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Test-Retest Reliability of the Closed Kinetic Chain Upper Extremity Stability Test in Children Aged 7-10 Years

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Title: Test-Retest Reliability of the Closed Kinetic Chain Upper Extremity Stability Test in Children Aged 7-10 Years
Language: English
Authors: Cemre Yaren Güngörenler (ORCID 0000-0001-8661-1416), Tülay Tarsuslu (ORCID 0000-0003-3797-8857)
Source: Measurement in Physical Education and Exercise Science. 2025 29(3):246-255.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 10
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Test Reliability, Physical Activities, Performance Tests, Children, Foreign Countries, Human Body, Gender Differences
Geographic Terms: Turkey
DOI: 10.1080/1091367X.2024.2443860
ISSN: 1091-367X
1532-7841
Abstract: The aim of this study is to investigate the test-retest reliability of the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) and modified-CKCUEST in children aged 7-10 years and to compare the two test versions within the same group. The study was completed with fifty-three children. Average, normalized, and power scores were obtained from the maximum number of touches in 15 × 3 s in the tests. Tests were repeated seven days apart for test-retest reliability. Intraclass Correlation Coefficient (ICC[subscript 3,1]), Standard Error of Measurement (SEM), Minimum Detectable Change (MDC) were tested total/by gender. Children's opinions about the tests were questioned. The test-retest ICC[subscript 3,1] values for CKCUEST were 0.96 for average score, 0.95 for normalized score, 0.97 for power score. For the modified-CKCUEST, test-retest reliabilities were 0.94, 0.92, 0.96, respectively. CKCUEST and modified-CKCUEST demonstrated excellent test-retest reliability for children aged 7-10 years. Participants stated that the modified-CKCUEST was more suitable as a test position.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1477879
Database: ERIC
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  Value: <anid>AN0186774323;7mm01jul.25;2025Jul23.02:56;v2.2.500</anid> <title id="AN0186774323-1">Test-Retest Reliability of the Closed Kinetic Chain upper Extremity Stability Test in Children Aged 7–10 Years </title> <p>The aim of this study is to investigate the test–retest reliability of the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) and modified-CKCUEST in children aged 7–10 years and to compare the two test versions within the same group. The study was completed with fifty-three children. Average, normalized, and power scores were obtained from the maximum number of touches in 15 × 3 s in the tests. Tests were repeated seven days apart for test–retest reliability. Intraclass Correlation Coefficient (ICC<sub>3,1</sub>), Standard Error of Measurement (SEM), Minimum Detectable Change (MDC) were tested total/by gender. Children's opinions about the tests were questioned. The test–retest ICC<sub>3,1</sub> values for CKCUEST were 0.96 for average score, 0.95 for normalized score, 0.97 for power score. For the modified-CKCUEST, test–retest reliabilities were 0.94, 0.92, 0.96, respectively. CKCUEST and modified-CKCUEST demonstrated excellent test–retest reliability for children aged 7–10 years. Participants stated that the modified-CKCUEST was more suitable as a test position.</p> <p>Keywords: Closed kinetic chain; children; physical performance test; upper extremity</p> <hd id="AN0186774323-2">Introduction</hd> <p>Although open kinetic chain activities seem to be used more in the upper extremity due to the nature of the upper extremity, open and closed kinetic chain skills are used together in the shoulder complex during daily activities (Kibler, [<reflink idref="bib12" id="ref1">12</reflink>]). Closed kinetic chain activities have some biomechanical advantages compared to open kinetic chain activities. Closed kinetic chain activities cause co-contraction of the agonist/antagonist muscle groups and improvement of proprioception and neuromuscular control. Thanks to these advantages, proximal stabilization is achieved, and a more stable movement is achieved in the distal segments. Thus, closed kinetic chain activities are protective against joint deformations. This is an importantly emphasized detail in the rehabilitation of the upper extremity (Karandikar & Vargas, [<reflink idref="bib11" id="ref2">11</reflink>]; Kibler, [<reflink idref="bib12" id="ref3">12</reflink>]; Taylor et al., [<reflink idref="bib19" id="ref4">19</reflink>]).