Inter-examiner reliability of active combined movements assessment of subjects with a history of mechanical neck problems

Combined movement examination (CME) is used in clinical management of spinal dysfunction. Whilst reliability of lumbar spine CME has been investigated, reliability of cervical spine CME is unclear. The aim of this study was to assess the inter-rater reliability of a CME protocol in subjects who have previously experienced a neck problem. Subjects were evaluated to identify their "side of discomfort" , "dysfunctional active prime movement (PrM)" , "prime combination of movements (PrC)" and "stretch pattern" A secondary aim included the evaluation of a movement order effect. Inter-rater reliability of CME was evaluated in subjects (n = 25) with a history of mechanical neck problems. Through questioning and visual observation of the "functional demonstration" , raters (n = 3) had to classify subjects in anterior or posterior stretch patterns and determine movement combinations. Descriptive data for "PrC" showed moderate (67%) percentage agreement for anterior pattern and excellent (92%) for posterior pattern. AC1 values (95% Confidence Interval) were calculated for "Side" (AC1 = 0.96, CI: 0.89-1) and "Pattern" (AC1 = 0.96, CI: 0.89-1) demonstrating excellent inter-examiner reliability. "PrM" demonstrated total (100%) agreement. Establishing an order effect was unreliable (anterior pattern: 33%; posterior pattern: 38%). Results showed that a CME based protocol is a reliable assessment tool. Further research using larger samples and other clinical presentations is warranted.