Background
Design and methods
Deviations from the study protocol
Eligibility criteria
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Sample: people with and without neck pain aged ≥ 18 years. Those with neck pain included regardless of the stage of their neck pain (e.g., acute, or chronic) or aetiology (e.g., non-specific or attributed to pathology).
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Phenomena of interest: cervical proprioception.
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Design: any study which investigated at least one of the domains (reliability, validity, responsiveness, and their sub-domains) of the COSMIN checklist and reported absolute error (AE) or constant error (CE) in degrees.
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Evaluation: any study that evaluated measurement properties of the measure of cervical JPE.
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Research type: quantitative research.
Exclusion criteria
Information sources
Search strategy
Search terms | Neck pain OR neck dysfunction OR cervical pain OR cervical dysfunction AND Propriocept* OR movement sense OR kinesthes* OR repositioning OR repositioning error OR position sense OR motion perception OR active position sense OR passive position sense AND Reliability OR validity OR responsiveness OR reproducibility of results OR reproducib* OR reliab* OR valid* OR stability OR interrater OR interrater OR intrarater OR intrarater OR intra-rater OR intratester OR intra-tester OR interobserver OR inter-observer OR intraobserver OR intra-observer OR intertechnician OR inter-technician OR intratechnician OR intra-technician OR interexaminer OR inter-examiner OR intraexaminer OR intra-examiner OR intraclass correlation OR standard error of measurement OR sensitiv* OR responsive* OR minimal detectable concentration OR interpretab* OR small detectable change OR ceiling effect OR floor effect |
Data management
Study selection
Data extraction and data items
Risk of bias assessment
Data synthesis
Measurement property | Rating | Criteria |
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Reliability | Sufficient ( +) | ICC or weighted Kappa ≥ 0.7 |
Indeterminate (?) | ICC or weighted Kappa not reported | |
Insufficient (-) | ICC or weighted Kappa < 0.70 | |
Measurement error | Sufficient ( +) | SDC or LoA < MIC |
Indeterminate (?) | MIC not defined | |
Insufficient (-) | SDC or LoA > MIC | |
Hypothesis testing for construct validity | Sufficient ( +) | The result is in accordance with the hypothesis |
Indeterminate (?) | No hypothesis defined (by the review team) | |
Insufficient (-) | The result is not in accordance with the hypothesis | |
Criterion validity | Sufficient ( +) | Correlation with gold standard ≥ 0.70 OR AUC ≥ 0.70 |
Indeterminate (?) | Not all information for ‘ + ’ reported | |
Insufficient (-) | Correlation with gold standard < 0.70 OR AUC < 0.70 | |
Responsiveness | Sufficient ( +) | The result is in accordance with the hypothesis OR AUC ≥ 0.70 |
Indeterminate (?) | No hypothesis defined (by the review team) | |
Insufficient (-) | The result is not in accordance with the hypothesis7 OR AUC < 0.70 |
Quality of evidence | Lower if there is |
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High Moderate Low Very low | Risk of bias -1 Serious -2 Very serious -3 Extremely serious Inconsistency -1 Serious -2 Very serious Imprecision -1 Sample size (n = 50–100) -2 Sample size (n < 50) Indirectness -1 Serious -2 Very serious |
Results
Authors | Population and sample size | Age (mean or range) | Testing instrument | Testing position | Testing procedure | Property domain | Statistical test used | Results |
