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Prone Hip Extension Assessment Gabriella Baran OMSIV, William Andrew OMSIV, Robert Murphy, M.S., Kurt P

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Prone Hip Extension Assessment Gabriella Baran OMSIV, William Andrew OMSIV, Robert Murphy, M.S., Kurt P Dissecting the Diagnosis of Iliopsoas: Validation of Prone Hip Extension Assessment Gabriella Baran OMSIV, William Andrew OMSIV, Robert Murphy, M.S., Kurt P. Heinking, D.O., F.A.A.O., and Kyle K. Henderson, Ph.D. Midwestern University, Downers Grove, IL60515; Departments of Physiology, and Osteopathic Manipulative Medicine Abstract: Ranking Hip Extension Original Thomas Test Standard Thomas Test Modified Thomas Test Introduction: The father of British Orthopaedic surgery, Hugh Owen Thomas, is recognized for his method to assess hip flexion contracture in patients with Potts disease. The “Thomas Test” was modified to assess the iliopsoas muscle in healthy patients. In Osteopathic medical schools, prone hip extension is also used to Assessment: appreciate a palpable barrier. Objective: Provide historical context for hip extension assessment for medical education and validate prone hip extension assessment. 13 Versatility Specialization Muscle Groups Accuracy Methods: IRB approval was obtained (MWU#2852) and subjects assessed with the Modified- 12 15 Thomas Test (MTT), prone hip extension, and other structural examinations: pelvic side shift, leg length, lumbar curve, seated and standing flexion tests. A digital goniometer and force plate transducer were used to assess Applicability to Applicability to a # of muscle groups Diagnosis prone hip range of motion (ROM) and physician applied force. Results: The MTT, utilizing gravity as the force for hip extension, had high intra-rater reliability (0.969). different patient specific patient assessed and/or ability consistency: Preliminary data for prone hip extension assessment had high intra-rater reliability for ROM (0.973) and the populations: population: to treat: force required to reach the perceived restrictive barrier (0.928). Similar to the MTT, inter-rater reliability was poor for ROM (-0.430) and force (0.519). - Pregnant/ Obese - Pregnant/ Obese - Iliopsoas (IP) - Lumbar neutrality Conclusion: Prone hip extension is a valid and reproducible method for physicians to diagnose iliopsoas - Cerebral Palsy - Cerebral Palsy - Iliacus (I) - Force Consistency hypertonicity, but lacks inter-rater reliability. The latter can be explained by the variation of force during the prone assessment. This variation is thought to be due to differences in examiner strength, biomechanics, and - Severe Msk Dz - Severe Msk Dz - Rectus Femoris (RF) - Qualitative Barrier other subjective parameters (restrictive barrier). Future studies will identify the relationship between prone - Acute Back Inj. - Acute Back Inj. - Iliotibial band/ - Intra rater reliability assessment and structural exams in patients with iliopsoas dysfunction. - Healthy (2 pts) - Healthy (2 pts) Tensor Fasciae Latae - Inter rater reliability (ITB/ TFL) Background: > 5 = Excellent > 5 = Excellent 4 = 4 muscles 5 = Excellent 4 = Very Good 4 = Very Good 3 = 3 muscles 4 = Very Good 3 = Good 3 = Good 2 = 2 muscles 3 = Good 2 = Fair 2 = Fair 1 = 1 muscles 2 = Fair 1 = Poor 1 = Poor 0 = no muscles 1 = Poor Versatility Specialization Muscle Accuracy Bonus Points Versatility Specialization Muscle Accuracy Bonus Points Versatility Specialization Muscle Accuracy Bonus Points Groups Groups Groups Special Considerations: - Ease of exam for physician 1 5 0 3 3 2 3 2 3 3 3 2 4 3 3 - Ease of exam for patient - Treatment considerations The Original Thomas Test was developed to assess severe hip The Standard Thomas Test is used as a quantitative test for hip The Modified Thomas Test was developed to not only assess IP - Safety, stability, comfort flexion contracture and disease progression. During this time, the flexion contracture (IP, I) in patients with more severe hypertonicity in healthy patients, but also assess hypertonicity of predominant pathology causing hip flexion contracture was musculoskeletal disease and limited flexibility. Many COM’s the RF and ITB/TFL. If the examiner stabilizes the ipsilateral 0 – 0.5 – 1 point scale added for each category tuberculosis induced lumbar osteomyelitis. teach this test to assess iliopsoas hypertonicity. pelvis to the table, the I may be isolated from the IP. • Physicians have been using the prone hip extension for Staheli Sidelying Prone Hip Extension Validation of Prone Hip