Cervical Nonorganic Signs: A New Clinical Tool
to Assess Abnormal Illness Behavior in
Neck Pain Patients: A Pilot Study

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

FROM:   Arch Phys Med Rehabil 2000 (Feb); 81 (2): 170–175

Sobel JB, Sollenberger P, Robinson R, Polatin PB, Gatchel RJ

Productive Rehabilitation Institute of Dallas
for Ergonomics Research Foundation, TX, USA

---

OBJECTIVE:   To develop and assess the reliability of a group of cervical nonorganic physical signs to be used as a simple screening tool for identifying patients with low neck pain who exhibit abnormal illness behavior.

DESIGN:   Survey, consecutive sample.

DATA SET:   Double masked.

SETTING: Functional restoration program.

PATIENTS:   Twenty–six consecutive patients with complaints of chronic neck pain (greater than 4 months duration). Each patient was evaluated by a physician and then again by either a physical or occupational therapist, for the presence of specific cervical nonorganic signs. Both of the evaluations occurred on the same day.

MAIN OUTCOME MEASURES:   Five categories consisting of eight tests were appraised:

(1)   tenderness,
(2)   simulation,
(3)   range of motion,
(4)   regional disturbance, and
(5)   overreaction.

RESULTS:   The percent agreement between raters ranged from a high of 100% for regional sensory disturbance, to a low of 68% for one of the simulation tests. The average agreement between raters across all of the nonorganic test signs was 84.6%. Likewise, kappa coefficients ranged from 1.00 to .16, reflecting differences in strength of agreement.

CONCLUSION:   For many years, the lumbar nonorganic signs (developed by Waddell and colleagues) have been a useful screening tool in the assessment of abnormal illness behavior in the low back pain population. For the first time, a group of cervical nonorganic signs have been developed, standardized, and proven reliable.

Return to WHIPLASH

Since 4-01-2000