Report by Tyler Collings

Study information

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Concurrent validity and test-retest reliability of VALD ForceDecks strength, balance, and movement assessment tasks

Original Research published in Journal of Science and Medicine (May 2024) DOI: https://doi.org/10.1016/j.jsams.2024.04.014

Tyler J. Collings1,2 PhD , Yuri Lopes Lima1,2 MSc, Benjamin Dutallis1,2 AEP, Matthew N. Bourne1,2 PhD

1School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, QLD, Australia.
2Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Australia.

Griffith University logo GCORE logo

Corresponding author: Dr Tyler Collings
1 Parklands Drive, Griffith University, Gold Coast, Southport 4215, QLD, Australia.
Email: t.collings@griffith.edu.au

Funding Declaration: Funding was provided by VALD to cover the cost of data collection, analysis, and reporting of data. Data analysis was performed independently of VALD.

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Participants

Inclusion/exclusion criteria
Participants included 16 healthy individuals recruited from a population of Australian University students. To be included, participants were required to be aged between 18-40 years, physically active multiple times per week (30+ minutes), and free from any current injuries or neurological conditions that may influence the ability to perform tests, any major injuries in the previous 1-2 months that may influence test results, and any current shoulder pain or instability, or lower back pain. All participants were encouraged to refrain from performing resistance training or intense physical activity on the day before testing.

Ethics
All participants provided written informed consent prior to data collection. Study ethics were approved by the Griffith University Human Research Ethics Committee (GU reference: 2023/208).

Participant characteristics
Anthropometric measures for 16 participants. 10/16 (63%) participants were male and 6/16 (38%) were female. All participants except 1 were right-leg dominant.
Mean SD Range
Age (years) 25.9 2.9 20.3-29.7
Weight (kg) 71.8 14.9 50.2-102.5
Height (cm) 174.2 12.4 150-193.5
Days between tests 7.2 0.7 6-9

Equipment setup

Data were collected at the Griffith University motion laboratory, Gold Coast, Australia.

Force plates
Force plate data were acquired from the ForceDecks (FDLite, V.2, VALD, Brisbane, Australia) positioned on top of a tri-axial force plate embedded in the laboratory floor (AMTI, MA, United States). This arrangement enabled vertical ground reaction forces and centre of pressure to be measured from the ForceDecks as well as gold-standard laboratory-quality force plates simultaneously. Both force plates recorded data at 1000 Hz.

Before commencing testing, a weighted plate was used to determine the agreement in vertical ground reaction force between systems under static conditions, indicating a <1-2N difference between force plates.

The ForceDecks were operated using the iOS application (V.1.8.9) on an iPad (Apple, CA, United States) and the laboratory force plates were connected to VALD ForceDecks software for Windows (Microsoft, WA, United States).

Force plate arrangement
Force plate setup

Data collection

Participants attended two identically structured testing sessions approximately 7 days apart. A 5-minute warm-up was performed on a stationary cycle ergometry at a self-selected moderate intensity to increase core-body temperature and dynamic stretching.

Tasks
12 standard tests available in the ForceDecks software were performed in a pre-defined order:
1) Quiet Stand
2) Single Leg Range of Stability
3) Squat Assessment
4) Countermovement Jump
5) Squat Jump
6) Drop Jump
7) Hop Test
8) Single Leg Hop Test
9) Shoulder ISO-I
10) Shoulder ISO-Y
11) Shoulder ISO-T
12) Isometric Mid-Thigh Pull

Task protocols
All tests were performed in accordance with the protocol and instructions outlined on the VALD Knowledge Base website. Participant’s were shown how to perform each test and were given a chance to practice until they demonstrated satisfactory performance. Both force plates were ‘zeroed’ before beginning each trial. The participants weight was recorded in a stationary and relaxed standing position. Each repetition began and ended with 2-3 seconds of quiet standing. A total of 3 repetitions of each test were performed, with the unilateral task performed with 3 trials on the right followed by the left leg. Approximately 20-30 seconds rest was provided between repetitions of a task and 1-2 minutes rest between tasks.

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Data analysis

Force-time data from both force plates were automatically processed using the ForceDecks application for Windows, including the identification of movement phases and calculation of metrics. Trials were inspected for any errors in participant weighing or trial auto-detection and were corrected using the software re-analyse tool where possible. All force plate metrics were exported for analysis in R Studio (R version 4.3.0).

Reliabilty
Test-retest reliability of metrics between days (1 week apart) was assessed with intraclass coefficients (ICC) using a two-way random effects model, absolute agreement, and multiple measurements (ICC2,k, where k is the mean of 3 repetitions). ICC values were interpreted as less than 0.5 = poor reliability, 0.5-0.75 = moderate reliability, 0.75-0.9 = good reliability, and values greater than 0.90 indicated excellent reliability [1]. Measurement variability or consistency within a subject was quantified using standard error of measurement (SEM), where SEM=SD√(1-ICC) [2]. The minimal detectable change (MDC) or smallest real difference between two testing time points was calculated using the SEM and the 95% confidence interval for detecting a change in scores beyond 0, where MDC=1.96 × √2 ×SEM [2].

