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Objective: To develop and evaluate the reliability and validity of a new observational Drinking Task Assessment (DTA) designed to assess quality of movement in task performance after stroke. Design: Reliability and validity. Methods: The DTA measures movement time and movement quality (smoothness, trunk, shoulder, elbow, and grasp movements) on a 4-level ordinal scale. Thirty participants with chronic stroke were assessed independently by 2 therapists. Intra-class correlation (ICC), standard error of measurement (SEM) and minimal real difference (MRD), weighted kappa, percentage of agreement, and Svensson method were used for reliability assessment. Motion capture-based kinematics and established clinical scales were used to evaluate validity. Results: The absolute SEM and MRD for movement time were 0.4 and 1 s (11%), respectively. The ICC (≥ 0.93) and weighted kappa (0.71–1.0) showed good to excellent agreement for intra- and inter-rater reliability. DTA showed strong correlations with Fugl–Meyer Assessment (0.74), Action Research Arm Test (0.93), and kinematic measures of smoothness (0.93), trunk displacement (0.91), elbow extension (0.73), and shoulder movements (0.56), indicating good construct validity. Conclusions: The new DTA proved to be a reliable and valid tool for assessment of movement quality during task performance after stroke.

Abstract Background Adequate movement control and quality can be prerequisite functions for performance of the lower extremity. The purposes of our work were 1) to explore the agreement of an efficient test battery assessing qualitative movement execution and 2) to determine its consistency with quantitative performance tests from the corresponding movement pattern. Methods The participants were professional male association football players competing in the first German Bundesliga. They performed four movement quality tests (Single-limb balance squat, Balance forward hop, Balance side hop, Balance 90° rotation hop) and the corresponding performance tests (Y-balance test, Forward hop for distance, Side hop test, Square hop test). Qualitative tests were judged by two experienced raters; the ratings were compared to determine inter-rater agreement using Kappa statistics. The relationship with the quantitative tests was determined using Spearman’s rank correlations. Results Thirty participants (19 to 33 years old) were included in this study. We found an at least substantial level of agreement (Cohen’s Kappa, 0.64-0.84) with an excellent percentage of exact (83-93%) agreement between the two raters for the movement quality tests. Our findings revealed that the quantitative test results are only slightly related to the movement quality outcomes (ρ(27) 0.2). Conclusions Consequently, the qualitative test results provide unique information and complement corresponding quantitative performance tests in professional football athletes. Their observational judgement of foot position, lower limb alignment and upper body control in sagittal, frontal, and transverse planes is agreeable.

Abstract Background The Single Leg Squat (SLS) test is widely used in the clinical setting to examine and evaluate rehabilitation goals. It is simple to perform and is proposed to have biomechanical and neuromuscular similarities to athletic movements. The aim of the present study was to investigate whether demographics, previous injuries, and biomechanical and psychosocial factors are associated with the outcome of the SLS, assessed as a total score for all segments and as a separate knee segment in elite and sub-elite female soccer players. Methods We conducted a cross-sectional study involving 254 female soccer players (22 yrs; SD ± 4, height 1.69 m; SD ± 0.1, weight 64 kg; SD ± 6) from divisions 1–3 of the Swedish Soccer League. During the preseason, we assessed the participants using the SLS and tested their hip strength and ankle mobility. Demographics, previous injury, sleep quality, fear of movement, anxiety, and perceived stress were assessed with questionnaires. Logistic regression models were built to analyse the association between the outcome of the SLS and the independent variables for the dominant and non-dominant leg. Results Significantly more participants failed the SLS on the dominant leg compared with the non-dominant leg (p

(1) Background: This study aimed to describe upper-limb (UL) movement quality parameters in women after breast cancer surgery and to explore their clinical relevance in relation to post-surgical pain and disability. (2) Methods: UL movement quality was assessed in 30 women before and 3 weeks after surgery for breast cancer. Via accelerometer data captured from a sensor located at the distal end of the forearm on the operated side, various movement quality parameters (local dynamic stability, movement predictability, movement smoothness, movement symmetry, and movement variability) were investigated while women performed a cyclic, weighted reaching task. At both test moments, the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire was filled out to assess UL disability and pain severity. (3) Results: No significant differences in movement quality parameters were found between the pre-surgical and post-surgical time points. No significant correlations between post-operative UL disability or pain severity and movement quality were found. (4) Conclusions: From this study sample, no apparent clinically relevant movement quality parameters could be derived for a cyclic, weighted reaching task. This suggests that the search for an easy-to-use, quantitative analysis tool for UL qualitative functioning to be used in research and clinical practice should continue. [ABSTRACT FROM AUTHOR]

Background: Adequate movement control and quality can be prerequisite functions for performance of the lower extremity. The purposes of our work were 1) to explore the agreement of an efficient test battery assessing qualitative movement execution and 2) to determine its consistency with quantitative performance tests from the corresponding movement pattern. Methods: The participants were professional male association football players competing in the first German Bundesliga. They performed four movement quality tests (Single-limb balance squat, Balance forward hop, Balance side hop, Balance 90° rotation hop) and the corresponding performance tests (Y-balance test, Forward hop for distance, Side hop test, Square hop test). Qualitative tests were judged by two experienced raters; the ratings were compared to determine inter-rater agreement using Kappa statistics. The relationship with the quantitative tests was determined using Spearman's rank correlations. Results: Thirty participants (19 to 33 years old) were included in this study. We found an at least substantial level of agreement (Cohen's Kappa, 0.64-0.84) with an excellent percentage of exact (83-93%) agreement between the two raters for the movement quality tests. Our findings revealed that the quantitative test results are only slightly related to the movement quality outcomes (ρ(27) <|0.3| and P > 0.2). Conclusions: Consequently, the qualitative test results provide unique information and complement corresponding quantitative performance tests in professional football athletes. Their observational judgement of foot position, lower limb alignment and upper body control in sagittal, frontal, and transverse planes is agreeable. [ABSTRACT FROM AUTHOR]

Background: The Single Leg Squat (SLS) test is widely used in the clinical setting to examine and evaluate rehabilitation goals. It is simple to perform and is proposed to have biomechanical and neuromuscular similarities to athletic movements. The aim of the present study was to investigate whether demographics, previous injuries, and biomechanical and psychosocial factors are associated with the outcome of the SLS, assessed as a total score for all segments and as a separate knee segment in elite and sub-elite female soccer players. Methods: We conducted a cross-sectional study involving 254 female soccer players (22 yrs; SD ± 4, height 1.69 m; SD ± 0.1, weight 64 kg; SD ± 6) from divisions 1–3 of the Swedish Soccer League. During the preseason, we assessed the participants using the SLS and tested their hip strength and ankle mobility. Demographics, previous injury, sleep quality, fear of movement, anxiety, and perceived stress were assessed with questionnaires. Logistic regression models were built to analyse the association between the outcome of the SLS and the independent variables for the dominant and non-dominant leg. Results: Significantly more participants failed the SLS on the dominant leg compared with the non-dominant leg (p < 0.001). The outcome of the SLS associated with various biopsychosocial factors depending on if the dominant or non-dominant leg was tested. The total score associated with hip strength for the dominant (OR 0.99, 95% CI 0.98–0.99, p = 0.04) and the non-dominant leg (OR 0.99, 95% CI 0.97–0.99, p = 0.03). The knee segment associated with division level for the dominant (div 2; OR 2.34, 95% CI 1.01–5.12, p = 0.033. div 3; OR 3.07, 95% CI 1.61–5.85, p = 0.001) and non-dominant leg (div 2; OR 3.30, 95% CI 1.33-8.00, p = 0.01. div 3; OR 3.05, 95% CI 1.44–6.43, p = 0.003). Conclusions: This study identified that leg dominance, division level, hip strength, and psychosocial factors were associated with the outcome of the SLS when assessed as a total score and as a separate knee segment. This indicates that clinicians need to understand that movement control is associated with factors from several domains. Whether these factors and, the results of the SLS are related to injury need to be studied prospectively. Trial registration: Clinical Trials Gov, date of registration 2022-03-01. Clinical trials identifier: NCT05289284A. [ABSTRACT FROM AUTHOR]

