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Types of Tests Used for Quick Screening

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A. Types of Screening Programs

1. Mass Screening

2. High-Risk (Selective) Screening

• Screening lower socioeconomic groups for cervical cancer (higher prevalence)
• Screening family members of known diabetic/hypertensive patients
• Screening for risk factors (elevated cholesterol, high blood pressure) that predict future disease

3. Multiphasic Screening

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B. By Mode/Method of the Test

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C. By Disease / Condition Screened

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D. Criteria a Good Screening Test Must Meet

1. Acceptability - not painful, embarrassing, or invasive (to maximize uptake)
2. Repeatability - gives consistent results (reliability/reproducibility)
3. Validity - accurately classifies people as diseased or non-diseased, measured by:
   • Sensitivity - correctly identifies all true positives (diseased people)
   • Specificity - correctly identifies all true negatives (non-diseased)
   • Positive predictive value - proportion of positives who truly have disease
   • Negative predictive value - proportion of negatives who truly don't
4. Simplicity - easy to perform and interpret
5. Safety - minimal harm to participants
6. Low cost - feasible for population-wide application
7. High yield - detects enough disease to justify the program

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E. Key Distinction: Screening vs. Diagnosis

Sources: Park's Textbook of Preventive and Social Medicine (p. 156-161) | Goldman-Cecil Medicine, International Edition (Table 12-1 to 12-4)

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Quick Screening Tests in Physiotherapy

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1. Pain Screening Tests

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2. Range of Motion (ROM) Screening

• Active ROM - patient moves the joint themselves (tests willingness, neuromuscular control)
• Passive ROM - therapist moves the joint (tests joint integrity and capsule)
• Accessory/Joint play testing - small gliding movements to detect stiffness or laxity

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3. Muscle Strength / Manual Muscle Testing (MMT)

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4. Movement Quality Screening

Functional Movement Screen (FMS)

• Deep squat
• Hurdle step
• Inline lunge
• Shoulder mobility
• Active straight-leg raise
• Trunk stability push-up
• Rotary stability

Y-Balance Test (YBT)

Landing Error Scoring System (LESS)

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5. Postural & Spinal Screening

• Postural observation (static): Looking for kyphosis, lordosis, scoliosis, pelvic tilt, shoulder asymmetry - done standing in seconds
• Adam's Forward Bend Test: Screens for structural scoliosis; rib hump on bending confirms rotation
• Scoliometer: Quantifies trunk rotation angle during Adams test
• Plumb line assessment: Checks sagittal and coronal spinal alignment

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6. Neurological Screening

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7. Balance & Fall-Risk Screening

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8. Special Orthopaedic (Region-Specific) Quick Screening Tests

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9. Functional & Disability Self-Report Questionnaires

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10. Cardiovascular / Exercise Tolerance Screening

• 6-Minute Walk Test (6MWT): Distance walked in 6 minutes; screens cardiorespiratory fitness and exercise capacity
• 2-Minute Step Test: Counts steps in 2 minutes; used with elderly/limited mobility
• 30-Second Chair Stand Test: Number of sit-to-stands in 30 sec; screens lower body strength and endurance
• PAR-Q (Physical Activity Readiness Questionnaire): 7-question self-report to screen for contraindications to exercise

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Summary: Which Test for Which Purpose?

Sources: APTA - Timed Up and Go | Korean Journal of Sports Medicine - MSK Screening Review | British Pain Society - Outcome Measures

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Physiotherapy Screening Tests Across Age Groups

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AGE GROUP OVERVIEW

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SECTION 1: PAEDIATRIC SCREENING TESTS

1A. Neonatal / Neonate (0-28 days)

General Movements Assessment (GMA)

• Observes spontaneous movement patterns (writhing movements in term and preterm)
• "Fidgety movements" absent at 3-5 months corrected age = strongest early predictor of cerebral palsy
• Requires video recording; high sensitivity and specificity for CP detection

Hammersmith Neonatal Neurological Examination (HNNE)

• 34 items covering tone, reflexes, movements, abnormal signs, and behaviour
• Takes ~10 minutes; scored on a proforma; normative data available for term neonates
• Identifies neurological compromise early

Standardized Infant NeuroDevelopmental Assessment (SINDA)

• Neurological, developmental, and socio-emotional screening in one tool
• Validated for neonates to 12 months corrected age

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1B. Infant (0-18 months)

Alberta Infant Motor Scale (AIMS)

