Co
1. 2. 3.
4. 5.
6
Med
Med
_______________ orresponding autho Department of O University of Med Department of Ph
Medical Sciences, Orthopedic Depart
Iran
Department of O University of Med Rehabilitation Ma
Iran .
Neuromusculoske Rehabilitation, Iran
A system
measure
Behshid Farah Mohammad K
Received: 16 M
Abstract
Background
measurement is and reliability o Methods: A using selected systematic sele Scale for qualit Results: A t measurement t studies. Also, 9 very high (ICC on subjects. Conclusion:
validity in mea discrepancy me
Keywords: Le
Conflicts of Interes Funding:Iran Univ
*This work has bee
Copyright© Iran
Cite this articl validity and re https://doi.org/10
Introducti Leg length skeletal disor suffers from L important top length assess by several pra pedics, techni (2, 3). LLD
dical Journa
J Islam Repub Ir
________________ or: Dr Masumeh Bag Orthotics & Prost
ical Sciences, Tehra hysiotherapy, Scho
Tehran, Iran tment, Firuzgar Hos
Orthotics & Prost ical Sciences, Tehra nagement Departm
eletal Research C n University of Med
matic rev
ement m
hmand1, Esma Kamali5, Masu
May 2018
d: Leg length s a common cli of the tape mea search was per keywords from ection process, t
ty assessment. total of 11 stu tool) studies an 9 out of 11 stud C=0.9) levels of
Tape measure asuring obese p easurement see
eg length discrep
st: None declared versity of Medical Sc
en published under University of Medi
le as:Farahman eliability of tap 0.14196/mjiri.33.4
on
discrepancy rder. Almost LLD of up to pic in evaluat ment procedu actitioners, su ical orthopedi assessment is
al of the Islam
ran. 2019(26 May
_
gherzadeh Cham, b
hetics, School of an, Iran
ool of Rehabilitatio
spital, Iran Universi
hetics, School of an, Iran
ment, Iran Universit
Center, Departmen dical sciences, Tehra
view on t
method in
aeil Ebrahimi T umeh Bagherz
Published
discrepancy inical method. T asurement meth
rformed in Pub m inception to the quality of th
udies were fina nd 4 were relia dies were deeme f interrater and
ment method h people and pati ms to be necess
pancy, Validity
ciences, Tehran, Ira
rCC BY-NC-SA 1.0 li ical Sciences
nd B, Ebrahimi T pe measurement
46
(LLD) is a c 70% of the g 1 cm (1). LLD ion of lower ures are comm uch as physica
ics, chiropract s a challengin
mic Republic
y);33.46. https://d
agherzadehcham.m
Rehabilitation Sc
on Sciences, Iran U
ity of Medical Scien
Rehabilitation Sc
ty of Medical Scien
nt of Physical M an, Iran
the valid
n leg leng
Takamjani2, H zadeh Cham*6
d: 26 May 2019
measurement This study aime hod and the qual Med, EBSCO, December 201 he included stu
ally considered ability analysis ed to be of high intrarater reliab
has acceptable ients with mus sary for obese a
y, Reliability
an
icense.
Takamjani E, Yaz t method in l
common musc general popul D assessment limb. Variou monly being al therapists, o tic, and podia ng task amon
c of Iran (MJ
doi.org/10.14196/
ciences, Iran
University of
nces, Tehran,
ciences, Iran
nces, Tehran,
edicine and
↑
T m w a i
N i a
ity and r
gth discr
Hamid Reza Ya 6
9
is an essentia ed to systemati lity of reporting
Science Direct 17.This system udies was assess
d for this syste only. Validity h quality based o
bility. The valid
reliability and sculoskeletal di and individuals
zdi HR, Saeedi H leg length disc
culo-lation
is an us leg used ortho-atrists ng
re-searc asse of m ing niqu urem patie mor
IRI)
/mjiri.33.46
↑What is “alrea
Tape measurem method to eval with leg length and reliability o in those with or
→What this ar
New valid, reli is needed to ev and in those wi
reliability
repancy
azdi3, Hassan S
al part of mus ically review th g the literature t, Web of Know matic review wa sed independen
ematic review. y and reliability
on Brink and L dity of the meth
validity in hea isorders. Thus, with leg length
H, Kamali M, B repancy. Med
chers and clin ssment of LL methods have b
techniques, ( ues are the sta ment, but they
ents to radiat e popular bec
ady known” in
ment is a simple uate limb lengt h discrepancy m
of this method rthopedic disord
rticle adds:
able, non-invas aluate leg lengt th orthopedic o
y of tape
Saeedi4,
sculoskeletal c he results of the on this topic. wledge, Scopus
as based on th ntly by 2 review
Two studies w y analyses wer
ouw Scale. Stud hods ranged fro
althy people, bu using a suitabl h discrepancy.
