Validity of clinical outcome measures to evaluate ankle range of motion during the weight-bearing lunge test

doi:10.1016/j.jsams.2016.11.001

Journal of Science and Medicine in Sport

Volume 20, Issue 7, July 2017, Pages 618-621

https://doi.org/10.1016/j.jsams.2016.11.001 Get rights and content

Abstract

Objectives

To determine the concurrent validity of standard clinical outcome measures compared to laboratory outcome measure while performing the weight-bearing lunge test (WBLT).

Design

Cross-sectional study.

Methods

Fifty participants performed the WBLT to determine dorsiflexion ROM using four different measurement techniques: dorsiflexion angle with digital inclinometer at 15 cm distal to the tibial tuberosity (°), dorsiflexion angle with inclinometer at tibial tuberosity (°), maximum lunge distance (cm), and dorsiflexion angle using a 2D motion capture system (°). Outcome measures were recorded concurrently during each trial. To establish concurrent validity, Pearson product–moment correlation coefficients (r) were conducted, comparing each dependent variable to the 2D motion capture analysis (identified as the reference standard). A higher correlation indicates strong concurrent validity.

Results

There was a high correlation between each measurement technique and the reference standard. Specifically the correlation between the inclinometer placement at 15 cm below the tibial tuberosity (44.9° ± 5.5°) and the motion capture angle (27.0° ± 6.0°) was r = 0.76 (p = 0.001), between the inclinometer placement at the tibial tuberosity angle (39.0° ± 4.6°) and the motion capture angle was r = 0.71 (p = 0.001), and between the distance from the wall clinical measure (10.3 ± 3.0 cm) to the motion capture angle was r = 0.74 (p = 0.001).

Conclusions

This study determined that the clinical measures used during the WBLT have a high correlation with the reference standard for assessing dorsiflexion range of motion. Therefore, obtaining maximum lunge distance and inclinometer angles are both valid assessments during the weight-bearing lunge test.

Introduction

An increased number of healthcare practitioners are utilizing evidence-based medicine principles in their clinical practice. Evidence-based medicine integrates research, clinical expertise, and patient preference to guide clinical decision making.¹ Researchers are encouraged to investigate clinical measures or techniques that are commonly used or most accessible in the clinical setting.² Incorporating clinical measures into research will ensure these measures and techniques are transferred to the clinical setting. For many injuries to the lower extremity, assessing dorsiflexion range of motion is essential to identify risk factors³ or alterations in gait or landing mechanics.⁴

The weight-bearing lunge test (WBLT) is a clinical test that measures dorsiflexion range of motion of the ankle joint. The WBLT has been used to detect range of motion deficits in those with chronic ankle instability⁵ and track progress in improving range of motion during rehabilitation protocols.⁶ The WBLT has been established as a reliable measure,7, 8, 9 however, no current research exists comparing the WBLT to a laboratory measure of joint kinematics. Based off a recent systematic review,¹⁰ a variety of procedural differences have been utilized in published research when obtaining data on the WBLT.8, 11, 12 Specifically, WBLT data can be quantified using either a digital inclinometer or maximum lunge distance from the wall. Previous research has determined a high correlation between the angle using a digital inclinometer and the distance from the wall,⁷ but the placement of the digital inclinometer has also varied between studies (i.e. tibial tuberosity9, 11 or 15 cm distal to the tibial tuberosity⁷).

Validity is defined as the ‘degree to which an instrument truly measures the construct(s) it purports to measure.’¹³ Concurrent validity is a subset of test validity that compares a test with an established measure. A higher correlation indicates that the test has strong concurrent validity with the ‘established’ measure in the literature. The ‘established’ measure for assessing range of motion in the laboratory setting is a video motion capture analysis.¹⁴ There have been no concurrent validity studies between the clinical measures and video motion capture analysis during the WBLT. Therefore, the purpose of this study is to determine if the clinical measures are valid assessments of range of motion compared to the laboratory measures during the weight-bearing lunge test.

Section snippets

Methods

Fifty participants between the ages of 18–35 were eligible to participate in this study (25 males, 25 females, 24.2 ± 3.5 years, 172.8 ± 10.3 cm, 76.4 ± 16.6 kg, 43 right foot dominant, and 7 left foot dominant). Prior to participation, all participants completed a Physical Activity Readiness Questionnaire (PAR-Q) and a health history questionnaire. The sample included participants with a heterogeneous age, physical activity level, and history of lower extremity injury. A heterogeneous sample was

Results

Descriptive data with means, standard deviations, mean differences, and 95% limits of agreement were calculated for each outcome measure (Table 1). There was a high correlation between each measure and the reference standard. Specifically, the correlation between the angle when the inclinometer was placed at 15 cm below the tibial tuberosity and the motion capture angle was r = 0.76 (p = 0.001) (Fig. 2a). The correlation between the angle when the inclinometer was placed at the tibial tuberosity and

Discussion

This was the first known study to evaluate the concurrent validity of clinician-oriented outcomes compared to their laboratory-oriented outcomes during the WBLT. Previously, high concurrent validity has been established between an electrogoniometer and motion capture analysis of hip, knee, and ankle during ballet movements,¹⁴ as well as high concurrent validity between a digital inclinometer and universal goniometer at the hip.²⁰ This is the first study to assess the validity of ankle range of

Conclusion

Using valid clinical measures is an important aspect of evidence-based clinical practice. This study determined that the clinical measures used during the WBLT have a high correlation with the laboratory measure of assessing dorsiflexion range of motion. Therefore, obtaining maximum lunge distance and inclinometer angles are valid assessments during the weight-bearing lunge test.

Practical implications

•
Incorporating clinical measures into research will ensure these measures and techniques are transferred to the clinical setting.
•
Maximum lunge distance and inclinometer angles are valid clinical measures during the weight-bearing lunge test.
•
Obtaining valid clinical measures will provide better patient care.

Acknowledgment

No financial assistance was received for this study.

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Original researchValidity of clinical outcome measures to evaluate ankle range of motion during the weight-bearing lunge test

Abstract

Objectives

Design

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusion

Practical implications

Acknowledgment

J Sci Med Sport

Aust J Physiother

Man Ther

Man Ther

Man Ther

J Sci Med Sport

Evidence-based medicine: what is it and how does it apply to athletic training?

J Athl Train

Finding context: a new model for interpreting clinical evidence

Int J Athl Ther Train

Intrinsic risk factors for inversion ankle sprains in females—a prospective study

Scand J Med Sci Sports

Ankle-dorsiflexion range of motion and landing biomechanics

J Athl Train

Original research
Validity of clinical outcome measures to evaluate ankle range of motion during the weight-bearing lunge test