Reliability,validity And Application Of Ankle Proprioception Test Device In Cutting Footwork Of Table Tennis Players

Objective:Cutting is a basic action for lateral body movement and weight shift in many sports,and it is also a common action of ankle inversion sprains.Proprioception plays an important role in neuromuscular motor control.Understanding the mechanism of ankle proprioception in cutting footwork control is important for improving sports performance and preventing sports injuries.Table tennis is a skill-oriented sport with a racket and net.Footwork is the foundation of table tennis.To complete a quality stroke,the player must quickly activate the ankle joint and quickly adjust the foot position to the different ball conditions.Therefore,ankle proprioception is crucial to the athletic ability of table tennis players.Cutting footwork is one of the basic lower limb skills of table tennis players and the basis of common footwork,but there is a lack of reliable and valid assessment methods for ankle proprioception in the cutting footwork,which makes it difficult to reveal the mechanism of ankle proprioception in the control of the cutting footwork.Based on the signal detection theory and active movement extent discrimination,this study developed an Ankle Inversion Discrimination Apparatus-Cutting（AIDAC）and applied it to table tennis players.The reliability and validity of the test were examined in table tennis players.By investigating the relationship between ankle inversion proprioception and lower limb motor function,specific sports performance and injury risk in table tennis players,this study explores the feasibility of applying AIDAC to distinguish and predict the risk of lower limb injury,to provide theoretical basis for injury prevention and scientific training of athletes.The research findings will provide a stable and effective method for the assessment of ankle proprioceptive function in table tennis players,and provide a theoretical reference for the improvement of motor skills and prevention of sports injuries in table tennis players.Methods:This study was approved by the Ethics Committee of Shanghai University of Sport,including four trials.The recruited table tennis players are from the China Table Tennis Academy.Trial 1:Reliability study of AIDAC.The sample size calculation resulted in the inclusion of the junior group of table tennis players（age:13.35±2.25 years,height:160.90±13.28 cm,weight:46.70±12.21 kg）and the youth group of table tennis players（age:19.15±1.14 years,height:171.40±8.06 cm,weight:61.18±8.37 kg）were20 each.Subjects were asked to retest 7 days apart after completing the first AIDAC test.The Area Under the ROC Curve（AUC）was obtained as the ankle proprioceptive sensitivity score by plotting the Receiver Operating Characteristic（ROC）curve.The IntraclassCorrelation Coefficient（ICC）was used as an index of retest reliability,and the Minimal Detectable Change with 90%confidence interval(MDC₉₀)to determine the measurement error of AIDAC.Trial 2:Validity study of AIDAC.Through sample size calculation,46 table tennis players（age:18.22±2.30 years,height:171.83±7.39 cm,weight:60.93±9.00 kg）were finally recruited.Subjects completed the AIDAC test,the Y Balance Test（Y Balance Test,YBT）for dynamic balance function,the Weight-Bearing Lunge Test（WBLT）for ankle dorsiflexion mobility,and the Single Hop for Distance（SHD）for lower limb strength in random order.Pearson correlation analysis was used to analyze the AIDAC value,YBT comprehensive value,WBLT value and SHD value,so as to explore the relationship between AIDAC and motor function of lower limbs,namely,the convergent validity of AIDAC.Trial 3:The relationship between ankle proprioception and specific sports performance in cutting footwork.Through sample size calculation,54 table tennis players（age:16.96±3.34 years,height:167.79±11.41 cm,weight:56.86±12.15 kg）were finally recruited.The proprioceptive function of the ankle joint in cutting footwork was measured by the AIDAC test,and their special sports performance ability was evaluated by setting the parameters of the intelligent ball serving robot and completing the Total score of 80（TS 80）.Spearman correlation analysis was used to analyze the AUC value of AIDAC and TS 80 score,and