Validity and Reliability Pdf Peer Review of Corrective Exercise Movement Assessment

More than 10 000 Americans seek medical treatment for sports, recreational activity, and exercise-related injuries on a daily basis.^xx Researchers have estimated that l% to 80% of these injuries are overuse in nature and involve the lower extremity.^{1 , 11 , 25} In the military, physical grooming and practice-related injuries business relationship for 30% of hospitalizations and xl% to 60% of all outpatient visits, with ten to 12 injuries per 100 soldier-months.¹² Although the risk of musculoskeletal atmospheric condition and injuries is multifactorial,^{seven , ix , ten , xv , 17 – 19} preliminary evidence suggests that neuromuscular and strength training programs may be beneficial for preventing the occurrence of these conditions.^{7 , 9 , 10 , xv , 17 – 19} Withal, tools that assess movement to assistance predict those at highest risk for musculoskeletal weather condition and injuries take been lacking for both able-bodied and military populations. The Functional Move Screen (FMS) is a relatively new tool that attempts to accost multiple movement factors, with the goal of predicting general risk of musculoskeletal atmospheric condition and injuries.^{three – 5 , 13 , 14 , 16}

The FMS was designed to place functional movement deficits and asymmetries that may be predictive of full general musculoskeletal conditions and injuries, with an ultimate goal of existence able to modify the identified motility deficits through individualized practise prescription.^{3 , 4} The FMS consists of 7 fundamental movement component tests (FIGURE 1) that are scored on a scale of 0 to 3, with the sum creating a composite score ranging from 0 to 21 points.^{iii , 4} The 7 movement patterns that are assessed include the deep squat, in-line lunge, hurdle stride, shoulder mobility, agile directly leg raise, torso stability push-up, and quadruped rotary stability.

FIGURE 1. Functional Movement Screen tests. (A) In-line lunge, (B) hurdle step, (C) deep squat, (D) quadruped rotary stability, (E) active straight leg enhance, (F) shoulder mobility, and (G) torso stability push-upward.

Preliminary inquiry by Kiesel et al¹⁴ suggests that National Football League (NFL) players (n = 46) who had a composite score less than or equal to 14 on the FMS had an odds ratio of 11.7 (95% confidence interval [CI]: 2.five, 54.5) and a positive likelihood ratio of 5.eight (95% CI: 2.0, 18.4) to sustain a time-loss injury. Although the specificity was relatively loftier (0.9; 95% CI: 0.viii, 1.0), the sensitivity was low (0.five; 95% CI: 0.iii, 0.7), indicating that FMS composite scores less than or equal to fourteen may propose higher injury risk but FMS composite scores greater than fourteen exercise not rule out future injury risk. In a separate study on a grouping of Marines, a composite score less than or equal to xiv on the FMS demonstrated limited ability to predict all future musculoskeletal injuries (traumatic or overuse), with a sensitivity of 0.45 and specificity of 0.71, while the aforementioned cutoff value was able to predict a serious injury (any injury that was severe enough to remove the participant from the grooming program) with a sensitivity of 0.12 and a specificity of 0.94.²¹ The FMS was likewise able to predict injury risk in female person collegiate athletes.^two Finally, in some other study, firefighters with a previous history of injury demonstrated lower FMS composite scores.²³ However, it is not articulate for which sports or professions the FMS is optimal in predicting injury risk, what types of musculoskeletal injuries are predicted past low FMS composite scores, and whether the original cutoff score of less than or equal to fourteen points on the FMS is valid in the different populations.

Additionally, researchers accept constitute that FMS blended scores increased in football players,^thirteen firefighters,^vi and service members⁸ following corrective exercises that addressed possible impairments associated with contradistinct motility patterns noted on the FMS component tests. In a group of Marines, 80% of those with a score less than or equal to 14 also demonstrated lower fitness scores on a standardized fettle examination compared to those who had an FMS composite score greater than xiv.²¹ Withal, Okada et al²² establish that FMS composite scores were non related to functioning or core stability measures amid healthy participants.

