Inter-rater and intra-rater reliability of the Triple Joint Flexion Test (TJFT) scores in adolescent field and court athletes by novice raters

Abstract

BACKGROUND: Despite the common use of lower limb movement screening tools, the limitations for clinical use are not well understood. In a movement screening context, there are two sources of variation associated with reliability measurements. These are: (1) the athlete's performance of the test; and (2) the observational ratings of the test movements made by the rater. The Triple Joint Flexion Test (TJFT) is a new movement screening tool based on work by Tainhague, (2015) with development level adolescent court and field athletes. To date, one previous study has reported objective data of intra-athlete within- and between-session variability of the TripleJoint Flexion Test (TJFT). To date, no objective data of observational ratings of the TJFT sub-test scores has been reported. This thesis is divided into 3 sections: (1) A review of the literature (2) A study of the inter- and intra-rater reliability of the Triple Joint Flexion Test reported in the form of a journal manuscript; and (3) supplementary material.

DESIGN: Video based, repeated measures.

AIMS: To establish the inter- and intra-rater reliability of the Triple Joint Flexion Test on screening adolescent male court and field athletes.

METHOD: Seven trained novice raters rated TJFT sub tests on two occasions using real time video. The TJFT was performed by 17 adolescent court and field athletes and 182 ratings were made on each occasion.

RESULTS: Inter-rater weighted agreement of the six TJFT sub tests by 7 raters on Day 1 and 6 raters on Day 2 demonstrated ‘moderate’ (AC2 > 0.41) to ‘substantial’ inter-rater agreement (AC2 > 0.61). Intra-rater weighted agreement of the six TJFT sub-tests by 6 raters was mostly ‘moderate’ (AC2 > 0.41) and ranged from ‘fair’ (AC2 > 0.21) to ‘near perfect’ (AC2 > 0.81).

CONCLUSION: The inter-rater and intra-rater agreement of TJFT sub-test scores have now been investigated, and found to sufficiently reliable. It is un-common for both athlete and rater sources of variability to be identified for a lower limb movement screen. As such, clinicians may use the TJFT with a greater understanding of the expected variability from both the rater and the athlete. In the wider movement screening literature, reports of rater-reliability for trained novices scoring multisegmental movements in real time is unique. This is also the first scoring protocol to have reported acceptable levels of inter and intra-rater agreement for a higher threshold movement task under these scoring conditions.