Context: Scapular dyskinesis has been identified as a possible risk factor for injury in overhead athletes. There is a need to develop a simple, inexpensive, time-efficient field-based test that can establish the presence and severity of both scapular dyskinesis and its individual components in a musculoskeletal preparticipation screening. To ensure confidence in the test results, high reliability must be displayed. Objective: To establish the intertester and intratester reliability of a simple field-based screening tool for scapular dyskinesis. Design: Reliability study. Setting: Athletic therapy facilities. Participants: 15 physically active men (19.46 ± 0.63 y) free from any orthopedic or neurological disorders, recruited from a convenience sample of college students. Intervention: Testers underwent 3 training sessions where the instructions and scoring system of the test were explained, demonstrations of the tests were given, and opportunities to practice the test were provided. Three testers independently rated 3 trials, and the process was repeated at the same time the following week. Main Outcome Measures: Scapular dyskinesis was assessed using the following components: winging, loss/lack of control when lifting, loss/lack of control when lowering, and scapular asymmetry. A 0-3 rating (0 = no issue, 1 = slight issue, 2 = moderate issue, 3 = severe issue) was provided by the tester independently on each side separately and on scapular asymmetry. The intraclass correlation coefficients (ICCs), 95% confidence intervals, and standard error of measurement (SEM) were computed to establish reliability. Results: Excellent ICC values were found for intertester reliability (ICCs .80-1.00) and good to excellent intratester reliability (ICCs .60-1.00 for tester A, .63-1.00 for tester B, and .75-1.00 for tester C) for all components of the test. The SEM was not found to be clinically significant. Conclusions: The simple field-based screening tool developed to assess scapular dyskinesis demonstrates high reliability and so is a reliable tool to use in preparticipation screenings. Future research should establish its validity.
Siobhan O'Connor, Noel McCaffrey, Enda Whyte and Kieran Moran
Siobhán O’Connor, Noel McCaffrey, Enda F. Whyte, Michael Fop, Brendan Murphy and Kieran A. Moran
Context: Hamstring injuries are a leading cause of injury in Gaelic games. Hamstring flexibility as a risk factor for hamstring injury has not yet been examined prospectively in Gaelic games. Objective: To examine whether hamstring flexibility, using the modified active knee extension (AKE) test, and previous injury are risk factors for hamstring injury in Gaelic players and to generate population-specific AKE cutoff points. Design: Prospective cohort study. Setting: School and colleges. Patients (or Other Participants): Adolescent and collegiate Gaelic footballers and hurlers (n = 570). Intervention(s): The modified AKE test was completed at preseason, and hamstring injuries were assessed over the course of one season. Any previous hamstring injuries were noted in those who presented with a hamstring injury. Main Outcome Measures: Bilateral AKE scores and between-leg asymmetries were recorded. Receiver operating characteristic curves were implemented to generate cutoff points specific to Gaelic players. Univariate and backward stepwise logistic regression analyses were completed to predict hamstring injuries, hamstring injuries on the dominant leg, and hamstring injuries on the nondominant leg. Results: Mean flexibility of 64.2° (12.3°) and 64.1° (12.4°) was noted on the dominant and nondominant leg, respectively. Receiver operating characteristic curves generated a cutoff point of < 65° in the AKE on the nondominant leg only. When controlled for age, AKE on the nondominant leg was the only predictor variable left in the multivariate model (odds ratio = 1.03) and significantly predicted hamstring injury (χ2 = 9.20, P = .01). However, the sensitivity was 0% and predicted the same amount of cases as the null model. It was not possible to generate a significant model for hamstring injuries on the dominant leg (P > .05), and no variables generated a P value < .20 in the univariate analysis on the nondominant leg. Conclusions: Poor flexibility noted in the AKE test during preseason screening and previous injury were unable to predict those at risk of sustaining a hamstring strain in Gaelic games with adequate sensitivity.
Siobhán O Connor, Noel McCaffrey, Enda Whyte and Kieran Moran
Hamstring injuries are prevalent among team and field sport athletes, and poor flexibility has been theorized as a risk factor. The active knee extension test has been proposed as the gold standard for assessment of hamstring flexibility. Many variations of this test are employed, each of which utilizes a complex apparatus that is difficult to transport, time-consuming to set up, and often unavailable to most clinicians. Thus, a method that utilizes inexpensive and readily available equipment is needed for screening.
To establish the intertester and intratester reliability of a modified active knee extension test that requires minimal equipment.
Athletic therapy facilities.
Patients or Other Participants:
Fifteen male athletes (19.5 ± 0.6 years) free from any orthopedic or neurological disorders were recruited from a convenience sample of collegiate students.
Three testers participated in three training sessions before data collection. Participants completed three trials of the modified active knee extension test and returned the following week at the same time and day to repeat the process.
Main Outcome Measure(s):
The intraclass correlation coefficient (ICC), 95% confidence interval, and the standard error of measurement were calculated to assess inter- and intratester reliability.
High ICC values were found for intertester reliability (right leg = .98; left leg = .99) and intratester reliability (right leg = .78−.89; left leg = .79−.94).
The modified active knee extension test utilizes readily available equipment and offers a quick, reliable, and low-cost alternative for measurement of hamstring flexibility.