Background and purpose. Assessment within rehabilitation usually focuses on the perceived functional limitations of patients and also provide information about whether the problems result from impairments in the muscles and skeletal system. These capabilities were evaluated through a brand new test for functional assessment called known as the Sock Test, simulating the process of wearing the sock. The Subjects as well as the Methods. Intertester reliability was tested with 21 individuals. Consistent validity, responsiveness as well as predictive accuracy were evaluated in a group of 337 patients, as well as subgroups of the sample. Conclusions. Intertester reliability was acceptable. Sock Test scores were linked to reports of concurrent the limitation of activity in dressing. Scores also reflected questionnaire-derived reports of problems in a broad range of activities of daily living and pain and were responsive to change over time. The aging process and the body mass index increased the probability for Sock Test scores indicating activity limitations. The scores from the pretest were predictive of the perceived difficulty in dressing after one year. Summary and discussion. Sock Test scores are a reflection of perceived limitations to activity and limitations of the musculoskeletal system.


The study was conducted as a conjunction with a large randomized clinical controlled study ( The Bergen Study Return to Work) of 523 patients suffering from musculoskeletal discomfort located in Bergen, Norway. A written informed consent form was sought from patients prior to their the time of inclusion. Each patient was employed but they were on a extended sick leaves. All patients were evaluated through a physical therapist prior to when being randomly allocated either an intense rehabilitation programme or to a control group that received traditional therapy. The patients received the same physical therapist’s examination one year following the pre-test examination.

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The Sock Test

This Sock Test simulates the activity of wearing a sock. It is a standard test and doesn’t permit different ways to move. The therapist will evaluate the performance of the patient, by observing the distance that the patient can travel and how quickly the task is completed.

The patient must wear loose clothes. The procedure is shown for the person. The patient is directed to lie on a bench with their feet separated from the floor. The patient is instructed to lift each leg one at a stretch in the sagittal axis and simultaneously moves down towards the elevated foot using both hands both on the opposite side, grasping toes with the fingertips in both hands. The foot should never touch the bench, and must be elevated throughout the test. After a single test of each leg and then giving the patient scores on the one with the weakest performance. Scores are provided in the form of ordinal values ranging between zero (can grasp the toes using fingertips and perform the movement effortlessly) up to three (can barely, if at all, extend to the malleoli) (Fig. 1). Several compensation maneuvers may be demonstrated (Fig. 2). Compensations are not evaluated. If they do occur during the test, they are explained or explained to the patient in a second time before testing is repeated.


The study involved 337 participants (65 percent females and 35% males) or subgroups of them were involved in the study to test the validity of the information obtained through The Sock Test. The median age of patients was 43 years old (median=43 10 years, SD=10 years minimum=21, maximum=64). The patients were listed as sick for a varying length period (X=3 months with SD=2 minimum=1 20 maximum). Sixty-three per cent of patients had been sick-listed up to 4 months. 25% were sick-listed for between 4 and six months and 12% were sick-listed for more than 6 months. Patients were diagnosed by their doctor in accordance with the International Classification of Primary Care (ICPC) A majority of the patients (52 percent) were suffering from back pain. 29% of patients were suffering from shoulder or neck pain. 12percent of patients experienced generalized musculoskeletal pain. 77% of the patients suffered from other types of muscular-skeletal pain.

The number of participants in different areas of the study varied based on available data on The Sock Test and the other methods of measurement. They also were convenience samples. In the clinical controlled study the various methods of measurement were utilized for various lengths of time and were distributed randomly. This suggests that subsamples were assessed.

Intertester reliability

Patients suffering from musculoskeletal pain (n=21) who took part in clinical tests over the period of 14 days were taken into consideration to determine the reliability of intertesters. Fiveteen women and six men with a median age of 44 (minimum=26 Maximum=62) The patients were examined. Nine patients complained of back pain; eight patients were suffering from shoulder, neck or arm pain. four patients suffered from generalized musculoskeletal pain.

Pain and activity limitations as perceived by the patient.