Abstract Background The Observable Movement Quality scale for patients with low back pain (OMQ-LBP) is a newly developed measurement instrument for use in primary care settings of physical and exercise therapists to assess movement quality (MQ) of patients with low back pain (LBP). Objective This study aims to determine validity, reliability and feasibility of the OMQ-LBP. The OMQ-LBP consists of a standardized movement circuit (performed twice) consisting of five daily activities problematic for LBP patients, which are scored with an 11-item observation list. Methods Construct validity was determined by testing seven hypotheses on associations between constructs (n = 85 patients with LBP) and four hypotheses on known group differences (n = 85 patients with LBP and n = 63 healthy controls; n = 35 matched participant-patients having VAS-pain ≥ 20 mm during and/or after both circuits and healthy controls). Internal consistency was analyzed with Cronbach’s alpha (n = 85 patients with LBP). For inter- and intra-rater reliability Intraclass Correlation Coefficient (ICC) values were examined (n = 14 therapists: seven primary care physical therapists and seven exercise therapists). Additionally, content validity and feasibility were determined using thematic analysis of a brief interview with participants, patients (n = 38) and therapists (n = 14). Results After Bonferroni correction 2/7 associations between constructs and 2/4 significant group differences were confirmed. Cronbach’s alpha was 0,79. The ICC-values of interrater reliability of the OMQ-LBP total score and the duration score were 0.56 and 0.99 and intra-rater reliability 0.82 and 0,93, respectively. Thematic analysis revealed five themes. Three themes elucidate that both patients and therapists perceived the content of the OMQ-LBP as valid. The fourth theme exhibits that OMQ-LBP provides a clear and unambiguous language for MQ in patients with LBP. Theme 5 depicts that the OMQ-LBP seems feasible, but video recording is time-consuming. Conclusions The OMQ-LBP is a promising standardized observational assessment of MQ during the five most problematic daily activities in patients with LBP. It is expected that uniform and objective description and evaluation of MQ add value to clinical reasoning and facilitate uniform communication with patients and colleagues.

IntroductionClinical assessment of upper limb sensorimotor function post-stroke is often constrained by low sensitivity and limited information on movement quality. To address this gap, recent studies proposed a standardized instrumented drinking task, as a representative daily activity combining different components of functional arm use. Although kinematic movement quality measures for this task are well-established, and optical motion capture (OMC) has proven effective in their measurement, its clinical application remains limited. Inertial Measurement Units (IMUs) emerge as a promising low-cost and user-friendly alternative, yet their validity and clinical relevance compared to the gold standard OMC need investigation.MethodIn this study, we conducted a measurement system comparison between IMUs and OMC, analyzing 15 established movement quality measures in 15 mild and moderate stroke patients performing the drinking task, using five IMUs placed on each wrist, upper arm, and trunk.ResultsOur findings revealed strong agreement between the systems, with 12 out of 15 measures demonstrating clinical applicability, evidenced by Limits of Agreement (LoA) below the Minimum Clinically Important Differences (MCID) for each measure.DiscussionThese results are promising, suggesting the clinical applicability of IMUs in quantifying movement quality for mildly and moderately impaired stroke patients performing the drinking task.

IntroductionReturn to Sport tests with functional hop tests are often used to decide when a person is ready to return to sport after an anterior cruciate ligament (ACL) injury. Poor movement quality, such as knee valgus, hip adduction and hip internal rotation is considered a risk factor for ACL injury. However, it is unclear whether existing tests adequately cover the aspect of movement quality. This study aims to investigate whether there is a relationship between the calculated limb symmetry index (LSI) of hop tests as an indication of performance and the total score of the “Quality First” assessment (movement quality). The second aim is to examine the reliability of the newly developed “Quality First” assessment for evaluating movement quality in hop tests.MethodsThe cross-sectional study recruited 34 patients with an ACL reconstruction. The vertical hop, single-leg hop for distance, and side hop tests were performed and recorded. The video recordings were assessed using the “Quality First” assessment. The Spearman correlation coefficient was calculated using the LSI and the “Quality First” total score. Intraclass correlation coefficients (ICC) and standard error of measurements (SEM) were used to calculate intra- and interrater reliability. In addition, the minimal detectable change (MDC) was determined.ResultsThe correlation test between the LSI and the “Quality First” total score showed no correlation for all three jumps (r = −0.1–0.02/p-value = 0.65–0.93). The interrater reliability of the “Quality First” assessment showed fair to good reliability (ICC2: 0.45–0.60), with SEM ranging from 1.46 to 1.73 and the MDC from 4.06 to 4.8. Intrarater reliability was good to excellent (ICC3: 0.73–0.85), with SEM values ranging from 0.89 to 1.09 and the MDC from 2.47 to 3.01.ConclusionThe quality of movement, measured with the “Quality First” assessment, indicated no correlation with the calculated LSI from jump performance, therefore movement quality should also be examined in Return to Sport tests. The “Quality First” assessment shows fair to good reliability when used by different raters. When used multiple times by the same rater, the assessment has good to excellent reliability.

Various assessments have contributed to inconsistent findings regarding the correlation between core stability and vertical jumps. Therefore, this study aimed to re-examine this correlation based on novel core stability assessments. Twenty-one recreationally active male college students (age, 21.7 ± 2.1 years; stature, 174.9 ± 6.7 cm; body mass, 67.7 ± 7.8 kg; leg length, 88.9 ± 4.8 cm; arm length, 87.8 ± 4.0 cm) participated in this experiment. Core stability was divided into static and dynamic core stabilities, with the static core stability measured using the Eight-Level Prone Bridge and Five-Level Side Bridge tests and the dynamic core stability measured using the Y Balance Test (YBT). These tests comprehensively evaluate core stability as it is defined. Kinematic and kinetic data on vertical jumps were collected to provide process information beyond the outcome performance. Subsequently, these data were correlated with core stability for a deeper insight into the relationship between core stability and the process and outcome performance of vertical jumps. The main results revealed that the Eight-Level Prone Bridge demonstrated moderate to substantial correlations with Δ Fy‾, Δ Iy, ΔDleftkneez, and ΔDleftankley (−0.62 ≤ r ≤ 0.52); the Five-Level Side Bridge exhibited moderate correlations with Δ Fx‾, Δ Fy‾, Δ Ix, Δ Iy, ΔDleftkneez, and ΔDleftankley (−0.52 ≤ r ≤ 0.59); YBT displayed moderate correlations with Fz‾, Fleftz‾, Δ Dleftankley, Δ Drightankley, Δ Dleftanklez, Δ Drightanklez, NΔ Tankley‾, and N Tleftanklez‾ (−0.54 ≤ r ≤ 0.54) during the propulsive phase of vertical jumps. However, no significant correlations were observed between static/dynamic core stability and jumping height. Therefore, individuals with greater core stability should experience improved process performance (better movement quality), although this benefit is ineffective in translating into jumping height improvement due to impaired explosive features. Coaches may consider core stability in training to trigger an improved process performance of the vertical jump when the technique is the key issue to be solved, although future studies are required to verify this further.

Introduction: Hop tests are used to assess knee function but outcomes often reflect rather performance than movement quality, which is crucial for proper knee function.1 Objectives: The movement quality scoring tool "Quality First", focusing on movement related risk factors for knee injury, was developed and quality criteria were assessed. Moreover, movement quality was correlated with performance and a comparison of real-time versus slow-motion analysis was executed. Study Design: Cross-sectional study in a clinical setting. Methods: 34 participants performed various hop tests and 2D-videos were evaluated using "Quality First". Content validity was assessed from the perspective of professionals, for interpretability, classical test theory was employed. Cron-bach's α was calculated to evaluate internal consistency. Intraclass correlation coefficients (ICC2,3), standard error of measurements (SEM) and minimal detectable changes (MDC) were analyzed to assess reliability. Hop performance (Limb- Symmetry-Index, LSI) was correlated with the "Quality First" total score (Spearman) and Bland- Altman analysis was performed for method comparison (slow-motion, real-time). Results: Content validity resulted in the final inclusion of single-leg hop for distance, vertical hop, and side hop test covering sagittal, vertical, and transversal plane. "Quality First" consists finally of 15 items on a 4-point scale and obtained a sufficient Cronbach's α. The interrater reliability showed ICC2s from 0.45-0.60, with SEMs ranging from 1.46-1.73 and MDCs from 4.06-4.80. Intrarater reliability revealed ICC3s from 0.73-0.85 with SEMs ranging from 0.89-1.09 and MDCs from 2.47-3.01. No correlations between LSIs and "Quality First" were found (r=-0.1-0.02, p=0.65-0.93). Bland-Altman analysis revealed no systematic mean differences between real-time and slow-motion except for the vertical hop (0.8 points). Conclusion: "Quality First" can be a promising and time-efficient tool to assess movement quality showing fair to good interrater- and good to excellent intrarater-reliability. Patient progress of movement quality in hop tests should be monitored in addition to performance. [ABSTRACT FROM AUTHOR]

