Intra and interrater reliability and clinical feasibility of a simple measure of cervical movement sense in patients with neck pain

Reliability of cervicocephalic sense of force

Cervicocephalic proprioception (CCP) is an important assessment item for people with a range of clinical conditions, where reduced CCP is associated with neck pain and imbalance. Reliability has been established for a range of positional and movements tests, but there is limited data regarding sense of force, particularly across three planes of movement. The current test-retest study assessed reliability when evaluating sense of force in healthy adults (8 males, 6 females, mean age 31.50 years [SD 10.14]) over two sessions, 4-7 days apart. A force matching protocol was used to evaluate reliability of absolute error (AE), constant error (CE), and variable error (VE) for 10 % and 25 % maximal voluntary contraction (MVC) target forces for flexion, extension, lateral flexion, and rotation. Participants were strapped to a chair to limit trunk movement and data was captured using a compressive force transducer fixed to an adjustable wall mount. Six trials were performed for each contraction-type, totaling 72 submaximal MVCs per session. ICC estimates for AE (0.15-0.77), CE (0.01-0.85), and VE (0.00-0.83) were varied and confidence intervals were mostly wide. Considering lower limits of confidence intervals, CE had best reliability values generally, but more specifically the most reliable contraction type and movement was 25 % MVC flexion (ICC 0.85, confidence interval 0.54-0.95). This study found that reliability for sense of force testing was dependent upon contraction, type of error, and target force utilized. Further reliability analysis should be performed when applying this test to measure validity outcomes in clinical populations.

Reliability and measurement error of sensorimotor tests in patients with neck pain: a systematic review

BACKGROUND

Neck pain is one of the leading causes of years lived with disability, and approximately half of people with neck pain experience recurrent episodes. Deficits in the sensorimotor system can persist even after pain relief, which may contribute to the chronic course of neck pain in some patients. Evaluation of sensorimotor capacities in patients with neck pain is therefore important. No consensus exists on how sensorimotor capacities of the neck should be assessed in physiotherapy. The aims of this systematic review are: (a) to provide an overview of tests used in physiotherapy for assessment of sensorimotor capacities in patients with neck pain; and (b) to provide information about reliability and measurement error of these tests, to enable physiotherapists to select appropriate tests.

METHODS

Medline, CINAHL, Embase and PsycINFO databases were searched for studies reporting data on the reliability and/or measurement error of sensorimotor tests in patients with neck pain. The results for reliability and measurement error were compared against the criteria for good measurement properties. The quality of evidence was assessed according to the modified GRADE method proposed by the COSMIN group.

RESULTS

A total of 206 tests for assessment of sensorimotor capacities of the neck were identified and categorized into 18 groups of tests. The included tests did not cover all aspects of the sensorimotor system; tests for the sensory and motor components were identified, but not for the central integration component. Furthermore, no data were found on reliability or measurement error for some tests that are used in practice, such as movement control tests, which apply to the motor component. Approximately half of the tests showed good reliability, and 12 were rated as having good (+) reliability. However, tests that evaluated complex movements, which are more difficult to standardize, were less reliable. Measurement error could not be evaluated because the minimal clinically important change was not available for all tests.

CONCLUSION

Overall, the quality of evidence is not yet high enough to enable clear recommendations about which tests to use to assess the sensorimotor capacities of the neck.

Acute effects of instrument assisted soft tissue mobilization technique on pain and joint position error in individuals with chronic neck pain: a double-blind, randomized controlled trial

PURPOSE/AIM

The aim of this study was to determine the acute effects of IASTM on cervical joint position error and pain in individuals with chronic neck pain.

METHODS

A total of 39 individuals with chronic neck pain were included in this study. Participants were randomized into three groups: Instrument-assisted soft-tissue mobilization(IASTM (n = 13), sham (n = 13), and control (n = 13). In the IASTM group, intervention was applied to the sternocleidomastoid and trapezius muscles with an application time of 45 s and a frequency of 60 beats/min. In the sham group, IASTM was applied at a 90° angle without pressure. The control group did not receive any intervention. The pain severity and joint position error(JPE) were evaluated before and after the intervention, by using the visual analogue scale and a cervical range of motion device.