Interpretation of FMS scores is limited by the scant evidence¹⁶ regarding the FMS'southward psychometric properties and, in particular, the reliability of both composite and individual component scores. An initial study by Minick et al¹⁶ establish acceptable levels of interrater agreement on the FMS component scores amid novice and expert raters in a sample of active college-age participants (to include higher varsity athletes). However, this study had several limitations: (1) information technology did non assess test-retest reliability, (2) all raters assessed the aforementioned move blueprint via videotaped analysis, and (3) it but assessed understanding of individual FMS component scores and did non assess the overall FMS composite score, which is typically used as the primary indicator of injury risk. Traditionally, the FMS is assessed in real time, without the benefit of video playback. Variability of human motility across trials theoretically should be; therefore, examination-retest assay could lower the reported agreement values. Additionally, the FMS is often assessed in a group setting (eg, preseason concrete or preparticipation screening), requiring the use of multiple raters, who may or may non be the same raters to assess the movement at follow-up testing. Therefore, a more robust reliability written report is required to enhance the understanding of the psychometric properties of the FMS.

Although these initial FMS studies, which established the validity of the FMS for predicting musculoskeletal conditions and injuries and the response to preparation, are encouraging, their data are preliminary and not published in widely accessible journals. Exploring the psychometric properties of the FMS in a large active population would raise the generalizability of the previous findings beyond a limited subgroup of professional and collegiate athletes and students. The primary purpose of this study was to decide the intrarater (test-retest) and interrater reliability of the FMS component and composite scores in young, healthy service members, when tested by a counterbalance group of novice raters in real time. Specifically, agreement was assessed on the FMS component scores, whereas reliability, response stability, and error threshold measurements were obtained for the FMS composite scores. A secondary purpose of this study was to describe the FMS component and composite scores in this population.

Methods

Participants

The convenience sample included participants who were recruited over an eight-calendar week menstruum from service members in training at Fort Sam Houston, TX. Potential participants were provided a briefing about the study and were given the opportunity to volunteer. Participants were eligible for inclusion if they were between the ages of xviii and 35 years or emancipated minors (17-year-olds who are considered adults and allowed to join the armed services), fluent in English, and had no current or previous complaint of lower extremity pain, spine pain, or medical or neuromusculoskeletal disorders that limited participation in work or exercise in the final vi months. Participants were excluded if they were currently seeking medical intendance for lower extremity injuries or had previous medical history that included any surgery for lower extremity injuries. Participants were also excluded if they were unable to participate in concrete grooming due to other musculoskeletal injuries; had a history of fracture (stress or traumatic) in the femur, pelvis, tibia, fibula, talus, or calcaneus; or were known to exist pregnant.

Potential participants were provided an overview of the research study and specific details of the archway criteria. Afterward the presentation was completed, those who met the entrance criteria were asked to squat and so hop unilaterally on each leg in the group setting. Individuals who met the entrance criteria and did not have hurting on the squat and hop tests were informed about upcoming information collection dates. Those individuals who opted to volunteer returned the following week to sign informed consent forms and were enrolled in the written report. Within the military training surroundings, these procedures allowed potential participants the option to not return if they were non interested in volunteering in the study, and were designed to minimize any potential perception of coercion. All participants signed consent forms approved by the Brooke Army Medical Heart Institutional Review Board.

Examiners

The novice examiners participating in this report consisted of 8 concrete therapy students enrolled in their second and 3rd semesters of a doctor of physical therapy training program prior to their 1-year clinical internship. Earlier testing, all examiners underwent 20 hours of FMS training led by four physical therapists and 1 research banana. Four physical therapy students were randomly assigned to the participants to appraise intrarater test-retest reliability by assessing the FMS on day 1 and mean solar day 2. The goal of randomly selecting a rater to perform the intrarater test-retest reliability was to increase the variability in the study design. Each rater used for the intrarater test-retest reliability measured betwixt 14 and xviii participants. In that location were no differences in outcomes beyond raters, so aggregate data were analyzed.