(1) Background: This study aimed to describe upper-limb (UL) movement quality parameters in women after breast cancer surgery and to explore their clinical relevance in relation to post-surgical pain and disability. (2) Methods: UL movement quality was assessed in 30 women before and 3 weeks after surgery for breast cancer. Via accelerometer data captured from a sensor located at the distal end of the forearm on the operated side, various movement quality parameters (local dynamic stability, movement predictability, movement smoothness, movement symmetry, and movement variability) were investigated while women performed a cyclic, weighted reaching task. At both test moments, the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire was filled out to assess UL disability and pain severity. (3) Results: No significant differences in movement quality parameters were found between the pre-surgical and post-surgical time points. No significant correlations between post-operative UL disability or pain severity and movement quality were found. (4) Conclusions: From this study sample, no apparent clinically relevant movement quality parameters could be derived for a cyclic, weighted reaching task. This suggests that the search for an easy-to-use, quantitative analysis tool for UL qualitative functioning to be used in research and clinical practice should continue.

Background: The Observable Movement Quality scale for patients with low back pain (OMQ-LBP) is a newly developed measurement instrument for use in primary care settings of physical and exercise therapists to assess movement quality (MQ) of patients with low back pain (LBP). Objective: This study aims to determine validity, reliability and feasibility of the OMQ-LBP. The OMQ-LBP consists of a standardized movement circuit (performed twice) consisting of five daily activities problematic for LBP patients, which are scored with an 11-item observation list. Methods: Construct validity was determined by testing seven hypotheses on associations between constructs (n = 85 patients with LBP) and four hypotheses on known group differences (n = 85 patients with LBP and n = 63 healthy controls; n = 35 matched participant-patients having VAS-pain ≥ 20 mm during and/or after both circuits and healthy controls). Internal consistency was analyzed with Cronbach's alpha (n = 85 patients with LBP). For inter- and intra-rater reliability Intraclass Correlation Coefficient (ICC) values were examined (n = 14 therapists: seven primary care physical therapists and seven exercise therapists). Additionally, content validity and feasibility were determined using thematic analysis of a brief interview with participants, patients (n = 38) and therapists (n = 14). Results: After Bonferroni correction 2/7 associations between constructs and 2/4 significant group differences were confirmed. Cronbach's alpha was 0,79. The ICC-values of interrater reliability of the OMQ-LBP total score and the duration score were 0.56 and 0.99 and intra-rater reliability 0.82 and 0,93, respectively. Thematic analysis revealed five themes. Three themes elucidate that both patients and therapists perceived the content of the OMQ-LBP as valid. The fourth theme exhibits that OMQ-LBP provides a clear and unambiguous language for MQ in patients with LBP. Theme 5 depicts that the OMQ-LBP seems feasible, but video recording is time-consuming. Conclusions: The OMQ-LBP is a promising standardized observational assessment of MQ during the five most problematic daily activities in patients with LBP. It is expected that uniform and objective description and evaluation of MQ add value to clinical reasoning and facilitate uniform communication with patients and colleagues. [ABSTRACT FROM AUTHOR]

Background Movement quality assessment is popular within clinical and sporting practice, due to the contribution diminished or suboptimal movement quality is believed to have on musculoskeletal (MSK) injury risk. Various movement quality assessments exist, many are limited to bilateral or jumping movements evaluation. Qualitative analysis of single leg loading (QASLS) is a new clinical assessment tool for unilateral tasks that utilizes a dichotomous scoring system of ten questions relating to the segmental body regions of the trunk, lower and upper limb. Purpose To determine the intra and inter-rater, within- and between-session reliability of the QASLS tool during two unilateral movement tasks, and provide insight to measurement error and smallest detectable difference (SDD). Study Design Reliability Study Methods Fifteen healthy females (mean age 19 years SD2; height 167 cm, +/- 6; weight 56 kg, +/- 6) completed two unilateral tasks, single leg squat (SLS) and single leg landing (SLL), within session data collection occurred on the same day, with between session data collection occurring seven days later. Tasks were scored with the QASLS tool via video playback. Intra-Class correlation coefficients (ICCk,3) were used to measure within and between session reliability, and Kappa coefficients and percentage of exact agreement (PEA%) were used to determine intra and inter-rater reliability. Standard error of measurement (SEM) and the SDD for the compound score of each limb was calculated. Results Within session reliability of QASLS scores was good (ICC = 0.82-0.86) for SLS and moderate (ICC = 0.67-0.87) for SLL. Between session reliability was moderate (ICC = 0.69-0.87) for SLS and excellent (ICC = 0.92-0.93) for SLL. SEM was less than 1 point, and SDD for compound score ranging from 1.0-2.5 points. Intra-rater agreement of compound QASLS score was near perfect (k = 0.85-100; PEA% 90-100%) and agreement of individual components was substantial- near perfect (k = 0.13-0.74; PEA% 78-100%). Inter-rater agreement for compound QASLS scores ranged from non-substantial (k = 0.13-0.74; PEA% 43.3-90%) for SLS and non-slight (k =0.03-0.17; PEA% 43.3-60%) for SLL. Conclusions The QASLS movement analysis tool can be used to analyze movement quality during two unilateral loading tasks with moderate to excellent within and between session reliability. PEA% was acceptable for inter-rater agreement, however rater education training is recommended to develop more acceptable levels of reliability. [ABSTRACT FROM AUTHOR]

(1) Background: This study focusses on establishing the relationship between quality of movement (based on the functional movement screen, or FMS) and foot posture (based on the foot posture index, or FPI-6). We hypothesised that a poor FMS test score may be derived from the foot position in the space measured by FPI-6. (2) Methods: a quasi-experimental and cross-sectional study was designed to analyse foot posture in 30 healthy football players, using the foot posture index and the functional movement screen. (3) Results: No significant relationships were found between movement quality and foot posture. Poor movement quality is present in more than half of all foot positions, supination, pronation, and neutral. Good quality seems to be more associated with a neutral foot position (23.3%) and supinated (16.6%) than a pronated foot position (6.6%). (4) Conclusions: this study found no relationship between the two tests; therefore, we cannot demonstrate that foot posture is relevant in the quality of the movement of the football players studied. [ABSTRACT FROM AUTHOR]

Background: Both autografts and allografts are used to reconstruct the anterior cruciate ligament (ACL) after injury; however, it is unclear whether graft source affects lower extremity functional test performance or failure rate in an active military population. Objective: To compare lower extremity functional test performance and graft failure rates between ACL grafts [allograft, hamstring, bone-patellar tendon-bone (BTB)]. Study Design: Cross-sectional. Level of Evidence: Level 2. Methods: Ninety-eight cadets entering a US Service Academy with a history of unilateral ACL reconstruction (ACLR) agreed to participate. Before basic training, participants completed 4 lower extremity functional tests. Active injury surveillance was conducted within the study cohort to identify all subsequent graft failures. Results: Cadets with hamstring autografts outperformed the BTB and allograft groups on the Lower Quarter Y-Balance Test-Posteromedial direction and single-leg hop test, respectively. No differences were detected by graft type for the other functional tests. The incidence of subsequent ipsilateral graft failures in patients with autograft was 8.11%. No failures were observed in the allograft group during the follow-up period. After controlling for sex, joint hypermobility, and time since injury and surgery, the risk of graft failure was 9.8 times higher for patients with a hamstring autograft than with a BTB (P = 0.045). Conclusion: After ACLR, graft type appears to influence some single-limb measures of lower extremity function and the risk of subsequent failure. Hamstring autografts demonstrated better functional performance but increased risk of graft failure. Clinical Relevance: Surgeons need to weigh the pros and cons of all graft options in relation to the patient's lifestyle. Regardless of graft type, individuals with an ACLR may require additional rehabilitation to regain neuromuscular control during dynamic single-limb tasks and mitigate graft failure. [ABSTRACT FROM AUTHOR]

