Ely's Test
Original Editor - Sam Verhelpen
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Purpose
Ely’s test also known as Duncan-Ely test is used to assess rectus femoris muscle's flexibility (Range of Motion). [1] It is commonly used in clinical settings to assess rectus femoris spasticity, especially in patients with cerebral palsy (CP) and stiff-knee gait. During the test, the examiner passively bends the patient's knee while they lie face down, observing for resistance or lifting of the hip as signs of spasticity.[2][3]
Technique
Follow this process to perform this the Ely's test.
- The patient lies prone in a relaxed state.
- The therapist is standing next to the patient, at the side of the leg that will be tested.
- One hand should be on the lower back, the other holding the leg at the heel.
- Passively flex the knee in a rapid fashion.
- The heel should touch the buttocks.
- Test both sides for comparison.
- The test is positive when the heel cannot touch the buttocks, the hip of the tested side rises up from the table, the patient feels pain or tingling in the back or legs.
Evidence
Studies show that Ely’s test has been tested among small populations and found to be effective in measuring range of motion of the rectus femoris as long as the population is asymptomatic. Studies are yet to be conducted on large population and symptomatic population. Ely's test has a sensitivity ranging from 56% to 59% and the specificity ranging from 64% to 85%. [1][4]
Reliability
Studies indicate mixed levels of reliability for the Duncan-Ely test:
- Intra-rater and Inter-rater Reliability: The test showed strong inter-observer reliability (ICC = 0.819) at high speeds, emphasising the need for velocity standardisation during assessments.[2]
- Method Variability: Methodological differences, such as the speed of knee flexion, have a considerable impact on reliability. For example, testing at the fastest speed regularly resulted in improved reliability.[3][2]
- Comparison with Other Tests: When performed using standardized equipment, the Ely flexibility test, a variation of the Duncan-Ely test, demonstrated high intra-rater reliability (ICC = 0.90).[1]
Validity
The validity of the Duncan-Ely test as a predictor of spasticity or dynamic gait abnormalities is debated:
- Sensitivity and Specificity: When compared with three-dimensional gait analysis (3DGA), the Duncan-Ely test at fast speeds had moderate sensitivity (66.7%) and perfect specificity (100%) for detecting reduced knee range of motion.[2]
- Poor Predictive Value in Stroke Survivors: A study by Tenniglo et al. found no significant correlation between Duncan-Ely test results and rectus femoris overactivity in stroke survivors, suggesting limited diagnostic value in this population.[5]
- Application in CP: The test is considered useful for preoperative assessment of rectus femoris spasticity in children with CP, though its subjective nature and variability limit its standalone application.[2]
Critical Review
Though the Duncan-Ely test is commonly performed clinically, the importance of a positive Duncan-Ely test for rectus femoris spasticity is uncertain. Perry et al[6] showed that the Duncan-Ely test is not a specific indicator of rectus tightness or spasticity since it elicits electromyographic (EMG) responses in both the rectus femoris and the iliacus in many subjects with CP. Chambers et al[7] reported that the Ely test has no predictive value for abnormal rectus femoris EMG activity.
It was observed that the study had a limitation of the participants not having to go on with their activities of daily like sporting activities as it can affect the result of the test. This is because sporting activities can contribute to soreness, pain and limitation of the range of motion. Also, the test can be affected when same participant is examined by two examiners because the muscle flexibility won't be the same. [1]
References
- ↑ 1.0 1.1 1.2 1.3 Olivencia O, Godinez GM, Dages J, Duda C, Kaplan K, Kolber MJ. The reliability and minimal detectable change of the ely and active knee extension tests. International journal of sports physical therapy. 2020 Oct;15(5):776.
- ↑ 2.0 2.1 2.2 2.3 2.4 Lee SY, Sung KH, Chung CY, Lee KM, Kwon SS, Kim TG, Lee SH, Lee IH, Park MS. Reliability and validity of the Duncan‐Ely test for assessing rectus femoris spasticity in patients with cerebral palsy. Developmental Medicine & Child Neurology. 2015 Oct;57(10):963-8.
- ↑ 3.0 3.1 Stott S. The Duncan-Ely test: time for standardization. Developmental Medicine & Child Neurology. 2015 Oct 1;57(10).
- ↑ Peeler J, Anderson JE. Reliability of the Ely's test for assessing rectus femoris muscle flexibility and joint range of motion. Journal of Orthopaedic Research. 2008 Jun;26(6):793-9.
- ↑ Tenniglo MJ, Nederhand MJ, Fleuren JF, Rietman JS, Buurke JH, Prinsen EC. Does the Duncan-Ely test predict abnormal activity of the rectus femoris in stroke survivors with a stiff knee gait?. Journal of rehabilitation medicine. 2021 Nov 1;54:637.
- ↑ Perry J, Hoffer MM, Antonelli D, et al. Electromyography before and after surgery for hip deformity in children with cerebral palsy. A comparison of clinical and electromyographic findings. J Bone Joint Surg [Am]. 1976;58:201–208.
- ↑ Chambers H, Lauer A, Kaufman K, et al. Prediction of outcome after rectus femoris surgery in cerebral palsy: the role of cocontraction of thefckLRrectus femoris and vastus lateralis. J Pediatr Orthop. 1998;18:703–711.