A 2d ready of 4 physical therapy students were randomly assigned to view the participants' movement simultaneously with the first ready of raters for the interrater reliability assessment on solar day 2. To minimize bias, raters were randomly assigned, raters for twenty-four hour period 2 were blinded to day 1 raters' measurements, pairs of raters on day 2 were blinded to each other'due south analysis and scoring, and 48 to 72 hours of time elapsed between intrarater test-retest reliability measurements. The goal of having a random set of 2 raters appraise each participant was to increase the variability in the study design to more closely mimic field conditions, which oft include mass screenings that utilize multiple raters.

Procedures

The FMS is composed of 7 component tests used to appraise different fundamental move patterns.^{three – 5} Participants completed the component tests in a counterbalanced guild, including the deep squat, hurdle pace, in-line lunge, shoulder mobility, active straight leg enhance, body stability push button-upwardly, and quadruped rotary stability tests ( Effigy 1 ). Five of 7 component tests assess asymmetry past measuring the test bilaterally. If discrepancies exist between the left and right sides, asymmetry is noted for that component examination and the lower of the ii scores is included in the FMS blended score. In addition to the 7 component tests, the FMS includes 3 clearing tests that assess for pain: shoulder internal rotation and abduction with the hand placed on the opposite shoulder, lumbar extension performed in the prone press-up position, and end-range lumbar flexion in quadruped. Pain on a clearing test resulted in a score of 0 for the shoulder mobility, trunk stability push-upwards, or rotary stability exam, respectively. Participants performed all tests without a preparticipation warm-up.

Each component test was scored on an ordinal scale (0 to 3 points), based on the quality of movement, with three being the maximum score.^{3 – v} A score of 2 indicated that the participant required some type of compensation or was unable to complete the entire movement. A score of 1 was given if the individual was unable to remain in the motility position throughout the motility, lost residual during the examination, or did non run across the minimum criteria to score a 2. Pain during any of the FMS component tests or during whatever of the clearing tests indicated a score of 0. All participants were allowed to perform each component examination up to 3 times, and the maximal score achieved was recorded. The scores of the component tests were summed, resulting in a blended score from 0 to 21 points, with 21 beingness the maximum blended score. Additional details on scoring of each of the component tests and the composite score are provided elsewhere^{three – 5} and in the APPENDIX.

Statistical Assay

Descriptive statistics and frequency counts were calculated. Agreement of the component tests was analyzed with a weighted kappa statistic. The weighted kappa scores were every bit follows: fourscore% and higher, excellent agreement; from 60% to 79.9%, substantial levels of agreement; from twoscore% to 59.nine%, moderate agreement; and below twoscore%, poor to fair agreement.²⁴ Reliability of the blended test scores was analyzed using intraclass correlation coefficients (ICCs). ICC values of 0.75 and above represent good reliability, those between 0.50 and 0.74 represent moderate reliability, and those beneath 0.50 indicate poor reliability.²⁴ Intrarater exam-retest reliability was assessed using an ICC_3,1 model, while interrater reliability was assessed using an ICC_ii,1 model. Response stability of the intrarater and interrater reliability of the composite scores was calculated using the standard error of the measurement (SEM) at the 95% level of confidence. The minimal detectable change (MDC₉₅) values at the 95% level of confidence were calculated to make up one's mind error thresholds. Statistical analyses were conducted using SPSS Version 17.0 (SPSS Inc, Chicago, IL).

Results

Sixty-four participants (53 males, eleven females) met the inclusion and exclusion criteria and completed the study (TABLE 1). The mean ± SD age of the participants was 25.2 ± 3.8 years and their body mass index was 25.1 ± 3.1 kg/m². Overall, the participants included routine exercisers who endorsed a statement that they exercised a minimum of four days per calendar week (n = 54, 78.2%). Although the participants were attending training for their military machine occupation, the majority of the participants were routine exercisers for more than 3 years. Specifically, 29 (45.3%) participants reported performing routine exercise for more than 5 years, 21 (32.8%) for 3 to v years, 9 (14.one%) for 1 to three years, and five (vii.viii%) for less than ane year. Descriptive statistics on FMS performance are provided in Tabular array 2. None of the participants had hurting on the iii FMS clearing tests. Interrater reliability was calculated on 63 participants, based on an disease of 1 of the raters on day 2 of testing. Only 15.six% (northward = 10) of the participants were identified to exist at risk for injury, based on an FMS blended score of less than or equal to 14 points.

