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

RobRoy L. Martin, Jon K. Sekiya

DOI: 10.2519/jospt.2008.2677

STUDY DESIGN: Descriptive and reliability study. OBJECTIVES: To evaluate the interrater reliability of the FABER test, flexion-internal rotation-adduction 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 subjects were 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 (κ) coefficients with 95% confidence intervals (CI) were as follows: FABER test κ was 0.63 (95% CI: 0.43-0.83); flexion-internal rotation-adduction impingement test κ was 0.58 (95% CI: 0.29-0.87); log roll test κ was 0.61 (95% CI: 0.41-0.81); and greater trochanteric tenderness κ 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.

J Orthop Sports Phys Ther. 2008;38(2):71-77, published online 21 September 2007. doi:10.2519/jospt.2008.2677

KEY WORDS: agreement, examination, kappa, reproducibility

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. The authors evaluate the interrater reliability of the FABER test, flexion-internal rotation-adduction impingement test, log roll test, and the palpation of the greater trochanter for tenderness.

View Full Article