Why screening tests to predict injury do not work-and probably never will … : a critical review
Two articles on PainSci cite Bahr 2016: 1. Sports Injury Prevention Tips 2. The Functional Movement Screen (FMS)
PainSci commentary on Bahr 2016: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.
Sadly, medical science has yet to figure out how to identify people who are at risk for injury: “To date, there is no intervention study providing support for screening for injury risk.”
~ Paul Ingraham
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
This paper addresses if and how a periodic health examination to screen for risk factors for injury can be used to mitigate injury risk. The key question asked is whether it is possible to use screening tests to identify who is at risk for a sports injury-in order to address the deficit through a targeted intervention programme. The paper demonstrates that to validate a screening test to predict and prevent sports injuries, at least 3 steps are needed. First, a strong relationship needs to be demonstrated in prospective studies between a marker from a screening test and injury risk (step 1). Second, the test properties need to be examined in relevant populations, using appropriate statistical tools (step 2). Unfortunately, there is currently no example of a screening test for sports injuries with adequate test properties. Given the nature of potential screening tests (where test performance is usually measured on a continuous scale from low to high), substantial overlap is to be expected between players with high and low risk of injury. Therefore, although there are a number of tests demonstrating a statistically significant association with injury risk, and therefore help the understanding of causative factors, such tests are unlikely to be able to predict injury with sufficient accuracy. The final step needed is to document that an intervention programme targeting athletes identified as being at high risk through a screening programme is more beneficial than the same intervention programme given to all athletes (step 3). To date, there is no intervention study providing support for screening for injury risk.
- “Evaluation of the Functional Movement Screen as an Injury Prediction Tool Among Active Adult Populations: A Systematic Review and Meta-analysis,” Dorrel et al, Sports Health, 2015.
- “Predicting sport and occupational lower extremity injury risk through movement quality screening: a systematic review,” Whittaker et al, British Journal of Sports Medicine, 2016.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Inciting events associated with lumbar disc herniation. Suri 2010 Spine J.
- Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople 1994 Spine (Phila Pa 1976).
- Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou 2015 BMC Musculoskelet Disord.
- Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken 2022 Evid Based Ment Health.
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.