title: Reliability and validity of the Duncan-Ely test for assessing rectus femoris spasticity in patients with cerebral palsy.
abstract: OBJECTIVE
  The aim of this study was to clarify the method of the Duncan-Ely test and to estimate its interobserver reliability and validity by comparing it with three-dimensional gait analysis (3DGA).
  
  
  METHODS
  This study included 36 consecutive ambulatory patients with cerebral palsy (CP) who underwent preoperative 3DGA. The Duncan-Ely test was performed during three different velocities (slow, gravity, and fast). The interobserver reliability was assessed by three examiners. The results of the test were compared with kinematic variables derived from the gait analysis to assess the sensitivity and specificity of the test. The cut-off value was determined at the point of trade-off between the highest sensitivity and specificity.
  
  
  RESULTS
  The intraclass correlation coefficient measuring interobserver reliability of the Duncan-Ely test was greatest during fast velocity (0.819). The sensitivity and specificity of the test during gravity velocity for knee range of motion total were 63.0% and 100% respectively, with a cut-off value of 78.3°. The sensitivity and specificity of the test during fast velocity for knee range of motion total were 66.7% and 100% respectively, with a cut-off value of 65°.
  
  
  CONCLUSIONS
  The Duncan-Ely test shows excellent reliability in fast knee-flexion velocity, and good sensitivity and specificity compared with 3DGA during physical examination as a preoperative assessment of rectus femoris spasticity in patients with CP.
authors.affiliation: Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea.
authors.forename: Seung Yeol
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Myongji Hospital, Kyungki, Korea.
authors.forename: Ki Hyuk
authors.initials: KH
authors.lastname: Sung
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea.
authors.forename: Chin Youb
authors.initials: CY
authors.lastname: Chung
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea.
authors.forename: Kyoung Min
authors.initials: KM
authors.lastname: Lee
authors.affiliation: Biomedical Research Institute, Seoul National University Bundang Hospital, Kyungki, Korea.
authors.forename: Soon-Sun
authors.initials: SS
authors.lastname: Kwon
authors.affiliation: Department of Orthopaedic Surgery, Konyang University Hospital, Daejon, Korea.
authors.forename: Tae Gyun
authors.initials: TG
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Kyungki, Korea.
authors.forename: Sang Hyeong
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Sungkyunkwan University Samsung Changwon Hospital, Gyeongnam, Korea.
authors.forename: In Hyeok
authors.initials: IH
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea.
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Park
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000175:diagnosis / Q000503:physiopathology*; D002648:Child; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D009128:Muscle Spasticity / Q000175:diagnosis* / Q000503:physiopathology*; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000503:physiopathology*; D012372:ROC Curve; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult