International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study

K Luedtke; W Boissonnault; N Caspersen; R Castien; A Chaibi; D Falla; C Fernández-de-Las-Peñas; T Hall; J R Hirsvang; T Horre; D Hurley; G Jull; L S Krøll; B K Madsen; J Mallwitz; C Miller; B Schäfer; T Schöttker-Königer; W Starke; H von Piekartz; D Watson; P Westerhuis; A May

doi:10.1016/j.math.2016.02.010

International consensus on the most useful physical examination tests used by physiotherapists for patients with headache: A Delphi study

Man Ther. 2016 Jun:23:17-24. doi: 10.1016/j.math.2016.02.010. Epub 2016 Feb 27.

Authors

K Luedtke¹, W Boissonnault², N Caspersen³, R Castien⁴, A Chaibi⁵, D Falla⁶, C Fernández-de-Las-Peñas⁷, T Hall⁸, J R Hirsvang³, T Horre⁹, D Hurley¹⁰, G Jull¹¹, L S Krøll³, B K Madsen³, J Mallwitz¹², C Miller¹³, B Schäfer¹⁴, T Schöttker-Königer¹⁵, W Starke¹⁵, H von Piekartz¹⁶, D Watson¹⁷, P Westerhuis¹⁸, A May¹⁹

Affiliations

¹ Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: [email protected].
² University of Wisconsin-Madison, Department of Orthopedics and Rehabilitation, Wisconsin, USA.
³ Danish Headache Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, DK-2600 Glostrup, Denmark.
⁴ Department of General Practice and Elderly Care Medicine, EMGO+Institute for Health Care Research, VU University Medical Center, Amsterdam, The Netherlands.
⁵ Head and Neck Research Group, Research Centre, Akershus University Hospital, 1478, Oslo, Norway; Institute of Clinical Medicine, Akershus University Hospital and University of Oslo, 1474, Nordbyhagen, Norway.
⁶ School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK; Pain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen, Göttingen, Germany.
⁷ Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
⁸ School of Physiotherapy and Exercise Science, Curtin University, P.O. Box U1987, Perth, WA 6845, Australia.
⁹ Physiotherapy Practice Jensen & Team, Nienstedtener Marktplatz 29, 22609 Hamburg, Germany.
¹⁰ Physiotherapy, Birmingham Community Healthcare NHS Trust, Birmingham, England, UK.
¹¹ Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Australia.
¹² Spine Center "Am Michel", Ludwig-Erhard-Str. 18, 20459 Hamburg, Germany.
¹³ Physiotherapy Department, University Hospital Birmingham Foundation Trust, Birmingham B15 2TH, UK.
¹⁴ Migraine and Headache Clinic Königstein im Taunus, Ölmühlweg 31, 61462 Königstein im Taunus, Germany.
¹⁵ Hochschule für Angewandte Wissenschaft und Kunst Hildesheim/Holzminden/Göttingen, Fakultät Soziale Arbeit und Gesundheit, Studiengang Ergotherapie, Logopädie und Physiotherapie, Goschentor 1, 31134 Hildesheim; Germany.
¹⁶ University of Applied Sciences Osnabrueck, Faculty of Business Managment and Social Science, Department Movement and Rehabilitation Science, Caprivistr. 30a, 49076 Osnabrück, Germany.
¹⁷ Watson Headache Institute, GPO Box 4714, Sydney, NSW 2001, Australia.
¹⁸ Heimlisbergstr. 47, 4513 Langendorf, Switzerland.
¹⁹ Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.

PMID: 27183831
DOI: 10.1016/j.math.2016.02.010

Abstract

Background: A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests.

Objectives: To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache.

Design/methods: Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache.

Results: Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests.

Conclusions: Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache.

Keywords: Consensus; Delphi; Examination; Headache; Migraine; Physical therapy.

MeSH terms

Adult
Aged
Aged, 80 and over
Delphi Technique
Female
Headache / diagnosis*
Headache / physiopathology*
Humans
Male
Middle Aged
Musculoskeletal Pain / diagnosis*
Neck Pain / diagnosis*
Neck Pain / physiopathology*
Physical Examination / standards*
Physical Therapists
Surveys and Questionnaires