Original researchReliability of common lower extremity musculoskeletal screening tests
Introduction
Pre-participation or pre-season screening is commonly adopted to identify intrinsic risk factors in sports participants (McKeag, 1985, Harvey, 1998). Screening protocol tests are primarily chosen to address potential risk factors for the specific injury profile of a sport and are generally based on clinical experience due to the paucity of quality injury risk factor studies in sport. Unfortunately, the reliability of many of these common clinical assessment tools has not been established. For musculoskeletal screening to be effective, it is vital that the testing procedures used are reliable, valid and simple to reproduce across a range of sports participants. Establishing the reliability of commonly used clinical assessment tests could progress the development of standardised musculoskeletal screening and profiling programmes in sport which, in turn can provide the basis for identifying sports injury risk factors.
Australian football is a sport for which the injury pattern is well described (Seward et al., 1993, Gabbe and Finch, 2001, Gabbe et al., 2002, Orchard and Seward, 2002) but little progress has been made towards identifying injury risk factors. Pre-season screening has been proposed as a potential injury countermeasure in Australian football (Gabbe & Finch, 2000) and, at the elite-level of this sport, pre-season screening of participants is widespread. Whilst screening guidelines have been developed for Olympic sports in Australia (Grant et al., 1998), none have been developed for Australian football. A survey of members of the Australian Football League Physiotherapists' Association during 1999 was undertaken to establish the musculoskeletal screening tests most commonly used in the pre-season screening protocols of elite Australian football clubs (Gabbe et al., unpublished). Whilst the list of tests performed at the clubs was extensive, a number of tests were common to the majority of clubs. The most commonly reported tests were the Modified Thomas Test (MTT), Passive Straight Leg Raise (PSLR), Active Knee Extension (AKE), Sit and Reach and the active slump test. Despite their description in the international literature, there is a paucity of reliability data published for these tests. Previous studies have assessed the test–retest reliability of the MTT (Harvey, 1998) and the Sit and Reach test (Sai-Chuen Hui & Yuen, 2000) but did not describe the inter-tester reliability of these tests. Two studies have found the AKE to be reliable (Gajdosik and Lusin, 1983, Sullivan et al., 1992), though each study used a methodology different to that described in the survey of AFL clubs. The reliability of the PSLR and the active slump test has not been reported in the literature. In addition to these tests, AFL clubs commonly reported measurement of lumbar spine extension and hip rotation range of movement (ROM) as part of their screening protocols. However, a consistent methodology was not used.
This paper establishes the inter-tester and test–retest reliability of eight clinical assessment tools commonly used in the pre-season musculoskeletal screening protocols of elite Australian football clubs.
Section snippets
Raters
Two raters were recruited to perform the testing of participants. Rater A was a postgraduate research student with experience in musculoskeletal screening of research participants whilst Rater B was a qualified physiotherapist with 7 years of clinical experience. The raters were chosen to reflect a range of clinical and measurement experience. The raters were trained by the first author over two sessions to ensure that uniform methodology was used throughout the screening procedures.
Participants
Fifteen
Inter-tester reliability
For inter-tester reliability, the results of Raters A and B from the first testing session were compared. Table 1 shows the results of these comparisons.
With the exception of the MTT (quadriceps), there was no significant difference between the raters for each of the musculoskeletal tests. However, the difference between the means of the raters for this test was very small (3°) and within the 95% CI of the SEM for this test. Inter-rater reliability for each of the tests was very good to
Discussion
The tests chosen for evaluation in this study are clinical measurement tools, commonly used in pre-season screening of Australian football players and other athletes, rather than laboratory-based tests. These clinical measures are simple to perform, can be performed at various locations, and require minimal and inexpensive equipment. Therefore, these tests are ideal for the screening of athletes in the field. The disadvantage of using such simple clinical measures in these settings is the
Conclusion
This study has shown that simple, commonly used clinical measures of flexibility and ROM are reliable. Hence, the use of these tests is recommended for use in pre-season or pre-participation screening protocols for sports participants.
Acknowledgements
This project was partially supported by a research grant from the Australian Physiotherapy Association (Victorian Branch). The staff and postgraduate students of The University of Melbourne, School of Physiotherapy are thanked for their participation in this study. Belinda Gabbe was supported by a Public Health Fellowship from the National Health and Medical Research Council during the preparation of this manuscript.
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