Reliability of common lower extremity musculoskeletal screening tests

Belinda J. Gabbe, Kim L. Bennell, Henry Wajswelner and Caroline F. Finch

Physical Therapy in Sport

May 2004, Vol 5, Issue 2, pages 90-97.

The purpose of this study was to establish the reliability of eight, musculoskeletal screening tests, commonly used in the screening protocols of elite-level Australian football clubs. The Australian researchers recruited fifteen participants (9 female, 6 male) who were tested by two raters, on two occasions, 1 week apart. This was to establish the inter-rater reliability (reliability between different testers) and test–retest reliability (reliability between test sessions) of the chosen measurement tools.

The methodology employed by the authors was sound, although more subjects (who were elite level Australian football players) would have added power to the findings of the study. Similarly, in the case of inter-rater reliability measures more testers would have been preferable.

The tests of interest were all soft tissue extensibility tests with emphasis on specific muscles, namely Sit and Reach, Active Knee Extension, Passive Straight Leg Raise, slump, active hip internal rotation range of movement (ROM), active hip external rotation ROM, lumbar spine extension ROM and the Modified Thomas Test. Imbalance of soft tissue extensibility has been implicated as an injury risk factor by numerous authors, so it is important that clinical measures of this variable are reliable in the population they are designed for.

Statistical analysis was performed to compare the differences between the results of raters for each of the measurement tools and to compare the differences between the first and second testing sessions for both raters. For seven of the eight tests there was no significant difference between the raters for each of the musculoskeletal tests. Similarly, both testers displayed no significant difference for seven of the eight techniques that were subject to test re-test analysis.

The authors concluded that these simple clinical measures have good to excellent test–retest and intra-rater reliability. The measures are simple to perform, can be performed at various locations, and require minimal and inexpensive equipment. The authors, therefore, advocate that these tests are ideal for the screening of athletes in the field. One threat to using such simple clinical measures in these settings is the possibility of a reduction in reliability – a fear that is allayed to some extent by this study.

Gabbe et al correctly stated that validity of these tests as injury risk predictors was not assessed by this study and that no conclusions can be drawn regarding their usefulness for predicting athletes at higher risk of injury. This is the next stage of the research process.

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