Reliability and Validity of Clinical Tests for Measuring Strength or Endurance of Cervical Muscles: A Systematic Review and Meta-analysis

Published:December 28, 2020DOI:



      To evaluate the reliability and validity of clinical tests for measuring cervical muscle strength or endurance in participants with and without neck pain.

      Data Source

      Systematic review and meta-analysis on reliability and validity. Literature search was conducted on January 28, 2020, using 5 databases: MEDLINE, Cumulative Index to Nursing and Allied Health, EMBASE, SPORTDiscus, and Scopus.

      Study Selection

      We included studies that investigated the reliability or validity of clinical tests for measuring cervical muscle strength or endurance in participants with nonspecific chronic neck pain, with or without irradiation, or healthy participants. We included only those that were viable for daily practice and of low cost.

      Data Extraction

      Data were extracted as follows: (1) author and year of publication, (2) demographic values and health condition, (3) reported clinical tests, (4) inclusion and exclusion criteria, (5) description of test, (6) interrater reliability, and (7) intrarater reliability. For validity studies we also extracted the (8) reference method and (9) validity estimates.

      Data Synthesis

      Methodological quality was assessed with the Quality Appraisal of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement Studies. Data on reliability and validity were extracted from included articles and then analyzed.


      Thirty-one studies were included. Cervical flexor and extensor endurance test, craniocervical flexion test (CCFT), AND cervical muscle strength using a handheld dynamometer (HHD) showed moderate to good intra- and interrater reliability (intraclass correlation coefficients ranging from 0.64-0.90). Concurrent validity was measured by only 2 studies, which do not provide adequate evidence for a recommendation.


      The cervical flexor and extensor endurance tests, CCFT, and HHD for measuring cervical strength presented an acceptable interrater and intrarater reliability.


      List of abbreviations:

      CCFT (craniocervical flexion test), GRRAS (Guidelines for Reporting Reliability and Agreement Studies), HHD (handheld dynamometer), ICC (intraclass correlation coefficient), QAREL (Quality Appraisal of Diagnostic Reliability)


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