Passive movement, either physiological or accessory, can be reported as range of motion, end-feel, or pain and is an indication of the integrity of joint structures (Cyriax 1982, Hengeveld and Banks 2005).
Inclusion criteria Design * Repeated measures between raters Participants * Symptomatic and asymptomatic individuals Measurement procedure * Performed passive (ie, manual) physiological or accessory movements in any of the joints of the shoulder, elbow, or wrist-hand-fingers * Reported range of motion or end-feel * Used methods feasible in clinical practice (considering instruments, costs, amount of training required) Outcomes * Estimates of inter-rater reliability Assessment of characteristics of the studies
The inter-rater reliability for measurement of physiological range of motion is presented in Table 3, accessory range of motion in Table 4 and physiological end-feel in Table 5.
Overall, measurements of range of motion were more reliable than measurements of end-feel. Kappa for end-feel ranged from 0.26 (95% CI -0.16 to 0.68) in full shoulder abduction to 0.70 (95% CI 0.31 to 1.0) in abduction with scapula stabilisation (Hayes and Petersen 2001).
The reliability of measurements of physiological range of motion reported by Rothstein et al (1983) was substantially higher than the reliability of measurements of end-feel of flexion (Kappa 0.40) and extension (Kappa 0.73) reported by Patla and Paris (1993).
Furthermore, measurements of physiological range of motion were also more reliable than measurements of end-feel or of accessory range of motion.
In addition, findings from four studies (Chesworth et al 1998, Hayes and Petersen 2001, Patla and Paris 1993, Van Duijn and Jensen 2001) indicated that measuring end-feel or accessory movements of joints with large ranges of motion was associated with lower reliability.
Instability of the participants' characteristics under investigation, in this case joint range of motion or end-feel, may be caused by changes in the biomechanical properties of connective tissues as a result of natural variation over time or the effect of the measurement procedure itself (Rothstein and Echternach 1993).
Future research should focus on comparing inter-rater reliability of end-feel and accessory movements with passive physiological range of motion assessment, using symptomatic individuals.
Tibial advancement continues until ankle end-feel, beyond which the sole of the foot begins to plantar flex past the "perpendicular" (ground).
It is upon this principle that the final measurement technique is based, measurement of the end-feel point of passive dorsiflexion of the ankle with the knee extended (DKE), using palpable subtalar congruence to eliminate noise from arbitrary dorsiflexion and plantar flexion of one of the landmarks, the fifth metatarsal.
Then pressure is focused upon the plantar aspect of the fifth MTP joint to both lock the midtarsal joint (eliminating noise) and passively maximally dorsiflex the foot till end-feel. It is important the subject not actively dorsiflex the foot, to avoid rotating the foot or arbitrary midtarsal extension.