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Artz et al. [21] | Asymptomatic subjects: n = 40, (within day n = 21, between day n = 19) | 29.9 years | 3-Space Fastrak | Sitting Standing | Trials: 3 trials Movements tested: THP: 25%, 50%, 75% in flexion (randomised) | Reliability within-day and between-day intra-rater (at least 1 week apart) | ICC, SEM | JPE: Sitting: Within-day (ICC range: -0.81–0.66) Between-day (ICC range: -0.48–0.77) SEM range(sitting): Within-day (0.71–1.48) Between-day (0.72–0.99) Standing: Within-day (ICC range: -0.11–0.68) Between-day (ICC range: 0.09–0.58) SEM range (standing): Within-day (0.91–1.48) Between-day (0.82–1.22) |
Kristjansson et al. [22] | Asymptomatic Subjects: n = 19 (12 females) | 31.5 years | 3-Space Fastrak | Siting | Trials: 3 trials each direction or test Movements tested: JPE: Right rotation, left rotation | Reliability (Intra-rater between-day in the same week) | ICC (2,1) | Reliability: JPE: NHP (ICC range: 0.35–0.44) THP (ICC range: 0.69–0.74) Preset trunk rotation (ICC range: 0.52–0.74) Figure of 8 relocation test (ICC: 0.67) |
Lee et al. [23] | Asymptomatic Subjects: n = 20 (11 men) | 21.9 years | Motion analysis system, CMS 70P | Sitting | Trials: 3 trials each direction Movements tested: Flexion/extension, left/right rotation, left/right side-bending (not randomised) | Reliability (Intra-rater within day 10 min in between) | ICC (3, 1) SEM | ICC range: NHP (0.38–0.84) THP (-0.48–0.83) SEM: 0.3–4 |
Strimpakos et al. [24] | Asymptomatic Subjects: n = 35 (17 males) | 18–63 years | Zebris CMS20 | Intra-rater: sitting, standing) Inter-rater (standing) | Trials: 3 trials Movements tested: Flexion, right and left rotation, right and left side bending (not randomised) | Reliability (Intra-rater between day 3 occasion 1 week apart) and Inter-rater reliability, 15 min between assessors (10 subjects only) | ICC (1,1), SEM, Bland and Altman | Intra-rater Sitting: (ICC range: -0.01–0.35) Standing: (ICC range: 0.17–0.5) SEM: Standing (1.5–3) Sitting (1.5–3.5) Inter-rater ICC range: -0.2–0.64 SEM: 0.7–2.9 |
Pinsault et al. [25] | Asymptomatic subjects: n = 44 (22 women) | 21.7 years | Laser pointer | Sitting | Trials: 10 trials Movements tested: Right and left rotation | Reliability (intra-rater 1 h apart) | ICC (2, 1), SEM, LoA | ICC range: (0.52–0.81) SEM (0.9) LoA (-2–2.2) |
Kramer et al. [26] | Asymptomatic subjects: n = 57 (30 male, 27 females) | 18–64 years | Virtual 3D scene via head mounted display + 3-Space Fastrak | Sitting | Trials: 8 trials in total Movements tested: Flexion, Extension, right and left rotation | Reliability (intrasession and intersession) | ICC (3, 1) | Intrasession ICC: 0.63 Intersession: ICC: 0.48 |
Roren et al. [27] | Asymptomatic and CNP subjects: n = 82 (41 each group) | Healthy: 30.5 CNP: 54.7 years | Revel visual technique US technique | Sitting | Trials: 10 trials each device (5 trials each movement) Movements tested: Right and left rotation | Reliability: Intra-rater within day 1 h apart for both devices Criterion validity (Revel visual technique vs US technique) Discriminative validity (healthy vs NP group) | Reliability: ICC, Bland and Altman agreement. Criterion validity: Pearson’s correlation. Discriminative validity: Kappa agreement | ICC: Revel visual system (0.68) US technique (0.62) Bland and Altman agreement: Revel technique (-3.6–4.2) US technique (-3.8–5.6) Pearson’s correlation range: 0.946–0.952 Kappa agreement: 0.65 |
Chen and Treleavan [28] | CNP subjects: n = 25 Asymptomatic subjects: n = 26 | 18–60 years | Fastrak, Laser pointer | Sitting | Trials: 6 trials each movement Movements tested: Right and left rotation | Criterion validity Discriminative validity Convergent validity | Pearson's correlation (criterion validity) Spearman's correlation (convergent validity) MANOVA (discriminative validity) | Discriminative validity: Conventional Fastrak (p = 0.28) Conventional Laser (p = 0.04) Torsion Fastrak (p = 0.00) Torsion Laser (p = 0.02) Enbloc Fastrak (head) (p = 0.43) Enbloc Fastrak (trunk) (p = 0.42) Criterion validity: Conventional JPE (r = 0.87) Torsion JPE (r = 0.67) Convergent validity: No correlation except Conventional Fastrak (r = 0.51) |
