Intrarater reliability and agreement of a modified Closed Kinetic Chain Upper Extremity Stability Test

The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) Performance in Elite Team Handball Players Playing with Shoulder Pain, Previous Pain, or No Pain

Background

Physical therapists use tests that could determine strength and weaknesses of the shoulder for overhead throwing athletes to enhance performance, prevent injury, and safely progress rehabilitation. The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) has been proposed to assess muscular capacity and dynamic shoulder stability in overhead athletes, which could provide information to determine a risk of injury.

Purpose

To investigate if the CKCUEST is an appropriate test to implement within team elite handball players to evaluate dynamic shoulder stability across sexes and in the screening of shoulder pain.

Study design

Cross-sectional study.

Methods

Elite team handball players were recruited and performed the CKCUEST from which three different scores (raw, touch, and power) were calculated and compared among handball players playing with shoulder pain, previous pain, and no pain.

Results

A total of 106 handball players were included: 49 females (1.74±0.03 m, 70.4±6.7 kg, and 22±4.9 years) and 57 males (1.90±0.08 m, 91.6±11.4 kg, and 22±5.4 years), A significant difference was found between the female and male handball players when comparing all three CKCUEST scores (p<0.01). No significant differences were found in the CKCUEST scores among the three different groups (F≤1.23, p≥0.30, η2≤0.03). Among the female participants, no significant differences were found between performing the CKCUEST and the modified test. A significant correlation was found between height and the power score for men (r=0.661, p≤0.001) and women (r=0.434, p=0.01).

Conclusion

A comparison of scores across sexes appears unsuitable, due to the possible positive influence of height on the final score. But within the female group, performances of the CKCUEST and the modified CKCUEST were comparable. Additionally, the CKCUEST was not able to differentiate among elite handball players who are playing with shoulder pain, previous shoulder pain, and no pain.

Level of evidence

3.

Measurement properties of upper extremity physical performance tests in athletes: a systematic review

BACKGROUND

Upper extremity Physical Performance Tests (PPTs) have been used in sports contexts to provide functional status of the athletes. However, whether these tests present appropriate measurement properties to be considered a valuable measurement is not clear.

OBJECTIVE

To systematically review the measurement properties of upper extremity PPTs in athletes.

METHODS

Databases (e.g., Medline, EMBASE, CINAHL, SPORTDiscus, CENTRAL) were searched in March 2021. Two reviewers independently rated the methodological quality using the 4-point Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Quality of evidence was graded by measurement property for each test, considering the adequacy, the sample size, and the methodological quality of the studies.

RESULTS

Fifteen studies were included with a pooled sample of 684 athletes. The PPTs analyzed were Arm-Jump Board Test, Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), Finger Hang Test, Medicine Ball Explosive Power Test, One-Arm Hop Test, Posterior Shoulder Endurance Test, Pull-Up Shoulder Endurance Test, Repetition to Failure Assessment, Seated Medicine Ball Throw Test (SMBT), Seated Single-Arm Shot-Put Test (SSPT), Shoulder Endurance Test, Two-Arm Bent Hang Test, Unilateral Seated Shot-Put Test, and Upper Limb Rotation Test. Evidence synthesis provided moderate and high-quality evidence for sufficient inter-session and intra-session reliability of the CKCUEST, respectively. There was moderate evidence for sufficient inter-session reliability of the SSPT and for insufficient validity of the SMBT.

CONCLUSION

The CKCUEST and the SSPT are sufficiently reliable in athletes. More studies are needed to investigate other psychometric properties for these tests and other upper extremity PPTs.

Upper extremity physical performance tests in female overhead athletes: a test-retest reliability study

OBJECTIVE

Despite the studies that have investigated the reliability of Upper Extremity Functional Tests(UEFTs), the reliability of Closed Kinetic Chain Upper Extremity Stability(CKCUES), Seated Medicine Ball Throw(SMBT), push-up(PU) and Unilateral Seated Shot Put(USSP) tests in overhead athletes has yet to be assessed. The objective of this study was to determine both the relative and absolute test-retest reliability of the four UEFTs in female overhead athletes.

METHODS

Twenty-nine female overhead athletes (age: 26.6 ± 5.29 years) underwent the four UEFTs twice within a three- day interval. The upper limb stability was assessed through PU and CKCUES tests, while the power was assessed though SMBT and USSP tests. The Intraclass Correlation of Coefficient (ICC) was applied to assess the relative reliability. Absolute reliability was determined by calculating the Standard Error of Measurement (SEM) and the Minimal Detectable Change (MDC). Furthermore, Bland-Altman plots were used to detect the agreements between the two measurements.

