Assessing Movement Quality in Youth Footballers: The Relationship between Hip and Lower Limb Movement Screen and Functional Movement Screen
, Paul E. Muckelt 2,3, Damian Sikora 1,4, Nadine Booysen 2,3,5 and Maria Stokes 2,3,5
Round 1
Reviewer 1 Report
GENERAL COMMENTS:
Thank you for submitting your manuscript to the Applied Sciences. Overall, the paper investigates the relationship between two movement screening tools assessing movement quality in youth footballers. The presented approach falls within the scope of the journal and should be of interest to the readership. However, in its current form, the manuscript presents some concerns which need to be addressed before potentially considering the paper for publication. In my point of view, these issues refer to the clarity and consistency in presenting the rationale for the investigation and the hypotheses. Furthermore, the conclusions drawn from the study should be more critically reflected. Please see the comments below.
- First, I was wondering why the relationship between two movement screening tools is investigated although, as presented by the authors, they assess mainly different aspects of the movement. Just comparing two tools, “that one has done it” is a too weak rational in my point of view (referring to your aim). I agree, that the HLLMS could be beneficial for use in a soccer-specific elite context, but the rationale why you compare this tool with the FMS has to be extended/more explained. I would recommend focussing more on the aspect that there are domains, that are different, and domains (e.g., deep squat) that are rather similar regarding the two tools. Later, in the results, this is done by giving this part the structure 1) total score; 2) asymmetrical, and 3) symmetrical tasks. Therefore, I recommend using this structure already before in the introduction to support your rationale for comparing the tools, and -even more important- also presenting your hypotheses for each of these 3 considerations (total, asymmetrical, symmetrical) separately. Sticking to this structure throughout the whole text would facilitate reading and understanding.
- Second, I am not totally convinced with the conclusion of your study: The two tools mainly assess different aspects of movement quality although you found parts that are comparable. Therefore, I would highlight the latter (already in the abstract, but also in the discussion) by indicating the specific domains where it was found to be comparable) as it is clear from the beginning that there are different aspects assessed by the two tools.
SPECIFIC COMMENTS:
Abstract:
l.19: provide age, level, and gender
l.20: provide the information in brackets (statistics) at the end of the sentence
l.19-16: stick to the structure given in general comment 1)?
l.20: provide information that you used spearman correlations also in the abstract (only once)
Introduction:
l.33-35: please provide examples here
l.38: what do you mean by “mechanistic evidence” Please explain shortly.
l.40-41: provide a reference for this statement
l.46-47: provide examples or rational
l.55-56: the transition to football as the investigated setting is rather abrupt; maybe you should at an “Especially”, “in particular” in order to improve the cohesion of the two paragraphs.
l.75-76: “directly assess”: a relationship is difficult to directly assess, please use “investigate” or “analyze” here
l.79-83: hypotheses should be presented in more detail here (see general comment)
Methods:
l.89: How the blinding process was performed? Provide information.
l.90: provide information on time duration of the measurements.
l.98: provide decimals also for range
l.99: is it really the youth club that is professional (or only the adults in the club). If not, consider using “elite youth football club” instead.
l.100 (and throughout the manuscript). Please, use spaces between values and “*”, “-“, “<”, …
l.107-109: please provide a reference for a detailed description of FMS here (although it is well-known)
l.109: how intrarater rel. was measured? Explain.
l.120pp: rationale for the use of FMS subcategories should be provided. Not clear to the reader.
l.126: it is not clear, which task of the HLLMS consists of which number of items, please elaborate (also the 40 movement faults for the total score seem not obvious to me)
l.139: Why did you consider only one rate for the HLLMS and two for the FMS. This is a real limitation of your study. By the way: did this rater also rate the FMS? Although mentioned in the limitations, you should provide more information on the possible effects of this limitation on your study.
