Real-time intersession and interrater reliability of the functional movement screen

Marker location and knee joint constraint affect the reporting of overhead squat kinematics in elite youth football players

Motion capture systems are used in the analysis and interpretation of athlete movement patterns for a variety of reasons, but data integrity remains critical regardless. The extent to which marker location or constraining degrees of freedom (DOF) in the biomechanical model impacts on this integrity lacks consensus. Ten elite academy footballers performed bilateral overhead squats using a marker-based motion capture system. Kinematic data were calculated using four different marker sets with 3DOF and 6DOF configurations for the three joint rotations of the right knee. Root mean squared error differences between marker sets ranged in the sagittal plane between 1.02 and 4.19 degrees to larger values in the frontal (1.30-6.39 degrees) and transverse planes (1.33 and 7.97 degrees). The cross-correlation function of the knee kinematic time series for all eight marker-sets ranged from excellent for sagittal plane motion (>0.99) but reduced for both coronal and transverse planes (<0.9). Two-way ANOVA repeated measures calculated at peak knee flexion revealed significant differences between marker sets for frontal and transverse planes (p < 0.05). Pairwise comparisons showed significant differences between some marker sets. Marker location and constraining DOF while measuring relatively large ranges of motion in this population are important considerations for data integrity.

Assessing injury risk in male and female Royal Navy recruits: does the Functional Movement Screen provide understanding to inform effective injury mitigation?

INTRODUCTION

Musculoskeletal injuries (MSKIs) are common during military and other occupational physical training programmes, and employers have a duty of care to mitigate this injury risk. MSKIs account for a high number of working days lost during initial military training, contribute to training attrition and impact training costs. Poorer movement quality may be associated with increased MSKI risk.

METHODS

The present study evaluated the relationship between the Functional Movement Screen (FMS) Score, as a measure of movement quality, and injury risk in Royal Navy (RN) recruits. A cohort of 957 recruits was assessed using the FMS prior to the 10-week phase I training programme. Injury occurrence, time, type and severity were recorded prospectively during the training period.

RESULTS

Total FMS Score was associated with injury risk (p≤0.001), where recruits scoring ≥13 were 2.6 times more likely to sustain an injury during training. However, FMS Score accounted for only 10% of the variance in injury risk (R2=0.1). Sex was the only additional variable to significantly affect the regression model. Mean FMS Scores for men (14.6±2.3) and women (14.4±2.4) were similar, but injury occurrence in women was 1.7 times greater than in men. Examining the influence of individual FMS movement tests on injury prediction did not improve the model, where those movements that significantly contributed to injury prediction only accounted for a small amount of the variance (R2=0.01).

CONCLUSION

There was a weak relationship between FMS and injury risk in RN recruits. Evidence is provided that FMS score alone would not be appropriate to use as an injury prediction tool in military recruits.

The Functional Movement Screen: Exploring Interrater Reliability between Raters in the Updated Version

Background

The Functional Movement Screen™ (FMS™) was updated by adding the ankle clearing test and modifying the rotary stability movement pattern and scoring criteria. This updated FMS™ may be used to support clinical decisions for the well-being of athletes and active adults.

Purpose

The purpose of this study was to determine if the updated FMS™ has acceptable interrater reliability, so that various practitioners can utilize it with their patients.

Study Design

Observational Laboratory Study.

Methods

Two licensed Physical Therapists (PTs) conducted the testing for the study. No warmup was allowed for the participants. Each participant underwent one FMS™ session while being recorded on video lasting approximately 15 minutes. Participants were allowed three attempts to complete each movement pattern with the best score recorded. The participants, 45 healthy active PT students, were taken through the FMS™ by a licensed PT and videotaped. The raters were four second-year PT students that observed and scored the FMS independently after videotaping was completed. SPSS was used for the interrater reliability analysis. ICC was calculated using a 2-way mixed model looking for absolute agreement.

Results

The interrater reliability was highest for the rotary stability test (ICC 0.96) while the deep squat was the least reliable (ICC 0.78). The total scores showed excellent reliability among the four student raters with an ICC of 0.95. The updated FMS™ produced good to excellent interrater reliability.

Conclusion

The updated FMS™ has acceptable interrater reliability between minimally, but adequately trained individuals. The updated FMS™ may be reliably used to assess risk for future injury.

Level of Evidence

3.

Three-Dimensional Motion Capture Data of a Movement Screen from 183 Athletes

Movement screens are widely used to identify aberrant movement patterns in hopes of decreasing risk of injury, identifying talent, and/or improving performance. Motion capture data can provide quantitative, objective feedback regarding movement patterns. The dataset contains three-dimensional (3D) motion capture data of 183 athletes performing mobility tests (ankle, back bend, crossover adduction, crossover rotation, elbows, head, hip turn, scorpion, shoulder abduction, shoulder azimuth, shoulder rotation, side bends, side lunges and trunk rotation) and stability tests (drop jump, hop down, L-cut, lunge, rotary stability, step down and T-balance) bilaterally (where applicable), the athletes' injury history, and demographics. All data were collected at 120 Hz or 480 Hz using an 8-camera Raptor-E motion capture system with 45 passive reflective markers. A total of 5,493 trials were pre-processed and included in .c3d and .mat formats. This dataset will enable researchers and end users to explore movement patterns of athletes of varying demographics from different sports and competition levels; develop objective movement assessment tools; and gain new insights into the relationships between movement patterns and injury.

Effects of Core Stability Training on Functional Movement Patterns in Tennis Players

The aim of this study was to assess the effects of a six-week core stability training program on the fundamental movement pattern assessed using the Functional Movement Screen Test in tennis players. The study group consisted of 160 subjects (74 women, 86 men) with a mean age of 20.26 ± 1.55. The Functional Movement Screen Test (FMS™), as well as the core stability tests including the lateral trunk muscles endurance test (the side bridge test), the abdominal muscles endurance test and the trunk extensors muscle endurance test—were used to evaluate the effects of core stability training. Statistical analysis revealed significant differences in the FMS test scores before and after introducing a core stability exercise program. Initially, the average total score of the FMS test in female tennis players was 14.58 ± 2.91, and after core stability training it was 17.20 ± 1.68 (p < 0.001). In the male group, the total FMS test score was 14.44 ± 2.76 before and 16.91 ± 1.36 after (p < 0.001) in the final assessment. Additionally, statistically significant differences were observed in the core stability test scores before and after introducing a stabilisation training program. The results of the study showed that specific core strengthening exercises could improve the FMS test scores in adult tennis players. This may also have an influence on reducing injury risk in this group, although further studies would be required to test this.

Inter-Rater and Intra-Rater Reliability of Return-to-Work Screening Tests for UK Firefighters Following Injury

The aim of this study was to assess the inter-rater and intra-rater reliability of a return-to-work (RTW) screening test to be used on UK firefighters following injury. The inter rater and intra-rater reliability of eight tasks involved in a screening test was used to assess readiness to RTW for UK firefighters following injury. These tasks included the following: (1) putting on and removing a breathing apparatus set (BA), (2) a ladder lift simulation, (3) a ladder carry simulation, (4) a light portable pump (LPP) lift and carry simulation, (5) a hose run, (6) a ladder climb with leg lock, (7) a casualty evacuation and (8) a confined space crawl simulation. The inter-rater reliability between each individual screening task was interpreted as Excellent (ICC = 0.94-1.00) for eleven (68.75%) of the screening task videos and as Good (ICC = 0.75-0.88) for five (31.25%) of the screening task videos. Intra-rater reliability was interpreted as Excellent (ICC = 1) for twenty-six participants (74.3%), Good (ICC = 0.76-0.88) for eight participants (22.9%) and Moderate for one participant (2.8%). Due to the reliability of this screening test, it allows conclusions to be made from the results which can inform a RTW decision for a firefighter.

