Reliability of tools measuring lumbar spine proprioception in athletic population : A Systematic Review C. Pazaridis¹, X. Konstantakis¹ , S. Spencer², N. Heneghan¹ ¹School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, ²English Institute of Sport Background: Low Back Pain prevalence in athletes is ~30% (George & Delitto, 2002). Proprioception deficits have been linked to the development of, or persistence of LBP (Astfalk et al, 2013). Despite a range of outcome measures there is uncertainty as to the ideal clinical measurement tool for use in an athletic population. Having a reliable outcome measure will assist clinicians in evaluating change over time, enhancing an athlete’s recovery thus reducing play time loss. Discussion: This systematic review is the first assessing risk of bias and reliability of instruments used to measure proprioception on subjects of athletic population. Overall the reliability estimates were moderate with only one study presenting excellent reliability (Dolan & Green, 2006), however all of the studies presented significant weaknesses in reporting and design which rendered their clinical applicability questionable. Of the included studies only those of (Brumagne et al., 1999; Dolan & Green, 2006) presented tools with easier clinical applicability, due to their low weight and ease of application. STRENGTH: WEAKNESS: English publication bias Aim: To review the existing literature and evaluate the quality level of the reports regarding the reliability of tools measuring proprioception in an athletic population Design & Methodology: A Systematic Review was conducted rigorously based on the CRD and Cochrane guidelines and reported according to PRISMA (Moher; CRD, 2009). An electronic database and grey literature search was performed as of September 2015. Female>Male ratio in line with athletic LBP prevalence literature Subject mean age is 24, that of a young athlete. Inclusion criteria: Participants: Human with a mean age of 18-40 NSLBP and/or healthy subjects were included Outcome: At least one component of RE Studies: English, full text, measuring simple motion tasks Design: Prospective reliability studies Conclusion: There is limited evidence to suggest that tools assessing lumbar spine proprioception present acceptable reliability to be used widely in clinical practice. Reliability studies of appropriate conduct and design Studies performed on athletes Studies of similar methodology to generalize results A Quality Appraisal of diagnostic RELiability studies tool was used for the methodological assessment.(QAREL) Table 1: Study characteristics and results Results: 260 articles were identified, with 5 studies meeting eligibility requirements. Studies originated from 3 different countries with 2 studies including both LBP and asymptomatic population (Koumantakis et al., 2002; Silfies et al., 2007). Sample size varied from 14-292. A total of 5 different instruments were used , see Table 1. Rater characteristics were unclear in all studies and all 5 studies were rated with a high risk of bias with only one study conducted better methodologically (Dolan & Green, 2006). All instruments were examined for intra-rater reliability. Author, Publication year, Country Nmber of Participants, Sex, Age Position, Movement Measured, Follow-up, Setting Instrument Reliability Data Comments Brumagne et al, 1999, Belgium Healthy: N=14 Standing, Pelvic tilt, 1 day, University Piezoresistive accelerometer AE ICC:0.51 (mod) SEM: 0.5° (mod) Very small sample size, no power calculation Asymptomatic population Rater blinding unclear University setting High risk of bias Koumantakis et al, 2002, United Kingdom LBP: N=62 Healthy: N=18 Standing, 20° Flexion, 15° bilateral rotation, 15° bilateral side flexion 1 week for healthy, at least 5 days for LBP, University LMM AE/VE Flexion: 0.41<ICC<0.76 (fair- good) 0.96°<SEM<3.90° (mod-large) AE/VE Rotation: 0.20<ICC<0.80 (low- good) 0.37°<SEM<1.98° (small-large) AE/VE Side Flexion 0.22<ICC<0.64 (low-good) 0.45°<SEM<1.68° (small-large) No power calculation LBP and asymptomatic population 1 more testing occasion for asymptomatic Dolan and Green, 2006, United Kingdom Healthy: N=32 Seated, slouching, 15mins, Not specified M180B electrogoniometer ICC: 0.89 (excellent) Sample based on power calculation Setting unclear Silfies et al, 2007, USA LBP: N=60 Healthy: N=232 Seated,20° trunk bilateral rotation, 2-3 years, University Custom built apparatus AE/VE 0.47<ICC<0.61 (mod-good) 0.57°<SEM<0.73° (small-mod) MPT ICC:0.89 (excellent) SEM:0.34° (small) Unclear recruitment and inclusion criteria Petersen et al, 2008, USA Healthy: N=57 Seated, 2/3 of flexion, 1 week, University AE ICC:0.38 (fair) SEM: 3.32° (large) References: Astfalck, et al. (2013). Lumbar spine repositioning sense in adolescents with and without non-specific chronic low back pain - an analysis based on sub-classification and spinal regions. Manual Therapy, 18(5), 410. Dolan, K. J., & Green, A. (2006). Lumbar spine reposition sense: The effect of a 'slouched' posture. Manual Therapy, 11(3), 202-207. George, S. Z., & Delitto, A. (2002). Management of the athlete with low back pain. Clinics in Sports Medicine, 21(1), 105-120. doi:10.1016/S0278-5919(03)00060-7 Koumantakis, et al. (2002). Thoracolumbar proprioception in individuals with and without low back pain: Intratester reliability, clinical applicability, and validity. Journal of Orthopaedic & Sports Physical Therapy, 32(7), 327-335. Mieritz, et al. (2012). Reliability and measurement error of 3- dimensional regional lumbar motion measures: A systematic review. Journal of Manipulative and Physiological Therapeutics, 35(8), 645-656. doi:10.1016/j.jmpt.2012.09.011 Silfies et al. (2007). Lumbar position sense and the risk of low back injuries in college athletes: A prospective cohort study. BMC Musculoskeletal Disorders, 8(1), 129. doi:10.1186/1471-2474-8-129 Abbreviations, CRD: Centre of Reviews and Dissemination, RE: reposition error, LMM: Lumbar motion monitor, AE: absolute error, VE: variable error, SEM: standard error of measurement, ICC: interclass correlation coefficient, MPT: motion perception threshold