RESULTS

The relative reliability of PU, CKCUES, SMBT, and non-dominant arm USSP tests was excellent (ICC = 0.83, 0.80, 0.91, and 0.83, respectively). SEM was within a range of 1.69 to 1.72 for stability tests and a range of 13.61 to 52.12 for power (based on a 95% confidence interval). The MDC was 4.68 for PU and 4.75 for CKCUES test. At least four repetitions are needed to be considered a real improvement on PU and CKCUES tests. This value was 144.04, in SMBT and 59.03, 37.62 cm (dominant and non-dominant arm, respectively) in USSP tests, which represents the minimum change that must occur to be considered an athlete's progression.

CONCLUSION

This study revealed that both the upper limb stability and power tests have acceptable relative and absolute intra-rater reliability in female overhead athletes. These can be considered as reliable tools in research and clinical settings.

Functional Deficits After Open Latarjet Procedure and Dominance of the Operated Shoulder: An Analysis of 133 Patients

BACKGROUND

Return to sport after stabilization surgery using the open Latarjet procedure remains challenging. Additional knowledge is needed about postoperative shoulder functional deficits in order to better design return-to-sport programs.

PURPOSE

To investigate the effects of the dominance status of the operated shoulder on the shoulder functional profile recovery at 4.5 months after open Latarjet procedure.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

A retrospective analysis of prospectively collected data was performed. All patients who underwent the open Latarjet procedure between December 2017 and February 2021 were eligible for the study. Functional assessment at 4.5 months after the surgery was performed using the following tests: maximal voluntary isometric contractions in glenohumeral internal and external rotation, upper-quarter Y balance test, unilateral seated shot-put test, and modified closed kinetic chain upper extremity stability test, leading to 10 outcome measures. Patients whose dominant side had undergone surgery and those whose nondominant side had undergone surgery were compared with a group of 68 healthy control participants.

RESULTS

A total of 72 patients who underwent an open Latarjet procedure on the dominant side and 61 patients who underwent open Latarjet on the nondominant side were compared with 68 healthy control athletes. In patients whose dominant shoulder had undergone surgery, significant deficits for the dominant side (P < .001) and for the nondominant side (P < .001) were found in 9 of 10 functional outcome measures. Among patients whose operations were on the nondominant shoulder, significant deficits for the nondominant side (P < .001) and for the dominant side (P < .001) were found in 9 and 5 of the 10 functional outcome measures, respectively.

CONCLUSION

Regardless of dominance of the stabilized shoulder, persistent deficits in strength, stability, mobility, power, and stroke frequency were observed at 4.5 months postoperatively. Stabilization of the dominant shoulder resulted in residual surgery-related functional impairments on both sides. However, stabilization of the nondominant shoulder resulted in impairments primarily noted in the nondominant, operative shoulder.

REGISTRATION

NCT05150379 (ClinicalTrials.gov identifier).

Assessment of return to play after an acute shoulder injury: protocol for an explorative prospective observational German multicentre study

INTRODUCTION

To date, there is no valid single test or battery of tests for informing return-to-play (RTP) decisions following an acute shoulder injury. The purpose of this exploratory study is to evaluate a diagnostic test battery based on a Delphi consensus at the time of unrestricted return to team training after acute shoulder injury.

METHODS AND ANALYSIS

Data for this prospective multicentre cohort study are collected at two measurement time points: when the respective physician clears the patient for RTP (t1) and 12 months after RTP (t2). The study participants are 18-35 years old athletes participating at a professional level in the following team sports: handball, basketball, ice hockey, soccer, volleyball and American football. Maximum comparability will be ensured via uninjured matched pair teammates. To assess the subjective assessment of shoulder functioning and the athlete's readiness to RTP, patient-reported outcome measures (Western Ontario Shoulder Instability Index, Quick-Disabilities of the Arm, Shoulder and Hand, Psychological Readiness of Injured Athlete to Return to Sport and Shoulder Instability-Return to Sport after Injury) will be completed. After a medical check-up with a range of motion and anthropometric measurements as well as clinical tests, the participants will perform a structured warm-up protocol. The functional tests comprise handgrip strength, upper quarter Y-balance test, isometric strength, closed kinetic chain upper extremity stability test, wall hop test, functional throwing performance index and the unilateral seated shot put test and isokinetic tests.

