The multiple hop test: a
discriminative or evaluative instrument for chronic ankle instability?

C, Bautmans I, De Hertogh W, Vaes P. Clin J Sport Med. 2012 May;22(3):228-33.

ankle instability (CAI) is a common concern for patients with a history of
ankle sprains but can be very challenging to diagnose.  Previous studies have validated the multiple-hop test for
assessing functional deficits
as well as dynamic postural stability among
participants with CAI
.  However,
before this test can be applied in the clinical setting it is important to
determine if it can accurately diagnose patients with CAI and if it is
sensitive to change over time. Therefore, the purpose of this study was to
determine if the multiple
hop test
is an evaluative (if it could measure change over time) or
discriminative (if it can differentiate patients with and without CAI; 29
participants/group) test for CAI. Inclusion criteria for the patients with CAI
were: 1) history of lateral ankle sprain requiring 2 or more medical consults,
2) complaints of repetitive lateral ankle sprains for more than 6 months, 3)
presence/fear of the ankle “giving way”, and 4) reporting a decreased level of
ankle performance in recreational, competitive, or professional
sports/activities. To complete the multiple hop test the participants were
instructed to hop from and land on one leg through each 11 numbered points. The
participants were instructed to maintain their balance and avoid posture
correction (balance errors). After landing, the participants were told to stand
still and then to resume the single-leg, hands-on hips, start position and then
finally hop to the next point. Both
legs were tested in a random order with a practice trial for each leg. The
participants performed 3 reps on each leg with 3 minutes between reps (30 sec
between legs). The
participants were scored on 3 outcomes: 1) the total number of balance errors
across three trials (range 0 to 30), as assessed on video tape, 2) the average
time taken to complete the test, and 3) the participant-reported perceived
difficulty measured on a 100-mm visual analog scale ranging from 0 = “not
difficult”  to 100 = “impossible to
perform.” The authors found that the multiple-hop test was deemed to be an
effective discriminative test for differentiating participants with and without
CAI, based on participants with CAI having poorer performance. For the three
outcomes, the authors determined the optimal cut-offs for differentiating those
with and without CAI: 1) 13.5 errors, 2) 35 seconds to complete the test, and
3) 32.5 mm on the visual analog scale for perceived difficulty. The authors
found that when two of the outcomes were positive (based on the cutoffs above)
the multiple hop test had the best ability to differentiate those with and
without CAI (diagnostic accuracy ~ 83%, sensitivity ~ 86%, specificity ~ 79%) .While
the multiple hop test may be able to discriminate the authors found that the
test’s ability to detect a change may be limited. They calculated that the
minimal detectable change for each outcome was quite large (the minimal
detectable change was based on how much the test varies among the participants
and how the outcomes vary over several trials). To detect changes participants
would need to increase or decrease their outcomes by ~ 7 errors, 2) 6 seconds
to complete the test, and 3) 27 to 55 mm on the visual analog scale for
perceived difficulty.

is an important study because it demonstrates that the multiple-hop test may be
capable of discriminating patients with and without CAI but not as effective at
monitoring change over time.  It is
important to note that the authors  state
that they are not certain which combination of outcomes best illustrates the
presence of CAI. The authors state there are some flaws in the make-up in this
study, and as it stands, more studies are going to need to be done to find
which outcomes help to determine the multiple-hop test’s evaluative and
discriminative properties. For example, there are several other approaches to
assess the ability of the multiple-hop test to detect change over time. What
are your thoughts on the use of the multiple-hop test for assessing ankle function?
Are you using anything like it in your setting to assess CAI?

by: Mark Rice
by: Steve Thomas and Jeffrey Driban

Related Posts:

Eechaute C, Bautmans I, De Hertogh W, & Vaes P (2012). The multiple hop test: a discriminative or evaluative instrument for chronic ankle instability? Clinical Journal of Sport Medicine, 22 (3), 228-33 PMID: 22504375