











































MANUSCRIPT TYPE


EVIDENCE-TO-PRACTICE REVIEW  

 

58 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 4 – Issue 2 – September 2021 

 
 

Rater Reliability of the Functional Movement Screen: An Evidence-to-
Practice Review  
Nate Orth, MS, SCAT, ATC; Adam Graham, MS, SCAT, ATC; Zachary K. Winkelmann, PhD, SCAT, ATC 
University of South Carolina, Columbia, SC 

  

 
ABSTRACT 
The purpose of this evidence-to-practice review is to 
summarize a systematic review on the inter- and intrarater 
reliability of the Functional Movement Screen (FMS). 
Reliability is crucial to the FMS, as clinicians may retest to 
view a patient’s changes and improvements in movement 
patterns. This review and analysis looked at 7 studies which 
showed that both inter- and intrarater reliability were 
good. Studies were only included if the primary focus was on 
inter- and intrarater reliability. Clinicians had varying levels 
of familiarity with the FMS process. Athletic training students 
with less than one year to no experience were found to have 
poor reliability. The findings also supported that clinicians 
who treated the same patient would have similar results 
about 80% of the time. The same clinician completing several 
screenings with the different patient would have reliable 
results about 85% of the time. Interrater reliability is an 
important aspect to a clinician’s ability to monitor progress or 
modifications that a patient may exhibit. Overall, the FMS 
has good inter- and intrarater reliability and can be a 
predictor of injury risk and mobility. For both inter- and 
intrarater reliability to improve, it is beneficial for clinicians 
to have clinical experience and practice using the test to aid 
in accurate scoring. Certification in FMS is a way to develop 
repetition training from a reliable source, but it is unclear 
from these studies if certification changes reliability. The FMS 
screening serves as a useful tool because it allows for 
unlimited testing, video recordings for patient education or 
additional clinician evaluation, and is reliable among 
clinicians. We suggest that components of the FMS be used 
clinically for injury prevention, such as pre-participation 
exams and return-to-play criteria for injuries if scored by a 
formally trained clinician with experience assessing patient 
functional movement.  
 
Key Phrases 
Preparticipation exams and screening, injury risk reduction, 
functional testing 
 
Correspondence 
Dr. Zachary Winkelmann, 1300 Wheat Street, Columbia, 
SC 29208. 
E-mail: winkelz@mailbox.sc.edu   
Twitter: @zachwinkelmann 
 
Full Citation 
Orth N, Graham A, Winkelmann ZK. Rater reliability 
of the functional movement screen: An evidence-to-
practice review. Clin Pract Athl Train. 2021;4(2): 58-
63. https://doi.org/10.31622/2021/0004.2.9.   
 
Submitted April 20, 2020 Accepted: November 16, 2020. 

 
 

ORIGINAL REFERENCE 
Cuchna JW, Hoch MC, Hoch JM. The interrater 
and intrarater reliability of the functional 
movement screen: A systematic review with 
meta-analysis. Phys Ther Sport. 2016;19:57-
65. 

SUMMARY 
 
CLINICAL PROBLEM AND QUESTION 
 

The Functional Movement Screen (FMS) is a 

standardized movement screen for individuals 
using a score to predict risk of injury and 
mobility.1-3 It uses a series of 7 tests including the 
deep squat, hurdle step, in-line lunge, shoulder 
mobility, active straight leg raise, trunk stability 
push-up, and rotatory stability.1,3 Each test is 
scored 0-3 with a score of 3 meaning that there is 
no compensation, a score of 2 meaning there is 
compensation during the movement, a score of 1 
meaning the movement  is not fully completed as 
instructed, and a score of 0 meaning there is pain 
with the associated movement.1 The use of the FMS 
as an clinical assessment tool to identify limitations 
and restrictions in athletic movement has 
previously come under scrutiny due to rater 
reliability.2,4,5 Interrater reliability is the measure 
that assesses how different evaluators agree or 
disagree upon the grading, while intrarater 
reliability assesses how reliable grading is by the 
same evaluator at different points in time.6 In 
theory, high rates of reliability for the FMS are 
necessary to be able to identify score differences 
over time or among a team of clinicians in physical 
medicine (athletic training and physical therapy). 
If the interrater reliability is not adequate, the use 
of multiple clinicians can misrepresent intervention 

mailto:winkelz@mailbox.sc.edu
https://doi.org/10.31622/2021/0004.2.9


Rater Reliability of the Functional Movement Screen: An Evidence-to-Practice Review 
 

 

59 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 4 – Issue 2 – September 2021 
 

outcome scores. If the intrarater reliability is not 
adequate, interventions over time may be 
misrepresented when the patient is re-tested. Due 
to the increased popularity of the movement 
screening in clinical practice,7 there is a need to 
review the evidence specific to inter- and 
intrarater reliability of the FMS. 