RESULTS

The effects of time and treatment group on visual analogue scale(VAS) score were statistically significant (p = .001). Instrument-assisted soft-tissue mobilization was more effective in VAS score than sham and control group (p < .001). Significant improvement was found in JPE in all range of motions of the cervical region in the instrument-assisted soft-tissue mobilization group (p < .05). In the sham group, significant improvements were observed in cervical extension, left rotation, and left lateral flexion movements in JPE during each cervical spine active movement (p < .05). Instrument-assisted soft-tissue mobilization group was more effective in JPE all directions than sham and control group.

CONCLUSIONS

Instrument-assisted soft-tissue mobilization may be a useful technique in individuals with chronic neck pain. Instrument-assisted soft-tissue mobilization decreases VAS and improves JPE.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04882397 (05 August 2021).

Investigation of Joint Position Sense and Balance in Individuals With Chronic Idiopathic Neck Pain: A Cross-Sectional Study

OBJECTIVE

The aim of this study was to determine the relationship between joint position sense and static and dynamic balance in female patients with chronic neck pain compared with healthy controls.

METHODS

The study sample comprised 25 female patients with chronic neck pain and 25 healthy (asymptomatic) female controls. Pain severity with the visual analog scale, joint position sense with the laser pointer method, static balance with the Single-Leg Balance Test, and dynamic balance with the Y Balance Test were assessed.

RESULTS

The deviation in cervical joint position sense was greater in extension (P < .001), right rotation (P < .001), and left lateral rotation (P < .05) in the patients with chronic neck pain compared with the healthy controls. The results of the patients with chronic neck pain were worse than the healthy controls in the Single-Leg Balance Test with both eyes open (P < .05) and eyes closed (P < .05). The patients with chronic neck pain had worse dynamic balance only in the anterior direction reach of the left leg (P < .05).

CONCLUSION

Cervical joint position sense and static balance were worse in female patients with chronic idiopathic neck pain when compared with asymptomatic controls. Dynamic balance in all other directions except for the anterior direction was not negatively affected in individuals with chronic idiopathic neck pain.

Proprioceptive Disturbance in Chronic Neck Pain: Discriminate Validity and Reliability of Performance of the Clinical Cervical Movement Sense Test

Chronic neck pain is associated with sensorimotor dysfunctions, which may develop symptoms, affect daily activities, and prevent recovery. Feasible, reliable, and valid objective methods for the assessment of sensorimotor functions are important to identify movement impairments and guide interventions. The aim of this study was to investigate the discriminative validity of a clinical cervical movement sense test, using a laser pointer and an automatic video-based scoring system. Individuals with chronic neck pain of idiopathic onset (INP), traumatic onset (TNP), and healthy controls (CON) were tested. Associations between movement sense and neck disability were examined and the repeatability of the test was investigated. A total of 106 participants (26 INP, 28 TNP, and 52 CON) were included in a cross-sectional study. Acuity, Speed, Time, and NormAcuity (i.e., normalized acuity by dividing acuity with movement time) were used as outcome measures. ANOVAs were used for group comparisons and Pearson correlations for associations between movement sense variables and neck disability index (NDI). Notably, 60 of the participants (30 CON, 17 INP, and 13 TNP) performed the test on a second occasion to explore test-retest reliability. Results revealed a reduced NormAcuity for both INP and TNP compared with CON (p < 0.05). The neck pain groups had similar Acuity but longer Time compared with CON. Among TNP, there was a fair positive correlation between Acuity and NDI, while there was a negative correlation between Acuity and NDI among INP. Reliability measures showed good to excellent ICC values between tests, but standard error of measurements (SEM) and minimal detectable change (MDC) scores were high. The results showed that NormAcuity is a valuable measure to identify disturbed cervical movement sense among INP and TNP. While Acuity was similar between the groups, different strategies, such as longer Time, to perform the task among neck patient groups were used. Few differences were identified between the neck pain groups, but altered strategies may exist. Reliability was acceptable, and the test is feasible to perform in the clinic. However, the technical complexity of the automated image analysis is a concern. Future developments will provide more feasible solutions.

Reliability of Cervicocephalic Proprioception Assessment: A Systematic Review

OBJECTIVE

The purpose of this systematic review was to determine the reliability and, where possible, the validity of cervicocephalic proprioceptive (CCP) tests in healthy adults and clinical populations.

