Inter-rater Reliability of Three Musculoskeletal Physical Examination Techniques Used to Assess Motion in Three Planes While Standing
Received 8 September 2008; accepted 13 May 2009.
Objective
The objective of the study was to measure the reliability between examiners of 3 basic maneuvers of the Total Body Functional Profile physical examination test. The hypothesis was musculoskeletal health care providers of different disciplines could reliably use the 3 basic maneuvers as part of the musculoskeletal physical examination.
Design
A prospective observational study was conducted. Twenty-eight adult volunteers were measured on both the left and right side by 2 independent raters on a single occasion.
Setting
The subjects were recruited through advertisements placed by the orthopedic department at a tertiary university.
Participants
Twenty-eight volunteers were recruited and completed the study. The volunteers were between the ages of 18 and 51 years of age, had no symptoms in the lower extremity or spine, had no previous history of surgery or tumor involving the lower extremity, and no medical conditions that would preclude participation.
Methods
On a single occasion, 2 examiners per 1 volunteer were blinded to their own and each others' measurements. Each examiner assessed the distance of frontal and sagittal plane lunge and angle of motion for transverse plane testing.
Main Outcome Measurements
Inter-rater agreement is expressed with intraclass correlation coefficients (ICCs) and corresponding 95% confidence intervals (CIs). The difference between raters is reported with 95% CIs. Baseline demographics, University of California Los Angeles (UCLA), and Harris hip questionnaires were completed by all participants.
Results
The UCLA and Harris hip scores showed no significant activity restrictions or pain limitations in all participants. The inter-rater reliability for sagittal, frontal, and transverse plane matrix testing was good with ICCs of 0.86 (95% CI 0.77-0.91), 0.90 (95% CI 0.84-0.94), and 0.85 (95% CI 0.75-0.91), respectively. The rater reliability between disciplines for transverse, sagittal, and frontal plane matrix testing was good with ICCs of 0.89 (95% CI 0.80-0.94), 0.88 (95% CI 0.79-0.94), and 0.90 (95% CI 0.81-0.95), respectively.
Conclusions
The inter-rater reliability for 3 basic maneuvers of the Total Body Functional Profile is good among musculoskeletal health care providers of different disciplines. These 3 maneuvers may be used consistently as part of the musculoskeletal physical examination.
aSection of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Ave, Campus Box 8233, St. Louis, MO†
bSection of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO‡
cDivision of Biostatistics, Washington University School of Medicine, St. Louis, MO§
dProgram in Physical Therapy, Washington University School of Medicine, St. Louis, MO¶
eSection of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO∥
fDepartment of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO#
Address correspondence to: H.P.
Supported in part by award number UL1RR024992 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. This work was also supported in part by the Curing Hip Disease Fund.
Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org
ABSTRACT