The Assessment of Functional Movement in Children and Adolescents: A Systematic Review and Meta-Analysis

Abstract

Background The Functional Movement Screen™ (FMS™) is an assessment of human movement that may signal potential deficits that could predispose an otherwise healthy person to injury risk. FMS™ scores are well reported in both athletic and adult samples. However, to date, there has been no comprehensive systematic review and meta-analysis of FMS™ data among school-aged children and adolescents. Objective We aimed to systematically review and analyse functional movement proficiency of children and adolescents, specifically when assessed using the FMS™, and to establish initial normative values for the FMS™ in this population group and to further estimate differences in functional movement proficiency between the sexes, by school level (i.e., between primary and secondary school-level children and adolescents), and based on differences in child and adolescent body mass index (BMI). Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, prospective studies were identified from searches across eight databases (MEDLINE, SPORTDiscus, CINAHL, Web of Science, EMBASE, ERIC, PsychINFO and PubMed), without any date restrictions, up to December 2020. The primary meta-analysis estimated the overall FMS™ score for school-aged children and adolescents across published studies. An additional three subgroup meta-analyses estimated comparisons for FMS™ data with school level, sex, and BMI across published studies. FMS™ data were meta-analysed using a number of different meta packages (Schwarzer et al. in Meta-Analysis with R, 1st ed, Springer International Publishing, Berlin, 2015), available in R Studio. Results A total of 19 articles were included in the systematic review. Meta-analysis revealed a weighted FMS™ mean score of 14.06, with a standardised Tau value of 0.56, signalling a moderate-to-large degree of variability in FMS™ means between studies. The difference in FMS™ means between samples of males (weighted FMS™ mean 13.91) and females (weighted FMS™ mean 14.56) was compatible with a possible small effect size (standardised mean difference − 0.27). The variability in FMS™ means between studies was approximately five times greater in samples of secondary school children (factor difference in Tau values 5.16). The final meta-regression identified a negative association between BMI and FMS™ scores (r = − 0.42), which signalled a moderate-to-large difference in FMS™ scores between healthy weight and overweight children/adolescents. Conclusion This systematic review and meta-analysis represents a novel and important synthesis of published FMS™ data from groups of children and adolescents. The study signals possible sex- and age-related differences in FMS™ scores, as well as a clear negative relationship between BMI and functional movement proficiency. More longitudinal research is needed to better understand the developmental trajectory and the effects of maturation milestones on FMS™ proficiency. Additional research is also needed to identify the types of interventions that could improve functional movement proficiency among ‘at risk’ groups, who are susceptible to functional movement deficiency, and whether changes in body composition mediate the relationship between these interventions and the improvement of FMS™ scores.

Association between Functional Movement Screen Scores and Athletic Performance in Adolescents: A Systematic Review

“…Only one study [ 20 ] considered maturation in their analysis. Furthermore, given the noted variability in the association between FMS © and BMI, potentially due to maturation, as noted in the recent review by O’Brien et al [ 25 ], it is a key consideration for future research in this area with youth participants, that biological maturation is captured and considered in any analysis of the association between functional movement and athletic performance. However, while the recent review by O’Brien et al [ 25 ] specifically examined sex and age differences in FMS© scores in youth, the current study is qualitatively different in focus, examining any associations between FMS© scores and measures of athletic performance in adolescents.…”

“…Understanding how functional movement might impact PA and sports performance in youth is important in developing positive trajectories of movement aligned with lifelong PA and sports participation. Recently, a systematic review by O’Brien et al [ 25 ] provided an important overview of the FMS© in children and adolescents. This work was undertaken in the context of PA specialists working in physical education and highlighted differences in FMS© scores between boys and girls and between primary and secondary school-aged children.…”

“…This work was undertaken in the context of PA specialists working in physical education and highlighted differences in FMS© scores between boys and girls and between primary and secondary school-aged children. In particular, there was over four times greater variability in FMS© scores for studies with secondary school-age children, possibly signalling potential developmental and maturational effects during the adolescent period [ 25 ]. O’Brien et al [ 25 ] also highlighted a consistent and negative association between FMS© scores and BMI, and greater variability in FMS© scores during adolescence, potentially due to maturation effects that were not assessed in their review.…”

“…In particular, there was over four times greater variability in FMS© scores for studies with secondary school-age children, possibly signalling potential developmental and maturational effects during the adolescent period [ 25 ]. O’Brien et al [ 25 ] also highlighted a consistent and negative association between FMS© scores and BMI, and greater variability in FMS© scores during adolescence, potentially due to maturation effects that were not assessed in their review. Understanding normative values for FMS© in children and adolescents is a useful step forward, but there remain key gaps in understanding.…”

“…These gaps relate to functional movement and how it might associate with a range of outcome measures (e.g., strength, speed, agility) aligned with PA, and sports performance. Unlike the recently published review by O’Brien et al [ 25 ] which focused on age and sex-related differences in FMS© scores as a means to provide normative data, the present study systematically reviews the literature which examines the association between FMS© scores and athletic performance in youth.…”