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
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.
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.
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.
At this moment, the examiner extends the knee slightly to return the sole to the perpendicular position, maintaining ankle end-feel position.
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.
When passive end-feel is achieved, the examiner drops an imaginary plumb line perpendicular to the long axis of the tibia from the fifth MTP joint to the plantar-most spot on the heel and takes a reading by visualizing the distance between that spot on the heel and the "plumb line" (Fig.