</p> <p>For the above reasons, the closed kinetic chain model should be considered in activity and/or pathological situations involving the upper extremity (Kibler, [<reflink idref="bib12" id="ref5">12</reflink>]; Taylor et al., [<reflink idref="bib19" id="ref6">19</reflink>]). Considering this aspect, the necessity of tests that can evaluate upper extremity stability and closed kinetic chain functions comes to the fore within the scope of both evaluating individuals and determining the effectiveness of treatment protocols (Karandikar & Vargas, [<reflink idref="bib11" id="ref7">11</reflink>]). Closed kinetic chain upper extremity stability test (CKCUEST) is one of the tests developed to meet this need. However, there is a lack of scientific evidence regarding the use of CKUEST in the upper extremity rehabilitation of non-athlete children.</p> <p>The original of the test was developed by Goldbeck and Davies to detect deficits in functional performance of the shoulder girdle region (Goldbeck & Davies, [<reflink idref="bib8" id="ref8">8</reflink>]). CKCUEST provides information about the strength, power, proprioceptive sense and neuromuscular control of the shoulder region in closed kinetic chain activities of the upper extremity (Callaway et al., [<reflink idref="bib1" id="ref9">1</reflink>]; de Oliveira et al., [<reflink idref="bib2" id="ref10">2</reflink>]). It is a performance-based test that does not require any technological equipment. Scoring according to the maximum number of touches against time provides clinicians with objective data (Silva et al., [<reflink idref="bib16" id="ref11">16</reflink>]; Tucci et al., [<reflink idref="bib21" id="ref12">21</reflink>]). Although the reliability of the test was investigated in different populations in many studies and different reliability values were obtained, the reliability of the test was found to be high in general (de Oliveira et al., [<reflink idref="bib2" id="ref13">2</reflink>]; Goldbeck & Davies, [<reflink idref="bib8" id="ref14">8</reflink>]; Silva et al., [<reflink idref="bib16" id="ref15">16</reflink>]; Tucci et al., [<reflink idref="bib21" id="ref16">21</reflink>]). However, there are no reliable data in the literature regarding its usability in non-athlete children aged 7–10 years.</p> <p>Individuals differ in terms of anthropometric measurements, age, gender, body structure, and physical activity level. Therefore, in terms of applicability of CKCUEST, there are different modifications of the test in the literature. These modifications, unlike the original test, were created by changing the number of sessions (Tarara et al., [<reflink idref="bib18" id="ref17">18</reflink>]; Taylor et al., [<reflink idref="bib19" id="ref18">19</reflink>]) and the starting position of the test (Callaway et al., [<reflink idref="bib1" id="ref19">1</reflink>]; Degot et al., [<reflink idref="bib4" id="ref20">4</reflink>]; Taylor et al., [<reflink idref="bib19" id="ref21">19</reflink>]). For example, gender-specific modifications have been investigated in the literature. The researchers who defined the test have applied the test only in males in the push-up position (Goldbeck & Davies, [<reflink idref="bib8" id="ref22">8</reflink>]). It has been shown that this test can be performed in the kneeling position in females and the use of this position is reliably (Tucci et al., [<reflink idref="bib21" id="ref23">21</reflink>]). There are also studies that apply the test in the push-up position in females (Heick et al., [<reflink idref="bib9" id="ref24">9</reflink>]; Powell et al., [<reflink idref="bib14" id="ref25">14</reflink>]). Thus, various alternatives are offered to clinicians for individuals who cannot adapt to the original form of the test. According to a systematic review evaluating six different upper extremity performance tests, the researchers have stated that although CKCUEST does not have a standardized procedure in the literature, this test can be used as a performance test for the upper extremity (Tarara et al., [<reflink idref="bib17" id="ref26">17</reflink>]).