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Hop Testing Provides a Reliable and Valid Outcome Measure During Rehabilitation After Anterior Cruciate Ligament Reconstruction

A Reid, PT, MSc, was a physiotherapist at the Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario, London, Ontario, Canada, during the completion of this project. She is currently a physiotherapist at the Allan McGavin Sports Medicine Centre, John Owen Pavilion, University of British Columbia, Vancouver, Canada.
TB Birmingham, PT, PhD, is Associate Professor and Tier 2 Canada Research Chair in Musculoskeletal Rehabilitation, School of Physical Therapy, Elborn College, University of Western Ontario, London, Ontario, Canada N6G 1H1, and Co-Director, Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario.
PW Stratford, PT, MSc, is Professor, School of Rehabilitation Science, and Associate Member, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada, and a Scientific Affiliate in the Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
GK Alcock, PT, MSc, is Physiotherapist, Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario.
JR Giffin, MD, FRCS(C), is Assistant Professor, Department of Surgery, University of Western Ontario, and Co-Director, Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario

tbirming{at}uwo.ca

BACKGROUND AND PURPOSE: Although various hop tests have been proposed as performance-based outcome measures following anterior cruciate ligament (ACL) reconstruction, limited reports of their measurement properties exist. The purpose of this study was to investigate the reliability and longitudinal validity of data obtained from hop tests during rehabilitation after ACL reconstruction.

SUBJECTS: Forty-two patients, 15 to 45 years of age, who had undergone ACL reconstruction participated in the study.

METHODS AND MEASURES: The study design was prospective and observational with repeated measures. The subjects performed a series of 4 hop tests on 3 separate occasions within the 16th week following surgery and on a fourth occasion 6 weeks later. The tests were a single hop for distance, a 6-m timed hop, a triple hop. and crossover hops for distance. Performance on the ACL-reconstructed limb was expressed as a percentage of the performance on the nonoperative limb, termed the "limb symmetry index." Subjects also completed the Lower Extremity Functional Scale and a global rating of change questionnaire.

RESULTS: Intraclass correlation coefficients for limb symmetry index values ranged from .82 to .96. Standard errors of measurement were 3.04% to 5.59%. Minimal detectable changes, at the 90% confidence level, were 7.05% to 12.96%. Changes in hop test scores on the operative limb were statistically greater than changes on the nonoperative limb. Pearson correlations (r) between change in hop performances and self-reported measures ranged from .26 to .58.

DISCUSSION AND CONCLUSION: The results show that the described series of hop tests provide a reliable and valid performance-based outcome measure for patients undergoing rehabilitation following ACL reconstruction. These findings support the use and facilitate the interpretation of hop tests for research and clinical practice.

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