ETHICS AND DISSEMINATION

The results of this study will be disseminated through peer-reviewed publications and scientific presentations at national and international conferences. Ethical approval was obtained through the Institutional Review Board of Martin-Luther-University Halle-Wittenberg (reference number: 2022-016).

TRIAL REGISTRATION NUMBER

DRKS00028265.

Factors affecting the shoulder functional profile in elite judo athletes

AbstractThe aim was to investigate the effects of sex, age, preferred judo technique, dominance, and injury history on the shoulder functional status of elite judo athletes. Sixty-one elite judo athletes (38 males, age: 18.1 ± 1.2 years, body mass: 69.3 ± 13.3 kg, body height: 172.2 ± 9.8 cm, brown belt to second-degree black belt) completed three questionnaires: Western Ontario Shoulder Instability, Western Ontario Rotator Cuff, and Shoulder Instability-Return to Sport after Injury. They performed four physical tests: the glenohumeral rotator isometric strength test, upper quarter Y-balance test, unilateral seated shot put test, and modified Closed Kinetic Chain Upper Extremity Stability Test. The results showed that the female athletes had less shoulder functional abilities than the male athletes (p < 0.001 to p = 0.02). The younger athletes had poorer shoulder stability and upper extremity power than the older athletes (p < 0.001 to p = 0.02), but their glenohumeral muscles were stronger in both internal (p = 0.03) and external (p = 0.005) rotations. All the judo athletes had similar bilateral differences in shoulder functional status, except for judokas who preferred throwing techniques (p = 0.01). Injury history affected self-perceived functional status (p < 0.001), as well as upper extremity muscle capacity and neuromuscular control (p = 0.01 to p = 0.05). This study provides new insight into the shoulder functional status of elite judo athletes, which may aid in the development of sports-specific injury prevention and return-to-sport programs to reduce the risk of shoulder injury occurrence and recurrence.

Reliability and validity of the One Arm Hop Test and Seated Medicine Ball Throw Test in young adults: A cross-sectional study

BACKGROUND

Functional performance tests are inexpensive, accessible, and easy to apply tools that can be used to help practitioners in daily decision making process. The purpose of this study was to evaluate the reliability and validity of the One Arm Hop Test (OAHT) and Seated Medicine Ball Throw Test (SBMT) in young adults.

METHODS

Cross-sectional study with a sample consisted of 59 young adults. The subjects performed the OAHT and SMBT in two moments separated by seven days and by two examiners. The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) was performed at the second moment. The time in OAHT, distance in SMBT, mean number of touches, normalized score, and power of the CKCUEST were measured. Reliability was determined using Intraclass Correlation Coeficient (ICC) and Bland-Altman Plots. Validity was assessed via Pearson's Correlation Coefficient (r) between these tests and CKCUEST.

RESULTS

We found good reliability of the OAHT between different raters (dominant limb - ICC = 0.83; non-dominant limb - ICC = 0.80) and moderate reliability between the same rater (dominant limb - ICC = 0.63; non-dominant limb - ICC = 0.62). In the SMBT we found good reliability inter-examiner (ICC = 0.84) and intra-examiner (ICC = 0.77). Low to moderate correlations with the CKCUEST were found (r < 0.70; p < 0.05).

CONCLUSIONS

The OAHT and the SMBT show moderate/good reliability intra and inter-examiner, however these tests are poorly correlated with CKCUEST. The SMBT presented higher values of ICC than OAHT. A combination of the SMBT and CKCUEST is recommended in clinical practice.

Intra- and intersession reliability and agreement of the Unilateral Seated Shot-Put Test outcome measures in healthy male athletes

BACKGROUND

The Unilateral Seated Shot-Put Test (USSPT) consists of pushing an overweight ball as far as possible to assess upper extremity power unilaterally and bilateral symmetry. Literature however reports various body positions and upper limb pushing patterns to perform USSPT, demanding to provide additional guideline to achieve overweight ball push. This study therefore aimed at assessing the reliability and agreement of USSPT outcome measures when pushing an overweight ball in a horizontal direction.