Results:
l.155: information in brackets should be provided (only) in the method section.
l.156: please do not use personal interpretations in the results section. E.g., “as expected”. Please remove and discuss the expectations in the discussion section.
l.173pp: symmetrical/asymmetrical tasks should be defined earlier (see general comment)
Tables: please use “p < .05” instead of “significant correlation” in the Note. By the way: please check (in alignment to the Journal’s instructions) as to whether the “0” in p = 0.02 (or similar (before the decimals), and also in al R values are really necessary).
Discussion:
l.182-197: please use the same order (total score, asymmetrical tasks, …) for this part as well
l.253: add here performance level of the players
l.258: here, more information why only one rater performed HLLMS ratings is needed. This is a real limitation of your study.
Conclusions:
l.269: think about revising this conclusion (see general comment).
Author Response
DETAILED RESPONSE TO REVIEWERS
Manuscript
Title: Assessing Movement Quality In Youth Footballers: Relationship Between Hip And Lower Limb Movement Screen, And Functional Movement Screen
The authors would like to thank the editor-and-chief as well as the reviewers for their thoughtful and constructive comments regarding this manuscript. We greatly appreciate the thorough review and suggestions, and believe that the revisions made improves the quality of the manuscript.
Our response to specific comments and recommendations are included below. In the following response, the original reviewer comments are listed using italics with our response listed immediately below in normal type.
Reviewer 1
Thank you for submitting your manuscript to the Applied Sciences. Overall, the paper investigates the relationship between two movement screening tools assessing movement quality in youth footballers. The presented approach falls within the scope of the journal and should be of interest to the readership. However, in its current form, the manuscript presents some concerns which need to be addressed before potentially considering the paper for publication. In my point of view, these issues refer to the clarity and consistency in presenting the rationale for the investigation and the hypotheses. Furthermore, the conclusions drawn from the study should be more critically reflected. Please see the comments below.
Response: Thank you for the general feedback on the paper. We appreciate all suggestions
First, I was wondering why the relationship between two movement screening tools is investigated although, as presented by the authors, they assess mainly different aspects of the movement. Just comparing two tools, “that one has done it” is a too weak rational in my point of view (referring to your aim). I agree, that the HLLMS could be beneficial for use in a soccer-specific elite context, but the rationale why you compare this tool with the FMS has to be extended/more explained. I would recommend focussing more on the aspect that there are domains, that are different, and domains (e.g., deep squat) that are rather similar regarding the two tools. Later, in the results, this is done by giving this part the structure 1) total score; 2) asymmetrical, and 3) symmetrical tasks. Therefore, I recommend using this structure already before in the introduction to support your rationale for comparing the tools, and -even more important- also presenting your hypotheses for each of these 3 considerations (total, asymmetrical, symmetrical) separately. Sticking to this structure throughout the whole text would facilitate reading and understanding.
Response: Thank you so much for this criticism and suggestions. We have corrected the introduction section as suggested by adding:
Both tests are analysed using a composite score (sum of all motor tasks), but each of the tasks of the HLLMS may also be analysed separately. A factorial analysis have shown that the FMS is not a unitary construct [25], meaning using the summed score may be misleading relative to the individual item scores. In fact, the FMS and the HLLMS contain symmetrical and asymmetrical motor tasks which are based on observation of different aspects of each task performance. One motor task (the deep squat) is in both screening tools. Therefore, both screening tests have some common features. Thus, the comparison between the results from these two assessment tools is needed to ensure they were testing different aspects of movement control and to provide further evidence of the need for the HLLMS, as it has been suggested the FMS is not appropriate for assessing hip dysfunction [20].
Second, I am not totally convinced with the conclusion of your study: The two tools mainly assess different aspects of movement quality although you found parts that are comparable. Therefore, I would highlight the latter (already in the abstract, but also in the discussion) by indicating the specific domains where it was found to be comparable) as it is clear from the beginning that there are different aspects assessed by the two tools.
Response: Discussion and conclusion were changed to be more consistent with corrected introduction section.
