A novel review of potential assessment tools for Para Dressage Classification

Abstract

The key aim of classification in Para sport is to try and ensure that competitors are grouped so that they compete against others with impairments that cause a similar level of activity limitation within a specific sport. This synthesis aimed to identify existing, valid, and reliable, impairment assessment tools to measure eligible impairments that influence an individual's ability to compete at Para dressage. A multi-stage approach was employed, where a systematic search of professional databases of impairment assessment tools first identified 35 tools for Para dressage. Then, a search strategy was developed, based on these 35 tools, and 305 scientific articles were identified from academic databases up to September 2021. From here, impairment assessment tools were evaluated and refined in a twostage process using known performance determinants for Para dressage and then an assessment of their reliability, validity and practical usability. This resulted in the selection of impairment assessment tools, which included measures of muscle tone, strength, coordination, sitting balance, and trunk function. From this synthesis, we present a novel process by which impairment assessment tools were selected, refined, and critically examined using knowledge of performance determinants for dressage, the views and experiences of stakeholders, and reliability and validity of tools. The processes described here could be applied to the development of evidence-based classification systems across a range of Para sports.

Towards an Evidence-Based Classification System for Para Dressage: Associations between Impairment and Performance Measures

“…Thus, in 2018, the FEI funded a research project designed to follow the framework set out by [9] as a first step in providing a strong, scientific evidence-base for the Para dressage classification system [11]. This project has already produced a scoping review of published studies that investigated key determinants of dressage performance [7], a study of stakeholder perceptions regarding the key determinants of and impact of impairment on Para dressage performance [8], and a research synthesis of existing clinical impairment assessment tools that are relevant to eligible impairment types, performance measures, and activity limitations for Para dressage [12].…”

“…The synthesis [12] recommended the following robust impairment assessment tools to take forward into further studies: the Function in Sitting Test (FIST) [13], the Trunk Impairment Scale (TIS) [14], the Scale of Assessment and Rating of Ataxia (SARA) [15], the modified Ashworth Scale, or "Re-modified Ashworth Scale" (R-MAS) [16], and handheld dynamometry (HHD) measures [17]. These tools had acceptable psychometric properties, captured the physical requirements for dressage performance, and were considered to meet the practical demands of athlete classification [12]. The FIST is considered to be a reliable measure of activity and performance-based deficits in sitting function [13], while the TIS is considered a reliable measure of trunk control in sitting [14].…”

“…The FIST is considered to be a reliable measure of activity and performance-based deficits in sitting function [13], while the TIS is considered a reliable measure of trunk control in sitting [14]. SARA, versions of the Ashworth and modified Ashworth Scale, and HHD measures are used in other Para sport classification systems [18][19][20][21], measuring aspects of coordination, muscle tone, and strength, respectively [12]. The tools also provide access to substantial data evaluating their reliability and repeatability across a range of conditions that are present within the Para dressage population, adding to the strength of their use within this study as impairment assessment measures.…”

“…Following on from the previous studies that form the FEI Classification Research project [7,8,12], and additional studies to identify suitable quantitative measures of performance [23][24][25], this article presents findings from the final study of the overarching research project. It is informed by the reviews [7,12], semi-structured interviews [8], and original studies [23][24][25] that have preceded it, extensive consultation and input from classifiers and physiotherapists, and pilot testing. This cumulative study aims to investigate and define measures of impairment, measures of performance, and the strength of association between impairment and activity limitation in Para dressage and non-disabled athletes, as described by [2].…”

“…In accordance with [9], performance and impairment measurements from non-disabled athletes were used to develop a normative dataset for comparison with Para athletes. The objectives were (1) to compare the outcome of a clinical battery of recommended impairment assessment tools for Para dressage between Para and non-disabled athletes [12]; (2) to compare non-disabled and Para athlete performance using a custom dressage test on a riding simulator; and (3) to objectively determine if, how, and to what extent impairment severity measured with these tools influences simulated riding performance.…”