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Vol. 23. Issue 5.
Pages 437-447 (01 September 2019)
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Vol. 23. Issue 5.
Pages 437-447 (01 September 2019)
Original Research
DOI: 10.1016/j.bjpt.2018.10.008
The interrater reliability of a pain mechanisms-based classification for patients with nonspecific neck pain
Vincent Dewittea,
, Robby De Pauwa,1, Lieven Danneelsa, Katie Boucheb, Arne Roetsc, Barbara Cagniea
a Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
b Centre for Musculoskeletal and Neurological Rehabilitation, Ghent University Hospital, Ghent, Belgium
c Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium

  • Nonspecific neck pain patients can be classified based on pain mechanisms.

  • The proposed classification strategy has clinically acceptable interrater reliability.

  • The classification holds the potential to guide physical therapy interventions.

  • Validity testing is the necessary next step to justify this approach for clinical use.

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Tables (5)
Table 1. Descriptions of the clinical criteria associated with the predominant pain patternsa and predominant pain mechanisms.b
Table 2. Definitions of the dysfunction patterns.a
Table 3. Subjective and physical examination criteria for the respective dysfunction patterns.a
Table 4. Characteristics of the included subjects (n=48).
Table 5. Interrater reliability of the 3 main outcome measures in patients with nonspecific neck pain (n=48).
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To examine the interrater reliability and agreement of a pain mechanisms-based classification for patients with nonspecific neck pain (NSNP).


Design – Observational, cross-sectional reliability study with a simultaneous examiner design. Setting: University hospital-based outpatient physical therapy clinic. Participants: A random sample of 48 patients, aged between 18 and 75 years old, with a primary complaint of neck pain was included. Interventions: Subjects underwent a standardized subjective and clinical examination, performed by 1 experienced physical therapist. Two assessors independently classified the participants’ NSNP on 3 main outcome measures. Main outcome measures: The Cohen kappa, percent agreement, and 95% confidence intervals (CIs) were calculated to determine the interrater reliability for (1) the predominant pain mechanism; (2) the predominant pain pattern; and (3) the predominant dysfunction pattern (DP).


There was almost perfect agreement between the 2 physical therapists’ judgements on the predominant pain mechanism, kappa=.84 (95% CI, .65–1.00), p<.001. There was substantial agreement between the raters’ judgements on the predominant pain pattern and predominant DP with respectively kappa=.61 (95% CI, .42–.80); and kappa=.62 (95% CI, .44–.79), p<.001.


The proposed classification exhibits substantial to almost perfect interrater reliability. Further validity testing in larger neck pain populations is required before the information is used in clinical settings.

Clinical trial registration number

NCT03147508 (

Neck pain
Physical therapy
Reproducibility of results


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Brazilian Journal of Physical Therapy

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