Journal of Orthop:reclic & Sports PhysicalTherapv
20 01; 31( 7) : 368- 3 4
PullTestandTilt
Reliability
of theLateral
Patellar
Alignment
in Subj€ctr
Testto Assess
Knees:
Raters
withSymptomatic
Student
CynthiaJ. Watson,PT,OCSI
PT'
HollisM. Ledd1,,
TineD. D1,njan,
PTI
PTI
L. Parham,
Jenniier
testcrs.
t tc sre
l l i a b i l irv
tvi thb l i n r l ecl
i r t c l l o [ ' e r n o r ':tll l ti r r st r tS t udyDe s i g nT:c sre
cr i abi l iol
ty thel ateral
pul ltestancl
c l l o r t t c ( l 'Fl 'S) i s o ttt'
n cei n tc r-a n ciln l ra -ralrel
O bjec t i v eTso:c l e tc rmith
o I t l r c n l ( ) st ( '( ) l l ) n ) ( ) l )
pat eilat rl
r tl e s t.
bv cl i ni cal
c anntb c dctcctercl
exami nati on,
thcn
t t t t r s t t l l <'sk.'l r 'l l tl r l i so t B ac k gro u nl idp:a tc l l anrra l a l rg n me
i n pati cnts
l ' vi th
r l t : r 'so [' l l r c kn t:<:.l2 : 't7
a ctm e inntl e rv c n ti omnasi 'be i mpl t:ntented
c onc liti o n -s p ctrc
c i [i
Hoivo'er,
servcral
clinicaltcslsLrsecl
kr asscss
patell,rr
patcllofenroral
painsl,nclronrc.
n 'i t l r t h c i n c i r l c r r c t'i r r tl r c g c'r tct'l tl
B ccause
n h a v ep o ortcii ai rrel i abi l i tv.
thcl atcral
pLrl l
nr obilitv
h a v erc c e n l lbve rcsnh o rvto
p o p r r l l r t i o n l r c 'i n g u s l r i g l r :ts I i r r I
v di ag,nosti
l ests
c forpatel l oi cnroral l r r <l t 'r 't 'r t h i g - l r c l ir r ;r tl r l cti <' i r r r l i lc s tandth cp a tc l l atirl ttc s la rcrv i c l c lLyrs etlcli ni cal l as
ior reli.rbiliLv,
r,vccxanrrned
teslccl
bLrtlravtnolbeonprcvioLrslv
lhcselests. v i <l r r a l sr. l r l ) l i 'P q i s l t co n <l i l i o tr i r r ltainsvnchonrc
(Jgcrangc,2l-,1f]
Fifty-tlvo
subjecls
providi:d
95 knccs(19
Methods
andMeasures:
vears)
r r r h 'i n q t h c p a t c l l :r l L r r r [:tr l j u t't'r tl
l s srri ssmcnt
of thel al eral
pul ltest.Tl votcsters,
s y nr lt t o m aatincc7l 6 l s v m p to n ra l i c )fo
l c t i n : r c r r l a r s t l 'r t (t i l r - ( ' 1 l t:r t i s l l ( ) t l tl i ncl cpcndentl
peri
y ormccl
thel atcral
pul l
t o th ep rc s e n cocr a b s e n cocf s v n rp tci nrs,
blinr led
t r i l r r r t a l r l c t o p e r r ip l t.cl l a l l r r r l si Ii s,
(/l
provi cl ecl
ts g erangc,2242 vcars)
9!)knces
t es in
t r a n c l oomrd c r.l ' i fty -i i vseu b j c c(a
r
t c n r l i r r i t . i s ,s l i c l c l . al l v i n r r tta ttr t t' u 1 ><
oi l hepatel l ar
ti l l tcst.Three
bl i nded
as v m ltto maalni cd2 6 s y m p to m a li locr)a s s cssnrent
r
l
cr
i
tr
tg
t'tttt:ttt
o
l
i
n
t
c
r
r
u
r
'l
plrvsitis,
till tcstin ranclom
All subjcr.ts
thepatellar
orcier.
lverir
indcpenclcntlv
pcriornrccl
tcsters
o l t h t : k r r t 't '. i s l 't 'r"so r tsr .r ,i thl 'Fl 'S
u'asusccl
A kappa{r<)statistjc
lo assess
within3-5 clavs,
theagrecnrenl <'o r r r r r r o r r l vl '( 'J l ( ) l'tsl r r tp to ttts o I
lcstcrl
anclrctcstecl
rvithincachlr:ster
andbcllveen
lcslers,
of findings
a c l r i r r g p l i n i n t l t c l ctl o p l tt'l l u r '
r el i abi l ivarj
l v ed
from0.39to 0.4/ forthe
Res ultTsh: ck a p p a
c o e ffi c i c ni otsr i n l ra ra ter
r - c g i o n , u 'l r i c h i n cr t'a scs n i tl t
l i l ttcst,w hi l ethci .oci fi ci ents
ttl r
lat c r al
pu l lte s a
to 0 .5 0i o rth cpatel l ar
t n dfro m0 .4 ,1
I l c x r '<l I i r t t : r ' l r o s t r tr t's sttt l 'Ll ts ch ttl ltcstanclvari cdi ronr0.20to 0.35i orthe
1 rth el a l c rapul
int c r r a te
rcrl i a b i l iw
tye re0 ..1 fo
i r i u s q r r i r t t i r t g - s, i t t i r r u , sta i r t l i r r i l >t ilt t es t .
i t t g , o r a t I r l c 't i c t l ( 'ti vi ti c\.r 'I1 ) '1 "'r r ':s
tilt testshadfairintrarater
latcral
pulltestsandp,rtellar
andpoor
Conclusions:
Repcatecl
'l 'l r t ' c l i o l o g r ' o i 'PFl 'S i s r r o t
int er r a te
rerl i a b i l i ty
s t a tc arcmLrsl
bc takeni n pl aci ng
toomuch
O u. rre s u l stsu g g cth
t l c a r - .S u v c l l t l l t t t h<>t- st't:l r o t'l l l tl tt
n h e nrn a k i ncgl rn i c al
dcci si ons.
P h,vsTher
2001;3l : t . x c : c s s i r . 'c
em pha soi n
s th e s tc
e s ts
J Orl hopS ports
l l r l t : t ': t l 1i l 1 57 s l i t:r 7o t' tl i s368 374 .
p l a r : c n r c n t T r l )r 7 ( ) f t.h c p a tcl l a u i tl r
Key Words: Iateraltracking,patcllarntobilityr,patellofenoral alignntent,
patelIoiemor,tl p ain syndrome, reli;tbiIi ty
l r n l r s s o c i u t c c l t i e l it l n te n tl ttti ttl ttttItrrn ("crxc:cssivclatct'nl pr(:ssttl'('
s1'ndromr:" ) pror,okcs svlrll)t()llllltologv. I Iolr'cvt:r, rrot all irrtli'n'ichrtrls
r'vitli PFI'S havc' r'aclio{rlaplric t'r'iderrctr of' exccssivcrl21t.cralpitt.clllrr()tlrcr ettiologics O1'
1ilt.Io,'r0.:.),r2
t Untverstty
oi Icxas.Southlr,eslern
lt4edrcal
Center,Dallas,Texas.
Fttndedby the lexasPhysit:al
TharapyFduc,ttion
and Re.search
Foundation
andapprovedbv the
lt4eclical
University
oi lexa.sSorilhr,r,estern
Centcrat DallasInstttutional
Rc'r,ler,r,
Soarc/.
to CynthiaWatson,Universitv
Sendcorrespondence
oi TexasSouthwestern
l4edical(enterat Dallas, P F I 'S i r r c l r r r l c l r s l u r l l ,r r r 'i l tl ct t o ttDallas,TX7.5390-8876.
E-mail:
C,vnthia.l\/;rtson(rUl5oufhrntestern.eclu
532.3HarryHincsBoulevarcl,
d v l : r r g t o o v e l T 'l '1'u l ( l o ve fu sc ( ) r
overirctivit\'' of the patellofcmoral joint in stnrcturzrllv
nornral knc('s.3.r3.2iQrraclriccps rveakness (specificalli.
