Factors influencing the relationship between the functional movement screen and injury risk in sporting populations: a systematic review and meta-analysis

Emma Moore, Samuel Chalmers, Steve Milanese, Joel T. Fuller

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Background: Studies investigating the association between the Functional Movement Screen (FMS) and sports injury risk have reported mixed results across a range of athlete populations. Objectives: The purpose of this systematic review was to identify whether athlete age, sex, sport type, injury definition and mechanism contribute to the variable findings. Study design: Systematic review and meta-analysis. Methods: A systematic search was conducted in October 2018 using PubMed, EBSCOhost, Scopus, EmBase and Web of Science databases. Studies were included if they were peer reviewed and published in English language, included athletes from any competition level, performed the FMS at baseline to determine risk groups based on FMS composite score, asymmetry or pain, and prospectively observed injury incidence during training and competition. Study eligibility assessment and data extraction was performed by two reviewers. Random effects meta-analyses were used to determine odds ratio (OR), sensitivity and specificity with 95% confidence intervals. Sub-group analyses were based on athlete age, sex, sport type, injury definition, and injury mechanism. Results: Twenty-nine studies were included in the FMS composite score meta-analysis. There was a smaller effect for junior (OR = 1.03 [0.67–1.59]; p = 0.881) compared to senior athletes (OR = 1.80 [1.17–2.78]; p = 0.008) and for male (OR = 1.79 [1.08–2.96]; p = 0.024) compared to female (OR = 1.92 [0.43–8.56]; p = 0.392) athletes. FMS composite scores were most likely to be associated with increased injury risk in rugby (OR = 5.92 [1.67–20.92]; p = 0.006), and to a lesser extent American football (OR = 4.41 [0.94–20.61]; p = 0.059) and ice hockey (OR = 3.70 [0.89–15.42]; p = 0.072), compared to other sports. Specificity values were higher than sensitivity values for FMS composite score. Eleven studies were included in the FMS asymmetry meta-analysis with insufficient study numbers to generate sport type subgroups. There was a larger effect for senior (OR = 1.78 [1.16–2.73]; p = 0.008) compared to junior athletes (OR = 1.21 [0.75–1.96]; p = 0.432). Sensitivity values were higher than specificity values for FMS asymmetry. For all FMS outcomes, there were minimal differences across injury definitions and mechanisms. Only four studies provided information about FMS pain and injury risk. There was a smaller effect for senior athletes (OR = 1.28 [0.33–4.96]; p = 0.723) compared to junior athletes (OR = 1.71 [1.16–2.50]; p = 0.006). Specificity values were higher than sensitivity values for FMS pain. Conclusion: Athlete age, sex and sport type explained some of the variable findings of FMS prospective injury-risk studies. FMS composite scores and asymmetry were more useful for estimating injury risk in senior compared to junior athletes. Effect sizes tended to be small except for FMS composite scores in rugby, ice hockey and American football athletes. Protocol registration: CRD42018092916.

LanguageEnglish
Pages1449-1463
Number of pages15
JournalSports Medicine
Volume49
Issue number9
Early online date18 May 2019
DOIs
Publication statusPublished - 1 Sep 2019

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Athletes
Meta-Analysis
Odds Ratio
Wounds and Injuries
Population
Football
Athletic Injuries
Hockey
Sports
Pain
PubMed
Language
Databases
Confidence Intervals
Sensitivity and Specificity