SUMMARY OF LITERATURE 

The focus of the guiding systematic review8 was to 
determine the inter- and intrarater reliability of 
the FMS in clinical practice. Articles that were 
selected included active populations (secondary 
school and collegiate athletes). The included 
studies had to use the original scoring system1,7 
and incorporated all 7 tests that make up the 
standard movement screen for the FMS, with or 
without the three clearing tasks.3,7 The FMS 
clearing tasks (shoulder clearing, extension 
clearing, and flexion clearing) are pain 
provocation tests that take a joint through a full 
range of motion and meant to provide a clear 
stopping point when a medical referral is 
necessary. No studies involving injured athletes or 
that measured reliability as part of a larger study 
were included. The authors originally retrieved 
110 articles and narrowed to 14 studies based 
off the purpose of the study. After author review, 
was narrowed to 7 studies that met specific 
inclusion criteria for the purpose of the study.  

SUMMARY OF OUTCOMES 

Of these 7 articles included, 6 studies evaluated 
interrater reliability and 6 studies evaluated 
intrarater reliability. All 7 of the studies went 
through rigorous risk bias using a Quality 
Appraisal of Reliability Studies (QAREL) checklist. 
The QAREL checklist further identified the quality 
of the studies included in the final grouping. After 
article selection and quality appraisal, the results 
from all included studies were meta-analyzed to 
identify FMS reliability. The sample size of 
clinicians in the included articles was also assessed 
(range=1-38), with 5 of the 7 articles reporting 

1-5 clinicians. The studies also included a mixture 
of assessment procedures that used real-time 
assessments and video recordings.  

FINDINGS AND CLINICAL IMPLICATIONS 

The meta-analysis identified that the FMS has 
good inter- and intrarater reliability.8 The 
intraclass coefficient (ICC), or the measure of how 
a score closely matches up to another score, value 
for interrater reliability was 0.843. A value closer 
to 1 indicates similarity between different tests for 
a single rater. The 95% confidence interval for the 
interrater reliability ICC value was 0.797 to 
0.882. The ICC value for intrarater reliability was 
0.869 with a 95% confidence interval between 
0.854 to 0.885. 

There was a moderate level of quality evidence 
showing good interrater reliability. There was 
only one study9 that found it to be fair or poor, 
but did not lower the overall average. From the 
one fair/poor study,9 the authors identified poor 
reliability in clinicians that were limited in their 
FMS experience, which ranged from self-taught to 
less than 1 year of experience. However, the 
study did not mention if the clinicians had been 
formally certified in FMS. The guiding systematic 
review findings8 indicated formal training paired 
with experience as the best way to achieve 
accurate results. It is unclear if certification is 
necessary, based on these studies, other than that 
a certification course provides the formal training 
and educational resources.3 The other aspect 
analyzed was clinical experience with the studies 
including healthcare providers and students from 
various fields including physical therapy,9-13 
athletic training,9,14,15 strength & conditioning9,15 
with certified and non-certified FMS testers of 
various experiences (0-4 years). Based off the 
data from the guiding systematic review, when the 
rater had greater experience with FMS scoring 
the interrater reliability subsequently 
increased.9,11  

 



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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 4 – Issue 2 – September 2021 
 

Intrarater reliability received similar results to 
interrater, which identified a moderate level of 
quality evidence for good reliability on the 
FMS. There was one study that was deemed fair, 
but the clinicians were athletic training students 
with no previous FMS experience.14 Based on the 
findings, it was determined that experience 
played a significant role in the intrarater 
reliability for many of the same reasons as 
interrater reliability. Several reiterations with the 
same patient would also be a major benefit for 
the clinician, as observing how different 
movements are completed could indicate which 
muscles are activated. Inter- and intrarater 
reliability were assessed with real time and video 
recorded scoring. Both scoring methods were 
deemed good. The finding suggests that scoring 
could be completed several times and by several 
clinicians if needed, or videos could be sent to a 
certified FMS tester for screening confirmation if 
additional input was warranted. Formal 
certification can be expensive with current Level 1 
FMS training costing $400.3 Certification is a 
reasonable option for situations where analysis is 
needed, and the clinician will be primarily 
involved in correction strategies. However, 
sending videos to a more experienced FMS tester 
could also be an option for newly trained 
clinicians and athletic training students to obtain 
experience while receiving feedback on their 
scoring assessment. Video review may also be a 
viable option for FMS scorers who do not receive 
many repetitions of the test but still have a desire 
to implement the outcome measure. 

CLINICAL BOTTOM LINE 

One domain of athletic training practice is injury 
and illness prevention and wellness promotion.16 
Through this domain, athletic trainers should seek 
to minimize the risk of injury,  which has often been 
linked to mechanisms such as pre-participation 
exams, screening practices, and maintaining a 
safe environment for activities.17 One specific 
screening mechanism, the FMS, has been used as 

an established method to evaluate movement 
quality and subsequent insufficiencies.1,11 
However, there is conflicting evidence whether the 
FMS tests can predict specific or overall injury risk 
using the scoring criteria.4,5,18 The issue is that the 
test is scored by a rater for movement quality at 
specific joints and through the kinetic chain on a 
graded scale which does not account for sport 
specific movements.7 Additionally, previous 
research has noted that there are conflated 
reports of injury prediction modeling leading to 
questions specific to its ability to screen for injury.2 
In the guiding systematic review, the FMS test has 
shown good interrater and intrarater reliability 
which provides support to clinicians for long term 
outcome measures and evaluation.8 However, 
despite the data supporting the reliability, the 
external resources often call into question if the 
FMS test has the predictive capabilities or 
screening sensitivity necessary for that of directing 
prevention resources towards a targeted 
population.19  

