The purpose of this study was to examine the intratester and intertester reliability for goniometric measurements of knee flexion and extension passive range of motion (PROM). In addition, parallel-forms reliability for PROM measurements of the knee obtained by use of a goniometer and by visual estimation was examined. The intertester reliability for visual estimates of the PROM of the knee was also examined. Repeated measurements were obtained on 43 patients in a clinical setting. The intraclass correlation coefficients (ICCs) for intratester reliability of measurements obtained with a goniometer were .99 for flexion and .98 for extension. Intertester reliability for measurements obtained with a goniometer was .90 for flexion and .86 for extension. The ICCs for parallel-forms reliability for measurements obtained with a goniometer and by visual estimation ranged from .82 to .94. The intertester reliability for measurements obtained by visual estimation was .83 for flexion and .82 for extension. Results suggest clinicians should use a goniometer to take repeated PROM measurements of a patient's knee to minimize the error associated with these measurements.

The purpose of this study was to examine the intratester and intertester reliabilities for clinical goniometric measurements of shoulder passive range of motion (PROM) using two different sizes of universal goniometers. Patients were measured without controlling therapist goniometric placement technique or patient position during measurements. Repeated PROM measurements of shoulder flexion, extension, abduction, shoulder horizontal abduction, horizontal adduction, lateral (external) rotation, and medial (internal) rotation were taken of two groups of 50 subjects each. The intratester intraclass correlation coefficients (ICCs) for all motions ranged from .87 to .99. The ICCs for the intertester reliability of PROM measurements of horizontal abduction, horizontal adduction, extension, and medial rotation ranged from .26 to .55. The intertester ICCs for PROM measurements of flexion, abduction, and lateral rotation ranged from .84 to .90. Goniometric PROM measurements for the shoulder appear to be highly reliable when taken by the same physical therapist, regardless of the size of the goniometer used. The degree of intertester reliability for these measurements appears to be range-of-motion specific.

Determining the difference in the length of an individual's legs is often an important component of a musculoskeletal examination. Although measurements are easily obtained with a tape measure, the validity of these measurements is not known. The purpose of this study was to examine the validity of determinations of leg-length differences (LLDs) obtained by use of a specified tape measure method (TMM). Leg-length differences using the TMM and a radiographic technique were determined for 10 subjects who were candidates for clinical leg-length measurements and for 9 healthy control subjects. Validity of the TMM measurements was determined by assessing the degree of agreement between TMM-obtained LLDs and those obtained by the radiographic method. Validity estimates as determined by intraclass correlation coefficients (ICCs) were .770 for patients, .359 for healthy subjects, and .683 for all subjects. When the means of the two values obtained by use of the TMM were compared with the radiographic measurements, the ICCs were .852 for the patient group, .637 for the healthy subjects, and .793 for all subjects. This study suggests that TMM-derived LLD measurements are valid indicators of leg-length inequality and that the estimates of validity are improved by using the average of two determinations rather than a single determination.

The purpose of this study was to examine the intratherapist and intertherapist reliability of measurements obtained with a modified version of the fingertip-to-floor method of assessing forward bending. With the modified fingertip-to-floor (MFTF) method, patients stand on a stool and forward bend so that measurements can be taken on patients who are able to touch the floor or reach beyond the level of the floor. Randomly paired physical therapists took repeated MFTF measurements on 73 patients with low back pain. Intraclass correlation coefficients (ICCs) were calculated for intratherapist and intertherapist reliability. The ICC value for intratherapist reliability was .98, and the ICC value for intertherapist reliability was .95. The results of this study suggest that measurements of forward bending obtained on patients with low back pain using the MFTF method are highly reliable.

Objective: Knee arthroplasty (KA) is an effective surgical procedure. However, clinical studies suggest that a considerable number of patients continue to experience substantial pain and functional loss following surgical recovery. We aimed to estimate pain and function outcome trajectory types for persons undergoing KA, and to determine the relationship between pain and function trajectory types, and pre-surgery predictors of trajectory types. Design: Participants were 384 patients who took part in the KA Skills Training randomized clinical trial. Pain and function were assessed at 2-week pre-and 2-, 6-, and 12-months post-surgery. Piecewise latent class growth models were used to estimate pain and function trajectories. Pre-surgery variables were used to predict trajectory types. Results: There was strong evidence for two trajectory types, labeled as good and poor, for both Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function scores. Model estimated rates of the poor trajectory type were 18% for pain and function. Dumenci's latent kappa between pain and function trajectory types was 0.71 (95% CI: 0.61e0.80). Pain catastrophizing and number of painful body regions were significant predictors of poor pain and function outcomes. Outcome-specific predictors included low income for poor pain and baseline pain and younger age for poor function. Conclusions: Among adults undergoing KA, approximately one-fifth continue to have persistent pain, poor function, or both. Although the poor pain and function trajectory types tend to go together within persons, a significant number experience either poor pain or function but not both, suggesting heterogeneity among persons who do not fully benefit from KA.

Recent reports have characterized force measurements obtained with hand-held dynamometers from brain-damaged patients as being highly reliable. The purposes of this two-part study were to replicate essential parts of those studies and to further examine the reliability of these measurements in a clinical context. Repeated force measurements were taken from the nonparetic and paretic limbs of brain-damaged patients during the same testing session (Part 1) and during two testing sessions separated by two days (Part 2). The intratester intraclass correlation coefficients (ICCs) for all measurements taken during a single session ranged from .88 to .98. The ICCs for repeated measurements taken two days apart from the paretic limbs ranged from .90 to .98. The ICCs for repeated measurements taken two days apart from the nonparetic limbs ranged from .31 to .93. The ICCs for repeated measurements taken two days apart from the combined data for all limbs ranged from .79 to .97. Hand-held dynamometer measurements taken on brain-damaged patients appear to be highly reliable when taken during the same testing session. When repeated measurements are separated by a longer time interval, the measurements taken from the paretic limbs continue to be highly reliable, whereas most measurements taken on the nonparetic limbs exhibit poor reliability.

Physical therapists frequently evaluate the lower extremity, and this evaluation often includes measuring the subtalar joint neutral (STJN) position and subtalar joint (STJ) passive range of motion (PROM). This report critically reviews methods used to measure STJN position and STJ PROM. Standardized methods for taking these measurements, which have been clinically tested and appear to be theoretically sound, are presented. Although these methods are based on anatomical considerations, their reliability is less than optimal. However, these are the only methods of measuring STJN position and STJ PROM that have been tested adequately for reliability.

This study assessed the intratester and intertester reliability and the validity of judgments of the integrity of the anterior cruciate ligament (ACL) based on the use of the Lachman's test. End-feel and tibial translation judgments made during the Lachman's test were also assessed. Patients with unilateral knee problems (N = 32), 13 of whom had documented ACL damage, were examined by two physical therapists and two orthopedic surgeons. Intratester Kappa values for whether the test was positive or negative were .44 for physical therapists, .60 for orthopedic surgeons, and .51 for all examiners. Intertester Kappa values were .69 for the therapists, .61 for the surgeons, and .42 for all examiners. The predictive value of a positive test was 47% for all examiners, whereas the predictive value of a negative test was 70%. Results indicate that Lachman's test judgments have limited reliability and may be more useful for predicting that a patient does not have an ACL injury than for predicting that the ACL is injured. [Cooperman JM, Riddle, DL, Rothstein JM: Reliability and validity of judgments of the integrity of the anterior cruciate ligament of the knee using the Lachman's test.