Inter-examiner and intra-examiner reliability of the standing flexion test

The practice of musculoskeletal medicine requires the use of a wide variety of clinical examination procedures to establish a diagnosis, plan treatment, and monitor patient progress. Many of these examination procedures constitute a significant part of daily practice. Despite their extensive use, the reliability and validity of many of these assessment procedures remains questionable. The aim of this study was to determine the inter- and intra-examiner reliability of palpatory findings for the standing flexion test; one test for sacroiliac joint (SIJ) dysfunction. Nine examiners performed the standing flexion test on nine asymptomatic subjects. Inter-examiner reliability data, with a mean percentage agreement of 42% and a kappa coefficient of 0.052, demonstrated statistically insignificant reliability. Intra-examiner reliability data demonstrated a mean percentage agreement of 68% and a kappa coefficient of 0.46 indicating moderate reliability. These results suggest that the reliability of the standing flexion test as an indicator of SIJ dysfunction still remains questionable. Before this test can be relied upon as an accurate indicator of SIJ dysfunction it must undergo further research. This research must not only further standardize the procedure, but also ascertain reliability and validity.