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Am J Sports Med. 2019 Jan;47(1):197-205. doi: 10.1177/0363546518812820. Epub 2018 Dec 3.

Association of Dynamic Balance With Sports-Related Concussion: A Prospective Cohort Study.

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Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland.
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.
Medical Department, Irish Rugby Football Union, Dublin, Ireland.
Medical Department, Connacht Rugby, Galway, Ireland.



Concussion is one of the most common sports-related injuries, with little understood about the modifiable and nonmodifiable risk factors. Researchers have yet to evaluate the association between modifiable sensorimotor function variables and concussive injury.


To investigate the association between dynamic balance performance, a discrete measure of sensorimotor function, and concussive injuries.


Cohort study (diagnosis); Level of evidence, 3.


A total of 109 elite male rugby union players were baseline tested in dynamic balance performance while wearing an inertial sensor and prospectively followed during the 2016-2017 rugby union season. The sample entropy of the inertial sensor gyroscope magnitude signal was derived to provide a discrete measure of dynamic balance performance. Logistic regression modeling was then used to investigate the association among the novel digital biomarker of balance performance, known risk factors of concussion (concussion history, age, and playing position), and subsequent concussive injury.


Participant demographic data (mean ± SD) were as follows: age, 22.6 ± 3.6 years; height, 185 ± 6.5 cm; weight, 98.9 ± 12.5 kg; body mass index, 28.9 ± 2.9 kg/m2; and leg length, 98.8 ± 5.5 cm. Of the 109 players, 44 (40.3%) had a history of concussion, while 21 (19.3%) sustained a concussion during the follow-up period. The receiver operating characteristic analysis for the anterior sample entropy demonstrated a statistically significant area under the curve (0.64; 95% CI, 0.52-0.76; P < .05), with the cutoff score of anterior sample entropy ≥1.2, which maximized the sensitivity (76.2%) and specificity (53.4%) for identifying individuals who subsequently sustained a concussion. Players with suboptimal balance performance at baseline were at a 2.81-greater odds (95% CI, 1.02-7.74) of sustaining a concussion during the rugby union season than were those with optimal balance performance, even when controlling for concussion history.


Rugby union players who possess poorer dynamic balance performance, as measured by a wearable inertial sensor during the Y balance test, have a 3-times-higher relative risk of sustaining a sports-related concussion, even when controlling for history of concussion. These findings have important implications for research and clinical practice, as it identifies a potential modifiable risk factor. Further research is required to investigate this association in a large cohort consisting of males and females across a range of sports.


Y balance test; balance; concussion; inertial sensor; postural stability; risk factor; traumatic brain injury

[Indexed for MEDLINE]

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