• 58 items across prone, supine, sitting, and standing positions
• Assesses weight-bearing, posture, and antigravity movement
• Takes 10-20 minutes; observational (no handling required)
• Gold standard for tracking early motor development from 0-18 months

Harris Infant Neuromotor Test (HINT)

• 27 items covering neuromotor milestones, muscle tone, head circumference, stereotypical movements
• 3-12 months; includes parent/caregiver background questionnaire
• Screens for developmental delay and neuromotor problems

Hammersmith Infant Neurological Examination (HINE)

• Used alongside GMA; assesses cranial nerve function, posture, movements, tone, and reflexes
• Score <40 at 6-12 months = high risk for CP
• Takes ~10 minutes; requires minimal equipment

Test of Infant Motor Performance (TIMP)

• 42-item test of functional motor performance in response to handling and positioning
• Used in NICU and early intervention; premature to 4 months corrected age
• Predicts later motor outcomes in high-risk infants

Infant Motor Profile (IMP)

• Assesses variation, adaptability, symmetry, fluency, and performance of movements
• 2-18 months; differentiates typical from atypical development

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1C. Toddler and Preschool (1-6 years)

Peabody Developmental Motor Scales - 2nd Ed. (PDMS-2)

• Assesses both gross motor (reflexes, stationary, locomotion, object manipulation) and fine motor skills
• Birth to 72 months; provides standardised scores (GMQ, FMQ, TMQ)
• Takes 45-60 minutes; widely used in paediatric physiotherapy

Movement Assessment Battery for Children - 2nd Ed. (Movement ABC-2)

• 3-16 years; 3 age bands
• Assesses manual dexterity, ball skills, and balance
• Takes 20-40 minutes; identifies Developmental Coordination Disorder (DCD)
• Norm-referenced; widely used globally

Denver Developmental Screening Test-II (DDST-II)

• Screens gross motor, fine motor-adaptive, language, and personal-social domains
• 0-6 years; takes ~20 minutes
• Quick pass/fail format - identifies children who need further evaluation

Gross Motor Function Measure (GMFM-88 / GMFM-66)

• Designed specifically for children with cerebral palsy (up to 18 years)
• 88 items across 5 dimensions: lying/rolling, sitting, crawling/kneeling, standing, walking/running/jumping
• GMFM-66 uses Rasch analysis for interval-level measurement
• The standard outcome measure for motor function in CP

Gross Motor Function Classification System (GMFCS)

• 5-level descriptive classification of motor function in CP (I = walks without limitations, V = transported in manual wheelchair)
• Quick observational tool; determines realistic functional goals and prognosis

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1D. School-Age Child (6-12 years)

Bruininks-Oseretsky Test of Motor Proficiency - 2nd Ed. (BOT-2)

• 4.5-21 years; 8 subtests
• Fine manual control, manual coordination, body coordination, strength and agility
• Takes 45-60 minutes (short form ~15 min)
• Identifies motor impairment; used in DCD, ASD, ADHD

Test of Gross Motor Development - 3rd Ed. (TGMD-3)

• 3-10 years; 13 skills (locomotor + ball skills)
• Locomotor: run, gallop, hop, leap, jump, slide
• Ball skills: two-hand strike, stationary dribble, catch, kick, overhand throw, underhand roll
• Takes 15-20 minutes; criterion-referenced

Ages and Stages Questionnaire (ASQ-3)

• Parent-completed developmental screening questionnaire
• 1 month to 5.5 years; screens communication, gross motor, fine motor, problem-solving, personal-social
• Takes 10-15 minutes; flags children needing referral

Functional Mobility Scale (FMS)

• Rates walking ability over 5m, 50m, and 500m distances
• 1-18 years; used in CP and neurodevelopmental conditions
• Quick observational rating (1-6 per distance)

School Function Assessment (SFA)

• Assesses participation, task supports, and activity performance in school settings
• Identifies children needing support; overlaps with OT assessment

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1E. Adolescent (12-18 years)

Functional Movement Screen (FMS)

• 7 movement tests scored 0-3 (max 21); screens for asymmetry and movement dysfunction
• Used for pre-participation injury screening in adolescent athletes
• Score ≤14 or any asymmetry = elevated injury risk

Y-Balance Test (YBT)

• Dynamic balance and lower limb reach asymmetry
• Anterior reach asymmetry >4 cm between limbs = elevated ACL/lower limb injury risk
• Used widely in adolescent sports screening

Landing Error Scoring System (LESS)

• Evaluates jump-landing mechanics in 17 criteria
• Screens for ACL injury biomechanical risk factors (valgus collapse, trunk lean, stiff landing)
• Particularly important for adolescent female athletes