</p> <p>Although it has been stated that the original version of CKCUEST is reliable in children aged 15–19 years who were overhead athletes (de Oliveira et al., [<reflink idref="bib2" id="ref27">2</reflink>]), insufficient information has been reached about its usability, validity, and reliability in non-athlete children under the age of 15. However, a version of CKCUEST created by modifying the starting position has been applied to the 12–17 between age population (Declève et al., [<reflink idref="bib3" id="ref28">3</reflink>]). Hollstadt et al. ([<reflink idref="bib10" id="ref29">10</reflink>]) demonstrated that the biacromial starting position modified version of the test we used in our study is reliable for college athletes (Hollstadt et al., [<reflink idref="bib10" id="ref30">10</reflink>]). The lack of data on the validity and reliability of the test in young children was an important factor in the emergence of this study idea. It is very important to conduct this study because appropriate evaluation methods are not sufficient to evaluate upper extremity stabilization in healthy children under the age of 12 who are not athletes.</p> <p>The primary aim of this study is to investigate the reliability of CKCUEST in children aged 7–10 years. Another aim of the study is to investigate the version of the test that has modified the biacromial starting position which has been shown to be reliable for groups disadvantaged in terms of anthropometric characteristics (Hollstadt et al., [<reflink idref="bib10" id="ref31">10</reflink>]) on the same sample according to gender and to determine the suitability of two different implementation methods.</p> <hd id="AN0186774323-3">Materials and methods</hd> <p></p> <hd id="AN0186774323-4">Study design and participants</hd> <p>The study was designed as an observational test–retest reliability study to determine the reliability of two different versions of CKCUEST in children aged 7–10 years.</p> <p>Healthy non-athletes but physically active individuals between the ages of 7 and 10 were included in the study. Participants were reached from the playgrounds in the Cukurova region of Adana Province. The researchers randomly recruited the first potential participant. The required number of participants was reached with the snowball sampling method. Participants/their parents who applied to participate in the study were interviewed. Consent was obtained from participants who agreed to participate in the study via an informed consent form in-person. Then, inclusion and exclusion criteria were applied to the participants. Inclusion criteria for the study were determined as children/parents who voluntarily consented to participate in the study and children who understood and followed the instructions given about taking the test position or performing the test. Children with upper extremity pathology, a history of upper extremity injuries, and/or surgery, who could not follow the instructions given to take the test position or perform the test, did not participate in the second evaluations, had psychiatric and severe cognitive problems were excluded from the study.</p> <p>The sample size of the study was calculated using the G*Power (3.1.9.7) program. Equation values used in sample size calculations in reliability studies (Shoukri et al., [<reflink idref="bib15" id="ref32">15</reflink>]) were set as follows: power of the study = 80%, α = 0.05, correlation rate for null hypothesis (ρH0) = 0.40, correlation rate for alternative hypotheses (ρH1) = 0.80. Considering the possible loss in follow-up, 20% of the sample size was added. The required minimum sample size was determined as 24.</p> <p>A total of sixty-five participants were reached to be included in the study. However, it was completed with fifty-three participants who met the inclusion criteria and successfully completed the assessments. The flow chart of the participants was shown in Figure 1. Consent of all participants and their parents for participation in the study was obtained with an informed consent form. The study was conducted in accordance with the principles of the Declaration of Helsinki.</p> <p>Graph: Figure 1. Flow chart of participants.</p> <hd id="AN0186774323-5">Measurements</hd> <p>All evaluations were made in the playgrounds suitable for evaluation in the Cukurova region of Adana Province. The area where the evaluations were made was prepared by the researchers on a flat ground (rubber floor).</p> <p>Height, weight, and shoulder width measurements were made for participants who met the inclusion criteria. Weight was measured with a digital scale and height was measured with a 0.1 cm sensitive meter. Shoulder width was measured with the help of an inflexible tape measure as biacromial.