Is cervical Joint Position Error (JPE) a valid and reliable measure?

From the Guidelines

Cervical joint position error (JPE) testing is not considered a reliable or valid method for assessing cervical radiculopathy, as the current evidence suggests limited correlation between physical examination findings and MRI evidence of cervical nerve root compression 1. The diagnostic accuracy of cervical JPE is not well established, and its use as a standalone diagnostic tool is not recommended. Key points to consider when evaluating the validity and reliability of cervical JPE include:

• The lack of correlation between physical examination findings and MRI evidence of cervical nerve root compression 1
• The high rate of both false-positive and false-negative findings on MRI in the setting of suspected cervical radiculopathy 1
• The limited evidence for a correlation between physical examination tests and MRI evidence of cervical nerve root compression 1 In clinical practice, a comprehensive assessment of cervical radiculopathy should include a thorough medical history, physical examination, and imaging studies, such as MRI, to confirm the diagnosis and guide treatment planning. The use of cervical JPE testing should be approached with caution and considered in the context of other clinical findings, rather than relied upon as a primary diagnostic tool. It is essential to prioritize a thorough clinical evaluation and consider the potential limitations and biases of cervical JPE testing when interpreting results 1.

From the Research

Validity and Reliability of Cervical JPE

• The study published in 2024 2 found that assessing proprioception using a head-mounted laser to assess joint position error (JPE) is a reliable and valid measure.
• The same study 2 also found that the measure of cervical JPE has sufficient internal responsiveness, but the external responsiveness was inadequate.
• Another study published in 2006 3 found that cervical JPE is related to balance and eye movement disturbances in persistent whiplash, but assessing cervical JPE alone is not sufficient to signal the presence of disturbances in other tests.
• A study published in 2017 4 found that cervical joint position sense is impaired in subjects with chronic neck pain, and the errors were larger in all movement directions tested.

Comparison with Other Studies

• A systematic review published in 2011 5 found inconclusive evidence for the effectiveness of non-invasive management of cervicobrachial pain, but potential benefits were indicated in the provision of manual therapy and exercise and behavioural change approaches to reduce pain.
• A systematic review published in 2012 6 found that the indicated evidence for cervical radiofrequency neurotomy and cervical medial branch blocks is fair, but the evidence for cervical intraarticular injections is limited.
• The study published in 2006 3 found significant but weak-to-moderate correlations between cervical JPE, balance, and eye movement control, while the study published in 2017 4 found no significant differences in cervical JPE between young and older subjects with chronic neck pain.

Key Findings

• Cervical JPE is a reliable and valid measure of proprioception 2.
• Cervical JPE is related to balance and eye movement disturbances in persistent whiplash 3.
• Cervical joint position sense is impaired in subjects with chronic neck pain 4.
• The measure of cervical JPE has sufficient internal responsiveness, but the external responsiveness is inadequate 2.