(A) Hip flexor tests | Prevalence (test) | Sen | Spe | LR+ | LR− | PPV (%) | NPV (%) | AUC |
---|---|---|---|---|---|---|---|---|
Palpation | 0.37 | 0.89 (0.64 to 0.98) | 0.78 (0.65 to 0.87) | 4.00 (2.45 to 6.53) | 0.14 (0.04 to 0.53) | 53 (35 to 71) | 96 (85 to 99) | 0.83 (0.73 to 0.94) |
Resisted hip flex 0° | 0.47 | 0.72 (0.46 to 0.89) | 0.60 (0.47 to 0.72) | 1.82 (1.20 to 2.76) | 0.46 (0.21 to 0.99) | 34 (20 to 51) | 88 (74 to 96) | 0.66 (0.52 to 0.80) |
Resisted hip flex 90° | 0.31 | 0.67 (0.41 to 0.86) | 0.79 (0.67 to 0.88) | 3.23 (1.80 to 5.79) | 0.42 (0.22 to 0.81) | 48 (28 to 68) | 89 (77 to 96) | 0.73 (0.59 to 0.87) |
Resisted hip flexion (TT) | 0.42 | 0.72 (0.46 to 0.89) | 0.67 (0.54 to 0.78) | 2.20 (1.39 to 3.49) | 0.41 (0.19 to 0.88) | 39 (23 to 58) | 89 (76 to 96) | 0.70 (0.56 to 0.84) |
Resisted knee extension (TT) | 0.29 | 0.67 (0.41 to 0.86) | 0.82 (0.70 to 0.91) | 3.80 (1.98 to 7.28) | 0.40 (0.21 to 0.78) | 55 (33 to 75) | 89 (76 to 95) | 0.75 (0.60 to 0.89) |
Passive hip extension (TT) | 0.33 | 0.61 (0.36 to 0.82) | 0.75 (0.62 to 0.85) | 2.49 (1.40 to 4.41) | 0.52 (0.29 to 0.93) | 42 (24 to 63) | 87 (74 to 94) | 0.68 (0.54 to 0.83) |
Passive knee flexion (TT) | 0.21 | 0.56 (0.31 to 0.78) | 0.89 (0.78 to 0.96) | 5.28 (2.22 to 12.50) | 0.50 (0.30 to 0.84) | 63 (36 to 84) | 86 (74 to 94) | 0.73 (0.58 to 0.88) |
3+ positive tests | 0.35 | 0.78 (0.52 to 0.93) | 0.79 (0.66 to 0.88) | 3.69 (2.11 to 6.47) | 0.28 (0.12 to 0.67) | 54 (34 to 73) | 92 (80 to 97) | 0.78 (0.66 to 0.91) |
All tests positive (7 of 7) | 0.09 | 0.33 (0.14 to 0.59) | 0.98 (0.89 to 1.00) | 19.00 (2.47 to 147.53) | 0.68 (0.49 to 0.94) | 86 (42 to 99) | 82 (71 to 90) | 0.66 (0.50 to 0.82) |
All tests negative (0 of 7) | 0.39 | 0.11 (0.02 to 0.36) | 0.53 (0.39 to 0.66) | 0.23 (0.01 to 0.24) | 1.69 (1.39 to 2.05) | 7 (1 to 24) | 65 (50 to 78) | 0.32 (0.19 to 0.45) |
(A) Hip flexor tests | Prevalence (test) | Sen | Spe | LR+ | LR− | PPV (%) | NPV (%) | AUC |
Iliopsoas palpation | 0.25 | 1.00 (0.60 to 1.00) | 0.86 (0.73 to 0.93) | 7.00 (3.69 to 13.30) | 0.00 (NA) | 50 (26 to 74) | 1.00 (91 to 100) | 0.93 (0.87 to 0.99) |
Resisted hip flex 0° | 0.55 | 0.88 (0.47 to 0.99) | 0.50 (0.36 to 0.64) | 1.75 (1.21 to 2.53) | 0.25 (0.04 to 1.62) | 20 (9 to 37) | 97 (80 to 100) | 0.69 (0.51 to 0.86) |
Resisted hip flex 90° | 0.36 | 0.75 (0.36 to 0.96) | 0.70 (0.56 to 0.81) | 2.47 (1.41 to 4.34) | 0.36 (0.11 to 1.21) | 26 (11 to 49) | 95 (82 to 99) | 0.72 (0.54 to 0.91) |
Resisted hip flexion (TT) | 0.44 | 0.75 (0.36 to 0.96) | 0.61 (0.47 to 0.74) | 1.93 (1.14 to 3.25) | 0.41 (0.12 to 1.39) | 22 (9 to 43) | 94 (79 to 99) | 0.68 (0.49 to 0.87) |
Passive hip extension stretch (TT) | 0.34 | 0.63 (0.26 to 0.90) | 0.70 (0.56 to 0.82) | 2.11 (1.07 to 4.15) | 0.53 (0.21 to 1.32) | 24 (9 to 48) | 93 (79 to 98) | 0.66 (0.46 to 0.87) |