METHODS

A systematic search, utilizing 7 databases from the earliest possible date to April 14, 2021, identified studies that measured reliability of CCP tests. Studies were screened for eligibility, and included studies were appraised using Quality Appraisal Tool for Studies of Diagnostic Reliability (QAREL) and Quality Assessment and Diagnostic Accuracy Studies-2 Tool (QUADAS-2) tools. Validity outcomes were assessed for included studies.

RESULTS

Of 34 included studies, 29 investigated reliability for sense of position tests, 10 involved sense of movement tests, and 1 used a sense of force test. The head to neutral test was reliable and valid when 6 or more repetitions were performed within the test, discriminating between those with and without neck pain. Head tracking tests were reliable with 6 repetitions, and 1 study found discriminative validity in a whiplash population. Studies that found discriminative validity in sense of position reported mean joint position error generally >4.5° in the neck pain group and <4.5° in the asymptomatic group. No sense of force test was applied to a clinical population. Convergent validity analysis showed that these proprioceptive tests have low correlations with each other.

CONCLUSION

The reliability and validity of CCP tests for sense of position and movement are dependent upon equipment and repetitions. Six repetitions are generally required for good reliability, and joint position error >4.5° is likely to indicate impairment in sense of position.

Head kinematics in patients with neck pain compared to asymptomatic controls: a systematic review

BACKGROUND

Neck pain is one of the most common musculoskeletal disorders encountered by healthcare providers. A precise assessment of functional deficits, including sensorimotor control impairment, is regarded necessary for tailored exercise programmes. Sensorimotor control can be measured by kinematic characteristics, such as velocity, acceleration, smoothness, and temporal measures, or by assessing movement accuracy. This systematic review aims to identify movement tasks and distinct outcome variables used to measure kinematics and movement accuracy in patients with neck pain and present their results in comparison to asymptomatic controls.

METHODS

Electronic searches were conducted in MEDLINE, PEDro, Cochrane Library and CINAHL databases from inception to August 2020. Risk of bias of included studies was assessed. Movement tasks and specific outcome parameters used were collated. The level of evidence for potential group differences in each outcome variable between patients with neck pain and controls was evaluated.

RESULTS

Twenty-seven studies examining head kinematics and movement accuracy during head-aiming, functional and unconstrained movement tasks of the head were included. Average Risk of Bias of included studies was moderate. In total, 23 different outcome variables were assessed. A strong level of evidence for an increased movement time and for an increased number of errors during head aiming tasks was found. Moderate evidence was found in traumatic neck pain for a decreased mean velocity, peak acceleration, and reaction time, and for point deviation and time on target during head aiming tasks. Moderate evidence was found for decreased acceleration during unconstrained movements, too. Results on the remaining movement task and outcome variables showed only limited, very limited or even conflicting level of evidence for patients with neck pain to differ from controls.

CONCLUSIONS

Sensorimotor control in NP in the way of kinematic and movement accuracy characteristics of head motion was examined in head aiming, functional or unconstrained movement tasks. The results from this review indicate that for some characteristics that describe sensorimotor control, patients with NP differ from healthy controls.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020139083.

HeadUp: A Low-Cost Solution for Tracking Head Movement of Children with Cerebral Palsy Using IMU

Cerebral palsy (CP) is a common reason for human motor ability limitations caused before birth, through infancy or early childhood. Poor head control is one of the most important problems in children with level IV CP and level V CP, which can affect many aspects of children’s lives. The current visual assessment method for measuring head control ability and cervical range of motion (CROM) lacks accuracy and reliability. In this paper, a HeadUp system that is based on a low-cost, 9-axis, inertial measurement unit (IMU) is proposed to capture and evaluate the head control ability for children with CP. The proposed system wirelessly measures CROM in frontal, sagittal, and transverse planes during ordinary life activities. The system is designed to provide real-time, bidirectional communication with an Euler-based, sensor fusion algorithm (SFA) to estimate the head orientation and its control ability tracking. The experimental results for the proposed SFA show high accuracy in noise reduction with faster system response. The system is clinically tested on five typically developing children and five children with CP (age range: 2–5 years). The proposed HeadUp system can be implemented as a head control trainer in an entertaining way to motivate the child with CP to keep their head up.

Effects of dry needling of the obliquus capitis inferior on sensorimotor control and cervical mobility in people with neck pain: A double-blind, randomized sham-controlled trial

BACKGROUND

Impairments of sensorimotor control relating to head and eye movement control and postural stability are often present in people with neck pain. The upper cervical spine and particularly the obliquus capitis inferior (OCI) play an important proprioceptive role; and its impairment may alter cervical sensorimotor control. Dry needling (DN) is a valid technique to target the OCI.