TABLE 1 Demographics

Type	Mean ± SD	95% CI
Age, y	25.2 ± 3.8	24.3, 26.2
Peak, cm	175.5 ± nine.6	173.1, 177.9
Weight, kg	77.5 ± 12.five	74.four, eighty.7
Body mass index, kg/mtwo	25.one ± 3.one	24.3, 25.nine

TABLE 2 FMS Descriptive Assay*

	FMS Component Score
Test	0	1	2	iii	Mean ± SD
Torso stability push-up	0	vii	29	27	two.3 ± 0.seven
Quadruped rotary stability	0	three	56	five	2.0 ± 0.3
Shoulder mobility	0	2	xix	43	2.6 ± 0.half-dozen
Active straight leg raise	0	i	36	27	2.iv ± 0.v
Deep squat	0	three	42	19	ii.3 ± 0.v
Hurdle step	0	1	51	12	2.ii ± 0.iv
In-line lunge	0	1	29	33	ii.v ± 0.five

Understanding of the seven component tests of the FMS (scored 0 to iii) demonstrated moderate to excellent interrater agreement (Table 3). Specifically, the novice raters demonstrated excellent interrater understanding on the body stability button-upward; substantial interrater agreement on the quadruped rotary stability, deep squat, agile straight leg raise, hurdle step, and shoulder mobility component tests; and moderate interrater understanding on the in-line lunge. Intrarater (test-retest) understanding scores at 48 to 72 hours demonstrated substantial agreement on the torso stability push-up, shoulder mobility, active straight leg raise, deep squat, and in-line lunge component tests; moderate agreement on the hurdle step; and poor agreement on the quadruped rotary stability component exam.

Table iii Agreement of FMS Component Scores (0–3 points)

Type/Test	Per centum Understanding	κw	95% CI
Interrater
Torso stability button-up	78	0.82	0.73, 0.90
Quadruped rotary stability	92	0.77	0.57, 0.96
Shoulder mobility	86	0.73	0.57, 0.89
Active straight leg heighten	84	0.69	0.51, 0.87
Deep squat	83	0.68	0.51, 0.85
Hurdle stride	88	0.67	0.45, 0.88
In-line lunge	68	0.45	0.25, 0.65
Intrarater
Trunk stability push-up	68	0.68	0.55, 0.81
Quadruped rotary stability	83	0.29	0.05, 0.50
Shoulder mobility	81	0.68	0.53, 0.80
Active directly leg raise	80	0.threescore	0.42, 0.74
Deep squat	88	0.76	0.63, 0.85
Hurdle step	86	0.59	0.42, 0.73
In-line lunge	83	0.69	0.48, 0.77

The interrater reliability (same solar day) of the FMS composite score (scored 0-21) resulted in an ICC_2,one of 0.76 (95% CI: 0.63, 0.85) and was considered good (TABLE 4). The SEM for interrater reliability of the blended test was 0.92 points, and the MDC₉₅ was 2.54 points on the 21-point scale. Visual representation of the FMS composite scores between raters is provided in Effigy 2. The intrarater reliability (test-retest at 48 to 72 hours) of the FMS composite scores resulted in an ICC_3,1 of 0.74 (95% CI: 0.60, 0.83) and was considered to exist moderate (Table 4). Visual representation of the intrarater examination-retest FMS blended scores is provided in FIGURE 3 . The SEM for intrarater test-retest reliability was 0.98 points and the MDC₉₅ was 2.07 points.

