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An Examination of Cyriax's Passive Motion Tests With Patients Having Osteoarthritis of the Knee

1994; Oxford University Press; Volume: 74; Issue: 8 Linguagem: Inglês

10.1093/ptj/74.8.697

1538-6724

Karen Hayes, Cheryl M. Petersen, Judith Falconer,

Shoulder Injury and Treatment

Background and Purpose. We explored the construct validity and test-retest reliability of the passive motion component of the Cyriax soft tissue diagnosis system. We compared the hypothesized and actual patterns of restriction, end-feel, and pain/resistance sequence (P/RS) of 79 subjects with osteoarthritis (OA) of the knee and examined associations among these indicators of dysfunction and related constructs of joint motion, pain intensity, and chronicity. Subjects. Subjects had a mean age of 68.5 years (SD=13.3, range=28–95), knee stiffness for an average of 83.6 months (SD=122.4, range=1–612), knee pain averaging 5.6 cm (SD=3.1, range=0–10) on a 10-cm visual analogue scale, and at least a 10-degree limitation in passive range of motion (ROM) of the knee. Methods. Passive ROM (goniometry, n=79), end-feel (n=79), and P/RS during end-feel testing (n=62) were assessed for extension and flexion on three occasions by one of four experienced physical therapists. Test-retest reliability was estimated for the 2-month period between the last two occasions. Results. Consistent with hypotheses based on Cyriax's assertions about patients with OA, most subjects had capsular end-feels for extension; subjects with tissue approximation end-feels for flexion had more flexion ROM than did subjects with capsular end-feels, and the P/RS was significantly correlated with pain intensity (rho=.35, extension; rho=.30, flexion). Contrary to hypotheses based on Cyriax's assertions, most subjects had noncapsular patterns, tissue approximation end-feels for flexion, and what Cyriax called pain synchronous with resistance for both motions. Pain intensity did not differ depending on end-feel. The P/RS was not correlated with chronicity (rho=.03, extension; rho=−.01, flexion). Reliability, as analyzed by intraclass correlation coefficients (ICC[3,1]) and Cohen's kappa coefficients, was acceptable (≥.80) or nearly acceptable for ROM (ICC=.71–.86, extension; ICC=.95–.99, flexion) but not for end-feel (κ=.17, extension; κ=.48, flexion) and P/RS (κ=.36, extension; κ=.34, flexion). Conclusion and Discussion. The use of a quantitative definition of the capsular pattern, end-feels, and P/RS as indicators of knee OA should be reexamined. The validity of the P/RS as representing chronicity and the reliability of end-feel and the P/RS are questionable. More study of the soft tissue diagnosis system is indicated.