OBJECTIVES

To investigate if a single DN session of the OCI muscle improves head and eye movement control-related outcomes, postural stability, and cervical mobility in people with neck pain.

METHODS

Forty people with neck pain were randomly assigned to receive a single session of DN or sham needling of the OCI. Cervical joint position error (JPE), cervical movement sense, standing balance and oculomotor control were examined at baseline, immediately post-intervention, and at one-week follow-up. Active cervical rotation range of motion and the flexion rotation test were used to examine the global and upper cervical rotation mobility, respectively.

RESULTS

Linear mixed-models revealed that the DN group showed a decrease of JPE immediately post-intervention compared to the sham group (mean difference [MD]= -0.93°; 95% confidence interval [CI]: -1.85, -0.02) which was maintained at one-week follow-up (MD= -1.64°; 95%CI: -2.85, -0.43). No effects on standing balance or cervical movement sense were observed in both groups. Upper cervical mobility showed an increase immediately after DN compared to the sham group (MD= 5.14°; 95%CI: 0.77, 9.75) which remained stable at one-week follow-up (MD= 6.98°; 95%CI: 1.31, 12.40). Both group showed an immediate increase in global cervical mobility (MD= -0.14°; 95%CI: -5.29, 4.89).

CONCLUSION

The results from the current study suggest that a single session of DN of the OCI reduces JPE deficits and increases upper cervical mobility in patients with neck pain. Future trials should examine if the addition of this technique to sensorimotor control training add further benefits in the management of neck pain.

Change in a clinical measure of cervical movement sense following four weeks of kinematic training

BACKGROUND

Training targeted towards improving cervical movement accuracy is an effective strategy in the management of neck pain. Relatively complex measures have been validated to measure this in research although a simple clinical measure using a head mounted laser tracing a standardised pattern has been shown to be reliable. It is not known if this method demonstrate clinically meaningful change to training.

OBJECTIVE

To assess change responsiveness of the clinical cervical movement sense (CCMS) test following home kinematic training (KT).

STUDY DESIGN

Pre-post treatment observational study.

METHODS

The CCMS measure was assessed in 56 patients with chronic neck pain (41 intervention, 15 control) at baseline and 4 weeks post intervention by blinded assessors. Task completion time and error number were assessed reviewing video of the performances. Change pre-post intervention was compared between groups.

RESULTS

There was a significantly greater mean improvement in the intervention (-9.2 ± 9.3) seconds) for completion time and combined time and error (-13.3 ± 16) compared to the control group for time (-2.0 ± 9.8) and combined time and error (-1.8 ± 14) with moderate to high effect sizes (Cohen's d 0.76). There was a non-significant trend for decreased number of errors in the intervention (-4.1 ± 9.0) compared to control group (0.2 ± 8.3).

CONCLUSION

Completion time of the CCMS test appears to be able to demonstrate meaningful change following four weeks of KT. This further supports its clinical utility as a measure of cervical movement accuracy and provides direction for future clinical use.

German version of the Chedoke McMaster arm and hand activity inventory (CAHAI-G): intra-rater reliability and responsiveness

BACKGROUND

The English version of the Chedoke Arm and Hand Activity Inventory is a validated, upper-limb measure with the purpose of assessing functional recovery of the arm and hand after a stroke. A German translation and cross-cultural adaptation was recently produced and demonstrated high validity, inter-rater reliability and internal consistency. As a follow-up, the present study evaluated the intra-rater reliability and responsiveness of the CAHAI-G for the long and all shortened versions.

METHODS

The CAHAI-G and the Action Research Arm Test were assessed on three different measurement events: upon entry (ME1), two to 3 days after entry (ME2), and after three to 4 weeks (ME3). For the intra-rater reliability analysis, the ME1 CAHAI assessments were recorded on video and rated by three therapists to obtain the intraclass coefficients (ICC). The data of all three MEs were analysed in a group of stroke inpatients for the evaluation of responsiveness. To test for responsiveness, the CAHAI-G change data were compared to concurrent instruments: The Global Rating of Change-questionnaire and the Global Rating of Concept-questionnaire. Both served as external criteria. For all CAHAI-G versions (7, 8, 9 or 13 items), the same analysis procedures for the evaluation of the responsiveness parameter were performed.