"ovcrpr.rll" by the vastus latcralis muscle in tlrc prcsertcc o{' an zrtrophic vastus lrlcr(lialis rnr-rscle)1)r 7.If},37.38
21 D .
.'),/ )
nil
irncl lcxvcr e:xtrernitv ntalzrlisnrnentl7.37.3,c
hztrrcalscr
bcc'n ilrrplicatccl as c2tuseso1'erxccssivet
lzrtcral patellar
Prcssrlrc.
Th c e tiolo et' o f PFPS is im por t ant t o c linici n r - r sb r : crrrsc kncxvlcdse o[ the prcsirnrccl sorircc of svrnp-
tr;
torn s u'ill clirect t r c ut m ent . For ex ir nr plc , if e l t a t i c n t
l rls :r ti gh t l:rt-cral rt--t.irracrrl urn c:ursi r-re c--xccssir,
e lltr: ral prcssru-c, therri t.hc:vnlrv bcncfit fiorn ltatellar tapin g an cl n rurrru r l s t r e t c hilt g t . o lenet hc n lhc lr - . t i r t r <. t r lr rrrr ltrrcl irrrJlro v c pat ellir r - align nr c r r t . sl l) . : r I; n t . c l v t : n ti( )ns to clo rrga l. c lt et - i; r at et llarc ( ) n n( r : c t iv ct is s r r c sr r r : n '
l r ir r c liv ir lr r : r ' ls
lt ( )t l)c irrclicra(c r ir
n, ho li: t v c lt ir te l l l u rn llal ign rn crrl se< : or r r lalt 't . o alt r r or r r r al lt or r v c c l rr l i g r r ratiort o r-r,r'ho htn' c ( ) \ ' c r lls o l' 1. ' l' Sn, illr or r t c v i r l <t n c c o 1 '
c'rc<'ssivt:l:rl.cr':ilpt'cssrrrc s)rltclr()lnc. I{osct srregesls
t lllt pa ticr)ts sho r r lt l lr < :r ' las s if ic r l I r v t hc il s pc c i f i r .
rn ()\'('llrcnt rlr,'sf
rr r r c lion i r r or r ler t o c lilet c l l r c l l l . l l l ( 'nt
t.o
id
crrtih
,
c r lr r iv llc nt gr - ( ) ups lir r c lI ir ' : r c v r - e anrl
s Ci-tt cl t.l tl
\\Iilk t't :rl:r;L ec t : nt lv int r ' or lr r c c c l a c l: r s s ific ; r t i {) n s l s t('rll l() (lil-o(t trc ut r l) c nt . illt c l \ , c lr t i( ) lr s it r t I r c l l ( ) n ( ) pcnrt.ive lrr:rna!.1'crnclt
t ol' 1r:rtt'l lofi'ntolirl clisr>rrlcrs. In
th cir- classilit':ltio t t s y s t t ' r t r ,p: t t ic r r t s n' it . | I ) lil) S a l c s c l ) arirt('(i irrlo 8 u lor r y t s lr as e< l( ) n t hc inilial c x : r r r r i r l r -
liYll-
)n ('
]()ll
I'i()l ri.l7
I t t't':tl
I in.l
rt rrl i r i t r''.'l I I
uot a tr s it is ,
I ( ' lt l)( l 'tll('llt
i'1.'l)s
', ol
i'l l;tr'
ll
rts tlltf-
: linrbr : i.ll; . '1 8
ilol
l t t hat
or (lis'lla rvitlt
lctitlacLt'
' ssttfc
r)l()lllilt-
,
rclir'iclttrts
Itic erti. --11 rl
l):lt rt t " '
cs of
rtcf c(lnusc or
tiorr, r'vhiclr in t lr r r lc s I es t s of pr r t t ' llar ' . joint r no l t i l i t r , .
' l hr' :rrrtlro r-spo ir r t or r t t hat ar lc lit ior ur l lc s c t ar c l r i s
nct'rlt'rl t o clctcln t i r r t ' i f ' t lr c ir ' pr ' opos c r I c : l: r s si
l i c l t i r l rr
svstcrrris vlrlirl a r r r l r r ' lialr lc , ir r r : lLr r linet ht ' t t ' s fi n g o [ '
t lic lclia lrilin oI s 1> c c it irlt' at c ll: r r r r r olr ilit i t r : st s r r s c - r l
t o ca tt:g<>r'izr'
lnti c r r t s . j;
Scvt'r-lilclin ic:r l t ( ' s f s ( ) l p: r t c llat ' r t r olr ilit v ur r r l p o s i lion lrlve lrct'rr s t ic r r t i{ ir ' : r llv t ' x lur r ir r c r l, l> r r t s tr r ( [ i ( ] s
I tltvc vct (() l)l'()\' ( 't lt t ' r r r r c lialt lc . TI it : N{ c( k r in c l l s t 's -
Those arithors suggcst a clinical cxarniuation that inchrclcs thc lateral ptrll test, patellar tilt test, :rnci patellar elide test t() exarnine patellar trackins ancl cliasnoso littcral cornpression svnrlromc. 'fhe patellar tilt
:rrrcl glicle tcsts :tre specifically r.ecomntenclt:d to clcterrlliltc lr.hethc:r or lloL a pat.iernthas a tiqlit lateral
restraint :rncl will bcneht frorn surgc11,.
T h c p a t c l l : r r t i l t , r i i g l i c l e , t t ; : ; ; : r r r c il a t e r : r l p t r l l tcstr ( i
are t-cstsr-ctcornrricrtrlccllty clirric:il experts to cittc-gorizc p:rt.icnl.s;horvc-vcr, thc reliabilitv ol' thesc rnt':rstrrcs is unknorvn. f itc prrrposc of orrr stri(lv \v2lsto
cvalrri.rtctflrc irrtr:r'-arr<l intla-ratcl. tcst:l.etcst relialtility
o [ 2 c l i n i c a l t c s l s t ] ) 2 r ta r c p ( ) L c n t i a l l v r r s c f i r l i r r cl e l cc'1 ing.-excc'ssir,'clatenrI i)rcssurc svrrrllorn<': fhcr patcrIIur
tilt tcst lrrrrl llrt.l:rrt-r:rl lrrrll lr.sr.
METHODS
Subjects
Srrlrjcr:ts rrsr:rl to <'r,alrr:rtctlrt: latcr.:rl
ltull t.cst w,t'r-c'
rncrr (rr:
l5) :rrrrl tvorncrr (n:37
1 l t e ( r , v c c tr tl r t'
a g c s o f 2 l l r r c l 4 , 9 u 'i t h : r n l c r : r n l r e c o l ') , 9
) , c a r- s.
'f l r c s c s L r l t j c c l s
l t l o v i c l c r l 1 ) t 'rk r r c c s f i r r . t 'r 'a l r r a t i o r r , l {)
r i v l l l p t . ( ) r n a t . ia
( r t r l 7 ( i a s v l n p t ( ) n ) : r t i <. S t r l r j e <t s r rscr l t<r
c v a l r r a t t 't h t : 1 t a ( c l l i i r t i l t L c s t \ \ r c r c r l ) ( 'l t ( l :
22) anrl
\ \ r ( ) l n e l t ( r r - i l l i ) l t c t r , v t : c n t l r c a g c . r so 1 2 ') a n r l ' 1 2 u 'i th
: l n l c r r ) u g e o 1 2 7 . l l y c a l s . S r r b j e c t . si r r t l r i s
P o r - ti o r r o l '
l l l c ' s t r r ( l \ , p r - o v i <[ t 'c1[ ) 9 k t r c t c s , T i ] a s 1 'r r r p t o r r r l l ti (l .u l ( l
2 ( i s v r n p t o r t r : r t i r '.
( J s i n e : r s l r n P l c ( ) l L ( ) n \ c r r i ( 'r r r 't . ,r r . ; l i 1 1 1 P l i l cr l sr r l r j c c t s i r r r : l r r r l t 'c ls t u c l c t r t s : r t t h c L l n i v c l s i t r , o {'T i 'xa s
S ( ) u t l l \ v ( . s t o lt r , \ l l i c <l I l c a l t l r S <: i c t r c . cS
s c . l r o o l : rr r r l r ,o l u l l t . c c l s I i - o n r t l r c t s r r l r r l r n r l i r r e c o r r r r r i r r n i t t '.'l 'l r o st'
t v i t l r s v r n l t t o r r r : r 1 i rk: r r c c s l v c r c r c c r r r i t c r I f l o r r r () r r tl ) a t i t 'n t s u l t l r c . f i r r n c s W. A s l o r r r \ n t l t r r l l r t o r '1 ,( l u r . c ( l t'r r tcr .