METHODS

Twenty-seven healthy male athletes performed two sessions, one week apart, of three unilateral pushes per upper limb using a 3-kg medicine ball, for which the distances were measured. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), minimum detectable change at a 95 % confidence level (MDC_95 %) and coefficient of variation (CV) were assessed for the pushing distances based on one, two or three trials per side to produce two outcome measures: the pushing distance per limb and USSPT Limb Symmetry Index (LSI) when dividing pushing distance of the dominant side by that of the non-dominant side.

RESULTS

The most reliable pushing distance per limb was obtained when averaging three pushing distances, normalized by body mass with the exponent 0.35. The mean USSPT LSI was 1.09 ± 0.10 for the first session and 1.08 ± 0.10 for the second session, highlighting good reliability and agreement (ICC = 0.82; SEM = 0.045; MDC_95 % = 0.124; CV = 5.02 %).

CONCLUSIONS

When the overweight ball is pushed in a horizontal direction, averaging the distances of three trials for both the dominant and non-dominant limbs is advised to provide the most reliable USSPT distance per limb and USSPT LSI.

The S-STARTS Test: Validation of a Composite Test for the Assessment of Readiness to Return to Sport After Shoulder Stabilization Surgery

BACKGROUND

The time elapsed since surgery is the primary criterion for allowing athletes to return to sport after shoulder stabilization surgery using the Latarjet procedure. The objective assessment of shoulder functional status through the return-to-sport continuum demands a scoring instrument that includes psychological and physical dimensions. This study aimed to statistically validate the Shoulder-SanTy Athletic Return To Sport (S-STARTS) score in patients who have undergone primary shoulder stabilization surgery.

HYPOTHESIS

The S-STARTS score fulfils the criteria for statistical validation for assessing return-to-sport readiness after shoulder stabilization surgery.

STUDY DESIGN

Diagnostic study.

LEVEL OF EVIDENCE

Level 4.

METHODS

Fifty patients and 50 controls completed the Shoulder Instability-Return to Sport after Injury questionnaire and performed 4 physical performance tests, from which 8 outcome measures were extracted to provide a composite score, named S-STARTS, according to a scoring procedure. The statistical validation of the S-STARTS score was based on construct validity, discriminant validity, sensitivity to change, internal consistency, reliability, agreement, and feasibility.

RESULTS

The 8 components of the S-STARTS score provided additional information (0.01 ≤ |r| ≤ 0.59). The S-STARTS score exhibited good reliability (intraclass coefficient of correlation [3,k] = 0.74), no ceiling or floor effects, and high discrimination and sensitivity to change. The S-STARTS score was significantly lower in patients than in controls (13.5 ± 3.8 points vs 16.1 ± 2.7 points, respectively; P < 0.001). A significant increase was reported between 4.5 and 6.5 months postoperatively (12.8 ± 2.3 points vs 17.2 ± 2.4 points, respectively; P < 0.001).

CONCLUSIONS

The S-STARTS score meets statistical validation criteria for the assessment of shoulder functional status after shoulder stabilization surgery using the Latarjet procedure.

CLINICAL RELEVANCE

Using an S-STARTS score-based assessment to monitor an athlete's progression through the return-to-sport continuum may help clinicians and strength and conditioning coaches in return-to-sport decision-making.

Reliability of the Modified CKCUEST and correlation with shoulder strength in adolescent basketball and volleyball players

BACKGROUND

Physical performance tests provide a more complete picture of the functional status of the athlete's upper extremity.

OBJECTIVES

The primary purpose was to evaluate the reliability of the Modified Closed Kinetic Chain Upper Extremity Stability Test (MCKCUEST) in adolescent volleyball and basketball players. The secondary objective was to evaluate the relationship between the MCKCUEST and shoulder rotation isometric strength in this population.

METHODS

Seventy-three healthy basketball (n=39) and volleyball (n=34) players participated to establish the reliability and correlations of the MCKCUEST. We used a two-session measurement design to evaluate the reliability of the MCKCUEST. Shoulder rotation isometric strength was performed to determine relationships with the MCKCUEST.

RESULTS

The intraclass correlation coefficients (ICC_2,1) for intra-session reliability of the MCKCUEST ranged from 0.86 to 0.89, and the between days test-retest reliability (ICC_3,1) was 0.93. The standard error of measurement (1 touch) and the minimal detectable change (3 touches) showed clinically acceptable absolute reliability values. A weak correlation was found between the MCKCUEST power score and shoulder rotation isometric strength (r values between 0.3 and 0.4).

