Intra-Rater reliability of the Functional Movement Screen (FMS) amongst NHS Physiotherapists

Abstract

Objectives: The primary aim of this study was to evaluate the intra-rater reliability of the FMS amongst a group of novice National Health Service (NHS) Physiotherapists. The secondary objective was to establish if Intra-rater reliability differed between non-specialist rotational Physiotherapists and Physiotherapists working within the musculoskeletal (MSk) setting. Design: Reliability Study. Method: Forty participants with no recent MSk injury were video recorded completing the 7 component FMS tests. Six NHS Physiotherapists with no previous experience using the FMS attended a 2 hour training programme delivered by a certified FMS practitioner. Raters then viewed and scored videos of the 40 participants completing the FMS. Results: The intra-rater reliability of FMS composite scores was Excellent (mean ICC of 0.91 (95% CI 0.81-0.96)). The non-specialist rotational Physiotherapist group demonstrated Good-Excellent intra-rater reliability (ICC 0.9; 95% CI 0.79-0.95). Specialist MSk Physiotherapists demonstrated Excellent intra-rater reliability (ICC 0.92; 95% CI 0.84-0.96). Intra-rater reliability of the 7 component tests of the FMS ranged from Poor-Excellent (KW 95% CI 0.11-0.98). Conclusion: Among novice NHS Physiotherapists, the FMS composite score demonstrated Excellent intra-rater reliability. MSk specialists were found to demonstrate a marginally superior level of intra-rater agreement compared to non-specialist rotational Physiotherapists; however this is likely to be negligible in a clinical context. Clinical specialism also appears to have little impact on the intra-rater reliability of FMS components with both groups of raters achieving a Poor-Excellent level of agreement.

Inter-Rater reliability of the Functional Movement Screen (FMS) amongst NHS Physiotherapists

“…Those individuals who met the entrance criteria were then provided with an information sheet and given the opportunity to volunteer, before signing the informed consent form and being entered into the study. Participants provided informed consent for inclusion in both the intra-rater [20] and inter-rater reliability studies.…”

“…These are then scored using a categorical scale ranging from 0-3, resulting in a potential overall score ranging from 0-21. The scoring method is described in detail in our previous study [20] and for a detailed description of how each component/ screening movement is performed, the reader is directed to Cook et al (2010) [17].…”

“…A score of 3 corresponds with the individual being able to correctly complete the movement without compensation; a score of 2 corresponds with the individual being able to perform the movement with compensation; a score of 1 corresponds with the individual being unable to perform the movement; a score of 0 corresponds with the individual reporting pain at any time when performing the movement [19]. A recent study conducted by Palmer, Cuff and Lindley (2017) questioned the intra-rater reliability of the FMS amongst NHS clnicians; both specialist musculoskeletal (MSK) and rotational Physiotherapists [20]. Furthermore, the inter-rater reliability is unclear with reports ranging from fair-excellent [16,21] and has not been determined amongst UK public sector clinicians [20].…”

“…A recent study conducted by Palmer, Cuff and Lindley (2017) questioned the intra-rater reliability of the FMS amongst NHS clnicians; both specialist musculoskeletal (MSK) and rotational Physiotherapists [20]. Furthermore, the inter-rater reliability is unclear with reports ranging from fair-excellent [16,21] and has not been determined amongst UK public sector clinicians [20].…”

“…The intra-rater reliability of the FMS when used by novice National Health Service (NHS) Physiotherapist raters has been shown to be excellent (ICC 0.91; 0.89-0.93 95%CI) as part of a concurrent study [20].…”