Limitations of Separating Athletes into High or Low-Risk Groups based on a Cut-Off. A Clinical Commentary
# Background Athlete injury risk assessment and management is an important, yet challenging task for sport and exercise medicine professionals. A common approach to injury risk screening is to stratify athletes into risk groups based on their performance on a test relative to a cut-off threshold. H...
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| Format: | Article |
| Language: | English |
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North American Sports Medicine Institute
2024-09-01
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| Series: | International Journal of Sports Physical Therapy |
| Online Access: | https://doi.org/10.26603/001c.122644 |
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| _version_ | 1825197048889081856 |
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| author | Justin M. Losciale Linda K. Truong Patrick Ward Gary S. Collins Garrett S. Bullock |
| author_facet | Justin M. Losciale Linda K. Truong Patrick Ward Gary S. Collins Garrett S. Bullock |
| author_sort | Justin M. Losciale |
| collection | DOAJ |
| description | # Background
Athlete injury risk assessment and management is an important, yet challenging task for sport and exercise medicine professionals. A common approach to injury risk screening is to stratify athletes into risk groups based on their performance on a test relative to a cut-off threshold. However, one potential reason for ineffective injury prevention efforts is the over-reliance on identifying these ‘at-risk’ groups using arbitrary cut-offs for these tests and measures. The purpose of this commentary is to discuss the conceptual and technical issues related to the use of a cut-off in both research and clinical practice.
# Clinical Question
How can we better assess and interpret clinical tests or measures to enable a more effective injury risk assessment in athletes?
# Key Results
Cut-offs typically lack strong biologic plausibility to support them; and are typically derived in a data-driven manner and thus not generalizable to other samples. When a cut-off is used in analyses, information is lost, leading to potentially misleading results and less accurate injury risk prediction. Dichotomizing a continuous variable using a cut-off should be avoided. Using continuous variables on its original scale is advantageous because information is not discarded, outcome prediction accuracy is not lost, and personalized medicine can be facilitated.
# Clinical Application
Researchers and clinicians are encouraged to analyze and interpret the results of tests and measures using continuous variables and avoid relying on singular cut-offs to guide decisions. Injury risk can be predicted more accurately when using continuous variables in their natural form. A more accurate risk prediction will facilitate personalized approaches to injury risk mitigation and may lead to a decline in injury rates.
# Level of Evidence
5 |
| format | Article |
| id | doaj-art-d8d7a6faa1d64cfaa22f4e335753efa2 |
| institution | Kabale University |
| issn | 2159-2896 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | North American Sports Medicine Institute |
| record_format | Article |
| series | International Journal of Sports Physical Therapy |
| spelling | doaj-art-d8d7a6faa1d64cfaa22f4e335753efa22025-02-11T20:27:35ZengNorth American Sports Medicine InstituteInternational Journal of Sports Physical Therapy2159-28962024-09-01199Limitations of Separating Athletes into High or Low-Risk Groups based on a Cut-Off. A Clinical CommentaryJustin M. LoscialeLinda K. TruongPatrick WardGary S. CollinsGarrett S. Bullock# Background Athlete injury risk assessment and management is an important, yet challenging task for sport and exercise medicine professionals. A common approach to injury risk screening is to stratify athletes into risk groups based on their performance on a test relative to a cut-off threshold. However, one potential reason for ineffective injury prevention efforts is the over-reliance on identifying these ‘at-risk’ groups using arbitrary cut-offs for these tests and measures. The purpose of this commentary is to discuss the conceptual and technical issues related to the use of a cut-off in both research and clinical practice. # Clinical Question How can we better assess and interpret clinical tests or measures to enable a more effective injury risk assessment in athletes? # Key Results Cut-offs typically lack strong biologic plausibility to support them; and are typically derived in a data-driven manner and thus not generalizable to other samples. When a cut-off is used in analyses, information is lost, leading to potentially misleading results and less accurate injury risk prediction. Dichotomizing a continuous variable using a cut-off should be avoided. Using continuous variables on its original scale is advantageous because information is not discarded, outcome prediction accuracy is not lost, and personalized medicine can be facilitated. # Clinical Application Researchers and clinicians are encouraged to analyze and interpret the results of tests and measures using continuous variables and avoid relying on singular cut-offs to guide decisions. Injury risk can be predicted more accurately when using continuous variables in their natural form. A more accurate risk prediction will facilitate personalized approaches to injury risk mitigation and may lead to a decline in injury rates. # Level of Evidence 5https://doi.org/10.26603/001c.122644 |
| spellingShingle | Justin M. Losciale Linda K. Truong Patrick Ward Gary S. Collins Garrett S. Bullock Limitations of Separating Athletes into High or Low-Risk Groups based on a Cut-Off. A Clinical Commentary International Journal of Sports Physical Therapy |
| title | Limitations of Separating Athletes into High or Low-Risk Groups based on a Cut-Off. A Clinical Commentary |
| title_full | Limitations of Separating Athletes into High or Low-Risk Groups based on a Cut-Off. A Clinical Commentary |
| title_fullStr | Limitations of Separating Athletes into High or Low-Risk Groups based on a Cut-Off. A Clinical Commentary |
| title_full_unstemmed | Limitations of Separating Athletes into High or Low-Risk Groups based on a Cut-Off. A Clinical Commentary |
| title_short | Limitations of Separating Athletes into High or Low-Risk Groups based on a Cut-Off. A Clinical Commentary |
| title_sort | limitations of separating athletes into high or low risk groups based on a cut off a clinical commentary |
| url | https://doi.org/10.26603/001c.122644 |
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