STUDY DESIGN: Reliability study. OBJECTIVES: To determine intrarater test-retest and interrater reliability of the Functional Movement Screen (FMS) among novice raters. BACKGROUND: The FMS is used by various examiners to assess movement and predict time-loss injuries in diverse populations (eg, youth to professional athletes, firefighters, military service members) of active participants. Unfortunately, critical analysis of the reliability of the FMS is currently limited to 1 sample of active college-age participants. METHODS: Sixty-four active-duty service members (mean ± SD age, 25.2 ± 3.8 years; body mass index, 25.1 ± 3.1 kg/m²) without a history of injury were enrolled. Participants completed the 7 component tests of the FMS in a counterbalanced order. Each component test was scored on an ordinal scale (0 to 3 points), resulting in a composite score ranging from 0 to 21 points. Intrarater test-retest reliability was assessed between baseline scores and those obtained with repeated testing performed 48 to 72 hours later. Interrater reliability was based on the assessment from 2 raters, selected from a pool of 8 novice raters, who assessed the same movements on day 2 simultaneously. Descriptive statistics, weighted kappa (κ_w), and percent agreement were calculated on component scores. Intraclass correlation coefficients (ICCs), standard error of the measurement, minimal detectable change (MDC₉₅), and associated 95% confidence intervals (CIs) were calculated on composite scores. RESULTS: The average ± SD score on the FMS was 15.7 ± 0.2 points, with 15.6% (n = 10) of the participants scoring less than or equal to 14 points, the recommended cutoff for predicting time-loss injuries. The intrarater test-retest and interrater reliability of the FMS composite score resulted in an ICC_3,1 of 0.76 (95% CI: 0.63, 0.85) and an ICC_2,1 of 0.74 (95% CI: 0.60, 0.83), respectively. The standard error of the measurement of the composite test was within 1 point, and the MDC₉₅ values were 2.1 and 2.5 points on the 21-point scale for interrater and intrarater reliability, respectively. The interrater agreement of the component scores ranged from moderate to excellent (κ_w = 0.45-0.82). CONCLUSION: Among novice raters, the FMS composite score demonstrated moderate to good interrater and intrarater reliability, with acceptable levels of measurement error. The measures of reliability and measurement error were similar for both intrarater reliability that repeated the assessment of the movement patterns over a 48-to-72–hour period and interrater reliability that had 2 raters assess the same movement pattern simultaneously. The interrater agreement of the FMS component scores was good to excellent for the push-up, quadruped, shoulder mobility, straight leg raise, squat, hurdle, and lunge. Only 15.6% (n = 10) of the participants were identified to be at risk for injury based on previously published cutoff values.

J Orthop Sports Phys Ther 2012;42(6):530-540, Epub 14 May 2012. doi:10.2519/jospt.2012.3838

KEY WORDS: injury prediction, injury prevention, injury risk, interrater, intrarater

STUDY DESIGN: Secondary analysis of a randomized clinical trial (RCT). OBJECTIVES: To perform a secondary analysis on the treatment arm of a larger RCT to determine differences in treatment outcomes, adverse reactions, and effect sizes between patients who received cervical thrust manipulation and those who received only nonthrust manipulation as part of an impairment-based, multimodal treatment program of manual physical therapy (MPT) and exercise for patients with mechanical neck pain. BACKGROUND: A treatment regimen of MPT and exercise has been effective in patients with mechanical neck pain. Limited research has compared the effectiveness of cervical thrust manipulations and nonthrust mobilizations for this patient population, and no studies have investigated the added benefit of cervical thrust manipulations as part of an overall MPT treatment plan. METHODS: Treatment outcomes from 47 patients in the treatment arm of a larger RCT, with a primary complaint of mechanical neck pain, were analyzed. Twenty-three patients (49%) received cervical thrust manipulations as part of their MPT treatment, and 24 patients (51%) received only cervical nonthrust mobilizations. All patients received up to 6 clinic sessions, twice weekly for 3 weeks, and a home exercise program. Primary outcome measures were the Neck Disability Index (NDI), 2 visual analog scales for cervical and upper extremity pain, and a 15-point global rating of change scale. Blinded outcome measurements were collected at baseline and at 3-, 6- and 52-week follow-ups. RESULTS: Consistent with the larger RCT, both subgroups in this secondary analysis demonstrated improvement in short- and long-term pain and disability scores. Low statistical power (β≤.28) and the resultant small effect size indices (–0.21 to 0.17) preclude the identification of any between-group differences. No serious adverse reactions were reported by patients in either subgroup. CONCLUSIONS: Clinically meaningful and statistically significant improvements in both subgroups of patients over time suggest that cervical thrust manipulation, as part of the MPT treatment plan, did not influence the results of the treatment arm of the larger RCT from which this study was drawn. Although no between-group differences can be identified, the small observed effect sizes in this study may benefit future studies with sample size estimation for larger RCTs and indicate the need to incorporate clinical prediction rule criteria as a means to improve statistical power. LEVEL OF EVIDENCE: Therapy, level 4.