Comparison of machine learning classifiers for differentiating level and sport using movement data

The purposes of this study were to determine if 1) recurrent neural networks designed for multivariate, time-series analyses outperform traditional linear and non-linear machine learning classifiers when classifying athletes based on competition level and sport played, and 2) athletes of different sports move differently during non-sport-specific movement screens. Optical-based kinematic data from 542 athletes were used as input data for nine different machine learning algorithms to classify athletes based on competition level and sport played. For the traditional machine learning classifiers, principal component analysis and feature selection were used to reduce the data dimensionality and to determine the best principal components to retain. Across tasks, recurrent neural networks and linear machine learning classifiers tended to outperform the non-linear machine learning classifiers. For all tasks, reservoir computing took the least amount of time to train. Across tasks, reservoir computing had one of the highest classification rates and took the least amount of time to train; however, interpreting the results is more difficult compared to linear classifiers. In addition, athletes were successfully classified based on sport suggesting that athletes competing in different sports move differently during non-sport specific movements. Therefore, movement assessment screens should incorporate sport-specific scoring criteria.

The Relationship Between Functional Movement, Dynamic Stability, and Athletic Performance Assessments in Baseball and Softball Athletes

ABSTRACT

Stapleton, DT, Boergers, RJ, Rodriguez, J, Green, G, Johnson, K, Williams, P, Leelum, N, Jackson, L, and Vallorosi, J. The relationship between functional movement, dynamic stability, and athletic performance assessments in baseball and softball athletes. J Strength Cond Res 35(12S): S42-S50, 2021-Despite recent popularity, the relationship between movement quality and measures of athletic performance remains inconclusive. This investigation sought to clarify the relationships between measures of movement quality and measures of athletic performance in baseball and softball athletes. Thirty-eight National Collegiate Athletic Association Division I baseball (n = 23; age 20.00 ± 1.38 years, lower-extremity [LE] limb length 93.91 ± 4.37, upper-extremity [UE] limb length 92.37 ± 4.48) and softball (n = 15; age 19.93 ± 1.28 years, LE limb length 89.43 ± 4.67, UE limb length 84.61 ± 4.39) athletes completed the Functional Movement Screen (FMS) and the Y Balance Test for the lower and upper extremities (YBTLQ and YBTUQ, respectively). Performance assessments were proagility (PA), vertical jump (VJ), and rotational medicine ball throw to the right and left (RMTR and RMTL, respectively). No significant correlations were seen between any of the composite scores of movement quality and athletic performance in baseball athletes; shoulder mobility was weakly correlated with PA (rs = 0.442, p = 0.035). Composite FMS was negatively correlated with RMTR (rs = -0.753) in softball athletes. In addition, in softball athletes, RMTR was negatively correlated with in-line lunge (rs = -0.544, p = 0.04), trunk stability push-up (rs = -0.761, p = 0.002), anterior YBTLQ reach (r = -0.628), and posterolateral YBTLQ reach (r = -0.683); VJ was correlated with posterolateral YBTLQ reach (r = 0.531) and superolateral (SL) YBTUQ reach (r = 0.591), and PA was negatively correlated with posterolateral YBTLQ (r = -0.60) and SL YBTUQ reach (r = -0.557). The differences in correlations of movement quality and athletic performance between baseball and softball athletes suggest movement quality influences performance differently in female athletes and male athletes.

The Effect of a Functional Strength Training Intervention on Movement Quality and Physical Fitness in Adolescents

This study compared a 12 week Functional Strength Training (FST) program on functional movement and physical performance to typical physical education (PE) classes for middle school (MS) and high school (HS) students. We randomly assigned 266 participants (M age = 14.35, SD = 0.57 years; M height = 164.82, SD = 6.13 cm; M mass = 55.09, SD = 12.19 kg; M BMI = 20.11, SD = 3.54 kg/m²) into an FST or control group. The FST group trained in flexibility and stability, functional movement patterns, and health-related functional strength. The control group continued regular physical education (PE) classes. Each group trained three-times/week in 45 minute sessions for 12 weeks. Outcome measures included the Functional Movement Screen protocol and seven physical performance tests, assessed every four weeks over a 12 week period. We employed a mixed model ANOVA with Bonferroni post-hoc tests to examine differences between and within groups. Compared to the control group, the FST group significantly (p < 0.01) improved Functional Movement Screen total scores (25.7%), curl-ups (70.4%), pull-ups (281.6%), and flexibility (83.6%). We suggest including the FST program in the MS and HS PE curriculum.

Effect of body composition on Functional Movement Screen scores in elite youth male soccer players

BACKGROUND

The Functional Movement Screen (FMS) is a clinical assessment tool used to determine musculoskeletal dysfunctions and asymmetries in athletes.

OBJECTIVE

The aim of this study was to investigate whether FMS scores differed between elite youth male soccer players with low body fat percentage and those with normal body fat percentage and between those with and without a history of soccer injury.

METHODS

Fifty-three elite youth male soccer players were included in the study. The participants' injury histories were recorded, followed by body composition assessment and FMS tests. The participants were grouped according to body fat percentage and injury history for data analysis.

RESULTS

The mean age, weight and height of the participants were 17.11 ± 0.91 years, 68.78 ± 7.41 kg and 1.77 ± 0.57 meters, respectively. Comparisons of the groups according to body fat percentage and injury history revealed no differences in FMS scores (p> 0.05).

CONCLUSION

Lower body fat percentage did not confer an advantage or disadvantage to elite youth male soccer players in terms of FMS scores FMS scores provide limited information to predict injuries in elite youth male players.

Item-level and Composite-level Interrater Reliability of Functional Movement Screen™ Scores Following Condensed Training in Novice Raters

BACKGROUND

The Functional Movement Screen™ (FMS™) is a clinical instrument designed to use movement behaviors to screen individuals for injury risk. Current rater certification programs focus on extensive, individualized training, which may not be appropriate in all screening contexts.

PURPOSE

The purpose of this research was to examine the effect of a two-hour FMSTM training seminar on measures of reliability between previously untrained scorers.

STUDY DESIGN

Repeated measures, descriptive cohort study.

METHODS

Four novice raters completed a two-hour training course administered by an FMS™-certified, licensed physical therapist. The novices and the instructor then scored a group of 16 individuals on the seven FMS™ component tests on two separate occasions. Interrater reliability was assessed for FMS™ component scores using Fleiss' kappa and Krippendorff's α. Interrater reliability for the FMS™ composite score was assessed using a two-way ICC for agreement (a priori significance level=0.05).

RESULTS

Reliability ranged from fair to almost perfect (kappa) for Deep Squat (0.61 Day 1, 0.79 Day 2), Shoulder Mobility (0.90 Day 1, 1.00 Day 2), Active Straight Leg Raise (0.53 Day 1, 0.69 Day 2), and Trunk Stability Push Up (0.48 Day 1, 0.49 Day 2) on both testing occurrences (p<0.05). Reliability (kappa) was fair for Inline Lunge (0.24 Day 1, 0.39 Day 2), and poor for Hurdle Step (Day 1 -0.01, Day 2 no result) and Rotary Stability (Day 1 -0.03, Day 2 -0.01). Results for Krippendorff's α were similar, with unacceptable interrater reliability for Hurdle Step (Day 1 -0.01, Day 2 1.00), Inline Lunge (Day 1 0.31, Day 2 0.39), and Rotary Stability (Day 1 -0.02, Day 2 -0.01). Interrater composite score reliability (ICC) was good (0.79 Day 1, 0.84 Day 2; both p<0.05).

CONCLUSIONS

Findings suggest that a brief training seminar may be sufficient to ensure acceptable reliability in many, but not all, of the FMS™ component tests and composite score.

LEVELS OF EVIDENCE

Level 2b.

Reliability and Validity of the Functional Movement Screen™ with a Modified Scoring System for Young Adults with Low Back Pain

Background

Low back pain (LBP) is one of the most common complaints in individuals who seek medical care and is a leading cause of movement impairments. The Functional Movement Screen (FMS™) was developed to evaluate neuromuscular impairments during movement. However, the reliability and validity of the FMS™ have not yet been established for the LBP population because of a limitation of its original scoring system.

