Advertisement

Inter-examiner and intra-examiner agreement for assessing simulated leg length inequality using palpation and observation during a standing assessment

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Osteopaths commonly assess leg length. Inequalities in leg length are associated with an increased incidence of low back pain, adaptive muscle shortening, ligamentous and capsular hypomobility and degenerative joint disease. Accurate detection of leg length inequality could allow early preventative intervention. Several clinical methods of assessing leg length are documented, yet few show convincing reliability. The aim of this study was to determine the inter-examiner and intra-examiner reliability of the standing assessment of leg length inequality using heel inserts to simulate leg length discrepancy. Twenty-seven subjects (mean age=23) were examined by eight examiners. Assessment of leg length was performed by palpation of iliac crests, posterior superior iliac spines, greater trochanters and gluteal folds with the subjects standing. Examiners indicated whether leg length was equal or if there was a longer leg on the left or right. Subjects were assessed with no heel insert and heel inserts of 0.5cm and 1 cm in their shoes. Each insert intervention was examined twice on each subject by each examiner. Zero, 0.5cm and 1cm interventions demonstrated inter-examiner percentage agreement of 52.5% (K=0.27), 53.9% (K=0.28) and 63.4% (K=0.19) respectively. Zero, 0.5cm and 1cm interventions demonstrated intra-examiner percentage agreement of 58.4% (K=0.35), 60.7% (K=0.34) and 63.5% (K=0.14) respectively. The results of this study indicate that examiners are unable to reliably detect simulated leg length discrepancies of 1cm or less by standing assessment.

