Patient's Subjective Impression of Cervical Range of Motion

A Mixed-Methods Approach

Anke Langenfeld, MSc; Carolien Bastiaenen, PhD; Judith Sieben, PhD; B. Kim Humphreys, DC, PhD; Jaap Swanenburg, PhD


Spine. 2018;43(18):E1082-E1088. 

In This Article

Abstract and Introduction


Study Design: Mixed-method.

Objective: To evaluate the association between objective and subjective cervical range of motion (ROM) among patients with neck pain, and to assess the awareness of impairments.

Summary of Background Data: Cervical ROM is frequently used to evaluate neck pain, but it is also important to know what a patient expects from treatment, because this can profoundly affect treatment outcomes and patient satisfaction.

Methods: We used a cervical ROM instrument, the Neck Disability Index (NDI), and a self-administered ROM questionnaire for the neck (S-ROM-Neck). Ten patients took part in semi-structured interviews. Correlations were analyzed using Spearman rank order correlations (rs). Differences between patient and assessor were evaluated by the Mann-Whitney U test. Qualitative data were analyzed by content analysis.

Results: Thirty participants (mean age 43.80 years; 21 females) were included. The correlation (rs) for the S-ROM-Neck between patient and assessor was 0.679 [95% confidence interval (95% CI) 0.404–0.884; P = 0.000]. The correlation between the NDI and S-ROM-Neck was 0.178 (95% CI −0.233 to −0.533; P = 346) for the assessor and −0.116 (95% CI −0.475 to −0.219, P = 0.541) for the patient (U = 448, z = −0.030, P = 0.976). Qualitative analysis revealed that patients had general restrictions in daily life and with specific movements, but that they adjusted their behavior to avoid impairment.

Conclusion: There was a significant correlation between patient and therapist ratings of cervical spine mobility. Although patients experience restriction while moving and are impaired in specific activities, they adjust their lifestyle to accommodate their limitations.


Range of motion (ROM) is used to assess joint movement for treatment, symptom monitoring, and treatment evaluation.[1,2] Cervical ROM (CROM) is specifically assessed for neck problems,[3–7] and includes flexion, extension, lateral flexion (left/right), and rotation (left/right).[7] Although measurements can be taken by various methods (e.g., tape measure or inclinometer),[8–15] it is equally important to know a patient's expectations of treatment,[16,17] because these can affect outcomes and satisfaction.[16] Expectations are unique to an individual, and may be influenced by a multitude of factors.[16,18] To date, there has only been limited research on the patient's perspective, including why they consult doctors and what they think about the different therapies for neck pain.[17] This must be rectified if we are to direct therapy to meet patient needs and expectations, and, ultimately, improve outcomes.[19,20] Therefore, we studied the association between objective CROM restriction and the subjective perspectives of patients and therapists. We also evaluated patient awareness of impaired neck movement and how it limited their activities of daily living (ADLs). We hypothesized that differences would exist in the subjective and objective measures of CROM, and that restricted CROM would not be important to patients until it interfered with their ADLs.