Validity of an Upper Extremity Physical Performance Test Battery in Healthy Athletes

Construct and Predictive Validity of an Upper Extremity Physical Performance Test Battery in Healthy Athletes: a Cross-sectional and Prospective Study

This project comprises two studies; a cross-sectional study and a prospective study.

1. The cross-sectional study aims to develop and validate a new sport-specific test battery (PROMs, analytical and physical performance tests) in healthy tennis players and swimmers.The construct validity of this upper extremity test battery will be examined through two different methods.

   1. Firstly, the performance on the test battery will be correlated to sport performance (sprint time at 100m freestyle in swimming and serve speed/accuracy in tennis)
   2. Secondly, the correlation between test battery performance and upper limb/trunk kinematics in a tennis serve (measured via inertial measurement units (IMUs)) will be examined.

2. In the prospective study, the predictive validity of the test battery will be evaluated. Healthy swimmers and tennis players will be tested at baseline using the same test battery as mentioned above. The athletes will be followed for one year and new injuries will be recorded via a weekly questionnaire. Performance on the test battery will be associated with the incidence of musculoskeletal injuries.

Upper extremity physical performance tests (PPTs) of the upper limb are physically challenging tests and are supposed to be sport-specific and mimic the sport specific movements or load.

Currently, there is no strong evidence for the validity of many upper extremity physical performance tests, although these tests are widely used in the return-to-sport phase after upper limb injuries. There is a clear need for a validating test physical performance tests.

Validation of these PPTs is possible in several ways, e.g. correlation to an analytical construct such as strength. However, it is important that these tests are sport-specific. For this reason, the correlation between physical performance tests on the one hand and sports performance (in swimming and tennis) and upper limb kinematics during a tennis serve on the other hand will be evaluated in this study. However, a single PPT is unlikely to correlate strongly with sport performance or tennis serve kinematics, as previous studies have shown a weak to moderate association when a single PPT was correlated with sport performance or another construct. Therefore, a cluster of tests will be assessed; four PPTs per sport and three analytical tests measuring strength and mobility of shoulder and hand, since these are the cornerstone of testing protocols in sports rehabilitation.

In addition, patient-reported outcome measures (PROMs), questionnaires that measure physical and psychosocial factors, are becoming increasingly important in sports. Recent studies show that these factors influence sports performance and rehabilitation outcomes. Therefore, these questionnaires can be very useful in the return-to-sport phase and injury risk screening. The PROMs that will be used in this study are the following: Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Score (KJOC-SES), Competitive State Anxiety Inventory-2 (CSAI-2) and the general self-efficacy scale.

To conclude, the test battery consists of PPTs, analytical tests (strength and mobility) and PROMs.

Inclusion Criteria:

• In good general health
• Play tennis or swim competitively, at least 3 hours per week (training + competition)

Exclusion Criteria:

• History of shoulder dislocation in dominant and/or nondominant shoulder
• History of upper extremity surgery
• At the moment of participation, participants should not report a substantial injury (defined by the Oslo Sports Trauma Research Centre questionnaire on health problems) in the past two months. A substantial injury is defined as a moderate or severe reduction in training volume or reduction in sports performance or complete inability to participate in sport as substantial injuries and illnesses.
• Neurological symptoms in any extremity
• Suffering from a systemic disease (such as diabetes, lupus, arthrosis,.. )