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Reproducibility of cervical range of motion in patients with neck pain

Jan Lucas Hoving12, Jan JM Pool1*, Henk van Mameren3, Walter JLM Devillé4, Willem JJ Assendelft5, Henrica CW de Vet1, Andrea F de Winter6, Bart W Koes7 and Lex M Bouter1

Author Affiliations

1 Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, the Netherlands

2 Department of Clinical Epidemiology, Cabrini Hospital and Monash University Department of Epidemiology and Preventive Medicine, Melbourne, Australia

3 Department of Anatomy and Embryology, Faculty of Medicine, Maastricht University, the Netherlands

4 NIVEL Foundation, Utrecht, The Netherlands

5 Department of General Practice and Nursing Home Medicine, LUMC Medical Centre, Leiden, the Netherlands

6 Department of Social Psychiatry, University of Groningen, the Netherlands

7 Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands

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BMC Musculoskeletal Disorders 2005, 6:59  doi:10.1186/1471-2474-6-59

Published: 13 December 2005



Reproducibility measurements of the range of motion are an important prerequisite for the interpretation of study results. The aim of the study is to assess the intra-rater and inter-rater reproducibility of the measurement of active Range of Motion (ROM) in patients with neck pain using the Cybex Electronic Digital Inclinometer-320 (EDI-320).


In an outpatient clinic in a primary care setting 32 patients with at least 2 weeks of pain and/or stiffness in the neck were randomly assessed, in a test- retest design with blinded raters using a standardized measurement protocol. Cervical flexion-extension, lateral flexion and rotation were assessed.


Reliability expressed by the Intraclass Correlation Coefficient (ICC) was 0.93 (lateral flexion) or higher for intra-rater reliability and 0.89 (lateral flexion) or higher for inter-rater reliability. The 95% limits of agreement for intra-rater agreement, expressing the range of the differences between two ratings were -2.5 ± 11.1° for flexion-extension, -0.1 ± 10.4° for lateral flexion and -5.9 ± 13.5° for rotation. For inter-rater agreement the limits of agreement were 3.3 ± 17.0° for flexion-extension, 0.5 ± 17.0° for lateral flexion and -1.3 ± 24.6° for rotation.


In general, the intra-rater reproducibility and the inter-rater reproducibility were good. We recommend to compare the reproducibility and clinical applicability of the EDI-320 inclinometer with other cervical ROM measures in symptomatic patients.