88 for measuring ankle inversion ( Diamond et al 1989). Inter-rater reliability of measurements of physiological range of motion of the first ray in nonsymptomatic participants by podiatric physicians using a goniometer was unacceptable ( Van Gheluwe et al

2002). Finally, the only study in this review investigating accessory range of motion showed fair (Kappa 0.35) to moderate (Kappa 0.48) inter-rater reliability for measurements of medio-lateral talar motion by physiotherapists in symptomatic participants ( Erichsen et al 2006). This systematic review included 17 studies investigating inter-rater reliability of passive movements in lower extremity joints. Five studies demonstrated acceptable reliability. In four of these, physiotherapists acted as raters. Reliability Selleck EPZ-6438 of measurements of physiological range of motion ranged from Kappa –0.02 for rheumatologists using a goniometer to measure knee extension in patients with knee osteoarthritis,

to ICC 0.97 for physiotherapists visually estimating knee flexion in symptomatic participants. Measuring physiological range of knee flexion consistently yielded acceptable reliability using either vision or instruments. Measurements of end-feel check details were unreliable for all hip and knee movements. Two high-quality studies (Cibere et al 2004, Watkins et al 1991) reported acceptable reliability for measuring physiological range of knee flexion and extension. Overall, however, methodological quality of the included studies was poor. Inter-rater reliability for measurement

of passive physiological range of motion in lower extremity joints was, overall, considerably less than that in upper extremity joints (Van de Pol et al 2010). In upper extremity joints, measuring large physiological ranges of motion like those in the shoulder, wrist, or fingers using instruments frequently yielded satisfactory reliability (Van de Pol et al 2010). This finding could PD184352 (CI-1040) only partly be confirmed for the lower extremity. For instance, measurement of physiological knee flexion using either vision or instruments indeed showed acceptable reliability, but measurements of relatively smaller ankle movements were unreliable in four out of five studies. However, inter-rater reliability for hip measurements varied widely across movements and methods of measurement. This heterogeneity in reliability could be explained by the large variation among studies in operational definitions of measurement procedures particularly with respect to participant positioning and instruction, and raters’ execution of movements and handling of instruments. New research investigating inter-rater reliability for measurement of passive physiological hip movements should incorporate measurement procedures that are in accordance with international standards such as described by Clarkson (2005).