A perspective on the use of the cervical flexion rotation test in the physical therapy management of cervicogenic headaches

Archives of Physiotherapy

Viewpoint

Jean-Philippe Paquin¹  Thomas Gérard²  Jean-Pierre Dumas³  Yannick Tousignant-Laflamme⁴ 

[1] Laboratoire de Recherche Biomécanique et Neurophysiologique en Réadaptation Neuro- musculosquelettique(BioNR), Université du Québec à Chicoutimi (UQAC), G7H 2B1, Saguenay, Qc, Canada;Department of health sciences, Université du Québec à Chicoutimi (UQAC), G7H 2B1, Saguenay, Qc, Canada;Research Center of the CHUS (CRCHUS), Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Qc, Canada;Cabinet de kinésithérapie, 7 rue Antigna, 45000, Orléans, Loiret, France;School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, J1H 5N4, Sherbrooke, QC, Canada;School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, J1H 5N4, Sherbrooke, QC, Canada;Research Center of the CHUS (CRCHUS), Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Qc, Canada;

关键词: Cervicogenic headache;    Physiotherapy;    Cervical flexion-rotation test;    Diagnostic;    Validity;   

DOI  :  10.1186/s40945-022-00153-2

 received in 2022-02-15, accepted in 2022-10-03,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe Cervical Flexion-Rotation Test (CFRT) is widely used in the assessment of upper cervical spine mobility impairments and in the diagnosis of cervicogenic headache (CGH) by physiotherapist. Many studies investigated its different properties, and the results show that the CFRT has good construct validity in the measurement of C1-C2 rotation as well as good to excellent reliability.PurposeIn this theoretical paper, we explore the value and point out two methodological issues associated to the CFRT, one related to the procedures and another related to its diagnostic accuracy.ResultsOur analysis indicate that there are many confounding factors that could affect the CFRT cut-off’s accuracy, which are likely to overestimate the diagnosis properties of CFRT. Potential solutions are discussed. Moreover, the gold standard (manual examination) used to examine the validity of the CFRT for the diagnosis of CGH appears to be far from perfect - we could argue that the diagnostic properties of the CFRT for CGH might be biased and the likelihood ratios are likely to be overestimated. However, it could be relevant to explore if results of the CFRT could be considered as a treatment-effect modifier. Maybe the CFRT could be more valuable as a prognostic factor?ConclusionThe quality of evidence supporting the validity of the CFRT is most likely biased. In the absence of a better gold standard, maybe the CFRT could be a more valuable test to establish the patient’s prognosis and help the clinician to choose the most appropriate treatment options.

【 授权许可】

CC BY   
© The Author(s) 2022