Purpose

The purposes of this study were to determine the reliability and validity of the FMS™ with a modified scoring system in young adults with and without LBP. The FMS™ scores were modified by assigning a zero score only when there was an increase in LBP during the FMS™, not simply for the presence of pain, as in the original FMS™ scoring system.

Study Design

Reliability and validity study.

Methods

Twenty-two participants with LBP (8 males and 14 females, 26.7 ± 4.68 years old) and 22 age- and gender-matched participants without LBP (26.64 ± 4.20 years old) completed the study. Each participant performed the FMS™ once while being scored simultaneously and independently by two investigators. In addition, each participant's FMS™ performance was video-recorded and then was scored by another two investigators separately. The video-recorded performance also was scored twice six weeks apart by the same investigator to determine intra-rater reliability.

Results

The results showed excellent inter-rater and intra-rater reliability of the FMS™ composite score with intraclass correlation coefficients ranging from 0.93 to 0.99 for both groups. In addition, the LBP group scored significantly lower than the group without LBP (p = 0.008).

Conclusions

The results indicate that the FMS™ is able to distinguish between individuals with and without LBP, and that it could be a useful test for clinicians to quantify movement quality and to assess movement restrictions in individuals with LBP.

Levels of Evidence

2b.

Prior Knowledge of the Grading Criteria Increases Functional Movement Screen Scores in Youth Soccer Players

ABSTRACT

Bryson, A, Arthur, R, and Easton, C. Prior knowledge of the grading criteria increases Functional Movement Screen scores in youth soccer players. J Strength Cond Res 35(3): 762-768, 2021-We sought to determine whether familiarity with the grading criteria of the Functional Movement Screen (FMS) impacted the outcome score in elite youth soccer players. Thirty-two trained male youth soccer players (aged 17 ± 1 years) participated in a randomized control trial. Subjects were randomly assigned to evenly sized control and experimental groups, who each completed the FMS on 2 separate occasions. Subjects in the experimental group were provided the FMS grading criteria between their first and second screens. Time-synchronized video footage was used to grade the FMS using standardized criteria. Structured interviews were then conducted with selected subjects (n = 4) in the experimental group to establish athletes' perception of the FMS. The experimental group had a large increase in overall FMS score from the first to the second screen in comparison with the control group (Δ2.0 ± 1.0, p < 0.001, d = 1.3). Scores for the deep squat, hurdle step, and rotary stability tests components of the FMS all increased in the experimental group in comparison with the control group (p < 0.05). Thematic analysis of the interview data suggested that the subjects in the experimental group improved their understanding between good and poor technique during the FMS. These findings support the notion that FMS scores are influenced by awareness of the grading criteria. As a consequence, the FMS may not be suitable for objectively predicting injury in youth soccer players.

Differences of quadriceps activity during inline lunge by using FMS assessment

[Purpose] This study assessed the exercise capacity of healthy adults while performing the inline lunge exercise by using Functional Movement Screen (FMS). Compared the difference in muscle activity of the quadriceps according to the exercise capacity. [Participants and Methods] Thirty two healthy participants (12 males, 20 females) participated in this study. The surface electromyography (sEMG) was used to measure the electrical activities for the vastus medialis (VM), rectus femoris (RF), vastus lateralis (VL) of quadriceps. [Results] Both groups had significant difference when sitting up and getting up during the inline lunge. In scores 3 group, vastus medialis showed higher muscle activity than vastus lateralis. On contrary, in scores 2 group, vastus lateralis had higher muscle activity than vastus medialis. [Conclusion] Therefore, this study suggests that inline lunge can help to strengthen the quadriceps effectively by showing the difference of quadriceps activity according to exercise capacity.

Reliability assessment of the functional movement screen for predicting injury risk in Japanese college soccer players

[Purpose] This study aimed to assess the reliability of the Functional Movement Screen and explore whether this evaluation tool can predict the risks of personal injuries in Japanese soccer players. [Participants and Methods] Seventy-five Japanese college soccer players who participated in our 1 year prospective cohort study underwent a Functional Movement Screen assessment. Demographic data, athletic characteristics, and types and frequency of injuries sustained, were analyzed with the assessment results. [Results] There was no significant difference in the mean Functional Movement Screen composite scores between genders. Although the Functional Movement Screen showed excellent inter-rater reliability (0.92), low overall internal consistency (0.35) was observed. A maximum score of 3 in straight leg raise occurred in 94% of the females and was considered a ceiling effect. None of the cut-off point scores of the Functional Movement Screen were associated with the number of overall injuries, lower limb injuries, and traumatic injuries, or time to return to play. The Functional Movement Screen composite score of ≤15 represented the maximum sensitivity of 76.92% and specificity of 34.78% with 0.56 in the area under the curve. [Conclusion] Functional Movement Screen composite scores do not have sufficient sensitivity and specificity for predicting injuries in Japanese college soccer players.

Classifying Elite From Novice Athletes Using Simulated Wearable Sensor Data

Movement screens are frequently used to identify differences in movement patterns such as pathological abnormalities or skill related differences in sport; however, abnormalities are often visually detected by a human assessor resulting in poor reliability. Therefore, our previous research has focused on the development of an objective movement assessment tool to classify elite and novice athletes’ kinematic data using machine learning algorithms. Classifying elite and novice athletes can be beneficial to objectively detect differences in movement patterns between the athletes, which can then be used to provide higher quality feedback to athletes and their coaches. Currently, the method requires optical motion capture, which is expensive and time-consuming to use, creating a barrier for adoption within industry. Therefore, the purpose of this study was to assess whether machine learning could classify athletes as elite or novice using data that can be collected easily and inexpensively in the field using inertial measurement units (IMUs). A secondary purpose of this study was to refine the architecture of the tool to optimize classification rates. Motion capture data from 542 athletes performing seven dynamic screening movements were analyzed. A principal component analysis (PCA)-based pattern recognition technique and machine learning algorithms with the Euclidean norm of the segment linear accelerations and angular velocities as inputs were used to classify athletes based on skill level. Depending on the movement, using metrics achievable with IMUs and a linear discriminant analysis (LDA), 75.1–84.7% of athletes were accurately classified as elite or novice. We have provided evidence that suggests our objective, data-driven method can detect meaningful differences during a movement screening battery when using data that can be collected using IMUs, thus providing a large methodological advance as these can be collected in the field using sensors. This method offers an objective, inexpensive tool that can be easily implemented in the field to potentially enhance screening, assessment, and rehabilitation in sport and clinical settings.

Machine Learning and Deep Neural Network Architectures for 3D Motion Capture Datasets

Biomechanical movement data are highly correlated multivariate time-series for which a variety of machine learning and deep neural network classification techniques are possible. For image classification, convolutional neural networks have reshaped the field, but have been challenging to apply to 3D movement data with its intrinsic multidimensional nonlinear correlations. Deep neural networks afford the opportunity to reduce feature engineering effort, remove model-based approximations that can introduce systematic errors, and reduce the manual data processing burden which is often a bottleneck in biomechanical data acquisition. What classification techniques are most appropriate for biomechanical movement data? Baseline performance for 3D joint centre trajectory classification using a number of traditional machine learning techniques are presented. Our framework and dataset support a robust comparison between classifier architectures over 416 athletes (professional, college, and amateur) from five primary and six non-primary sports performing thirteen non-sport-specific movements. A variety of deep neural networks specifically intended for time-series data are currently being evaluated.

The 9+ screening test score does not predict injuries in elite floorball players

We aimed to examine whether the 9+ screening test score could predict injuries in elite floorball players. Eighty-four elite floorball players participated in the study. At baseline, two physiotherapists assessed the participants using the 9+ screening test. The test score reflects strength, stability, mobility, and functional movement pattern with an emphasis on the lower body and core. Injuries that occurred the following season (2013/2014) were recorded by medical staff, coaches, and/or self-reported by the players. Overall, there was no relationship between the 9+ screening test score and injury risk (OR = 0.96 per SD lower test score, P = .84). We, therefore, conclude that the 9+ screening test is not suited for overall injury risk prediction in elite floorball players. Whether the test may be used to predict risk of certain injury types more strongly related to inadequate mobility and strength (eg, muscle ruptures or strains) warrants further investigation.

