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Ressman J1, Johannes Andreas Grooten W2, Rasmussen-Barr E1
1Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden, 2Karolinska University Hospital, Allied Health Professionals Function, Functional Area Occupational Therapy and Physiotherapy, Stockholm, Sweden
Background: Visual assessment of movements is a common tool used in the clinical examination to set and evaluate rehabilitation goals, but also to assess lower extremity function in active people. In sports medicine, such tests aim to recognize the quality of movement proposed to predispose for injuries
Purpose: The aim of this study was to systematically review and meta-analyse the inter- and intrarater reliability of visual assessment of the Single Leg Squat (SLS), including the Lateral Step Down (LSD) and Forward Step Down test (FSD).
Methods: A systematic review and meta-analysis was performed using the literature from following data-bases: CINAHL, Cochrane Library, Embase, Medline (OVID) and Web of Science. Methodological studies which through observation assessed the reliability of the SLS, LSD and FSD were included. The methodological quality was assessed using the Quality Appraisal of Reliability Studies Checklist (QAREL).
Results: In total 31 studies were included. The reliability varied largely between studies (interrater: kappa/ICC=0.00-0.95; intrarater: kappa/ICC=0.13-1.00), but most of the studies reached “moderate” measures of agreement. The meta-analyses of pooled ICC, kappa and AC1 showed a “moderate” agreement for interrater reliability, 0.58 (95% CI 0.50-0.65), and a “substantial” agreement for intrarater reliability, 0.68 (95% CI 0.60-0.74). Subgroup analyses showed a higher pooled agreement for interrater reliability of ≤3-point rating scales while no difference was found for different numbers of segmental assessments.
Conclusion(s): Our findings indicate that the SLS test can be suitable for clinical use regardless of number of observed segments and particularly with a ≤3-point rating scale. Since most of the included studies were affected by some form of methodological bias, our findings must be interpreted with some caution.
Implications: Our data indicate that the SLS tests are feasible and reliable in a clinical setting. The multi-segmental approach might give the clinician more information which could be relevant and helpful in targeted rehabilitation. As most of the included studies were assessed with some risk of bias, further studies of reliability should focus on the fulfilment of stricter methodological quality and the validity aspect of the SLS.
Keywords: Reproducibility of Results, Single Leg Squat, Visual Assessment
Funding acknowledgements: Funding; None declared
Purpose: The aim of this study was to systematically review and meta-analyse the inter- and intrarater reliability of visual assessment of the Single Leg Squat (SLS), including the Lateral Step Down (LSD) and Forward Step Down test (FSD).
Methods: A systematic review and meta-analysis was performed using the literature from following data-bases: CINAHL, Cochrane Library, Embase, Medline (OVID) and Web of Science. Methodological studies which through observation assessed the reliability of the SLS, LSD and FSD were included. The methodological quality was assessed using the Quality Appraisal of Reliability Studies Checklist (QAREL).
Results: In total 31 studies were included. The reliability varied largely between studies (interrater: kappa/ICC=0.00-0.95; intrarater: kappa/ICC=0.13-1.00), but most of the studies reached “moderate” measures of agreement. The meta-analyses of pooled ICC, kappa and AC1 showed a “moderate” agreement for interrater reliability, 0.58 (95% CI 0.50-0.65), and a “substantial” agreement for intrarater reliability, 0.68 (95% CI 0.60-0.74). Subgroup analyses showed a higher pooled agreement for interrater reliability of ≤3-point rating scales while no difference was found for different numbers of segmental assessments.
Conclusion(s): Our findings indicate that the SLS test can be suitable for clinical use regardless of number of observed segments and particularly with a ≤3-point rating scale. Since most of the included studies were affected by some form of methodological bias, our findings must be interpreted with some caution.
Implications: Our data indicate that the SLS tests are feasible and reliable in a clinical setting. The multi-segmental approach might give the clinician more information which could be relevant and helpful in targeted rehabilitation. As most of the included studies were assessed with some risk of bias, further studies of reliability should focus on the fulfilment of stricter methodological quality and the validity aspect of the SLS.
Keywords: Reproducibility of Results, Single Leg Squat, Visual Assessment
Funding acknowledgements: Funding; None declared
Topic: Musculoskeletal: lower limb
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: This is a systematic literature review and meta-analysis
All authors, affiliations and abstracts have been published as submitted.