( n - 1 ) , r r u r r i ( 'l 's i n t l r t : [ ] r r v l o r '/ T o r r r l , u r r c l r . r 'Ml r r .i r
tcttt ol pirtclltrl clt r s s iI ic : ir liorllr
r s ] t c c r r s lior v r r t o t 'x t h o r r 'l \ 'i r i r r i r l g l ) r ( ) g r ': l 1 t ( , : 8 ) , a r r r l s t r r r l l r r t s 6 r '
hilrit p oo l to lair t c s t - t ' c t ( ' s 1ir r lr . r ' ( es t . t : r - r - t . lia l r i l iitrvr 2
c o r t t t t t i t r t i t v r , 'o l r r n t . c c r s( r r : i i . e r ) .l ) r 'i o l t o
J r r t lti r 'i l r r r tscPala t('slrr<lit's, ( ; , rirrnr
( ; l it lac ' k s v ir lir lit t , ir r < : < , t r r p l r r . i s o r r i r r g i r r t l r i s s t l l ( l y , c a c l l s r r l t j c c t s i q r r e r l u n i r r l i r r rr r t:r l
witlt n urg ncri(. r.c s ( ) nlul(( , inr : Lgir r g. - ;( ) t ht . r r r r a r t r u r l
c '( ) r ) s c n tf i r r r r r . '1 'l r i s s l r r r l 'ur v a s l l t p r 'o v c r l l r v l h c Ir r sti tr r a lld in stru lncrrtcc l r r r c t I r or ls < t l c lLr ar r t ilv ir t upat c l l u r .
tional llc:vicr,vlJo:rrcl trt tht: L]nivclsity o[ 'fcxlis Sorrthnlo vcln('t)t ]tlrvC als o ( lc r n( ) ns t J ' iit . c rpt
l t < . r Ir ' c 1r r 'o c l r r r . i \'\'csl('ln -Vccliclrl (lt'rrterr':rt l)allas.
l)llitv.33.jr
I'iaclr srrlrj<'ctt.
wus scr'('errcc[ltv a clesign:r1erlsccorrclIn tlrcil lcccntlv pr ' opos c c l c lus s ilic ir lion s YS t ( 'r n ,
v c l l p h v s i r : i t l t h t : n r 1 t r ,s' t r r <l c n t , l v h o <l i c l r ) ( ) t l ) i u 1 i ( i _
Wilk et al srrgecst tirat in r:xccssivt' kttenrl.
p a t c i n t l t c t o s t i l ) e l ) l ( ) c ( : s s rl O c k : t c r r n i r r c r v l r cth r :r .tl r c
J)r('sslll'cl
synclrorrrc,"t.lrc r nos t c lilic lLl linc lir r g on plr v si c : a l c x s t r l r j c c t r n c t t l r r ) i n c l r r s i o n c 'r 'i t c r i t ra r r r l r v l r c t h c r.tl r t'
ilmina tiori is th at t hr :
sLrbjcct Iracl plit.c:llofi:rrror:rlpuin sl'nchornc. 'l'her.tr u'lls
lnt c lla is t ilt c < l lat r : r ' allv ,a n r l
ttrcrc is t:x<:etssit'c'
( ) n c s c l o o r ) c r ' l o r s r r l t j c c t s r : x : r n r i n c d r l t r r - i n g i r tvt'sti g l r tight.nr:ss<tl'thc laLcr-ll rctinacrrlarstr_ttcttucs
rvhclr c or npar e< l r v it lr t he r r r c c lial
t i o n o f t . l r c p a t i : l l : r r t i l t t c s t n r r d n r r o t l t c l s c r c c n cr . Ii r r
slfls.":r)11 '31 |;1
T'h c 1' s r r ugr : s tt lr at ir r c liv it lr r alsu, it h c x c c s subject.s cxarninr-:cl dtrring inrrcstiq:rt.ionol tht: lirtcr-al
sr,"eluktrr,I
prcsslrrc syncll()nlc u,ill exhibit diniinishcrl
prrll tcst. 'lir l>c inclrrdccl in thc sttrclr',srrbjcc:tsrvr:r-e
Pitssive
rrrt.clill p r t t c ll: r r -c lis plac et lc nt ( ic , pat e l l z r r
l c r l r r i r - e c l l o h u v e f i r l l k n e c r n n g e o f l n ( ) t i o l l a n d t<r
ltttd e"). '; Ollr1 'r ' ar r t lr or s hav c r c c onr nr c n< lc r l s i n r i l a r
b c i t r c l c p c n c l c n t a r n b r r l : r t o l s i n t h c c o n t r n u l i t r '.
t c stso ['rrrcclial
ar c l ln( er al pat c ll. r - glic lt _- . ; . s .r : : , r r . r {] . 2 2 , 2 {) Strbjccts'
.i0
kncr-'s rvcle cxcluclccl iI thc p:rrticiltant r-r't l el l" s ugq( . 51t lr : r t phr s it lt l r . r lr r r r i r l t l i o r r
p ( ) r t e c l a n t ' h i s t o r v o { t r z r n r l i r t i c k n c e o l l t i l t i r r .j u r t.
^"trttltt\ttr'll
"L pa tella r n rollili t r nr ev be us c c l t o c las s if l' pa t i e n t s a s
stlrgel-y, patcllar clisloc;rtion, ()l' ll cr.lr-outrrscular-clis$ood or poor canrliciatcs
for lateral rclcasc surgcrv.
e:rsc. Iinccs prt--scnting ivith oltviotrs iirramentcttrs or'
(
^l
I r,
J urlh(,p
Spr,p15 pll1r
Tht,r.\lelrrnrc
3l .NLrnrltcr
7..Iuh
2001
3(i9
m
v1
m
m
- ll
\'i ,."
\,
\
TABLE2. Kappacoefficients
.1ndpercentage
of aqreement
ior interrater
r e ) t - r e l er)cl l i , r h i l i o
t yr l h c p . r , c l l .trirl t t e s t .
\
F,,
Testers
Kappa
Percentagreemenl
I and2
0.33*
570k
2and3
0.208
47To
I and3
0.35+
62u/,,
* All testsr'vere
uscclin thecaiculation
of kapPafor interratcr
reliabiliq,
L\I
1....
Hr
l.i,\
1: t
t;il
,l.4':)
clrancc. ('I-lrc pcrcer-rtairesol agrectncnt ancl kiippa
coefficicnts :lro sulnrnurizc:d itr -fables 1-3). Irlrl.aralcr rc r,'alrresviiricri {iont 0.4.1 to 0.50 f<rr tfre patcllar
Ialer,r
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lt '
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li
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t i l t . t c r s t: r n c l 0 . 3 9 t <t 0 . 1 7 l i i r t h c l a t e r a l p r r l l t e st. In _
t c r r : r t c r r c r 'i r l r r e sn 'r t r r : 0 . 3 i f i r r t l r c : l : i t r : r . i r lp r r ll tctst
a r r c l r , a t 'i c r l l i r t r n 0 . 2 0 t o 0 . i : i 5 f r t r t h c
l t a t e l l a r ti l t r c,st.
I i r p p i r v a l i r e s r n a v l l c i r r t e r - p r t : t c c la s f i t l l o r . v s:<0 .4 0
: p ( ) o l ', >0 . 4 0 t o ( 0 . 7 5
- f : r i r . t o r l o o r l , t i n c l >0 .7 i r
: c x c t 'l l t : n t . r r , r i r'f l l ( ' k a p p a
c o c f l i t : i e n t s r t : p r c s cr r t th e
p r o p o r '1 i o n o l ' : r g r e c l r r t 'r r t a l i c r - t r c : r : o r r r r t i r r g
f i r r. cl r a n ct,
a g l c r c n l c n t , r v h i c h i s p i u 't i c u l : r r h i l n l ) ( ) l . t i t I I t i n tl ti s
s t r r r l l r v l r c l c t c s t e l s o r r l y l r a c l 2 o r . i l c l r o i c : c s l r r cl
t l r c r c l i r r - c : r l r i e l r r - a r r <l o r rrt : l r : r r r t . t o
: f : r g r - c . c r n cn t.
