THE RELIABILITY OF A QUALITATIVE SCORING SYSTEM OF TRUNK AND LIMB ALIGNMENT DURING A 45-DEGREE SIDE STEP CUT

BACKGROUND: Three dimensional (3D) motion analysis is considered the “gold standard” for evaluating human movements. However, its clinical utility is limited due to cost, operating expertise and lengthy post-processing time. Numerous qualitative scoring systems, using videos, have been introduced to assess trunk and lower extremity (LE) alignment in dynamic maneuvers. However, it is unknown if a qualitative scoring system is a reliable method to evaluate cutting movement. HYPOTHESIS/PURPOSE: To assess the inter-rater and intra-rater reliability of a qualitative scoring system to evaluate trunk and LE alignment during a 45-degree side step cut. The sub-aim was to investigate the effect of interactive peer discussion on inter-rater reliability. METHODS: A repeated measures study design was used. Six raters (2 MDs, 2 PTs, and 2 ATs) independently viewed 10 videos, consisting of a 45-degree side step cut performed by adolescent male and female athletes. A clinically established checklist (Figure 1) was given to examine quality of movements. After the 1(st) round, an interactive peer discussion was held to discuss videos, movement quality, and the checklist. Subsequently, after a 1-week wash out period, a 2(nd) round of evaluation (examining the same 10 videos) was performed. Following the 2(nd) round, and a 2-week wash out period, a 3(rd) round was performed to assess intra-rater reliability. In each round, video sequences were altered in random order to avoid memory bias. Intraclass correlation coefficient (ICC) and their 95% confident intervals (95% CIs) were calculated. Values less than 0.50, between 0.50 and 0.75, between 0.75 and 0.90, and greater than 0.90 were defined as poor, moderate, good and excellent reliability, respectively. RESULTS: Inter-rater reliability for the 1(st) round was moderate (ICC: 0.565, 95%CIs: 0.074-0.866). Inter-rater reliability for the 2(nd) round was better, however, was still moderate (ICC: 0.632, 95%CIs: 0.100-0.895). Intra-rater reliability between the 2(nd) and 3(rd) round ranged from moderate to excellent (ICC: 0.589-0.910). CONCLUSION: The results of this study showed moderate inter-rater reliability and moderate to excellent intra-rater reliability of the qualitative checklist. Following the interactive peer discussion, slight improvements in inter-rater reliability were observed. The findings indicate that this checklist may allow clinicians to standardize their assessment of trunk and LE alignment during a cutting task, however, more objective methods to evaluate multiplane movements, such as genu valgum, may be warranted.