Abstract Background The relearning of movements after brain injury can be optimized by providing intensive, meaningful, and motivating training using virtual reality (VR). However, most current solutions use two-dimensional (2D) screens, where patients interact via symbolic representations of their limbs (e.g., a cursor). These 2D screens lack depth cues, potentially deteriorating movement quality and increasing cognitive load. Head-mounted displays (HMDs) have great potential to provide naturalistic movement visualization by incorporating improved depth cues, reduce visuospatial transformations by rendering movements in the space where they are performed, and preserve eye-hand coordination by showing an avatar—with immersive VR (IVR)—or the user’s real body—with augmented reality (AR). However, elderly populations might not find these novel technologies usable, hampering potential motor and cognitive benefits. Methods We compared movement quality, cognitive load, motivation, and system usability in twenty elderly participants (>59 years old) while performing a dual motor-cognitive task with different visualization technologies: IVR HMD, AR HMD, and a 2D screen. We evaluated participants’ self-reported cognitive load, motivation, and usability using questionnaires. We also conducted a pilot study with five brain-injured patients comparing the visualization technologies while using an assistive device. Results Elderly participants performed straighter, shorter duration, and smoother movements when the task was visualized with the HMDs than screen. The IVR HMD led to shorter duration movements than AR. Movement onsets were shorter with IVR than AR, and shorter for both HMDs than the screen, potentially indicating facilitated reaction times due to reduced cognitive load. No differences were found in the questionnaires regarding cognitive load, motivation, or usability between technologies in elderly participants. Both HMDs proved high usability in our small sample of patients. Conclusions HMDs are a promising technology to be incorporated into neurorehabilitation, as their more naturalistic movement visualization improves movement quality compared to conventional screens. HMDs demonstrate high usability, without decreasing participants’ motivation, and might potentially lower cognitive load. Our preliminary clinical results suggest that brain-injured patients may especially benefit from more immersive technologies. However, larger patient samples are needed to draw stronger conclusions.**

Abstract Background Recently, a novel method for improving movement quality called open-ended augmented feedback has been introduced. However, the effects of using such feedback in a training intervention have not yet been examined. The aim of this study was to assess the changes in performance and movement quality following a five-week resistance-training program with either (1) technological feedback or (2) traditional, verbal feedback from an experienced trainer. Methods Nineteen untrained females (age: 21.84 ± 2.24 years, height: 169.95 ± 5.92 cm, body mass: 65.05 ± 7.93 kg) randomly allocated to one of the two conditions completed five weeks of training with two weekly sessions. Pre- and post-intervention, participants were tested for physical performance (i.e., back squat and isometric mid-thigh pull strength) and movement quality parameters (weight distribution, center of gravity variation, and subjective rating of the back squat technique). Results Both groups similarly increased the training resistance throughout the intervention (p

Abstract Background During the growth period, before and after maturity, considerable biological changes occur. It seems that these changes are related to neuromuscular patterns and have significant differences in the functional movements performed of young boys and girls during the maturation process. The current study aimed to look at the movement quality scores of school-aged girls and boys. Methods This Cross-Sectional Study assessed the movement quality of 700 school-aged boys and girls aged 8 to 17, divided into 10 groups of 35 girls and 10 groups of 35 boys. Movement quality was evaluated by the Fusionetics scoring system, which includes 7 tasks: two-leg squat, two-leg squat with heel raise, one-leg squat, push-up, shoulder, trunk, and cervical movements that require a person to complete different movement patterns. The data was analyzed using the Wilcoxon signed-rank and McNemar tests (p

IntroductionCurrent approaches fail to adequately identify sport readiness after anterior cruciate ligament (ACL) rehabilitation. Altered landing biomechanics after ACL reconstruction are associated with increased risk of a noncontact ACL reinjury. There is a lack of objective factors to screen for deficient movement patterns. Therefore, the aim of this study was to investigate content validity, interpretability, and internal consistency for the newly developed “Quality First” assessment to evaluate movement quality during hop tests in patients after ACL rehabilitation.MethodParticipants in this cross-sectional study were recruited in collaboration with the Altius Swiss Sportmed Center in Rheinfelden, Switzerland. After a successful ACL reconstruction, the movement quality of 50 hop test batteries was evaluated between 6 and 24 months postoperatively with the “Quality First” assessment. Content validity was assessed from the perspective of professionals. To check the interpretability, classical test theory was employed. Cronbach's α was calculated to evaluate internal consistency.ResultsContent validity resulted in the inclusion of three different hop tests (single-leg hop for distance, vertical hop, and side hop). The “Quality First” assessment is enabled to evaluate movement quality in the sagittal, vertical, and the transversal plane. After the exclusion process, the “Quality First” assessment was free from floor and ceiling effects and obtained a sufficient Cronbach's α. The final version consists of 15 items, rated on a 4-point scale.DiscussionBy means of further validations, the “Quality First” assessment could offer a possibility to evaluate movement quality after ACL rehabilitation during hop tests.

Abstract Background The benefits to be obtained from home-based physical therapy programmes are dependent on the proper execution of physiotherapy exercises during unsupervised treatment. Wearable sensors and appropriate movement-related metrics may be used to determine at-home exercise performance and compliance to a physical therapy program. Methods A total of thirty healthy volunteers (mean age of 31 years) had their movements captured using wearable inertial measurement units (IMUs), after video recordings of five different exercises with varying levels of complexity were demonstrated to them. Participants were then given wearable sensors to enable a second unsupervised data capture at home. Movement performance between the participants’ recordings was assessed with metrics of movement smoothness, intensity, consistency and control. Results In general, subjects executed all exercises similarly when recording at home and as compared with their performance in the lab. However, participants executed all movements faster compared to the physiotherapist’s demonstrations, indicating the need of a wearable system with user feedback that will set the pace of movement. Conclusion In light of the Covid-19 pandemic and the imperative transition towards remote consultation and tele-rehabilitation, this work aims to promote new tools and methods for the assessment of adherence to home-based physical therapy programmes. The studied IMU-derived features have shown adequate sensitivity to evaluate home-based programmes in an unsupervised manner. Cost-effective wearables, such as the one presented in this study, can support therapeutic exercises that ought to be performed with appropriate speed, intensity, smoothness and range of motion.

Background: The relearning of movements after brain injury can be optimized by providing intensive, meaningful, and motivating training using virtual reality (VR). However, most current solutions use two-dimensional (2D) screens, where patients interact via symbolic representations of their limbs (e.g., a cursor). These 2D screens lack depth cues, potentially deteriorating movement quality and increasing cognitive load. Head-mounted displays (HMDs) have great potential to provide naturalistic movement visualization by incorporating improved depth cues, reduce visuospatial transformations by rendering movements in the space where they are performed, and preserve eye-hand coordination by showing an avatar—with immersive VR (IVR)—or the user's real body—with augmented reality (AR). However, elderly populations might not find these novel technologies usable, hampering potential motor and cognitive benefits. Methods: We compared movement quality, cognitive load, motivation, and system usability in twenty elderly participants (>59 years old) while performing a dual motor-cognitive task with different visualization technologies: IVR HMD, AR HMD, and a 2D screen. We evaluated participants' self-reported cognitive load, motivation, and usability using questionnaires. We also conducted a pilot study with five brain-injured patients comparing the visualization technologies while using an assistive device. Results: Elderly participants performed straighter, shorter duration, and smoother movements when the task was visualized with the HMDs than screen. The IVR HMD led to shorter duration movements than AR. Movement onsets were shorter with IVR than AR, and shorter for both HMDs than the screen, potentially indicating facilitated reaction times due to reduced cognitive load. No differences were found in the questionnaires regarding cognitive load, motivation, or usability between technologies in elderly participants. Both HMDs proved high usability in our small sample of patients. Conclusions: HMDs are a promising technology to be incorporated into neurorehabilitation, as their more naturalistic movement visualization improves movement quality compared to conventional screens. HMDs demonstrate high usability, without decreasing participants' motivation, and might potentially lower cognitive load. Our preliminary clinical results suggest that brain-injured patients may especially benefit from more immersive technologies. However, larger patient samples are needed to draw stronger conclusions.** [ABSTRACT FROM AUTHOR]