Are Functional Movement Screen Tests Performed at the Right Time, if It Is an Injury Risk Predictor?

CONTEXT

Sports injuries are more common when players are fatigued and occur more frequently at the end of matches; therefore, determining the right time for employing an injury screening test is important.

OBJECTIVE

To determine the role of timing (prematch vs postmatch fatigue) on the functional movement screen (FMS) scores, a frequently used injury risk screening method.

DESIGN

Cross-sectional study.

SETTING

Field.

PARTICIPANTS

Twenty-four women soccer players from a professional team were included.

MAIN OUTCOME MEASURES

The players were evaluated with a visual analog scale for perceived fatigue and with the FMS. Assessments were conducted before and after a 60-minute match.

RESULTS

The subtest scores for deep squat, hurdle line, in-line lunge, trunk stability push-up, and the total FMS scores showed a significant decrease following the match (P < .05). Compared with prematch, the number of players who could achieve the highest score of 3/3 postmatch was lower for all subtests except right shoulder mobility.

CONCLUSIONS

Our results suggest a negative relationship between perceived fatigue level and performance on the deep squat, hurdle line, in-line lunge, and trunk stability push-up subtest scores and in the total FMS score. Therefore, the authors suggest that screening tests such as the FMS should be employed following a match when players present with fatigue.

Accuracy of Functional Movement Screen Deep Squat Scoring and the Influence of Optimized Scoring Criteria: A 3-Dimensional Kinematic Approach

CONTEXT

The deep squat (DS) test is a component of the functional movement screen, which is used to assess the quality of fundamental movement patterns; however, the accuracy of the DS has not been studied. The DS is a complex, total body movement pattern with evaluation required at several points along the kinematic chain.

OBJECTIVE

To assess the accuracy of DS scoring by an athletic trainer, physical therapist, and exercise science professional via a comparative analysis with kinematic data (KD) and to identify scoring criteria that would improve agreement between raters and KD scores.

DESIGN

Cross-sectional study.

SETTING

Motion analysis laboratory.

PARTICIPANTS

A rater from each of 3 movement science disciplines rated the DS of 23 male college athletes (20.3 [1.2] y; 70.5 [3.5] kg).

INTERVENTIONS

Subjects were outfitted with reflective markers and asked to perform the DS. The DS performance was scored by 3 raters and kinematic analysis. Subsequently, the optimal set of criteria that minimized the difference between mode rater score and KD was determined via a Nelder-Mead simplex optimization routine.

MAIN OUTCOME MEASURES

Intraclass correlation coefficients (ICCs) were calculated using SPSS (version 23; IBM, Armonk, NY) to determine tester agreement with the KD score and between the mode score and KD score.

RESULTS

Agreement was poor for the athletic trainer (ICC = .387), physical therapist (ICC = .298), exercise science professional (ICC = .378), and raters' DS scores when compared with the KD. Agreement was poor for the mode score when compared with KD prior to optimization and good following optimization (ICC = .830), thereby allowing identification of specific scoring errors.

CONCLUSIONS

Agreement for DS scores is poor when compared with KD; however, it may be improved with optimization of DS scoring criteria.

Assessment instruments of movement quality in patients with non-specific low back pain: A systematic review and selection of instruments

BACKGROUND

Observing and analyzing movement quality (MQ) in patients with non-specific low back pain (NS-LBP) is important in the clinical reasoning of primary care physiotherapists and exercise therapists. However, there is no standardized form of assessment.

RESEARCH QUESTION

which MQ domains are measured with which instruments, and which activities are relevant, appropriate and methodologically sound for assessing MQ in patients with NS-LBP?

METHODS

The study had three phases. In phase 1 we conducted a systematic review in PubMed, CINAHL and SPORTDiscus of literature published until October 2018. The selected studies measured MQ domains with instruments that enabled us to 1) compare MQ in self-paced dynamic activities of patients with NS-LBP and healthy controls, and/or 2) determine change over time of MQ in patients with NS-LBP. In phase 2 we established relevant dynamic activities to assess in patients with NS-LBP. In phase 3 we determined appropriateness and methodological qualities of the selected instruments.

RESULTS

Thirty cross-sectional and three pre-post-test studies were eligible. The instruments consisted of complex (n = 19) and simple (n = 7) instrumented motion analysis systems and standardized observational tests (n = 7). We identified three domains representative for MQ: range of motion (ROM), inter-segmental coordination, and whole-body movements. In these domains, patients with NS-LBP significantly differed from healthy controls, respectively 7/12, 12/13 and 13/20 studies. Moreover, ROM and whole-body movements significantly improved over time in patients with NS-LBP (3/3 studies). Based on phase 3, we concluded that none of the instruments are appropriate to assess MQ in patients with NS-LBP in primary care.

SIGNIFICANCE

Forward bending, lifting, and walking seem the most relevant activities to evaluate in patients with NS-LBP. However, we found no suitable instruments to measure ROM, inter-segmental coordination, or whole-body movements as determinants of MQ in these activities in daily practice. We therefore recommend such an instrument be developed.

Development and Reliability of an Athlete Introductory Movement Screen for Use in Emerging Junior Athletes

PURPOSE

A novel 4-task Athlete Introductory Movement Screen was developed and tested to provide an appropriate and reliable movement screening tool for youth sport practitioners.

METHODS

The overhead squat, lunge, push-up, and a prone brace with shoulder touches were selected based on previous assessments. A total of 28 mixed-sport junior athletes (18 boys and 10 girls; mean age = 15.7 [1.8] y) completed screening after viewing standardized demonstration videos. Athletes were filmed performing 8 repetitions of each task and assessed retrospectively by 2 independent raters using a 3-point scale. The primary rater reassessed the footage 3 weeks later. A subgroup (n = 11) repeated the screening 7 days later, and a further 8 athletes were reassessed 6 months later. Intraclass correlation coefficients (ICC), typical error (TE), coefficient of variation (CV%), and weighted kappa (k) were used in reliability analysis.

RESULTS

For the Athlete Introductory Movement Screen 4-task sum score, intrarater reliability was high (ICC = .97; CV = 2.8%), whereas interrater reliability was good (intraclass correlation coefficient = .88; CV = 5.6%). There was a range of agreement from fair to almost perfect (k = .31-.89) between raters across individual movements. A 7-day and 6-month test-retest held good reliability and acceptable CVs (≤ 10%) for sum scores.

CONCLUSION

The 4-task Athlete Introductory Movement Screen appears to be a reliable tool for profiling emerging athletes. Reliability was strongest within the same rater; it was lower, yet acceptable, between 2 raters. Scores can provide an overview of appropriate movement competencies, helping practitioners assess training interventions in the athlete development pathway.

Comprehensive movement system screening tool (MSST) for athletes: Development and measurement properties

OBJECTIVES

Non-traumatic extremity injuries are particularly common in sports, representing a significant economic, academic, and psychosocial burden on athletes. Proposed musculoskeletal risk factors for increased injury and decreased performance in athletes include movement pattern inefficiency, decreased regional stability, decreased mobility, and asymmetrical movement. The Movement System Screening Tool (MSST) is a comprehensive screening tool designed to assess these factors. Thus, the purpose of this study was to describe the development and determine the content and construct validity and inter-rater reliability of the MSST.

METHODS

A modified Delphi panel of experts determined content validity. 80 athletes (40 with and 40 without a current non-traumatic shoulder injury) completed 21 clinical tests, with exploratory factor analysis and known group analysis performed to determine construct validity. Two independent raters were used to establish individual item and composite score inter-rater reliability.

