Visual assessment of movement quality: a study on intra- and interrater reliability of a multi-segmental single leg squat test

Does a Hip Muscle Activation Home Exercise Program Change Movement Patterns on the Forward Step-Down Test?

CONTEXT

Poor knee biomechanics contribute to knee joint injuries. Neuromuscular control over knee position is partially derived from the hip. It is unknown whether isolated activation training of the gluteal muscles improves lower-extremity frontal plane mechanics. This study examined if a home-based hip muscle activation program improves performance on the Forward Step-Down Test as well as increases surface electromyography (sEMG) activation of the gluteal muscles.

DESIGN

The study utilized a single-group repeated-measures design.

METHODS

Thirty-five participants (24 females, mean age = 23.17 [SD 1.36] years) completed an 8-week hip muscle activation program. The Forward Step-Down Test score and sEMG of gluteus maximus and medius were assessed preintervention and postintervention.

RESULTS

Forward Step-Down Test scores improved significantly from preintervention (Mdn = 3.5) to postintervention (Mdn = 3.0, T = 109, P = .010, r = .31.), but this result did not meet clinical significance. sEMG analysis revealed a significant increase in mean gluteus maximus activation (P = .028, d = 1.19). No significant dose-response relationship existed between compliance and the Forward Step-Down Test scores or sEMG results.

CONCLUSIONS

A home-based hip activation program increases gluteus maximus activation without clinically significant changes in frontal plane movement quality. Future studies may find clinical relevance by adding motor learning to the activation training program to improve functional muscle use.

Can tests of physical fitness predict traumatic knee injury in youth female athletes? A prospective cohort study

OBJECTIVES

To compile a battery of test including various aspects of physical fitness that could be used on the field and to assess whether any of these tests are associated with future traumatic knee injuries in youth female team sports athletes.

DESIGN

Prospective cohort.

SETTING

Sport setting.

PARTICIPANTS

Female athletes (n = 117, age 15-19 years), from Swedish sport high schools, active in soccer, handball, or floorball.

MAIN OUTCOME MEASURES

Differences in pre-injury tests values of 11 physical fitness tests in injured versus non-injured athletes, assessed as number of traumatic knee injuries over one season.

RESULTS

28 athletes sustained 34 traumatic knee injuries. Athletes who sustained an injury had a shorter distance on the Yo-Yo IR1 test at baseline than those without an injury (mean difference -193 m, CI -293- -65 m). None of the other tests, assessed for muscular strength, endurance, power, flexibility and dynamic knee valgus, differed between injured and non-injured athletes.

CONCLUSIONS

Youth female athletes with lower intermittent endurance capacity, assessed with the Yo-Yo IR1, seemed to be at greater risk of traumatic knee injury. Neither hop performance, flexibility, dynamic knee valgus nor isolated strength tests at baseline could distinguish between injured and non-injured youth female athletes at follow-up.

A comprehensive two-dimensional scoring system to assess the single-leg squat task in football players

BACKGROUND

The single-leg squat (SLS) is a safe and widespread functional test commonly performed in the mid-stages of rehabilitation after severe knee injuries. The use of reliable objective measures has been advocated to improve the quality of SLS assessment. The aim of this study was to describe a qualitative whole-body scoring system based on two-dimensional (2D) video analysis during SLS test and validate it against three-dimensional (3D) kinetics and kinematics.

METHODS

Thirty-four competitive football (soccer) players performed a series of SLS tasks. 3D kinematics and kinetics were collected through infrared cameras, and 2D video analysis was performed through a scoring system with sub-scores ranging from 0/2 (non-adequate movement) to 2/2 (adequate movement) based on frontal and lateral planes objective measurements. 3D kinematics and kinetics were grouped according to the results of the 2D evaluation and compared through the analysis of variance (P < 0.05).

