Abstract
Objectives: The primary objective of this study was to determine the inter-rater reliability of the FMS when used by novice NHS (National Health Service) Physiotherapists. The secondary objective was to determine whether clinical specialism has any impact on the inter-rater reliability of the FMS. Design: Reliability study. Methods: Forty participants with no recent MSK injury were video recorded completing the 7 component FMS tests. Six NHS Physiotherapists with no previous experience using the FMS attended a 2 hour training programme delivered by a certified FMS practitioner. Raters then viewed and scored videos of the 40 participants completing the FMS. Results: The inter-rater reliability of the FMS composite score was excellent (ICC of 0.82 (95% CI: 0.41- 0.93)).Non-specialist rotational Physiotherapists demonstrated excellent inter-rater reliability (ICC = 0.89, 95%CI 0.78-0.94), whereas the specialist musculoskeletal Physiotherapists demonstrated good interrater reliability (ICC = 0.79, 95%CI 0.19-0.92) for FMS composite score. The seven individual movement tests of the FMS demonstrated poor to excellent inter-rater reliability. The Hurdle Step was the least reliable of the movement tests (kw = 0.15, 95% CI: -0.09-0.38), whereas Shoulder Mobility was the most reliable of the movement tests (kw= 0.85, 95%CI: 0.72-0.97).The seven individual movement tests of the FMS demonstrated moderate to excellent inter-rater reliability between non-specialist rotational Physiotherapists. In contrast, the seven individual movement tests of the FMS demonstrated poor to excellent inter-rater reliability between specialist musculoskeletal Physiotherapists. Conclusion: The FMS represents a good attempt to objectify the subjective with the FMS composite score demonstrating excellent inter-rater reliability Due to poor construct validity, it has been suggested only component scores should be utilised. The results from this study suggest that five of the seven individual movement tests do not demonstrate acceptable reliability for clinical use. With the composite score lacking construct validity and the majority of the component scores lacking both intra- and inter-rater reliability, the continued use of FMS within clinical practice is not supported.
Highlights
Traditional approaches to musculoskeletal examination and treatment have focused on isolated methods such as joint range of movement, muscle strength and muscle length [1]
The results from this study suggest that five of the seven individual movement tests do not demonstrate acceptable reliability for clinical use
The findings of this study suggest that the Functional Movement Screen (FMS) has an acceptable level of reliability when used by National Health Service (NHS) Physiotherapists [30]
Summary
Traditional approaches to musculoskeletal examination and treatment have focused on isolated methods such as joint range of movement, muscle strength and muscle length [1]. In order to achieve this, cognitive effort and motor skill training of meaningful movements or tasks is required; a potential limitation of the current bed-based methods of assessment and treatment [5]. This has been well demonstrated where static hip extension range measured using the Thomas’Test was not reflective of the peak hip extension seen during running, showing a low correlation between static and dynamic measures of hip extension [6]. Improvements in hip flexibility did not transfer to increased mobility during dynamic movement [7]; changes in passive range of motion do not automatically transfer to changes in movement
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