RESULTS

Exploratory factor analysis identified three of the four apriori constructs over 7 factors (14 tests), representing 63% of the variance. Known group analysis revealed a significantly lower composite score in athletes with vs. without a current non-traumatic shoulder injury (56.9±5.8 vs. 62.7±4.5, respectively). A preliminary cut score of 62 was chosen with sensitivity of 85% and specificity of 44%. Composite score inter-rater reliability was excellent ICC _(2,1)=0.94, 95% CI (0.91, 0.96) and item reliability ranged from κ=.57 to 1.00.

CONCLUSIONS

The MSST possesses constructs representative of injury risk and measurement properties acceptable for use in clinical settings. Comprehensive screens with construct validity and known measurement error are needed not only to identify athletes at risk of injury, but also provide an instrument that can be used in studies that seek to validate training approaches proposed to change movement impairment and injury risk in athletes.

Association between motor competence and Functional Movement Screen scores

Background

Motor competence (MC) is generally used to describe a person’s proficiency in a variety of motor skills and is the basis for one’s performance in sports and recreational activities. Functional Movement Screen (FMS^TM) is one of the most used screening systems to provide interpretable measure of movement quality. Both FMS^TM and MC constructs share three components: locomotor, manipulative and stabilizing movements. In the present study, it was hypothesized that MC scores can explain FMS^TM variables. It was also predicted that better MC leads to better functional movement patterns in young adults.

Methods

A sample of 92 young adults (73.9% men) with a mean age of 21.2 years participated in this study. All participants were evaluated on anthropometric measurements, dual x-ray absorptiometry; FMS^TM and MC.

Results

Men showed better MC scores and fat mass composition than women. Regarding specific tests, women scored higher in the FMS^TMactive straight leg raise test, whereas men performed better in the FMS^TM trunk stability push-up (TSP) test. Manipulative tasks and construct presents’ significant and positive associations with FMS^TM composite score (r ≥ 0.303). The significant negative correlation were more related to FMS^TM TSP and MC shuttle run and FMS^TM in-line lunge and MC manipulative. The FMS^TM TSP presents significant associations with all MC constructs and tasks. Meanwhile, the FMS^TM composite score is associated with all components of MC Stability (p < 0.05). In young adults, and independent of gender, the FMS^TMexplains fundamental movements based on motor control according to the stability construct. Moreover, the FMS^TM TSP is associated with better performance in the all MC constructs and MC tasks. The FMS^TM, on its own, is linked to objective MC stability measures.

RELIABILITY of a MOVEMENT QUALITY ASSESSMENT TOOL to GUIDE EXERCISE PRESCRIPTION (MOVEMENTSCREEN)

BACKGROUND/PURPOSE

Movement quality is commonly assessed to identify movement limitations and guide exercise prescription. Rapid growth in the movement assessment landscape has led to the development and utilization of various movement quality assessments, many without reliability estimates. MovementSCREEN is a novel, tablet-based, video-recorded movement assessment tool, currently without published reliability information. Therefore, the purpose of this study was to determine the intra and inter-rater reliability of the MovementSCREEN, including the impact of rater experience, and provide estimates of measurement error and minimal detectable change.

STUDY DESIGN

Cross-sectional design; reliability study.

METHODS

Thirty healthy young adults (14M:16F, mean age 28.4 yrs, SD 9.1) were video recorded completing the nine MovementSCREEN assessment items on two occasions, two weeks apart. Each individual movement was assessed against objective scoring criteria (component items: yes/no) and using a 100-point sliding scale. To create an overall score for each movement, the scale score is weighted against the objective items to provide a score out of 100. At the completion of all nine individual movements, a mean composite score of movement quality is also established (0-100). The first recording was scored twice by two expert and two novice assessors to investigate inter- and intra-rater reliability. The second recording was scored by one expert assessor to investigate within-subject error. Inter- and intra-rater reliability was calculated using intraclass correlation coefficients (ICCs) and Kappa statistics. The standard error of measurement (SEM), and minimal detectable change (MDC95) for the overall score for each movement, and the composite score of movement quality, were calculated.

RESULTS

Intra-rater reliability for the component items ranged from κ = 0.619 - 1.000 (substantial to near perfect agreement) and 0.233 - 1.000 (slight to near perfect agreement) for expert and novice assessors, respectively. The ICCs for the overall movement quality scores for each individual movement ranged from 0.707 - 0.952 (fair to high) in expert and 0.502 - 0.958 (poor to high) in novice assessors. Inter-rater agreement for the component items between expert assessors ranged from κ = 0.242 - 1.000 (slight to almost perfect agreement), while for novice assessors ranged from 0.103 - 1.000 (less than chance to almost perfect agreement). ICCs for the overall scores for each individual movement from expert and novice assessors ranged from 0.294 - 0.851 (poor to good) and 0.249 - 0.775 (poor to fair), respectively. The SEM for the composite score was 2 points, while the MDC95 was 6 points, with an ICC 0.901.

CONCLUSIONS

The MovementSCREEN can assess movement quality with fair to high reliability on a test-retest basis when used by experienced assessors, although reliability scores decrease in novice assessors. Comparisons between assessors involve greater error. Therefore, the training of inexperienced assessors is recommended to improve reliability.

LEVEL OF EVIDENCE

2b.

Effects of Functional Strength Training Program on Movement Quality and Fitness Performance Among Girls Aged 12-13 Years

Liao, T, Li, L, and Wang, YT. Effects of functional strength training program on movement quality and fitness performance among girls aged 12-13 years. J Strength Cond Res 33(6): 1534-1541, 2019-The purpose of this study is to evaluate the effects of a 12-week intervention of functional strength training (FST) on movement quality and fitness performance among 12- to 13-year-old untrained girls. One hundred forty-four girls (age 12.47 ± 0.57 years) were randomly assigned to the FST group and traditional strength training (TST) group. The FST group underwent 10 functional movement corrective exercises in the first 6 weeks and 10 functional strength promotion exercises in the following 6 weeks, whereas the TST group did 10 TST exercises with progressive intensity in 12 weeks. The training was 3 times per week and 45 min per session for both groups. The subjects were tested at the beginning and at the end of the intervention on movement quality and fitness performance variables. To compare the 2 groups pretest vs. posttests, analysis of variance with mixed model analysis of variance, paired t-test and independent t-test, and 2 × 2 contingency chi-squared analysis were used. The main time-by-group interaction effect of the total score of Functional Movement Screen (FMS) showed FST group significantly better than TST group explicitly (p ≤ 0.05). Differences between groups were detected for individual components in FMS test, injury-related problem items of FMS, and fitness performance variables. Although TST group increased the muscular strength significantly (p ≤ 0.05), the FST group has significant improvements on more variables such as deep squat and trunk stability, muscular strength, flexibility, and power (p ≤ 0.05). In comparison with TST program, FST program may be more effective on the improvements of movement quality, muscular strength, flexibility, and power among untrained healthy girls aged 12-13 years, and may result in better health promotion and injury prevention as well.

The Influence of Corrective Exercises on Functional Movement Screen and Physical Fitness Performance in Army ROTC Cadets

Context: The functional movement screen (FMS) is a tool designed to identify limitations between sections of the body during fundamental movements. However, there is limited evidence on the effectiveness of corrective exercises to improve FMS scores. Objective: To examine the effects of individualized corrective exercises on improving FMS scores in Reserve Officers’ Training Corps cadets and to correlate these changes with physical fitness performance as established with the standard Army Physical Fitness Test (APFT). Design: Cluster randomized, cohort study. Setting: Controlled laboratory setting (FMS) and a field-based setting (APFT). Participants: Forty-four healthy, physically active cadets met all inclusion and exclusion criteria. Intervention: Participants were randomly assigned to the experimental (n = 24) or control (n = 20) group by cluster. Personalized intervention programs were developed through the FMS Pro360 system, a subscription-based software that generates corrective exercises based on individual FMS test scores. The experimental group performed the individualized programs 3 times per week for 4 weeks prior to morning physical training regime. The control group continued to participate in the standard warm-up drills as part of morning physical training. Main Outcome Measures: The dependent variables included the individual and composite FMS and APFT scores. Scores were reported and analyzed in several ways to determine the efficacy of corrective exercises. Results: Group FMS and APFT scores were similar at pretest. The experimental group had a significantly greater improvement in FMS composite score at 4 weeks post (U = 87; z = −3.83; P = .001; effect size = 1.33; 95% confidence interval, 0.69–1.98). No significant changes in APFT scores were found (U = 237.5, z = −0.33, P = .74). A nonsignificant weak correlation between the FMS and APFT scores (r = .25, P = .10) was found. Conclusion: Individualized corrective exercises improved FMS scores, but did not change physical fitness performance. FMS composite scores and APFT performance are not related.