Discussion:
The aim of the present study was to assess the relationship between the two move-ment screening tools (FMS and HLLMS) in youth football players. This study found that out of all asymmetrical tasks: 1) two pairs of tasks were moderately correlated (FMS trunk rotary stability was correlated with the HLLMS SKB with trunk rotation; 2) two HLLMS tasks (standing hip flexion and hip abduction with lateral rotation) were weakly related with one FMS task (hurdle step); 3) four FMS tasks (in-line lunge, active straight-leg raise, shoulder mobility) and one HLLMS task (SKB) were not related. Of the symmetrical tasks, only the deep squat from FMS was moderately correlated with deep squat from HLLMS. Analyses of total scores for the two assessment tools found that FMS total score and FMSMOVE score were moderately correlated with the HLLMS total score. Thus, our preliminary hypothesis that the relationship between the FMS and the HLLMS should be weak or even absent was not fully achieved. However, a) most (four out of seven) FMS tasks were not related to the HLLMS at all (three asymmetrical and one symmetrical; and b) the moderate relationship between both screening tools was caused directly by two pairings between asymmetrical trunk rotary stability (FMS) and the SKB with trunk rotation (HLLMS), and symmetrical the deep squat tasks from the two assessment tools.
Conclusion:
Out of the seven FMS tasks only one asymmetrical (trunk rotary stability) and one symmetrical (deep squat) task was moderately related to the newly developed HLLMS tool contributing moderate relationship between the FMS total score and the HLLMS total score. Other FMS tasks were weakly or unrelated with the HLLMS.
Now, We hope that the whole manuscript is much more consistent.
Thank you once again!!
SPECIFIC COMMENTS:
Abstract:
l.19: provide age, level, and gender
Response: Corrected
l.20: provide the information in brackets (statistics) at the end of the sentence
Response: Corrected
l.19-16: stick to the structure given in general comment 1)?
Response: Corrected
l.20: provide information that you used spearman correlations also in the abstract (only once)
Response: Information was added
Introduction:
l.33-35: please provide examples here
Response: The example was added and the structure of the first paragraph was changed.
l.38: what do you mean by “mechanistic evidence” Please explain shortly.
Response: The structure of the paragraph was changed and this expression was deleted.
l.40-41: provide a reference for this statement
Response: There is no reference for it. Thus we have decided to rewrite the sentence.
Now is:
The functional movement screen (FMS) seems to be one of the most well-known movement screening tool.
I think that we agree with such a statement.
l.46-47: provide examples or rational
Response: We have corrected the sentence to:
“It may be that the ability of the FMS to predict injury is limited to specific sports or types of injuries, but more homogeneous studies in term of type of sport and/or injury are needed.”
Because there are rather heterogeneous studies and there no possibility to present examples that the FMS is really specific to predict injury in a given sport o type of injury.
Thank you for this remark.
l.55-56: the transition to football as the investigated setting is rather abrupt; maybe you should at an “Especially”, “in particular” in order to improve the cohesion of the two paragraphs.
Response: Thank you for this remark. We have added the following sentence:
Athletes are at an increased risk of subsequent OA [13].
Additionally, the first sentence in the next paragraph was also corrected. We hope that the sentence resolve the problem.
Athletes are at an increased risk of subsequent OA [15].
This is particularly prevalent in football where higher rates of hip and groin injuries where among sports
l.75-76: “directly assess”: a relationship is difficult to directly assess, please use “investigate” or “analyze” here
Response: Corrected as suggested.
l.79-83: hypotheses should be presented in more detail here (see general comment)
Response: Thank you again.
