Does the patient and clinician perception of restricted range of cervical movement agree with the objective quantification of movement in people with neck pain? And do clinicians agree in their interpretation?

Research output: Contribution to journalArticle


  • Marloes Thoomes-de Graaf
  • Erik Thoomes
  • César Fernández-de-Las-Peñas
  • Francois Maissan
  • Joshua A Cleland

Colleges, School and Institutes

External organisations

  • Fysio-Experts
  • Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, U.K.
  • School of Sport
  • Physical Therapy Department
  • HU University of Applied Sciences Utrecht
  • Tufts University School of Medicine


BACKGROUND: Measurement of cervical range of motion (ROM) is recommended when physically examining people with neck pain. However, little is known about the clinician's perception of "normal" versus restricted movement. Additionally, it is unknown if an objective measure of restricted movement correlates with the patient's perception of movement restriction.

METHODS: One hundred patients with neck pain were asked to rate their total amount of restriction, using a movement restriction scale. Two physical therapists (PTs) measured cervical ROM using a CROM device. Assessors independently rated whether the patient was restricted in their cervical ROM for each movement direction ("yes" or "no"). Cohen's kappa was used to assess reliability between both assessor's interpretation for all movement directions. Correlations between the perception of 'normal' versus 'restricted' movement according to both the assessor and patient was compared with an objective classification of movement restriction using normative data.

RESULTS: The agreement between PTs was high, ranging from substantial (K: 0.74) to almost perfect (K: 0.94). The correlation between the self-reported restriction scale and objective restriction was 0.44, indicating moderate correlation. The correlation between the PT's interpretation and objective restriction ranged from 0.55 to 0.66 depending on the direction of movement.

CONCLUSION: A large proportion (85%) of the patients with neck pain exhibited restricted cervical ROM, relative to normative data. The agreement between PTs was high in judging whether a patient had restricted cervical ROM. However, the judgement of both the patient and the PT was not always in accordance with the objective measure of movement.

Bibliographic note

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Original languageEnglish
Pages (from-to)102226
JournalMusculoskeletal Science and Practice
Publication statusE-pub ahead of print - 5 Aug 2020