Analysis of Balance and Functional Hop Tests in Athletes With Lower Extremity Injuries by Dual Task Study

Functional Hop tests and balance measurements are frequently used to decide on returning to sports after lower extremity injuries. Although the athletes show proficiency in these tests and measurements, re-injuries occur when returning to sports. The causes of these re-injuries are mostly functional deficiencies such as inadequate neuromuscular control and stability.

In the competition or sports environment, especially in team games, the athlete also shows cognitive performance, such as communication with teammates and following the game, which are included in the game setup, as well as the physical performance. Performing many tasks or performances at the same time divides the focus of attention on the activities performed, and if the person cannot adequately meet the attention demands, the quality of one or more of the tasks performed will deteriorate. As the level of expertise in the sport increases, the athlete tends to manage his posture, balance and movement with automatic postural control and can focus his attention on a new task.

The concept of focus of attention has been evaluated from different perspectives over time. If it is examined in terms of direction; It is divided into two as the internal focus of attention, which is used by focusing on body movements during the performance of the person, and the external focus of attention, which is used by focusing on the effect of the movement during the performance of the person. As the investigators planned in this study, a second cognitive task assigned to the participant simultaneously during his or her physical performance acts as an external focus of attention, allowing movement control during performance to be carried out by unconscious or automatic processes.

The investigators's aim; It is to examine the balance and functional hop tests that the investigator will apply in athletes by combining them with a simultaneous dual cognitive task that will reflect the field conditions more realistically. In the meantime, investigators think that with the sharing of our results with the literature, it can contribute to both the decision-making processes to return to sports after injury and preventive rehabilitation programs.

Study Overview

• Status: Completed
• Conditions: Knee Injuries; Hip Injuries; Ankle Injuries; Athletic Injuries; Ankle Sprains; Reinjuries
• Intervention / Treatment: Procedure: Dual tasking paradigm

Detailed Description

As a result of this study, the possible changes in balance and functional jump performances of athletes who have previously had unilateral lower extremity injuries will be examined with the dual-task paradigm. In line with these results, it will be possible to comment on the balance and functional hop test performances of the athletes together with the cognitive task. Balance measurements and functional performance evaluations are used in the decision to return to sports after previous injuries. After the measurements, the affected and unaffected side are compared and an evaluation is made. However, even with these tests and evaluations, athletes are injured again when they return to sports. One of the reasons for this may be that the protective and controlled environment applied during rehabilitation is less challenging and requires less attention when compared to the competitive and sports environment in which the person is involved. For this reason, the investigator think that the evaluations and tests used in the decision to return to sports include both cognitive and physical performance by forcing the attention demands of the person, and it may be more effective in determining the real performance of the person. Thus, the use of physical assessments applied with simultaneous cognitive tasks can be used in the evaluation of the athletes during the return to sports by calculating the possible measurement differences between the affected and unaffected sides compared to the classical procedure, and in the planning of preventive rehabilitation programs of the athletes if there is a decrease in performance in the measurements applied as a dual task. It also contributes to studies that examine performance together with the dual task previously applied to athletes. Secondly, by examining the relationship between balance and functional hop test parameters, it will be determined how effective the independent variables are on each other. If the performance of individuals who have had a previous injury change with the dual task and the mechanisms of these possible changes are known, protective and performance-enhancing strategies can be developed, the cognitive and physical preparation of the athletes for the sports environment can be accelerated, and the risks of re-injury of the athletes can be reduced, as a result of which medical costs can be reduced.

• Study Type: Interventional
• Enrollment (Actual): 39
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Fatih
    • Istanbul, Fatih, Turkey
      • Istanbul University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 10 years to 26 years (Child, Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Having a history of injury to only one lower extremity before
• Having to stay away from sports activities for at least 1 week and maximum 6 weeks after the injury.
• Not having a lower extremity injury in the last 6 months
• Age range of 14-30 and still being active at high school or university level in sports involving sudden changes of direction and jumping physically

Exclusion Criteria:

• Bilateral lower extremity injury history
• Pregnancy
• Vestibular, respiratory and visual disturbances
• Diabetes
• Auditory or cognitive deficit
• Use of drugs that affect balance, cognition and attention
• Pain in the affected lower extremity (at least 2/10 according to the VAS -Visual Analogue Scale-)
• Lower extremity or waist operation history
• Conditions or neurological disorders that may affect balance
• Head trauma or symptoms related to head trauma