Validity
To enable concurrent validation of ground reaction forces and centre of pressure independent of weighing and movement phase detection, time series data over the entire movement were cross-correlated and time-adjusted. Due to differences in origin location between force plates, the centre of pressure was centred around 0 by subtracting the mean of the time series data for both force plate systems. Note: The stacked arrangement of force plates is not a perfect method for assessing concurrent validity with some discrepancies in force/centre of pressure occurring during impact or at extreme ranges. A small number of trials were removed due to errors created by stacking forceplates.

The validity of metrics was assessed using the percentage difference compared to the laboratory forceplates. Where <5% was interpreted as excellent validity, 5-10% was good validity, 10-20% was moderate validity, and 20% + was poor validity. Bland-Altman 95% limits of agreement for metrics are also presented. Validity of force and centre of pressure data was assessed between force plates over the duration of the movement using root mean square error (RMSE). To visualise the agreement between forceplates, individual trials ranging from the worst (lowest RMSE), and average (mean RMSE), to the best (highest RMSE) were displayed. The overall agreement for all trials was assessed using Bland-Altman plots for the mean ground reaction force, with mean bias and limits of agreement between force plates [3].

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References

  1. Koo, T.K. and M.Y. Li, A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic medicine, 2016. 15(2): p. 155-163. DOI: https://doi.org/10.1016/j.jcm.2016.02.012

  2. Beckerman, H., et al., Smallest real difference, a link between reproducibility and responsiveness. Quality of Life Research, 2001. 10: p. 571-578. DOI: https://doi.org/10.1023/A:1013138911638

  1. Bland, J. M., & Altman, D. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. The lancet, 327(8476), 307-310. DOI: https://doi.org/10.1016/S0140-6736(86)90837-8

Countermovement jump

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Task

Reliability (repeatability between-days)

Validity (agreement with lab forceplate)

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Validity: time-series comparison between force plates

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Reliability compared to lab forceplate

Validity: Bland-Altman agreement between force plates

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Reliability & validity of metrics

Squat Jump

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Task

Reliability (repeatability between-days)

Validity (agreement with lab force plates)

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Validity: time-series comparison between force plates

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Reliability compared to lab forceplate

Validity: Bland-Altman agreement between force plates

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Reliability & validity of metrics

Drop Jump

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Task

Reliability (repeatability between-days)

Validity (agreement with lab force plates)

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Validity: time-series comparison between force plates

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Reliability compared to lab forceplate

Validity: Bland-Altman agreement between force plates

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Reliability & validity of metrics

Hop Test

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Task

Reliability (repeatability between-days)

Validity (agreement with lab force plates)

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Validity: time-series comparison between force plates

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Reliability compared to lab forceplate

Validity: Bland-Altman agreement between force plates

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Reliability & validity of metrics

Single Leg Hop Test

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Task

Reliability (repeatability between-days)

Validity (agreement with lab force plates)

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Validity: time-series comparison between force plates

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Reliability compared to lab forceplate

Validity: Bland-Altman agreement between force plates

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Reliability & validity of metrics

Isometric Mid-Thigh Pull

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Task

Reliability (repeatability between-days)

Reliability compared to lab forceplate

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Reliability & validity of metrics

Shoulder ISO-I

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Task

Reliability (repeatability between-days)

Validity (agreement with lab force plates)

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Validity: time-series comparison between force plates

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Reliability compared to lab forceplate

Validity: Bland-Altman agreement between force plates

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Reliability & validity of metrics

Shoulder ISO-T

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Task

Reliability (repeatability between-days)

Validity (agreement with lab force plates)

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Validity: time-series comparison between force plates

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Reliability compared to lab forceplate

Validity: Bland-Altman agreement between force plates

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Reliability & validity of metrics

Shoulder ISO-Y

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Task

Reliability (repeatability between-days)

Validity (agreement with lab force plates)

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Validity: time-series comparison between force plates

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Reliability compared to lab forceplate

Validity: Bland-Altman agreement between force plates

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Reliability & validity of metrics

Squat Assessment

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Task

Reliability (repeatability between-days)

Validity (agreement with lab force plates)

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Validity: time-series comparison between force plates

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Reliability compared to lab forceplate

Validity: Bland-Altman agreement between force plates

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Reliability & validity of metrics

Quiet Stand

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Task

Reliability (repeatability between-days)

Validity (agreement with lab force plates)

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Centre of pressure Validity: comparison between force plates

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Reliability compared to lab forceplate

Centre of pressure validity: agreement between force plates

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Reliability & validity of metrics

Single Leg Range of Stability

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Task

Reliability (repeatability between-days)

Validity (agreement with lab force plates)

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Centre of pressure Validity: comparison between force plates

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Reliability compared to lab forceplate

Centre of pressure validity: agreement between force plates

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Reliability & validity of metrics