Table 4 Reliability of FMS Composite Scores (0–21 points)

Type	ICC	95% CI	SEM	MDC95
Interrater	0.76	0.63, 0.85	0.92	2.54
Intrarater (exam-retest)	0.74	0.sixty, 0.83	0.98	two.07

Figure 2. Comparing of Functional Movement Screen composite scores between rater 1 and rater 2. Greenish boxes signal agreement (n = 20), xanthous boxes indicate a composite-score departure of only 1 betoken (n = 27), and orange boxes indicate a composite-score difference of 2 to 3 points (n = 16).

Figure iii. Comparison of FMS composite scores for rater i (day 1 to day 2). Green boxes indicate agreement (n = 17), yellowish boxes bespeak a composite-score difference of only ane point (n = 26), orange boxes indicate a composite-score deviation of 2 to iii points (n = 20), and the carmine box indicates a blended-score difference greater than 3 points (n = 1). Abbreviation: FMS, Functional Motion Screen.

Discussion

The FMS has an adequate level of reliability when assessed in healthy service members by novice raters. The interrater understanding of the FMS component scores ranged from moderate to excellent, with 6 of the 7 tests categorized as having substantial understanding (κ _w≥60%). The intrarater and interrater bespeak estimates of the FMS composite score reliability ranged from 0.74 to 0.76, with the 95% CIs suggestive of moderate to expert reliability. The SEMs for both interrater and intrarater reliability were less than one point, while the MDC₉₅ ranged from two.i to two.5 points on the 21-point scale. The SEM and MDC values were similar for both intrarater reliability that repeated the assessment of the movement patterns over a 48-to-72-hour period and interrater reliability that had 2 raters appraise the same motility pattern simultaneously. Therefore, one can expect the error of measurement to be inside 1 indicate across raters and across fourth dimension, while a minimum improvement between ii and three points on the 21-point calibration would be required to demonstrate a real change over time.

These results are consistent with a prior publication on FMS reliability. Minick et al¹⁶ reported substantial to excellent interrater agreement on individual FMS component scores when using 2 novice and two expert raters assessing videotape performance of active college-age students and varsity athletes. Calculation to the literature, our written report provides detailed data on the intrarater and interrater reliability of both FMS component and blended scores by randomly assigned novice raters. Specifically, our study utilized 8 entry-level physical therapy students as raters to collect information prior to their clinical internship. Additionally, these raters measured all movements in real time, without the benefit of being able to replay a videotape (the methodology used by Minick et al¹⁶). The increased number of raters and real-time analysis of movement in multiple participants in our study mimic a preparticipation screening surround, thus enhance the generalizability of the results. Further research is needed to assess the stability of the FMS scores over longer periods. Ultimately, the reliability of this group of novice raters was comparable to previously published research and provides further support for the FMS as a reliable tool to screen in a relatively various, noncollegiate just physically active population.^xvi

Only 15.half dozen% (due north = 10) of the participants in this study had an FMS blended score less than or equal to 14 points. Although this may not seem surprising, given that the participants were relatively healthy, it supports the suggestion past Melt et al^{3 , 4} that FMS scores can place contradistinct movement patterns in by and large healthy and pain-costless participants. Our results are similar to those published by O'Connor et al,²¹ who found that 10% of the 874 Marine officer candidates scored less than or equal to xiv points on the FMS. If the initial inquiry that identified the cutoff value were validated, it would advise that the FMS would be capable of identifying a subset of individuals at increased risk for time-loss injury within a population of young, good for you service members. Based on the use of the FMS for mass screenings (eg, preseason or almanac physical examinations), an injury prediction screening that could identify only 15.half-dozen% of the population as having a loftier injury risk would allow the associated medical staff to prioritize the allocation of express resource toward the development of individualized injury prevention interventions (eg, corrective exercise prescriptions) for this group. However, the validity of the xiv-betoken cutoff score for this sample cannot be verified in this study, because longitudinal follow-upward was not performed to assess actual injury rates. Based on the SEM of i point and the MDC₉₅ value betwixt 2.ane and two.v points, it would be more conservative to use a cutoff score of fifteen (based on SEM) or 16 to 17 (based on MDC₉₅) to determine those who may benefit from corrective exercise prescription to help mitigate injury adventure, until the validity of the 14-point cutoff value can be determined.