agherzadeh Cham J Islam Repub
icians. There i D measureme been used for (2) clinical m ndard procedu y are costly,
ion (4). Ther ause of their a
this topic:
e, affordable, a th inequality in more than 5 m decreased in ob der.
sive, and cost-e th discrepancy or neuromuscula
e
clinical assessm e findings of stu
s, Embase, and he PRISMA gu wers using the B
were about the re simultaneous udies showed hi
om low to very
ut it does not h le method for
m M. A systema b Iran. 2019
is still controv ents. Two gen r LLD assessm methods (4). I ure for accura time-intensiv refore, clinica availability, ea
nd non-invasiv n healthy peopl mm. The validity
bese people an
effective metho in obese peopl ar disorder.
ment, and tap udies on validity
Google Schola uideline. After
Brink and Louw
e validity of ( sly applied to 5
gh (ICC=0.7) to high depending
have acceptabl LLD leg length
atic review on th (26 May);33:46
versy about th neral categorie ment: (1) imag Imaging tech ate LLD meas e, and expose al methods are asy procedure
ve le y nd
d le
e y
ar a w
a 5 o g
e h
he 6.
e es g- h- s-e e e,
Validity and
and low cost clinical LLD blocks of diff and then the methods, tap used to measu iliac spine (A the lateral or Despite easy known.
There is so of these meth conflicting re cluded that A inaccurate an LLD error of mm intrateste single measur agreement wi ity estimates o cient (ICC) o ing ASIS to m and Braatz (3 intertester rel an intertester intratester reli medial malleo sults have be the method. T systematic rev as a common evaluate the q factors affecti
Methods Search stra To systema the date of i SCO, Science Embase datab follow: ("leg ancy" OR "l "limb length" ter-tester" OR "tape measur assessment"). in the text or additional sea also perform hand searchin found from th
Inclusion cr
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b)Full-tex
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measurement of the study
d)Pearson
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reliability of t
t. Indirect an assessment ferent thickne
leveling of t e measureme ure the distanc ASIS) or anteri r medial mall
procedure, v
me controver hods. Several l esults. In thei ASIS to media nd imprecise m f 8.6 mm com
er mean error rement of AS ith this finding of LLD to hav of 0.683, when medial malleo
) reported ICC iability of 0.9
reliability ran iability rangin olus measure en reported o Thus, the aim view on the v n clinical met quality of thes ing the reliabi
ategy
atically search nception to D e Direct, We bases were ex length discrep eg length ine ") AND ("val R "intra-teste rement" OR " . A word from r the title-abst
arch of Goog med. These se
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riteria of the s language xt availability
ing the validit t method sho
n’s r, Cronbac hould have be ere excluded
tape measurem
nd direct meth (4-6). In indi esses are put u the pelvis is c ent methods ( ce between th ior inferior ili leolus in supi validity of th
rsy about valid literatures on ir study, Frib al malleolus m
measure of L mpared to radio
r. Authors of SIS to the me g, Beattie et a ve intra-class n utilizing a s olus measure.
