Original ResearchConstruct validity and inter-rater reliability of the Gymnastic Functional Measurement Tool in the classification of female competitive gymnasts in Canada
Introduction
There are more than 200 000 registered members of the Canadian Gymnastics Federation (Gymnastics Canada [Internet], 2011). In the last two decades, the number of children involved in gymnastics has increased significantly (Cohen & Sala, 2010). Moreover, competition at the international level takes place at a young age. Gymnasts submit their bodies to hundreds of thousands of repetitions of their training elements each year (Caine et al., 1989, Sands et al, 1989), with training loads reaching forces ranging from 5 to 17.5 times their bodyweight (Caine and Linder, 1985, McNitt-Gray et al., 1994). Such high training loads combined with the immaturity of their neuromusculoskeletal system (Micheli and Klein, 1991, Wilkins, 1980) and the complexity of the skills required may lead to repetitive strain injuries. This is particularly true if the gymnast's physical readiness or musculoskeletal maturity is below the demands required for her competitive level. Gymnastics is associated with a high injury rate, with an average of 4.8 injuries reported in emergency rooms per 1000 participants per year (Haycock and Gillette, 1976, Singh et al, 2008). Considering that gymnastics has one of the highest injury rates of all female sports (Caine, 2005, Sands, 2000, Singh et al, 2008), injury prevention should be the main focus for coaches, sports physical therapists and gymnastics federations. A measurement tool ensuring better management of female gymnasts by coaches and sports physical therapists could lead to better injury prevention.
In his article in 2000, Sands proposed measures to prevent injury in gymnastics (Sands, 2000). His recommendations are divided into several distinctive groups: gymnastics apparatus, gymnastics rules, training loads and training for children. Interventions pertaining to apparatus and rules must be considered by the federations in order to aid in reduction of injury rate. However, the focus for coaches and physical therapists’ work is on training load while bearing in mind the musculoskeletal maturity in children. Sands states: “Knowledge of the requisite physical and mental fitness levels for various skills can assist the coach and gymnast in determining skill readiness. (…) The optimum training of children is perhaps the most important problem facing contemporary gymnastics for women. A healthy balance between training, aspirations, talent, age-appropriate abilities, resources, economics and so forth is difficult to achieve in any group of children.”(14 - p.367−368).
In gymnastics, training increases as a function of the gymnast's competitive level. The competitive categories in Canada differ from the classification system of other countries, namely the United States of America (USA), where categories range from Level 1 to Level 10 (USA Gymnastics [Internet], 2016). In Canada, gymnasts are organised into seven categories: Provincial 1 to Provincial 5 (P1 to P5) followed by National and then High Performance, each of them categorized according to the athlete's age. The P1 category does not exist in the province where this study was conducted. Therefore, this research focuses on six categories of competition (Fédération de Gymnastique du Québec, 2015-2016). As seen in Table 1, each category is defined by the level of difficulty of the elements or skills to be executed by the athlete. The individual elements are rated according to their level of difficulty, ranging from A to G with element A being the easiest (Fédération Internationale de Gymnastique [Internet], 2015). Using the floor exercise as an example, a salto forward tucked has an A value, whereas a double salto forward tucked has an E value (Fédération Internationale de Gymnastique [Internet], 2015). As the level of competition increases, both the number of required elements and their level of difficulty increase. At the National and High Performance level, the requirements are defined by the International Gymnastics Federation. The more a gymnast's competitive level increases, the more she will require fine-tuned physical abilities to execute her combinations of complex elements. This progression of required physical abilities underlines the importance of classifying gymnasts into categories that not only keep pace with their ability to perform elements and combinations, but also respect their physical abilities and physical maturity. A valid and reliable sport specific measurement tool would be useful to help identify weaknesses in gymnasts' physical abilities and related deficits that may predispose to future injury.