All tests positive (5 of 5) | 0.11 | 0.63 (0.26 to 0.90) | 0.96 (0.86 to 0.99) | 16.88 (3.91 to 72.81) | 0.39 (0.16 to 0.95) | 71 (30 to 95) | 95 (84 to 99) | 0.79 (0.58 to 1.00) |
All tests negative (0 of 5) | 0.34 | 0.00 (0.00 to 0.40) | 0.61 (0.47 to 0.74) | 0.00 (NA) | 1.64 (1.60 to 1.67) | 0 (0 to 19) | 80 (65 to 91) | 0.31 (0.15 to 0.46) |
(A) Hip flexor tests | Prevalence (test) | Sen | Spe | LR+ | LR− | PPV (%) | NPV (%) | AUC |
Rectus femoris palpation | 0.20 | 1.00 (0.60 to 1.00) | 0.91 (0.80 to 0.97) | 11.20 (4.85 to 25.86) | 0.00 (NA) | 62 (32 to 85) | 100 (91 to 100) | 0.96 (0.91 to 1.00) |
Resisted hip flex 0° | 0.55 | 0.75 (0.36 to 0.96) | 0.48 (0.35 to 0.62) | 1.45 (0.90 to 2.32) | 0.52 (0.15 to 1.79) | 17 (7 to 34) | 93 (76 to 99) | 0.62 (0.42 to 0.82) |
Resisted hip flex 90° | 0.36 | 0.75 (0.36 to 0.96) | 0.70 (0.56 to 0.81) | 2.47 (1.41 to 4.34) | 0.36 (0.11 to 1.21) | 26 (11 to 49) | 95 (82 to 99) | 0.72 (0.54 to 0.91) |
Resisted hip flexion (TT) | 0.44 | 0.88 (0.47 to 0.99) | 0.63 (0.49 to 0.75) | 2.36 (1.53 to 3.66) | 0.20 (0.03 to 1.27) | 26 (12 to 47) | 97 (83 to 100) | 0.75 (0.59 to 0.92) |
Resisted knee extension (TT) | 0.34 | 1.00 (0.60 to 1.00) | 0.76 (0.62 to 0.86) | 4.17 (2.54 to 6.82) | 0.00 (NA) | 40 (20 to 64) | 100 (89 to 100) | 0.88 (0.79 to 0.97) |
Passive hip extension (TT) | 0.34 | 0.75 (0.36 to 0.96) | 0.72 (0.58 to 0.83) | 2.70 (1.50 to 4.86) | 0.35 (0.10 to 1.17) | 29 (12 to 52) | 95 (82 to 99) | 0.74 (0.55 to 0.92) |
Passive knee flexion (TT) | 0.26 | 0.88 (0.47 to 0.99) | 0.84 (0.70 to 0.92) | 5.47 (2.75 to 10.87) | 0.15 (0.02 to 0.94) | 47 (22 to 73) | 98 (86 to 100) | 0.86 (0.71 to 1.00) |
All tests positive (7 of 7) | 0.12 | 0.38 (0.10 to 0.74) | 0.92 (0.80 to 0.97) | 4.69 (1.28 to 17.16) | 0.68 (0.40 to 1.17) | 43 (12 to 80) | 96 (78 to 96) | 0.65 (0.42 to 0.88) |
All tests negative (0 of 7) | 0.36 | 0.00 (0.00 to 0.40) | 0.58 (0.43 to 0.72) | 0.00 (NA) | 1.72 (1.68 to 1.77) | 0 (0 to 19) | 78 (51 to 90) | 0.29 (0.14 to 0.44) |
(A) In relation to a positive or negative finding in the hip flexors on MRI in all athletes. (B) In relation to a positive or negative finding in the iliopsoas on MRI with athletes with a negative MRI excluded. (C) In relation to a positive or negative finding in the rectus femoris on MRI with athletes with a negative MRI excluded. Sixty-four out of 81 (79%) athletes had a positive MRI, and 18 out of 81 (22%) athletes had an MRI hip flexor lesion (N=8 psoas, N=8 rectus, N=2 sartorius). Eight out of 64 (13%) athletes with an MRI-positive result had an acute lesion in the iliopsoas, and 8 (13%) in the rectus femoris.
Continuity corrected 95% CIs presented in brackets.
AUC, area under the receiver operating characteristic curve; LR−, negative likelihood ratio; LR+, positive likelihood ratio; NA, not available; NPV, negative predictive value; PPV, positive predictive value; Sen, sensitivity; Spe, specificity; TT, modified Thomas test position.