moseley GL.
        Evidence of impaired proprioception in chronic, idiopathic neck pain: systematic review and meta-analysis.
        Phys Ther. 2016; 96: 876-887
        • Chen H
        • Chen C
        • Hsueh I
        • Huang S
        • Hsieh C.
        Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke.
        Neurorehabil Neural Repair. 2009; 23: 435-440