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b Manual fixation of the expansion tool.
All the 5 tests that did not require manual fixation of the patient by the examiner were reliable.
This suggests that there was a slight shift in ankle position during manual fixation of the ankle, but that the change averaged less than 3° and represents a potential confounding variable that may have influenced the outcome measures.
It is equally important to test the reliability and validity of manual fixation of ankle positioning during SLR testing, as was the aim of Phase 2. Previous research has suggested that ankle dorsiflexion to 10° with the knee in full extension and during SLR testing is difficult to achieve and dorsiflexion may be limited to only 4.3-4.8° 4.3-4.8°6-4.8°) in thiSDsosition [ 6, 19].
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The proportion was significantly lower for the five tests requiring manual fixation (two out of five tests).
Notwithstanding the absence of previous references, it seems reasonable to predict that an examiner without medical education and practice will experience even greater difficulties in performing a standardized technique of manual fixation than an examiner with such skills.
Thus, the composition of the 10-test package proved to be fairly suitable for answering the question of this study, indicating inter alia that an examiner without formal medical education should not perform tests that require manual fixation, with the possible exception of cervical rotation.
As a matter of fact, all the technically least advanced of our tests, i.e. the five that required no manual fixation by the examiner, had acceptable inter-rater reliability (five out of five tests).
All five tests that required no manual fixation had acceptable reliability (ICC >.60 and no indication of systematic error).
All the tests requiring no manual fixation had acceptable intra-rater reliability for both A and B. Of the five tests that required manual fixation, five and three tests had acceptable intra-rater reliability for A and B, respectively (NS).
All five tests that required no manual fixation by the examiner had acceptable inter-rater reliability, compared with two of the five tests that required such fixation.
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