C of 0.99, wit 98. Also, Hoy nging from 0. ng from 0.89 t ment. The w on the validity m of this study validity and re thod for LLD se studies, and ility and valid
h the literatur December 20 eb of Knowle xplored. The pancy" OR 'lim equality" OR lidity" OR "re r") AND ("ta "clinical meth m each area w
tract-keyword gle Scholar s earches were ence lists of
studies:
ty and/or reli uld have been
ch α, and intr een used for st if they exam
ment method
hods are used irect methods under the shor checked. In d (TMM), a tap he anterior sup
iac spine (AII ine position ( his method is
dity and reliab TMM have sh erg et al (9) measurement LLD, with a m
ographs, and this study us edial malleolu l (10) found v correlation co single measur
In addition, G th radiographs yle et al (11) n .96 to 0.98 an to 0.95 for AS idely differen y and reliabili y was to perfo eliability of T D measuremen d to investigat
ity of this met
re published 17, PubMed, edge, Scopus, keywords we mb length disc
"leg length" eliability" OR ape measure" hods" OR "cli was required t d of the study search engine supplemente the final art
ability of the n the primary
raclass correl tatistical analy mined the val
d for s, lift rt leg direct pe is perior IS) to (4-8). s not
bility hown con-is an mean a 1.1 sed a us. In
valid- oeffi-re us-Gogia
s and noted nd an SIS to nt
re-ity of orm a TMM nt, to te the thod.
from EB-, and ere as crep-" OR R
"in-" OR inical to be y. An e was d by ticles
tape y aim
lation ysis.
lidity and/ disa racy
St In tion, artic & M revie cle ( were full– the i
Qu Ul Two qual cord as ac
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Da Th relat as v 0.69 tion,
Re St W iden er, a inclu of th A syste to va relia ity a 8, 2
Ch To The samp eval
/or reliability rticulation of y and/ or preci
tudyselection
n this systema , quality asse cles were scre MB). In case o ewers, a third (MK). Initially e selected by –text articles
inclusion crite
uality assessm ltimately, 11 o reviewers c lity of the 11 dingly, a Kapp
cceptable. he Brink and L ssessment (13 combining QU ostic Accuracy sal of Diagn cted studies c he tape measu veniently used REL independ d as of high q % (14, 15). Tw lity of each stu
ata analysis he intra-class tion coefficien ery low correl 9 as moderate , and 0.90-1.0
esults tudy Selection With a prelimin ntified without after applying uded in the re he selection pr
total of 11 ematic review alidity studies ability analysi analyses were
1, 22).
haracteristics otal numbers healthy sam ple included luated healthy
of tape measu patients and sion of tape m
n
atic review, al ssment, data eened indepen of any differen d reviewer was y, based on th y reading the were explore eria.
ment
articles were conducted an studies based pa score of 0
Louw Scale c ). This 13-item UADAS (the
y Studies) and ostic Reliabil could assess b urement. Thus
d as compared dently (13, 14
quality if the wo reviewers
udy.
correlation co nt were interp lation, 0.30-0. e correlation, 00 as very high
n
nary literature t excluding no g the inclusio
view. Figure
rocess based o studies were w (Table 1). T
s only (10, 17) s only (11, 18 applied to 5 s
of participan mple included
284 (Table 2
y individuals (
urement in tot if they evalu measurement.
ll search proc extraction, an ndently by 2 r nce of opinio as asked to eva
he inclusion c titles and ab ed to choose t
selected for appraisal of d on Kappa sc .92 or higher
checklist was u m scale has b
Quality Asse d QAREL (th lity Studies) both reliabilit s, this checklis
d to either of 4). The studies eir scores wer independently
oefficient and preted as foll .49 as low cor 0.70-0.89 as h correlation (
e search, 496 on-English art on criteria, 11
1 presents the
on the PRISM finally consi Two studies w
), while 4 wer 8-20). Validit studies simulta
nts in all sam 174 individu
2). Five studi
(3, 7, 11, 18,
tal hip or knee uated the accu
cedures; selec nd reading the
reviewers (BF on between the aluate the arti criteria, studie bstracts. Then those that me
final analysis f the reporting cores (12). Ac
was regarded
used for quali een developed essment of Di he Quality Ap scales, as the ty and validity st can be more f QUADAS o
s were consid re higher than
y assessed the
Pearson's cor low: 0.00-0.29 rrelation, 0.50
high correla (16).