RESULTS

Higher hip adduction, hip internalrotation, and knee valgus collapse were found in trials rated 0/2 or 1/2 compared with theone rated 2/2 in the limb stability score. Hip flexion and hip/knee moment ratio were lower in those scoring 0/2 comparedwith those scoring 2/2 in the movement strategy criterion. A low total score was associated with higherknee valgus collapse and lower hip/knee extensor moment ratio. Compensatory strategieswere found in frontal plane scores.

CONCLUSIONS

The 2D scoring system described was strongly associated with kinematics and kinetics from gold-standard 3D motion capture and might represent a valid tool to describe the movement quality of an SLS task.

Factors associated with the Single Leg Squat test in female soccer players: a cross-sectional study

BACKGROUND

The Single Leg Squat (SLS) test is widely used in the clinical setting to examine and evaluate rehabilitation goals. It is simple to perform and is proposed to have biomechanical and neuromuscular similarities to athletic movements. The aim of the present study was to investigate whether demographics, previous injuries, and biomechanical and psychosocial factors are associated with the outcome of the SLS, assessed as a total score for all segments and as a separate knee segment in elite and sub-elite female soccer players.

METHODS

We conducted a cross-sectional study involving 254 female soccer players (22 yrs; SD ± 4, height 1.69 m; SD ± 0.1, weight 64 kg; SD ± 6) from divisions 1-3 of the Swedish Soccer League. During the preseason, we assessed the participants using the SLS and tested their hip strength and ankle mobility. Demographics, previous injury, sleep quality, fear of movement, anxiety, and perceived stress were assessed with questionnaires. Logistic regression models were built to analyse the association between the outcome of the SLS and the independent variables for the dominant and non-dominant leg.

RESULTS

Significantly more participants failed the SLS on the dominant leg compared with the non-dominant leg (p < 0.001). The outcome of the SLS associated with various biopsychosocial factors depending on if the dominant or non-dominant leg was tested. The total score associated with hip strength for the dominant (OR 0.99, 95% CI 0.98-0.99, p = 0.04) and the non-dominant leg (OR 0.99, 95% CI 0.97-0.99, p = 0.03). The knee segment associated with division level for the dominant (div 2; OR 2.34, 95% CI 1.01-5.12, p = 0.033. div 3; OR 3.07, 95% CI 1.61-5.85, p = 0.001) and non-dominant leg (div 2; OR 3.30, 95% CI 1.33-8.00, p = 0.01. div 3; OR 3.05, 95% CI 1.44-6.43, p = 0.003).

CONCLUSIONS

This study identified that leg dominance, division level, hip strength, and psychosocial factors were associated with the outcome of the SLS when assessed as a total score and as a separate knee segment. This indicates that clinicians need to understand that movement control is associated with factors from several domains. Whether these factors and, the results of the SLS are related to injury need to be studied prospectively.

TRIAL REGISTRATION

Clinical Trials Gov, date of registration 2022-03-01.

CLINICAL TRIALS IDENTIFIER

NCT05289284A.

Gwet's AC1 is not a substitute for Cohen's kappa - A comparison of basic properties

Gwet's AC1 has been proposed as an alternative to Cohen's kappa in evaluating the agreement between two binary ratings. This approach is becoming increasingly popular, and researchers have been criticized for still using Cohen's kappa. However, a rigorous discussion of properties of Gwet's AC1 is still missing. In this paper several basic properties of Gwet's AC1 are investigated and compared with those of Cohen's kappa, in particular the dependence on the prevalence of positive ratings for a given agreement rate and the behaviour in case of no association or maximal disagreement. Both approaches compare the observed agreement rate with a comparative number. Cohen's kappa uses an expected agreement rate as comparator, whereas Gwet's AC1 uses an expected disagreement rate. Consequently, for a fixed agreement rate, Gwet's AC1 increases with increasing difference of the prevalence of positive ratings from 0.5. In contrast, Cohen's kappa decreases. Gwet's AC1 can take positive and negative values in the case of no association between the two raters, whereas Cohen's kappa is 0. Due to these fundamental differences, Gwet's AC1 should not be seen as a substitute for Cohen's kappa. In particular, the verbal classification of kappa values by Landis & Koch should not be applied to Gwet's AC1.

