Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity
# Background Deficits in dynamic neuromuscular control have been associated with post-injury sequelae and increased injury risk. The Y-Balance Test Lower Quarter (YBT-LQ) has emerged as a tool to identify these deficits. # Purpose To review the reliability of the YBT-LQ, determine if performance...
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| Format: | Article |
| Language: | English |
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North American Sports Medicine Institute
2021-10-01
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| Series: | International Journal of Sports Physical Therapy |
| Online Access: | https://doi.org/10.26603/001c.27634 |
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| author | Phillip Plisky Katherine Schwartkopf-Phifer Bethany Huebner Mary Beth Garner Garrett Bullock |
| author_facet | Phillip Plisky Katherine Schwartkopf-Phifer Bethany Huebner Mary Beth Garner Garrett Bullock |
| author_sort | Phillip Plisky |
| collection | DOAJ |
| description | # Background
Deficits in dynamic neuromuscular control have been associated with post-injury sequelae and increased injury risk. The Y-Balance Test Lower Quarter (YBT-LQ) has emerged as a tool to identify these deficits.
# Purpose
To review the reliability of the YBT-LQ, determine if performance on the YBT-LQ varies among populations (i.e., sex, sport/activity, and competition level), and to determine the injury risk identification validity of the YBT-LQ based on asymmetry, individual reach direction performance, or composite score.
# Study Design
Systematic Review
# Methods
A comprehensive search was performed of 10 online databases from inception to October 30, 2019. Only studies that tested dynamic single leg balance using the YBT-LQ were included. Studies were excluded if the Y-Balance Test kit was not utilized during testing or if there was a major deviation from the Y-Balance test procedure. For methodological quality assessment, the modified Downs and Black scale and the Newcastle-Ottawa Scale were used.
# Results
Fifty-seven studies (four in multiple categories) were included with nine studies assessing reliability, 36 assessing population differences, and 16 assessing injury prediction were included. Intra-rater reliability ranged from 0.85-0.91. Sex differences were observed in the posteromedial direction (males: 109.6 \[95%CI 107.4-111.8]; females: 102.3 \[95%CI 97.2-107.4; p = 0.01]) and posterolateral direction (males: 107.0 \[95%CI 105.0-109.1]; females: 102.0 \[95%CI 97.8-106.2]). However, no difference was observed between sexes in the anterior reach direction (males: 71.9 \[95%CI 69.5-74.5]; females: 70.8 \[95%CI 65.7-75.9]; p=0.708). Differences in composite score were noted between soccer (97.6; 95%CI 95.9-99.3) and basketball (92.8; 95%CI 90.4-95.3; p <0.01), and baseball (97.4; 95%CI 94.6-100.2) and basketball (92.8; 95%CI 90.4-95.3; p=0.02). Given the heterogeneity of injury prediction studies, a meta-analysis of these data was not possible. Three of the 13 studies reported a relationship between anterior reach asymmetry reach and injury risk, three of 10 studies for posteromedial and posterolateral reach asymmetry, and one of 13 studies reported relationship with composite reach asymmetry.
# Conclusions
There was moderate to high quality evidence demonstrating that the YBT-LQ is a reliable dynamic neuromuscular control test. Significant differences in sex and sport were observed. If general cut points (i.e., not population specific) are used, the YBT-LQ may not be predictive of injury. Clinical population specific requirements (e.g., age, sex, sport/activity) should be considered when interpreting YBT-LQ performance, particularly when used to identify risk factors for injury.
# Level of Evidence
1b |
| format | Article |
| id | doaj-art-67df0304c3de48d6af0841aaa499ce5f |
| institution | Kabale University |
| issn | 2159-2896 |
| language | English |
| publishDate | 2021-10-01 |
| publisher | North American Sports Medicine Institute |
| record_format | Article |
| series | International Journal of Sports Physical Therapy |
| spelling | doaj-art-67df0304c3de48d6af0841aaa499ce5f2025-02-11T20:27:54ZengNorth American Sports Medicine InstituteInternational Journal of Sports Physical Therapy2159-28962021-10-01165Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive ValidityPhillip PliskyKatherine Schwartkopf-PhiferBethany HuebnerMary Beth GarnerGarrett Bullock# Background Deficits in dynamic neuromuscular control have been associated with post-injury sequelae and increased injury risk. The Y-Balance Test Lower Quarter (YBT-LQ) has emerged as a tool to identify these deficits. # Purpose To review the reliability of the YBT-LQ, determine if performance on the YBT-LQ varies among populations (i.e., sex, sport/activity, and competition level), and to determine the injury risk identification validity of the YBT-LQ based on asymmetry, individual reach direction performance, or composite score. # Study Design Systematic Review # Methods A comprehensive search was performed of 10 online databases from inception to October 30, 2019. Only studies that tested dynamic single leg balance using the YBT-LQ were included. Studies were excluded if the Y-Balance Test kit was not utilized during testing or if there was a major deviation from the Y-Balance test procedure. For methodological quality assessment, the modified Downs and Black scale and the Newcastle-Ottawa Scale were used. # Results Fifty-seven studies (four in multiple categories) were included with nine studies assessing reliability, 36 assessing population differences, and 16 assessing injury prediction were included. Intra-rater reliability ranged from 0.85-0.91. Sex differences were observed in the posteromedial direction (males: 109.6 \[95%CI 107.4-111.8]; females: 102.3 \[95%CI 97.2-107.4; p = 0.01]) and posterolateral direction (males: 107.0 \[95%CI 105.0-109.1]; females: 102.0 \[95%CI 97.8-106.2]). However, no difference was observed between sexes in the anterior reach direction (males: 71.9 \[95%CI 69.5-74.5]; females: 70.8 \[95%CI 65.7-75.9]; p=0.708). Differences in composite score were noted between soccer (97.6; 95%CI 95.9-99.3) and basketball (92.8; 95%CI 90.4-95.3; p <0.01), and baseball (97.4; 95%CI 94.6-100.2) and basketball (92.8; 95%CI 90.4-95.3; p=0.02). Given the heterogeneity of injury prediction studies, a meta-analysis of these data was not possible. Three of the 13 studies reported a relationship between anterior reach asymmetry reach and injury risk, three of 10 studies for posteromedial and posterolateral reach asymmetry, and one of 13 studies reported relationship with composite reach asymmetry. # Conclusions There was moderate to high quality evidence demonstrating that the YBT-LQ is a reliable dynamic neuromuscular control test. Significant differences in sex and sport were observed. If general cut points (i.e., not population specific) are used, the YBT-LQ may not be predictive of injury. Clinical population specific requirements (e.g., age, sex, sport/activity) should be considered when interpreting YBT-LQ performance, particularly when used to identify risk factors for injury. # Level of Evidence 1bhttps://doi.org/10.26603/001c.27634 |
| spellingShingle | Phillip Plisky Katherine Schwartkopf-Phifer Bethany Huebner Mary Beth Garner Garrett Bullock Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity International Journal of Sports Physical Therapy |
| title | Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity |
| title_full | Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity |
| title_fullStr | Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity |
| title_full_unstemmed | Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity |
| title_short | Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity |
| title_sort | systematic review and meta analysis of the y balance test lower quarter reliability discriminant validity and predictive validity |
| url | https://doi.org/10.26603/001c.27634 |
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