</p> <hd id="AN0186774323-6">CKCUEST</hd> <p>The test version defined by Tucci et al. was used as the first test version in the study (Tucci et al., [<reflink idref="bib21" id="ref33">21</reflink>]). Two parallel lines were determined on a stable ground, approximately 91.4 cm (36 inches) apart. Participants were asked to assume the push-up position of the males and the modified push-up (kneeling) position of the females, with the third fingers on these lines. In this position, participants were asked to lift one hand off the ground and touch the dorsal of the other hand, which provides support, crossing the body, as much as possible within 15 s. Participants were allowed to perform a trial at submaximal intensity to familiarize themselves with the test. Then, the participants were asked to perform the same movement at maximal intensity for 3 sets of 15 s. Forty-five-second rest interval was given between each set. The number of touches in each set of 15 s was recorded. The test has three different scorings (Goldbeck & Davies, [<reflink idref="bib8" id="ref34">8</reflink>]). First, the number of touches performed by the participants is counted, and the number of touches obtained in 3 sets is averaged. The second, called the normalized score, is calculated by dividing the average number of touches by the participant's height. The third, called the power score, is calculated by multiplying the average number of touches by 68% of the participant's body weight in kilograms, then dividing by 15. All three scorings were calculated based on the number of touches performed by the participants in 3 sets.</p> <hd id="AN0186774323-7">Modified CKCUEST</hd> <p>The modified CKCUEST described by Taylor et al. was used as the second version of the test (Taylor et al., [<reflink idref="bib19" id="ref35">19</reflink>]). According to this modification, two lines approximately 91.4 cm (36 inches) apart, as in the original test, were determined on a stable ground parallel to each other. Unlike the original version of the test, according to the described modification, the participants assume push-up position with their hands directly under their shoulders. During the test, participants were asked to perform the test by touching the lines placed at 91.4 cm apart, not by touching the dorsal of the hand as in the first version of the test. After a trial at submaximal intensity, participants were asked to perform the test at maximal intensity for 3 sets of 15 s with 45-s rest interval. The three scoring methods described above were also calculated for the modified version of the test. Images of CKCUES and modified CKCUES tests are presented in Figure 2. Informed consent was obtained from the participant/parent for the images.</p> <p>Graph: Figure 2. a. CKCUEST starting position for females, b. CKCUEST starting position for males, c. Modified CKCUEST starting position for both genders.</p> <p>Since all children were tested under the same conditions, the evaluations started with CKCUEST. Modified CKCUEST assessments were conducted seven days after the CKCUEST assessments were completed. The original form of CKCUEST was administered to the children included in the study by the same evaluator one week apart in order to examine the test-retest reliability and to minimize possible memory effects (de Oliveira et al., [<reflink idref="bib2" id="ref36">2</reflink>]). Seven days after the evaluation of the original version of the test was completed, the modified version of the test was administered to the same study group by the same evaluator under the same conditions. The modified version of the test was also repeated at one week interval in order to examine the test–retest reliability and to minimize possible memory effects (Taylor et al., [<reflink idref="bib19" id="ref37">19</reflink>]). The obtained data were then used for statistical analysis.</p> <p>Test and re-test evaluations of both the original and modified versions of the test were made by the same researcher. The same evaluator evaluated all children. The evaluator was trained for both test versions according to the test instructions provided by the authors who described the tests. The evaluator was experienced in administering the test before starting the study.</p> <p>In order to eliminate possible motivational effects, the participants were not aware of the test–retest results, which were carried out with a one-week interval, until the study was completed.