Participants (n=237) who, at the beginning were examined using in the Sock Test and on the same occasion , answered questions from physical therapists on perceived difficulties related to the process of wearing shoes and socks. They were also included to investigate the connection between the clinician’s Sock Test scores and data from patients.

Patients who took the Sock Test and who concurrently completed the Disability Rating Index (DRI) during the time of the pretest exam were also included to examine the relation with Sock Test scores and perceived functional issues in different activities of daily living as measured through the questionnaire. The DRI includes 12 questions on issues related to daily life activities, all measured on a 10-cm analog scale. Its DRI scores are the median score of all the items.

Musculoskeletal system because of demographic reasons

Patients (n=326) assessed using the Sock Test at the pretest examination with prior data on age and BMI (BMI) (in kgs/ square meters) as well as were examined to determine the possibility that Sock Test scores reflected differences in the restrictions of the musculoskeletal structure according to age.

Prediction of perceived limitation in activity

The patients (n=257) that were tested by the Sock Test at the pretest exam and who responded to the question about perceived issues with putting on socks and shoes during the posttest exam were analyzed to determine if the pretest Sock Test scores could predict perceived problems at the one-year posttest exam.

Intertester reliability

The reliability of the intertester between two physical therapists was evaluated. The therapists did not work together in the clinic prior to they began the study. Therapist 1 had been an PT for over 25 years, including 7 years of clinical experience treating patients suffering from muscular and skeletal pain. She also taught for 18 years of teaching at a college for physical therapy. Therapist 2 was an PT for 10 years. He had three years of clinical practice dealing with patients suffering from muscular and skeletal pain, as well as in heart rehabilitation , and seven years working in the occupational health service. The therapists evaluated a small group of patients in a group prior to beginning the study. One therapist showed how to perform the Sock Test to each patient while both therapists evaluated the patient’s performance on the test independently on the same day. This ensured that the test’s reliability was not tied to the ability of the therapist who gave instructions, which could improve the estimation of reliability because it eliminates a source of error that could be common in clinical routine practice.

Pain and activity limitations as perceived by the patient.

The patients were asked respond to the questions below on a definite yes or not basis: Do you have difficulties putting on socks and shoes? Did you alter your method of dressing due to musculoskeletal issues? Did the dressing process hurt? The percentage of patients who said “yes” in the survey relative to the respective Sock Test scores were calculated. The hypothesis that there is the absence of a relationship with Sock Test scores and the information on the patient was examined through using chis-quare tests.

To determine the “sensitivity” and “specificity” of Sock Test scores to reflect the perceived limitation in activity in patients, the patient data were compiled in the following manner. If a patient answered “yes” for at minimum one of the questions from the previous paragraph was deemed to be a sign of perceived limitation in activity and was coded as 1 While responses to “no” to every question were thought to be in no way indicative of any perceived limitations in activity and were classified as zero. “Sensitivity” along with “specificity” were assessed by examining each possible cutoff value for Sock Test results.

Pain and Perceived Activity Limitation for Patients

Patients’ percentages who reported functional issues, altered performance or discomfort related with Sock Test scores are shown in bar graphs that show that rising Sock Test scores tend to show an increase in the percentage of patients suffering from various aspects of limitation to the dressing procedure (Fig. 3). Chi-square tests revealed that there was a relationship with Sock Test scores and functional challenges (kh2 =44.66 (df = 3) and performance changes (kh2 =60.73 (df = 3) as well as pain (kh2 =68.01 and df =3) All of them were important (P <.001). Sock Test scores that have an upper cutoff of 1 showed an “sensitivity” score of 0.77 and an “specificity” number of 0.91. The Sock Test scores that had cutoff values between 2 and 3 showed “sensitivity.

Restriction of Musculoskeletal System Because of Demographic Factors

A higher probability (P <.05) to score higher than 1 in the Sock Test with increases in BMI and age was evident by examining the different variables (Tab. 4). Patients aged 51 to 65 were three times as likely be above zero in the Sock Test than the group of patients who were between 21 and 35. Patients who had BMI higher than 27.1 that represent the top quarter of BMI assessed, were about 10-fold more likely be above 0 when taking the Sock Test than patients in the lower quarter.