Objectively Differentiating Movement Patterns between Elite and Novice Athletes

INTRODUCTION

Movement screens are frequently used to identify abnormal movement patterns that may increase risk of injury or hinder performance. Abnormal patterns are often detected visually based on the observations of a coach or clinician. Quantitative or data-driven methods can increase objectivity, remove issues related to interrater reliability and offer the potential to detect new and important features that may not be observable by the human eye. Applying principal component analysis (PCA) to whole-body motion data may provide an objective data-driven method to identify unique and statistically important movement patterns, an important first step to objectively characterize optimal patterns or identify abnormalities. Therefore, the primary purpose of this study was to determine if PCA could detect meaningful differences in athletes' movement patterns when performing a non-sport-specific movement screen. As a proof of concept, athlete skill level was selected a priori as a factor likely to affect movement performance.

METHODS

Motion capture data from 542 athletes performing seven dynamic screening movements (i.e., bird-dog, drop-jump, T-balance, step-down, L-hop, hop-down, and lunge) were analyzed. A PCA-based pattern recognition technique and a linear discriminant analysis with cross-validation were used to determine if skill level could be predicted objectively using whole-body motion data.

RESULTS

Depending on the movement, the validated linear discriminant analysis models accurately classified 70.66% to 82.91% of athletes as either elite or novice.

CONCLUSIONS

We have provided proof that an objective data-driven method can detect meaningful movement pattern differences during a movement screening battery based on a binary classifier (i.e., skill level in this case). Improving this method can enhance screening, assessment, and rehabilitation in sport, ergonomics, and medicine.

Utility of FMS to understand injury incidence in sports: current perspectives

The Functional Movement Screen (FMS) is a popular movement screen used by rehabilitation, as well as strength and conditioning, professionals. The FMS, like other movement screens, identifies movement dysfunction in those at risk of, but not currently experiencing, signs or symptoms of a musculoskeletal injury. Seven movement patterns comprise the FMS, which was designed to screen fundamental movement requiring a balance between stability and mobility. The 7 movement patterns are summed to a composite FMS score. For an instrument to have wide applicability and acceptability, there must be high levels of reliability, validity, and accuracy. The FMS is certainly a reliable tool, and can be consistently scored within and between raters. Although the FMS has high face and content validity, the criterion validity (discriminant and convergent) is low. Additionally, the FMS does not appear to be studying a single construct, challenging the use of the summed composite FMS score. The accuracy of the FMS in screening for injury is also suspect, with low sensitivity in almost all studies, although specificity is higher. Finally, within the FMS literature, the concepts of prediction and association are conflated, combined with flawed cohort studies, leading to questions about the efficacy of the FMS to screen for injury. Future research on the use of the FMS, either the composite score or the individual movement patterns, to screen for injury or injury risk in adequately powered, well-designed studies are required to determine if the FMS is appropriate for use as a movement screen.

Is There a Relationship Between the Functional Movement Screen, Star Excursion Balance Test, and Balance Error Scoring System?

OBJECTIVE

To evaluate associations between the Functional Movement Screen (FMS), Star Excursion Balance Test (SEBT), and Balance Error Scoring System (BESS) scores.

DESIGN

Correlational.

SETTING

College athletic training facilities.

PARTICIPANTS

Fifty-two intercollegiate athletes (men = 36 and women = 16) representing 8 sports and cleared for unrestricted sport participation.

INTERVENTIONS

Participants completed the FMS, SEBT, and BESS, in random order, during 1 testing session. Testing order was randomized to control for fatigue and learning effects.

MAIN OUTCOME MEASURES

Composite and item scores for the FMS, SEBT, and BESS.

RESULTS

A fair, negative correlation was found between FMS asymmetry and SEBT composite (r = -0.31, P = 0.03) scores. Fair, positive correlations were reported for FMS rotary stability task and SEBT anterior (r = 0.37-0.41, P ≤ 0.007) and posteromedial (r = 0.31, P = 0.03) reaches. Fair, negative correlations were reported for FMS deep squat and BESS single-leg firm (r = -0.33, P = 0.02), double-leg foam (r = -0.34, P = 0.02) and tandem foam (r = -0.40, P = 0.003), FMS inline lunge and BESS single-leg firm (r = -0.39, P = 0.004), FMS trunk stability pushup and tandem foam (r = -0.31, P = 0.025), and FMS composite and BESS single-leg firm (r = -0.37, P = 0.007). Little-to-no correlations were reported for remaining comparisons.

CONCLUSIONS

Results indicate that each instrument provides distinct information about function, with only small areas of overlap. Associations between the FMS asymmetry score and SEBT composite score may indicate a relationship between movement asymmetry and postural stability. Associations between the FMS deep squat and BESS foam tasks may be related to underlying neuromuscular control factors.

Automated Quantification of the Landing Error Scoring System With a Markerless Motion-Capture System

CONTEXT

  The Landing Error Scoring System (LESS) can be used to identify individuals with an elevated risk of lower extremity injury. The limitation of the LESS is that raters identify movement errors from video replay, which is time-consuming and, therefore, may limit its use by clinicians. A markerless motion-capture system may be capable of automating LESS scoring, thereby removing this obstacle.

OBJECTIVE

  To determine the reliability of an automated markerless motion-capture system for scoring the LESS.

DESIGN

  Cross-sectional study.

SETTING

  United States Military Academy.

PATIENTS OR OTHER PARTICIPANTS

  A total of 57 healthy, physically active individuals (47 men, 10 women; age = 18.6 ± 0.6 years, height = 174.5 ± 6.7 cm, mass = 75.9 ± 9.2 kg).

MAIN OUTCOME MEASURE(S)

  Participants completed 3 jump-landing trials that were recorded by standard video cameras and a depth camera. Their movement quality was evaluated by expert LESS raters (standard video recording) using the LESS rubric and by software that automates LESS scoring (depth-camera data). We recorded an error for a LESS item if it was present on at least 2 of 3 jump-landing trials. We calculated κ statistics, prevalence- and bias-adjusted κ (PABAK) statistics, and percentage agreement for each LESS item. Interrater reliability was evaluated between the 2 expert rater scores and between a consensus expert score and the markerless motion-capture system score.

RESULTS

  We observed reliability between the 2 expert LESS raters (average κ = 0.45 ± 0.35, average PABAK = 0.67 ± 0.34; percentage agreement = 0.83 ± 0.17). The markerless motion-capture system had similar reliability with consensus expert scores (average κ = 0.48 ± 0.40, average PABAK = 0.71 ± 0.27; percentage agreement = 0.85 ± 0.14). However, reliability was poor for 5 LESS items in both LESS score comparisons.

CONCLUSIONS

  A markerless motion-capture system had the same level of reliability as expert LESS raters, suggesting that an automated system can accurately assess movement. Therefore, clinicians can use the markerless motion-capture system to reliably score the LESS without being limited by the time requirements of manual LESS scoring.