1 of the limitations noted in the FMS component tests was a brake in the range of scores. Specifically, based on our inclusion/exclusion criteria, no participants scored a 0 on whatsoever of the FMS component tests, and simply 18 of the 446 scored move patterns resulted in a score of 1; the remaining movement patterns either received a score of 2 or 3. This brake in range might have reduced the reliability estimates of the FMS component scores. For case, the in-line lunge was determined to accept a weighted kappa of 0.45; for this test, no movements were scored as a 0 or i. Additionally, only eleven of the 63 paired ratings had a disagreement, with 25 agreements for a score of 2 and 27 agreements for a score of three. Compared to the other FMS component scores, the in-line lunge and the quadruped rotary stability had the biggest discrepancy between the percent agreement (68% and 83%, respectively) and weighted kappa (0.45 and 0.29, respectively). Interestingly, the everyman levels of agreement between novice raters for both our written report and Minick et al¹⁶ involved the in-line lunge and quadruped rotary stability tests. Difficulty in performing the quadruped rotary stability test (only 5 of the 64 participants obtained a score of three on twenty-four hour period one) also limited variability and potentially intrarater agreement of this measure. Although the restricted range might have influenced statistical calculations, it is important to point out that rater experience and lack of clearly divers scoring criteria, especially mid-range performance, may have also influenced results for these select measures. Future research should determine whether better criteria may help to differentiate levels of operation on the quadruped rotary stability examination or to determine the influence of removing the quadruped rotary stability test on the predictive validity of the FMS composite score.

Future written report designs should appraise the reliability of the FMS using novice raters and participants with varying activity levels and sport-specific requirements. Additional longitudinal studies are also required to found the predictive validity and optimal cut score for various populations. This level of critical investigation would assist to enhance the external validity of the FMS and to substantiate its employ in the full general clinical population, as well as in specific sports settings. Future research should also make up one's mind whether there is a ceiling upshot in the ability of the FMS to detect change over fourth dimension. Based on the MDC₉₅ of 2.1 to ii.5 points, positive alter may not be able to be noted for individuals who score greater than 18 points at baseline testing. Different scoring criteria or cutoff values may exist needed to better differentiate high-end operation on the FMS.

Conclusions

Among novice raters, the FMS composite score demonstrated moderate to good interrater and intrarater reliability, and adequate levels of measurement fault. The measures of reliability and measurement error were similar for both intrarater reliability that repeated the assessment of the movement patterns over a 48-to-72-hour period and interrater reliability that had 2 raters appraise the same move pattern simultaneously. The interrater agreement of the FMS component scores was good to first-class for the push-up, quadruped, shoulder mobility, straight leg raise, squat, hurdle, and lunge. Only 15.half-dozen% (northward = ten) of the participants were identified as being at hazard for injury based on previously published cutoff values.

Key Points

Findings

When using novice raters, the FMS composite scores had moderate to skilful reliability (ICC = 0.74 and 0.76; SEM, ane.0 points; MDC₉₅, 2.1 and ii.5 points) and the FMS component scores ranged from moderate to excellent agreement (κ _{due west} = 0.29-0.82).

Implications

The FMS has adequate reliability when assessed in young, good for you service members past novice raters over a 48-to-72-60 minutes menses.

Caution

Reliability data must be interpreted within the context of the sample tested and the methods used (ie, time between testing for test-retest reliability estimates).

Acknowledgements

This study was done in collaboration with research assistants from the University of Texas Health Science Centre, Concrete Therapy Department, San Antonio, TX: Mark Bauernfeind, Francis Bisagni, Jordan Boldt, Cindy Boyer, Cara Dobbertin, Steve Elliot, Angela Gass, Germaine Herman, Lacey Jung, Jake Mitchess, Teddy Ortiz, Kelly Rabon, Jason Smith, Megan Swint, Joshua Trock, and Jerry Yeung. Additional enquiry assistants from US Ground forces-Baylor University, Section of Physical Therapy, The states Army Medical Section Middle and School, San Antonio, TX: Offset Lieutenant Moshe Greenberg, Captain Sarah Hill, First Lieutenant Crystal Straseske, First Lieutenant Sarah Villena, First Lieutenant Christina Yost, Outset Lieutenant Kristen Zosel, First Lieutenant Rick Warren, and Get-go Lieutenant Sam Forest. Illustrations for the APPENDIX were provided by Elizabeth Holder.