Wibault et al. [5] | CDD subjects: n = 24 Asymptomatic subjects: n = 12 | CDD: 51 years Healthy: 42 years | Reliability: CROM device Validity: CROM device vs laser pointer | Sitting | Trials: Reliability: 3 trials each direction Validity: 8 trials each direction Movements tested: Reliability and validity: right and left rotation | Reliability: 24 subjects with CDD (Intra-rater within day 1 h in between) Criterion validity: 12 healthy subjects | ICC (2,1) SEM | Reliability: ICC range: 0.79–0.85 SEM range: 1.4–2 Validity: ICC range: 0.43–0.91 |
Dugailly et al. [29] | Asymptomatic and CNP subjects Validity group (n = 17) Reliability group (n = 5) | 42 years | Laser + electrogoniometer | Sitting | Trials: 6 trials in each direction Movements tested: Right and left rotation, flexion, extension (no evidence of randomisation) | Criterion validity Intra-rater reliability (1 week apart) Convergent validity | Spearman's correlation ICC Bland Altman (LoA) | ICC range: 90 cm low speed: 0.22–0.47 90 cm high speed: 0.58–0.79 180 cm low speed: 0.52–0.75 180 cm high speed: 0.8–0.86 Convergent validity: JPE vs disability (r = 0.32) JPE vs pain intensity (r = 0.03), JPE vs pain duration (r = 0.14) LoA range: -9 to 9 |
Burke et al. [30] | Asymptomatic and NP subjects: n = 50 | NA | CROM, AL | Sitting | Trials: 3 trials in each direction for two devices (no randomisation) Movements tested: Right and left rotation | Reliability (intra and inter-rater reliability) | ICC (type C) | ICC range: Intra-rater CROM: 0.253–0.386 Intra-rater AL: 0.488–0.556 Inter-rater CROM: 0.717–0.773 Inter-rater AL: 0.589–0.75 |
Alahmari et al. [3] | NP and Asymptomatic subjects: NP: n = 36 Asymptomatic: n = 33 | Healthy: 56 year NP: 36 years | Digital inclinometer | NHP (sittin) THP (sitting and supine) | Trials: 3 trials in all tests and directions Movements tested: NHP (extension) THP (50% of ROM in flexion, extension, right and left side bending, right and left rotation in a randomised order) | Intra-rater reliability, Inter-rater reliability (≤ 3 working days apart) | ICC (2.1.A) SEM | Intra-rater reliability: NHP (ICC range: 0.74–0.78) (SEM: 1.78–1.88) THP: (ICC range: 0.7–0.83) (SEM: 1.78–1.88) Inter-rater reliability: NHP (ICC range: 0.74–0.79) (SEM 1.79–1.87) THP (ICC range: 0.62–0.84) (SEM: 1.5–2.23) |
Goncalves and Silva [31] | Asymptomatic vs CNP subjects: n = 66 (33 each group) | Healthy: 43.6 years NP 43.5 years | Laser pointer on a helmet | Sitting | Trials: 6 trials each direction Movements tested: Right and left rotation | Reliability (Intra-rater within day and between day with 1–2 days in between) Construct validity | Reliability: ICC (2,1) SEM Validity: t-tests or Mann Whitney, Pearson correlation coefficient, Spearman's correlation coefficient | Chronic Neck pain: Within day ICC range: HRNT: 0.9–0.93 TT: 0.88–0.9 HR30T: 0.73–0.79 F8T: 0.89–0.93 Between day ICC range: HRNT: 0.61–0.85 TT: 0.58–0.71 HR30T: 0.67–0.7 F8T: 0.66–0.85 Asymptomatic: Within day ICC range: HRNT: 0.79–0.89 TT: 0.75–0.87 HR30T: 0.78–0.83 F8T: 0.83–0.93 Between day ICC range: HRNT: 0.75–0.8 TT: 0.57–0.59 HR30T: 0.55–0.76 F8T: 0.8–0.83 All tests between groups (NP vs healthy) were < 0.05 but the HR30T Between test correlations ranged between 0.35 and 0.61 and correlations between proprioceptive tests and catastrophizing, fear of movement and disability were, in general, lower than 0.3 |