Inter- and Intra-rater Reliability of the Athletic Ability Assessment in Subelite Australian Rules Football Players

Rogers, DK, McKeown, I, Parfitt, G, Burgess, D, and Eston, RG. Inter- and intra-rater reliability of the athletic ability assessment in subelite Australian rules football players. J Strength Cond Res 33(1): 125-138, 2019-The aim of this study was to determine the inter- and intra-rater rater reliability of the Athletic Ability Assessment (AAA) in subelite Australian Rules football (ARF) players. Eighteen male ARF players completed the AAA movement assessment (overhead squat, double lunge [left and right], single-leg Romanian deadlift [left and right], chin-up and push-up), on 2 occasions separated by 1 week. During the first movement assessment, players were filmed in the frontal and sagittal planes. Ten raters took part in the study (1 experienced rater and 9 novices) and were assigned in a quasirandom manner, to complete either (a) real-time assessment on 2 occasions, (b) real-time assessment on 1 occasion, or (c) video-based assessment on 2 occasions. When assessed in real-time, of the 7 component movements of the AAA, raters registered moderate or greater intrarater agreement on between 2 and 5 occasions. Intraclass correlation coefficients (ICCs) of between 0.50 and 0.61 for the AAA total score indicated poor real-time intrarater reliability for this variable. When assessed by video-recording, raters registered moderate or greater intrarater agreement on between 6 and 7 occasions. The ICC for total score ranged between 0.60 and 0.93. Overall poor interrater reliability was evident for AAA component movements regardless of whether it was assessed in real-time or from video. Findings suggest the AAA is most reliably used when assessed through video. It is recommended that if comparison between multiple raters is desired, a stringent training process be applied so that the interpretation of AAA scoring criteria is standardized across raters.

Performance of high school male athletes on the Functional Movement Screen™

OBJECTIVES

(1) Describe the performance of the Functional Movement Screen™ (FMS™) by reporting the proportion of adolescents with a score of ≤14 and the frequency of asymmetries in a cross-sectional sample; (2) explore associations between FMS™ to age and body mass, and explore the construct validity of the FMS™ against common postural stability measures; (3) examine the inter-rater and test-retest reliability of the FMS™ in adolescents.

DESIGN

Cross-sectional.

SETTING

Field-setting.

PARTICIPANTS

94 male high-school athletes.

MAIN OUTCOME MEASURE

The FMS™, Y-Balance Test (YBT) and Balance Error Scoring System (BESS).

RESULTS

The median FMS™ composite score was 16 (9-21), 33% of participants scored below the suggested injury risk cutoff composite score of ≤14, and 62.8% had at least one asymmetry. No relationship was observed between the FMS™ to common static/dynamic balance tests. The inter-rater reliability of the FMS™ composite score suggested good reliability (ICC = 0.88, CI 95%:0.77, 0.94) and test-retest reliability for FMS™ composite scores was good with ICC = 0.83 (CI 95%:0.56, 0.95).

CONCLUSIONS

FMS™ results should be interpreted cautiously with attention to the asymmetries identified during the screen, regardless of composite score. The lack of relationship between the FMS™ and other balance measures supports the notion that multiple screening tests should be used in order to provide a comprehensive picture of the adolescent athlete.

Influence of body mass index on movement efficiency among firefighter recruits

BACKGROUND

Previous research has demonstrated links between musculoskeletal injury risk and measures of obesity and movement efficiency among the firefighter population. However, the influence of obesity on movement efficiency among firefighter recruits remains uninvestigated.

OBJECTIVE

To investigate the influence of obesity on movement efficiency measures among firefighter recruits.

METHODS

Measures of obesity were collected among 73 male firefighter recruits. Participants were grouped into standard body mass index (BMI) categories (normal, overweight, obese). Differences in Total Functional Movement Screen (FMS) scores and Y-Balance Test (YBT) composite scores were examined between BMI categories. In addition, the relationships between measures of obesity and movement efficiency were also examined.

RESULTS

No significant differences in movement efficiency measures were identified between BMI categories (p > 0.05). However, significant bivariate correlations were identified between BMI (kg/m2) and Total FMS score (r = -0.235, p = 0.045), as well as between fat-free mass (FFM) and Total FMS score (r = -0.231, p = 0.049), when examined among all participants.

CONCLUSIONS

BMI may influence measures of movement efficiency among firefighter recruits to a lesser extent than among other previously examined populations. Future research should examine the influence of other unexamined physiological variables on movement efficiency.

Reliability, Validity, and Injury Predictive Value of the Functional Movement Screen: A Systematic Review and Meta-analysis

BACKGROUND

The Functional Movement Screen (FMS) is utilized by professional and collegiate sports teams and the military for the prevention of musculoskeletal injuries.

HYPOTHESIS

The FMS demonstrates good interrater and intrarater reliability and validity and has predictive value for musculoskeletal injuries.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A systematic review and meta-analysis were conducted using a computerized search of the electronic databases MEDLINE and ScienceDirect in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extracted relevant data from each included study were recorded on a standardized form. The Cochran Q statistic was utilized to evaluate study heterogeneity. Pooled quantitative synthesis was performed to measure the intraclass correlation coefficient (ICC) for interrater and intrarater reliability, along with 95% CIs, and odds ratios with 95% CIs for the injury predictive value for a score of ≤14.

RESULTS

Eleven studies for reliability, 5 studies for validity, and 9 studies for the injury predictive value were identified that met inclusion and exclusion criteria; of these, 6 studies for reliability and 9 studies for the injury predictive value were pooled for quantitative synthesis. The ICC for intrarater reliability was 0.81 (95% CI, 0.69-0.92) and for interrater reliability was 0.81 (95% CI, 0.70-0.92). The odds of sustaining an injury were 2.74 times with an FMS score of ≤14 (95% CI, 1.70-4.43). Studies for validity demonstrated flaws in both internal and external validity of the FMS.

CONCLUSION

The FMS has excellent interrater and intrarater reliability. Participants with composite scores of ≤14 had a significantly higher likelihood of an injury compared with those with higher scores, demonstrating the injury predictive value of the test. Significant concerns remain regarding the validity of the FMS.

Functional Movement Screen Scores and Physical Performance among Youth Elite Soccer Players

This study had two main objectives: (1) to determine if differences in Functional Movement Screen (FMS) scores exist between two levels of competition; and (2) to analyze the association between FMS individual and overall scores and physical performance variables of lower-limb power (jumps), repeated sprint ability and shot speed. Twenty-two Under 16 (U16) and twenty-six Under 19 (U19) national competitive soccer players participated in this study. All participants were evaluated according to anthropometrics, FMS, jump performance, instep kick speed and anaerobic performance. There were no significant differences in the individual FMS scores between competitive levels. There were significant negative correlations between hurdle step (right) and Running-based Anaerobic Sprint Test (RAST) power average (ρ = −0.293; p = 0.043) and RAST fatigue index (RAST FatIndex) (ρ = −0.340; p = 0.018). The hurdle step (left) had a significant negative correlation to squat jump (SJ) (ρ = −0.369; p = 0.012). Rotary stability had a significant negative correlation to RAST fatigue index (Right: ρ = −0.311; p = 0.032. Left: ρ = −0.400; p = 0.005). The results suggest that individual FMS scores may be better discriminants of performance than FMS total score and established minimal association between FMS scores and physical variables. Based on that, FMS may be suitable for the purposes of determining physical function but not for discriminating physical performance.

The Inter-rater Reliability of the Functional Movement Screen Within an Athletic Population Using Untrained Raters

Elias JE. The inter-rater reliability of the functional movement screen within an athletic population using untrained raters. J Strength Cond Res 30(9): 2591-2599, 2016-The functional movement screen (FMS) is a commonly used screening tool designed to identify restrictions to movement patterns and increased injury risk using 7 predesigned tests. The purpose of this study was to analyze the inter-rater reliability of scoring of the FMS using a group of "untrained" subjects. Additionally, the study also examined if clinical experience level had any effect on reliability. Twenty fully qualified Physiotherapists working at the English Institute of Sport, with elite athletes, volunteered to participate in the study. The group comprised both level 2 and level 3 physiotherapists based on clinical experience levels. Five elite athletes, free from injury, were recruited and videoed completing 6 of the 7 FMS tests using a 3 camera system. The videos were scored by each Physiotherapist using the standardized scoring sheet, as developed by Cook et al. Each practitioner marked each athlete completing the 6 tests. The total scores were calculated for each athlete (maximum score of 18). The inter-rater reliability of the test was shown to be high, intraclass coefficient 0.906. An independent t test showed no significant differences between the level 2 and level 3 practitioners in the total scores (p = 0.502). The results of the test indicate that the FMS is a reliable screening tool when used by untrained practitioners in determining faulty movement patterns and that clinical experience level does not affect the reliability, therefore it may be a useful tool in the screening of athletic populations.

The Reliability of Functional Movement Screening and In-Season Changes in Physical Function and Performance Among Elite Rugby League Players

This study aimed to (a) assess the reliability of the functional movement screening (FMS) protocol and (b) to establish changes in both FMS and tests of physical performance throughout a season. The reliability of the FMS components (12 in total) was assessed through a nonparametric statistical approach, based on 2 trials, separated by 1 week. Score on the FMS, strength (3 repetition maximum full squat, 1 repetition maximum [1 RM] bench press), running speed (10 and 40 m), and jump height of 12 elite male under-19 rugby league players was monitored at pre-, mid-, and late-season periods. There was no bias (p > 0.05) found between trials for the FMS, with the majority of components reaching 100% "perfect agreement," reflecting the good reliability of the FMS tool. There were no effects (p > 0.05) of season stage on any of the FMS components; however, an improvement (p ≤ 0.05) between the pre- and both mid- and late-season periods was apparent in every component of fitness, such as 1 RM bench press (112.92 ± 24.54 kg; 125.83 ± 21.41 kg; 125.98 ± 24.48 kg) and 40-m sprint time (5.69 ± 0.35 seconds; 5.62 ± 0.31 seconds; 5.64 ± 0.27 seconds). Our findings demonstrate that the FMS can be reliably administered to elite rugby league players but will not change in accordance with physical performance across a competitive season. Our findings should not necessarily deter practitioners from using the FMS but begin to question the specific qualities that are being assessed through its administration.

Interseason variability of a functional movement test, the 9+ screening battery, in professional male football players

BACKGROUND

The Nine Plus screening battery test (9+) is a functional movement test intended to identify limitations in fundamental movement patterns predisposing athletes to injury. However, the interseason variability is unknown.

AIM

To examine the variability of the 9+ test between 2 consecutive seasons in professional male football players.

METHODS

Asymptomatic Qatar Star League players (n=220) completed the 9+ at the beginning of the 2013 and 2014 seasons. Time-loss injuries in training and matches were obtained from the Aspetar Injury and Illness Surveillance Program. No intervention was initiated between test occasions.

RESULTS

A significant increase in the mean total score of 1.6 points (95% CI 1.0 to 2.2, p<0.001) was found from season 1 (22.2±4.1 (SD)) to season 2 (23.8±3.3). The variability was large, as shown by an intraclass correlation coefficient (ICC) of 0.24 (95% CI 0.11 to 0.36) and a minimal detectable change (MDC) of 8.7 points. Of the 220 players, 136 (61.8%) suffered a time-loss injury between the 2 tests. There was an improvement in mean total scores in the injured (+2.0±0.4 (SE), p<0.001) group but not in the uninjured group (+0.9±0.5, p=0.089). The variability from season 1 to season 2 was large both in the injured (ICC 0.25, 0.09 to 0.40, MDC 8.3) and uninjured (ICC 0.24, 0.02 to 0.43, MDC 9.1) groups.

CONCLUSIONS

The 9+ demonstrated substantial intraindividual variability in the total score between 2 consecutive seasons, irrespective of injury. A change above 8 points is necessary to represent a real change in the 9+ test between seasons.

Use of clinical movement screening tests to predict injury in sport

Clinical movement screening tests are gaining popularity as a means to determine injury risk and to implement training programs to prevent sport injury. While these screens are being used readily in the clinical field, it is only recently that some of these have started to gain attention from a research perspective. This limits applicability and poses questions to the validity, and in some cases the reliability, of the clinical movement tests as they relate to injury prediction, intervention, and prevention. This editorial will review the following clinical movement screening tests: Functional Movement Screen™, Star Excursion Balance Test, Y Balance Test, Drop Jump Screening Test, Landing Error Scoring System, and the Tuck Jump Analysis in regards to test administration, reliability, validity, factors that affect test performance, intervention programs, and usefulness for injury prediction. It is important to review the aforementioned factors for each of these clinical screening tests as this may help clinicians interpret the current body of literature. While each of these screening tests were developed by clinicians based on what appears to be clinical practice, this paper brings to light that this is a need for collaboration between clinicians and researchers to ensure validity of clinically meaningful tests so that they are used appropriately in future clinical practice. Further, this editorial may help to identify where the research is lacking and, thus, drive future research questions in regards to applicability and appropriateness of clinical movement screening tools.

Injury prediction in veteran football players using the Functional Movement Screen™

The Functional Movement Screen™ (FMS™) is aimed at assessing fundamental movements and is often used to identify players' injury risk. The purpose of this study was to determine whether the FMS™ can be used to predict injuries in veteran footballers (aged > 32 years). Eighteen veteran football teams (n = 238) were recruited and prospectively followed for 9 months. The players (44 ± 7 years; 178 ± 7 cm, 84 ± 11 kg) performed the FMS™ at the start of the study period. Players' exposure hours and injuries were recorded. The difference of FMS™ overall score between injured and uninjured players was not significant (11.7 ± 2.9 vs 12.2 ± 2.8 points; Mann-Whitney U-test P = 0.17). Players scoring <10 (score < 1 standard deviation [SD]) below the mean) had a significantly higher injury incidence (z-statistics P < 0.05) compared to an intermediate reference group (mean ± 1 SD; scores of 10-14). No lower injury incidence for players with scores of >14 (score > 1 SD above the mean) was found. Further analyses of potential risk factors suggest higher age, lower body mass and a longer football career to be risk factors for injuries. The findings of this study suggest that the suitability of the FMS™ for injury prediction in veteran footballers is limited.

The Functional Movement Screen and Injury Risk: Association and Predictive Value in Active Men

BACKGROUND

The Functional Movement Screen (FMS) is a series of 7 tests used to assess the injury risk in active populations.

PURPOSE

To determine the association of the FMS with the injury risk, assess predictive values, and identify optimal cut points using 3 injury types.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

Physically active male soldiers aged 18 to 57 years (N = 2476) completed the FMS. Demographic and fitness data were collected by survey. Medical record data for overuse injuries, traumatic injuries, and any injury 6 months after the FMS assessment were obtained. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated along with the receiver operating characteristic (ROC) to determine the area under the curve (AUC) and identify optimal cut points for the risk assessment. Risks, risk ratios (RRs), odds ratios (ORs), and 95% CIs were calculated to assess injury risks.

RESULTS

Soldiers who scored ≤14 were at a greater risk for injuries compared with those who scored >14 using the composite score for overuse injuries (RR, 1.84; 95% CI, 1.63-2.09), traumatic injuries (RR, 1.26; 95% CI, 1.03-1.54), and any injury (RR, 1.60; 95% CI, 1.45-1.77). When controlling for other known injury risk factors, multivariate logistic regression analysis identified poor FMS performance (OR [score ≤14/19-21], 2.00; 95% CI, 1.42-2.81) as an independent risk factor for injuries. A cut point of ≤14 registered low measures of predictive value for all 3 injury types (sensitivity, 28%-37%; PPV, 19%-52%; AUC, 54%-61%). Shifting the injury risk cut point of ≤14 to the optimal cut points indicated by the ROC did not appreciably improve sensitivity or the PPV.

CONCLUSION

Although poor FMS performance was associated with a higher risk of injuries, it displayed low sensitivity, PPV, and AUC. On the basis of these findings, the use of the FMS to screen for the injury risk is not recommended in this population because of the low predictive value and misclassification of the injury risk.