treatment of Iliopsoas and rectus femoris tension since 1903 • Discussion at Spring ECOP 2016 suggests that in addition to Test Assessment Assessment Extension Assessment history, postural assessment, and palpation, the Standard Thomas Test remains the most widely taught hip extension examination at COMs. 11 13 14.5 Objectives: • Provide a historical and educational perspective for the origin of the Thomas test. • Compare and contrast hip extension assessment methods and treatment potential to determine which methods should be emphasized at Osteopathic medical schools. Methods: Ranking of Hip Extension Assessment: • A hip extension literature review was conducted to provide background information on the history of the Thomas Test. Versatility Specialization Muscle Accuracy Bonus Points Versatility Specialization Muscle Accuracy Bonus Points Versatility Specialization Muscle Accuracy Bonus Points • Four categories were identified to evaluate the characteristics Physician Applied Force and Range of Motion: of each assessment tool and ranked on a 1-5 point scale. Groups Groups Groups • A special considerations point scale (0, 0.5, 1) was added to Inter-rater reliability for applied force and hip extension angle the total value of each tool’s score. 1 5 1 2 2 1 5 3 2 2 2 3 3 3 3.5 were low, with an intra-class correlation (ICC) of 0.519 for force • The sums were compared to identify the overall utility of each and -0.430 for range of motion (ROM). On the other hand, intra- examination technique. The Staheli Test is a modification of the Prone Assessment used The Sidelying Assessment is primarily used in pregnant, obese The Prone Hip Extension Assessment is unique in its ability to rater reliability was strong (ICC: 0.928 force & 0.973 angle). Validation Study: in patient’s with cerebral palsy. This test is reserved for specific patients, and those who do not tolerate the other body positions. provide qualitative and quantitative evaluation of hip extension. These data suggest prone assessment of hip extension is similar • IRB approval was obtained (MWU#2852) pediatric populations and is limited by performance difficulty, Lumbar stabilization is difficult and limits both the diagnostic From this position, the physician is able to palpate ‘end feel” of to the Modified Thomas Test, which allows the same physician to • A digital goniometer and force plate transducer were used to lack of muscle specificity, and poor transition to treatment. and therapeutic value of this test. While difficult to set up, the IP and RF. The ITB/TFL may be assessed by adducting the monitor changes in IP tonicity and efficacy of treatment. assess prone hip ROM and physician applied force, qualitative information of the IP, RF, ITB/ TFL is gained. leg, but might be limited by examiner position/strength. respectively • Five (5) investigators assessed prone hip extension. References: Summary and Conclusions: 1. Bartlett, M.D., et al., Hip flexion contractures: a comparison of measurement methods. Arch Phys Med Rehabil, 1985. 66(9): p. 620-5. • The Modified Thomas test is the most versatile test for diagnosis and treatment of restricted hip extension. 2. Chevillotte, C.J., et al., Variability in hip range of motion on clinical examination. J Arthroplasty, 2009. 24(5): p. 693-7. 3. D, T., Principles of Osteopathy. 1903, Los Angeles CA: Baumgardt Publishing Company. • Preliminary data suggest the Prone Hip Extension Assessment has similar inter and intra-rater reliability as the Modified Thomas test. 4. H.O., T., Diseases of the Hip Knee and Ankle Joints with their Deformaties Treated by a new and Efficient Method. 2 ed. 1876, Liverpool England: T. Dobb and Co. 406. 5. Harvey, D., Assessment of the flexibility of elite athletes using the modified Thomas test. Br J Sports Med, 1998. 32(1): p. 68-70. • The Prone Hip Extension Assessment has the distinct advantage for the clinicians to assess the quality of the restrictive barrier. 6. Moriguchi, C.S., et al., Reliability of intra- and inter-rater palpation discrepancy and estimation of its effects on joint angle measurements. Man Ther, 2009. 14(3): p. 299-305. 7. Peeler, J. and J.E. Anderson, Reliability of the Thomas test for assessing range of motion about the hip. • Osteopathic schools should consider the merits of teaching each technique for special patient populations. Physical Therapy in Sport, 2007. 8(1): p. 14-21. 8. Staheli, L.T., The prone hip extension test: a method of measuring hip flexion deformity. Clin Orthop Relat Res, 1977(123): p. 12-5..
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