RESULTS

In total, 27 patients (9 females, age 63 ± 13.7) were enrolled in the study. The ICCs for the intra-rater reliability were calculated to be between 0.988 and 0.998 for all CAHAI versions. Responsiveness parameters were as follows from CAHAI-G 7 to 13: Minimal Detectable Change (MDC₉₀₎ 5.3, 6.0, 6.1, 8.2; Pearson's correlation coefficients CAHAI-Gs with ARAT 0.365, 0.409^*, 0.500^**, 0.597^**. The Area und Under the Curve and the Minimal Clinical Important Difference values for all CAHAI-G versions and the three external criteria ranged between 0.483 to 0.603 and 2.5 to 9.0, respectively.

CONCLUSION

In addition to the high validity, inter-rater reliability and internal consistency, the CAHAI-G revealed high intra-rater reliability. The data also suggest an adequate responsiveness of the CAHAI-G versions 9 and 13.

High-vs. low-tech cervical movement sense measurement in individuals with neck pain

OBJECTIVES

To compare diagnostic ability of the clinical cervical movement sense (CCMS) test to the neck virtual reality (VR) system accuracy module.

BACKGROUND

Altered cervical proprioception is common in patients with persistent neck pain (NP). Recently a simple CCMS has been found to be feasible and reliable. However, it is not known how this compares to a valid method.

METHODS

Twenty participants with persistent NP and 20 healthy controls were videoed while performing the CCMS using a laser pointer and traced a zigzag pattern and then assessed using the VR accuracy module which consisted of following 8 segments in four directions. Diagnostic ability using a model from potential variables from the video analysis of number of errors and task performance time was compared to a model provided from VR data.

RESULTS

Subjects with NP had significantly greater horizontal errors in the CCMS and VR accuracy. Both CCMS and VR measurement models utilising measurements of horizontal movement error demonstrated good diagnostic ability (AUC = 0.88, 0.91 respectively) and there was no statistical difference between the models' AUC (p = 0.7).

CONCLUSION

The simple clinical testing tool appears to provide a measure of cervical movement sense, similar to the established Neck VR accuracy measure. Both tools differentiated individuals with NP from controls with similar sensitivity and specificity, with some advantage to the VR. The rotational motion measures seem most suitable in the assessment of motion accuracy. CCMS has potential to be used as a simple clinical measure and warrants further research.

Clinical assessment of cervical movement sense in those with neck pain compared to asymptomatic individuals

BACKGROUND

A simple clinical test involving subject tracing zigzag (ZZ) and figure of eight (F8) patterns with a head mounted laser device in determining cervical movement sense has proven reliability and feasibility. However, its validity in comparing individuals with and without neck pain (NP) has not been examined.

METHODS

Seventy-six subjects (38 NP and 38 asymptomatic subjects) performed both patterns while motion of their laser point was videoed. Independent examiners subsequently rated the videos (real-time) to record the time needed and the number of errors when completing each task. Sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for various cut-offs to optimise clinical interpretation were determined. Comparisons between 25 subjects with idiopathic neck pain versus 13 with whiplash-associated disorders were also undertaken.

RESULTS

All outcome variables except ZZ time were significantly different between individuals with NP and controls. Optimal cut-offs of 9 and 10 errors yielded LR+/LR- of 3.67/0.17 (F8) and 3.00/0.38 (ZZ). Whiplash patients performed the ZZ task faster with similar errors to those with idiopathic neck pain.

CONCLUSION

The clinical utility of this inexpensive measure to assess cervical movement sense in people with NP is supported. Moderate LRs+ were demonstrated for number of errors for both patterns. Individuals with NP generated significantly more errors while tracing each pattern. Optimal cut offs of 9 errors for ZZ and 10 errors for F8 were established. Overall, these tests appear to be clinically suitable to determine altered cervical movement sense in those with NP.