Knee joint functional deficits are common after anterior cruciate ligament (ACL) injury, but different assessment methods of joint function seem to provide contradicting information complicating recovery monitoring. We previously reported improved perceived knee function and functional performance (forward lunge ground contact time) in patients with an ACL injury from pre to 10 months post ACL reconstruction without improvement in knee-specific biomechanics. To further investigate this discrepancy, we additionally analyzed knee extensor and flexor muscle strength, and movement quality in the forward lunge (subjective and objective evaluations) and performed a full lower limb biomechanical analysis of the forward lunge movement. We included 12 patients with an ACL injury (tested before and after ACL reconstructive surgery) and 15 healthy controls from the previous study to the current investigation. Outcome measures were obtained pre and ~11 months post ACL reconstruction for the patients and at a single time point for the controls. Objective movement quality in the patients with an ACL injury showed an improvement from their pre reconstruction surgery visit to the post reconstruction visit but this was not observable in the subjective evaluation. Knee extensor muscle strength declined after the ACL reconstruction by 29% (p = 0.002) and both knee extensors (p < 0.001) and flexors (p = 0.027) were weaker in the patients post ACL reconstruction compared to healthy controls. ACL injured patients had an altered movement strategy in the forward lunge with reduced knee extensors contribution and increased hip extensor contribution compared to the controls both before and after the reconstruction. The altered movement strategy was associated with knee extensor muscle strength. This explorative study with a limited sample size found that clinicians should be aware that significant functional deficits in the knee extensor muscles, both in isolated muscle strength testing and during a functional movement, may be present although patients perceive an improvement in their knee function and present good functional performance without obvious movement quality issues.

(1) Background: This study focusses on establishing the relationship between quality of movement (based on the functional movement screen, or FMS) and foot posture (based on the foot posture index, or FPI-6). We hypothesised that a poor FMS test score may be derived from the foot position in the space measured by FPI-6. (2) Methods: a quasi-experimental and cross-sectional study was designed to analyse foot posture in 30 healthy football players, using the foot posture index and the functional movement screen. (3) Results: No significant relationships were found between movement quality and foot posture. Poor movement quality is present in more than half of all foot positions, supination, pronation, and neutral. Good quality seems to be more associated with a neutral foot position (23.3%) and supinated (16.6%) than a pronated foot position (6.6%). (4) Conclusions: this study found no relationship between the two tests; therefore, we cannot demonstrate that foot posture is relevant in the quality of the movement of the football players studied.

Background: Recently, a novel method for improving movement quality called open-ended augmented feedback has been introduced. However, the effects of using such feedback in a training intervention have not yet been examined. The aim of this study was to assess the changes in performance and movement quality following a five-week resistance-training program with either (1) technological feedback or (2) traditional, verbal feedback from an experienced trainer. Methods: Nineteen untrained females (age: 21.84 ± 2.24 years, height: 169.95 ± 5.92 cm, body mass: 65.05 ± 7.93 kg) randomly allocated to one of the two conditions completed five weeks of training with two weekly sessions. Pre- and post-intervention, participants were tested for physical performance (i.e., back squat and isometric mid-thigh pull strength) and movement quality parameters (weight distribution, center of gravity variation, and subjective rating of the back squat technique). Results: Both groups similarly increased the training resistance throughout the intervention (p < 0.01), as well as strength in the back squat (technological feedback group: effect size (ES) = 1.31, p = 0.002; traditional feedback group: ES = 1.48, p = 0.002). Only the traditional feedback group increased isometric mid-thigh pull strength (ES = 1.11, p = 0.008) and subjectively rated lifting technique at the same load (p = 0.046). No changes in force distribution (p = 0.062–0.993) or center of gravity variation (p = 0.160–0.969) occurred in either group when lifting the same absolute loads at post-test. However, both groups displayed a greater variation in center of gravity when lifting the same relative load at post-test (technological feedback group: p < 0.001; traditional feedback group: p = 0.006). No differences were found between the groups for any of the observed changes (p = 0.205–0.401). Conclusions: Five weeks of back-squat training with verbal feedback increased isometric mid-thigh pull strength and subjectively rated lifting technique from pre- to post-test, whereas technological feedback did not. Both methods improved back squat strength and training resistance. For resistance-training beginners, the choice between feedback methods should be based on the desired outcomes and the availability of expertise and equipment. [ABSTRACT FROM AUTHOR]

Background: The Functional Movement Screen (FMS) and the Y Balance Test (Y-BT) are screening tools to detect movement deficits and to identify footballers at high risk of injury. If these tools are able to identify athletes with high risk of injury, they should measure the same construct and also be highly correlated. Objectives: The aim of the study was to determine the relationship between the FMS and Y-BT in youth footballers. The present study also aimed to assess the degree of association between the FMS and Y-BT considering high-injury-risk (FMS <= 14 points and Y-BT <= 89.6%) and low-injury-risk groups (FMS > 14 points and Y-BT > 89.6%). Method: A sample of 226 healthy athletes (mean age: 14.0 ± 2.3 years) was selected from a football club. The FMS and Y-BT data were collected from all participants. The Y-BT raw data were normalised to the relative length of the lower limbs. Spearman's correlation was used in the analysis. Results: For the whole group, there was a moderate correlation (R = 0.41; p < 0.001) between the composite FMS score and composite Y-BT score. The strength of relationships varied from weak to moderate between the FMS subtests and most Y-BT results for each direction. In the high-injury-risk group, there was no correlation (R = 0.11; p = 0.61) between the composite FMS score and composite Y-BT score. For the low-injury-risk group, there was a weak significant correlation (R = 0.27; p < 0.007) between the composite FMS score and composite Y-BT score. Additionally, 56 and 53 athletes were classified to the high-injury-risk group based on the FMS and Y-BT, respectively. Only 23 athletes were classified to the high-risk group by both tests. Conclusions: Youth footballers showed only weak to moderate correlations between the FMS and the Y-BT. Footballers classified in the high-injury-risk group based on the FMS and Y-BT presented a different relationship between the FMS and Y-BT tasks compared to the low-injury-risk group. The results confirmed that the FMS and Y-BT should not be used interchangeably as they assess different movement deficits in the group of youth football players. The study results may partially suggest that using one of these screening tools cannot successfully predict injury risk in adolescent football players. This justifies the need to use these tests simultaneously to identify possible neuromuscular control deficits in youth footballers. [ABSTRACT FROM AUTHOR]

Background: During the growth period, before and after maturity, considerable biological changes occur. It seems that these changes are related to neuromuscular patterns and have significant differences in the functional movements performed of young boys and girls during the maturation process. The current study aimed to look at the movement quality scores of school-aged girls and boys.Methods: This Cross-Sectional Study assessed the movement quality of 700 school-aged boys and girls aged 8 to 17, divided into 10 groups of 35 girls and 10 groups of 35 boys. Movement quality was evaluated by the Fusionetics scoring system, which includes 7 tasks: two-leg squat, two-leg squat with heel raise, one-leg squat, push-up, shoulder, trunk, and cervical movements that require a person to complete different movement patterns. The data was analyzed using the Wilcoxon signed-rank and McNemar tests (p <0.05).Results: This is the first study to our knowledge to examine the movement quality scores in a large school age child with Fusionetics. The overall results showed that the most errors were recorded in all age groups during the double leg squat, double leg squat with heel lift, single leg squat, and push-up and school-age children showed less errors during the shoulder movements, trunk/lumbar spine movements and cervical spine movements. Furthermore, younger girls and boys made more errors than older girls and boys. In relation to gender, this study found that girls scored better on the total Fusionetics score than boys.Conclusions: The Fusionetics scoring system explains how well school-aged children perform fundamental movements. Under the guidance of coaches and physical educators, students' movement compensation should be assessed and relevant training interventions implemented. Taking steps to address movement compensation could help to avoid injuries and improve school-age children performance. [ABSTRACT FROM AUTHOR]

Background The Functional Movement Screen (FMS) and the Y Balance Test (Y-BT) are screening tools to detect movement deficits and to identify footballers at high risk of injury. If these tools are able to identify athletes with high risk of injury, they should measure the same construct and also be highly correlated. Objectives The aim of the study was to determine the relationship between the FMS and Y-BT in youth footballers. The present study also aimed to assess the degree of association between the FMS and Y-BT considering high-injury-risk (FMS 14 points and Y-BT > 89.6%). Method A sample of 226 healthy athletes (mean age: 14.0 ± 2.3 years) was selected from a football club. The FMS and Y-BT data were collected from all participants. The Y-BT raw data were normalised to the relative length of the lower limbs. Spearman’s correlation was used in the analysis. Results For the whole group, there was a moderate correlation (R = 0.41; p < 0.001) between the composite FMS score and composite Y-BT score. The strength of relationships varied from weak to moderate between the FMS subtests and most Y-BT results for each direction. In the high-injury-risk group, there was no correlation (R = 0.11; p = 0.61) between the composite FMS score and composite Y-BT score. For the low-injury-risk group, there was a weak significant correlation (R = 0.27; p < 0.007) between the composite FMS score and composite Y-BT score. Additionally, 56 and 53 athletes were classified to the high-injury-risk group based on the FMS and Y-BT, respectively. Only 23 athletes were classified to the high-risk group by both tests. Conclusions Youth footballers showed only weak to moderate correlations between the FMS and the Y-BT. Footballers classified in the high-injury-risk group based on the FMS and Y-BT presented a different relationship between the FMS and Y-BT tasks compared to the low-injury-risk group. The results confirmed that the FMS and Y-BT should not be used interchangeably as they assess different movement deficits in the group of youth football players. The study results may partially suggest that using one of these screening tools cannot successfully predict injury risk in adolescent football players. This justifies the need to use these tests simultaneously to identify possible neuromuscular control deficits in youth footballers.

