Reliability of goniometric and trigonometric techniques for measuring hip-extension range of motion using the modified Thomas test.

CONTEXT Goniometric assessment of hip-extension range of motion is a standard practice in clinical rehabilitation settings. A weakness of goniometric measures is that small errors in landmarking may result in substantial measurement error. A less commonly used protocol for measuring hip range of motion involves applying trigonometric principles to the length and vertical displacement of the upper part of the lower extremity to determine hip angle; however, the reliability of this measure has never been assessed using the modified Thomas test. OBJECTIVE To compare the intrarater and interrater reliability of goniometric (GON) and trigonometric (TRIG) techniques for assessing hip-extension range of motion during the modified Thomas test. DESIGN Controlled laboratory study. SETTING Institutional athletic therapy facility. PATIENTS OR OTHER PARTICIPANTS A total of 22 individuals (12 men, 10 women; age range, 18-36 years) with no pathologic knee or back conditions. MAIN OUTCOME MEASURE(S) Hip-extension range of motion of each participant during a modified Thomas test was assessed by 2 examiners with both GON and TRIG techniques in a randomly selected order on 2 separate days. RESULTS The intraclass correlation coefficient (ICC) revealed that the reliability of the GON technique was low for both the intrarater (ICC = 0.51, 0.54) and interrater (ICC = 0.30, 0.65) comparisons, but the reliability of the TRIG technique was high for both intrarater (ICC = 0.90, 0.95) and interrater (ICC = 0.91, 0.94) comparisons. Single-factorial repeated-measures analyses of variance revealed no mean differences in scoring within or between examiners for either measurement protocol, whereas a difference was observed when comparing the TRIG and GON tests due to the differences in procedures used to identify landmarks. CONCLUSIONS Using the TRIG technique to measure hip-extension range of motion during the modified Thomas test results in superior intrarater and interrater reliability when compared with the GON technique.

[1]  John D. Childs,et al.  Development of a clinical prediction rule for diagnosing hip osteoarthritis in individuals with unilateral hip pain. , 2008, The Journal of orthopaedic and sports physical therapy.

[2]  J. J. Gerhardt,et al.  Range-of-motion measurements. , 1995, The Journal of bone and joint surgery. American volume.

[3]  D. Cicchetti.  Guidelines, Criteria, and Rules of Thumb for Evaluating Normed and Standardized Assessment Instruments in Psychology. , 1994 .

[4]  R. Wainner,et al.  Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: a randomized clinical trial. , 2004, Physical therapy.

[5]  G. Bollini,et al.  Hip Flexion Contracture and Lumbar Spine Lordosis in Myelomeningocele , 2005, Journal of pediatric orthopedics.

[6]  C. Tinberg,et al.  The effects of two stretching procedures on hip range of motion and gait economy. , 1989, The Journal of orthopaedic and sports physical therapy.

[7]  Andrew D. Vigotsky,et al.  Acute effects of anterior thigh foam rolling on hip angle, knee angle, and rectus femoris length in the modified Thomas test , 2015, PeerJ.

[8]  R. Markert,et al.  Knee range of motion: reliability and agreement of 3 measurement methods. , 2011, American journal of orthopedics.

[9]  Caroline F. Finch,et al.  Reliability of common lower extremity musculoskeletal screening tests , 2004 .

[10]  J. M. Rothstein,et al.  Goniometric Reliability in a Clinical Setting , 1983 .

[11]  Robert E. Boyles,et al.  Development of a Clinical Prediction Rule to Identify Patients With Knee Pain and Clinical Evidence of Knee Osteoarthritis Who Demonstrate a Favorable Short-Term Response to Hip Mobilization , 2007, Physical Therapy.

[12]  A. Daluiski.  Validity of Goniometric Elbow Measurements: Comparative Study with a Radiographic Method , 2012 .

[13]  M. Tanigawa,et al.  Comparison of the hold-relax procedure and passive mobilization on increasing muscle length. , 1972, Physical therapy.

[14]  R. S. Ingber.  Iliopsoas myofascial dysfunction: a treatable cause of "failed" low back syndrome. , 1989, Archives of physical medicine and rehabilitation.

[15]  S. Bierma-Zeinstra,et al.  Comparison between two devices for measuring hip joint motions , 1998, Clinical rehabilitation.

[16]  Joan M. Walker,et al.  Straight-Leg-Raising Test , 1983 .

[17]  Jason D Peeler,et al.  Reliability limits of the modified Thomas test for assessing rectus femoris muscle flexibility about the knee joint. , 2008, Journal of athletic training.

[18]  D. Harvey.  Assessment of the flexibility of elite athletes using the modified Thomas test. , 1998, British journal of sports medicine.

[19]  J. M. Walker,et al.  Straight-leg-raising test. Comparison of three instruments. , 1983, Physical therapy.

[20]  R. Oostendorp,et al.  Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: a systematic review. , 2010, Journal of physiotherapy.

[21]  S. Stuckey,et al.  Reliability of measuring trunk motions in centimeters. , 1982, Physical therapy.

[22]  Phyllis A. Clapis,et al.  Reliability of inclinometer and goniometric measurements of hip extension flexibility using the modified Thomas test , 2008, Physiotherapy theory and practice.

[23]  G Atkinson,et al.  Statistical Methods For Assessing Measurement Error (Reliability) in Variables Relevant to Sports Medicine , 1998, Sports medicine.

[24]  Robert Riener,et al.  Robot-aided assessment of lower extremity functions: a review , 2016, Journal of NeuroEngineering and Rehabilitation.

[25]  Emiel van Trijffel,et al.  Inter-rater reliability for measurement of passive physiological range of motion of upper extremity joints is better if instruments are used: a systematic review. , 2010, Journal of physiotherapy.

[26]  J M Bland,et al.  Statistical methods for assessing agreement between two methods of clinical measurement , 1986 .