Pre-Participation Examination (PPE) Physical Screen

• Musculoskeletal screening before sports participation
• Includes ROM, MMT, postural assessment, special orthopaedic tests, cardiovascular screening
• Standard protocol before school/college sports clearance

Scoliosis Screening (Adam's Forward Bend Test + Scoliometer)

• Screening for adolescent idiopathic scoliosis (AIS) - peak onset 10-16 years
• Forward bend test: observe for rib hump / trunk rotation
• Scoliometer reading >5-7° = refer for X-ray
• Routinely done in school physiotherapy programs

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SECTION 2: ADULT SCREENING TESTS (18-60 years)

2A. Musculoskeletal Screening

Functional Movement Screen (FMS)

• Primary movement quality screening tool in active adults and athletes
• Detects mobility restrictions, asymmetries, and movement pattern deficits
• Guides prehabilitation and corrective exercise prescription

Selective Functional Movement Assessment (SFMA)

• 7 top-tier movement patterns assessed for pain and dysfunction
• Directs clinician to the most dysfunctional, non-painful pattern first
• Used in adults with musculoskeletal pain to guide movement-based diagnosis

Y-Balance Test (YBT) - Upper and Lower Quadrant

• Upper quadrant: assesses shoulder/upper extremity reach symmetry
• Lower quadrant: composite reach asymmetry for lower limb injury risk
• Used in overhead athletes, workers with upper limb demands

Oswestry Disability Index (ODI)

• 10-item self-report questionnaire for low back pain disability
• Takes <5 minutes; 0-100% scale (0-20% = minimal disability, >60% = crippled)

Neck Disability Index (NDI)

• 10-item questionnaire for cervical spine-related disability
• Cut-off: >28% = moderate disability

Quick DASH / DASH (Disabilities of the Arm, Shoulder, Hand)

• 11-item (Quick DASH) or 30-item self-report for upper limb function
• Work and sports/performing arts optional modules

Lower Extremity Functional Scale (LEFS)

• 20-item self-report; scores 0-80 (80 = full function)
• Sensitive to change; used for knee, hip, ankle conditions

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2B. Neurological Screening (Adults)

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2C. Special Orthopaedic Quick Screening Tests

Shoulder

Knee

Lumbar Spine / Hip / Ankle

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2D. Cardiorespiratory / Fitness Screening

PAR-Q+ (Physical Activity Readiness Questionnaire)

• 7-question self-screen before starting an exercise program
• Identifies contraindications and need for medical clearance
• Mandatory in physiotherapy for exercise prescription

6-Minute Walk Test (6MWT)

• Distance covered walking on a flat surface in 6 minutes
• Screens aerobic capacity and exercise tolerance
• Used in chronic conditions: COPD, heart failure, post-surgery

Incremental Shuttle Walk Test (ISWT)

• Externally paced walking test of increasing speed
• Better for detecting maximal capacity; used in cardiac rehab

VO₂ max Estimation Tests

• Step test, Chester step test, 1.5-mile run - estimate cardiorespiratory fitness for exercise program planning

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2E. Return to Sport Screening (Post-Injury Adults)

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SECTION 3: GERIATRIC SCREENING TESTS (60+ years)

3A. Falls Risk Screening

Timed Up and Go (TUG)

• Stand from chair, walk 3 m, turn, return, sit - timed
• >12 seconds = fall risk; >30 sec = dependent
• Simplest, most widely used fall-risk screen in the world
• Can add dual-task (TUG Cognitive: count backwards) to increase sensitivity

Berg Balance Scale (BBS)

• 14-item balance test; 0-56 score
• Score <45 = fall risk; <36 = almost 100% fall rate
• Takes 15-20 minutes; the gold standard comprehensive balance assessment

Tinetti Performance-Oriented Mobility Assessment (POMA)

• Balance subscale (9 items) + Gait subscale (7 items) = 28 points total
• Score <19 = high fall risk; 19-24 = moderate risk
• Covers sit-to-stand, standing balance, turning, gait initiation, step length/height

Functional Reach Test (FRT)

• Maximum forward reach distance with arms at 90° without stepping
• <15 cm = high fall risk; 15-25 cm = moderate risk
• Takes 2-3 minutes; quick bedside screening

Single Leg Stance Test (SLS)

• Time balancing on one leg (eyes open and closed)
• Norms: 60-69 years = ~27 sec (eyes open); <5 sec (eyes closed) = significant impairment
• Rapid vestibular and proprioceptive screening

