Research Review By Jessica Sleeth©

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Date Posted:

March 2011

Study Title:

Interrater reliability of the functional movement screen

Authors:

Minick KI, Kiesel KB, Burton L et al.

Author's Affiliations:

Department of Physical Therapy, University of Evansville, Evansville, Indiana; ProRehab PC, Evansville, Indiana; Department of Physical Education, Averett University, Danville, Virginia.

Publication Information:

Journal of Strength and Conditioning Research 2010; 24(2): 479-486.

Background Information:

Recent research suggests that isolated muscle stretching may not be the most effective intervention for addressing muscle soreness and musculoskeletal injuries. Instead, sports medicine professionals are now focusing on improving movement patterns to reduce injury (1, 2). Rehabilitation that focuses on isolated joint movement may not be sufficient to normalize whole-body movement patterns after injury (3). Regional interdependence, which is defined as, 'why dysfunction in one body region may be contributing to weakness, tightness, or pain in another region' (4) is an increasingly popular term in rehabilitation and sports medicine.

Tests that assess multiple areas of function, such as; balance, strength, speed, agility, flexibility, and range of motion concurrently may be the most accurate and efficient way to assess athletes for injury (5). With an increasing demand to test an athlete’s fundamental movement characteristics in such a manner, the Functional Movement Screen (FMS) was developed. The FMS is a series of 7 fundamental movement tests that attempts to assess an athlete’s functional capacity and potential kinetic weaknesses. The movements are based on complex movement patterns that are used in daily activities of living and many sports.

An earlier study established a relationship between professional football player’s functional movement characteristics (measured by FMS) and injury risk; yet there is no data investigating interrater reliability using FMS. In this study the authors compared individual FMS raters with both expert and novice training to gain perspective on interrater reliability with respect to level of training and experience.

Pertinent Results:

The novice raters were scored as excellent for agreement on 6 of the 17 tests, including the deep squat, shoulder mobility tests, portions of the trunk stability and push-up test, and active straight leg raise. Substantial agreement was achieved on 8 of the 17 tests and moderate agreement on the right and left components of the lunge and final component of the rotary stability tests.

The expert raters were scored as excellent for agreement on 4 of the 17 tests, including the shoulder mobility test and the final component of the active straight leg raise. Substantial agreement was achieved in 9 of the 17 tests and moderate agreement of the lunge and rotary stability tests.

When paired together, the novice and expert raters demonstrated excellent agreement in 14 of the 17 tests. The pairs achieved substantial agreement in 1 component of the rotary stability test and 2 components of the in-line lunge.

Clinical Application & Conclusions:

These results suggest high interrater reliability when using the Functional Movement Screen. The authors confidently report that reliable scores can be achieved using the standardized procedures of FMS with proper training.

Study Methods:

Experimental Approach to the Problem
The authors investigated their hypothesis with four individuals trained in FMS – two experts and two novices. An expert rater is defined as an individual who was involved in the development of the FMS tool and has at least 10 years experience using it. A novice rater is an individual who has completed the standardized introductory training course and has used FMS for less than a year.

The individual scores of the two experts were compared, as well as the scores of the two novices. Then, the expert and novice raters were paired together and those scores were compared (i.e. expert/novice pair compared to expert/novice pair). A level of agreement was determined for each test to determine interrater reliability.

Subjects
  • 40 healthy college students (23 women, 13 varsity athletes)
  • At least 18 years old, average age 20.8 years old
  • Recruited by word of mouth
  • Free of injury and able to participate in desired physical activities (self-reported)
Procedures
The seven movement patterns of the FMS are designed to be evaluated together as a comprehensive cross-section of functional movement. The movement patterns are:
  1. deep squat
  2. hurdle step
  3. in-line lunge
  4. shoulder mobility
  5. active straight leg raise
  6. trunk stability push-up
  7. rotary stability test
Furthermore, there are three tests, associated with the FMS, which check for pain with shoulder internal rotation/flexion, end-range spinal flexion, and extension pain. Subjects were videotaped performing all seven FMS tests from both the lateral and anterior views.

The Functional Movement Screen is scored on an ordinal scale from 0-3. A participant scores 0 if there is pain associated with any portion of the test; 1 if the participant is unable to perform the movement pattern; 2 if some type of compensation is present when completing the pattern; and 3 if the participant performs the functional movement pattern as described.

Statistical Analyses
Between the two pairs of raters, the weighted Kappa statistic was calculated (a measure of ‘true’ agreement, beyond what is expected due to chance). The weighted Kappa attaches greater emphasis to large differences between ratings than to small differences, thus reflecting the degree of disagreement.

Study Strengths / Weaknesses:

  • The authors can only speculate on variance between raters. Possible variance could be due to experience of the raters, testing protocol, and poorly defined scoring criteria.
  • Some of the functional movements would be better assessed in 3-dimensional viewing, however, this protocol is not very practical when using video cameras (which was necessary so all reviewers saw exactly the same movement pattern).
  • Scoring variability may also have resulted from the FMS criteria. Some of the tests have less clear criteria, making the movement harder to score, for example, midrange performance (intermediate scores) of the lunge, hurdle step, and rotary stability tests. However, the results of the study are being used to review the current FMS scoring criteria.
  • Real-time analysis (as opposed to reviewing video recordings) is recommended to provide efficient and immediate feedback to athletes.

Additional References:

  1. Cook EG. Athletic body in balance; optimal movement skills and conditioning for performance. Champaign, IL: Human Kinetics, 2004.
  2. Kiesel K, Burton L, & Cook EG. Mobility screening for the core. Athl Ther Today. 2004; 9:42-45.
  3. Nadler SF, Malanga GA, Feinberg JH, Ruanni M, Moley P, et al. Functional performance deficits in athletes with previous lower extremity injury. Clin J Sport Med. 2002; 12:73-78.
  4. Wainner RS, Whitman JM, Cleland JA, & Flynn TW. Regional interdependence: A musculoskeletal examination model whose time has come. J Orthop Sports Phys Ther. 2007; 37:658-660.
  5. Plisky PJ, Rauh MJ, Kaminski TW, & Underwood FB. Star excursion balance test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther. 2006; 36:911-919.