Abstract Background The Single Leg Squat test (SLS) is a common tool used in clinical examination to set and evaluate rehabilitation goals, but there is not one established SLS test used in the clinic. Based on previous scientific findings on the reliability of the SLS test and with a methodological rigorous setup, the aim of the present study was to investigate the intra- and interrater reliability of a standardised multi-segmental SLS test. Methods We performed a study of measurement properties to investigate the intra- and interrater reliability of a standardised multi-segmental SLS test including the assessment of the foot, knee, pelvis, and trunk. Novice and experienced physiotherapists rated 65 video recorded SLS tests from 34 test persons. We followed the Quality Appraisal for Reliability Studies checklist. Results Regardless of the raters experience, the interrater reliability varied between “moderate” for the knee variable (ĸ = 0.41, 95% CI 0.10–0.72) and “almost perfect” for the foot (ĸ = 1.00, 95% CI 1.00–1.00). The intrarater reliability varied between “slight” (pelvic variable; ĸ = 0.17, 95% CI -0.22-0.55) to “almost perfect” (foot variable; ĸ = 1.00, 95% CI 1.00–1.00; trunk variable; ĸ = 0.82, 95% CI 0.66–0.97). A generalised kappa coefficient including the values from all raters and segments reached “moderate” interrater reliability (ĸ = 0.52, 95% CI 0.43–0.61), the corresponding value for the intrarater reliability reached “almost perfect” (ĸ = 0.82, 95% CI 0.77–0.86). Conclusions The present study shows a “moderate” interrater reliability and an “almost perfect” intrarater reliability for the variable all segments regardless of the raters experience. Thus, we conclude that the proposed standardised multi-segmental SLS test is reliable enough to be used in an active population.

• A new metric, synergy index, is introduced to analyze hip, knee, and ankle movements. • Using this metric, we obtained a functional interpretation of lower limb joint movements in five different walking tasks. • This study reveals distinct muscle coordination patterns in Heel and Toe walking tasks. • The k-means method is employed to extract commonalities in joint movements across different walking tasks. • We address synergy weight variations within the common muscle synergy across different walking tasks. The limb is the most common site for sports injuries. The objective of this study is to validate lower limb muscle synergy as a biomarker for movement quality. The proposed method comprises the following steps: (i) extraction of muscle synergies using nonnegative matrix factorization, (ii) estimation of hip, knee, and ankle joint movements from synergy weights, (iii) identification of common muscle synergies across five walking tasks using k-means clustering and (iv) conducting cluster-wise analysis of muscle contraction intensity during lower limb joint movements using synergy weights. In this study, we used surface Electromyography signals from the Lencioni et al. 2019 dataset recorded during normal walking, heel walking, toe walking, stair ascending and stair descending tasks involving fifty heterogeneous subjects. For the first time in the literature, we performed a functional interpretation of lower limb joint movements during these five walking tasks based on synergy weights and compared the results with the multiple muscle co-activation index (p < 0.005). Further, the clustering results revealed similarities in muscle synergies among normal, toe, and stair walking tasks (p < 0.05), while highlighting the distinct synergy pattern of the heel walking task. Notably, this study also explored the variations in muscle contraction intensities across different walking tasks that share common muscle synergies. Additionally, we extensively analysed the impact of age-gender factors on stride length and walking speed, uncovering small but discernible gender-specific differences in muscle synergies during different walking tasks. Hence, muscle synergy shows promise as a potential biomarker for the functional assessment of lower limb movements. [ABSTRACT FROM AUTHOR]

Background The test battery classically used for return-to-sport (RTS) decision-making after anterior cruciate ligament (ACL) reconstruction (ACLR) may not be sufficient, as it does not include a qualitative analysis of movement. Therefore, the Landing Error Scoring System (LESS) scale was adapted to a primary functional test in the typical RTS test battery: the single leg hop for distance (SHD). Hypothesis/ Purpose The aim of this study was to determine the intra-rater reliability of the LESS scale adapted to the SHD (SHD-LESS scale) in healthy young athletes. Study Design Reliability analysis Methods Nineteen healthy individuals (14 men, 5 women; mean age: 22.4 years) participated in the study. Participants performed the SHD tasks on both limbs (dominant and non-dominant) using a standardized protocol in two sessions that were one week apart (single reviewer; 2-dimensional video). Intra-class correlation coefficients (ICC2,1) were used to measure the reproducibility of the scale in the dominant (dom) and non-dominant (nondom) limbs. Additionally, limb data (dom and nondom) were pooled and evaluated collectively with intra-class correlation coefficients. The Kappa coefficient was used to assess the reproducibility of each individual item of SHD-LESS scale. Results The intra-rater reliability was good (ICCdom = 0.77; ICCnondom = 0.87; ICCpooled = 0.87) for the overall SHD-LESS scale scores. Agreement of SHD-LESS individual items ranged from 62% to 100%. Dorsiflexion at initial contact (97% agreement; kappa value=0.79) and knee valgus after landing (88% agreement; kappa value=0.65) had excellent agreement and kappa values. Conclusion The newly-adapted SHD-LESS scale showed good intra-rater reliability overall. Further studies should evaluate the impact of using the SHD-LESS scale within the RTS test battery on outcomes in patients after ACLR. [ABSTRACT FROM AUTHOR]

This study's aim is threefold: (I) Evaluate movement quality parameters of gait in people with hip or knee osteoarthritis (OA) compared to asymptomatic controls from a single trunk-worn 3D accelerometer. (II) Evaluate the sensitivity of these parameters to capture changes at 6-weeks, 3-, 6-, and 12-months following total knee arthroplasty (TKA). (III) Investigate whether observed changes in movement quality from 6-weeks and 12-months post-TKA relates to changes in patient-reported outcome measures (PROMs). We invited 20 asymptomatic controls, 20 people with hip OA, 18 people pre- and post-TKA to our movement lap. They wore a single trunk-worn accelerometer and walked at a self-selected speed. Movement quality parameters (symmetry, complexity, smoothness, and dynamic stability) were calculated from the 3D acceleration signal. Between groups and between timepoints comparisons were made, and changes in movement quality were correlated with PROMs. We found significant differences in symmetry and stability in both OA groups. Post-TKA, most parameters reflected an initial decrease in movement quality at 6-weeks post-TKA, which mostly normalised 6-months post-TKA. Finally, improved movement quality relates to improvements in PROMs. Thus, a single accelerometer can characterise movement quality in both OA groups and post-TKA. The correlation shows the potential to monitor movement quality in a clinical setting to inform objective, data-driven personalised rehabilitation. [ABSTRACT FROM AUTHOR]

This study aimed to explore the association between developmental coordination disorder (DCD) diagnosed after the age of three and both a standardized motor test—the Alberta Infant Motor Scale (AIMS)—and non-standardized observation of movement quality carried out before the age of three. Children at risk or with developmental concerns were studied retrospectively. Children were excluded in case of a diagnosis, excluding DCD, e.g., cerebral palsy, or IQ < 70. Of the 503 included children, 246 were diagnosed with (at-risk) DCD. Multivariate binary logistic regression revealed a significant association between DCD diagnosis after the age of three and male gender and with different aspects of poor movement quality in different age groups before the age three. Univariate analyses revealed an association between DCD diagnosis and the number of poor movement-quality descriptions at 0–6 months, 6–12 months, and 18 months–3 years but not with the AIMS scores. The MABC-2 scores after the age of three were significantly correlated with the number of poor movement-quality descriptions in age groups 0–6 months and 18 months–3 years and with the AIMS scores in age groups 6–12 months and 12–18 months. The results suggest that DCD can be associated with poor movement quality before the age of three. [ABSTRACT FROM AUTHOR]