More specifically, the FMS has also been used as 
a tool to monitor and evaluate rehabilitation 
progress. As the FMS seems not to have the 
screening or preventative nature necessary for 
sports medicine, we suggest that raters 
incorporate the FMS as a baseline screening not 
for injury prevention planning but as a model for 
return-to-activity basis. The data supports the use 
of video recording for FMS testing,8 as well as 
during injury rehabilitation as a means to reduce 
the psychosocial impact of fear avoidance 
movements.20 We suggest that athletic trainers 
wishing to implement the FMS as a screening tool 
do so for all patients, regardless of injury, and 
video record their movements. After doing so, if 
the patient sustains an injury, the clinician could use 
the video recording of the FMS as a baseline for 
movement quality pre-injury and a goal setting 
technique for the rehabilitation phases.  

 



Rater Reliability of the Functional Movement Screen: An Evidence-to-Practice Review 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 4 – Issue 2 – September 2021 
 

However, the issue still with the FMS is the 
subjective nature of the objective scoring.7 While, 
as an outcome measure, the FMS provides a 
specific and measurable goal for the patient to 
achieve following their injury. The FMS score alone 
leaves a lot to be desired, since there are many 
factors that lead to a specific score; thus, clinician 
interpretation is crucial. Factors such as range of 
motion across multiple joints and muscle 
recruitment are all integrated to create one 
numerical score, as well as observation from a 
singular vantage point through dynamic 
movement is of concern.15 The main takeaway of 
the FMS is to identify if there is an issue; however 
the unique biomechanical movements of specific 
athletes cannot be viewed in a score. The score 
also must be supplemented by commentary by a 
trained clinician who interprets the scoring to 
identify associated weaknesses and steps to 
strengthen primary muscle movers. The FMS does 
not guarantee the clinician will always notice the 
weakness either. For example, a clinician watching 
a deep squat might score a 2 for an athlete that 
has excessive forward lean as a compensatory 
movement. While this score would be correct, if 
another clinician received that score without any 
notes, it would be difficult to know where the 
incorrect movement occurred. A qualified 
individual scoring the FMS would be able to take 
that score and implement changes to ankle 
dorsiflexion to eliminate the compensatory 
movement, retest, and determine if further 
changes were necessary. Since the FMS has strong 
inter and intrarater reliability suggesting that it 
has a place in clinical practice, we suggest that 
athletic trainers wishing to incorporate it see the 
score as one piece of the data and that notes or 
qualitative explanations of the movement 
insufficiencies be explained in detail for clarity on 
the scoring, intervention planning, and later 
reevaluation of the test. 

 

The guiding systematic review suggested that for 
both inter- and intrarater reliability to improve, 
clinicians must have opportunities to use the FMS 
test with repetitions and directed feedback in 
their scoring.8 The use of feedback and deliberate 
practice requires time, which athletic training has 
continued to identify as a limitation in 
implementing evidence-based practice.21 
However, we believe that the use of video to 
record the patient throughout the testing 
movements would allow multiple clinicians to score 
the patient outside of real time. The proposal 
would be best integrated during pre-season or a 
pre-participation exam. A clinician among the 
healthcare team, whether that be within the same 
college/university or hospital outreach team, or 
even a cohort of students within an athletic training 
program, could evaluate and score the videos 
from multiple angles (frontal and sagittal planes 
of the body) with specific feedback on the 
movement quality noted. Not only would this allow 
for a future clinician to get the needed practice 
with the current patient population, but it also 
removes the burden from a singular formally 
trained clinician with experience assessing patient 
functional movement.  

Overall, the data supports that there is reliability 
with the scoring within and between raters. 
However, clinicians have begun to adopt the FMS 
as the singular screening tool to predict injury, 
which is not supported by the literature. We must 
be creative in our pursuits of using objective 
outcome measures, such as the FMS, not as a 
number based criteria for injury prevention 
planning or ruling out risk, but as a means to have 
baseline data among the team of raters in case 
of an injury occurring for future return-to-activity 
therapeutic interventions. 

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All rights reserved. ISSN Online 2577-8188                                                                     Volume 4 – Issue 2 – September 2021 
 

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All rights reserved. ISSN Online 2577-8188                                                                     Volume 4 – Issue 2 – September 2021 
 

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https://bocatc.org/system/document_versions/versions/23/original/boc-comparison-of-pa7-to-rd-pa6-20170612.pdf?1497278853
https://bocatc.org/system/document_versions/versions/23/original/boc-comparison-of-pa7-to-rd-pa6-20170612.pdf?1497278853
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https://dx.doi.org/10.4085%2F1062-6050-49.2.15
https://dx.doi.org/10.4085%2F1062-6050-49.2.15

	ABSTRACT

