Test Retest Reliability of the Slump TestKimberly Menendez, SPT

Faculty Advisor: Abbigail L. Fietzer, PT, DPT, PhD

Background: The Slump Test was first described by Maitland in 1979 as a test that provokes neural tissue to assess patients with spinal and lower extremity pain. However, the literature on assessing the test-retest reliability of the Slump Test is limited, and there is no evidence on the reliability of the Slump Test when conducted by novice clinicians.1-7

Purpose: The purpose of this study is to investigate the test-retest reliability of the Slump Test administered by a physical therapist student on functionally asymptomatic subjects.

Background and Purpose

Dominant lower extremity of 39 healthy and functionally asymptomatic subjects. (N=39; men=12; female= 27; R leg dominant= 37; L leg dominant=2)

Exclusion criteria: Subjects with a history of neurological symptoms, low back pain, acute lower extremity injury or surgery that would limit joint ROM, or past lumbar surgeries such as discectomy or spinal fusion, were excluded from the study based on a pre-participation survey.

The research protocol was approved by the Mount Saint Mary’s University Institutional Review Board. Subjects signed an IRB subject bill of rights and a consent form acknowledging voluntary and informed participation.

The Slump Test was administered on the dominant limb for a convenience sample of 39 doctor of physical therapy students by a single examiner. The second data collection occurred 48 hours to one week after the first. Standardized verbal instructions were used. Any sensation or response was recorded at six different times throughout the test: in the starting position, during slumped sitting (SS), with knee extension (KE), with ankle dorsiflexion (AD), following cervical extension, and upon return to a comfortable seated position. The exam ended at the stage when subjects felt any change in sensation or response.

Thoracolumbar flexion was measured during SS with inclinometers placed over the spinous processes of T1 and S2. The sum of the absolute value of the two inclinometer measurements was taken for total thoracolumbar flexion. During the KE and AD stages, joint position was measured with a standard goniometer. The goniometer placement for KE angle included the lateral femoral epicondyle as the axis, the proximal arm along the femur pointed towards the greater trochanter, and the distal arm along the fibula pointed towards the lateral malleolus. For AD measurement, the goniometer axis was placed on the lateral malleolus, the proximal arm along the midline of the fibula pointed towards the head of the fibula, and the distal arm along the lateral aspect of the fifth metatarsal.

Materials and MethodsResults of this study demonstrated

that the test-retest reliability of the Slump Test administered by student physical therapists ranges from poor to good depending on the aspect of the Slump Test position analyzed. Therefore, test-retest reliability of the Slump Test is inconclusive at this time. Evidence on the test-retest reliability of the Slump Test administered by experienced clinicians was not available for comparison.

Limitations of this study include a small sample size and a wide window in between data collection points (2-7 days). Additionally, there was no monitoring of the type of activities subjects participated in between their day 1 and day 2 data collection times meaning there may have been more unnoted confounding variables.

Future studies should explore how participation in physical activities between test dates impacts the test-retest reliability of the Slump Test. Additionally, a larger more heterogeneous sample of participants would better represent the general population. Finally, a sample population including a mixture of participants with and without radicular and peripheral neuropathic symptoms would make the results more applicable to the population typically seen in a standard outpatient orthopedic clinic.

1. Maitland GD. Negative disc exploration: positive canal signs. Aust J Physiother. 1979;25(3):129-134. http://dx.doi.org/10.1016/S0004-9514(14)61220-4.

2. Maitland GD. The slump test: examination and treatment. Aust J Physiother. 1985;31(6):215-219.

3. Walsh J, Flatley M, Johnston N, Bennett K. Slump test: sensory responses in asymptomatic subjects. J Man Manip Ther. 2007;15(4):231-238.

4. Van der Windt DA, Simons E, Riphagen II, et al. Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane database Syst Rev. 2010;(2):CD007431.

5. Trainor K, Pinnington MA. Reliability and diagnostic validity of the slump knee bend neurodynamic test for upper/mid lumbar nerve root compression: a pilot study. Physiotherapy. 2011;97(1):59-64.

6. Walsh J, Hall T. Agreement and correlation between the straight leg raise and slump tests in subjects with leg pain. J Manipulative Physiol Ther. 2009;32(3):184-192.

7. Philip K, Lew P, Matyas TA. The inter-therapist reliability of the slump test. Aust J Physiother. 1989;35(2):89-94.

8. Janjigian M, Menendez K, Yoo H. The Intra- and Inter-Rater Reliabilities of the Slump Test among Student Physical Therapists. [doctoral capstone project]. Los Angeles, CA: Mount Saint Mary’s University ; 2019.

Conclusions

Participants

References

Data Analysis Data were analyzed using the Statistical Package for Social Sciences

(SPSS) for windows software. The test retest reliability for the Slump Test was calculated using the Intraclass Correlation Coefficient (ICC). Cronbach alpha coefficient was used to evaluate reliability of cervical extension.

ResultsThe ICC (95% CI) scores for test retest reliability were 0.85 (0.74 – 0.92) for degree of slumped sitting, 0.74 (0.53 – 0.87) for knee extension, and 0.36 (-0.47 –0.85) for ankle dorsiflexion. The ICC values indicated good reliability for slumped sitting, moderate for knee extension, and poor for ankle dorsiflexion. The Cronbach’s alpha coefficient for cervical extension was 0.92, suggesting good consistency for whether cervical extension eased symptoms.

Table 1

Analysis and Results

Measurement ICC 95% CI p-valueSS 0.853 0.738-0.920 < 0.001KE 0.743 0.527-0.869 < 0.001AD 0.356 -0.468-0.849 0.193