A Lower Limb Functional Screening Tool For Predicting Lower Limb Injury: A Prospective Cohort Study

Abstract

PURPOSE: The purpose of the current study was to assess the usefulness of the lower limb functional screening tool (LoLiFST) for predicting low back and lower limb injury in active athletes. METHODS: Fifty athletes (32M,18F; mean age: 19.4 ± 2.5 yrs) from six different sports volunteered. Athlete injury history and general information were recorded. The LoLiFST is based on five lower limb movements in different movement planes, directions, modes, and at varying intensities. Both legs were assessed in a random order and each athlete was given both technique and symptom scores. Intra-rater and inter-rater reliability was evaluated. Participants were followed up for 12 months, and their exposure to sport and injuries were recorded. Independent samples t-tests were performed to determine if a significant difference existed in LoLiFST scores between those injured and non-injured athletes. Receiver operating characteristic (ROC) analysis was employed to assess the instrument’s capacity to predict injury. RESULTS: The inter-rater reliability was 0.900 and the intra-rater reliability was 0.955. Fourteen participants experienced injury within the following 12 months. Injured athletes had significant lower scores than non-injured in both technique and symptom scores of the LoLiFST (df=48, t=4.149, P<0.05; df=16.402, t=2.979, P<0.05). When technique or symptom score alone was included in the ROC analysis, the area under the ROC curve (AUC) scores were 0.793 (P<0.05, 95%CI: 0.649-0.936) and 0.761 (P<0.05, 95%CI: 0.599-0.923), respectively. When technique and symptom scores combined, the AUC discrimination score was 0.835 (P<0.05, 95%CI: 0.709-0.962). When injury history was added into the variable set, the AUC discrimination score was 0.860 (P<0.05, 95%CI: 0.746-0.974), resulting in 86.0% of cases being correctly predicted as low back or lower limb injured/non-injured. CONCLUSIONS: The new functional assessment tool LoLiFST had excellent intra-rater and inter-rater reliability. The findings from the current study suggest that the technique, reported symptoms, and injury history should be used in combination to maximize its capacity for predicting injuries. Future larger sample size research is warranted to explore the validity of the LoLiFST in predicting low back and lower limb injury in various sports.