abstracts were ticles. Howev
articles were e flow diagram MA guidelines.
idered for thi were subjected
re subjected to ty and reliabil
aneously (3, 7
mples was 458 uals and LLD
ies had solely 19), 3 focused e
u- c-e F e
i-s n, et
s. g
c-d
i-d i- p-e y e or
d-n e
r-9 0-
a-e
v-e m . s d o l-7,
8. D y d
on LLD patie and LLD par and 98 males not report the
Study chara Among the only Neelly e examiners an ation was com 21, 22). More the validity o patient (ICC: In studies t expert examin were 0.477- 0 11, 18-22). O expert examin pert examiner
Fig. 1.PRISMA Records id
ents (17, 20), rticipants (8, 1 s were studied e gender of the
acteristics e studies that e et al (7) and G
d in other stu mpared to th eover, only B of TMM in he
0.770- 0.852) that measured ners and inter 0.991 and 0.6 Only in Duff e
ners evaluate rs intertester r A flow diagram dentified throug
Pubme Ebsco Science d Web of Kno Scopu Embas Google Sc
Records
Full-text
Validity (
, and 3 evalu 10, 21). A tot d in 7 studies, eir participant
evaluated the Gogia et al (3) dies only one e reference m Beatie et al (10 ealthy (ICC:
) groups (Tab
d reliability, a rtester and int 79- 0.990, res et al (21) stud
d LLD and f reliability of 0 gh database sear ed (n=29)
(n= 316) direct (n= 7) owlage (n= 40)
s (n= 66) e (n= 29) cholar (n = 6)
Records
after title and a (n = 35)
t articles assesse (n = 11)
Studi qualit
Reli n= 2)
uated both he tal of 129 fem , and 3 studie
s (17, 20, 21)
validity of T studies had us examiner's ev method (8, 10
0) study comp 0.359- 0.786) le 1). all studies ap
tratester reliab spectively (3, dy expert and found between 0.49, between
rch (n = 493)
after duplicates (n = 412)
abstract screened )
ed for eligibility )
ies included in tative synthesis
(n = 11)
ability (n=4)
ealthy males es did
.
TMM, sed 2 valu-0, 17,
pared ) and
pplied bility 7, 8, non-n ex-
non-expe and et al bility ry et of T 0.80 Th stud In B nogr In med (22) male from only from male s removed
d
y
Validity & Additional
refere
ert examiners non-expert ex l (11) study m y of TMM in t al (20) meas TMM in 2 po 0) and to latera
here were 4 dy with CT Sc Beattie et al (1 ram were used n most studies dial maleolus (
) study, leg le eolus and in m ASIS to bot
y in lamp et m ASIS to kn
eolus (Table 2
Records (n =
Full-text ar (n = 24) Not fu Not validi
New clinica No tape mea Not English
& Reliability (n= l records identif
other sources ences searching
reliability of xaminers relia measured inter right and left sured intertest ositions: ASIS al maleolus (IC
radiography an (7), and 3 w 0) study, both d as reference , leg length w (3, 7, 8, 10, 1
ngth was mea Terry et al (2 th medial and al (17) study nee joint and 2).
s excluded = 377)
rticles excluded with reasons: ull text (n=1)
ity or reliability (n=7)
al methods (n=3 asurement (n=1 h language (n=
=5) fied through
(n = 3)
f 0.19, and b ability of 0.01 ertester and in ft foot separate
ter and intrate S to medial m
CC: 0.83). studies (3, 1 with scanogra h radiography
e method (Tab
was measured 1, 18, 19, 21) asured from A 20) study, it
lateral maleo y, leg length w
from knee jo d,
y
3) 2) 1)
etween exper 1- 0.69. Hoyle ntratester relia
ely. Also, Ter ester reliability maleolus (ICC
17, 21, 22), am (8, 19, 20) y and mini sca ble 2).
