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Although Troyanovich and Harrison [ 41 ] consider face and content validity as synonymous, there is an important distinction: content validity studies employ a reference standard.
The Chiropractic Mercy Center Consensus Conference held in January 1993 identified and rated the value of various measurement instruments related to spinal joint functional assessment that could be used as reference standards [ 43 ] . Based on their critical review of the literature, Troyanovich and Harrison [ 44 ] suggested postural assessment instruments and radiographic measurement as valid, reliable and clinically useful objective measurement tools to help identify dysfunctional spinal vertebral joints.
Troyanovich and Harrison [ 33 ] pointed out that in spite of the common perception or belief that motion tests are valid and reliable for assessment of presence or absence of restricted vertebral motion, there was no evidence to support this concept.