Morse Fall Scale (MFS)

• 6-item scale (fall history, secondary diagnosis, ambulatory aid, IV access, gait, mental status)
• Used in hospital/inpatient settings
• Score ≥45 = high fall risk

STRATIFY (St. Thomas Risk Assessment Tool in Falling Elderly)

• 5-item inpatient fall risk screen
• History of falling, agitation, visual impairment, frequent toileting, transfer/mobility score
• Quick; validated for hospital use

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3B. Frailty Screening

Fried Frailty Phenotype

• 5 criteria: unintentional weight loss, exhaustion, weakness (grip strength), slow gait speed, low physical activity
• ≥3 criteria = Frail; 1-2 = Pre-frail; 0 = Robust
• Most widely validated frailty model; physiotherapists measure grip strength and gait speed components

Short Physical Performance Battery (SPPB)

• 3 tests: standing balance (side-by-side, semi-tandem, tandem), 4-metre gait speed, 5x chair stand
• Total score 0-12; Score ≤9 = frailty / disability risk
• Each test takes ~2 minutes; highly predictive of hospitalisation and mortality

Clinical Frailty Scale (CFS)

• 1-9 visual/descriptor scale from "Very Fit" to "Terminally Ill"
• Takes <2 minutes; based on clinical judgment
• Widely used in emergency, acute, and community settings
• Recommended by ICHOM as standard outcome measure for older adults

FRAIL Scale

• 5 items: Fatigue, Resistance (unable to climb one flight), Ambulation (unable to walk one block), Illnesses (>5), Loss of weight (>5%)
• Quick, self-reported; 3+ = frail

Edmonton Frail Scale (EFS)

• 11 domains including cognition (clock drawing), general health, functional independence, nutrition, mood, continence, polypharmacy, social support
• Score 0-17; ≥8 = severe frailty
• Takes ~5 minutes; performed during physical examination

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3C. Gait and Mobility Screening

Gait Speed (4-metre or 10-metre walk test)

• <0.8 m/s = mobility limitation; <0.6 m/s = high disability/mortality risk
• One of the strongest single predictors of adverse outcomes in older adults - the "6th vital sign"
• Takes <2 minutes; requires only a measured corridor

Dynamic Gait Index (DGI)

• 8 walking tasks (level surface, change of speed, head turns horizontal/vertical, pivot turns, step over/around obstacles, stairs)
• Score 0-24; <19 = fall risk
• Assesses gait adaptability in changing conditions

Functional Gait Assessment (FGA)

• Modified and expanded DGI; 10 items; score 0-30
• <22 = fall risk in community-dwelling older adults

10-Metre Walk Test (10MWT)

• Comfortable and fast walking speed over 10 metres
• Assesses gait speed; used to track rehabilitation progress

30-Second Chair Stand Test

• Number of full stands from a chair in 30 seconds without arm use
• Age-specific norms; <8 stands = lower limb weakness and fall risk in adults >60 years

Five Times Sit-to-Stand (FTSTS)

• Time to complete 5 full sit-to-stand cycles
• >12 seconds = impaired; used for lower limb power and fall risk

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3D. Cognitive + Functional Independence Screening

Mini-Cog

• 3-word recall + Clock Drawing Test
• Takes ~3 minutes; screens for dementia
• Physiotherapy uses this to adjust treatment planning for cognitive impairment

Mini-Mental State Examination (MMSE)

• 30-point questionnaire covering orientation, recall, attention, language, visuospatial
• ≤24 = cognitive impairment - flags patients needing modified physiotherapy instructions

Barthel Index

• 10 ADL items: feeding, bathing, grooming, dressing, bowel/bladder, toilet use, transfers, mobility, stairs
• Score 0-100; <60 = dependent; tracks functional recovery in rehabilitation

Functional Independence Measure (FIM)

• 18-item scale across motor (13 items) and cognitive (5 items) domains
• 7-level scoring (1 = total assistance, 7 = complete independence)
• Standard outcome measure in inpatient rehabilitation

Katz ADL Index

• 6 basic ADL activities; quick observational assessment
• Tracks independence in self-care; useful for discharge planning

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3E. Respiratory / Cardiovascular Screening (Geriatric)

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MASTER REFERENCE TABLE

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Sources: APTA Geriatrics - Balance and Falls Outcome Measure Toolkit | Medical Science Group - Assessment Batteries in Paediatric Rehabilitation | Ontario Falls Prevention Collaborative - Screening and Assessment Tools