Reliability and Psychometric Properties of the Hand Behind Back Test in Young Healthy Adults: A Cross-sectional Study

Published: June 1, 2026 | DOI: https://doi.org/10.7860/JCDR/2026/87588.23538

Chhaya, Manu Goyal, Muskan Bathla, Aditi Nagpal, Ritika Kashyap, Kanu Goyal

1. Postgraduate Student, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar Deemed to be University, Ambala, Haryana, India. 2. Professor, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar Deemed to be University, Ambala, Haryana, India. 3. Postgraduate Student, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar Deemed to be University, Ambala, Haryana, India. 4. Postgraduate Student, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar Deemed to be University, Ambala, Haryana, India. 5. Postgraduate Student, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar Deemed to be University, Ambala, Haryana, India. 6. Assistant Professor, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar Deemed to be University, Ambala, Haryana, India.

Correspondence
Dr. Kanu Goyal,
Assistant Professor, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, MMDU, Mullana-133207, Ambala, Haryana, India.
E-mail: goyalkanu02@gmail.com

Introduction: The Hand Behind Back (HBB) test is often used in clinical practice to evaluate shoulder internal rotation; yet, additional clarification regarding its measurement reliability using a tape measure is required.

Aim: To identify the HBB test’s intra-rater and inter-rater reliability and its psychometric qualities such as Standard Error of Measurement (SEM), Minimum Detectable Changes (MDC) at the 95% Con-fidence level (MDC95), Coefficient of Variation (CV%) and Smallest Worthwhile Change (SWC) using tape measurement in healthy adults.

Materials and Methods: A prospective observational cross-sectional test-retest study was con-ducted at the Outpatient Physiotherapy Department of Maharishi Markandeshwar Deemed to be University, Ambala, Haryana, India, between March 2025 to November 2025 on total of 60 healthy individuals which were evaluated by two physiotherapists. Each rater completed two measurement sessions under uniform con-ditions. The inter-rater and intra-rater reliability were assessed by analysing Cronbach’s alpha and interclass correlation coefficients. Cohen’s Kappa was used to assess agreement for the categorical variable of gender. SEM, MDC95, CV%, and SWC were analysed for evaluation of absolute reliability and psychometric qualities. Bland-Altman analysis was further used to investigate the agreement.

Results: Both raters showed excellent intra-rater reliability, with ICC values of 0.988 and 0.953, respectively. With an ICC of 0.967, it showed excellent inter-rater reliability. Cohen’s Kappa showed excellent agreement for gender classification with a value of κ=1.00, while Cronbach’s alpha values revealed high internal consistency (≥0.97). The MDC95 value was 0.69 cm, and the SEM values were low (0.25 cm). The SWC (0.46 cm) was higher than the SEM, and the CV% was 5.92%. There was no indication of proportional bias, and Bland-Altman plots showed narrow Limits of Agreement (LoA) and small mean bi-ases.

Conclusion: In healthy adults, the tape measure hand behind the back test showed good psycho-metric qualities with low measurement error, and excellent intra-rater and inter-rater reliability. The results obtained indicate that it can be applied as a sensitive and trustworthy clinical outcome measure for evaluating internal rotation of the shoulder joint.

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