Examination of a Clinical Method of Assessing Postural Control During a Function
Examination of a Clinical Method of Assessing Postural Control During a Functional Performance Task
Abstract & Commentary
Synopsis: A test was developed that could be used to determine how much postural control an athlete has. A difference existed between balance scores but not landing scores.
Source: Riemann BL, et al. Examination of a clinical method of assessing postural control during a functional performance task. J Sport Rehabil 1999;8:171-183.
Functional testing uses such skills as the single-leg hop. This type of testing has become quite prevalent in orthopedics and sports medicine, particularly for athletes returning from a lower extremity injury. These tests mimic conditions inherent in sports, perhaps better than many other clinical tests. The purpose of this study was to assess a "multiple single-leg-hop stabilization test" (modified Bass test). Specifically, Riemann and colleagues wanted to develop a test that could be used clinically to determine how much postural control an athlete has during this test.
As implied in the title of the test, it used a numbered floor pattern, with each of the 11 positions marked by white tape and numbered. The athlete was instructed to jump from number to number, in sequence. Based on a pilot study, the marks were separated by 45% of the subject’s height.
Thirty recreational athletes were used—19 males and 11 females (mean age 21.23; mean height, 173.37 cm; mean weight, 73.36 kg). In addition, three separate testers were trained during a one-hour training session. Error scores were given for two categories: landing and balance. Landing errors were: not covering tape mark with foot, stumbling on landing, foot not facing forward "with 10° of inversion or eversion, and hands off hips." Balance error entailed: touching down with nondominant limb, nondominant limb touching dominant limb, nondominant limb moving into excessive flexion, extension, abduction, and hands off hips. The subjects were divided into two groups of 15 each. No descriptive data were given for each group. Group one performed the test three times, 48 hours apart. Group two performed the test only once. Interrater reliability was measured.
Results were mixed. A significant difference existed between balance scores but not landing scores. In addition, Riemann et al concluded that there was interrater reliability. Finally, the study indicated that a learning curve was occurring across the three sessions.
Comment by Clayton F. Holmes, EdD, PT, ATC
This study is an important attempt to identify a functional test that could be used in a clinical setting. In addition, the criteria designed are such that, with minimal skill acquisition, the test can be performed. Unfortunately, the only finding that was demonstrated was a learning curve across three sessions, which would be expected. Other findings are not compelling due to either poor design issues or analysis issues. For example, Riemann et al report that an a priori power level calculation was performed in order to determine sample size. Unfortunately, this depends on knowing a standard deviation for the population, which was clearly not available. In addition, it is not clear why the two groups were divided. Also, the study did not address interrater reliability. It is assumed that differences are related to learning effect. Clearly, it is impossible for one to determine interrater reliability until interrater has been addressed.
These flaws notwithstanding, the description of a functional test is elegant. This is the type of functional test that demands further research because of its ease of administration and potential to evaluate an athlete’s functional status.
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