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Inter-Rater Reliability of Dynamic Exertion Testing (EXiT) Performance Among Healthy Adults.

Bricker, Indira and Allison, Katelyn and Lovalekar, Mita and Kontos, Anthony and Connaboy, Christopher (2021) Inter-Rater Reliability of Dynamic Exertion Testing (EXiT) Performance Among Healthy Adults. Master's Thesis, University of Pittsburgh. (Unpublished)

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INTRODUCTION: The Dynamic Exertion Test (EXiT) is a new standardized return to play (RTP) exertion assessment for athletes at medical clearance following a concussion. It incorporates aerobic, multiplanar dynamic, and functional movements, based on exercise prescription guidelines from the American College of Sports Medicine (ACSM), with objective measures that work to challenge all potentially affected systems of a concussed athlete. The purpose of this study is to determine the interrater reliability (IRR) of the EXiT between two raters assessing healthy, non-concussed athletes and to determine the level of systematic bias between the two raters. METHODS: A subgroup of 15 participants (F=5, 33.3%, age: 23.67 ± 4.22 years old) from a larger study were assessed with the EXiT on two visits. Two raters simultaneously scored participants at both visits on the number of errors committed on all dynamic tasks and on time to completion on agility cone tasks. IRR was estimated using intraclass correlation coefficients (ICC) and 95% confidence intervals (CI) for time and Kappa Coefficients and 95% CI were used for errors. Paired t-tests and NcNemar Tests were used to assess for systematic bias between raters’ scores. RESULTS: Time to completion had good IRR (ICCs > 0.759), Arrow Agility at visit 1 had the highest (0.999 [95% CI 0.997-1.0]) and Box Drill Carioca at visit 2 had the lowest (0.759 [95% CI 0.314-0.929]). Fifteen of the 20 tasks showed no statistically significant difference between raters scores. Errors had poor to excellent IRR (p-values: 0.324-1.00) and an observed percent agreement >83.33% for 10 of 14 tasks, Zigzag at visit 1 had the lowest (66.66%). McNemar Test showed no statistically significant difference (p-values > 0.250) for all task errors, but Arrow Agility had the largest difference between raters at both visits (13.33% vs. 40%, 16.66% vs. 41.66%). CONCLUSION: IRR for the EXiT time and errors was good for the majority of tasks. This study was a good first step in evaluating the reliability of the new RTP exertional protocol, the EXiT. Future research should use a larger sample size to evaluate IRR in concussed participants along with intra-rater and test retest reliability.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Kontos, Anthonyakontos@pittledu
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee MemberAllison,
Committee MemberLovalekar,
Committee MemberKontos, Anthonyakontos@pittledu
Committee ChairConnaboy,
Date: 21 January 2021
Date Type: Publication
Defense Date: 16 November 2020
Approval Date: 21 January 2021
Submission Date: 27 November 2020
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 81
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Sports Medicine and Nutrition
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: concussion sports related concussion exercise exertional exercise dynamic exercise return to play reliability inter-rater reliability EXiT Dynamic Exertion Test athletes
Date Deposited: 21 Jan 2021 19:54
Last Modified: 21 Jan 2021 19:54

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