from ASIS to . In Badii et a ASIS to latera was measured olus. However
was measured oint to media
rt e a- r-y C:
1 ).
a-o al al
d r, d al
Validity and
Quality of s The 2 revie
Table 1.Summ Author Badii et al, 201 Neelly et al, 20
Jamaluddin et Leard et al, 20
Bretas et al, 20 Terry et al, 200
Duff et al, 200
Lampe et al, 19
Hoyle et al, 19
Beattie et al, 1
Gogia et al,198
T: test session, E
Table 2.Summ Author
Badii et al, 201
Neelly et al, 20
Jamaluddin et 2011
Leard et al, 20
Bretas et al, 20
Terry et al, 200
Duff et al, 200
reliability of t
studies ewers had no mary of studies an
14 013
al, 2011 09
009 05
00
996
991
990
S
86
E: examiner, EX: ex
mary of the includ
14 20 p
1
013 30
dwe 1 38.40
al, 35 p LLD a 3 22.60
09 1
6 23.7
009 3
50
05 16 p
9
00 13 p
LLD a Age
tape measurem
o disagreemen nd validity and re Val 0. E1: 0.984 (0 E2: 0.978 (0 0.81 (0.5
0.1
95% limit of agr Predict value bel Above the
First measureme Norma All subje Second measurem
Norma All subje Mean measurem Norma All subje E1: 0 E2: 0
xpert examiner, NEX
ded studies Patients
patients with LLD 0 M, 10 F
community elling adults 1 M, 19 F 0±13.10 years
patients with and 13 healthy
5 M, 13 F 0±15.80 years
18 healthy 6 M, 12 F 70±3.60 years
37 healthy 9M, 28F 0±18 years
patients with LLD 9.97 years
patients with and 12 healthy e range 21-53
ment method
nt about articl liability of the inc idity
75 0.973–0.990) 0.961–0.988)
9 to 0.91)
1 CI
reement: -1.8/2.1 ow the knee: 0.75 e knee:0.64
ent Patient: 0.770 al: 0.359 ects:0.683 ment Patient:0.80 al:0.786 ects:0.790 ment Patient:0.852
al:0.637 ects:0.793
0.990 0.990
X: non-expert exam
P
Inferior aspe aspect of
Inferior aspe aspect of
anterior superio distal tip of th the
Inferior aspect of the
Inferior aspe aspect of
- Inferior a or aspect o - Inferior a or aspect
Inferior aspe aspect of
le
se-lecti ty o ncluded studies
Int 0.477 0.991
0.92
The med The la E EX EX EX EX N
5
R
0
03
2
miner
Position test
Supine ect of the ASIS- I f the lateral malleo
Supine ect of the ASIS- I
the medial malle
Supine or iliac spine (AS he medial malleol e nearest 5 mm
Supine t of the ASIS- dis
medial malleolus
Supine ect of the ASIS- I
the medial malle
Supine aspect of the ASI of the medial mal aspect of the ASI t of the lateral ma
Supine ect of the ASIS- I
the medial malle
ion (kappa sco f the articles ter-tester ICC 7 (0.253–0.706) 1 (0.983–0.995)
2 (0.87 to 0.96) T1: 0.955 T2: 0.963
dial malleolus: 0.8 at malleolus: 0.83 EX1,2=0.49 X1,NEX1=0.69 X1,NEX2=0.17 X2,NEX1=0.43 X2,NEX2=0.01 NEX1,2=0.19
Left:0.989 Right: 0.965
0.990
Inferior olus
4 e ma p
s
Inferior olus
2
SIS) to the lus with
2
stal point s
1
Inferior olus
S- Inferi-leolus & S- Inferi-alleolus
4 o su f
Inferior olus
Tw
ore 1). Howev differently.
