INTRA- AND INTEREXAMINER RELIABILITY OF COMPRESSIVE LEG CHECKING AND CORRELATION WITH THE SIT-STAND TEST FOR ANATOMIC LEG LENGTH INEQUALITY

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Published Jun 13, 2017
Robert Cooperstein Madison Holzworth Aiden O'Brien

Abstract

Introduction: Most forms of leg checking are for functional short leg, believed related to a treatable clinical entity, such as pelvic subluxation. However, a short leg may be anatomic in nature, which could lead to different treatment procedures. A variant termed compressive leg checking is thought to identify an anatomic short leg. The primary objective of the present study was to study the intra- and interexaminer reliability of compressive leg checking. The secondary objective was to assess the inter-method agreement of compressive leg checking and the sit-stand test, another test for anatomic leg length inequality.Methods: A convenience sample of asymptomatic chiropractic college students was recruited. Each wore modified surgical boots capable of measuring LLI to the nearest millimeter, prone. To assess interexaminer reliability, each subject was measured 3 times, at 2.5-minute intervals. A subset of subjects entered an interexaminer module, and another subset an intermethod module comparing the results of compressive leg checking and the sit-stand test.Results: Intraexaminer reliability module: ICC=.71 (0.48, 0.85). Mean of the absolute values for 31 subjects, 3 measures per subject (93 paired examiner differences) was 2.8mm and the median of these absolute values was 2.0mm. The Median Absolute Deviation = 1.0 mm. Intraexaminer module: ICC=0.67 (0.25, 0.87). Mean of the absolute values of the 15 examiner differences was 3.1mm, and the median of the absolute values of these absolute values was 3.0mm. The Median Absolute Deviation=1.0mm. Inter-method module: Weighted kappa for n= 22 subjects agreement between compressive leg checking and the sit-stand test was 0.65 (0.38, 0.91).Conclusion: Compressive leg checking demonstrated good intra-  and interexaminer reliability, and correlates well with the sit-stand test. While compressive leg checking is reliable and valid for detecting artificially created LLI, its accuracy compared with a radiological reference standard has not been determined. (Chiropr J Australia 2017;45:184-195)
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Keywords

Leg Length Insufficiency, Reliability

References
1. Mannello DM. Leg length inequality. J Manipulative Physiol Ther 1992;15(9):576-90.
2. Knutson GA. The functional "short leg"; physiological mechanisms and clinical manifestations.J Vertebral Subluxation Res 2000;4(1):22-25
3. Knutson GA. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry. Chiropr Osteopat 2005;13(1):12
4. Cooperstein R, Bricker D, Jansen R, editors. Confirmation of leg length inequality as a stable, objectively-measured entity: The construction and implementation of a friction-reduced, multi-segmented table. Conference Proceedings of the Chiropractic Centennial Foundation; 1995; Washington, DC: Chiropractic Centennial Foundation.
5. Friberg O. Leg length inequality and low back pain. Clin Biomechan 1987;2:211-219
6. Knutson GA. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropr Osteopat 2005;13(1):11
7. Cooperstein R, Lew M. The relationship between pelvic torsion and anatomical leg length inequality: A review of the literature. J Chiropr Med 2009;8(3):107-118
8. Cooperstein R. Heuristic exploration of how leg checking procedures may lead to random (or worse) sacroiliac clinical interventions. J Chiropr Med 2010;9(3):146-153
9. Cooperstein R. Leg checking: Why and why not? DC Tracts 2012;24(2):4-11
10. Cooperstein R, Lisi A. Pelvic torsion: anatomical considerations, construct validity, and chiropractic examination procedures. Topics Clin Chiropr 2000;7(3):38-49
11. Irvin RE. Reduction of lumbar scoliosis by use of a heel lift to level the sacral base. J Am Osteopath Assoc 1991;91(1):34, 7-44
12. Beattie P, Isaacson K, Riddle DL, Rothstein JM. Validity of derived measurements of leg-length differences obtained by use of a tape measure. Phys Ther 1990;70(3):150-157
13. Leitzes AH, Potter HG, Amaral T, Marx RG, Lyman S, Widmann RF. Reliability and accuracy of MRI scanogram in the evaluation of limb length discrepancy. J Pediatr Orthop 2005;25(6):747-749
14. Machen MS, Stevens PM. Should full-length standing anteroposterior radiographs replace the scanogram for measurement of limb length discrepancy? J Pediatr Orthop B 2005;14(1):30-37
15. Bourdillon J, Day E. Spinal manipulation. 4th ed. Over Wallop, New Hamphsire, England: BAS Printers, Limited; 1987;250
16. Cooperstein R, Lagueux M. Concurrent validity of tape measure methods for determining leg length inequality compared to a radiographic reference standard. J Chirop Educ 2010;24(1):88
17. Cooperstein R, Lageuex M. Concurrent validity of the block method for measuring anatomical leg length inequality: A literature review. J Chirop Educ 2011;25(1):77
18. Cooperstein R, Haneline M, Young M. Mathematical modeling of the so-called Allis test: a field study in orthopedic confusion. Chiropr Osteopat 2007;15:3
19. Cooperstein R, Morschhauser E, Lisi A, Nick TG. Validity of compressive leg checking in measuring artificial leg-length inequality. J Manipulative Physiol Ther 2003;26(9):557-566
20. Cooperstein R, Morschhauser E, Lisi A. Cross-sectional validity of compressive leg checking in measuring artificially created leg length inequality. J Chiropr Med 2004;3(3):91-95
21. Portney LG, Watkins MP. Foundations of clinical research : applications to practice. 2nd ed. Upper Saddle River, NJ: Prentice Hall; 2000;xiv:768
22. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):159-174
23. Fuhr AW, Colloca CJ. Leg length inequality: an assessment of asymmetry. Chiropr Tech St. Louis: Mosby; 1997:65-91
24. Zemelka WH. The Thompson Technique. Bettendorf, Iowa: Victoria Press; 1992:64
25. Hartley A, Charley L. Dissecting the prone leg check. J Vertebral Subluxation Res 2000;4(1):22
26. Travell JG, Simons DG. Myofascial pain and dysfunction: The trigger point manual. The lower extremities. Baltimore: Williams and Wilkins; 1992:607
27. Schneider M. The "muscular" short leg. Am J Clin Chiropr 1993;3(3):8
28. Viera AJ, Garrett JM. Understanding interobserver agreement: the kappa statistic. Fam Med 2005;37(5):360-363
29. Cooperstein R, Morschhauser E, Lisi A, editors. Validity of prone, compressive leg checking in detecting artificial leg length inequality. 2002 International Conference on Spinal Manipulation; 2002; Toronto CA: FCER
30. Leys CL, C., Klein O, Bernard P, Licata L. Detecting outliers: Do not use standard deviation around the mean, use absolute deviation around the median. J Experimental Social Psychol 2013;49(4):764-766
31. Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977;33(2):363-374
32. Cooperstein R. The importance of repeated measures. J Am Chiropr Assoc 2003;40(6):30-31
33. Bandy WD, Sinning WE. Kinematic effects of heel lift use to correct lower limb length differences*. J Orthop Sports Phys The. 1986;7(4):173-179
34. Miller KJ, Sittler MD, Corricelli DM, Dimura DN, Comerford JS. Combination testing in orthopedic and neurologic physical examination: a proposed model. J Chiropr Med 2007;6(4):163-171
35. Triano JJ, Budgell B, Bagnulo A, Roffey B, Bergmann T, Cooperstein R, et al. Review of methods used by chiropractors to determine the site for applying manipulation. Chiropr Man Therap 2013;21(1):36
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