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Case Group; This group consists of athletes whose are between the ages of 14-30 and are still active at high school or university level in sports involving sudden changes of direction and jump physically and who have a history of injury to only one lower extremity before.	Procedure: Dual tasking paradigm; The dual task methodology is a testing model that requires one person to perform two tasks at the same time. The dual task is divided into two as motor-motor or motor-cognitive. Dual tasks provide an opportunity to examine the attention demands of both tasks and allow possible interference to be observed. The idea behind this design is that central processing capacity has a limit and must be distributed among concurrent tasks.
Other: Control Group; This group consists of athletes whose age range is 14-30, and who are still active at high school or university level in sports involving sudden changes of direction and jump physically and who do not have a history of lower extremity injuries.	Procedure: Dual tasking paradigm; The dual task methodology is a testing model that requires one person to perform two tasks at the same time. The dual task is divided into two as motor-motor or motor-cognitive. Dual tasks provide an opportunity to examine the attention demands of both tasks and allow possible interference to be observed. The idea behind this design is that central processing capacity has a limit and must be distributed among concurrent tasks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Balance Performance Measurement (OSI-injured/Worse Side-Single Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Balance Performance Measurement (APSI-injured/Worse Side-Single Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Balance Performance Measurement (MLSI-injured/Worse Side-Single Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Balance Performance Measurement (OSI-noninjured/Better Side-Single Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Balance Performance Measurement (APSI-noninjured/Better Side- Single Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Balance Measurement Performance (MLSI-noninjured/Better Side-Single Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Functional Hop Test (THD-injured/Worse Side-Single Task)	Triple hop for distance ,Crossover hop for distance-CHD -In these two tests, the distance between the starting line and the heel line in step 3 was measured. Normalization was done by dividing this distance (m) by the athlete's height (m). The results of this measurement method have certain cut-off values depending on gender and age. In this study, the performance was not compared according to the cut-off values, but between the groups.	day 1
Functional Hop Test (CHD-injured/Worse Side-Single Task)	Triple hop for distance ,Crossover hop for distance-CHD -In these two tests, the distance between the starting line and the heel line in step 3 was measured. Normalization was done by dividing this distance (m) by the athlete's height (m). The results of this measurement method have certain cut-off values depending on gender and age. In this study, the performance was not compared according to the cut-off values, but between the groups.	day 1
Functional Hop Test (6MHT-injured/Worse Side-Single Task)	6m hop for timed-6MTH: The participant was asked to jump on one leg as fast as possible from the marked start point to the finish point, which is 6 meters away from the marked start point. The time from the start to the end of 6 meters was recorded.	day 1
Functional Hop Test(THD-noninjured/Better Side- Single Task)	Triple hop for distance ,Crossover hop for distance-CHD -In these two tests, the distance between the starting line and the heel line in step 3 was measured. Normalization was done by dividing this distance (m) by the athlete's height (m).	day 1
Functional Hop Test(CHD-noninjured/Better Side-Single Task)	Triple hop for distance ,Crossover hop for distance-CHD -In these two tests, the distance between the starting line and the heel line in step 3 was measured. Normalization was done by dividing this distance (m) by the athlete's height (m).	day 1
Functional Hop Test(6MHT-noninjured/Better Side-Single Task)	6m hop for timed-6MTH: The participant was asked to jump on one leg as fast as possible from the marked start point to the finish point, which is 6 meters away from the marked start point. The time from the start to the end of 6 meters was recorded.	day 1
Functional Hop Test THD LSI-Single Task	The limb symmetry index (LSI) was calculated to evaluate the difference between the two legs in all functional tests. Calculation for the case group; LSI = Affected leg score ÷ Unaffected leg score × 100 This calculation for the control group; LSI= Worse score ÷ Better score × 100.	day 1
Functional Hop Test CHD LSI-Single Task	The limb symmetry index (LSI) was calculated to evaluate the difference between the two legs in all functional tests. Calculation for the case group; LSI = Affected leg score ÷ Unaffected leg score × 100 This calculation for the control group; LSI= Worse score ÷ Better score × 100.	day 1
Functional Hop Test 6MHT LSI-Single Task	The limb symmetry index (LSI) was calculated to evaluate the difference between the two legs in all functional tests. Calculation for the case group; LSI = Affected leg score ÷ Unaffected leg score × 100 This calculation for the control group; LSI= Worse score ÷ Better score × 100.	day 1

