617 Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Original article Intra-rater and inter-rater reliability of cranio cervical flexion test in symptomatic subjects of neck pain using pressure biofeedback V. Rajalaxmi 1 , S. Kotteswari 2 , R. Nithya Nisha 3 , Mohan Nallathambi 4 Abstract Objective: To investigate the intra – rater and inter – rater reliability of cranio cervical flexion test in symptomatic subjects. Background of study: Neck flexor muscles endurance was negatively correlated with cervical pain and dysfunction. Cranio cervical flexion test protocol has been advocated to train cranio cervical flexor muscle performance at present there is no consensus to the most effective method. The CCFT is a clinical test of neuromotor control of deep flexor of the cervical spine. Methodology: This was an observational study design with test-retest type and conducted in the ACS medical college and hospital. 50 samples were selected based on inclusion criteria. The CCFT was measured by one tester twice for intra rater reliability and two testers for inter-rater reliability were again tested after 24 Hours (Next day) by keeping time and environment optimal. In this CCFT, the activation pressure score and highest-pressure score was measured using Pressure Biofeedback unit. Result: The mean score for Activation Pressure by intra-rater tester one was found to be 2.24 (1.69) and 2.64 (1.48) in retest. The ICC intra- rater score for Highest pressure value by tester one was 23.92 (2.17) and 24.32 (1.99) in retest. The mean score for activation pressure by Inter – rater examiners was found to be 2.92(1.15) by examiner - 1 and 2.72(1.19) by examiner - 2. The ICC Inter – rater score for highest pressure value by examiner - 1 was 24.32(1.95) and 24.4(2.33) by examiner - 2. The ICC value of the study indicated high reliability of the activation pressure and highest-pressure value among the intra and inter-raters. Conclusion: The CCFT has high inter-rater and intra-rater reliabilities in symptomatic subjects. Keywords: Reliability; Neck pain; CCFT; Pressure Biofeedback unit; VAS. Correspondence: V. RAJALAXMI, Vice Principal, Faculty of Physiotherapy, Dr. M.G.R. Educational & Research Institute University, Velappanchavadi, Chennai - 600 077, Tamil Nadu, India. Email: rajalaxmiphysio@gmail.com 1. V. Rajalaxmi, Professor, Faculty of Physiotherapy, Dr. M.G.R. Educational & Research Institute University, Velappanchavadi, Chennai - 600 077, Tamil Nadu, India. 2. S. Kotteswari, Physsiotherapist, 3 Assistant Professor, Faculty of Physiotherapy, Dr. M.G.R. Educational & Research Institute University, Velappanchavadi, Chennai - 600 077, Tamil Nadu, India. 3. R. Nithya Nisha, Assistant Professor, Faculty of Physiotherapy, Dr. M.G.R. Educational & Research Institute University, Velappanchavadi, Chennai - 600 077, Tamil Nadu, India 4. Mohan Nallathambi, Senior Physical Therapy Practitioner, Al Farwaniya Hospital, Ministry Of Health, P.O.Box 13373, Farwaniya 81004 road 602, Hamoud Al-Jaber Al-Sabah road,Sabah Al-Naser, Kawait. Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 617-622 DOI: https://doi.org/10.3329/bjms.v22i3.65335 Introduction: Neck pain is a significant problem in modern society, with one-year prevalence values in world population varying from 16.7% to 75.1% 1 (Seema Kotwani,2016). It may be related to severe pathology such as nerve compression, prolapsed intervertebral disc, fracture. Neck pain has no specific and identifiable cause and is regarded as nonspecific neck pain 1 The primary function of cervical spine is to orient head against the opposing forces of gravity permitting