头颈复位试验评估颈部位置觉的信度与效度研究

The reliability and validity of using a head-neck relocation test to assess cervical position sense

目的探讨头颈复位试验(HRT)评估颈痛及健康受试者颈部位置觉的信度与效度。方法招募符合条件的受试者62例,其中颈痛患者32例,健康受试者30例。首次评估时,受试者分别参与了2位评估者独立进行的HRT,并于24 h后参与其中1位固定评估者进行的HRT。分别对3次试验中受试者的颈椎前屈、后伸、左旋和右旋四个方向的关节位置误差(JPE)进行测量并纳入统计分析。采用组内相关系数(ICC)计算其评估者内/间信度。对2组受试者的JPE进行组间对比,对差异有统计学意义的指标进行效度分析。结果HRT评估颈椎前屈、后伸、左旋和右旋位置觉的评估者内/间ICC分别分布于0.603~0.830和0.597~0.837,对应的测量误差(SEM)范围分别为1.516~2.154 cm和1.691~2.089 cm,最小可检测变化(MDC)分别为4.203~5.972 cm和4.687~5.789 cm。颈痛患者颈椎后伸JPE及右旋JPE与健康受试者比较,差异有统计学意义(JPE后伸P<0.01;JPE右旋P<0.05);颈椎后伸JPE受试者工作曲线(ROC)下面积(AUC)为0.755(P<0.05)。结论HRT评估颈部位置觉具有较好的评估者内及评估者间信度;试验中,颈椎后伸JPE能在一定的程度上帮助区分慢性颈痛及健康人群。

Objective To observe the reliability and validity of using a head-neck relocation test(HRT)in assessing cervical position sense.Methods A total of 62 subjects were recruited,including 32 with neck pain and 30 healthy subjects.All received two HRTs conducted by two independent assessors at a first session,and then they received another HRT 24 hours later administered by one of them.The joint position error(JPE)was measured in the four directions of cervical motion:flexion,extension,levorotation and dextrorotation.The intra-and inter-rater reliability was quantified in terms of intra-class correlation coefficients(ICCs)and the difference in JPE between the two groups was also determined for validity.Results The intra-and inter-rater reliability for the HRT in the four directions had ICC values of 0.603-0.830 and 0.597-0.837 respectively.The corresponding standard error of measurement(SEM)values were 1.52-2.15cm and 1.69-2.09cm,while the minimal detectable change(MDC)values were 4.20-5.97cm and 4.69-5.79cm,respectively.The patients with neck pain had significantly larger JPE in cervical extension and right rotation compared to healthy individuals,on average.And their JPE for cervical extension had an area under the curve(AUC)of the receiver′s operating curve of 0.755.Conclusions The HRT showed good intra-and inter-rater reliability in assessing cervical joint position sense.The JPE for cervical extension can be used to discriminate those with neck pain from healthy subjects.