Background: The benefits to be obtained from home-based physical therapy programmes are dependent on the proper execution of physiotherapy exercises during unsupervised treatment. Wearable sensors and appropriate movement-related metrics may be used to determine at-home exercise performance and compliance to a physical therapy program. Methods: A total of thirty healthy volunteers (mean age of 31 years) had their movements captured using wearable inertial measurement units (IMUs), after video recordings of five different exercises with varying levels of complexity were demonstrated to them. Participants were then given wearable sensors to enable a second unsupervised data capture at home. Movement performance between the participants' recordings was assessed with metrics of movement smoothness, intensity, consistency and control. Results: In general, subjects executed all exercises similarly when recording at home and as compared with their performance in the lab. However, participants executed all movements faster compared to the physiotherapist's demonstrations, indicating the need of a wearable system with user feedback that will set the pace of movement. Conclusion: In light of the Covid-19 pandemic and the imperative transition towards remote consultation and tele-rehabilitation, this work aims to promote new tools and methods for the assessment of adherence to home-based physical therapy programmes. The studied IMU-derived features have shown adequate sensitivity to evaluate home-based programmes in an unsupervised manner. Cost-effective wearables, such as the one presented in this study, can support therapeutic exercises that ought to be performed with appropriate speed, intensity, smoothness and range of motion. [ABSTRACT FROM AUTHOR]

Background: Sport specialization in youth athletes is associated with increased risk for musculoskeletal injury; however, little is known about whether sport specialization is associated with lower extremity movement quality. The purpose of this study was to examine differences in lower extremity movement quality by level of sport specialization in US Service Academy cadets. Hypothesis: Cadets who report an increased level of sport specialization would have a lower level of movement quality than those who are less specialized. Study Design: Cross-sectional analysis from an ongoing prospective cohort study. Level of Evidence: Level 3. Methods: Cadets completed the Landing Error Scoring System (LESS) and a baseline questionnaire evaluating level of sport specialization during high school. Data were analyzed using separate 1-way analysis of variance models. Results: Among all participants (n = 1950), 1045 (53.6%) reported low sport specialization, 600 (30.8%) reported moderate sport specialization, and 305 (15.6%) reported high sport specialization at the time of data collection during the first week. Ages ranged from 17 to 23 years. Men (1491) and women (459) reported comparable specialization levels (P = 0.45). There were no statistically significant differences in lower extremity movement quality by level of specialization for all subjects combined (P = 0.15) or when only men were included in the analyses (P = 0.69). However, there were statistically significant differences in movement quality by level of specialization in women (P = 0.02). Moderately specialized women had the best movement quality (mean, 4.63; SD, 2.21) followed by those with high specialization (mean, 4.90; SD, 2.08) and those with low levels of specialization (mean, 5.23; SD, 2.07). Conclusion: Women reporting moderate sport specialization had improved movement quality and significantly better LESS scores compared to those with high/low specialization. Clinical Relevance: Athletes, especially women, should be encouraged to avoid early sport specialization to optimize movement quality, which may affect injury risk. [ABSTRACT FROM AUTHOR]

The Hip and Lower Limb Movement Screen (HLLMS) was developed to detect altered movement patterns and asymmetry specifically related to hip, pelvic, and lower limb movement control, as the other tools, such as the Functional Movement Screen (FMS), lacked focus on the hip and pelvic area. Both screening tools contain symmetrical and asymmetrical motor tasks which are based on observation of different aspects of each task performance. One motor task is in both screening tools. Therefore, they have some common features. The present study aimed to assess the relationship between the HLLMS and FMS performance in youth football players. The study included 41 elite male football (soccer) players (age: 15.6 ± 0.50 years), and the HLLMS and FMS scores were analyzed by assessing Spearman's rank correlation. The FMS total score and the FMSMOVE were moderately correlated with the HLLMS total score (R = −0.54; −0.53, respectively). The FMS rotatory stability task was moderately correlated with the HLLMS small knee bend with the trunk rotation task (R = −0.50). The FMS deep squat task was moderately correlated with the HLLMS deep squat task (R = −0.46). The FMS hurdle step was weakly correlated with two of the HLLMS tasks: standing hip flexion (R = −0.37) and hip abduction with external rotation (R = −0.34). There were no other relationships found (p > 0.05). Out of the seven FMS tasks, only one asymmetrical (trunk rotary stability) and one symmetrical (deep squat) task were moderately related to the newly developed HLLMS tool contributing moderate relationship between the FMS total score and the HLLMS total score. Other FMS tasks were weakly or unrelated with the HLLMS. These findings indicate that these two screening tools mainly assess different aspects of movement quality in healthy youth football players. [ABSTRACT FROM AUTHOR]

Background: The Single Leg Squat test (SLS) is a common tool used in clinical examination to set and evaluate rehabilitation goals, but there is not one established SLS test used in the clinic. Based on previous scientific findings on the reliability of the SLS test and with a methodological rigorous setup, the aim of the present study was to investigate the intra- and interrater reliability of a standardised multi-segmental SLS test. Methods: We performed a study of measurement properties to investigate the intra- and interrater reliability of a standardised multi-segmental SLS test including the assessment of the foot, knee, pelvis, and trunk. Novice and experienced physiotherapists rated 65 video recorded SLS tests from 34 test persons. We followed the Quality Appraisal for Reliability Studies checklist. Results: Regardless of the raters experience, the interrater reliability varied between "moderate" for the knee variable (ĸ = 0.41, 95% CI 0.10–0.72) and "almost perfect" for the foot (ĸ = 1.00, 95% CI 1.00–1.00). The intrarater reliability varied between "slight" (pelvic variable; ĸ = 0.17, 95% CI -0.22-0.55) to "almost perfect" (foot variable; ĸ = 1.00, 95% CI 1.00–1.00; trunk variable; ĸ = 0.82, 95% CI 0.66–0.97). A generalised kappa coefficient including the values from all raters and segments reached "moderate" interrater reliability (ĸ = 0.52, 95% CI 0.43–0.61), the corresponding value for the intrarater reliability reached "almost perfect" (ĸ = 0.82, 95% CI 0.77–0.86). Conclusions: The present study shows a "moderate" interrater reliability and an "almost perfect" intrarater reliability for the variable all segments regardless of the raters experience. Thus, we conclude that the proposed standardised multi-segmental SLS test is reliable enough to be used in an active population. [ABSTRACT FROM AUTHOR]

This study’s aim is threefold: (I) Evaluate movement quality parameters of gait in people with hip or knee osteoarthritis (OA) compared to asymptomatic controls from a single trunk-worn 3D accelerometer. (II) Evaluate the sensitivity of these parameters to capture changes at 6-weeks, 3-, 6-, and 12-months following total knee arthroplasty (TKA). (III) Investigate whether observed changes in movement quality from 6-weeks and 12-months post-TKA relates to changes in patient-reported outcome measures (PROMs). We invited 20 asymptomatic controls, 20 people with hip OA, 18 people pre- and post-TKA to our movement lap. They wore a single trunk-worn accelerometer and walked at a self-selected speed. Movement quality parameters (symmetry, complexity, smoothness, and dynamic stability) were calculated from the 3D acceleration signal. Between groups and between timepoints comparisons were made, and changes in movement quality were correlated with PROMs. We found significant differences in symmetry and stability in both OA groups. Post-TKA, most parameters reflected an initial decrease in movement quality at 6-weeks post-TKA, which mostly normalised 6-months post-TKA. Finally, improved movement quality relates to improvements in PROMs. Thus, a single accelerometer can characterise movement quality in both OA groups and post-TKA. The correlation shows the potential to monitor movement quality in a clinical setting to inform objective, data-driven personalised rehabilitation.

