The reliability and validity development of an MSK profiling tool and its value in youth athletes and prospective injury risk

Parry, GN

Abstract

This work documents the development of a clinically feasible MSK qualitative profiling tool, and its subsequent application in adolescent athletes to improve profiling practise and the potential future impact of injury burden and incidence.
Research started by critically evaluating the literature to establish the current rationals, frameworks and models that underpin injury “screening” and profiling philosophies. Issues were identified around understanding of the injury problem beyond reductionist medical modelling to that of complex systems approaches, that were impacting contemporary profiling and injury prevention strategies. It was also identified that there were inherent limitations in general profiling practises, terminology and clinical utility of laboratory-based protocols that were non-transferable to real-world practise.
Therefore, nine 2D kinematic parameters and a compound and component qualitative scoring system was analysed to develop a methodological protocol, based on a holistic complex systems approach that had acceptable validity and reliability, but did not compromise on clinical utility. Significant correlations were found between the qualitative analysis and 2D kinematic measures at the trunk, hips and knees, along with moderate to excellent within and between session and intra-rater reliability. Indicating the QASLS tool is a valid and reliable field-based method of analysing movement quality, but recommendations included further refinement of statistical exploration and application into additional populations.
The following chapters built on the findings of the methodology and key learnings from the literature review to explore the application of the profiling tool in an adolescent population, where growth and maturation are a potential intricate driver to the movement quality complexity paradigm. Movement quality and performance of two unilateral loading tasks by and adolescent cohort demonstrated large movement variations with results suggesting that isolated evaluation of one kinematic parameter did not translate well into whole movement pattern evaluation, likely due to adolescent individual movement patterns being driven by numerous factors beyond one movement variable. Trends were observed between maturational groups with prepubertal athletes demonstrating greater variation and number
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of movement strategies to complete the same unilateral tasks than circa-PHV athletes, and landing tasks overall demonstrating greater movement variation than squatting. This cross- sectional work was further explored through investigation of adolescent task performance longitudinally over the course of an academic year and sporting season. Single-leg squat performance did not appear to change over the course of a season regardless of maturational status, however unilateral landing performance did.
Whilst overall compound QASLS score reflected a downward trend in the number of deployed strategies with advancing maturation, changes in landing performance between the start and mid and mid to end of season was observed in those at 85-95 PAH% - the time associated with the growth spurt – and start to end of season differences were noted in those between >96-100 PAH%. Consequently, findings suggest that practitioners who implement profiling tools in an adolescent population include a maturational measurement alongside, and apply a tool at multiple points through a year or season, rather than as a stand-alone pre-season measure. This ensures capture of movement quality that is potentially impacted by the growth spurt, and a more contextual inference of results. Correspondingly, QASLS component selection to complete either unilateral task demonstrated relationships to PAH%, it is recommended practitioners are mindful that certain observed movement strategies maybe relative to a phase of growth and not necessarily indicative of an intervention or movement correction requirement. Exploration of calculation methods highlighted the limitations of diminished insight into an individual’s movement bandwidth. This has important implications for the adolescent athlete that might be undergoing a natural change in their performance movement bandwidth.
Finally, an online education rater-training piece was developed to improve the overall inter- rater reliability of the QASLS tool for both the adult and adolescent populations. It is advised that rater training is completed in both specialist and none-specialist raters to improve levels of agreement and alignment to agreement of a criterion rater, to ensure the general robust application of the tool to improve profiling application and its utilisation overall.

Citation

Parry, G. The reliability and validity development of an MSK profiling tool and its value in youth athletes and prospective injury risk. (Thesis). University of Salford

• Thesis Type: Thesis
• Deposit Date: Oct 5, 2021
• Publicly Available Date: Oct 5, 2021
• Award Date: Jan 27, 2021