Nikkhoo et al. [32] | Asymptomatic (35 participants) | 21.2 | US MOCAP (CMS 10, Zebris) + IMU-based mobile devices | Sitting | Trials: 5 trials Movements tested: Flexion, extension, right and left rotation | Within-day and between-day intra-rater reliability (5–7 days in between) Measurement error Criterion validity | Reliability: ICC two-way mixed model, Measurement error: SEM Validity: Pearson’s correlation | Reliability: Within-day (US MOCAP): ICC range 0.83–0.93 Between-day (US MOCAP): ICC range 0.69–0.85 Within-day (IMU): ICC range 0.66–0.91 Between-day (IMU): ICC range 0.63–0.76 Validity: r range: 0.74–0.83 |
Cid Et al. [33] | Asymptomatic (14 men, 14 women) NP (13 women) | 24.4, 23.1, 26.6 | Laser pointer | Sitting | Trials: 10 trials Movements tested: Right and left rotation | Within-day intra-rater reliability (at least 7 days in between) | Reliability: ICC (two-way mixed model) | Reliability (NHP): NP: ICC range 0.77–0.86 Asymptomatic: ICC range -0.16–0.5 |
Absolute joint position error for people with neck pain
Intra-rater reliability
Neutral head position (Neck Pain population) | Summary or pooled results | Overall rating | Quality of evidence |
Intra-rater reliability | ICC: 0.58–0.93 Total sample size: 580 | Sufficient | Very low evidence for sufficient intra-rater reliability • Nine studies showed sufficient results, 4 showed insufficient results (Inconsistent results) • Multiple studies with doubtful/inadequate rating (risk of bias) • No imprecision • No indirectness |
Inter-rater reliability | ICC: 0.58–0.79 Total sample size: 169 | Sufficient | Low evidence for sufficient inter-rater reliability • Three studies showed sufficient results • Multiple studies with inadequate rating • No inconsistency • No imprecision • No indirectness |
Measurement error | Total sample size: 736 | Indeterminate | Not possible to apply GRADE as the minimal important change was not provided |
Convergent validity | Correlation (r < 0.5) Total sample size: 1890 | Insufficient | Low evidence for insufficient convergent validity • Thirteen studies showed sufficient results, 17 studies showed insufficient results (Inconsistent results) • Multiple studies with adequate rating (no risk of bias) • No indirectness • No imprecision |
Discriminative validity | Total sample size: 496 | Indeterminate | Very Low evidence for indeterminate discriminative validity • Seven studies were indeterminate and 1 study was sufficient (inconsistent results) • Multiple studies with inadequate rating • No imprecision • No indirectness |
Criterion validity | r = 0.87–0.95 Total sample size: 184 | Sufficient | Low evidence for sufficient criterion validity • Two studies were sufficient, 1 was insufficient (inconsistent results) • Multiple studies with adequate rating (no risk of bias) • No imprecision • No indirectness |
Target head position (Neck Pain population) | Summary of pooled results | Overall rating | Quality of evidence |
Intra-rater reliability | ICC: 0.67–0.83 Total sample size: 135 | Sufficient | Low evidence for sufficient intra-rater reliability • Three studies showed sufficient results • Multiple studies with doubtful/inadequate rating • No imprecision • No indirectness |
Inter-rater reliability | ICC: 0.58–0.84 Total sample size: 69 | Sufficient | Very low evidence of sufficient inter-rater reliability • One study showed sufficient results • One study with inadequate rating (risk of bias) • Imprecision • No indirectness |
Measurement error | Total sample size: 204 | Indeterminate | Not possible to apply GRADE as the minimal important change was not provided |
Neutral head position (asymptomatic population) | Summary or pooled results | Overall rating | Quality of evidence |
Intra-rater reliability | ICC: 0.52–0.93 Total sample size: 537 | Sufficient | Very low evidence of sufficient intra-rater reliability • Eleven studies showed sufficient results, 6 showed insufficient results (inconsistent results) • Multiple studies with doubtful/inadequate rating (risk of bias) • No imprecision • No indirectness |
