Validity and test-retest reliability of manual goniometers for measuring passive hip range of motion in femoroacetabular impingement patients

Silvio Nussbaumer, Michael Leunig, Julia F Glatthorn, Simone Stauffacher, Hans Gerber, Nicola A Maffiuletti, Silvio Nussbaumer, Michael Leunig, Julia F Glatthorn, Simone Stauffacher, Hans Gerber, Nicola A Maffiuletti

Abstract

Background: The aims of this study were to evaluate the construct validity (known group), concurrent validity (criterion based) and test-retest (intra-rater) reliability of manual goniometers to measure passive hip range of motion (ROM) in femoroacetabular impingement patients and healthy controls.

Methods: Passive hip flexion, abduction, adduction, internal and external rotation ROMs were simultaneously measured with a conventional goniometer and an electromagnetic tracking system (ETS) on two different testing sessions. A total of 15 patients and 15 sex- and age-matched healthy controls participated in the study.

Results: The goniometer provided greater hip ROM values compared to the ETS (range 2.0-18.9 degrees; P < 0.001); good concurrent validity was only achieved for hip abduction and internal rotation, with intraclass correlation coefficients (ICC) of 0.94 and 0.88, respectively. Both devices detected lower hip abduction ROM in patients compared to controls (P < 0.01). Test-retest reliability was good with ICCs higher 0.90, except for hip adduction (0.82-0.84). Reliability estimates did not differ between the goniometer and the ETS.

Conclusions: The present study suggests that goniometer-based assessments considerably overestimate hip joint ROM by measuring intersegmental angles (e.g., thigh flexion on trunk for hip flexion) rather than true hip ROM. It is likely that uncontrolled pelvic rotation and tilt due to difficulties in placing the goniometer properly and in performing the anatomically correct ROM contribute to the overrating of the arc of these motions. Nevertheless, conventional manual goniometers can be used with confidence for longitudinal assessments in the clinic.

Figures

Figure 1
Figure 1
Goniometric assessment of passive hip ROM. A) Hip flexion. B) Hip adduction. C) Hip abduction. D) Hip internal rotation. E) Hip external rotation. Note the positions/roles of the two examiners, the alignment of the goniometer, and the position of the dynamometer pad.
Figure 2
Figure 2
Electromagnetic tracking system (ETS). A) ETS instrumentation. B) ETS sensor taped over the sacrum with double sided tape and medical adhesive tape. C) ETS sensor attached to a mouldable plastic plate and tightly wrapped around the lateral aspect of the thigh. Standardized force was applied by a modified hand-held load cell system. D) ETS sensor taped over the medial aspect of the knee with double sided tape and medical adhesive tape.
Figure 3
Figure 3
Assessment of passive hip flexion. Manually-applied force (top) and hip flexion range of motion (ROM) (bottom) traces of the involved and uninvolved side of a femoroacetabular impingement patient. The horizontal dotted lines indicate the target force (mean of the two warm-up trials). ROM was calculated as the mean angle during the 1-s interval between "a" and "b", where "b" is the greatest ROM. Note that ROM is greater for the uninvolved than for the involved side.
Figure 4
Figure 4
Bland-Altman plots. Comparison of the difference between the two methods of measurement (ETS and goniometer) versus the average of the two methods, for femoroacetabular impingement patients (•) and healthy subjects (°). Systematic bias is given by the solid line. Limits of agreement are given by the ± 2SD limits. A) Hip flexion. B) Hip abduction. Note that modified limits of agreement (with equations) are shown for hip flexion, as data revealed proportional bias.

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