Intra- and inter-rater reliability of the selective functional movement assessment (sfma)

The Selective Functional Movement Assessment (SFMA) is a clinical assessment system designed to identify musculoskeletal dysfunction by evaluation of fundamental movements for limitations or symptom provocation. The purpose of this study was to determine the intra- and inter-rater reliability of the ten fundamental movement patterns of the SFMA in a healthy population using the SFMA categorical and criterion checklist scoring tools.

35 healthy subjects (22.9 years +/- 1.9) were recorded with two digital video cameras (1-frontal view/1-sagittal view) while they performed the ten fundamental movements patterns that comprise the SFMA. Evaluators with varying experience with the SFMA (rater A, > 100 hours; rater B, 25 hours; and rater C, 16 hours) and not present at the initial data collection evaluated each video using categorical and criterion checklist scoring tools. Evaluators repeated this process at least one week later. The evaluators' composite results were compared between and within raters using the kappa coefficient and ICC's for categorical scoring and criterion checklist scoring, respectively.

Substantial to almost perfect intra-rater reliability of the SFMA (kappa, % agreement) was observed for all raters using the categorical scoring tool (rater A: .83, .91; rater B: .78, .88; and rater C: .72, .85). The criterion checklist scoring tool yielded intra-rater ICCs (3,1; 95% confidence interval) ranging from good to poor with rater A demonstrating the highest reliability (ICC [SEM]) (.52 [2.36]) and rater C the lowest reliability (.26 [3.42]). Inter-rater reliability of the categorical scoring tool was slight to substantial (.41-.61, .69-.79) while the criterion checklist tool (ICC 2,1) demonstrated unacceptable inter-rater reliability when assessed in all raters together (.43 [2.7]).

As hypothesized, intra-and inter-rater reliability of categorical scoring and criterion checklist scoring of the ten fundamental movements of the SFMA was higher in raters with greater experience.