Influence of Standardized Procedures on the Reliability of Hip Clinical Assessment.

OBJECTIVE: This study evaluated a standardized and personalized approach to verify the effects of conditions on intrarater and interrater reliability, standard error of measurement, and minimal detectable difference for provocative tests and range-of-motion (ROM) tests used in hip pain assessment: flexion-adduction-internal rotation (FADIR), flexion-abduction-external rotation-extension (FABER), and hip internal rotation with 90° of hip flexion (hip IR). METHODS: Nineteen participants (mean [± SD] age = 24 ± 2 years; 10 women and 9 men) without lower limb or back pain were recruited. Three raters evaluated each participant during 2 testing sessions, 1 day apart. Raters performed the 3 tests in 4 conditions: classic (C), controlled pressure duration (CPD), subject-specific position (SSP), and mixed (M = CPD + SSP). RESULTS: For intrarater reliability, the CPD condition showed the highest intraclass correlation coefficients (ICCs; mean and 95% confidence interval [CI]) for hip IRROM (0.83; 95% CI, 0.53-0.94) and FADIRROM (0.75; 95% CI, 0.60-0.89). The SSP condition showed the highest ICCs for FABERheight (0.71; 95% CI, 0.42-0.87) and FABERROM (0.62; 95% CI, 0.27-0.83). Concerning interrater reliability, the classic condition presented the highest ICCs for FABER variables (height: 0.54; 95% CI, 0.28-0.76; ROM: 0.58; 95% CI, 0.32-0.79) and hip IR ROM (0.72; 95% CI, 0.51-0.87). The CPD condition showed the highest ICC for FADIRROM (0.57; 95% CI, 0.32-0.78). CONCLUSION: In the conditions of this study, CPD showed the highest ICCs for hip IRROM and FADIRROM, and SSP showed the highest ICCs for FABERheight and FABERROM.

Quantification and Reliability of Hip Internal Rotation and the FADIR Test in Supine Position Using a Smartphone Application in an Asymptomatic Population.

OBJECTIVE: The purpose of this study was to quantify and report the intrarater and interrater reliability of hip internal rotation (IR) range of motion supine with the hip and knee at 90° of flexion and for the flexion-adduction-internal rotation (FADIR) test. Hip internal rotation measured in a lying supine position with the hip and knee at 90° of flexion revealed information on hip impairments. To date no simple quantification approach has been presented in this position; therefore, the FADIR test has not been quantified yet. METHODS: Twenty participants (mean ± standard deviation [SD] age, 24.0 ± 2.1 years; 10 women and 10 men) without lower-limb or back pain were recruited. Three raters evaluated each participant during 2 testing sessions, 1 day apart. A built-in smartphone compass application was used to obtain the hip IR range of motion in both procedures. RESULTS: Mean (± SD) supine IR was 51.7° (± 9.7°) and 62.6° (± 11.4°) for men and women, respectively. Concerning the FADIR test, mean values were 41.8° (± 9.64°) and 50.1° (± 8.0°) for men and women, respectively. The mean intrarater and interrater reliability coefficients were 0.80 and 0.72 for hip IR and 0.75 and 0.40 for the FADIR test. The standard error of the mean ranged from 4.8° to 8.3° (minimal detectable difference [MDD], 13.3° to 22.9°) for hip IR and from 4.6° to 10.3° (MDD, 12.8° to 28.6°) for the FADIR test. CONCLUSION: Overall, the smartphone compass application is adequate to quantify hip IR in a lying supine position. However, the poor to moderate interrater reliability in the FADIR test and the size of the MDD values suggest that the FADIR test should be standardized.