Inter-rater reliability | ICC: -0.2–0.64 Total sample size: 35 | Insufficient | Very low evidence of insufficient inter-rater reliability • One study showed insufficient results • One study with inadequate rating (risk of bias) • Imprecision (sample size < 100) • No inconsistency • No indirectness |
Measurement error | Total sample size: 509 | Indeterminate | Not possible to apply GRADE as the minimal important change was not provided |
Intra-session reliability | ICC: 0.63 Total sample size: 57 | Insufficient | Very low evidence of insufficient intra-session reliability • One study with doubtful rating (risk of bias) • Imprecision • No inconsistency • No indirectness |
Inter-session reliability | ICC: 0.48 Total sample size: 57 | Insufficient | Very low evidence of insufficient intra-session reliability • One study with doubtful rating (risk of bias) • Imprecision • No inconsistency • No indirectness |
Criterion validity | Total sample size: 71 | Inconsistent | Not possible to apply GRADE due to inconsistency of results • One study showed indeterminate results and one showed sufficient results |
Target head position (asymptomatic population) | Summary of pooled results | Overall rating | Quality of evidence |
Intra-rater reliability | ICC: -0.48–0.83 Total sample size: 165 | Sufficient | Very low evidence of sufficient intra-rater reliability • Four studies showed sufficient results, three showed insufficient results (inconsistency of results) • Multiple studies with doubtful/inadequate rating (risk of bias) • No indirectness • No imprecision |
Measurement error | Total sample size: 165 | Indeterminate | Not possible to apply GRADE as the minimal important change was not provided |
Inter-rater reliability
Measurement error
Convergent validity
Discriminative validity
Criterion validity
Absolute joint position error for asymptomatic people
Intra-rater reliability
Inter-rater reliability
Intra-session reliability
Inter-session reliability
Measurement error
Criterion validity
Constant joint position error for asymptomatic people
Intra-rater reliability
Neutral head position (asymptomatic population) | Summary or pooled results | Overall rating | Quality of evidence |
Intra-rater reliability | ICC: 0.38–0.86 Total sample size: 40 | Sufficient | Very low evidence of sufficient intra-rater reliability • Four studies showed sufficient results and 1 showed insufficient results (inconsistency) • Multiple studies with inadequate rating (risk of bias) • Imprecision (sample size < 100) • No indirectness |
Measurement error | Total sample size: 40 | Indeterminate | Not possible to apply GRADE as the minimal important change was not provided |
Convergent validity | r = 0.03–0.32 Total sample size: 213 | Insufficient | High evidence for insufficient convergent validity • Multiple studies with adequate rating (no risk of bias) • No inconsistency of results • No imprecision • No indirectness |
Criterion validity | Total sample size: 17 | Indeterminate | Very Low evidence for indeterminate criterion validity • One study with doubtful rating (risk of bias) • Imprecision (sample size < 50) • No indirectness |
Target head position (asymptomatic population) | Summary of pooled results | Overall rating | Quality of evidence |
Intra-rater reliability | ICC: -0.47–0.83 Total sample size: 20 | Sufficient | Very low quality of evidence for sufficient intra-rater reliability • One study showed sufficient results • One study with inadequate rating (risk of bias) • Imprecision • No inconsistency • No indirectness |
Measurement error | Total sample size: 20 | Indeterminate | Not possible to apply GRADE as the minimal important change was not provided |