Reliability and Agreement of Hip Range of Motion and Provocative Physical Examination Tests in Asymptomatic Volunteers

Abstract

Objective The objectives of this study are the following: 1) report passive hip ROM in asymptomatic young adults, 2) report the intra-tester and inter-tester reliability of hip ROM measurements among testers of multiple disciplines, 3) report the results of provocative hip tests and tester agreement. Design descriptive epidemiology study Setting tertiary university Participants Twenty-eight young adult volunteers without musculoskeletal symptoms, history of disorder or surgery involving the lumbar spine or lower extremities were enrolled and completed the study. Methods Asymptomatic young adult volunteers completed questionnaires and were examined by two blinded examiners during a single session. The testers were physical therapists and physicians. Hip range of motion and provocative tests were completed by both examiners on each hip. Main Outcome Measurements Inter and intra-rater reliability for ROM and agreement for provocative tests was determined. Results Twenty-eight asymptomatic adults with mean age 31 years old (range 18–51 years) and mean modified Harris Hip Score of 99.5 ± 1.5 and UCLA Activity score of 8.8 ± 1.2 completed the study. Intra-rater agreement was excellent for all hip range of motion measurements, with intraclass correlation coefficients (ICCs) ranging from 0.76 to 0.97 with similar agreement if the examiner was a physical therapist or a physician. Excellent inter-rater reliability was found for hip flexion ICC 0.87 (95% CI 0.78 to 0.92), supine internal rotation ICC 0.75 (95% CI 0.60 to 0.84) and prone internal rotation ICC 0.79 (95% CI 0.66 to 0.87). The least reliable measurements were supine hip abduction (ICC 0.34) and supine external rotation (ICC 0.18). Agreement between examiners ranged from 96–100% for provocative hip tests which included the hip impingement, resisted straight leg raise, FABER/Patrick’s and log roll tests. Conclusions Specific hip ROM measures show excellent inter-rater reliability and provocative hip tests show good agreement among multiple examiners and medical disciplines. Further studies are needed to assess the utilization of these measurements and tests as a part of a hip screening examination to assess for young adults at risk intra-articular hip disorders prior to the onset of degenerative changes.

Relative Femoral Neck Lengthening Improves Pain and Hip Function in Proximal Femoral Deformities With a High-riding Trochanter

“…Different observers assessed the clinical outcomes throughout the preoperative and followup visits, resulting in potential assessment bias. However, substantial interobserver agreement has been found for these clinical parameters [7,12,22,24,33,34]. In contrast, a single observer evaluated the radiographic outcome.…”

“…Hip pain and function were assessed preoperatively and at most recent followup using the following parameters: anterior and posterior impingement tests (positive/negative) [43], limp (positive/negative), abductor strength (proportion of hips with abduction force M5 according to the British Medical Research Council [27]), full ROM (degrees of flexion/ extension; adduction/abduction; internal/external rotation), and the Merle d'Aubigné-Postel scoring system (worst-best score of 3-18 points; Table 2) [28]. Substantial inter-and intraobserver agreement has been reported for anterior and posterior impingement tests [24,34], abductor strength [12], full ROM [7,33], and the Merle d'Aubigné-Postel scoring system [22]. At latest followup, additional hip scores were assessed including the WOMAC [4], Harris hip score [20], SF-12 physical and mental component scales [13,45], and the UCLA activity scores [47].…”

Does Surgical Hip Dislocation and Periacetabular Osteotomy Improve Pain in Patients With Perthes-like Deformities and Acetabular Dysplasia?

“…Preoperative and postoperative HHS were available on all patients, whereas the UCLA activity score was available preoperatively and postoperatively in 14 of 16 patients. ROM was measured by one of the senior authors (JCC) [27].…”

Are There Sex-dependent Differences in Acetabular Dysplasia Characteristics?

“…All 180 patients who participated in the study had demographic data including sex, height, weight, BMI, and age at the time of surgery. All of the patients had a standard evaluation of bilateral hips, while in the supine position, for the endpoints to ROM, performed by one examiner (JCC) [32]. The patients were tested for ROM in flexion and flexion (90°) with internal rotation.…”