CONCLUSIONS

Results demonstrated good to excellent relative reliability and clinically acceptable absolute reliability values for the MCKCUEST on adolescent basketball and volleyball athletes. Performances on the MCKCUEST were weakly associated with shoulder rotation strength.

Investigation of the Closed Kinetic Chain Upper Extremity Stability Test in elite canoe/kayak slalom athletes

OBJECTIVE

To investigate the correlation of arm length with different CKCUEST measures and determine if a modification of the test position (modified-CKCUEST), or normalisation of the CKCUEST (normalised-CKCUEST) score after testing, control for arm length most effectively.

STUDY DESIGN

Quasi Experimental.

SETTING

British Canoe Slalom National Training Centre.

PARTICIPANTS

Thirteen (5 male, 8 female) asymptomatic national squad canoe/kayak slalom athletes were recruited during winter profiling.

MAIN OUTCOME MEASURE

Three measures of the CKCUEST were investigated. The CKCUEST, hands 36 inches apart; modified-CKCUEST, hands arm width apart (measured as C7 spinous process to tip of middle finger); and normalised-CKCUEST (measured as CKCUEST score/arm length).

RESULTS

A significant positive correlation was found between arm length and the CKCUEST score (r = 0.807; p = 0.001) and normalised-CKCUEST score (r = 0.654; p = 0.015). No significant correlation was found between the modified-CKCUEST score and arm length (p = 0.745). A statistically significant difference between narrow and wide hand positions, greater than the minimal detectable change, was found (p = 0.000).

CONCLUSIONS

Arm length has a significant impact on CKCUEST score. The modified-CKCUEST score corrected for arm length where the normalised-CKCUEST score did not. Modifying the CKCUEST to individual anthropometrics needs to be performed pre-testing when comparisons are being made between individuals or groups.

Biomechanical analysis of the closed kinetic chain upper extremity stability test in healthy young adults

OBJECTIVES

To compare kinematic and ground reaction force (GRF) patterns between the dominant and non-dominant limbs in males and females conducting the closed kinetic chain upper extremity stability test (CKCUEST).

DESIGN

Descriptive.

SETTING

Biomechanics laboratory.

PARTICIPANTS

Sixteen male and sixteen female healthy and physically active young adults.

MAIN OUTCOME MEASURES

Hand contact and flight times, peak and average vertical (vGRF) and medial-lateral (mlGRF) ground reaction forces, medial-lateral (ML) distance and ML velocity per repetition, three-dimensional (3D) distance and 3D velocity per repetition, and average number of touches per trial during the CKCUEST.

RESULTS

Only peak and average mlGRF were statistically different between limbs. Males and females were statistically different across every measured variable. ML and 3D velocities were the only variables strongly correlated to the number of touches achieved.

CONCLUSIONS

Both sexes were symmetrical between limbs in all but mlGRF; however, there were distinct differences in both kinematics and GRF patterns between sexes that may be attributed to differences in the testing position between males and females.

Shoulder functional status in rugby union players with and without history of shoulder problems

OBJECTIVES

To assess the effects of (1) rugby union practice, (2) history of injury managed nonoperatively, and (3) history of injury managed operatively on shoulder functional status in male rugby union players.

DESIGN

Cross sectional study.

SETTING

Clinical.

PARTICIPANTS

86 male athletes were assigned into four groups: multisport athletes, rugby union players without shoulder problems, with history of shoulder injury managed nonoperatively and with history of shoulder injury managed operatively.

MAIN OUTCOME MEASURES

SI-RSI questionnaire, maximal isometric glenohumeral internal and external rotator strength, unilateral seated shot put test, upper quarter Y balance test.

RESULTS

Healthy players presented higher internal (p = 0.03) and external (p = 0.04) rotator strength than multisport athletes. History of shoulder injury managed nonoperatively did not impair physical abilities but limited player's psychological readiness (p < 0.001). After 4.5-months, shoulder stabilization surgery impaired maximal muscle strength and upper quarter body stability and mobility (p < 0.001 for all).

CONCLUSIONS

The shoulder functional status in rugby union player presented increased glenohumeral rotator strength when compared to non-collision sport athletes. In rugby union players, psychological concerns remained in the long-term after a shoulder injury managed nonoperatively, and psychological and physical readiness seemed not be reached at 4.5 months postoperatively to respond to rugby union practice demand.