Test-retest reliability of clinical measurements of lower extremity joint motion and alignment in the pediatric population

Purpose: Manual anthropometric evaluations of pediatric lower extremities are essential in orthopedic pediatric practice due to their noninvasive and time-feasible nature. Therefore, this study aims to assess the test-retest reliability of clinical measurements obtained on children to examine measurement stability over time. Methods: In a test-retest design, data were collected from 50 Danish school children with 5-to 6 weeks between sessions. Measurements encompassed the joint range of motion (ROM), rotational profile, and angular alignment of lower extremities for a representative sample of school children. Reliability was assessed using intraclass correlations (ICC), and agreement was assessed using limits of agreement (LoA) and precision. Results: Reliability analysis revealed excellent results for foot length (ICC > 0.9), good results for foot width (ICC < 0.9), and poor to moderate results for all other measurements (ICC < 0.5, ICC < 0.75). Agreement results for hallux valgus were acceptable (within established reference) and the remaining variables were not acceptable (outside established reference). Conclusions: The majority of the manual assessment procedures were found to have poor reliability. This study highlights the need for reliable and time-efficient tools to assist clinicians in assessing manual clinical measurements and future research should explore this.