The study aimed to investigate the relationship between the perceived movement quality of a gymnastics skill and its kinematic pattern, as well as the influence of expertise. Thirty participants with different levels of gymnastics expertise (n = 10 visual experts, n = 10 motor experts and n = 10 novices) were recruited for the study. They were instructed to compare the movement quality of eleven video sequences, showing different handstand - back handspring performances. To extract the kinematics, the performances were digitized. By means of an ongoing cluster analysis, the kinematic pattern as well as the pattern of the perceived movement quality of the skills were determined for each experimental group. The results of the cluster analysis of the different experimental groups were analyzed and compared. Expertise differences were found regarding the pattern of the perceived movement quality. There was a significant correlation between the dendrograms of the visual experts and the motor experts (p =.021), as well as between the dendrograms of the visual experts and the novices (p =.011). There was no significant correlation between the dendrograms of the motor experts and the novices (p =.173). The pattern of the perceived movement quality was not correlated with the holistic kinematic pattern of judged skills (p >.143). These results suggest perceptual and cognitive differences of the participants due to their different previous visual and motor experience. [ABSTRACT FROM AUTHOR]

This study aimed to explore the association between developmental coordination disorder (DCD) diagnosed after the age of three and both a standardized motor test—the Alberta Infant Motor Scale (AIMS)—and non-standardized observation of movement quality carried out before the age of three. Children at risk or with developmental concerns were studied retrospectively. Children were excluded in case of a diagnosis, excluding DCD, e.g., cerebral palsy, or IQ < 70. Of the 503 included children, 246 were diagnosed with (at-risk) DCD. Multivariate binary logistic regression revealed a significant association between DCD diagnosis after the age of three and male gender and with different aspects of poor movement quality in different age groups before the age three. Univariate analyses revealed an association between DCD diagnosis and the number of poor movement-quality descriptions at 0–6 months, 6–12 months, and 18 months–3 years but not with the AIMS scores. The MABC-2 scores after the age of three were significantly correlated with the number of poor movement-quality descriptions in age groups 0–6 months and 18 months–3 years and with the AIMS scores in age groups 6–12 months and 12–18 months. The results suggest that DCD can be associated with poor movement quality before the age of three.

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The Hip and Lower Limb Movement Screen (HLLMS) was developed to detect altered movement patterns and asymmetry specifically related to hip, pelvic, and lower limb movement control, as the other tools, such as the Functional Movement Screen (FMS), lacked focus on the hip and pelvic area. Both screening tools contain symmetrical and asymmetrical motor tasks which are based on observation of different aspects of each task performance. One motor task is in both screening tools. Therefore, they have some common features. The present study aimed to assess the relationship between the HLLMS and FMS performance in youth football players. The study included 41 elite male football (soccer) players (age: 15.6 ± 0.50 years), and the HLLMS and FMS scores were analyzed by assessing Spearman’s rank correlation. The FMS total score and the FMSMOVE were moderately correlated with the HLLMS total score (R = −0.54; −0.53, respectively). The FMS rotatory stability task was moderately correlated with the HLLMS small knee bend with the trunk rotation task (R = −0.50). The FMS deep squat task was moderately correlated with the HLLMS deep squat task (R = −0.46). The FMS hurdle step was weakly correlated with two of the HLLMS tasks: standing hip flexion (R = −0.37) and hip abduction with external rotation (R = −0.34). There were no other relationships found (p > 0.05). Out of the seven FMS tasks, only one asymmetrical (trunk rotary stability) and one symmetrical (deep squat) task were moderately related to the newly developed HLLMS tool contributing moderate relationship between the FMS total score and the HLLMS total score. Other FMS tasks were weakly or unrelated with the HLLMS. These findings indicate that these two screening tools mainly assess different aspects of movement quality in healthy youth football players.

Abstract Background Observation of movement quality (MQ) is an indelible element in the process of clinical reasoning for patients with non-specific low back pain (NS-LBP). However, the observation and evaluation of MQ in common daily activities are not standardized within allied health care. This study aims to describe how Dutch allied health care professionals (AHCPs) observe and assess MQ in patients with NS-LBP and whether AHCPs feel the need to have a specific outcome measure for assessing MQ in patients with NS-LBP. Methods In this cross-sectional digital survey study, Dutch primary care AHCPs (n = 114) answered one open and three closed questions about MQ in NS-LBP management. Qualitative and quantitative analyses were applied. Results Qualitative analyses of the answers to the open questions revealed four main themes: 1) movement pattern features, 2) motor control features, 3) environmental influences and 4) non-verbal expressions of pain and exertion. Quantitative analyses clearly indicated that AHCPs observe MQ in the diagnostic (92%), therapeutic (91%) and evaluation phases (86%), that they do not apply any objective measurement of MQ and that 63% of the AHCPs consider it important to have a specific outcome measure to assess MQ. The AHCPs expressed added benefits and critical notes regarding clinical reasoning and quality of care. Conclusion AHCPs recognize the importance of observing MQ in the assessment and management of LBP in a standardized way. However, there is no consensus amongst AHCPs how MQ should be standardized. Prior to standardization, it will be important to develop a theoretical framework to determine which observable and measurable dimensions of MQ are most valid and relevant for patients with NS-LBP to include in the assessment.

Introduction: Clinical assessment of upper limb sensorimotor function post-stroke is often constrained by low sensitivity and limited information on movement quality. To address this gap, recent studies proposed a standardized instrumented drinking task, as a representative daily activity combining different components of functional arm use. Although kinematic movement quality measures for this task are well-established, and optical motion capture (OMC) has proven effective in their measurement, its clinical application remains limited. Inertial Measurement Units (IMUs) emerge as a promising low-cost and user-friendly alternative, yet their validity and clinical relevance compared to the gold standard OMC need investigation., Method: In this study, we conducted a measurement system comparison between IMUs and OMC, analyzing 15 established movement quality measures in 15 mild and moderate stroke patients performing the drinking task, using five IMUs placed on each wrist, upper arm, and trunk., Results: Our findings revealed strong agreement between the systems, with 12 out of 15 measures demonstrating clinical applicability, evidenced by Limits of Agreement (LoA) below the Minimum Clinically Important Differences (MCID) for each measure., Discussion: These results are promising, suggesting the clinical applicability of IMUs in quantifying movement quality for mildly and moderately impaired stroke patients performing the drinking task., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Unger, de Sousa Ribeiro, Mokni, Weikert, Pohl, Schwarz, Held, Sauerzopf, Kühnis, Gavagnin, Luft, Gassert, Lambercy, Awai Easthope and Schönhammer.)

Introduction: Return to Sport tests with functional hop tests are often used to decide when a person is ready to return to sport after an anterior cruciate ligament (ACL) injury. Poor movement quality, such as knee valgus, hip adduction and hip internal rotation is considered a risk factor for ACL injury. However, it is unclear whether existing tests adequately cover the aspect of movement quality. This study aims to investigate whether there is a relationship between the calculated limb symmetry index (LSI) of hop tests as an indication of performance and the total score of the "Quality First" assessment (movement quality). The second aim is to examine the reliability of the newly developed "Quality First" assessment for evaluating movement quality in hop tests., Methods: The cross-sectional study recruited 34 patients with an ACL reconstruction. The vertical hop, single-leg hop for distance, and side hop tests were performed and recorded. The video recordings were assessed using the "Quality First" assessment. The Spearman correlation coefficient was calculated using the LSI and the "Quality First" total score. Intraclass correlation coefficients (ICC) and standard error of measurements (SEM) were used to calculate intra- and interrater reliability. In addition, the minimal detectable change (MDC) was determined., Results: The correlation test between the LSI and the "Quality First" total score showed no correlation for all three jumps ( r  = -0.1-0.02/ p -value = 0.65-0.93). The interrater reliability of the "Quality First" assessment showed fair to good reliability (ICC 2 : 0.45-0.60), with SEM ranging from 1.46 to 1.73 and the MDC from 4.06 to 4.8. Intrarater reliability was good to excellent (ICC 3 : 0.73-0.85), with SEM values ranging from 0.89 to 1.09 and the MDC from 2.47 to 3.01., Conclusion: The quality of movement, measured with the "Quality First" assessment, indicated no correlation with the calculated LSI from jump performance, therefore movement quality should also be examined in Return to Sport tests. The "Quality First" assessment shows fair to good reliability when used by different raters. When used multiple times by the same rater, the assessment has good to excellent reliability., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Weber, Müller, Mathieu-Kälin, Caminada, Häberli and Baur.)