E E
80 Th
T
Examiner
experienced exam atologist, occupat ist, physical thera senior rheumatolo
2 expert physica
professional orth geons
0 physical therap
Trained exam
observe: pediatric urgeon, pediatric flow, fourth-year resident, physical
wo expert podiatri expert podia
ver, they asses Nine out of
Intra-tester IC
E1: 0.990 (0.984– E2: 0.985 (0.976–
E1: 0.991 E2: 0.993 0.679 he medial malleol
The lat malleolus EX1=0.17 EX2=0.32 NEX1=0.29 NEX2=0.31 C
Left E1:0.95 E2: 0.904 Right E1: 0.8 E2:0.942
ers
miners: rheu-ational thera-apist, and a ogy fellow
al therapist
hopedic
sur-pist student
miner
c orthopedic orthopedic orthopedic al therapist
ist, two non-atrists
ssed the quali the 11 studie CC
–0.994) –0.991)
lus: 0.78 s: 0.88
9 CI
54
95
Reference methods Radiographs
CT scans
CT scanogram
-
CT scanogram
CT scanogram
Radiographs
i-s
were deemed the studies su high quality ( found to be o which combin formed were
Table 2.Cntd Lampe et al, 199
Hoyle et al, 199
Beattie et al, 199
Gogia et al,1986
Table 3.Results Brink and Louw
Was the sample subjects’ represe tive?
Was the sample raters’ represent Was the referenc standard explain Were raters blin the findings of o raters? Were raters blin their own prior f ings?
Was the order of ination varied? Is the time perio tween reference ard and index te enough? Was the time int between repeate measures approp Was the referenc standard indepen the index test? Was the executio the index test de in sufficient deta Was the executio the reference sta described in suff detail? Were withdrawa the study explain Were the statisti methods appropr Total score
Not = Not applicab
d to be of high ubjected to val (10). Three o of high quali ned reliability
found to be o
96 1
1
Ag
90 10 pa
3
2
6
Ag
of quality assess w Scale Badi et al 2014 of
enta- +
of tative?
+
ce
ned? +
ded to other
+
ded to
find- +
f exam- Not
od be- stand-st short
Un
terval d priate?
Un
ce ndent to
+
on of escribed
ail?
+
on of andard
ficient
+
als from ned?
Un
ical
riate? + 9
ble, Un = Unclear, (
h quality (scor lidity studies w out of 4 reliab
ty (18-20). A y and validity of high quality 190 children
25 healthy 6 M, 19 F e range 22-40
atients with LLD 6M, 4F 34.10±11.20
9 healthy 26.50±3.70
3M, 6F
30 healthy 12 M, 18 F e range 18-65
sment of studies u ii
., 4
Neelly et al., 2013 +
+
+
+
+
t Not
Un
Un
+
+
+
Un
+
9
(+) = Yes, (-) = No.
re > 60%). On was found to b bility studies Also, all studi y studies were y (3, 7, 8, 21, - Anterio me - the med
Anterior
Anterior
Anterior
using Brink and L Jamaluddin et al., 2011
L e 2 +
+
+
+
Not
Not
Un
Un
+
+
+
Un
+
8
ne of be of were ies in e
per-, 22). Deta The and the t and Supine or Superior Iliac
edial knee joint li dial knee joint lin dial malleolus
Supine Superior Iliac Sp medial malleolus
Supine Superior Iliac Sp medial malleolus
Supine Superior Iliac Sp medial malleolus
Louw Scale Leard et al., 2009
Breats et al., 2009
+ +
+ +
Not Not
+ +
+ Un
Not Not
Not Not
+ +
Not Not
+ +
Not Not
Un +
+ +
7 7
ails of the sc main areas o intrarater blin time period be withdrawal fr Spine to the ine & ne to the
me-s
pine to the s
pine to the s
pine to the s
2
Terry et al., 2005
D et 20
+ +
+ +
+ +
+ +
un +
+ +
+ U
+ +
+ +
+ +
+ +
Un U
+ +
11 1
oring process of weakness nding, lack of etween referen rom the study.
