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METHODS TO IMPROVE RELIABILITY OF THE FUNCTIONAL REACH TEST IN CHILDREN

Volkman, K G.

Pediatric Physical Therapy: April 2005 - Volume 17 - Issue 1 - p 89
doi: 10.1097/01.PEP.0000155630.54603.B6
Section Information: Abstracts of Platform and Poster Presentations for the 2005 Combined Sections Meeting: Poster Presentations
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MMI Physical Therapy, University of Neb Med Center, Omaha, NE, USA

PURPOSE/HYPOTHESIS: The purpose was to compare the reliability of the Functional Reach Test (FRT) using two methods of reach and two methods of measurement: 1 arm finger-to-finger or 1AFF(using a pointed finger), 2 arm finger-to-finger or 2AFF (hands clasped and index fingers pointed), 1 arm toe-to-finger or 1ATF (measured from tip of toes to end of finger), and 2 arm toe-to-finger or 2ATF. It was hypothesized that a two-arm reach would improve reliability of the FRT in children over historical values (r = 0.75). It was also hypothesized that the toe-to-finger methods would improve reliability because the toes are a stationary point. It was expected that one-arm FRT scores would be greater than two-arm.

NUMBER OF SUBJECTS: 80 typically developing children, half male and female, aged 7–16 years were tested. 69 of the subjects were retested. Subjects were grouped into categories: 7–8 yrs, 11–12 yrs and 15–16 yrs.

MATERIALS/METHODS: Subjects stood on paper next to a measuring stick positioned horizontally at shoulder height. Feet were traced for repositioning purposes. Demonstration was given to subjects to show the reach using two strategies: feet flat or heels up. One practice trial was given. Subjects were told to use the same strategy on every test. Three trials were measured for the 1AFF and 2AFF with the best score used. Toe-to-finger scores were calculated mathematically from the location of the toes at the 0 point of the measuring stick.

RESULTS: Both toe-to-finger methods demonstrated significantly improved reliability coefficients (ICC [1,1] = 0.97-.98) compared to finger-to-finger methods (ICC [1,1] = 0.83). All methods produced significantly higher reliability values than the literature; however, finger-to-finger methods were only marginally better as indicated by the lower end of the 95% confidence interval (CI = 0.73-.74). The highest coefficients were in the oldest group (ICC [1,1] = 0.81-.93). Toe-to-finger methods had higher coefficients than finger-to-finger in all age groups. The 2ATF had the best limits of agreement. Results of method effect showed the 1ATF scores to be significantly higher than the 2ATF scores as hypothesized using a repeated measures ANOVA and least squares means analysis (F = 5959.61, t = 12.26, P < 0.0001). There was no difference between the 1AFF and 2AFF scores. A t test analysis indicated a significant difference in starting position of the hand between the 1AFF and 2AFF methods with the 1AFF score being greater. This was not reflected by the finger-to-finger FRT scores.

CONCLUSIONS: Improved reliability of FRT using a two-arm reach method was not supported. Reliability of FRT improved using a stationary starting point in the toe-to-finger methods. The 2ATF had the best limits of agreement, although the 2ATF and 1ATF had similar ICC values.

Clinical Relevance: Toe-to-finger methods show improved reliability compared to finger-to-finger methods. When performing finger-to-finger FRT, it may be desirable to have children put weight on their heels prior to measuring, in order to move the center of pressure to a consistent starting position.

© 2005 Lippincott Williams & Wilkins, Inc.