Evidence for Reliability and Validity of Functional Performance Testing in the Evaluation of Nonarthritic Hip Pain

McGovern, Ryan P.; Christoforetti, John J.; Martin, RobRoy L.; Phelps, Amy L.; Kivlan, Benjamin R.

doi:10.4085/1062-6050-33-18

Cited by 19 publications

(13 citation statements)

References 29 publications

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“…Because PPMs can be completed safely even by those with significant disability, these measures may also serve as a better “report card” to share with patients with dysplasia during treatment or rehabilitation than more difficult tests, such as the single-leg squat or Star Excursion Balance Test proposed for detecting FAI-related disability. 17 , 25 PPMs also may be useful in some situations as a way of corroborating results of a functional PRO instrument. Like PRO instruments, however, PPMs cannot be used to distinguish between specific causes of hip pain or disfunction.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Disability Related to Hip Dysplasia Using Objective Measures of Physical Performance

Scott

Willey

Mercado

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Lower extremity physical performance measures (PPMs), which can objectively quantify functional ability, are an attractive adjuvant to patient-reported outcome (PRO) instruments. However, few tests have been validated for use in hip instability. Purpose: To evaluate 4 different PPMs for their ability to differentiate between young adults with hip dysplasia indicated for treatment with periacetabular osteotomy (PAO) and asymptomatic controls and to test inter- and intratest reliability and relationship with popular hip PRO instruments. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 24 symptomatic patients aged 15 to 39 years (100% female) with hip dysplasia (lateral center-edge angle <25°) indicated for treatment with PAO completed the visual analog scale (VAS) for pain, Hip disability and Osteoarthritis Outcome (HOOS) Pain subscale, HOOS Short Version (HOOS PS), International Hip Outcome Tool Short Version (iHOT-12), modified Harris Hip Score (mHHS), Patient Reported Outcome Measurement Information System (PROMIS) physical function (PF) and pain interference (PI), and 4 physical function tests: (1) self-selected walking speed (SSWS), sit-to-stand 5 times (STS5), (3) 4-square step test (FSST), and (4) timed stair ascent (TSA). A further 21 young, asymptomatic adults aged 18 to 39 years (91% female) also underwent testing. Between-group comparisons were made with unpaired t test with Bonferroni-Holm correction. Inter- and intrarater reliability was assessed in 38 participants by repeating PPMs at a second visit and using 2 raters. Spearman rank correlation coefficients were used to determine associations between PPMs and PRO instruments. Results: Significant differences between patients with hip dysplasia and controls were observed for all PRO instruments (HOOS Pain, 47.8 vs 99.2; HOOS PS, 61.9 vs 99.2; iHOT-12, 32.2 vs 99.2; mHHS, 54.5 vs 90.6; PROMIS PF, 41.4 vs 65.6; and PROMIS PI, 62.0 vs 39.1 [all P < .001]), and all PPMs (SSWS, 1.21 vs 1.53 m/s; STS5, 10.85 vs 5.95 s; FSST, 6.59 vs 4.03 s [all P < .001]; and TSA, 4.58 vs 3.29 s [ P = .002]). All 4 PPMs demonstrated excellent intra- and intertest reliability (intraclass correlation coefficient, 0.83-0.99). STS5, FSST, and TSA were correlated highly ( r > 0.5) with physical function PRO instruments, including PROMIS PF, mHHS, and iHOT-12. Conclusion: Patients with symptomatic hip dysplasia demonstrated significant impairment on functional testing compared with asymptomatic controls, and performance measure testing demonstrated excellent test-retest reliability. Timed stair ascent and sit-to-stand testing in particular were correlated strongly with physical function PRO instruments. PPMs may be a viable and well-received adjuvant to PRO instrument administration for patients with nonarthritic hip conditions, and investigation of the ability of PPMs to assess surgical outcomes for hip dysplasia is warranted.

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Section: Discussionmentioning

confidence: 99%

Assessment of Disability Related to Hip Dysplasia Using Objective Measures of Physical Performance

Scott

Willey

Mercado

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…This protocol does not require equipment or time-consuming set-up and visual assessment of subject performance has been shown to be reliable. 20 To perform the SLST, a "T" (6" horizontal, 10" verti-…”

Section: Methodsmentioning

confidence: 99%

“…8,9 Excessive medial knee deviation (MKD) during the eccentric phase of the squat is a common finding 10,11 and is used as a marker of aberrant movement patterns in both visual rating scales [12][13][14][15][16] and kinematic measurements. 13,[17][18][19] The presence of increased MKD has been related to common lower extremity dysfunctions such as non-arthritic hip pain, 20 anterior knee pain, [21][22][23] and increased risk of noncontact ACL injury. 24,25 Clinicians [26][27][28] and reseachers 29,30 commonly associate excessive MKD with poor motor control of the muscular structures proximal to the knee joint.…”

Section: Introductionmentioning

confidence: 99%

The Single Leg Squat Test: A “Top-Down” or “Bottom-Up” Functional Performance Test?

