The Interrater Reliability of 4 Clinical Tests Used to Assess Individuals With Musculoskeletal Hip Pain

Abstract

STUDY DESIGN:Descriptive and reliability study. OBJECTIVES:To evaluate the interrater reliability of the FABER test, flexion-internal rotationadduction impingement test, log roll test, and the palpation of the greater trochanter for tenderness. BACKGROUND:Clinical examination for individuals with musculoskeletal hip pain is believed to provide critical diagnostic information. However, there is very limited information in the literature on the reproducibility of examination techniques for the hip region. METHODS AND MEASURES: Seventy subjectswere evaluated prospectively by an orthopaedic surgeon and physical therapist. Subjects had a mean age of 42 years (range, 18-76 years; SD, 15.4) and included 32 (46%) females and 38 (54%) males. Subject diagnoses were as follows: degenerative joint disease (n = 27 [39% of subjects]), labral tear (n = 35 [50% of subjects]), femoroacetabular impingement (n = 48 [69% of subjects]), capsular laxity (n = 28 [40% of subjects]), trochanteric bursitis (n = 29 [41% of subjects]), iliopsoas tendonitis (n = 10 [14% of subjects]), and adductor strain (n = 2 [3% of subjects]). Subjects could have more than 1 diagnosis. Kappa, prevalence indexes, bias indexes, and maximal attainable kappa were calculated. RESULTS:Kappa ( ) coefficients with 95% confidence intervals (CI) were as follows: FABER test was 0.63 (95% CI: 0.43-0.83); flexion-internal rotation-adduction impingement test was 0.58 (95% CI: 0.29-0.87); log roll test was 0.61 (95% CI: 0.41-0.81); and greater trochanteric tenderness was 0.66 (95% CI: 0.48-0.84). Bias indexes were low (0.06-0.08) for all 4 tests, while prevalence indexes were low (0.03-0.37) for 3 of the 4 tests. The flexion-internal rotation-adduction impingement test had a high prevalence index (0.76), with a higher proportion of positive tests. CONCLUSION:The kappa values for the FABER test, log roll test, and assessment of greater trochanteric tenderness were greater than 0.40 (fair level of agreement) at a 95% confidence level. The low reliability obtained for the flexion-internal rotation-adduction impingement test may be related to a prevalence concern.

Clinimetric properties of observer‐assessed impairment tests used to evaluate hip and groin impairments: A systematic review

“…Six different physical impairments were investigated. Nine studies investigated ROM (27)(28)(29)(30)(31)(32)(33)(34)(35), 6 studies measured muscle strength (12,29,31,36 -38), and 3 studies measured tenderness (11,29,36). Two studies each measured LLD (29,39), balance testing (33,37), and muscle length/flexibility (12,36).…”

“…Nine of the 15 studies included participants with hip OA (27,29 -32,34,35,38,39), and 2 studies each examined hip fractures (33,37), groin pain (12,36), and mixed samples of hip/groin diagnoses (11,28). Eleven studies investigated reliability (11,12,28 -34,36,37), 3 studies investigated validity (27,34,35,39), 1 study investigated internal consistency (38), and 1 study investigated both reliability and validity (34).…”

“…Interrater reliability for assessing tenderness of soft tissue and bony structures in response to combined hip movements and palpation was reported in 3 studies (11,29,36). One study was good quality in people with mixed hip-related pathologies (11).…”

“…Interrater reliability for assessing tenderness of soft tissue and bony structures in response to combined hip movements and palpation was reported in 3 studies (11,29,36). One study was good quality in people with mixed hip-related pathologies (11). Results of tenderness in response to the FABER test, log roll test (external rotation in supine position), and palpation of the greater trochanter were positive ( ϭ 0.61-0.66) (11).…”

“…One study was good quality in people with mixed hip-related pathologies (11). Results of tenderness in response to the FABER test, log roll test (external rotation in supine position), and palpation of the greater trochanter were positive ( ϭ 0.61-0.66) (11). Results for the impingement test (flexion/adduction/internal rotation) were indeterminate ( ϭ 0.58) (11).…”