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  1. Arnhild Bakken1,2,
  2. Stephen Targett1,
  3. Tone Bere2,
  4. Eirale Cristiano1,
  5. Farooq Aziz1,
  6. Tol Johannes1,3,4,
  7. Whiteley Rod1,
  8. Khan Karim5,
  9. Bahr Roald1,2
  1. 1Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  2. 2Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  3. 3The Sports Physician Group, Department of Sports Medicine OLVG, Amsterdam, The Netherlands
  4. 4Academic Center of Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands
  5. 5Center for Mobility and Hip Health, University of British Columbia, Vancouver, Canada


    Background The Nine Plus screening battery test (9+) is a series of 11 tests, used to assess limitations in fundamental movement patterns assumed to predispose athletes for injury.

    Objective To examine the association of the 9+ with lower extremity injuries, and to identify the optimal cut-off point for risk screening.

    Design Prospective cohort study.

    Setting Professional football league.

    Participants Male professional football players in Qatar.

    Interventions The 9+ test was performed prior to the 2013 and 2014 seasons. Time-loss injuries and exposure in training and matches were registered prospectively by club medical staff during 2 consecutive seasons. Univariate and multivariate regression analyses were used to calculate odds ratios (ORs), risk ratios (RR) and 95% confidence intervals (CIs). Receiver operating characteristics (ROC) curves were calculated to determine sensitivity and specificity, and identify the optimal cut-off point for risk assessment.

    Main Outcome Measurement Lower extremity injuries.

    Results In total, 363 players completed the 9+ and had injury and exposure registration. There were 527 injuries among 204 players (56.2%) during the 2 seasons; injuries to the thigh were most frequent. There was no association between 9+ total score and the risk of lower extremity injuries (OR, 1.02; 95% CI, 0.98–1.06; P=0.44), even when adjusted for exposure (RR, 1.04; 95% CI, 0.98–1.12; P=0.21) or other factors in a multivariate analysis (OR, 1.04; 95% CI, 0.97–1.06; P=0.60). ROC curve analysis revealed an area under the curve of 0.48 for lower extremity injury. No optimal cut-off point to distinguish between injured and non-injured players could be determined.

    Conclusions The 9+ total score was not associated with lower extremity injury. The 9+ total score was no better than chance for classifying injured and non-injured players. Therefore, the 9+ test cannot be recommended as a screening tool in this population.

    • Injury

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