'l i i c : a l <'r r l a t tk: a l t l t a
t . o c l '{i c i t 'r rt . s ,t h t : fi . c q r r t , r t.i c- so 1 '
t c s t c r s ' : i g l e c l l l c t l t i r n r l r [ i s a g r . c ( 'n l c l t t : r r . c
l t l o l tt- r l i r r
- I 'a l r l c '1 f i l t l r c l : r t c r - a l
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t
.
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r ': t t c l l e l i l r l t i l i t t - , l l l o f l l r o s t 'l ( ) s ( s \ \ '( 'r c r r s c c [ i r r t.l r c tIc_
l c t 'r t r i n : r t i o r r o l i n t t 'r l a t c r r . c l i : r l t i l i t v ,p r r x , i r l i n g l l o ta l
o f l 1 ) 0 . l n l 'l r b l c ' , {, u , l t i l c t c s l ( 'l 's l e r . r , t : <[o n t l i e i t. n te :r _
s t t l c s <l f e i t l t t 'r - ( 1 - ) o r ( - ) l a t c r . u l p r r l l I l l l t i r ri r :s,
l l t c y c l i s a g t 't 'c c l7 2 t i r r r c t s .'l 'l r r r s , t l t c . t . c s t c r . sl r g r .cccl
6 2 o h o l ' t l t <r l i r n t - . l l t 'c . l t r r s ct:l r c r . r ' t r r . t -o r r l r , ,2 ( . a t( ,g ( ) l .i ( ,s,
c : l t i u t t : t -l i g l c ( 'n r c r r t w i r s r - c r n ( , t , c t [ ,I r . : r r i n , i l L x o f'0 .1 i l
( 1 >o o l a g v 's 1 'l t r c l r t ) .
I )l'
ill
I l;tti t i t ' t r1
_'lii
i:ill(l
rl
lilt
DI S CUS S I O N
'l 'h c l l r l c l l l
l t r r l l t t : s t a n t l p u t c l l r r r . t i l t r t , s l , r v l r i r .l r
I r i n 'c r t o t l t c t : r r l t l c v i o r r s l v l c s t c r l l i r - r . c l i : t l r i l i r . y,Ita r l
P r i o r - i n t c r r u [ ( 'r u g l . c ( ] r n c r rt . C l l r s s i l i , i r ) gI ) : l t i L : l tt _si n r( )
[ f ( ] ? l t l n c n t c a l c q o l i c s n r : r v n e c c l l o l t t ' l r : t s c c l( ) l l l n ( ) r e
t lGURt2 . Tht'l.rte rp. ruI
I Ilt s t c or lpar es t hc ant uunl
ois Lr pc r i u r {A
v c)r s u s t h r r ' r 'l i . i c . l l t : s t s t h a t .
i 'r '. 1 '. p i L l p l r t i . ' a r r r l
r :slJtcr.ri
1 ll);t.rtelllr
tr.rns l. r li(dur
' n ingan r c t iv equ. r ( lr ic eps
f em o r im
s usclc
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( ) t r l t t - s t t : r - sr l i c I r r o t l i : c l t l r a t i t r v a s r'ilisrl f'ri cr
t
i
r
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r
1
i
o
n
.
conlnctjon.
r
lt
(Relrrinted
phvs
w,ilhltcrnrission
from:MageeD) Orthopedtc
t ( ) ( l c 1 c c l . i r r r l i v i c l r r t r l sw 'i t h s t : v c r . cl a t c r . u l r t u c k i n g o r .
icalThcrapr,.
lrclFclition.
O 1997,W.B.Saunders
Comltanyr.
p a t r : l l a l t i l t , l r r r t r l r t l r t , r . ,t l r t . y l r i r c l r l i f f i c u l t l ( k r r :i r l i r r {.1
I t o w ' t o c : t t c g o r i z c r n a r r v k r r t . c s t l l : r l l u - ( , l r o r - c [ cr .l i r r rl tc:
t w c c r r c x c t ( 's s i r . ci r r t r l " n o r . r n a l . "
'I 'r <: l a s s yi f
l t r r t i g r r t s i v i t l r a t i g I t l i r t c r - a l r t , s t r . u i r r t,,",r r r -
m
ct)
m
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ilor
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TABLE
3. k.rpp,r
rncfiicierrrs
.inc1
perccntage
oi agreemcnt
forreliallilrtv
oi
TABLE
1. Kapltacoefiicients
anclltercenlage
of agrecment
for inlrarater t h ( 'l J t e f JIlL t l lt e s f .
test-retest
reliabiiitr.,,
.' Oithe'oatellariilt test.
Percent
Kappa
agreement
Percent
Tester
Kappa
agreement
lntrarater
1 (test-retcstl
0.47
7 1 'f,
lntrafalcr
2
ltest-retesl)
1
0.39
0 .5 0
77"/,,
70,'1,
)
0 ,1 7
0.44
67u/,'
69"/,,
I O r t h o p S p o r l . sP l l v s -l- h e r .\' o lu r n e il1 .Nr u n b e r 7 ..JL r lv2 i )01
Interratcr
ltest-retest)
0.31*
62u/,'
* All festswefe
useclin thecalculation
of kappafor intertcster
rcliabilitv
rn
,ffi
lncniscal pathoioen', l1liijor.ioint cflirsion, tcncler.rress
Irt tl'rc irrferior patcll:rr polc (tenrlinitis) , or patcll:u.
sttlttel'in s rlttrirr g k nec ex t ens ion ( plic u s v t r c l r o t n c )
j
tr'ert-'also exc'luclccl.ri(Stzrnclirr-<l
ort h opircclic tests2l)
\\rcrc use(l tO r-ulc ()ut tltcj prcsen('ct of lig:rrrrc:Dt.0rrs
(r'irn rs/r,iile us stl e: js t . c s t s ,Lac lr r nalt ' s , : 1lt ( l
l) o s 1 . . r . i , , r .
clr-ancr-)uncl nierriscirl (\IcMrrr-r:rv's) p:rtholoui.'. A
positir,c resrrl t ( pain, pur lellar - s t t r t lc r - ing, lig: r r n e t rr o r r s
l: ixitr,, o l llrc pr- es c r r c cof . joint ef lir s ion) on a r r v o f '
tl) csc te sts r-t'srr lt t ' cin
l ex < ' lus ion. llas c c l ( ) n 1. l r ca l t r x . c
clilt'r'ia , 2 0 kn ccs u, c lc c x c lr r r lc c l.
L,a<'lrknt'c- (n : 104,) tt'as cllrssiIiccl lrv zr scr.(]('ncr
ruscil h cl st,ntltto r n: r t ir : ( PI , - l) S)( ) r it s v lllpt ( ) lnut i t . . S r r l t . jc<1s' knccs n 'clt' c r - r ns ir lc l' c ( ls v ull) t or nlt i< . ( r i - - l l - r )
lritscrl orr st'l{:r'c lt olt oI ar r t . c : r iork r r c : t :
lr ain t l) i l t w u s
rc arlilv r-c1lr'o rlr r c ilt lcr lr r line- ir t lc lr s l 2 of t lr t ' { i r l l o t
irr g 4 ilclivitics n , it lr in t lt t : llr s t nr ont lr : r r s <c nc li r r q
st ails, rlt'sccrrrlir r g s llit ' s , lt r olor r uc r l s it t ine, ( ) r . s . l u i l t t illg .:'; rr';
Experimental
Procedure
Fivc' scrrior-ltltv s ir ' : t l t ht ' nr 1t v s lr r r I c t r t s s t ' r . r ' c't l s ( l l ( .
t(' st('r-s.'I'lrrt'c l ('s t . c l' sc v lr lr ut t c r l s rr lljc c . t s< lrr r . n
i g t lrc,
filst lthrrsc ol lht's t r r c lr , ( pat t : lllr l t ilt lc s t ) ir r r c l 2 o t l r c , r .
t (' ) i(('l'sc\'trlu ute (l s r r lt jec t s < lt r lir r e t . lr c s c r . or r r l p l n s e o l '
llt c ' slrrrh, (lak:r'll lt r r ll t c s t ) . ' TI r c s t ' s lr r r lt ' r r t s I lr <l t . o r r r plcte rl corrlsctl'o lk ir r r r r r r s ct r los k elr : t lr 1t ' r , : lrr lr t i o r r t u rr l
nliln2 r!rcu telll, r'l i r r ic lr l k int , s iolog\ , , t r r r c lgr - os sl r r r r r r rr r
rul1 r1()ln \,.