Intraclass correlation - A discussion and demonstration of basic features

A re-analysis of intraclass correlation (ICC) theory is presented together with Monte Carlo simulations of ICC probability distributions. A partly revised and simplified theory of the single-score ICC is obtained, together with an alternative and simple recipe for its use in reliability studies. Our main, practical conclusion is that in the analysis of a reliability study it is neither necessary nor convenient to start from an initial choice of a specified statistical model. Rather, one may impartially use all three single-score ICC formulas. A near equality of the three ICC values indicates the absence of bias (systematic error), in which case the classical (one-way random) ICC may be used. A consistency ICC larger than absolute agreement ICC indicates the presence of non-negligible bias; if so, classical ICC is invalid and misleading. An F-test may be used to confirm whether biases are present. From the resulting model (without or with bias) variances and confidence intervals may then be calculated. In presence of bias, both absolute agreement ICC and consistency ICC should be reported, since they give different and complementary information about the reliability of the method. A clinical example with data from the literature is given.

Higher variability in cervical force perception in people with neck pain

BACKGROUND

A reduced capacity to generate and sustain cervical muscle force over a range of contraction intensities is a feature of some participants with neck pain. To date there have been no studies comparing the accuracy of force perception in participants with and without neck pain.

DESIGN

Cross-sectional observational study.

METHODS

Participants with (n = 25) and without (n = 25) neck pain performed isometric muscle contractions at three progressive self-perceived (no feedback provided) intensities (10, 25, 50) % of their maximal voluntary contraction (MVC) in cervical: flexion, extension, right and left lateral flexion. Absolute error (AE), constant error (CE), and variable error (VE) between actual and targeted force values were calculated.

RESULTS

The neck pain group had: (1) AE-combined direction -significantly higher at 10% and lower at 50% (p < 0.05); (2) significantly lower CE in most measures (p < 0.05); (3) higher mean VE in all measures, with 10, 25, and 50% combined direction and overall combined % extension significantly higher (p < 0.05).

CONCLUSIONS

Findings indicate higher variability in force generation perception across all directions and intensities in participants with neck pain compared to healthy controls. Potentially this greater variability might suggest impaired force sense, a construct of proprioception in participants with neck pain. Reduced force sense may have implications for participants with neck pain during functional activities requiring precision and may need to be trained. Further research is required.

Age-related kinematic performance should be considered during fast head-neck rotation target task in individuals aged from 8 to 85 years old

Kinematic behavior during fast cervical rotations is a useful parameter for assessing sensorimotor control performances in neck-pain patients. However, the influence of age in asymptomatic individuals from children to older people still needs to be explored. Our aim was to assess the impact of age on sensorimotor control performance of the head-neck with execution time and kinematic variables (time of task, mean speed/acceleration/deceleration, overshoots (OSs), minimum/maximum speed) during standardized fast rotation target task using the DidRen Laser test. A total of 80 volunteers were stratified in four different age-groups: Children (8–14 years): n = 16; Young Adults (18–35 years): n = 29; Old Adults (36–64 years): n = 18; Seniors (65–85 years): n = 17. Results showed that to perform the test, Children were slower (69.0 (60.6–87.3)s) compared to Young Adults (49.6 (45.6–55.6)s) with p < 0.001, and Old Adults (51.7 (48.4–55.8)s) with p < 0.001. It was also slower in Seniors (57 (52.3–67.6)s) compared to Young Adults with p < 0.013. Mean speed was slower in Children (9.4 ± 2.3 °s⁻¹) and Seniors (10.6 ± 2.4 °s⁻¹) compared to Young Adults (13.7 ± 1.9 °s⁻¹) with p < 0.001 and Old Adults (13.3 ± 2.4 °s⁻¹) with p < 0.001. Mean acceleration was slower for Children (8.4(7.6–10.2) °s⁻²) compared to Young Adults (11.1 (8.8–15.3) °s⁻²) with p < 0.016, and Old Adults (12.0(8.4–15.3) °s⁻²) with p < 0.015. Mean deceleration was slower for Children (−1.9(−2.6–1.4) °s⁻²) compared to Young Adults (−2.9(−3.7–2.5) °s⁻²) with p < 0.001 and Old Adults (−3.2(−3.7–2.3) °s⁻²) with p < 0.003. The DidRen Laser test allows us to discriminate age-specific performances for mean speed, acceleration and deceleration. Seniors and Children needed to be slower to become as precise as Young Adults and Old Adults. No difference was observed for OSs which assesses accuracy of movement. Age should therefore be considered as a key parameter when analyzing execution time and kinematic results during DidRen Laser test. These normative data can therefore guide clinicians in the assessment of subjects with neck pain.