Cervical nonorganic signs: A new clinical tool to assess abnormal illness behavior in neck pain patients: A pilot study

Jerry B. Sobel, Patti Sollenberger, Richard Robinson, Peter B. Polatin, Robert J. Gatchel

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


Objective: To develop and assess the reliability of a group of cervical nonorganic physical signs to be used as a simple screening tool for identifying patients with low neck pain who exhibit abnormal illness behavior. Design: Survey, consecutive sample. Data Set: Double masked. Setting: Functional restoration program. Patients: Twenty-six consecutive patients with complaints of chronic neck pain (greater than 4 months duration). Each patient was evaluated by a physician and then again by either a physical or occupational therapist, for the presence of specific cervical nonorganic signs. Both of the evaluations occurred on the same day. Main Outcome Measures: Five categories consisting of eight tests were appraised: (1) tenderness, (2) simulation, (3) range of motion, (4) regional disturbance, and (5) overreaction. Results: The percent agreement between raters ranged from a high of 100% for regional sensory disturbance, to a low of 68% for one of the simulation tests. The average agreement between raters across all of the nonorganic test signs was 84.6%. Likewise, kappa coefficients ranged from 1.00 to .16, reflecting differences in strength of agreement. Conclusion: For many years, the lumbar nonorganic signs (developed by Waddell and colleagues) have been a useful screening tool in the assessment of abnormal illness behavior in the low back pain population. For the first time, a group of cervical nonorganic signs have been developed, standardized, and proven reliable. (C) 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.

Original languageEnglish (US)
Pages (from-to)170-175
Number of pages6
JournalArchives of physical medicine and rehabilitation
Issue number2
StatePublished - Feb 2000


  • Back pain
  • Neck pain
  • Nonorganic
  • Psychosocial
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


Dive into the research topics of 'Cervical nonorganic signs: A new clinical tool to assess abnormal illness behavior in neck pain patients: A pilot study'. Together they form a unique fingerprint.

Cite this