      Key Words

      To read this article in full you will need to make a payment

      References

        • Nichols PJR
        • Bailey NTJ
        The accuracy of measuring leg length differences.
        British Medical Journal. 1955; 2: 1247-1248
        • DeBoer KF
        • Harmon RO
        • Savoie S
        • Tuttle CD
        Inter- and intra-examiner reliability of leg-length differential measurement: A preliminary study.
        Journal of Manipulative and Physiological Therapeutics. 1983; 6: 61-66
        • Shambaugh P
        • Sclafani L
        • Fanselow D
        Reliability of the Derfield-Thompson test for leg length inequality, and use of the test to demonstrate cervical adjusting efficacy.
        Journal of Manipulative and Physiological Therapeutics. 1988; 11: 396-399
        • Mannello DM
        Leg length inequality.
        Journal of Manipulative and Physiological Therapeutics. 1992; 15: 576-590
        • Rhodes DW
        • Mansfield ER
        • Bishop PA
        • Smith JF
        Comparison of leg length inequality measurement methods as estimators of the femur head height difference on standing X-ray.
        Journal of Manipulative and Physiological Therapeutics. 1995; 18: 448-452
        • Jonson SR
        • Gross MT
        Intraexaminer reliability, interexaminer reliability, and mean values for nine lower extremity skeletal measures in healthy naval midshipmen.
        Journal of Orthopaedics and Sports Physical Therapy. 1997; 25: 253-263
        • Greenman PE
        Principles of Manual Medicine.
        2nd Ed. W.B. Saunders Company, Philadelphia1996
        • Rush WA
        • Steiner HA
        A study of lower extremity length inequality.
        American Journal of Roentgenology. 1946; 55: 616-623
        • Beal MC
        A review of the short leg problem.
        Journal of the American Osteopathic Association. 1950; 50: 109-121
        • Nichols PJR
        Short-leg syndrome.
        British Medical Journal. 1960; 1: 1863-1865
        • Giles LGF
        • Taylor JR
        Low back pain associated with leg length inequality.
        Spine. 1981; 6: 510-521
        • Cyriax J
        Textbook of Orthopaedic Medicine. Vol 1: Diagnosis of Soft Tissue Lesions.
        8th Ed. W.B. Saunders, London1982
        • Friberg O
        Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality.
        Spine. 1983; 8: 643-651
        • Travell JG
        Volume 1. Myofascial Pain and Dysfunction: the trigger point manual.
        Williams and Wilkins, Baltimore1983
        • Stoddard A
        Manual of Osteopathic Technique.
        3rd Ed. Osteopathic Supplies, Hereford1993
        • Lawrence DJ
        Chiropractic concepts of the short leg: a critical review.
        Journal of Manipulative and Physiological Therapeutics. 1985; 8: 157-161
        • Magee DJ
        Orthopaedic Physical Assessment.
        3rd Ed. W.B. Saunders, Philadelphia1997
        • Kuchera WA
        • Kuchera ML
        Osteopathic Principles in Practice.
        2nd Ed. Greyden Press, Ohio1991
        • Dott GA
        • Hart CL
        • McKay C
        Predictability of sacral base levelness based on iliac measurements.
        Journal of the American Osteopathic Association. 1994; 94: 383-390
        • Saunder HD
        Evaluation, Treatment and Prevention of Musculoskeletal Disorders.
        Educational Opportunities, Minnesota1985
        • Friberg O
        Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality.
        Spine. 1983; 8: 643-651
        • Friberg O
        Leg length asymmetry in stress fractures.
        Journal of Sports Medicine. 1982; 22: 485-488
      1. (Aug)
        • Bogduk N
        An interview with Nikolai Bogduk. Musculoskeletal medicine, evidence based medicine and the meaning of life.
        in: Newsletter of the Australian Association of Musculoskeletal Medicine. 1988: 1-4
        • Bartko J
        • Carpenter WT
        On the methods and theory of reliability.
        Journal of Nervous and Mental Disease. 1976; 163: 307-317
        • Vincent-Smith B
        • Gibbons P
        Inter-examiner and intra-examiner reliability of the standing flexion test.
        Manual Therapy. 1999; 4: 87-93
        • Haas M
        Statistical methodology for reliability studies.
        Journal of Manipulative and Physiological Therapeutics. 1991; 14: 119-132
        • Hoyle DA
        • Latour M
        • Bohannon RW
        Intraexaminer, interexaminer and interdevice comparability of leg length measurements obtained with measuring tape and Metrecom.
        Journal of Orthopaedics and Sports Physical Therapy. 1991; 4: 263-268
        • Venn EK
        • Wakefield KA
        • Thompson PR
        A comparative study of leg-length checks.
        European Journal of Chiropractic. 1983; 31: 68-80
        • Soukka A
        • Alaranta H
        • Tallroth K
        • Heliovaara M
        Leg length inequality in people of working age.
        Spine. 1991; 16: 429-431
        • Hoppenfeld S
        Physical Examination of the Spine and Extremities.
        Appleton & Lange, California1976
        • Corrigan B
        • Maitland GD
        Practical Orthopaedic Medicine.
        Butterworth-Heinemann, Oxford1983
        • McRae R
        Clinical Orthopaedic Examination.
        3rd Ed. Churchill Livingstone, Edinburgh1990
        • Bourdillon JF
        Spinal Manipulation.
        5th Ed. Butterworth-Heinemann, Oxford1992
        • Apley AG
        • Solomon L
        Apley's System of Orthopaedics and Fractures.
        7th Ed. Butterworth-Heinemann, Oxford1993
        • Petty NJ
        • Moore AP
        Neuromusculoskeletal Examination and Assessment.
        2nd ed. Churchill Livingstone, London2001
        • Sammut EA
        • Searle-Barnes PJ
        Osteopathic Diagnosis.
        Stanley Thornes, Cheltenham1988
        • Mitchell FL
        • Moran PS
        • Pruzzo NA
        An Evaluation and Treatment Manual of Osteopathic Muscle Energy Techniques.
        Mitchell, Moran and Pruzzo Associates, Valley Park1979
        • Winterstein JF
        Letters to the Editor.
        Journal of Manipulative and Physiological Therapeutics. 1989; 12: 241-242
        • Cailliet R
        Low Back Pain Syndrome.
        4th Ed. F.A. Davis Company, Philadelphia1988
        • Downing C
        Osteopathic Principles in Disease.
        Orozko, San Fransisco1985
      2. DiGiovanna EL Schiowitz S An Osteopathic Approach to Diagnosis and Treatment. JB Lippincott, Philadelphia1991
        • Clarke GR
        Unequal leg length: an accurate method of detection and some clinical results.
        Rheumatology and Physical Medicine. 1972; 11: 385-390
        • Aspegren DD
        • Cox JM
        • Trier KK
        Short leg correction: a clinical trial of radiographic vs. non-radiographic procedures.
        Journal of Manipulative and Physiological Therapeutics. 1987; 10: 232-238
        • Mann M
        • Glasheen-Wray M
        • Nyberg R
        Therapist agreement for palpation and observation of iliac crest heights.
        Physical Therapy. 1984; 64: 334-338
        • Ward RC
        • Kuchera ML
        • Kuchera WA
        Postural considerations in coronal and horizontal planes.
        in: Ward RC Foundations for Osteopathic Medicine. Williams and Wilkins, Baltimore1997
        • Landis JR
        • Koch G
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Lantz CA
        Application and evaluation of the kappa statistic in the design and interpretation of chiropractic clinical research.
        Journal of Manipulative and Physiological Therapeutics. 1997; 20: 521-528
        • Mann M
        • Glasheen-Wray M
        • Nyberg R
        Therapist agreement for palpation and observation of iliac crest heights.
        Physical Therapy. 1984; 64: 334-338
        • Keating JC
        • Bergmann TF
        • Jacobs GE
        • Finer BA
        • Larson K
        Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality.
        Journal of Manipulative & Physiological Therapeutics. 1990; 13: 463-470
        • Boline PD
        • Haas M
        • Meyer JJ
        • Kassak K
        • Nelson C
        • Keating JC
        Interexaminer reliability of eight evaluative dimensions of lumbar segmental abnormality: Part II.
        Journal of Manipulative & Physiological Therapeutics. 1993; 16: 363-374
        • O'Haire C
        • Gibbons P
        Inter-examiner and intra-examiner agreement for assessing sacroiliac anatomical landmarks using palpation and observation: pilot study.
        Manual Therapy. 2000; 5: 13-20
        • Jull G
        • Bullock MA
        A motion profile of the lumbar spine in an ageing population assessed by manual examination.
        Physiotherapy. 1987; 10: 1-4