Craniocervical Flexion Test (CCFT)

Execution Stage 1:

  1. The patient is in supine hook-lying position with or without a towel underneath the head to have the patient’s line of the face aligned horizontally
  2. Then the deflated biofeedback unit is placed behind the neck so that it abuts the patient’s occiput
  3. The examiner inflates the biofeedback unit to a baseline pressure of 20mmHg
  4. The patient is asked to perform a head nod as if the back of their head is sliding up the bench. The patient tries to achieve a pressure increase of 2mmHG from 20 to 22mmHG and holds this position 2-3 seconds
  5. The process is repeated for each 2mmHG increment for a total of 5 stages until 30mmHG is reached

 

Outcome: The stage/pressure increase that the patient is able to achieve and holf for 2-3 seconds with correct craniocervical flexion is the baseline measure.

A trial is perfomed incorrectly if a patient compensates by retraction, lifting of the head, use of the sternocleidomastoideus or scalene muscles.

 

 

Execution Stage 2: Stage 2 is achieved if the patient is able to perform all 5 levels of stage 1 without compensation. In this stage isometric endurance of the deep cervical flexors is tested.

  1. The patient is in the same position like in stage 1 with the biofeedback unit deflated to 20mmHG and abutted against the patient’s occiput
  2. The patient starts by perfoming 3 x 10 second holds at a pressure increase of 2mmHG from 20 to 22mHG
  3. The process is repeated for each 2mmHG increment for a total of 5 stages until 30mmHG is reached

 

Outcome: The stage/pressure level that the patient is able to achieve and hold for 3x 10 seconds without previously mentioned compensations and without jerkyness or reduction of the pressure during the hold is documented

 

Study

 Reliability Sn Sp LR+ LR-

De Koning et al. (2008)

 Intra ICC= 0.65-0.93
Inter-rater ICC= 0.54		 NA NA NA

NA
de Pau et al. (2020) Intra-rater ICC=0.69
Inter-rater ICC=0.75		 75 80 3.6 0.35
de Araujo et al. (2020) NA NA NA NA NA

Comment: The discriminative accuracy values concern the test’s ability to distinguish between patients with neck pain seeking care vs. healthy controls. De Araujo et al. (2020) found the CCFT to be a valid and reliable assessment test that can be used in clinical practice. Because of the conflicting and low-quality evidence, caution is advised when using the CCFT as a discriminative test and as an outcome measure