Do the reductions in active knee range of motion during slump testing show variation from day to day?
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Objective: The objective of this study was to investigate whether the reductions in active knee range of motion (ROM) during slump testing show variation from day to day. Study Design: Firstly a literature review investigating the slump test and the factors which may influence variation in using this clinical test and secondly, a pilot study with a test-retest with experiment design. Background: The slump test is a common test used clinically to assess neural dynamics through the spine and lower limbs, however, there is a paucity of literature that has investigated the reliability of the test. A number of clinical factors may influence day to day variation such as the presence of lumbar disc injury, the pain levels of the patient, the facial connections of other tissues and the way in which the test is performed and measured. This variation may alter the clinical assumptions associated with the test. This study provided an opportunity to review the literature with respect to the factors which may influence variation and collect baseline information the reliability of the slump test in normal subjects. The review of the literature found that experimental design, the mechanics involved with the test, the muscular system, the fascial system, nerve injury, central pain and homeostatic mechanisms may influence the measurement of slump testing. Method: A pilot study using a repeated measures experimental design was undertaken to measure knee extension ROM in the slump position (full spinal flexion) then with the cervical spine in extension. Three repeated measures were taken for knee extension ROM on two consecutive days. Results: The findings of the 2-factor repeated measures ANOVA for both slumped and extended conditions showed that there was no statistically significant difference across days (p>0.05), however, there was a significant difference across trials for both conditions (p<0.05). There was no interaction effect (p>0.05) across day and trial factors. Pairwise contrasts showed that the knee flexion angle was greatest in the first trial compared with latter trials for both flexed and extended conditions (p<0.05). High ICC values, low typical error, low Bland and Altman limits of agreement, bias values close to zero and a random scatter of the Bland and Altman plots indicated the difference across days was relatively low. Conclusion: The findings of the literature review demonstrated that there was a considerable amount of variation in the measurement on knee extension during slump testing. This may mainly due to differences and inconsistencies in experimental design. There are several clinical factors which may also influence variation during slump testing. The pilot study demonstrated that knee extension ROM could reliably be measured from day to day. It has also shown that some viscoelastic response may be occurring if the test is repeated in a clinical setting.