This part of the study was substantially changed:
Thus, the aim of the present study was to investigate the relationship between the FMS and the HLLMS performance in youth football players. Both tests are analysed using a composite score (sum of all motor tasks), but each of the tasks of the HLLMS may also be analysed separately. A factorial analysis have shown that the FMS is not a unitary construct [25], meaning using the summed score may be misleading relative to the individual item scores. In fact, the FMS and the HLLMS contain symmetrical and asymmetrical motor tasks which are based on observation of different aspects of each task performance. One motor task (the deep squat) is in both screening tools. Therefore, both screening tests have some common features. Thus, the comparison between the results from these two assessment tools is needed to ensure they were testing different aspects of movement control and to provide further evidence of the need for the HLLMS, as it has been suggested the FMS is not appropriate for assessing hip dysfunction [20]. Taking into account that the FMS does not appear to detect abnormal movement patterns specifically of the lower limbs, and the HLLMS was developed specifically to detect abnormal movement patterns of the hips, pelvis and lower limbs, we hypothesized that the relationship would be weak or even absent in youth footballers.
Methods:
l.89: How the blinding process was performed? Provide information.
Response: We have added:
Measurements were conducted in two separate rooms, the physiotherapists were only informed that the results of both screening tools will be used for training purpose.
l.90: provide information on time duration of the measurements.
Response: We have added:
The time taken to complete each screening tool ranged between 10 to 20 minutes.
The time taken to complete each screening tool ranged from 10 to 20 minutes.
l.98: provide decimals also for range
Response: range from 15 to 16 years of age
l.99: is it really the youth club that is professional (or only the adults in the club). If not, consider using “elite youth football club” instead.
Response: Thank you. Corrected as suggested.
l.100 (and throughout the manuscript). Please, use spaces between values and “*”, “-“, “<”, …
Response: Thank you. Corrected as suggested.
l.107-109: please provide a reference for a detailed description of FMS here (although it is well-known)
Response: The reference was added.
l.109: how intrarater rel. was measured? Explain.
Response: The reliability was not measured for this study. The sentence about reliability comes from Bonazza, N.A.; Smuin, D.; Onks, C.A.; Silvis, M.L.; Dhawan, A. Reliability, Validity, and Injury Predictive Value of the Func-tional Movement Screen: A Systematic Review and Meta-analysis. Am. J. Sports Med. 2017, 45, 725–732, doi:10.1177/0363546516641937.
This is a consistent results from mentioned systematic review.
l.120pp: rationale for the use of FMS subcategories should be provided. Not clear to the reader.
Response: This was carried out to verify the potential relationship of some grouped the FMS tasks with the HLLMS.
l.126: it is not clear, which task of the HLLMS consists of which number of items, please elaborate (also the 40 movement faults for the total score seem not obvious to me)
Response: We have decided to add table 1 for clarity.
l.139: Why did you consider only one rate for the HLLMS and two for the FMS. This is a real limitation of your study. By the way: did this rater also rate the FMS? Although mentioned in the limitations, you should provide more information on the possible effects of this limitation on your study.
Response: There was to trials for HLLMS as well
We have added:
The physiotherapist performed two trials (one from the front and one from the side) to observe and collect all the movement faults.
Additionally, we have clearly explain that two raters performed assessment.
See method section
All outcomes were measured by two experienced physiotherapists blinded to the study aim
We have also added for better clarity in limitation section:
To minimize bias being introduced during the data collection process the FMS and the HLLMS data was collected by two separate raters, ensuring the therapists collecting the data was not aware of previous FMS/HLLMS scores, preventing the investigator’s test interpretation being influenced. However, we are unsure whether past experience with the FMS of the physiotherapist assessing the HLLMS may affect in some way this study results.
Results:
l.155: information in brackets should be provided (only) in the method section.
Response: Thank you. Corrected as suggested.
l.156: please do not use personal interpretations in the results section. E.g., “as expected”. Please remove and discuss the expectations in the discussion section.
Response: Thank you. Corrected as suggested.
l.173pp: symmetrical/asymmetrical tasks should be defined earlier (see general comment)
Response: Corrected as asuggested
Tables: please use “p < .05” instead of “significant correlation” in the Note. By the way: please check (in alignment to the Journal’s instructions) as to whether the “0” in p = 0.02 (or similar (before the decimals), and also in al R values are really necessary).
Response: Thank you. Corrected as suggested. The presentation of the results meet the Journal`s requirements.
