European Journal of Pediatrics

, Volume 178, Issue 5, pp 657–671 | Cite as

Measurement properties of instruments for assessment of cervical spine function in infants with torticollis: a systematic review

  • Anthea SeagerEmail author
  • Helen French
  • Dara Meldrum
Original Article


The aim of this study was to systematically review the measurement properties of instruments which assess cervical spine function in infants with torticollis. Electronic searches were performed in MEDLINE, CINAHL, Embase, Web of Science and the Cochrane Library, combining three constructs (‘torticollis’, ‘cervical spine assessment’ and ‘measurement properties’). Two reviewers independently rated the methodological quality and the quality of measurement properties of identified articles, using both the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist and quality criteria for measurement properties. Five studies, using six instruments, met the inclusion criteria and were analysed. Included instruments were the goniometer, electronic pendular goniometer, protractor, still photography, Muscle Function Scale and a range of motion limitation scale. All studies assessed reliability, and one study also assessed content validity and hypothesis testing. The methodological quality of the studies varied from poor to excellent according to the COSMIN checklist. Two instruments were found to have good measurement properties from high-quality studies: still photography for the assessment of habitual head tilt in supine and the Muscle Function Scale for the assessment of side-flexor muscle function in lateral head righting.

Conclusion: This systematic review identified two reliable tools for the assessment of cervical spine function in infants with torticollis. Further research is required to assess the measurement properties of tools already described in the literature and to develop further tools for use in this population.

What is known?

A thorough assessment of the infant presenting with torticollis is essential, in order to correctly diagnose, rule out ‘red flags’ and manage appropriately

• Assessment tools need to have robust measurement properties in order to be of value for clinical practice and research

What is new?

This systematic review identified two valid and reliable tools for the assessment of cervical spine function in infants with torticollis

Further research is required to assess the measurement properties of tools already described in the literature and to develop further tools for use in infants with torticollis


Torticollis Cervical spine Assessment Measurement properties Systematic review 



Congenital muscular torticollis


COnsensus-based Standards for the selection of health status Measurement INstruments


Cervical spine


Health-related patient-reported outcomes


Minimal important change


Postural torticollis


Range of motion




Sternocleidomastoid muscle


Smallest detectable change


Standard error of measurement


Side flexion


Authors’ contributions

AS, HF and DM conceived the research idea and developed the protocol; AS did the database searches; AS and HF screened studies for eligibility; AS performed data extraction; AS and HF performed COSMIN assessment and DM arbitrated in the case of disagreement; AS drafted the manuscript; All authors contributed to the manuscript and approved the final version for publication.


This study was funded by the Temple Street Foundation (grant number 13.032).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

431_2019_3338_MOESM1_ESM.pdf (267 kb)
ESM 1 (PDF 266 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PhysiotherapyTemple Street Children’s University HospitalDublin 1Ireland
  2. 2.Department of Physiotherapy, Royal College of Surgeons in IrelandSt Stephen’s GreenDublin 2Ireland
  3. 3.Department of Physiotherapy, Trinity CollegeDublin UniversityDublin 2Ireland

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