Concurrent Validity of The Expanded Cutting Alignment Scoring Tool (E-CAST)

# Background The Expanded Cutting Alignment Scoring Tool (E-CAST) has been previously shown to be reliable when assessing lower extremity alignment during a 45-degree sidestep cut, however, the validity of this tool remains unknown. The purpose of this study was to assess the concurrent validity of the E-CAST by comparing visually identified movement errors from two-dimensional (2D) video with three-dimensional (3D) biomechanical variables collected using motion capture. # Study Design Cross Sectional # Methods Sixty female athletes (age 14.1 ± 1.5 years) who regularly participated in cutting/pivoting sports performed a sidestep cut with 2D video and 3D motion capture simultaneously recording. One clinician scored the 2D videos for each limb using the E-CAST criteria. Joint angles and moments captured in 3D were computed for the trunk and knee. Receiver operating characteristic (ROC) curve analyses were performed to determine the accuracy of each E-CAST item and to provide cut-off points for risk factor identification. # Results ROC analyses identified a cut-off point for all biomechanical variables with sensitivity and specificity ranging from 70-85% and 55-89%, respectively. Across items, the area under the curve ranged from 0.67 to 0.91. # Conclusion The E-CAST performed with acceptable to outstanding area under the curve values for all variables except static knee valgus. # Level of evidence 3

Reliability of the Cutting Alignment Scoring Tool (CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut

# Background Three-dimensional (3D) motion analysis is considered the gold standard for evaluating human movement. However, its clinical utility is limited due to cost, operating expertise, and lengthy data processing time. Numerous qualitative scoring systems have been introduced to assess trunk and lower extremity biomechanics during functional tasks. However, the reliability of qualitative scoring systems to evaluate cutting movements is understudied. Purpose/Hypotheses: To assess the inter-rater and intra-rater reliability of the Cutting Alignment Scoring Tool (CAST) among sports medicine providers and to evaluate rater agreement of each component of the CAST. The hypotheses were: 1) there would be good–to-excellent inter-rater and intra-rater reliability among sports medicine providers, 2) there would be good to almost perfect agreement for cut width and trunk lean variables and moderate to good agreement for valgus variables of the CAST. # Study Design Repeated Measures # Methods Ten videos of a 45-degree side-step cut performed by adolescent athletes were independently rated on two occasions by six raters (2 medical doctors, 2 physical therapists, and 2 athletic trainers). The variables assessed include trunk lean to the opposite direction of the cut, increased cut width, knee valgus at initial load acceptance (static), and knee valgus throughout the task (dynamic). Variables were scored as either present, which were given a score of “1”, or not present, which were given a score of “0”. Video sequence was randomized in each rating session, and a two-week wash out period was given. # Results The cumulative inter-rater and intra-rater reliabilities were good (ICC: 0.808 and ICC: 0.753). Almost perfect kappa coefficients were recorded for cut width (k=0.949). Moderate kappa coefficients were found for trunk lean (k= 0.632) and fair kappa coefficients were noted for dynamic and static valgus (k=0.462 and k= 0.533 respectively). # Conclusion These findings suggest that the CAST is a reliable tool to evaluate trunk and LE alignment during a cutting task by sports medicine providers. # Level of Evidence Level 2 Diagnosi

PHYSICAL LITERACY IN ELEMENTARY PHYSICAL EDUCATION: A SURVEY OF FUNDAMENTAL MOVEMENT SKILL PRACTICE PATTERNS

Background: Pediatric physical inactivity is a major public health concern. According to the 2017 State of Play report, only 24% of youth meet the recommended physical activity (PA) dosage. Previous studies identified fundamental movement skill (FMS) proficiency as a predictor of physical literacy and PA. Mastery of FMS requires direct instruction and practice; however, it is unknown how well FMS are implemented in physical education (PE). Hypothesis/Purpose: To describe FMS practice patterns in the elementary PE curriculum. We had two hypotheses: 1) Fewer PE teachers provide comprehensive FMS instruction in later curriculum (grades 4-6) compared to early curriculum (grades 1-3) and 2) Fewer PE teachers teach FMS with direct instruction methods in later curriculum compared to early curriculum. Methods: A cross sectional survey design was used. PE teachers (grades 1-6) were recruited via electronic mail from various U.S. regions from January 2018 to March 2019. An electronic questionnaire was developed to ask about timing of FMS teaching and method of instruction. Additional questions were asked about methods used to evaluate FMS proficiency, including use of a standardized assessment of gross motor development, referrals and remediation recommended for children who appeared to be falling behind, and perceived barriers to FMS instruction. Chi-square tests (p<0.05) were employed. Results: We collected 87 responses with approximately 9% from West, 42% from Midwest, and 49% from South regions. Among all responses, 54% of PE teachers taught all FMS and 40% taught all FMS with direct instruction. Approximately, 66 % taught all FMS for grades 1-3 compared to 42% for grades 4-6 (p<0.0001). Regarding instruction methods, 47% of teachers for grades 1-3 utilized direct instruction to teach all FMS compared to 27% for grades 4-6 (p=0.0007). Only 3.7% of teachers used a standardized assessment of gross motor development to evaluate FMS proficiency. For children who appeared to be falling behind, 6.7% of teachers reported accepting the child’s “best effort” in participation. Only 7.3% reported referring to an exercise program and no PE teacher sought a healthcare referral. Time was reported as the greatest barrier to improving a child’s FMS competency in 52.4% of responses. Conclusion: Results suggests that fewer PE teachers teach all FMS in late elementary PE curriculum compared to early curriculum. Additionally, fewer teachers utilize direct instruction methods to teach skills in late elementary curriculum. With time reported as the greatest barrier, a more efficient screening tool to evaluate FMS competency may be needed