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Balance Performance Measurement (OSI-injured/Worse Side-Dual Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Balance Performance Measurement (APSI-injured/Worse Side-Dual Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Balance Performance Measurement (MLSI-injured/Worse Side-Dual Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Balance Performance Measurement (OSI-noninjured/Better Side- Dual Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Balance Performance Measurement(APSI-noninjured/Better Side-Dual Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Balance Performance Measurement(MLSI-noninjured/Better Side-Dual Task)	For balance measurement, Athlete Single Leg Stability, one of the test modes in the Biodex Balance System SD balance device, was preferred. The participant took a position with her/his eyes open, the foot of the untested leg resting on the back of the ankle of the tested leg, her arms crossed over her chest, and the balance center in the middle of the platform most comfortably. The analysis protocol was applied at 5 level, consisting of 20 seconds, 1 sample and 3 test repetitions, with a 10-second rest between repetitions. General stability index (OSI), anterior/posterior stability index (APSI), medial/lateral stability index (MLSI) were recorded. The unit of data obtained in this device is the balance index. And values close to 0 indicate high stability.	day 1
Functional Hop Test(THD-injured/Worse Side-Dual Task)	Triple hop for distance ,Crossover hop for distance-CHD -In these two tests, the distance between the starting line and the heel line in step 3 was measured. Normalization was done by dividing this distance (m) by the athlete's height (m).	day 1
Functional Hop Test (CHD-injured/Worse Side-Dual Task)	Triple hop for distance ,Crossover hop for distance-CHD -In these two tests, the distance between the starting line and the heel line in step 3 was measured. Normalization was done by dividing this distance (m) by the athlete's height (m).	day 1
Functional Hop Test (6MHT-injured/Worse Side-Dual Task)	6m hop for timed-6MTH: The participant was asked to jump on one leg as fast as possible from the marked start point to the finish point, which is 6 meters away from the marked start point. The time from the start to the end of 6 meters was recorded.	day 1
Functional Hop Test(THD-noninjured/Better Side-Dual Task)	Triple hop for distance ,Crossover hop for distance-CHD -In these two tests, the distance between the starting line and the heel line in step 3 was measured. Normalization was done by dividing this distance (m) by the athlete's height (m).	day 1
Functional Hop Test(CHD-noninjured/Better Side-Dual Task)	Triple hop for distance ,Crossover hop for distance-CHD -In these two tests, the distance between the starting line and the heel line in step 3 was measured. Normalization was done by dividing this distance (m) by the athlete's height (m).	day 1
Functional Hop Test(6MHT-noninjured/Better Side-Dual Task)		day 1
Functional Hop Test THD LSI-Dual Task	The limb symmetry index (LSI) was calculated to evaluate the difference between the two legs in all functional tests. Calculation for the case group; LSI = Affected leg score ÷ Unaffected leg score × 100 This calculation for the control group; LSI= Worse score ÷ Better score × 100.	day 1
Functional Hop Test CHD LSI-Dual Task	The limb symmetry index (LSI) was calculated to evaluate the difference between the two legs in all functional tests. Calculation for the case group; LSI = Affected leg score ÷ Unaffected leg score × 100 This calculation for the control group; LSI= Worse score ÷ Better score × 100.	day 1
Functional Hop Test 6MHT LSI-Dual Task	The limb symmetry index (LSI) was calculated to evaluate the difference between the two legs in all functional tests. Calculation for the case group; LSI = Affected leg score ÷ Unaffected leg score × 100 This calculation for the control group; LSI= Worse score ÷ Better score × 100.	day 1

Collaborators and Investigators

• Sponsor: Istanbul University

Study record dates

Study Major Dates

• Study Start (Actual): September 28, 2022
• Primary Completion (Actual): September 28, 2022
• Study Completion (Actual): September 30, 2022

Study Registration Dates

• First Submitted: July 4, 2022
• First Submitted That Met QC Criteria: July 30, 2022
• First Posted (Actual): August 2, 2022

Study Record Updates

• Last Update Posted (Actual): August 13, 2025
• Last Update Submitted That Met QC Criteria: August 8, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Keywords: dual-task paradigm
• Additional Relevant MeSH Terms: Leg Injuries; Reinjuries; Ankle Injuries; Wounds and Injuries; Athletic Injuries; Knee Injuries; Hip Injuries
• Other Study ID Numbers: IU-ELIF-001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No