Original researchThe reliability of shoulder range of motion measures in competitive swimmers
Introduction
Reliable measurement tools are essential for interpreting research investigating risk factors for sports injuries, or evaluating the effectiveness of treatment interventions (Bahr and Holme, 2003, Cools et al., 2014, Valentine and Lewis, 2006). Studies investigating shoulder range of motion (ROM) measurement reliability suggest that no single method affords superior measurement reproducibility (Cools et al., 2014, Hoving et al., 2002, Mullaney et al., 2010, Valentine and Lewis, 2006). Methodologies and results vary with the movement type (active or passive ROM), measurement device, test position, and study population (symptomatic or asymptomatic) investigated (Andrews and Bohannon, 1989, Boon and Smith, 2000, Cools et al., 2014, Croft et al., 1994, de Winter et al., 2004, Green et al., 1998, Hayes et al., 2001, Hoving et al., 2002, Muir et al., 2010 Kolber, Vega, Widmayer, & Cheng, 2011; Riddle et al., 1987, Sabari et al., 1998, Valentine and Lewis, 2006). Nonetheless, the measurement of shoulder ROM is an important component of the clinical examination of the shoulder joint, as alterations in ROM have been implicated in the aetiology of pathology (Cools et al., 2014, de Winter et al., 2004, Ellenbecker et al., 2002, Valentine and Lewis, 2006). In competitive swimmers, the incidence of reported shoulder pain is high, and some authors have suggested a correlation between shoulder ROM and injury (McMaster et al., 1998, Ozcaldiran, 2002, Walker et al., 2012). Competitive swimmers regularly undergo pre-participation screening to identify possible intrinsic risk factors for shoulder injury (Walker et al., 2012, Blanch, 2004). These tests include shoulder rotational measurements, as well as the sport-specific tests abduction in internal rotation (ABIR) and combined elevation (CE) (Blanch, 2004). The reliability of measurement of these tests in competitive swimmers has not been reported to date. This study sought to investigate the intra and inter-examiner reliability of tests of range of shoulder internal (IR) and external rotation (ER) at 90° abduction, ABIR and CE in competitive swimmers.
Section snippets
Setting and study design
A reliability study was conducted involving two physiotherapist examiners.
Participants
A convenient sample of 17 swimmers was recruited from five competitive swimming clubs in Melbourne, Australia. Swimmers participating in at least five swim sessions per week were eligible for this study. Exclusion criteria included a history of shoulder surgery or dislocation, shoulder pain on the day of testing or the presence of any other injury that would interfere with the test procedures. Examiners were two
Results
Swimmers ranged in age from 12 to 24 years and participated in six weekly swim sessions, on average, as summarized in Table 1. Means and standard deviations for the ROM tests are shown in Table 2. A priori examination of the raw ROM data revealed extreme outlying scores for right-sided IR recorded by Examiner B, for one participant. The entire ROM data set for this participant was deleted to prevent any undue influence of this data on results (Tabachnick & Fidel, 1989), leaving 16 participants
Discussion
This study quantified the reliability of several shoulder ROM tests using relative and absolute indices. Overall, the ROM tests demonstrated good to excellent intra- and inter-examiner reliability in competitive swimmers. To date, there is no research available for comparison of this study's results for ABIR measurement. Measurement reliability of CE has been previously investigated in cricketers with similarly excellent intra and inter-examiner reliability reported (ICCs: 0.87–0.97) although
Conclusions
The accuracy of measurement of the variables of interest is crucial to a study's ability to detect potential associations between risk factors and injury (Krosshaug, Andersen, Olsen, Myklebust, & Bahr, 2005). This study provides meaningful information regarding the reliability and standard errors of measurement for several shoulder ROM measurements, such that the results of future prospective cohort studies employing these tests can be assessed with confidence with respect to effect size and
Conflicts of interest
None declared.
Ethical approval
The study was approved by the University of Melbourne Human Research Ethics Committee and all participants or their parents/guardians provided written informed consent.
Funding
None declared.
Acknowledgements
Professor Kim Bennell is supported by a National Health and Medical Research Council Principal Research Fellowship.
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