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- Limitations of separating athletes into high…
Limitations of separating athletes into high or low-risk groups based on a cutoff. A clinical commentary
Key Points
- The common practice of dichotomizing athletes as high or low risk based on test cutoffs is fraught with statistical and practical issues.
BACKGROUND & OBJECTIVE
To assess athletes’ injury risk, clinicians often take a “risk stratification” approach. This process involves measuring a continuous variable, such as limb symmetry index (LSI) for quadriceps strength or single-leg hop performance. Based on whether the athlete performs above or below a numerical cutoff (typically 90% for LSI), the athlete is categorized as either “high risk” or “low risk.” This dichotomous classification then informs clinical decisions, such as determining readiness to return to sport.
The purpose of this clinical commentary was to discuss the surface-level pros of this cutoff-based approach and raise awareness of the cons, which can render the approach more harmful than helpful. The authors also recommended alternatives for interpreting and applying testing for injury risk assessment.
Interventions should be continued even after reaching the 90% goal to support return to performance, not just return to participation.
METHODS
This commentary discusses the following: