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De cervicale
         flexie-rotatie test bij
        cervicogene hoofdpijn
Een literatuuronderzoek naar de betrouwbaarheid en validiteit




                                                Rob Donkers - MSPT11
Cervicogene hoofdpijn




                        Rob Donkers - MSPT11
Cervicogene hoofdpijn
Hoofdpijn veroorzaakt door een dysfunctie van structuren
in de hoog cervicale regio.

Provocatie d.m.v. houding en/of beweging.


International Headache Society

Sjaastad




                                              Rob Donkers - MSPT11
Flexie-rotatie test C1-C2




                            Rob Donkers - MSPT11
Onderzoeken




              Rob Donkers - MSPT11
Flexie-rotatie test C1-C2
 Met en zonder
  kompasgoniometer

 Normale rotatie ROM: 44°    1-2



 Positief: verschil links-rechts
  rotatie ≥ 10° bij beperkte
  eindstand

 Afkappunt 32°-33°    1-2




                                    Rob Donkers - MSPT11
Betrouwbaarheid
 Interbeoordelaarsbetrouwbaarheid:
   kappa 0,67 – 0,85
   ICC 0,76 – 0,93



 Intrabeoordelaarsbetrouwbaarheid:
   ICC 0,84 – 0,89




                                      Rob Donkers - MSPT11
Validiteit
 Sensitiviteit:
   Ervaren therapeuten: 90 - 91,3 %
   Onervaren therapeuten: 83 %

 Specificiteit:
   Ervaren therapeuten: 85 - 91,4 %
   Onervaren therapeuten: 83 - 92 %

 Positief voorspellende waarde: 84 - 87,5%

 Negatief voorspellende waarde: 93,9 - 94,1%

 Accuraatheid: 89 - 91%
                                                Rob Donkers - MSPT11
Conclusie
         Eenvoudig hanteerbaar en toepasbaar
         Goede mate van betrouwbaarheid en
          validiteit bij CHP




         Gebruikte referentietest maakt
          uitkomsten mogelijk te optimistisch
         Diagnose ‘cervicogene hoofdpijn’ staat
          ter discussie




                                           Rob Donkers - MSPT11
Vragen?



          Rob Donkers - MSPT11

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Mspt11 presentatie frt bij chp-rob donkers

  • 1. De cervicale flexie-rotatie test bij cervicogene hoofdpijn Een literatuuronderzoek naar de betrouwbaarheid en validiteit Rob Donkers - MSPT11
  • 2. Cervicogene hoofdpijn Rob Donkers - MSPT11
  • 3. Cervicogene hoofdpijn Hoofdpijn veroorzaakt door een dysfunctie van structuren in de hoog cervicale regio. Provocatie d.m.v. houding en/of beweging. International Headache Society Sjaastad Rob Donkers - MSPT11
  • 4. Flexie-rotatie test C1-C2 Rob Donkers - MSPT11
  • 5. Onderzoeken Rob Donkers - MSPT11
  • 6. Flexie-rotatie test C1-C2  Met en zonder kompasgoniometer  Normale rotatie ROM: 44° 1-2  Positief: verschil links-rechts rotatie ≥ 10° bij beperkte eindstand  Afkappunt 32°-33° 1-2 Rob Donkers - MSPT11
  • 7. Betrouwbaarheid  Interbeoordelaarsbetrouwbaarheid:  kappa 0,67 – 0,85  ICC 0,76 – 0,93  Intrabeoordelaarsbetrouwbaarheid:  ICC 0,84 – 0,89 Rob Donkers - MSPT11
  • 8. Validiteit  Sensitiviteit:  Ervaren therapeuten: 90 - 91,3 %  Onervaren therapeuten: 83 %  Specificiteit:  Ervaren therapeuten: 85 - 91,4 %  Onervaren therapeuten: 83 - 92 %  Positief voorspellende waarde: 84 - 87,5%  Negatief voorspellende waarde: 93,9 - 94,1%  Accuraatheid: 89 - 91% Rob Donkers - MSPT11
  • 9. Conclusie  Eenvoudig hanteerbaar en toepasbaar  Goede mate van betrouwbaarheid en validiteit bij CHP  Gebruikte referentietest maakt uitkomsten mogelijk te optimistisch  Diagnose ‘cervicogene hoofdpijn’ staat ter discussie Rob Donkers - MSPT11
  • 10. Vragen? Rob Donkers - MSPT11

Notes de l'éditeur

  1. Hoewel CHP geen diagnose is die vermeld wordt in de NHG standaard Hoofdpijn, wordt er veel onderzoek gedaan naar dit klinische beeld.
  2. Meerdere definities in omloop. In het kort komt het hierop neer. Regelmatig wordt CHP gerelateerd aan rotatiebeperking C1-2!
  3. De FRT beoogt vast te stellen of er sprake is van een rotatiebeperking op C1-C2. De gestudeerde onderzoeken
  4. Referentietest: passieve segmentale mobiliteitstests en dorsoventrale palpatoire druk
  5. Voorwaarde: maximale flexie CWK!
  6. Inter: laagste kappa 0,67, laagste ICC 0,76, ervaren therapeuten scoren beter Intra: alleen onderzocht bij onervaren therapeuten, laagste ICC 0,84 P<0,001