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 IR_ROM (0.83; 95% CI, 0.53-0.94) and FADIR_ROM (0.75; 95% CI, 0.60-0.89). The SSP condition showed the highest ICCs for FABER_height (0.71; 95% CI, 0.42-0.87) and FABER_ROM (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 FADIR_ROM (0.57; 95% CI, 0.32-0.78).

Conclusion: In the conditions of this study, CPD showed the highest ICCs for hip IR_ROM and FADIR_ROM, and SSP showed the highest ICCs for FABER_height and FABER_ROM.