Hip and lower limb movement screen: validity and reliability of observational assessment in comparison to 3D motion analysis

Abstract

Movement screens are used widely to assess quality of movement by visual observation. However, there is a lack of research on the reliability and validity of the observation rating of the movement criteria that are assessed. The Hip and Lower Limb Movement Screen (HLLMS) is a new tool, specifically designed to focus on assessing control of hip movement, which is related to alignment of other joints in the lower limb. Good control of movement is thought to prevent injuries, particularly in sports, and in the longer-term, to protect the joints from developing osteoarthritis. If the HLLMS is to be used to inform exercise interventions to improve movement control, its reliability and validity need to be established to support its use as a robust tool.
The aims of the studies in this thesis were to examine the reliability and validity (criterion validity) using 3D motion analysis and sensitivity to change, of the observational rating of criteria from the HLLMS in male academy footballers, healthy young sedentary controls and professional golfers. Four experiments examined the reliability and validity of the HLLMS. Observational rating, video footage and 3D motion analysis data were collected while participants carried out the HLLMS. Motion analysis data were used to calculate kinematics corresponding to the movement criteria from the HLLMS.
Intra-rater reliability was assessed from video recordings, and between day and inter-rater observer rater agreement were examined in real-time, with mean AC1 values ranging from 0.6 to 0.8. However, individual criterion rater agreement ranged from -0.47 to 1.00 indicating poor to excellent agreement. Approximately 50% of the criteria assessed had criterion validity with significant differences between the kinematics for fault and no fault ratings. The majority of the ICC values for within day kinematic reliability were excellent (ICC>0.75) but between day kinematic reliability was lower with 10 of the 19 ICC values < 0.75. The validity to detect change of the observational rating of the criteria were assessed following a 12-week exercise intervention to improvement movement patterns in academy footballers. Four of the criteria had changes in their rating that consistently corresponded with a change in the kinematics.
The reliability and validity results from this thesis have demonstrated the potential for the HLLMS to be a robust tool in assessing movement patterns. Criteria that were found to be poor have either been revised or excluded from an updated HLLMS. Further research is needed to improve the accuracy of the criteria and establishing the validity and reliability of the revised criteria in the latest version of the HLLMS, in different populations. This thesis has advanced the field of movement screening by contributing to the development of a novel assessment tool that has the potential to inform exercise interventions to protect joints from injury and osteoarthritis.

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Identifiers

ORCID for David Wilson: orcid.org/0000-0002-6304-2836

ORCID for Maria Stokes: orcid.org/0000-0002-4204-0890

ORCID for Cyrus Cooper: orcid.org/0000-0003-3510-0709

ORCID for Martin Warner: orcid.org/0000-0002-1483-0561

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