Reliability of the hip examination in osteoarthritis: Effect of standardization

Cibere, Jolanda, Thorne, Anona, Bellamy, Nicholas, Greidanus, Nelson, Chalmers, Andrew, Mahomed, Nizar, Shojania, Kam, Kopec, Jacek and Esdaile, John M. (2008) Reliability of the hip examination in osteoarthritis: Effect of standardization. Arthritis Care and Research, 59 3: 373-381. doi:10.1002/art.23310

Author Cibere, Jolanda
Thorne, Anona
Bellamy, Nicholas
Greidanus, Nelson
Chalmers, Andrew
Mahomed, Nizar
Shojania, Kam
Kopec, Jacek
Esdaile, John M.
Title Reliability of the hip examination in osteoarthritis: Effect of standardization
Journal name Arthritis Care and Research   Check publisher's open access policy
ISSN 2151-464X
Publication date 2008-03-15
Year available 2008
Sub-type Article (original research)
DOI 10.1002/art.23310
Open Access Status Not Open Access
Volume 59
Issue 3
Start page 373
End page 381
Total pages 9
Place of publication Hoboken, NJ, U.S.A.
Publisher John Wiley & Sons
Language eng
Subject 11 Medical and Health Sciences
Abstract Objective To assess the reliability of the physical examination of the hip in osteoarthritis (OA) among rheumatologists and orthopedic surgeons, and to evaluate the benefits of standardization. Methods Thirty-five physical signs and techniques were evaluated using a 6 × 6 Latin square design. Subjects with mild to severe hip OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of physical examination techniques. For dichotomous signs, agreement was calculated as the prevalence-adjusted bias-adjusted kappa (PABAK), whereas for continuous and ordinal signs a reliability coefficient was calculated using analysis of variance. A PABAK >0.60 and a reliability coefficient >0.80 were considered to indicate adequate reliability. Results Adequate post-standardization reliability was achieved for 25 (71%) of 35 signs. The most highly reliable signs included true and apparent leg length discrepancy 1.5 cm; hip flexion, abduction, adduction, and extension strength; log roll test for hip pain; internal rotation and flexion range of motion; and Thomas test for flexion contracture. The standardization process was associated with substantial improvements in reliability for a number of physical signs, although minimal or no change was noted for some. Only 1 sign, Trendelenburg's sign, was highly unreliable post-standardization. Conclusion With the exception of gait, a comprehensive hip examination can be performed with adequate reliability. Post-standardization reliability is improved compared with pre-standardization reliability for some physical signs. The application of these findings to future OA studies will contribute to improved outcome assessments in OA.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2009 Higher Education Research Data Collection
ERA 2012 Admin Only
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 28 times in Thomson Reuters Web of Science Article | Citations
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Created: Sat, 08 Nov 2008, 01:40:28 EST by Chesne McGrath on behalf of National Research on Disability and Rehabilitation Medicine