The cranio-cervical flexion test using pressure biofeedback : a useful measure of cervical dysfunction in the clinical setting?

Aims.The cranio-cervical flexion test (CCFT) was developed to indirectly measure the strength of the deep cervical flexor muscles. This pragmatic study was designed to analyse the reliability and discriminative validity of the test as used by osteopaths in the clinical setting.Methods. Forty subjects were categorised into groups according to two different sets of criteria. Firstly they were divided into three groups who had either current neck pain, a history of neck pain but no current pain, or no history of neck pain. Secondly they were divided into three groups according to their level of neck disability, which was either no disability, mild disability, or moderate disability. The intra-rater and inter-rater reliability of the CCFT was calculated. Four practitioners performed the CCFT on each of the 40 subjects and CCFT scores were analysed in terms of pain intensity, pain history and neck disability. Results. Intra-rater reliability (ICC) was 0.78 (95% CI 0.47, 0.92) for performance index (PI), and 0.78 (95% CI 0.47, 0.92) for activation score (AS). Inter-rater reliability (ICC) was 0.54 (95% CI 0.36, 0.70) for PI, and 0.57 (95% CI 0.37, 0.72) for AS. A significant correlation was found between the intensity of current pain and PI (r = −0.37, P = 0.02), but not for AS (r = −0.29, P = 0.16). No statistically significant difference in the CCFT score was found between groups for either pain history or neck disability. This result is in contrast to previous studies. Conclusion. The practitioners in this study demonstrated ‘good’ inter-rater reliability and ‘excellent’ intra-rater reliability when using the CCFT. However, the discriminative validity of the CCFT was not demonstrated in this study as the CCFT failed to discriminate between those with current neck pain, those with a history of neck pain but no current pain, and those without neck pain