TIre lcs t t ' r ' s lr : t < l : r ls o c ' or r r lt lc t r : r l 120 l r o r r r . s
ol clirric::rlcrlrrr':r t ior r r lr . r ling u' lt ic . lt r lir . t ' c t
Pr r l i r . r r t t : r r - r :
! 1,:rsl'('(lllit o (1.
i)r'ir>r'to dlrtl c ollt , t c lion, t lt c 1( ' s t ( ' sl t r n< l s <r 'r 't 'r r c 'r - s
1;t,rltict'rl Ilrc les ls n' it lr t lr c I ir - s t ur r t lr or ' ( ( ) . |. \ , \ r . ) , x , l r o
lut:.,ox'r'l0 r,eu ls o1 < : lit r ir : lr tl ' x lt c r . ic nc : c . ( lr ir r t o s s t . s
' n' tiL' u :icrl 1 o rrr:t int t r ir r t ' lnr lor r r iz ut ior r t hr . or r e l t o r r t
t . t 'slit,l; Irr'o cu rlrrlc s ( t es lc : r 'lt r r r l t es l or c lc r ' ) . Tit : n r r i <l
lt irrs. ili t('s1e lsl ' ( ' llllr inc ( l lt lir r r lc r l t ( ) t lt ( , lr lr s c r r r . co r .
l)r'()s('ir{('o l p lrirr in s r r lt jt : c t st lr c v t es t t . c l ult lil ( l a t : r
collt't iirrl n 'as co r r r lr lelc .
( )nct' lr :;L ll;jct. tr v lr s ir r r : lr r c lc r lir i
t lr c s t r r < 1r t, l,t c
s( t('('ll( r 1 rl.r,,.rllr ir r r , r r . lr r . r . ir r t lr t . r r r lr ir r t .
lr osi l i o r r o r r
lr [.rc:tt.n )('nip lintl r n' it h s lr oes of . l. T' lr c t r : s t c r .s: r l t . e r _
nlrlcl)' ('l)ii'r'r'rl tlr c ' r . < i< . r rt r rnr l gr li< ic r l t lr c p: r t cl l a r r . i l t
I' )(l l:rtcrlrl ltrrll tes r s . S. lt jc c : t s \ v . r . l. . t c t s t . . <iv
l ithirr..rr_
ir r lu t's of ttrrt'ir.ir r it i: r l1. c : sttr s ir r g t it c s anr c
Jrr.ric:crlur.c.
1 hc pirt<rlirrrlil t t es t r { ;t v u. spc r f t r r . r nc c l lt y pos i t i o n _
ing the sL rbjt'r'tin s t Llt ine r v it lr llt c k r r ec s c x t c n <l c c l
w illl in strllctirirrs lo r c lax t lt c qulr r h. ic : c psr r r r r s c l c s
ttir'<ltrgltout tht pr-ot.t:cftrrc.'I'hc tcstel. stal)ilizecl tlrt:
I otve r e xtrcmltv tr ' 11' , , , , . , r . , hip
11 r ot at i( ) n at t llc a l l k l e
-lo
using one hiin<l.
rissesstilt, the tcstet- liltecl th<: l:rtcral edge of the ltatt'ilu fr.cirn the later-ul fer.noral cnu_
rlvle u sirtg th e itlr lc l { i r r ger and t hlr r lb of ' t he , t h c r
; rrLnd (Fier-rre I). T' 1' r elr iLt c lla s houlc l r er nain ir - r t h e
tr,;r-'hlear groovc attcl rtril be allorvecl t9 laterallv sublrrx rluring the test.r'i 'l-esrersc:rtegorizccl srrlr-jects'pa;tllac as having either a
1r,sitii,e, ne'tral, or
'cgari\.e
370
; ,#u"
{p
F I C U R t1 . T o l t u r l o r ntrh e p ; r t c l l rtri l t t c s t ,t h c e x . r n r i n e
l i ri lsth e l a l cr a l
e r l g eo i t h c l t a t c l l ai r o r nt h e l a l c r ailc m o r arl o n c l v l c . 'f hpeate l i a
sh o u l r l
r e m a i ni n t h et r o c h l c agrr o o v ca r r rnl o tl r c . r l k i r v etdo s u b l i r xl a te r a l l r ,.
r t n g l c n , i t h l 'c s p e ( 't t r r t l t c ' l r o r - i z o r r t . : r lI.t o l o r , " 'i cl i r .t u l r l
l ) r '( ) J ) ( ) s (t 'l l l l { : 1 r )t 'x c C s s i v c l r 'l i q l t t l : r t t 'r - l t lr - c s t t .:r i r rits
r l c r r r o r r s t l l t t . r l l t v l r r c 'r r {r 'aol r . r i c q t r {i v t 't r n g l c to tl r <,
horizon tlrl.
'l 'l r c
l a t c l a l l t r r l l t <'s tu 'u s p c r 'I i r - r n c r l u i t l t s r r l tj ccts i n
t . l r c s l r r r r c l t o s i t i o r r , r v i t l r t l r t ' l o r v c r - c x l r . t 'r n i t r i r r r r cr r t r a l l r i p r '( ) l a l i ( ) n : r t t l i t : ; r r r k l c . l l r c l : r t c r - a lp r r l l tt'st
\ r 'u s i l s s t 's s t . r l x ' g l i r c l i r r g t l t c t r . l r c . k i n go I t l t c
P ltcl l l r
<l r r r i n g r n l r ( 't i v c i s o n r r 'l l i c r l r u r <l l i c t '1 r s{i . r r r o r i s r r r r r s<.l t'
r 'o r r t l l t t i o r r . - [ 'l r c ' l t 's l c t - o l r s c r - r , r 'r tl l t c l . r . a c . k i r rrgvi tl r
itrtcl rvitlrorrl liulrt 1lallltiorr ol tltc srrltcr.ior.
1 to l r . o ['
t h t ' 1 t : r t t 'l l l . , . \ <<r >r 'r l i r r gt o I i o l o n 'i c l r t 't a l , " t l r c p i l tcl l tr
s l t o t r l r I l r c l t r r l l c r l i r r : r s t l u i g l r l . s r r p i : r . i o r <l
. i r . c : r ti o r ro r
sttpcliol lrncl l:rterll in crlrurl
1 l r 'o 1 . r o r - t i o r r s( ''F ie L u .t'
'l r) t . t c s t l l a s s c o l c <l a s I i r l l o r v s : ( i
2 ) . r ( ; 1 r ) r i ('l; ?
a
) u r .;r r l t.
t v u s g i v c r r i f t l r t : P i r t c l l l r r r ': r t . k t '<lr n o r t ' l t r t t : r . u l l yth ;r n
s t r p c l i o l l r , : r r r r l r r ( ) r r r ': r c l cr v u s : r s s i Q r r t '(fl i , r s rr l r t.r i o r
o r c <l r r i r l i s t : r n ts r r l ) r 'ti ( ) l l u i ( l l l r l r 'l . a l p l t c l l : r r . l r - l r cki r r g .
il\
DataAnalysis
'l 'l r c r l : r t a {i r l t l r c
r r r o r l i f i c r l l ) u t c l l : l r . l i l t t c s t i rn cl l u tc l l l p r r l l l c s t u l c r i o r n i r i l l c l t r t a . 'l h e k n p l t a r . o c r l l i <:i cn t
( r c ) i s : i c l u r r r c t '- t 'o L r '( 'c t c ( pl c l c c r n t : r g c ( ) f l r g r - ( : cl r ) cn t
r n c z l s t u 't '.r3 S t l a i c h t l ) c l 'c c n t : I g r . c ( 'l n e )r t r t t c l t s t r r .e sttttr l
klrpJrir valucs rvc'r'c<:llcrrlutcrclt() lrsscsstl)(' lr:r'el ol'
: t g l 'c ( : l r i ( 'n ( o l t : : r t : l t t c s t e r a n r l l t c l t v t 'r 'n t e s t ( '1 . s .
