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

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

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.

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