Reliability of the Frontal Plane Knee Alignment Measurement Based on a Remote Protocol

Introduction

The analysis of movement quality is important for better exercise prescription. This study tested the reproducibility of a protocol for remote assessment of dynamic knee alignment using images taken by patients.

Methods

Thirteen women filmed themselves performing single-leg squats on two days at a 15-day interval. Three raters measured the knee frontal plane projection angle using the resultant images.

Results

Two participants (15.4%) were excluded for not performing the protocol correctly. The intraclass correlation coefficient was between 0.880 and 0.999 for the intra-rater comparison, and between 0.817 and 0.987 for the inter-rater comparison.

Discussion

The success of the protocol in 84.6% of participants and the excellent reproducibility suggest that the methodology of analyzing patient-captured cell phone images might be a plausible alternative for remote evaluation of dynamic knee alignment.

Comparing a Sensor for Movement Assessment with Traditional Physiotherapeutic Assessment Methods in Patients after Knee Surgery-A Method Comparison and Reproducibility Study

Wearable sensors offer the opportunity for patients to perform a self-assessment of their function with respect to a variety of movement exercises. Corresponding commercial products have the potential to change the communication between patients and physiotherapists during the recovery process. Even if they turn out to be user-friendly, there remains the question to what degree the numerical results are reliable and comparable with those obtained by assessment methods traditionally used. To address this question for one specific recently developed and commercially available sensor, a method comparison study was performed. The sensor-based assessment of eight movement parameters was compared with an assessment of the same parameters based on test procedures traditionally used. Thirty-three patients recovering after arthroscopic knee surgery participated in the study. The whole assessment procedure was repeated. Reproducibility and agreement were quantified by the intra class correlation coefficient. The height of a one-leg vertical jump and the number of side hops showed high agreement between the two modalities and high reproducibility (ICC > 0.85). Due to differences in the set-up of the assessment, agreement could not be achieved for three mobility parameters, but even the correlation was only fair (r < 0.5). Knee stability showed poor agreement. Consequently, the use of the sensor can currently only be recommended for selected parameters. The variation in degree of agreement and reproducibility across different parameters clearly indicate the need for developing corresponding guidance for each new sensor put onto the market.

Measurement Properties of Clinically Accessible Movement Assessment Tools for Analyzing Single-Leg Squats and Step-Downs: A Systematic Review

CONTEXT

Poor lower-extremity biomechanics are predictive of increased risk of injury. Clinicians analyze the single-leg squat (SLS) and step-down (SD) with rubrics and 2D assessments to identify these poor lower-extremity biomechanics. However, evidence on measurement properties of movement assessment tools is not strongly outlined. Measurement properties must be established before movement assessment tools are recommended for clinical use.

OBJECTIVE

The purpose of this study was to systematically review the evidence on measurement properties of rubrics and 2D assessments used to analyze an SLS and SD.

EVIDENCE ACQUISITION

The search strategy was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. The search was performed in PubMed, SPORTDiscus, and Web of Science databases. The COnsensus-based Standards for the selection of health Measurement INstruments multiphase procedure was used to extract relevant data, evaluate methodological quality of each study, score the results of each movement assessment, and synthesize the evidence.

EVIDENCE SYNTHESIS

A total of 44 studies were included after applying eligibility criteria. Reliability and construct validity of knee frontal plane projection angle was acceptable, but criterion validity was unacceptable. Reliability of the Chmielewski rubric was unacceptable. Content validity of the knee-medial-foot and pelvic drop rubrics was acceptable. The remaining rubrics and 2D measurements had inconclusive or conflicting results regarding reliability and validity.

CONCLUSIONS

Knee frontal plane projection angle is reliable for analyzing the SLS and SD; however, it does not serve as a substitute for 3D motion analysis. The Chmielewski rubric is not recommended for assessing the SLS or SD as it may be unreliable. Most movement assessment tools yield indeterminate results. Within the literature, standardized names, procedures, and reporting of movement assessment tool reliability and validity are inconsistent.