to explore the relationship between ankle proprioception and specific sports performance in cutting footwork of table tennis players.Trial 4:Application of AIDAC to distinguish and predict the risk of lower limb injury.Through sample size calculation,66 table tennis players（age:16.33±3.55years,height:166.75±11.81 cm,weight:55.31±12.88 kg）were finally recruited.The proprioceptive function of the ankle joint in cutting footwork was measured by AIDAC.Lower Extremity motor performance was assessed and the injury risk was screened using the Lower Extremity Functional Test（LEFT）.The regression equation P=1/1+e^{-（12.142-0.088MQ-0.085SS）}shown in previous studies of the LEFT was used to calculate the risk of lower limb injury,and the risk of injury≥10 was defined as high risk.The AIDAC value and LEFT score were analyzed by Pearson correlation analysis.The AIDAC value and LEFT score in high-risk group and low-risk group were analyzed by independent sample T-test.The optimal cutoff value,sensitivity and specificity of AIDAC to distinguish high-risk and low-risk table tennis player with lower limb injury were determined by diagnostic analysis of ROC curve and Youden index.The optimal cutoff value was obtained by the maximum Youden index,so as to explore the feasibility of AIDAC to distinguish the risk of lower limb injury.Results:The results of the reliability study in trial 1 showed that,the ICC_（3,1）value of the junior group was 0.875（95%CI=0.712-0.949）,the ICC_（3,1）value of the youth group was 0.785（95%CI=0.534-0.909）,and the ICC_（3,1）value of the whole group was0.854（95%CI=0.7414-0.920）.The MDC₉₀ value of the junior group was 0.053 and the youth group was 0.049.The results show that AIDAC has good test-retest reliability and small measurement error.The results of the trial 2 validity study showed that,the AUC value of AIDAC was strongly positively correlated with the comprehensive value of YBT（r=0.621,p<0.001）,and moderately significantly positively correlated with the value of SHD（r=0.466,p=0.001）,but no significant correlation with WBLT value（r=0.052,p=0.732）in the cutting footwork.The results of the correlation analysis between ankle proprioception and specific sports performance in trial 3 showed a moderately significant positive correlation between AIDAC values and TS 80 scores（r=0.456,p=0.001）.Trial 4 application of AIDAC to distinguish and predict the risk of lower limb injury.Correlation analysis showed a moderately significant positive correlation between the AUC value of AIDAC and the LEFT score（r=0.481,p<0.001）.The AUC value of AIDAC was 0.757±0.054 in the high-risk group and 0.805±0.055 in the low-risk group.The AUC value in the high-risk group was significantly lower than that in the low-risk group（t=3.567,p=0.001,95%CI=0.021-0.074,Cohen’s d=0.881）.The mean scores of LEFT in high-risk group and low-risk group were 75.03±7.01 and87.66±4.77,with a statistically significant difference between the two groups（t=8.606,p<0.001,95%CI=9.69-15.57,Cohen’s d=2.095）.ROC curve analysis results showed that the AUC value of AIDAC to distinguish between people at high and low risk of lower extremity injury was 0.750,the optimal cutoff value was 0.769,the sensitivity was 71.9%,and the specificity was 70.6%.Conclusion:（1）AIDAC has good test-retest reliability and small measurement error in measuring ankle inversion proprioception in cutting footwork of table tennis players.（2）AIDAC has good convergent validity with YBT,SHD,and LEFT.（3）AIDAC has a moderately significant positive correlation with the performance ability of table tennis specific performance ability,indicating the important role of ankle proprioception index in the performance of table tennis players.（4）AIDAC can be used to distinguish high-risk and low-risk groups of lower limb injury.In the prevention of sports injury,AIDAC and LEFT can be used together to accurately identify high-risk groups of lower limb injury,and provide a theoretical basis for injury prevention and scientific training of athletes.（5）The results of this study suggest that by improving ankle proprioception in table tennis players with high risk of lower limb injury,it may improve their basic lower limb motor function,dynamic balance function and special sports performance ability.