[논문]Intra-Rater Test-Retest Reliability of Ely's Test Using Smartphone in Patients With Lumbar Extension-Rotation Syndrome

Park, Kyue-Nam; Ha, Sung-Min; Chung, Sung-Dae; Kim, Si-Hyun; Jang, Jun-Hyeok

doi:10.12674/ptk.2012.19.4.046

[국내논문] Intra-Rater Test-Retest Reliability of Ely's Test Using Smartphone in Patients With Lumbar Extension-Rotation Syndrome 원문보기

한국전문물리치료학회지 = Physical Therapy Korea, v.19 no.4, 2012년, pp.46 - 54

Park, Kyue-Nam (Dept. of Physical Therapy, The Graduate School, Yonsei University) , Ha, Sung-Min (Laboratory of Kinetic Ergocise based on Movement Analysis) , Chung, Sung-Dae (Dept. of Physical Therapy, The Graduate School, Yonsei University) , Kim, Si-Hyun (Dept. of Physical Therapy, The Graduate School, Yonsei University) , Jang, Jun-Hyeok (Haeundae Jaseng Hospital of Oriental Medicine)

Abstract ▼ AI-Helper

Ely's test is commonly used to assess rectus femoris muscle flexibility. however, a reliability limit of this test was demonstrated by a previous study. In this study, we present an alternative method using an application for a digital horizontal level in a smartphone (DHLS) to complement the reliability limit of Ely's test. The aim of this study was to examine the reliability of Ely's test using DHLS on the pelvis, compared to using visual observation (VO) of pelvic and hip motions. Nineteen patients with lumbar extension-rotation syndrome were recruited for this study. An examiner examined the rectus femoris flexibility (both pass/fail and goniometer scoring) through Ely's test using both DHLS and VO. A retest session was completed two hours later for within-day reliability and seven days later for between-day intra-rater test-retest reliability. Results showed higher Kappa values for pass/fail scoring and higher intraclass correlation coefficient values for goniometer scoring in Ely's test using DHLS, compared to using VO. Measurement error and Bland and Altman plots further demonstrated the degree of intra-rater variance during Ely's test using DHLS in a clinical setting, compared to using VO. These results demonstrated that Ely's test using DHLS showed acceptable reliability compared to using VO. Ely's test using DHLS could be widely used for measuring the rectus femoris muscle flexibility in patients with lumbar extension-rotation syndrome, although the inter-rater reliability needs to be established first.

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문제 정의

The purpose of this investigation was to test the hypothesis that the Ely’s test using DHLS provides more acceptable reliability of rectus femoris muscle flexibility and joint ROM than Ely’s test using VO of pelvic and hip movements.
This is the first study to examine the intra-rater reliability of assessment of rectus femoris muscle flexibility through Ely’s test using DHLS in patients with lumbar extension-rotation syndrome.

제안 방법

To develop the reliability of Ely’s test, Peeler and Anderson (2008) pointed out the need for an alternative method in further studies. Therefore, our study would use an application for a digital horizontal level in a smartphone (DHLS) on the pelvis as an alternative method. Smartphones and applications are popular among clinicians and can be easily used for assessment of the ROM of shoulder and knee joints (Rosser and Eccleston, 2011; Shin et al, 2012).
To classify the lumbar extension-rotation syndrome, we used the evaluation methodology proposed by Sahrmann (2002) and Maluf et al (2000). This classification method consists of alignment and movement tests. The principal investigator performed classification using criteria proposed by Sahrmann (2002).
The subject characteristics are presented in Table 1. Before this study, the principal investigator explained all of the procedures to the subjects in detail and all subjects signed an informed consent form.
Before starting the Ely’s test for assessing pass/fail and knee joint ROM, we determined the resting prone position of the pelvis as a neutral position subjectively and calibrated the DHLS to zero point at the starting position of each session.
To examine the pass/fail and goniometer score using VO of Ely’s test, all procedures were the same except for the use of the DHLS.
To examine the goniometer score, the examiner assessed knee joint ROM when spontaneous hip flexion and pelvic motion occurred. We examined the two methods (DHLS and VO) randomly.

대상 데이터

Assessment took place in a work-conditioning center located in Korea. An examiner in this study had six years experience of assessment and treatment in musculoskeletal disorders and often uses the Ely’s test for evaluating patients with LBP.
For this study, 19 men (40.2±3.17 years) with lumbar extension-rotation syndrome were recruited from 28 subjects diagnosed with work-related mechanical chronic LBP at work-conditioning centers in Korea (Figure 1).

이론/모형

The examiner decided pass/fail using DHLS according to Magee’s method (Magee, 2005).

성능/효과

Corrected Kappa values for pass/fail scoring and ICC values for goniometer scoring of both within-day and between-day intra-rater reliability were on average higher for when the examiner performed Ely’s test using DHLS compared to using VO (Table 2).
The results of this study support the hypothesis that Ely’s test using DHLS provides more acceptable reliability of rectus femoris muscle flexibility and joint ROM than Ely’s test using VO.
Corrected Kappa values for pass/fail scoring and ICC values for goniometer scoring of both within-day and between-day intra-rater reliability were on average higher for when the examiner performed Ely’s test using DHLS compared to using VO (Table 2). Lesser values of SEM, CV, ME, and MD of goniometer scoring appeared when using DHLS, compared to using VO (Table 3). Bland and Altman plots (with accompanying 95% limits of agreement) represent lesser difference of the goniometer scoring over the test-retest sessions in within-day and between-day reliability when using DHLS, compared to VO (Figure 3).
The SEM values indicate that the MD required to assume that a “real” difference exists between test/retest scores of an examiner for the Ely’s test was approximately from 1.4 to 1.7 degrees when using DHLS, compared to using VO (MD range from 5.3 to 7.0).
The study demonstrated that within- and between-day intra-rater test-retest reliability for Ely’s test using DHLS was superior to the results of using VO in patients with lumbar extension-rotation syndrome.

후속연구

Further studies are required to compare the within- and between-day inter-rater reliability using between DHLS and VO for Ely’s test in patients with lumbar extension-rotation syndrome.

참고문헌 (21)

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[국내논문] Intra-Rater Test-Retest Reliability of Ely's Test Using Smartphone in Patients With Lumbar Extension-Rotation Syndrome 원문보기

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[국내논문] Intra-Rater Test-Retest Reliability of Ely's Test Using Smartphone in Patients With Lumbar Extension-Rotation Syndrome 원문보기

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