Carroll

Kivlan

Martin

et al. 2021

International Journal of Sports Physical Therapy

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Background Medial knee deviation (MKD) during the single leg squat test (SLST) is a common clinical finding that is often attributed to impairments of proximal muscular structures. Investigations into the relationship between MKD and the foot and ankle complex have provided conflicting results, which may impact clinicians’ interpretation of the SLST. Purpose The purpose of this study was to compare ankle dorsiflexion range of motion (ROM) and foot posture in subjects that perform the SLST with MKD (fail) versus without MKD (pass). Hypothesis There will be a difference in ankle dorsiflexion ROM and/or foot posture between healthy individuals that pass and fail the SLST for MKD. Study Design Cross-sectional study. Methods Sixty-five healthy, active volunteers (sex = 50 female, 15 male; age = 25.2 +/- 5.6 years; height = 1.7 +/- .1 m; weight = 68.5 +/- 13.5 kg) who demonstrated static balance and hip abductor strength sufficient for performance of the SLST participated in the study. Subjects were divided into pass and fail groups based on visual observation of MKD during the SLST. Foot Posture Index (FPI-6) scores and measures of non-weight bearing and weight bearing active ankle dorsiflexion (ROM) were compared. Results There were 33 individuals in the pass group and 32 in the fail group. The groups were similar on age (p = .899), sex (p = .341), BMI (p = .818), and Tegner Activity Scale score (p = .456). There were no statistically significant differences between the groups on the FPI-6 (pass group mean = 2.5 +/- 3.9; fail group mean = 2.3 +/- 3.5; p = .599), or any of the measures of dorsiflexion range of motion (non-weight bearing dorsiflexion with knee extended: pass group = 6.9 o +/- 3.7 o , fail group = 7.8 o +/- 3.0 o ; non-weight bearing dorsiflexion with knee flexed: pass group = 13.5 o +/- 5.6 o , fail group = 13.9 o +/- 5.3 o ; weight bearing dorsiflexion: pass group = 42.7 o +/- 6.0 o , 42.7 o +/- 8.3 o , p = .611). Conclusions Failure on the SLST is not related to differences in clinical measures of active dorsiflexion ROM or foot posture in young, healthy individuals. These findings suggest that clinicians may continue using the SLST to assess neuromuscular performance of the trunk, hip, and knee without ankle dorsiflexion ROM or foot posture contributing to results. Level of Evidence Level 3.

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“…Interrater reliability using the Cohen κ assessed dichotomous results of a positive PART versus a negative PART, whereby κ ≥0.75 was considered excellent; between 0.75 and 0.40, moderate; and ≤0.40, poor. 2,15…”

Section: Methodsmentioning

confidence: 99%

“…2,15 RESULTSA total of 96 patients (190 hips) were included in this study (61 women and 35 men; average age, 32 ± 12.1 years; average body mass index [BMI], 26.2 ± 6.2 kg/m 2 ) (Table1). Of the total, 23 hips had a positive PART for both examiners, 158 hips had a negative PART for both examiners, and 9 hips had discordant results between examiners, with the extenders overcalling a positive PART 1.6% of the time relative to the surgeon.…”

mentioning

confidence: 99%

Interrater Reliability of the Prone Apprehension Relocation Test

Watchmaker

Hetzel

Sink

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The Prone Apprehension Relocation Test (PART) augments existing radiographic measures and clinical provocative maneuvers in diagnosing hip instability. One measure of the potential clinical utility of the PART depends on the reproducibility of test results by evaluating providers including physicians, licensed athletic trainers, and physical therapists. Purpose: To determine the interrater reliability of the PART among health care providers. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We retrospectively identified patients in our institution’s hip preservation registry who presented between September 2017 and June 2019 for evaluation of hip pain. Patients included in the study had the PART performed by a single physician as well as 1 of 12 physician extenders (a licensed athletic trainer or a physical therapist). The providers were blinded to the findings of the other examining professional. Interrater reliability was assessed using the Cohen κ (≥0.75 was considered excellent; between 0.75 and 0.40, moderate; and ≤0.40, poor). Results: A total of 96 patients (190 hips) were included in this study (61 women and 35 men, average age 32 ± 12.1 years). A total of 23 hips had a positive PART from both examiners. Interrater reliability was excellent between health care professionals for the PART when evaluating the right hip (κ = 0.80), left hip (κ = 0.82), and when combining the results for left and right (κ = 0.81). A subanalysis of patients with a positive PART from both raters demonstrated that 19 of the 23 hips had a lateral center-edge angle >25°. Conclusion: Our study demonstrated excellent interrater reliability of the PART, supporting its use in the physical evaluation of painful hips.

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Evidence for Reliability and Validity of Functional Performance Testing in the Evaluation of Nonarthritic Hip Pain

Cited by 19 publications

References 29 publications

Assessment of Disability Related to Hip Dysplasia Using Objective Measures of Physical Performance

Assessment of Disability Related to Hip Dysplasia Using Objective Measures of Physical Performance

The Single Leg Squat Test: A “Top-Down” or “Bottom-Up” Functional Performance Test?

Interrater Reliability of the Prone Apprehension Relocation Test

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