Cite this

@article{9783d73898fd4f208144e19abab471b8,
title = "Factors influencing the relationship between the functional movement screen and injury risk in sporting populations: a systematic review and meta-analysis",
abstract = "Background: Studies investigating the association between the Functional Movement Screen (FMS) and sports injury risk have reported mixed results across a range of athlete populations. Objectives: The purpose of this systematic review was to identify whether athlete age, sex, sport type, injury definition and mechanism contribute to the variable findings. Study design: Systematic review and meta-analysis. Methods: A systematic search was conducted in October 2018 using PubMed, EBSCOhost, Scopus, EmBase and Web of Science databases. Studies were included if they were peer reviewed and published in English language, included athletes from any competition level, performed the FMS at baseline to determine risk groups based on FMS composite score, asymmetry or pain, and prospectively observed injury incidence during training and competition. Study eligibility assessment and data extraction was performed by two reviewers. Random effects meta-analyses were used to determine odds ratio (OR), sensitivity and specificity with 95{\%} confidence intervals. Sub-group analyses were based on athlete age, sex, sport type, injury definition, and injury mechanism. Results: Twenty-nine studies were included in the FMS composite score meta-analysis. There was a smaller effect for junior (OR = 1.03 [0.67–1.59]; p = 0.881) compared to senior athletes (OR = 1.80 [1.17–2.78]; p = 0.008) and for male (OR = 1.79 [1.08–2.96]; p = 0.024) compared to female (OR = 1.92 [0.43–8.56]; p = 0.392) athletes. FMS composite scores were most likely to be associated with increased injury risk in rugby (OR = 5.92 [1.67–20.92]; p = 0.006), and to a lesser extent American football (OR = 4.41 [0.94–20.61]; p = 0.059) and ice hockey (OR = 3.70 [0.89–15.42]; p = 0.072), compared to other sports. Specificity values were higher than sensitivity values for FMS composite score. Eleven studies were included in the FMS asymmetry meta-analysis with insufficient study numbers to generate sport type subgroups. There was a larger effect for senior (OR = 1.78 [1.16–2.73]; p = 0.008) compared to junior athletes (OR = 1.21 [0.75–1.96]; p = 0.432). Sensitivity values were higher than specificity values for FMS asymmetry. For all FMS outcomes, there were minimal differences across injury definitions and mechanisms. Only four studies provided information about FMS pain and injury risk. There was a smaller effect for senior athletes (OR = 1.28 [0.33–4.96]; p = 0.723) compared to junior athletes (OR = 1.71 [1.16–2.50]; p = 0.006). Specificity values were higher than sensitivity values for FMS pain. Conclusion: Athlete age, sex and sport type explained some of the variable findings of FMS prospective injury-risk studies. FMS composite scores and asymmetry were more useful for estimating injury risk in senior compared to junior athletes. Effect sizes tended to be small except for FMS composite scores in rugby, ice hockey and American football athletes. Protocol registration: CRD42018092916.",
author = "Emma Moore and Samuel Chalmers and Steve Milanese and Fuller, {Joel T.}",
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month = "9",
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Factors influencing the relationship between the functional movement screen and injury risk in sporting populations : a systematic review and meta-analysis. / Moore, Emma; Chalmers, Samuel; Milanese, Steve; Fuller, Joel T.

In: Sports Medicine, Vol. 49, No. 9, 01.09.2019, p. 1449-1463.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Factors influencing the relationship between the functional movement screen and injury risk in sporting populations

T2 - Sports Medicine

AU - Moore, Emma

AU - Chalmers, Samuel

AU - Milanese, Steve

AU - Fuller, Joel T.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background: Studies investigating the association between the Functional Movement Screen (FMS) and sports injury risk have reported mixed results across a range of athlete populations. Objectives: The purpose of this systematic review was to identify whether athlete age, sex, sport type, injury definition and mechanism contribute to the variable findings. Study design: Systematic review and meta-analysis. Methods: A systematic search was conducted in October 2018 using PubMed, EBSCOhost, Scopus, EmBase and Web of Science databases. Studies were included if they were peer reviewed and published in English language, included athletes from any competition level, performed the FMS at baseline to determine risk groups based on FMS composite score, asymmetry or pain, and prospectively observed injury incidence during training and competition. Study eligibility assessment and data extraction was performed by two reviewers. Random effects meta-analyses were used to determine odds ratio (OR), sensitivity and specificity with 95% confidence intervals. Sub-group analyses were based on athlete age, sex, sport type, injury definition, and injury mechanism. Results: Twenty-nine studies were included in the FMS composite score meta-analysis. There was a smaller effect for junior (OR = 1.03 [0.67–1.59]; p = 0.881) compared to senior athletes (OR = 1.80 [1.17–2.78]; p = 0.008) and for male (OR = 1.79 [1.08–2.96]; p = 0.024) compared to female (OR = 1.92 [0.43–8.56]; p = 0.392) athletes. FMS composite scores were most likely to be associated with increased injury risk in rugby (OR = 5.92 [1.67–20.92]; p = 0.006), and to a lesser extent American football (OR = 4.41 [0.94–20.61]; p = 0.059) and ice hockey (OR = 3.70 [0.89–15.42]; p = 0.072), compared to other sports. Specificity values were higher than sensitivity values for FMS composite score. Eleven studies were included in the FMS asymmetry meta-analysis with insufficient study numbers to generate sport type subgroups. There was a larger effect for senior (OR = 1.78 [1.16–2.73]; p = 0.008) compared to junior athletes (OR = 1.21 [0.75–1.96]; p = 0.432). Sensitivity values were higher than specificity values for FMS asymmetry. For all FMS outcomes, there were minimal differences across injury definitions and mechanisms. Only four studies provided information about FMS pain and injury risk. There was a smaller effect for senior athletes (OR = 1.28 [0.33–4.96]; p = 0.723) compared to junior athletes (OR = 1.71 [1.16–2.50]; p = 0.006). Specificity values were higher than sensitivity values for FMS pain. Conclusion: Athlete age, sex and sport type explained some of the variable findings of FMS prospective injury-risk studies. FMS composite scores and asymmetry were more useful for estimating injury risk in senior compared to junior athletes. Effect sizes tended to be small except for FMS composite scores in rugby, ice hockey and American football athletes. Protocol registration: CRD42018092916.