The Gymnastic Functional Measurement Tool (GFMT) was developed by Mark D. Sleeper, a physical therapist working with gymnastics, to assess a female gymnast's overall fitness level (Sleeper and Casey, 2010, Sleeper et al., 2012). The GFMT is sport specific and produces an objective measurement of the gymnast's physical abilities without explicitly measuring gymnastic skills (Sleeper and Casey, 2010, Sleeper et al., 2012). It can be used to assess beginner gymnasts as well as elite competitive athletes. In order to assess muscular strength, endurance, flexibility, agility, coordination and balance, Sleeper designed a test composed of ten items, each of which bestows a point value (0–10) related the gymnast's performance. The GFMT items are as follows: Rope Climb Test (Belinda, Gabbe, Finch, Wajswelner, & Bennell, 2004); Jump Test (Brooks, Schiff, & Rivara, 2009); Hanging Pikes Test (Caine, 2005); Shoulder Flexibility Test (Caine et al., 1989); Agility Test (Caine & Linder, 1985); Over-grip Pull-up Test (Cohen & Sala, 2010); Splits Tests (Fédération Internationale de Gymnastique [Internet], 2015); Push-up Test (Gymnastics Canada [Internet], 2011); 20-Yard Sprint Test (Haycock & Gillette, 1976) and Handstand Test (McNitt-Gray et al., 1994) (Sleeper et al., 2012). Each item is assessed by an evaluator who will attribute the scores. The total score of the GFMT is calculated by adding the individual item scores, which are rated on a scale of 0–100 (Sleeper et al., 2012). The GFMT's construct validity has been demonstrated in the USA levels classification system by Sleeper (Sleeper and Casey, 2010, Sleeper et al., 2012), who reported a positive linear relationship between the GFMT total score and gymnasts' competitive level (r2 = 0.602, p < 0.0001) (Sleeper et al., 2012). The GFMT total score and individual component scores showed good test-retest reliability (Intraclass correlation coefficient (ICC) = 0.97 for total score and ICC ranging from 0.80 to 0.92 for individual components) (Sleeper et al., 2012). Inter-rater reliability has not yet been established. In Canada, however, the categorisation of competitive gymnasts differs from the level system in the USA (Fédération de Gymnastique du Québec, 2015-2016, USA Gymnastics Internet, 2016 Jan 5). Utilisation of the GFMT by Canadian coaches and sports physical therapists requires that validity and reliability of the GMFT be investigated.
The purpose of this study is to assess 1) the construct validity and 2) the inter-rater reliability of the GFMT within the parameters of the Canadian classification of female competitive gymnasts. The hypotheses are 1) that there is a positive relationship between a female gymnast's GFMT total score and her competitive level in the Canadian classification of competitive gymnasts (coefficient of determination r2 > 0.6) and 2) that the inter-rater reliability will reach a satisfactory level (Intraclass correlation coefficient ICC > 0.6. (Hinkle et al., 2003, Mukaka, 2012).
Section snippets
Population
Ninety five (95) female gymnasts were recruited in this study. The subjects were aged between the ages of 8 and 18 years old. Inclusion criteria were: 1) a female gymnast 8 years old and older, 2) competing in categories from P2 to High Performance. Exclusion criteria included the presence of any condition limiting the gymnast's ability to train or compete without restriction. The eligibility criteria are summarized in Table 2. The target population was composed of a minimum of ten gymnasts per
Results
The multiple linear regression analysis demonstrated an excellent relationship between the total GFMT scores and the gymnasts’ competition level according to the Canadian classification (r2 = 0.97), as seen in Fig. 1. This confirms the hypothesis that the GFMT is a useful tool for the assessment of gymnasts within the Canadian classification system. Upon further analysis, a statistically significant difference between the GFMT total scores was found for the P2 to P5 categories (p < 0.05). The
Discussion
Physical therapists monitor musculoskeletal readiness and physical abilities in the treatment and return to sport of injured gymnasts. These same attributes are also important when considering injury prevention in gymnastics. The importance of using sport specific tools to evaluate physical abilities has been reported in other domains (Belinda et al., 2004, Brooks et al., 2009). The GFMT is the first field measurement tool developed specifically to evaluate the physical abilities necessary for
Conclusion
This study demonstrated the construct validity of the GFMT in the classification of female competitive gymnasts in Canada and it is the first to document the inter-rater reliability of the GFMT.
Ethical approval
This study was approved by the University Ethical Review Committee.
Funding
This study was supported by a grant from the Ordre professionnel de la physiothérapie du Québec (OPPQ).
Conflict of interest
None declared.
Acknowledgements
The authors would like to acknowledge the contribution of the following University of Sherbrooke physiotherapy students: Mathieu Savard, Timothy Ho, Andreanne Belley-Houle, Julie Charbonneau and Jean-Pascal Beauchamp.
The authors would also like to recognize the financial contribution of the Quebec Order of Physiotherapy (Ordre professionnel de la physiothérapie du Québec) that permitted the completion of this study.
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