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Assessments of Lumbar Flexion Range of Motion: Intertester Reliability and Concurrent Validity of 2 Commonly Used Clinical Tests

Robinson, Hilde Stendal PhD, RPT; Mengshoel, Anne Marit PhD, RPT

doi: 10.1097/BRS.0000000000000131
Diagnostics
SLIDE

Study Design. Cross-sectional.

Objective. To compare intertester reliability and concurrent validity of 2 frequently used methods for assessing lumbar flexion range of motion: the fingertip-to-floor distance (FFD) test and the modified Schober (mSchober) test.

Summary of Background Data. An assessment of lumbar flexion range of motion is often incorporated in the clinical evaluation of patients with low back pain, as well as in clinical studies when examining the effects of different therapies on these patients. In both cases, the validity and reliability of assessment methods are important.

Methods. The FFD test and the mSchober test were used in a heterogeneous study sample (n = 98) including patients with low back pain, pelvic girdle pain, and individuals without pain in either of these areas. Each participant was examined by 2 of 3 randomly selected assessors on the same day. Intraclass correlation coefficient3,1, together with the Bland and Altman plot, were used to examine intertester reliability. Absolute reliability was calculated by the smallest detectable change. The relationship between the 2 tests was measured using Pearson correlation coefficient (r), which was used as the measure of concurrent validity.

Results. The FFD test and the mSchober test showed an intraclass correlation coefficient of 0.93 and 0.77, and a smallest detectable change of 9.8 and 1.8 cm, respectively. There was a medium negative correlation between the 2 tests; an increase in the mSchober test resulted in a decrease in the FFD test (r = −0.47, P ≤ 0.001).

Conclusion. In our heterogeneous study sample, the FFD and the mSchober test showed excellent intertester reliability but with a relatively large smallest detectable change. However, the medium correlation between these 2 tests to measure lumbar flexion range of motion indicates that they do not fully assess the same phenomenon and hence should be used in combination when examining patients.

Level of Evidence: 2

The fingertip-to-floor distance and the modified Schober test showed excellent intertester reliability on the basis of intraclass correlation coefficient values. Smallest detectable changes were rather large in this presumably stable situation, which implies variation between assessors. The medium correlation between the tests indicates that they do not fully assess the same phenomenon.

From the Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.

Address correspondence and reprint requests to Hilde Stendal Robinson, PhD, RPT, Department of Health Sciences, Institute of Health and Society, University of Oslo, PO Box 1089 Blindern, N-0317 Oslo, Norway; E-mail: h.s.robinson@medisin.uio.no

Acknowledgment date: September 9, 2013. Revision date: October 24, 2013. Acceptance date: October 28, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Norwegian Fund for Postgraduate Training in Physiotherapy funds were received to support this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins