The reliability of musculoskeletal screening tests used in cricket

doi:10.1016/j.ptsp.2007.09.004

Physical Therapy in Sport

Volume 9, Issue 1, February 2008, Pages 25-33

https://doi.org/10.1016/j.ptsp.2007.09.004 Get rights and content

Abstract

Objectives

To determine the inter- and intra-observer reliability of a field-based musculoskeletal screening protocol used to measure potential injury risk factors in cricket fast bowlers.

Design

Test–retest reliability study.

Setting

High performance Australian cricket.

Participants

Ten volunteers. Two sports physiotherapists conducted the testing.

Main outcome measures

Participants completed the following tests: knee extension; modified Thomas test (hip extension and abduction); hip internal and external rotation; combined elevation; ankle dorsiflexion lunge; bridging hold; prone four point hold; and calf heel raises.

Methods

For each of the tests, the participants were tested by each physiotherapist twice, and the inter- and intra-observer reliability were concurrently assessed.

Results

The inter-observer reliability of the tests was generally poor, with only four of the ten tests having an intraclass correlation coefficient (ICC) greater than 0.80 (range of ICCs 0.27–0.99). The intra-observer reliability of the tests was considerably higher, with nine tests having an ICC greater than 0.80 (range of ICCs 0.56–0.99).

Conclusions

With the exception of the bridging hold, all tests would be considered acceptable where only one observer was conducting the testing. However, only the ankle dorsiflexion lunge, combined elevation test, calf heel raise test and prone four point hold have acceptable reliability when there are multiple physiotherapists recording measurements.

Introduction

The development of successful sports injury prevention strategies relies on a solid evidence base. Sports injury prevention is a staged process which consists of a series of steps (Finch, 2006; van Mechelen, Hlobil, & Kemper, 1992). The second step involves developing an understanding of the aetiology of injury, which includes identifying intrinsic injury risk factors to understand why an athlete may be predisposed to injury (Bahr & Krosshaug, 2005; Finch, 2006).

Preparticipation (or baseline) screening is commonly used to measure potential intrinsic injury risk factors (DiFiori, 1999), by identifying characteristics of the musculoskeletal system that may predispose an athlete to injury, or to identify incomplete recovery from a previous injury. In prospective studies, measurements are made on uninjured athletes at the start of a playing season and these are related to injury outcomes during the course of the season.

This approach was taken with a prospective epidemiological study of 91 cricket fast bowlers. Studies have identified variations in technique, physical characteristics and workload as injury risk factors for this population. However, a limitation of prior studies is that many have used specialised equipment and laboratory facilities to test the fast bowlers, and the degree to which the testing procedures can be adopted in the cricket “real world” is unclear. The advantages of using a field-based screening protocol are that it can be conducted with easily obtainable and inexpensive equipment, as well as with a large number of athletes at multiple locations. Therefore, the aim of our earlier epidemiological study (Dennis, 2006) was to identify intrinsic risk factors for injury to fast bowlers using a field-based screening protocol, which included a musculoskeletal assessment.

A major issue encountered by studies of intrinsic risk factors, such as those described above, is the reliability of the screening measures used. The ability for studies to clearly identify injury risk factors is highly dependent on the accuracy with which measurements are made (Bahr & Holme, 2003), and it is vital that the screening protocols are reliable (Gabbe, Bennell, Wajswelner, & Finch, 2004; Harvey, 1998b). Measurements need to be reproducible over time and by different observers, as well as being repeatable within a given individual (Hayen, Dennis, & Finch, 2007). Poor reproducibility limits the ability of researchers to reach conclusions about whether a measured variable is indeed a risk factor for injury, because it is difficult to differentiate participants with or without the variable of interest if there is large random measurement error (Haas, 1995; Hayen et al., 2007).

Unfortunately, the reliability of many of the tests included in the musculoskeletal assessment of fast bowlers has not previously been established for this group of athletes. Therefore, this paper presents a reliability assessment of the tests, to inform the development of an appropriate field-based preparticipation musculoskeletal screening protocol for use in cricket and potentially in a range of other sports.

Section snippets

Development of the protocol

The screening protocol was developed in collaboration with a sports physiotherapist (PF, with 15 years of experience working with cricketers) and consisted of a number of tests measuring flexibility, strength, and stability. The majority of injuries reported among fast bowlers are to the back, trunk and lower limb (Dennis, Farhart, Goumas, & Orchard, 2003; Dennis, Finch, & Farhart, 2005; Orchard, James, Alcott, Carter, & Farhart, 2002), and hence the identification of injury risk factors for

Results

The inter-observer reliability of the tests is presented in Table 1 and the intra-observer reliability is shown in Table 2. Generally, the inter-observer reliability of the tests was low, with only four of the ten tests being considered almost perfect with an ICC greater than 0.80. The intra-observer reliability of the tests was considerably higher than inter-observer reliability, with nine tests in the category of almost perfect. The 95% CIs were wide, especially for inter-observer

Discussion

Pre-participation screening is a commonly used method for the collection of data relating to potential intrinsic risk factors. So that the data collected during these pre-participation screenings can be used to identify injury risk factors and subsequently inform the development of effective injury prevention strategies, it is vital that the screening protocols are reliable. This study has demonstrated that the intra-observer reliability of a musculoskeletal assessment used with cricket fast

Conclusions

Sports injury prevention requires a firm evidence base. An important component of this is the accuracy and reliability of measurements taken in studies attempting to identify risk factors for injury. This study has established the reliability of a screening protocol for fast bowlers to measure potential risk factors for injury; it also has implications for screening completed with athletes in other sports. All tests (except the bridging hold) would be considered acceptable where only one

Acknowledgements

RD was supported by an NHMRC Public Health PhD scholarship during the data collection and analysis phase, and by an NHMRC Population Health Capacity Building Grant in Injury Prevention, Trauma and Rehabilitation during the reporting and publication phase. CF was supported by an NHMRC Principal Research Fellowship. Funding for the project was provided by Cricket Australia. The authors wish to acknowledge the valuable contributions of Andrew Hayen, Andrew Nealon, Kate Watson, Kevin Sims, Danny

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Cronbach's alpha (Cα) revealed a mean result of high reliability for both iliopsoas (Cα = 0.95) and rectus femoris (Cα = 1.00) flexibility. TFL flexibility values ranged from 0.64 to 0.95, demonstrating some inconsistencies within some of the 6 raters. Fleiss kappa (Fк) revealed a high mean reliability result across the 3 testing sessions for both iliopsoas (Fк = 0.78) and rectus femoris (Fк = 0.80) flexibility, along with a moderate reliability mean result for TFL (Fк = 0.56).
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Increased hip internal rotation ROM on the dominant side was associated with injury This finding confirms previous research in cricket which found that fast bowlers with ipsilateral hip internal rotation of ≤30° were at a reduced risk of sustaining trunk, back and lower limb injury (Dennis, Finch, Elliott, et al., 2008). In addition, army recruits with an increased hip external and internal rotation ROM were more likely to develop exertional medial tibial pain (Burne et al., 2004).
To determine the musculoskeletal risk factors for injury amongst professional, domestic cricket players.
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Medical suites associated with the respective cricket franchises.
Professional, domestic cricket players (n = 97).
A pre-participatory musculoskeletal screening battery consisting of 21 tests including flexibility, neural tension, stability, strength, balance and pain provocation tests at the start of the cricket season. Non-contact, low back and lower limb (lower quarter) injuries were monitored throughout the season. Binary logistic regression and receiver operating curves were used to determine predictive value of each test.
During the course of the cricket season, 38 of the 97 (39.2%) cricketers sustained a non-contact low back and/or lower limb injury. Increased hip internal rotation ROM on the dominant side (OR = 1.065; p = 0.036), no symptoms on active slump dominant side (OR = 0.289; p = 0.014), decreased combined elevation (OR = 0.934; p = 0.029), increased shoulder internal rotation ROM on the non-dominant side (OR = 1.022; p = 0.035) and increased GIRD (glenohumeral internal rotation deficit) (OR = 1.026; p = 0.042) predicted in-season non-contact lower quarter injuries. Although statistically significant, none of these variables were strong predictors of injury as shown by the logistic regression models (accuracy in classification rate: 59.8–62.9%), the area under the curve (AUC) of the receiver operating characteristic (ROC) curves (AUC≤0.652) and the cut-off scores which revealed high sensitivity (68.4–86.8%), but low specificity (25.4–54.2%).
Although only a few of the many tests included in the battery showed predictive validity, the value of screening procedures should not be underestimated due to other benefits such as building patient rapport, identification of pre-existing injuries, establishing clinical and functional baselines upon which individualised management programmes can be based.
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To evaluate strength and flexibility measures pre- and post- Australian Football (AF) competition to determine their potential utility as secondary prevention measures.
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Semi-professional AF club.
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Maximal unilateral isometric knee flexion strength performed in 45 degrees of hip flexion and 30 degrees of knee flexion, flexibility measures of hip and knee extension and ankle dorsiflexion. All outcome measures were evaluated pre-match to determine baseline measurements and repeated acutely post-match and at 26, 50 and 74 h following. Comparisons were made between baseline measures and all other time points.
Knee flexion strength was significantly reduced at a group level acutely (−122.8N, 95%CI −156.2 to −89.4, p = 0.000) and at 26 h (−89.6N, 95%CI −122.9 to −56.2, p = 0.000) following competition. Hamstring flexibility was significantly reduced at all time periods following competition (all p < 0.05), however these values were not clinically meaningful.
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Original researchThe reliability of musculoskeletal screening tests used in cricket

Abstract

Objectives

Design

Setting

Participants

Main outcome measures

Methods

Results

Conclusions

Introduction

Section snippets

Development of the protocol

Results

Discussion

Conclusions

Acknowledgements

Australian Journal of Physiotherapy

Journal of Science and Medicine in Sport

Journal of Science and Medicine in Sport

Physical Therapy in Sport

Journal of Science and Medicine in Sport

Journal of Hand Therapy

Risk factors for sports injuries—A methodological approach

British Journal of Sports Medicine

Understanding injury mechanisms: A key component of preventing injuries in sport

British Journal of Sports Medicine

Joint range of motion and muscle length testing

Is bowling workload a risk factor for injury to Australian junior cricket fast bowlers?

British Journal of Sports Medicine

Overuse injuries in children and adolescents

The Physician and Sports Medicine

Original research
The reliability of musculoskeletal screening tests used in cricket