One examin
2 professional p therapist
One examin
2 expert physical
uff al., 000
Lampe et al., 1996
+ +
+ +
+ +
+ -
+ Not
+ Not
Un Un
+ Un
+ +
+ +
+ -
Un Un
+ -
11 5
s are presente were insuffic f variation in nce standard a .
ner Ort
physical t
ner R
M
l therapist R
Hoyle et al., 1991
Be e 1 +
+
-
+ N
Un N
Not N
Not
Un
Not
+
Not
Un
+
5
ed in Table 3
cient interrate testing order and index test thoradiography
-
Radiographs ini scanogram
Radiographs
eattie t al., 1990
Gogia et al., 1986
- +
- +
+ +
Not +
Not Not
Not Not
Un +
+ +
+ +
+ +
+ +
+ Un
+ +
7 10
3. er r, t,
Validity and
Discussion The aim of liability of T study showed LLD measur weight or mu examiner mea maleolus twic considered. E cedure for LL the subject to Therefore, ba TMM serves search centers
TMM refer landmarks (4 position with tion (extended sition) (3, 10 distances (eg malleolus, AS medial malleo num to malleo The results between ASIS est validity, w malleolus me Other measur validities. Re strated that th the ASIS to was 0.78 and reliability of spectively.
In these stu investigated i tients had a h ease, Tibia or omyelitis, ost obesity, or oth validity and r were accepta compared to t Beattie et al (
1). Significan
served in obe In the mean measurement tion of the AS (thighs, knee contracture, o and alter the cause LLD bu
Incorrect de placement of errors into the skill and exp fects reliabilit studies, LLD pert examine
reliability of t
n
f this study wa MM for LLD d that TMM rement in he usculoskeletal asured LLD f ce or more, an Even though r LD measurem o radiation, a ased on the re as a safe met s.
rs to direct me , 5). In this m his/her lower d hip and kne 0). Different
, ASIS to me SIS to medial olus, umbilicu olus) (17, 20,
of the presen S to the medi while the dista erely provide rement metho esults of a stu he values of
the medial m d 0.88, respec
the same dis
udies, validity in healthy ind history of low r Femur Hem teoarthritis, l her deformitie reliability of t able in health
the patients (I (10) found re ntly lower va se participant ntime, TMM , making it d SISin obesity s, ankles) du or obesity can e results. Pelv
ut can affect m etection of bo f the tape alon e measuremen perience in LL ty and validity measuremen ers, such as
tape measurem
as to review th D measuremen is a valid and ealthy people l disorder. Mo
from ASIS to nd the mean m radiography is ment, it is too e and requires s sults of this s thod for LLD
easurement of method, the p r limb being in ee with the an
studies have edial malleolu knee joint, m us to medial m
22, 23). t study showe ial malleolus p ance between A
s acceptable ds provided s udy by Terry
ICC for intra malleolus and ctively, and th stances was 0
y and reliabil dividuals and wer limb frac mimelia, hemih
ow back pain es. The results the TMMfor L
hy participan ICC=0.33-0.3 elatively differ alidity and re s (ICC=0.22) uses bony la difficult to det y. Asymmetry ue to swelling change the di vic obliquity measurement ( ony landmarks ng the lower l nt, and theref LD measurem y of the result nt via TMM i physiotherap
ment method
he validity an nt. Results of d reliable too e with no ex
oreover, an ex o medial or la measurements
s the standard expensive, exp special equipm
tudy, it seems in clinics an
f LLD using person is in su
n anatomical kles in neutra checked diff us, ASIS to la medial knee joi malleolus, or
ed that the dist provides the h ASIS to the la
validity (17, significantly l
et al (20) dem arater reliabili d lateral malle
hose for inter 0.80 and 0.83
ity of TMM patients. The ctures, Blount
hypertrophy, n, tibia dyspl s also revealed LLD measure nts 0.97-0.98) 9) (19). How
rent results (T
eliability were (19). andmarks for
tect accurate in other segm g, muscle atro
irection of the may not act (10, 19). s and inapprop
imb can intro fore the exami ment via TMM
s (21, 23). In s practiced by pists, occupat
nd re-f this ol for xcess xpert ateral were d
pro-poses ment. s that nd
re-bony upine posi-al po-ferent
ateral int to
ster-tance high-ateral
20). lower mon-ity of
eolus rrater 3,
