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

Abstract

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 Diagnosis

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

“…27 In a another study by Weir et al, an unplanned 45-degree side step cut was assessed in 15 junior (age 15.1 + 1.2 years) and 15 elite senior (age 22.1+ 2.3 years) female field hockey players utilizing 2-D video based measurements of whole body kinematics. 26 Weir et al found excellent intra-rater reliability (ICC: 0.99-1.00) for angular measurements including dynamic knee valgus angle, trunk lateral flexion angle, knee flexion angle, thigh abduction angle and trunk flexion angle, and poor to good reliability (ICC: 0.38-0.54) for displacement based measurements including foot placement and dynamic medial knee shift. 26 Weir et al found good to excellent inter-rater reliability (ICC: 0.66-0.97) for all angular measurements and poor to excellent inter-rater reliability (ICC: 0.22-0.87) for displacement based measurements.…”

“…26 Weir et al found excellent intra-rater reliability (ICC: 0.99-1.00) for angular measurements including dynamic knee valgus angle, trunk lateral flexion angle, knee flexion angle, thigh abduction angle and trunk flexion angle, and poor to good reliability (ICC: 0.38-0.54) for displacement based measurements including foot placement and dynamic medial knee shift. 26 Weir et al found good to excellent inter-rater reliability (ICC: 0.66-0.97) for all angular measurements and poor to excellent inter-rater reliability (ICC: 0.22-0.87) for displacement based measurements. 26 Again, several differences in study design need to be discussed between the work of Weir et al and this study.…”

“…Then, participants completed three trials planting on the right LE and three trials planting on the left LE, with a trial considered "good" if the subject's foot landed within the stance/pivot area necessary for successful completion of the task. The testing order was standardized for all participants following the protocol by Butler et al 26 Video data were captured at 60 frames per second with 1080p quality using three Sony RX10 IV cameras adjusted to 36 inches tall. Two cameras were positioned 136 inches from either side of the stance/pivot area, and one camera was positioned 146 inches in front of the stance/ pivot area.…”

“…25 The screening tool involved 2-D kinematic measurement of frontal and sagittal plane variables using video analysis software and reported poor to excellent intra-rater and inter-rater reliability. 26 The Cutting Movement Assessment Score (CMAS), a qualitative scoring system to evaluate a 90-degree cutting maneuver, was found to be a reliable and valid tool to assess risky movement patterns during a 90-degree cutting task in college-aged athletes. 27 The Cutting Alignment Scoring Tool (CAST), demonstrates good inter-rater and intra-rater reliability for the assessment of LE and trunk alignment in young athletes (age=14.7+1.2 years).…”

“…27 The Cutting Alignment Scoring Tool (CAST), demonstrates good inter-rater and intra-rater reliability for the assessment of LE and trunk alignment in young athletes (age=14.7+1.2 years). 26 The CAST involves dichotomous scoring of four frontal plane movement variables observed from 2-D video during a planned 45-degree side-step cut. However, the CAST may not sufficiently address sagittal plane foot and ankle assessments.…”