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Appendix Functional Movement Screen

Score	Criteria	Illustration
Deep Squat
three	Upper trunk is parallel with tibia or toward vertical Femur below horizontal Knees are aligned over feet Dowel aligned over anxiety
2	Performed with heels on two × 6-in lath Upper torso is parallel with tibia or toward vertical Femur below horizontal Knees are aligned over anxiety Dowel aligned over feet
1	Performed with heels on 2 × 6-in lath If any of the 4 criteria are non met when the squat is performed with heels on 2 × 6-in board, the score is one
0	Pain during test
Hurdle Footstep (examination both correct and left sides)*
3	Human foot clears string (does non affect) and remains dorsiflexed equally leg is lifted over hurdle Hips, knees, and ankles remain aligned in the sagittal plane Minimal to no motility is noted in lumbar spine Dowel and hurdle remain parallel
2	Alignment is lost between hips, knees, and ankles Movement is noted in lumbar spine Dowel and hurdle exercise not remain parallel
1	Contact between foot and hurdle Loss of balance is noted
0	Hurting during test
In-line Lunge (exam both right and left sides)*
iii	Articulatio genus touches board behind heel Dowel and feet remain in sagittal plane Dowel contacts remain (caput, thoracic spine, sacrum) Dowel remains vertical, no torso movement noted
2	Knee does not touch backside heel Dowel and anxiety do not remain in sagittal airplane Dowel contacts do non remain Dowel remains vertical Move is noted in torso
1	Loss of balance is noted Inability to achieve starting time position Inability to touch knee joint to board
0	Pain during test
Active Straight Leg Enhance (test both right and left sides)*
3	Malleolus of tested lower extremity located in the region between mid-thigh and anterior superior iliac spine of opposite lower extremity (green region) Opposite hip remains neutral (hip does not externally rotate), toes remain pointing upwardly Opposite knee remains in contact with board
2	Malleolus of tested lower extremity located in the region between mid-thigh and knee joint line of opposite lower extremity (yellow region) while other criteria are met
1	Malleolus of tested lower extremity located in the region below knee articulation line of opposite lower extremity (red region) while other criteria are met
0	Pain during test
Shoulder Mobility (exam both right and left sides)*
three	Fists are within 1 hand length
two	Fists are inside 1.5 hand lengths
one	Fists are non within 1.5 mitt lengths
0	Pain during test
	Shoulder mobility immigration test: if pain is noted every bit elbow is lifted, shoulder mobility is scored equally 0
Trunk Stability Push-upward
3	Perform one repetition; the thumbs are aligned with brow for males and chin for females Body is lifted as i unit (no sag in lumbar spine)
2	Perform 1 repetition; the thumbs are aligned with chin for males and clavicle for females Body is lifted as ane unit of measurement (no sag in lumbar spine)
i	Unable to perform 1 repetition with thumbs aligned with chin for males and clavicle for females
0	Pain during test
	Extension clearing test: if hurting is noted during a decumbent press-up, button-upward is scored every bit 0
Quadruped Rotary Stability (examination both right and left sides)*
3	one unilateral repetition (lift arm and leg from same side of trunk) Continue spine parallel to lath Knee and elbow touch in line over the lath and then render to the start position
2	1 diagonal repetition (lift arm and leg from opposite sides of body) Go along spine parallel to board Knee and elbow touch in line over the board and and so return to the showtime position
1	Inability to perform diagonal repetition
0	Pain during test
	Flexion immigration test: if pain is noted during quadruped flexion, rotary stability is scored every bit 0

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Source: https://www.jospt.org/doi/10.2519/jospt.2012.3838

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