Inter- and intra-observer reliability of clinical movement-control tests for marinesReport as inadecuate

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BMC Musculoskeletal Disorders

, 13:263

Rehabilitation, physical therapy and occupational health


BackgroundMusculoskeletal disorders particularly in the back and lower extremities are common among marines. Here, movement-control tests are considered clinically useful for screening and follow-up evaluation. However, few studies have addressed the reliability of clinical tests, and no such published data exists for marines. The present aim was therefore to determine the inter- and intra-observer reliability of clinically convenient tests emphasizing movement control of the back and hip among marines. A secondary aim was to investigate the sensitivity and specificity of these clinical tests for discriminating musculoskeletal pain disorders in this group of military personnel.

MethodsThis inter- and intra-observer reliability study used a test-retest approach with six standardized clinical tests focusing on movement control for back and hip. Thirty-three marines age 28.7 yrs, SD 5.9 on active duty volunteered and were recruited. They followed an in-vivo observation test procedure that covered both low- and high-load threshold tasks relevant for marines on operational duty. Two independent observers simultaneously rated performance as -correct- or -incorrect- following a standardized assessment protocol. Re-testing followed 7–10 days thereafter. Reliability was analysed using kappa κ coefficients, while discriminative power of the best-fitting tests for back- and lower-extremity pain was assessed using a multiple-variable regression model.

ResultsInter-observer reliability for the six tests was moderate to almost perfect with κ-coefficients ranging between 0.56-0.95. Three tests reached almost perfect inter-observer reliability with mean κ-coefficients > 0.81. However, intra-observer reliability was fair-to-moderate with mean κ-coefficients between 0.22-0.58. Three tests achieved moderate intra-observer reliability with κ-coefficients > 0.41. Combinations of one low- and one high-threshold test best discriminated prior back pain, but results were inconsistent for lower-extremity pain.

ConclusionsOur results suggest that clinical tests of movement control of back and hip are reliable for use in screening protocols using several observers with marines. However, test-retest reproducibility was less accurate, which should be considered in follow-up evaluations. The results also indicate that combinations of low- and high-threshold tests have discriminative validity for prior back pain, but were inconclusive for lower-extremity pain.

KeywordsMilitary Motor control Reproducibility Screening Sensitivity Specificity Validity Electronic supplementary materialThe online version of this article doi:10.1186-1471-2474-13-263 contains supplementary material, which is available to authorized users.

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Author: Andreas Monnier - Joachim Heuer - Kjell Norman - Björn O Äng


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