A Hip Test Battery for Clinical Practice - Reliability, Normative Data, and the Pitfalls of Limb Symmetry Index

Q: What clinical need does this hip test battery address?

It targets the need for hip assessments that are reliable and interpretable for evaluation, monitoring, and return-to-sport decision-making.

Q: How was intra-rater reliability evaluated in the study?

A subsample of 22 participants completed a retest after 7 ± 2 days to assess intra-rater reliability.

Q: Why is the Limb Symmetry Index (LSI) problematic according to the findings?

LSI showed poor reliability (ICC < 0.50) with high minimal detectable change (about 27%), which limits its use as a standalone decision criterion.

Sep 15, 2026

Uploaded by Levi

Reliable and clinically interpretable hip assessments are essential for evaluation, monitoring, and return-to-sport decisions, yet no comprehensive test battery unifies intra- and inter-rater reliability, normative data in healthy individuals, and Limb Symmetry Index (LSI) reliability. A cross-sectional reliability study tested 94 healthy adults; 22 completed a retest after 7 ± 2 days. Measures covered ROM, isometric hip strength, and functional tasks, with ICC, SEM, and MDC95% reported.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages25

Reading Time1 h 3 min

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Abstract

Background

Methods

Results

Conclusions

Introduction

A hip test battery for clinical practice: reliability, normative data, and the pitfalls of Limb Symmetry Index Joévin BURNEL Université Libre de Bruxelles Marine GONY Université Libre de Bruxelles Romane BOURREAU Université Libre de Bruxelles Benoit PAIROT DE FONTENAY Clinique de la Sauvegarde Joachim VAN CANT Université Libre de Bruxelles Research Article Keywords: (max 5) : Hip test battery, Reliability, Normative data, Limb Symmetry Index, Clinical assessment Posted Date: April 10th, 2026 DOI: [https://doi.org/10.21203/rs.3.rs-9252188/v1](https://doi.org/10.21203/rs.3.rs-9252188/v1) License: 􀁱 􀅏 This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Additional Declarations: No competing interests reported. Version of Record: A version of this preprint was published at BMC Musculoskeletal Disorders on July 28th, 2026. See the published version at [https://doi.org/10.1186/s12891-026-10248-7](https://doi.org/10.1186/s12891-026-10248-7) . Abstract Background Reliable and clinically interpretable hip assessments are essential to guide evaluation, monitoring, and return-to-sport decision-making. However, no comprehensive test battery currently integrates intra-and inter-rater reliability, normative data in healthy individuals, and the reliability of the Limb Symmetry Index (LSI) . Methods This cross-sectional reliability study included 94 healthy recreational adults (mean age 28.4 ± 8.5 years; 39% women) . A subsample (n = 22) underwent a retest after 7 ± 2 days to assess intra-rater reliability. Outcome measures included hip range of motion (ﬂexion, internal and external rotation), isometric hip strength (ﬂexors, abductors, adductors), and functional performance tests (medial hop, single-leg squat, modiﬁed Star Excursion Balance Test [mSEBT], and endurance squat) . The Limb Symmetry Index (LSI) was calculated for relevant outcomes. Reliability was assessed using intraclass correlation coeﬃcients (ICC[2,1]), along with standard error of measurement (SEM) and minimal detectable change at the 95% conﬁdence level (MDC95%) . Results Most hip strength and range-of-motion measures demonstrated good reliability (ICC > 0.70), with MDC values of 55–79 N for strength and 15–18° for hip ﬂexion. Medial hop performance showed excellent reliability (ICC = 0.89– 0.95; MDC = 18–26 cm), and mSEBT demonstrated low measurement error (MDC = 9–14 cm) . In contrast, single-leg squat and endurance squat tests showed lower reliability. Medial hop performance was moderately correlated with hip abductor (r = 0 . 52) and adductor strength (r = 0 . 51) . LSI demonstrated poor reliability (ICC < 0 . 50; MDC ≈ 27%) . Conclusions Range-of-motion measures, particularly active and passive hip ﬂexion, demonstrated the highest levels of reliability. Strength tests showed good reliability but were associated with high measurement error, limiting their sensitivity to detect individual changes. Among functional tests, the medial hop demonstrated excellent reliability. In contrast, adductor-to-abductor strength ratios and the Limb Symmetry Index (LSI) showed poor reliability and high MDC values (≈ 27%), limiting their use as standalone decision-making criteria. These ﬁndings support the preferential use of absolute measures within a multidimensional assessment framework. Introduction Hip injuries account for 10–16% of sport-related musculoskeletal disorders, particularly in disciplines demanding high pelvic–femoral control such as football, hockey, dance, and martial arts [1, 2] . These conditions include groin pain, muscle and tendon injuries, labral tears, and femoroacetabular impingement (FAI), often associated with measurable biomechanical impairments. The Doha consensus provides a clinical framework for hip and groin pain classiﬁcation, yet the associated impairments and deﬁcits remain challenging to assess reliably [3, 4] . Athletes with hip pain frequently exhibit r

FAQs

What clinical need does this hip test battery address?

It targets the need for hip assessments that are reliable and interpretable for evaluation, monitoring, and return-to-sport decision-making.

How was intra-rater reliability evaluated in the study?

A subsample of 22 participants completed a retest after 7 ± 2 days to assess intra-rater reliability.

Why is the Limb Symmetry Index (LSI) problematic according to the findings?

LSI showed poor reliability (ICC < 0.50) with high minimal detectable change (about 27%), which limits its use as a standalone decision criterion.

Sep 15, 2026

Uploaded by Levi