Study Design: Prospective methodological study of repeated measures using a sample of consecutive patients. Objective: To determine the test-retest reliability and responsiveness of the Anterior Knee Pain Scale (AKPS) and the Lower Extremity Functional Scale (LEFS) in patients with anterior knee pain. Background: Anterior knee pain is one of the most common orthopedic complaints affecting the knee. Yet there is currently no self-report outcome measure that has well-established reliability and responsiveness, specifically for this population. As a result, clinicians and researchers may be making inappropriate conclusions regarding patient outcomes by using questionnaires that are misleading. Methods and Measures: This multisite study involved 30 patients from 4 outpatient physical therapy clinics in Dallas, TX (24 women, 6 men; age range, 16-50 years; mean ± SD age, 35.2 ± 9.1 years). Patients receiving physical therapy for a chief complaint of anterior knee pain completed the AKPS and LEFS at their initial appointment and again 2 to 3 days later. Upon completion of physical therapy, the patients completed the AKPS, LEFS, and a global rating of change form. The treating therapist also completed a global rating of change form at the patient’s final visit. The mean of the patient’s and therapist’s global rating of change was used as the criterion measure of change. Results: Test-retest reliability was high for both questionnaires (ICC_2,1 = 0.95 for the AKPS and 0.98 for the LEFS). A significant correlation was found between the criterion measure of change and both questionnaires. Receiver-operating characteristic curve analysis revealed that both questionnaires were moderately responsive with the area under the curve slightly higher for the LEFS (0.77) than the AKPS (0.69). Conclusion: The LEFS and the AKPS both demonstrated high test-retest reliability and appear to be moderately responsive to clinical change in patients with anterior knee pain. Reliability and responsiveness were slightly higher in the LEFS than the AKPS. Further research is needed to determine if these measures could be modified, or new measures created, to produce an even more sensitive tool for this population.

J Orthop Sports Phys Ther. 2005;35(3):136-146. doi: 10.2519/jospt.2005.1403

Key Words: iliotibial band syndrome, outcome measures, patellofemoral pain syndrome, patellar tendinitis

Study Design: Test-retest reliability study with blinded testers. Objectives: To determine the intratester reliability of the McConnell classification system and to determine whether the intertester reliability of this system would be improved by one-on-one training of the testers, increasing the variability and numbers of subjects, blinding the testers to the absence or presence of patellofemoral pain syndrome, and adhering to the McConnell classification system as it is taught in the "McConnell Patellofemoral Treatment Plan" continuing education course. Background: The McConnell classification system is currently used by physical therapy clinicians to quantify static patellar orientation. The measurements generated from this system purportedly guide the therapist in the application of patellofemoral tape and in assessment of the efficacy of treatment interventions on changing patellar orientation. Methods and Measures: Fifty-six subjects (age range, 21-65 years) provided a total of 101 knees for assessment. Seventy-six knees did not produce symptoms. A researcher who did not participate in the measuring process determined that 17 subjects had patellofemoral pain syndrome in 25 knees. Two testers concurrently measured static patellar orientation (anterior/posterior and medial/lateral tilt, medial/lateral glide, and patellar rotation) on subjects, using the McConnell classification system. Repeat measures were performed 3-7 days later. A kappa (K) statistic was used to assess the degree of agreement within each tester and between testers. Results: The K coefficients for intratester reliability varied from -0.06 to 0.35. Intertester reliability ranged from -0.03 to 0.19. Conclusion: The McConnell classification system, in its current form, does not appear to be very reliable. Intratester reliability ranged from poor to fair, and intertester reliability was poor to slight. This system should not be used as a measurement tool or as a basis for treatment decisions.

J Orthop Sports Phys Ther. 1999;29(7):378-385,386-393.

Key Words: classification systems, patellofemoral alignment, reliability