Discussion:
l.182-197: please use the same order (total score, asymmetrical tasks, …) for this part as well
Response: We have done it. Thank you.
l.253: add here performance level of the players
Response: Thank you. Corrected as suggested.
l.258: here, more information why only one rater performed HLLMS ratings is needed. This is a real limitation of your study.
Response: As above
We have added the following sentence:
To minimize bias being introduced during the data collection process the FMS and the HLLMS data was collected by two separate raters, ensuring the therapists collecting the data was not aware of previous FMS/HLLMS scores, preventing the investigator’s test interpretation being influenced. However, we are unsure whether past experience with the FMS of the physiotherapist assessing the HLLMS may affect in some way this study results.
Conclusions:
l.269: think about revising this conclusion (see general comment).
Response: Corrected to:
Out of the seven FMS tasks only one asymmetrical (trunk rotary stability) and one symmetrical (deep squat) task was moderately related to the newly developed HLLMS tool contributing moderate relationship between the FMS total score and the HLLMS total score. Other FMS tasks were weakly or unrelated with the HLLMS.
Reviewer 2 Report
Thank you for your submission.
The further validation of a more specific movement test battery for the lower-limb is well justified and your study was well written and presented, it was pleasant to read, thank you!
My main concern with this paper is the scope; the sample size is comparable to other studies (as noted by the authors), however the comparison is very basic. In the introduction, you state "This allowed for the comparison between the results from these two assessment tools to ensure they were testing different aspects of movement control and to provide further evidence of the need for the HLLMS." This evidence, that the HLLMS is better than the FMS at diagnosing lower limb movement deficiencies (directional results, not just comparison), would make a much more powerful study. I understand this might be the next step you take! I am leaving it to the discretion of the editor whether the scope of this study is sufficient for publication.
The only other constructive feedback I have is minor:
- Line 156: should it read 'with a lower' rather than 'with lower a'
- 170: lung >> lunge
- 176: p=0.4 - report to same amount of decimal places as in table (i.e. 0.34)
I wish you all the best for your research project and ongoing work with the HLLMS!
Author Response
DETAILED RESPONSE TO REVIEWERS
Manuscript
Title: Assessing Movement Quality In Youth Footballers: Relationship Between Hip And Lower Limb Movement Screen, And Functional Movement Screen
The authors would like to thank the editor-and-chief as well as the reviewers for their thoughtful and constructive comments regarding this manuscript. We greatly appreciate the thorough review and suggestions, and believe that the revisions made improves the quality of the manuscript.
Our response to specific comments and recommendations are included below. In the following response, the original reviewer comments are listed using italics with our response listed immediately below in normal type.
Thank you for your submission.
The further validation of a more specific movement test battery for the lower-limb is well justified and your study was well written and presented, it was pleasant to read, thank you!
My main concern with this paper is the scope; the sample size is comparable to other studies (as noted by the authors), however the comparison is very basic. In the introduction, you state "This allowed for the comparison between the results from these two assessment tools to ensure they were testing different aspects of movement control and to provide further evidence of the need for the HLLMS." This evidence, that the HLLMS is better than the FMS at diagnosing lower limb movement deficiencies (directional results, not just comparison), would make a much more powerful study. I understand this might be the next step you take! I am leaving it to the discretion of the editor whether the scope of this study is sufficient for publication.
Response: Thank you for your feedback and criticism. We have corrected the whole manuscript along with the first reviewer suggestions. I hope that this form of the manuscript is more suitable.
The only other constructive feedback I have is minor:
- Line 156: should it read 'with a lower' rather than 'with lower a'
- 170: lung >> lunge
- 176: p=0.4 - report to same amount of decimal places as in table (i.e. 0.34)
Response: Thank you. Corrected
I wish you all the best for your research project and ongoing work with the HLLMS!
Response: Thank you so much for the support.
Round 2
Reviewer 1 Report
The authors revised the manuscript in a satisfying manner.
Author Response
Thank you so much for your time and effort to improve the paper.