FIC U R
I
l.iter.r
contta(
ic,tl Tl
RESUTTS
F O r ' l t o t h t h r : l : r t e | u l p U l l t e s t n r r r l t l i c p a t e l l a r - ti l t
tcst, t('stcfs :tgrecrl ri'itlr tlrcir' ()\\'lt l-cpe1t tric2rsprcts
irpprcrxirrr:rtr:Iy7)c/c of tlrc tirrrc :urd zrgr-ecclrr'ith e:rc.h
otlrcrs nlcusilrcs approxinrirtcll, 57o/ool the tinre. perrclcntagc of itgreernent rneAsufcs lirr thc 2 lcsts r,:rriccl
tr'()nr b / t<t t /a/u it'hcrr it testcr-w?lscontp:rrecl r,vitl-r
tliernsr:lrresanci Iionr 47 ro 627a u,hen one testcr \,vas
corllltirrccl tr,ith anothcr tester.
TABLE
tc s t-rej
Te
Hor'r,ever,the patcllar tilt test an(l the lateral pull
test riicl ltot pro\re to be rcliuble tvhc:n corrt:cted ibr| ()rthop S ports P hvs Thcr.\'ol urre 3l .N untber 7..fLrl v2001
J Ol tl
pulltest:agreement
matrixfor testers
I and2
4. Lateral
TABLE
inrbzrlanced (vc.rticul Iotals incr-citsc il-ont top to bott<'xrr,horizonlirl t<>tirlsclc:crc'ascfr-om lefi to right),
Tester
1
Iester1
(- )
(+ )
Total
kappur nrav bc clcvatcci ancl reliabiliLv overcstimatc : c l . 1 {iA n a s v n i r r i t : t r i r : ; r li r n l >z i l a n c ei r r t l r e r r i a l g i n a l to 45
J
48
Testcr
2 i+)
(-l
t:tls rr'as prcsel)t in thc intcrr:itcrr clirt.aof thc latcral
2
69
73
142
Tr.slur
Total
|4
76
190
1;ull test. In fablc 4 firl cxalnltlc, thc holizont:tl rnitrth epa tel. ac liv ely
t r ac k slat er all,>vs uper ior l(v-;1 , p a t c l l a sinal totirls clcr:rcasc 1l-orn lcrfi to ligl-rt n'hile thc i'crtiI ' t ind ica tes
su1-rerolatural
lv.
.rctivclv
tr,rcks
supcriorlv
or equidisLrnt
cal ttrarqirrirl totals incrcasc liorn top t() l)ott.()ln.
T h u s , k a p p : r I i r r i r r t t 'r 'r 'a t c r r c l i a l r i l i t v r r r a y l i a v e b cc- n
arti fic:iallV eleYlrtcrl. Ll o$,errer,i r.rtcr-r'utcI J)crcclt 1
iorrs :rrL tlrorsha vc s t Lgges t e' ctllr c pat er llar t ilt a n d s l i r l c
a e r e r e l n c r r t f i r l t h e s e t c s t s w a s n o t h i a i r ( ( r 2 %) , a n d
1r' sts.Irt tlrc'first phas t : ol llr is s t Lr dr ' ,n' t : c lir l n o t I i n t l
t h c r t : l i r r r : r i r r r k a p p a r ': r l r r e sr v t : r 'c p r o l x r l r l v r r o l se l i thc tilt t('st t() b c lc liablc : . [ ) r r r . ins t his phas e: r v c l l s o
o r r s l v a {I 'e c t c r l . {i
t ' x:rrrrirrccllhc gli c lc t c s t , c lr r r ins n, lr ic h t hc 1l:r t t 'l l t ri s
A r e r l i a b l c t l i n i c : u l l l ) c a s u r c o f ' l t i t s s i l c p 2 r t o l la r n l ( F
rliv irlc<l irrto 4 rlr r ir r lr ' : r nt sur r c l t lr c ?ull( ) ul) t of l t a s s i v c '
l r i l i t t ' t . o : r s s c s st l l o l c r i g t l r o l ' l r ( ) t l c ( ) n t l : r c t i l c ' l a te n l r - c:rlis ltlaccrtrr:rrtis <lr r ant il' ic r l bv nt r r nlr c t ' of c lr ux l r i u ) t s .r ( i s 1 l 'a i l r t sr - c r r r i r i r r sc l r r s i v t : . T I r c l b i l i t r ' o [ ' o r r r ' 1 ( 'st( 'r st( )
' Iir (cs1
r.clia lrilitr ' oI t lr e glir lc t c s t ir r t lr ; r t I ir r - n r , h o r 'r .
c : l : t s s i l \<h
' , n a n r i t ' P a t c l l : r l r r r o t . i r i r r: r s e i t l r e l n o r - r r l r l o r '
ruvcr',tlrc sarrrp lt' r ) r us t inc lll( lc l s igr r if it it r r t nr r r n l r c r c x c t 's s i v c 'l v : r s u l s o l i n r i l c : r l . \ \ l r v i s [ ) i l l c l l i r l r n o l ti l i t.r ,so
ol' s rrbjt:cLs witlr lr r ' p< : r ' r nobilr '( t o t hc point o{ t l i s l o t l i l f l c r r l t t ( ) n r c t r s r r l e r v i l l r c o r r s i s t e r r c v i ( i r : r r c r a ll r ,, tl r c
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cut:rlllr') p alcllac.
c lir l r r ot P( ) s s ( ' ss: i l r \ r
l t r i t r u t t - v s ( ) u r '(( 's o f i r r c o n s i s t c t r c \ , i r r c l i r r i c t r l l ) ) r ':r sl r r ( 's
.1
srr lrjcc:tsn ,i1lr cl r ut r lt : t r t lsof pas s iv t ' nr obilit v l r t r l ,
l t t - c t l t c a l t l i l n t c l r t 'i r r g n r c l s r r l c c l , t l t t ' 1 ) l ( 'a s u r( 'r n ( 'n t
t lrcr-cfirr-r:,lv<' r'otr lt l n( ) t u( lc ( luat c h' r ' r ' alr r : r t ct l r c l c l i i t s c l l , l r r t r l t l r c ' n r c : r s r r r c 'r1'.I l h c I 'r l s t p r 'o l r l c r r r i s 1 .l r a t
gli(
[
c
lrlrilitv o f fhc lcst . Fr r t ule s lr r r lic s oI t lr c
tcs(
t l r c : u t l r i l r r r l c b c i n g r r r c : r s r r r e r ci tlr t l i i s s t r r c l r ',P : rtr 'l l i r r '
slr orrl<[ cithcr- inr : lr r r lt ' l r r r r r t r bc r -o( s r r bjc c ls r v i t l r t l i s n i o b i l i t r ', l l i c k s r r o l r r l l t i \ '( ' ( l u t a . \ \ r i t l r o r r t . l r r r r i rr r l su l
l< >czrla blc'
pa tclla r : ol lt ' r ' is c t lr c u, l) , t lr c ac t ' r ' s s o r - \r' n ( F
c l c I i r r i t i o r r o t ' n o l r r r a l , i t . i s o l ( '( ) u l s c <l i {fi c : r r l t t o i <l cr r
glar
k
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l.
lrilitr' o J th t' Pa tc ll; r is
t i l r ' r t b n o r r r i a l . E t 'c n c x l ) c 1 1 s c l i s a g r t 'r ' u l l o r r l l , h tr t. i s
Irr tlre st:<on cl phlr s c o1' t [ r is s t r r r lr , ,r ' r c inv t : st i g l r t t 'r l
t t o r r n l t l \ r c l s u s l r l r rr o l r r u r l 1 t : rtl'l l t r l r rr o l t i l i t r '. [ , 'o l t'xl r r n tlit' l:rtc'r-irlprrll tc s t , r ' r ' lt ith r t r av lr t : inc lic at iv c o { i r
l r l e , I i o l o r 'r 'i c l r c t a l r '; c o r r s i c l c l u l ) t r t i ( 'n t n , i t l r r rr cr l i l r l
t ig lrt lltcllrl rc'str ' : r ir t l,lr r r t r r ur r ,lls o lr t ' ir t f lt r en c r : c l l n '
l . r i t t t 'l l a r g l i c l t : o l 'o r r u r l r u r r l r - a r r t o l i <' l r g o o r l s r u g i r ':r l
lrlr rro r-rrr:rllro rrv t: onligr r lr r t . ior t of t . hc t r ot hlc : r , g ( 'l ) r 'r '<l r r c l i c l : r t e ,t l 'l r i l c \ \ j i l k c t l r l r ] 7c l c s c r i l r c o r r c r c l r u rcl r ';r r i t
lrlizt'rI lie arrrcnt() r r s llr x it v or ' < lr r ac hic c lr s r v t ' r r kr t e s s .
o l p l t t i 'l l l t r r l i s l t l l c c n r r : r r t l s r r o l r n a l .
