Assessment of quality of movement during a lateral step-down test: Narrative review

Abstract

IntroductionAltered lower limb movement patterns during weight-bearing activities have been described as risk factors for several injuries. The lateral step-down test (LSD) was developed to be a simple, clinician-friendly tool to facilitate the assessment of lower extremity quality of movement during a functional activity. However, there is still conflicting information across the literature regarding how the LSD should be performed. ObjectiveTo critically review the literature regarding the assessment of quality of movement using the LSD and to provide an overview of how this test has been used, describing confounding factors and factors associated with altered movement patterns. MethodsA literature review was conducted in PubMed/MEDLINE, COCHRANE, PEDro, SciELO and LILACS databases, by two independent reviewers. ResultsSixteen articles met the inclusion criteria. One was a prospective cohort study to identify risk factors for injuries in military recruits. The fifteen remaining were cross-sectional studies involving healthy military recruits, physically active individuals, athletes and/or sedentary subjects, as well as participants with knee and ankle disorders. Worst quality of movement during the LSD has been associated with deficits in hip external rotation and knee extension strength as well as in ankle dorsiflexion range of motion. The reliability of the LSD has been reported to be moderate (κ = 0.59–0.81). ConclusionsThe LSD has adequate reliability and is a simple tool that can be used to quantify lower extremity quality of movement. Future studies should include standardized methods for application, scoring and interpretation of the test, so that confounding factors can be minimized.