Reliability of the Ely's test for assessing rectus femoris muscle flexibility and joint range of motion

Abstract

Rehabilitative protocols and orthopadic research are significantly influenced by the ability to perform reliable measures of specific physical attributes or functions. The hypothesis was that the Ely's test for evaluating rectus femoris flexibility and joint range of motion (ROM) is a reliable clinical tool. Participants (n ¼ 54) were between the ages of 18 and 45, and had no history of trauma. Three clinicians with orthopedic expertise assessed quadriceps flexibility and joint ROM using pass/fail and goniometer scoring systems. A retest session was completed 7 to 10 days later. Statistically, Kappa values for pass/fail scoring (intrarater X ¼ 0.52, interrater X ¼ 0.46) and ICC values (intrarater X ¼ 0.69, interrater X ¼ 0.66) for goniometer data both indicated that the Ely's test demonstrated only moderate levels of intra-and interrater reliability. Measurement error values (SEM ¼ 48, ME ¼ 48, and CV ¼ 3%) and Bland and Altman plots (with 95% Limits of Agreement) further demonstrated the degree of intrarater variance for each examiner when executing the Ely's test in a clinical setting. Results call into question the statistical reliability of the Ely's test, and provide clinicians with important information regarding the reliability limits of the Ely's test when used to clinically evaluate flexibility and joint ROM in a physically active population. More research is required to determine the variables that may confound statistical reliability of this orthopedic technique that is commonly used in a clinical setting to assess function about the thigh region. ß

Intra-Rater Test-Retest Reliability of Ely's Test Using Smartphone in Patients With Lumbar Extension-Rotation Syndrome

“…Whenever the subjects performed the Ely's test, they found difficulty in performing a regular amount of neutral pelvic and hip position by themselves in each session, indicating the reliability limit identified in the previous study (Peeler and Anderson, 2008). Additionally, different results were obtained because the time to stop the passive knee flexion by an examiner was ambiguous during Ely's test when using subjective visual observation (VO) (Peeler and Anderson, 2008).…”

“…Ely's test is commonly performed by clinicians to examine the flexibility of the rectus femoris muscle in clinical rehabilitation (Peeler and Anderson, 2008). The face validity of Ely's test is confirmed by prominent textbook on orthopedic physical measurement, as is its usefulness as an assessment tool regarding the thigh region (Magee, 2005).…”

“…If the anterior pelvic tilt or hip flexion occurs during passive prone knee flexion by an examiner, this can indicate that the rectus femoris is tight (Magee, 2005). However, a recent study demonstrated the reliability limits of the knee's active range of motion (ROM) using Ely's test to quantify the rectus femoris flexibility (Peeler and Anderson, 2008). The subjects in the previous study were instructed to maintain a neutral pelvic posture and contact the anterior aspect of the hip on the table without any motions of the hip and pelvis while performing active prone knee flexion (Peeler and Anderson, 2008).…”

“…However, a recent study demonstrated the reliability limits of the knee's active range of motion (ROM) using Ely's test to quantify the rectus femoris flexibility (Peeler and Anderson, 2008). The subjects in the previous study were instructed to maintain a neutral pelvic posture and contact the anterior aspect of the hip on the table without any motions of the hip and pelvis while performing active prone knee flexion (Peeler and Anderson, 2008). Whenever the subjects performed the Ely's test, they found difficulty in performing a regular amount of neutral pelvic and hip position by themselves in each session, indicating the reliability limit identified in the previous study (Peeler and Anderson, 2008).…”

“…The subjects in the previous study were instructed to maintain a neutral pelvic posture and contact the anterior aspect of the hip on the table without any motions of the hip and pelvis while performing active prone knee flexion (Peeler and Anderson, 2008). Whenever the subjects performed the Ely's test, they found difficulty in performing a regular amount of neutral pelvic and hip position by themselves in each session, indicating the reliability limit identified in the previous study (Peeler and Anderson, 2008). Additionally, different results were obtained because the time to stop the passive knee flexion by an examiner was ambiguous during Ely's test when using subjective visual observation (VO) (Peeler and Anderson, 2008).…”