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Chiropractic Research Review

Inclinometry of the Cervical Spine: Is It Valid?

An estimated 80% of the North American population will suffer at least one episode of back pain in their lifetime. Decisions regarding patient status and treatment are frequently based on joint motion measurements, underscoring the need for reliable and valid noninvasive outcome measures.

Previous research suggests a lack of validated tools available for measurement of cervical range of motion, a deficiency that led to this study of the Cervical Range of Motion (CROM) instrument. The CROM measures flexion, extension and lateral bending of the cervical spine using inclinometers, and has demonstrated very good inter- and intra-examiner reliability in previous studies. CROM measurements were taken in 31 asymptomatic subjects (no cervical problems in the previous three months) in three positions: neutral, fully flexed, and fully extended.

Validity of the CROM goniometer was evaluated using radiography as the comparison. Radiographs were taken for each of the three positions immediately after CROM assessment, and degrees of motion in flexion and extension were determined from line drawings made on plain films. Statistical analysis demonstrated that CROM measurements accounted for 94% of the variance on flexion films and 97% variance on extension films. Results also showed a high level of correlation between CROM and radiographic measurements.

The authors conclude that radiographic measurement of cervical spine ROM is a reliable technique, albeit an invasive one. However, they note that "...the excellent results of this study confirming the validity of the noninvasive CROM method of measuring the cervical spine range of motion point to an alternative for clinicians."

Tousignant M, de Bellefeuille L, ODonoughue S, et al. Criterion validity of the cervical range of motion (CROM) goniometer for cervical flexion and extension. Spine, Feb. 1, 2000:25(3), pp324-30.

Chiropractic Research Review

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