Sports Medicine Research: In the Lab & In the Field: Little Value Added to Injury Prediction with Functional Movement Screen (Sports Med Res)
Wednesday, October 28, 2015

Little Value Added to Injury Prediction with Functional Movement Screen

Evaluation of the Functional Movement Screen as an Injury Prediction Tool Among Active Adult Populations: A Systematic Review and Meta-analysis

Dorrel BS, Long T, Shaffer S, Myer GD. Sport Health. Published Online First: September 27, 2015; DOI: 10.1177/1941738115607445

Take Home Message: Based on data from six studies, the Functional Movement Screen fails to predict who is at risk for injury.  Unfortunately, the current research is low quality. 

The Functional Movement Screen (FMS) is an assessment tool to analyze movement patterns to detect faulty performance patterns that may predispose a person to injury.  However, the predictive ability of this tool to identify someone at risk for an injury has not been determined.  Therefore, the authors of this systematic review critically analyzed 7 studies that examined predictive validity of FMS among active adults.  The included articles consisted of 3 with a low risk of bias, 2 with a high risk of bias, and 2 with an unclear risk based on the QUADAS-2.  The authors decided that the overall quality of the studies was low despite 6 of the studies being prospective in nature. The main limitation was a lack of blinding.  Collectively, the authors conducted a meta-analysis with six studies. They found that the FMS had 85% specificity (ability of FMS to correctly identify adults without a future injury), 24% sensitivity (ability of FMS to correctly identify adults with a future injury), positive likelihood ratios of 1.65, and negative likelihood ratio of 0.87. The ability of FMS to accurately discriminate between those at risk and not at risk of injury was just above chance. 

The authors of this study discovered that the FMS provided good specificity, relatively poor sensitivity, and poor diagnostic accuracy for injury prediction.  The authors noted an inconsistency between studies in injury diagnosis/definition as well as statistical analyses.  Injury definition ranged from any injury where an athlete had to seek medical attention to any injury where an athlete was removed from activity for 3 weeks or more.  It is also unclear which cut point is appropriate with the FMS score because authors used various cut points.  Obviously, there is a need for more research that uses standard definitions and cut points but you would hope that a screening tool would have a higher sensitivity when trying to identify individuals at risk for an injury.  Clinically, it does not appear that the FMS has value as a predictive tool for injury. At least for now we should continue to focus on deploying injury prevention programs for all physically active individuals.     

Questions for Discussion:  Do you use any injury screening tools?  What has your experience been with injury screening tools?  Are there any other things you use to identify risk factors?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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Dorrel, B., Long, T., Shaffer, S., & Myer, G. (2015). Evaluation of the Functional Movement Screen as an Injury Prediction Tool Among Active Adult Populations: A Systematic Review and Meta-analysis Sports Health: A Multidisciplinary Approach, 7 (6), 532-537 DOI: 10.1177/1941738115607445

7 comments:

Andrea Baellow said...

I have had the same frustrations/issues with FMS. I've found that although the screening does provide information about imbalances and muscle insufficiencies I'm not sure I'm too concerned if one of my athlete's foot hits a hurdle while they're walking over it. I feel the FMS does not give sufficient reasoning for what impairments are present if they are not able to complete a portion of the screening, and they do not give any information about how to intervene. I think injury screening tools need to be more sport specific in nature. Working swimming & diving with 60 athletes I don't do an injury screening I already know the general injuries they're likely to have and I work with the strength and conditioning coach to ensure they're warm-up includes general shoulder strengthening.

Jeffrey Driban said...

Thanks Andrea for the comments. I think your strategy of working with a strength and conditioning coach is a good idea.

Jennifer Joseph said...

I’ve personally never conducted a FMS screening but I have been apart of one. I think the FMS has potential to be a useful tool for Athletic Trainers and Strength and Conditioning coaches. We care more about muscle imbalances and decreases of ROM and how that can alter ground reaction forces and force attenuation throughout a movement pattern. Knowing these imbalances and decreases of ROM, clinicians can work with strength and conditioning coaches to develop and implement programs to improve performance outcomes. I think its also important to recognize global movement dysfunctions tell more of a story compared to fine motor mistakes such as touching a hurdle with a foot. I think we can also help make FMS a more sports specific tool, utilizing portions that only pertain to our specific’s sports demands, ultimately making screening time more efficient. I think if FMS is continued to be used and standardized better, sensitivity will increase and the likelihood ration will also better.

Jeffrey Driban said...

Great points Jennifer. Thanks! I agree that the FMS seems to be a good starting point and deserves to be better standardized and tweaked.

Christina Hollis said...

Injury screening tools can be extremely helpful when working with an at risk population such as previously injured athletes, or athletes in poor condition. I have used the FMS before but not consistently as a prescreening tool for my athletes. Because of the poor sensitivity it is not worth my time to screen every athlete, but rather use it as a tool in my tool box. If an athlete is complaining of a chronic injury I am more likely to use different types of screening to try and find the root of the problem and address that, not just treat the symptoms. I will use general walking gait and a simple arms overhead squat to try and find at risk athletes. I believe that these two activities show many deficits that usually go unnoticed. Typically deficits that can be addressed with stretching or strengthening. Thank you!

Nicole Cattano said...

Thank you for your comment Christina - you bring up some good points. Are you utilizing a particular check list for gait or the overhead squat? As mentioned in the earlier comments, I think some standardization is critical for accuracy.

Unknown said...

I think this article brings up multiple interesting discussion points. I know multiple athletic trainers that live by FMS, and some that want nothing to do with it. I have seen the screening process done, but never been a part of it. I believe using FMS alone to monitor your athletes and determine their risk of future injury is probably not in our best interests based on the low sensitivity of FMS described in this article. However, there are definitely still benefits of using FMS, such as identifying gross symmetrical differences or deficiencies within an athlete. Like most interventions within the athletic training profession, we should treat FMS as just another tool in our toolbox, but not rely on it to be a tell-all screen.

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