Interrater Reliability of the Prone Apprehension Relocation Test

Abstract

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.

Prone Apprehension Relocation Test significantly correlates with radiological instability scores of the hip

“…Thus, there is a bias with regard of the interpretation and assessability of the PART result. However, a recent study demonstrated a high inter- and intraobserver reliability regarding the PART interpretation [ 19 ], so that we consider this bias as low. It should also be noted that the study was performed in a high-volume center, so that a high number of dysplastic hips were included in the patient population.…”

“…A very recently described clinical test for the detection of hip instability is the Prone Apprehension Relocation Test (PART) [ 18 , 19 ]. A correlation between anterior undercoverage detected by computed tomography (CT) and a positive Part was demonstrated, as PART-positive patients had significantly more acetabular anteversion at the 3 o’clock position [ 18 ].…”