AB - Background: Studies investigating the association between the Functional Movement Screen (FMS) and sports injury risk have reported mixed results across a range of athlete populations. Objectives: The purpose of this systematic review was to identify whether athlete age, sex, sport type, injury definition and mechanism contribute to the variable findings. Study design: Systematic review and meta-analysis. Methods: A systematic search was conducted in October 2018 using PubMed, EBSCOhost, Scopus, EmBase and Web of Science databases. Studies were included if they were peer reviewed and published in English language, included athletes from any competition level, performed the FMS at baseline to determine risk groups based on FMS composite score, asymmetry or pain, and prospectively observed injury incidence during training and competition. Study eligibility assessment and data extraction was performed by two reviewers. Random effects meta-analyses were used to determine odds ratio (OR), sensitivity and specificity with 95% confidence intervals. Sub-group analyses were based on athlete age, sex, sport type, injury definition, and injury mechanism. Results: Twenty-nine studies were included in the FMS composite score meta-analysis. There was a smaller effect for junior (OR = 1.03 [0.67–1.59]; p = 0.881) compared to senior athletes (OR = 1.80 [1.17–2.78]; p = 0.008) and for male (OR = 1.79 [1.08–2.96]; p = 0.024) compared to female (OR = 1.92 [0.43–8.56]; p = 0.392) athletes. FMS composite scores were most likely to be associated with increased injury risk in rugby (OR = 5.92 [1.67–20.92]; p = 0.006), and to a lesser extent American football (OR = 4.41 [0.94–20.61]; p = 0.059) and ice hockey (OR = 3.70 [0.89–15.42]; p = 0.072), compared to other sports. Specificity values were higher than sensitivity values for FMS composite score. Eleven studies were included in the FMS asymmetry meta-analysis with insufficient study numbers to generate sport type subgroups. There was a larger effect for senior (OR = 1.78 [1.16–2.73]; p = 0.008) compared to junior athletes (OR = 1.21 [0.75–1.96]; p = 0.432). Sensitivity values were higher than specificity values for FMS asymmetry. For all FMS outcomes, there were minimal differences across injury definitions and mechanisms. Only four studies provided information about FMS pain and injury risk. There was a smaller effect for senior athletes (OR = 1.28 [0.33–4.96]; p = 0.723) compared to junior athletes (OR = 1.71 [1.16–2.50]; p = 0.006). Specificity values were higher than sensitivity values for FMS pain. Conclusion: Athlete age, sex and sport type explained some of the variable findings of FMS prospective injury-risk studies. FMS composite scores and asymmetry were more useful for estimating injury risk in senior compared to junior athletes. Effect sizes tended to be small except for FMS composite scores in rugby, ice hockey and American football athletes. Protocol registration: CRD42018092916.

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DO - 10.1007/s40279-019-01126-5

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