re-were e pa-t dis- oste-lasia, d that ement ) (7) wever, Table e
ob-LLD loca-ments
ophy, e tape tually
priate oduce iner's M
af-most y ex-tional
thera trists teste TMM skill
TM its v via T that mea befo et al and tivel mea in g the f ever one-Va show ly, h than for Beat 5 mm mini indiv the d Di proc phy sam mea scan the l stud ty of stan
Th exam trate repo trate terte inter alud relia Th First som publ cles ed a of p for t unif
Co In
apist, rheuma s (3, 7, 8, 11 er's skill on
M and found l and reliabilit MM was com validity. For th TMM for 1 o to enhance asure LLD for ore comparing l (10) demon second measu ly. They also asurements to
eneral, the se first, perhaps r, Neely et al -time measure alidity of TM wn to depend higher errors h n 5 mm, while cases where ttie et al (10) m in leg lengt ing the shorte viduals, and th difference exc ifferent studie cedures, such
(4). In LLD m e bone landm asurements are n method, bio leg and ankle dies where TM
f LLD measur ding radiograp he results of a miners were ester reliability orted an inter ester reliability ester reliabilit
rtester error ex ddin et al (8) a ability of 0.80
he current lit t, as with an me related artic
lished work o in English w accuracy and p participants, ex the measurem form.
onclusion n general, acco
atologist, orth , 22). One stu
intertester an a direct relati ty of the result mpared to a re
his purpose, th or more than
the validity r at least 2 tim g it to the refe
strated the va urements to b o found the
be 0.852. The econd measure due to increa (7) and Jama ement still pro MM for LLD m
on the length have been rep e significantly
the differenc found that any th can increas er length by t he examiner w ceeded 5 mm.
es have comp as radiograph measurement, marks as those e made in supi omechanical o e is not shown MM was comp
rements was h phs (7, 8, 20) a reliability stu
adequately s y were accept rtester reliabi y of 0.99. Al y of 0.99. D xceeds that of and Brêtas et 7 and an intra terature revie y systematic cles could not
r conferences ere included. precision were xaminers, and ment and the r
ording to studi
hopedic surgeo udy evaluated nd intratester ionship betwe ts (21). eference meth
he examiner m 1 time. The r
of TMM, th mes and avera erence method alidity of TM be 0.359 and highest valid e results also ement was m ased examiner aluddin et al ovides accepta measurement h of the 2 limb ported for diff
y lower error ce exceeds 5 ny difference o
se the rate of the examiner will not make
pared TMM hy, CT scan, , using CT sca
used in TMM pine position (
or structural n due to weig pared to CT sc higher than th
udy showed t skillful, intert tably high. Le ility of 0.95 lso, Gogia et Duff et al (21 f intratester re
al (19) found atester reliabil ew has sever review, it is ot be identified
s articles. Sec Third, studie e not included d landmarks t reference meth
ies in which v
ons, or podia d the effect o reliability o een examiner'
od to evaluate measured LLD results showed he tester mus
age the result d (10). Beattie MM at the firs
0.786, respec dity with dua indicated that more valid than
r's skill. How (8) found tha able validity.
has also been bs. According ference of les rs are reported
mm (9, 10) of smaller than
error in deter on 4 out of 9 any mistake i
with standard and scanogra an images, the M are used and 24). In the CT asymmetry o ght bearing. In can, the validi
at provided by
that when both tester and in eard et al (18 -0.96 and in al showed in ) showed tha eliability. Jam d an interteste ity of 0.668. ral limitations s possible tha d, such as un ond, only arti es that evaluat d. Finally, type that were used hods were no
validity and re a-of of s
e D d st ts e st c-al
t, n
w-at
n
g-s d ). n
r-9 if
d
a-e d T of n
i-y
h n-8) n-at
m-er
s. at
n- i- t-e d ot
liability of the shown to exh healthy indiv validity for o thopedic prob sary skill and form LLD m unrealistic res lems. Thus, it ble for both th method shoul nate the need skill and expe
Acknowled The authors ical sciences, study.
Conflict of I The authors d
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