Classifying trunk strength impairment according to the activity limitation caused in wheelchair rugby performance.

International Federations in Paralympic sports should develop evidence-based classification, based on the relative strength of association between impairment and activities that determine sport-specific performance. The purpose of the current study was to assess the relationship between trunk strength impairment and three activities that determine performance in wheelchair rugby, and to determine whether this relationship supports the concept of "natural classes." Trunk muscle strength and three determinants of performance were assessed in 27 athletes. The correlations between lateral trunk muscle strength and the determinant tilting the chair, and between forward trunk muscle strength and the determinants 1 m acceleration and sprint momentum were calculated. To group athletes based on impairment, K-means cluster analysis was used to group athletes according to how much trunk muscle strength affected the activities. There were significant, moderate to strong correlations between left-right strength and chair tilting (r=.50), between forward strength and 1 m acceleration (r=.59), and between forward strength and sprint momentum (r=.79). Cluster analysis indicated at least one cut-point in performance with a decrease in impairment in all three wheelchair activities, supporting the concept of "natural classes."

The impact of trunk impairment on performance-determining activities in wheelchair rugby.

In Paralympic sport, classification of impairment is needed to prevent a one-sided and predictable outcome of competition, in which the least impaired athlete has the best chance to win. To develop evidence-based classification in wheelchair rugby, the impact of trunk impairment, measured by the Trunk Impairment Classification (TIC), on performance-determining activities was assessed. Arm impairment was analyzed as a covariant. Fifty-five athletes, 21 with TIC score 0, 13 with TIC score 0.5, 11 with TIC score 1.0, and 10 with TIC score 1.5 performed standardized sport-specific activities. A multiple step forward regression analysis was performed for all activities to assess the relative impact of trunk and arm impairment on performance. Trunk impairment was the most important factor for tilting the chair and acceleration in the first 2 m. The explained variance of the performance by trunk and arm impairment ranged from 23% for acceleration in the first meter, to 37% for sprint momentum, the tilt test left, and the time to cover 3 and 4 m. This study shows that athletes with limited trunk impairment are more proficient in wheelchair rugby than athletes with severe trunk impairment.

Reliability of the revised wheelchair rugby trunk impairment classification system.

STUDY DESIGN: Observational, cross-sectional. OBJECTIVES: A new classification system for trunk impairment in wheelchair rugby was introduced in 2010. It consists of 10 tests, arranged in an algorithm, to assign four different trunk scores (0, 0.5, 1.0 or 1.5) to athletes. The purpose of this study was to assess the inter-rater reliability of this classification system. SETTING: National competition for wheelchair rugby and wheelchair basketball in the Netherlands and Belgium. METHODS: Three experienced wheelchair rugby classifiers independently assigned trunk scores to wheelchair rugby and wheelchair basketball athletes in two sessions. After each session, test descriptions were adjusted. The inter-rater reliability was evaluated by determining the agreement and Fleiss Kappa. RESULTS: In the first session, all classifiers agreed on the trunk score in 13 out of 16 athletes; the overall Kappa was 0.76 (P<0.001). The Kappa per trunk score ranged from 0.29 to 1. Four test descriptions were adjusted after the first session. In the second session, there was an agreement in trunk score between the classifiers in 15 out of 21 athletes. The overall Kappa was 0.75 (P<0.0001), and the Kappa per trunk scores ranged from 0.58 to 0.92. After the second session, two test descriptions were improved. CONCLUSION: The revised classification system for trunk impairment in wheelchair rugby showed a adequate inter-rater reliability for the allocation of trunk scores.