J Orthop Sports Phys Ther 2010;40(3):133-140, Epub 5 February 2010. doi:10.2519/jospt.2010.3106

Study Design: Case series. Objective: To describe an impairment-based physical therapy treatment approach for 4 patients with plantar heel pain. Background: There is limited evidence from clinical trials on which to base treatment decision making for plantar heel pain. Methods and Measures: Four patients completed a course of physical therapy based on an impairment-based model. All patients received manual physical therapy and stretching. Two patients were also treated with custom orthoses, and 1 patient received an additional strengthening program. Outcome measures included a numeric pain rating scale (NPRS) and self-reported functional status. Results: Symptom duration ranged from 6 to 52 weeks (mean duration ± SD, 33 ± 19 weeks). Treatment duration ranged from 8 to 49 days (mean duration ± SD, 23 ± 18 days), with number of treatment sessions ranging from 2 to 7 (mode, 3). All 4 patients reported a decrease in NPRS scores from an average (± SD) of 5.8 ± 2.2 to 0 (out of 10) during previously painful activities. Additionally, all patients returned to prior activity levels. Conclusion: In this case series, patients with plantar heel pain treated with an impairment-based physical therapy approach emphasizing manual therapy demonstrated complete pain relief and full return to activities. Further research is necessary to determine the effectiveness of impairment-based physical therapy interventions for patients with plantar heel pain/plantar fasciitis.

J Orthop Sports Phys Ther. 2004;34(11):725-733. doi:10.2519/jospt.2004.1506

Key Words: ankle, manipulation, mobilization, plantar fasciitis

Study Design: Clinical case report. Objectives: To describe a manual physical therapy examination and intervention approach for a patient with radial-sided wrist pain. Background: A 55-year-old woman with a 2-year history of chronic right wrist and forearm pain was referred to physical therapy with a diagnosis of de Quervain’s disease. Her current symptoms were present for 6 weeks despite primary care management with wrist splinting and medications. Previous episodes were partially resolved following occupational therapy treatments. Methods and Measures: Examination of the patient’s wrist and hand revealed isolated radiocarpal, intercarpal, and carpometacarpal joint dysfunctions. Evaluation of the cervical spine, shoulder, and elbow were negative. Impairment-based treatment was provided during 8 visits over a 4-week period. These treatments consisted of manual physical therapy techniques and self-mobilizations applied to the radiocarpal, intercarpal, and carpometacarpal joints. Results: The initial treatment session decreased the patient’s numeric pain rating scale (NPRS) from 7/10 to 4/10 and improved her functional rating on the Patient-Specific Functional Scale (PSFS) from an average of 4/10 to 8.2/10. At treatment completion, she achieved a pain-free state (NPRS, 0/10) and nearly full function (PSFS, 9.8/10). These results were maintained at a long-term follow-up performed 10 months after treatment. Conclusion: Several diagnoses have the potential for causing or referring pain into the radial wrist and forearm region, often times mimicking de Quervain’s disease. An impairment-based manual physical therapy model may be an effective approach in identifying joint dysfunctions and managing patients with radial wrist pain.

J Orthop Sports Phys Ther. 2004;34(12):761-769. doi:10.2519/jospt.2004.1504

Key Words: de Quervain’s disease, impairment-based, manipulation, mobilization

Clinicians often rely on visual inspection and descriptive terms to document a patient's forward shoulder posture. The purpose of this study was to assess the validity and intrarater reliability of 4 objective techniques to measure forward shoulder posture. Subjects were 25 males and 24 females. Subjects had a lateral cervical spine radiograph taken, from which the horizontal distance from the C7 spinous process to the anterior tip of the left anterior acromion process was measured. Subjects then proceeded twice through a random order of 4 measurements: the Baylor square, the double square, the Sahrmann technique, and scapular position. These results were then used to determine the intrarater reliability of each technique. Multiple regression analyses were performed on each measure's mean scores to determine both the correlation with and the predictive value for the radiographic measurement. The intraclass correlation coefficients for intrarater reliability ranged from .89 to .91. The correlation coefficients ranged from -.33 to .77, and the coefficients of determination ranged from .10 to .59 (N = 49). The researchers demonstrated clinical reliability for each technique; however, validity compared with the radiographic measurement could not be established. These techniques may have clinical value in objectively measuring change in a patient's shoulder posture as a result of a treatment program. Before any of these measures could be universally recommended in clinical practice, future research is necessary to establish interrater reliability and assess each technique's ability to detect postural changes over time.

J Orthop Sports Phys Ther. 1997;25(1):34-42.

Key Words: shoulder, posture, method