' l lrrrs, lrt, itscll tlr c lat e' r ' ir lpt r ll t es t r llt v n( ) [ lr t' r r s c l r r l
'l 'h t : s e c o r r c l p o t c r r t i a l s o u r c c o {'i r r < o r r s i s t c 'n cvi s th t'
i rr rlisc:r'in rina ti n e l) r ' 1nt ' r ' rr v alior r s t ' l iologi( ' s . H o r , r 'e l .
i n t l i r r s i r ' p l o l r l c r r r s l r s s o ci : r l e c l u 'i t l i p : r t . t 'l l : r rt ( 's t.s.l ) l l l .
cr,:l t('st u'lriclr lr t ' lps t lr c r ' lir r ic ilr r i c k : lc r r r r ir r e i l l p r i r t g t l r t ' p l t c l l a l t . i l t a n r l I u t t 'r : r l p t r l l r c 's t s ,t h c no r r t icrrt h :is cx<'r'ssiv cl: r t c lal pat c lllu' t luc k ing r v o r r l r l l t c r
y t l a n l t r -s l n p e o l 1 l r c ; r l t t : l l l u n r l t l r c v r r r v i r r e : r nr ( ) r r n ts
I rcl1 llirl in <lilcctin{ r - t l c lr t . lnc - nt .
o l s r r p r - a p l t t r - l l a rt . i s s r r cl r r n ( ) l l u t . l r r :s t r l i j r : <t s r n i r l ' h i i vc
'fo cstirn:rtt: th c t r : s t - r ' c t . c srtc lilbilit v ol t lr c r s t :
r n l r c k : i 1 r l i l i i c r r l t . 1 o p l l l r r r l c a r r r l v i s r r a l l v l o r : l t c th t: 1 xr Jntt:lllrr':rlig nn rct)t (cs ( s , k lt ppa x ' lt s t t s t ' c l bc c lt t r s t : it . t o r t . c 'l l a .T 'h t : p a t t 'l l u l t i l t t ( : s 1i s a r r n r r r r : r l t t : s t o [ '. j o i n 1
rcc ts lirr c lltrtt'r: ugr ( ' r ' ln( : lr t . I ilr pplL is gc nelall l ' u l ) l 'c r n o b i l i t v r l r r l i r r g r v l r i c l r t t 's t t 'r 'st r l t l t l - vr r I i r r c c t o ti l t tl tc
It:r'r'crl s(lrtistic tri c ' s t ir r lt t t ' ir r t t ' r r lr t t ' r ' lr glt c nr <: n t l i r r '
p i r t c l l i L r n c r l i : r l l l ', n l r i l c s t i r l r i l i z i r r s i t f i . o r r r s l i ( l i l )u l r r trt orrrirrill scalt: <l:t ll; lt or ' r c r , c r ' t, : : r r r t ior rs lr or r lc l b c r r s c c l
c r a l l v . I 'l r e : r n l ( ) r u r t o l t : x t c r - r u r l I i r r c : t 'r r s c c l t o n r ( ) \'c
rlrlrcl intcl-Prctirr g k ir PPa if llr c lc is lr r r ir nLr al r n c c i r r
. j o i r i t s l r r r d 1 o s l . r t : t c : i rt i s s r r e si s p o o r - l v <l o c t u n e r r tcr l
t lic <l:rtirbc:ing u s s r : s s t ' r l.ln t his s it r r ir t ion, t lr c k : r 1 >1 ; a
i u t r l r t c <: c l sl i r r t . h t : r i n v c s t i g : r t i o r r . r t 'rI n u p i l o t s 1r r r l r ,,
t:o cflit icn t rrn v b c s ig- nilic ar r t lr .lor
' ' r , elec iol inf l a t c d . 'r , ( l 'f h l c l k e l ( l r J r r c c o r '<l c c lt h c t 'x t c l n a l f o r c e s p l o c l rr ce <l
II rtr:rrgin al totals ir r t . hc agr t : t : r lic r r l.r r lit lir u r c s l l r b 1 ' 2 c x p c r i c n c t : r l p h y s i c r r l t h e r a p i s l s p t : r f i r r - n r i r r g vr r r .i ntetricallv irn ltaIa nc c c l ( r ' elt ic al t ot : r ls illc l' c as e I i - c i m
orrs elircles ol 1.1ror':rcic
spir-rt:rri<ibiliz:rtion :rnrl rc:portt.()p t() l)()tt()nl irnrl h<irizorrtlil tol.als incrctasc fi'ont
t:cl :r larsc clisparitr, lrcnvccn tl-rc thcrapists. Similu'I1',
lcft to right), tlrc kappa will bc lou'crccl ancl rvill tt:ncl
L e s l c r s i n t h i s s t r r d y f 'c l t t h a t i t \ \ 'a s ( l i l f i c u l t [ ( ) ( l u u n ti to rurdcrcstinralc' r'eliirltilitr'. 'l'hc eliect cii rnurginal
fv the arnourrt of {irrce 1() usc witl-r thcir hands rvlrcrr
t()1 2rlson kap pa i s pr obr Llr lv r n, t s t s igr r il- ic lr r t r vl r c n
passir,e jrirtcllar tilt.
1-rcr-frrrnrirre
'I h e f i n a l
pcrccltt 2lg recnlc nt is lr iglr . A s 1' r r t r net r - ic al
ir nb i r l a n c e ,
s o l l l 'c c r o [ 'i n c o n s i s t c n ( \ ', l l l e r l l e : l s u r e l ,
in drer pr(lsell(lu <tf )7j(ft, :rgre.lltcllt. dicl r:xist irr ,'rrnay bc :r firclor in tl'ris inr,estigation bcczu-rscthr: tt:slint|trrzitcr data. A strnrnr:tric inrbalance \{as prcscnt
cfs \rere senior pl-rvsical therap]' stuclents. \,\tl-rileit
in the agrecnrctrt rnatrix of testcr 2 chrrin{r intrarat.er
shorrlcl be notecl th:rt thcsc students receivecl a signif; rliabili$' lneasurclncnts ()f thc lateral ptrll te st. Thus,
icnnt amount of trainir-ig, their skills may not be re[1r.. kappa coef{icients lbr thc inrrarater reliabilih'of
{lective of rnost expericncecl clir-ricians r'vhcicnrrcntl,v
lesitr 2 may have bcen arlificially lou'erccl.
ernplo,v these tesls. It appcars tllat se\rer'2rl
sc,xrrccsof
Cr,rtr,crseh,, if marginal totals are asymme tricallv
inconsistcr-rcy confbtrnd the clinicai exarnination of'
3;'l
I Orthop S por-tsP ]rvsTher.\'ol rrnre 3l .N umber 7.J uh 2001
p r r l cl l a r
\ rl 1 \ ' c l l l
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abilit '
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patellar rnobilih,. These retlsons ntav explain, in part,
whv currer)t clinical tests havc llot beelt plot'en rcliab le.
Inclivicltral tests commonlv rrsecl to iclentifv sacroili2rcrclvsfiinction ha.\'e also been shown to l-rave cluestion:rble reli?rbiliq,,2:rinclicatins aszrin thar inclividual
and.fennif'er l,llison, PhD, P1',fbr critical r-eadinsof
thc rnanrrscl i pt.
REFERENCES
1 . A r r o l l B , E l l i s - P e g l eE
r , F d r , v a r cA
l s, S u t c l i f f eC . p a te l l o fe m o r a l p a i n s y n d r o m c . A c r i t i c a l r e v i c r vo f t h e r 'l i n i ca l tr i a l s o n n o n o p e r a t i v e[ h c r a p y . A n t J S p o n sM e d. 1 9 9 7 ;2 5 :
207.212.