No Difference in Two-Dimensional Kinematic Assessment of a 45-Degree Sidestep Cut Compared to Qualitative Assessment

# Background and Purpose The Expanded Cutting Alignment Scoring Tool (E-CAST) is a two-dimensional qualitative scoring system that has demonstrated moderate inter-rater and good intra-rater reliability for the assessment of trunk and lower extremity alignment during a 45-degree sidestep cut. The primary purpose of this study was to examine the reliability of the quantitative version of the E-CAST among physical therapists and to compare the reliability of the quantitative E-CAST to the original qualitative E-CAST. The hypothesis was that the quantitative version of the E-CAST would demonstrate greater inter-rater and intra-rater reliability compared to the qualitative E-CAST. # Study Design Observational cohort, repeated measures reliability study # Methods Twenty-five healthy female athletes (age 13.8±1.4 years) performed three sidestep cuts with two-dimensional video capturing frontal and sagittal views. Two physical therapist raters independently scored a single trial using both views on two separate occasions. Based on the E-CAST criteria, select kinematic measurements were extracted using a motion analysis phone application. Intraclass correlation coefficients and 95% confident intervals were calculated for the total score, and kappa coefficients were calculated per kinematic variable. Correlations were converted to z-scores and compared to the six original criteria for significance (*α*\<0.05). # Results Cumulative intra- and inter-rater reliability were both good (ICC=0.821, 95% CI 0.687-0.898 and ICC=0.752, 95% CI 0.565-0.859). Cumulative intra-rater kappa coefficients ranged from moderate to almost perfect, and cumulative inter-rater kappa coefficients ranged from slight to good. No significant differences were observed between the quantitative and qualitative criteria for either inter- or intra-rater reliability (Z~obs(intra)~= -0.38, *p*=0.352 and Z~obs(inter)~= -0.30, *p*=0.382). # Conclusion The quantitative E-CAST is a reliable tool to assess trunk and lower extremity alignment during a 45-degree sidestep cut. No significant differences were observed in reliability of the quantitative versus qualitative assessment. # Level of evidence 3

Reliability of the Expanded Cutting Alignment Scoring Tool (E-CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut

Current clinical screening tools assessing risky movements during cutting maneuvers do not adequately address sagittal plane foot and ankle evaluations. The Cutting Alignment Scoring Tool (CAST) is reliable in evaluating frontal plane trunk and lower extremity alignment during a 45-degree side-step cut. The Expanded Cutting Alignment Scoring Tool (E-CAST) includes two new sagittal plane variables, knee flexion and ankle plantarflexion angle. To assess the inter-and intra-rater reliability of the E-CAST to evaluate trunk and lower extremity alignment during a 45-degree side-step cut. Repeated Measures. Participants included 25 healthy females (13.8 ± 1.4 years) regularly participating in cutting or pivoting sports. Participants were recorded performing a side-step cut in frontal and sagittal planes. One trial was randomly selected for analysis. Two physical therapists independently scored each video using the E-CAST on two separate occasions, with randomization and a two-week wash-out between rounds. Observed movement variables were awarded a score of "1", with higher scores representing poorer technique. Intraclass correlation coefficients (ICC) and 95% confident intervals (95% CI) were calculated for the total score, and a kappa coefficient (k) was calculated for each variable. The cumulative intra-rater reliability was good (ICC=0.78, 95% CI 0.59-0.96) and the cumulative inter-rater reliability was moderate (ICC=0.71, 95% CI 0.50-0.91). Intra-rater kappa coefficients ranged from moderate to excellent for all variables (k= 0.50-0.84) and inter-rater kappa coefficients ranged from slight to excellent for all variables (k=0.20-0.90). The addition of two sagittal plane variables resulted in lower inter-rater ICC compared to the CAST (ICC= 0.81, 95% CI 0.64-0.91). The E-CAST is a reliable tool to evaluate trunk and LE alignment during a 45-degree side-step cut, with good intra-rater and moderate inter-rater reliability. Level 2, Diagnosis