<lt:nv tlrc prcscncc of sacroiliac rlysfr-rncl.ion,tlrct intcr2 . C i b u l k a M ] , D e l i t t o A , l ( o l d e h o f i R M . C h a n g csi n i n n o m i n a t e t i l t a f t e r m a n i p u l a t i o n o f t h e s a c r o i l i a cjo i n t i n p a r :rte r r-clia bilitv was ex t t . llc r r r ( r c - ( ) 8f t ) . [ ' t : r h i r p s
tients
with Iow bacl<ytain. An cxpcrirnental stucly.ph1,-s
clrrstcrs ol' tcsts t hir t c las s ili, pat ie llt s n. it h PF P S i n t c r
T h e r . 1 9 8 t 1 ; 6 t l :315 9 13 6 3 .
srrbe rorrp s \\'ortl( l inc r et Ls c ir r l. c r r at er r c liabili t i '.
- i . t ) y e S F , V a u p e l C t . T h e p a r h o p h y s i o l o g yo f p a te l l o fr :It is also po ss ilt lc t hat pat c llal r r r obilit r ' / t la c k i r r s
n'roral pairr. Sports Mxdic:inc anc! Arthroscoltv Ravicw.
irttp aiIrrrcnts :u' c lt ( ) t t lr t : ( ) r r ly c lat . at hit t . s hor r l d b C
1 9 9 4 ; ) : ') O\ - 2 | O .
. 1 . F c i n s t c 'i nA l t , C i c c h c t t i D V H i g h a g r c e n r c n tb u t l o w ka p
r :orrsi<lcr'ccl
rvhcr r i' las s ilv ing inc liv ir lr r : r lsu' it h I ) F P S .
pa: l. The 1>rolrlcrns
of two ltaracloxcs./ (./irr Epidentiol.
I)cr1rirp sIlte pa ir r c or npluint s : r r r r l f ir nc t . ionul l i r n i t a l
9
!
)
0
;
4
.
)
:
5
;
l
i
5
4
9
.
tio ris ol vrrlio rrs s r r lr gr ' oir psof inc liv ir lr r alsr v it l r P l i l r S
5. Fic;rl RP, Hr-rngcrlordDS. Disctrdcrsol' LheP.ttellot't,ntoral
rvorrlrI b c Lrscll r l t < t c lir r ic : iit ns\ v ll( ) al' c t r t ' inil- t o c . l u s s i , r l : Wi l l i a n r s & Wi l k i n s , 1 ( ) ZZ
/ o i r r t . 1 3 a l t i m o r cM
[y pa t.it:n1 s.It l'o r r lr l lr t ' ilt c r r . s lir r q t o t or r r lll t l r : t h c
( r . I 'i t z g c r a l r lL l K , M r ( - l L r r cP W. R c l i a b i l i t vo f n r c'.r sL r r o m e n r s
o b t a i n e r l l v i t h f o u r t e s t s f o r l t a t o l l o f e n t o r . rla l i g n m c:n t.
1 -xtitrco ntp lrrin t. s: r r r c lI ir r r t ' tior r ul I ir r rit at ior r s o 1 'c li f 'fb r I)hvs I ltt'r. 19()5;75 1\1-()O.
cnl. sillr)p lc:i o l'pat ic r r t . s u, it lr PI il' S ( t hos e' u' h o h a v t :
7
.
F u l k u r s o r rl l ) . A w a r c n e s so f l l - r ur c t i n , i ru l u r n i n e va l u a ti n g
cxccssivt' l:L lcllr l t r ar : k ing c lr r t ' 1o ir llt or nr al lr o r r v t 'o r r y r a t c r l l o l . e r m o1rt;ar |i n .A n t J S y t c t r M
t st , c l . 1 ( ) 8 2 ; | 0.1 4 7 i 4 9
[ig rrlirtiorr ol {lr c I r oc lr lc : r , t I r os c r v lr o hlt v t ' t 'r t : t . s s i 'u t :
t i . F u l l <r l r s o jn[ '] ,S h c . r l ( [ , . [ J i s o r c l e r so f p a t i , l l o f c mo r a la l i g n
lalcr-ll trackirrg lir r t c lo r r ot lunc t r lt r t or r l: r l lr o r r y t 'o n ,
n r c n [ . / B o n t : J c t i r t tS u r g ,l A r n l . 1 9 9 0 ; 7 ) : 1 4 ) 4 j4 2 9 .
( ) . C , r c l s ; r n r clrt.I
f ig rrratio rr o f tlr r ' 1r ' oc lr lr : : rar
, r r l t hos e w' lt o r lo r r o t
l(lcin lR. thc biomcc:hanir.o
s f th c p a te l
lolcrnrrrral
h:tvt' t'xccssivc lut c ' t al lr at c llul t nLc k inu) r r s in g k i r i r . r I'lrys I'her. I9l)f);2fi:286
l>int. I (.)rtltop-5irort.s
298.
t tutl.ic rrng rrr'1it' r ' c s onlr r r ( c illr agine. I I t lr c er o r r p s c l i l .l
0 . ( , r r : l s a n r c r l l P , M c . ( . o n n e l l 1 . I h c f l r t t l l a : A Te a n t AytI i'r'sig rrific:a ntlr ' ,t lr c r n y r c r lt lps lr c or nlt it ur t ior r o I t h e
g ,c l : A s p e r nI r L r bi sl l r r t r sIn
t a <'h (. , a i t h u r s l r r - r r M
, t_ ;19 9 9 .
.l ltrr
s rrlrjr:r'{ivcn ting s , I ir uc t ional lir r r it ir lior r s , : r r r c l a t : l r r s ,
I . l l a l c y S M , ( ) s l t c r g i S . K a p l r ar o e f f i ci e . r 'rt ta l c L rl a ti o nL r si n g
t c r' o l p utt'll:rl s1?r t ic / ( lv nar r r icnr olt ilit v t es t s r v o r r l r l
n t r - r l t i l t l er , t t i n g s p c r s L t l r j t : c ta: s p t 't 'i a l c r i r . t r n tr - r n i <..tti o n .
f 'h v s T h e r . l 9 8 9 ; 6 ( ) 9 7 0 9 7 4 .
Plo vc r lLlru rltlc i n c lus s i[ \ , irr e t lt c c l inir : : r l ir r r ln i r r r r t 'r r t s
1 2 . I l a r r i s o nF , M a e i : e D , ( J u i n n e y I l . D c v c l c >1 r n r r :n
o l -t.r <.l i n
o[' I lrcst: irr<[ivic lr r lls .
i c a l t o o l ; r n c lp a t i r t r r tq u r , r s t i o n n a i rfrr:t r c v . r l u . tti),r , ) f l ) .1 t c l l o f r r r r r r r a ll t a i n s y n r l r o m r :p . r t i e n t s .( 'l i n I S l to r t tr 1 a r l .
CO N C LUSIONS
I()(16;(r6
: ..1J 1 7 0 .
l - 1. l n s . r l l J . ( - r - r r r e n(t. o n r e l . r l sI {e v i c r v :l ) . r l c l l a rp ai n . / l 3 t- r n r ,
()rrl strrrlv tt:s t t : r l t lt c ir r t ll- lr nr l ir r l< ' r . r ' lt t c l l c l i J o i n t S t t r gA n t . 1 ( ) 8 ) ; 6 4 1 4 7 l 5 ) .
I 4 . J c t l t ' A M . M e . r s L t r i n es L t b j c c t i v er , l i n i c . . rol u t c .o m r _ .s.
Ph ys
ab ilitr'of tlrt: lul c lul lr Lr ll t t : s t r r r r r l r noc lif ir ' < l l l r t c 'l l l r '
[ |tcr. 1()tt9 69:5f]0 5tJ4
t ilt 1('rit.
rrs t'liriic : ll t c s t s r r s er l t o uv alt lr t r ' lnt . e l l l l r r r o I 5. l(altenlrornl. M.tnual Mobilizatictrtri tltt,Extrernitylctints.
b ilitr'.'l'lrt'lrrtcra l pr r ll t c s t al) c l r l) c l) ar c llal r i l t t c s r
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