</p> <p>Apart from the scientific analyzes, the opinions of the participants about two different versions of the test were questioned. For this purpose, at the end of the study, each participant was asked which of the two different versions of the test was more suitable for them and which test they preferred. The question asked to the children was: ''Which test version was easier and more suitable (or preferable) for you? One (CKCUEST) or Two (Modified CKCUEST)? Why?'.' The children answered this question as one or two. Participants' preferences were recorded.</p> <hd id="AN0186774323-8">Ethics committee approval</hd> <p>Ethics committee approval was obtained for the conduct of the research with the decision number 2021/15–25 of the Dokuz Eylül University Non-Interventional Research Ethics Committee dated May 21, 2021.</p> <hd id="AN0186774323-9">Data analysis</hd> <p>Statistical Package for Social Sciences (IBM Corp., Armonk, NY, 2019) version 26.0 program was used for the analysis of the study. Whether the numerical data showed that the normal distribution was evaluated with the Shapiro – Wilk test. The numbers and percentages of participants' descriptive data and the mean and standard deviation (SD) of all scores from two different versions of CKCUEST were calculated. <emph>p</emph> <.05 was accepted as statistical significance level. Independent t-tests were conducted to examine differences in descriptive characteristics between genders. The Intraclass Correlation Coefficient (ICC<subs>3,1</subs>) for both implementations of CKCUEST was calculated using the two-way mixed model, with absolute type and 95% Confidence Interval (CI 95%). Values of 0.75 and above represented excellent reliability, values between 0.74 and 0.40 represented moderate reliability and values below 0.40 represented poor reliability (Fleiss, [<reflink idref="bib7" id="ref38">7</reflink>]).</p> <p>Standard Error of Measurement (SEM) and Minimum Detectable Change (MDC) were determined at CI 95% for all three scorings of CKCUES and modified CKCUES tests (Denegar & Ball, [<reflink idref="bib5" id="ref39">5</reflink>]). The SEM provides an estimate of the precision of measurement. The data show how much measurement error is acceptable (Denegar & Ball, [<reflink idref="bib5" id="ref40">5</reflink>]). MDC is data that shows how much change is significant in the clinic.</p> <p>For SEM<subs>95%</subs><emph>SD*</emph></p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><msqrt><mo stretchy="false">(</mo><mn>1</mn><mo>−</mo><mi mathvariant="italic">ICC</mi></msqrt></math> </ephtml> <subs> <emph>test-retest</emph> </subs>), for MDC<subs>95%</subs><emph>1.96*SEM</emph><subs><emph>95%</emph></subs><emph>*</emph></p> <p>Graph</p> <p> <ephtml> <math xmlns="http://www.w3.org/1998/Math/MathML"><msqrt><mn>2</mn></msqrt></math> </ephtml> formulas were used. The weighted mean of test and retest standard deviations was used for SD. The constant 1.96 corresponds to the z-score associated with the 95% confidence level.</p> <hd id="AN0186774323-10">Results</hd> <p>Thirty-two (60.4%) of the participants were female and twenty-one (39.6%) were male. The mean age of the participants was recorded as 8.62 ± 1.21 years. Other descriptive statistics of the participants, descriptive statistics grouped separately by gender and difference between groups in terms of descriptive data are presented in Table 1.</p> <p>Table 1. Descriptive statistics of participants.</p> <p> <ephtml> <table><thead><tr><td /><td>Total</td><td>Female</td><td>Male</td><td>p</td></tr></thead><tbody><tr><td>Number (n/%)</td><td>53 (100)</td><td>32 (60.38)</td><td>21 (39.62)</td><td /></tr><tr><td>Age (years)</td><td>8.62 (1.21)</td><td>8.62 (1.23)</td><td>8.62 (1.20)</td><td /></tr><tr><td>Weight (kg)</td><td>33.76 (9.88)</td><td>33.52 (9.54)</td><td>34.12 (10.59)</td><td>.82</td></tr><tr><td>Height (m)</td><td>1.32 (0.10)</td><td>1.31 (0.11)</td><td>1.33 (0.09)</td><td>.44</td></tr><tr><td>Shoulder width (cm)</td><td>30.18 (2.96)</td><td>30.15 (3.15)</td><td>30.22 (2.73)</td><td>.93</td></tr></tbody></table> </ephtml> </p> <p>1 p <.05</p> <p>Test and retest means and standard deviations of the average, normalized, and power scores of the CKCUES and modified CKCUES tests of the participants included in the study according to gender are summarized in Table 2.</p> <p>Table 2. Test and re-test mean (standard deviation) of CKCUEST and modified CKCUEST scores.</p> <p> <ephtml> <table><thead><tr><td>CKCUEST</td><td>Modified CKCUEST</td></tr><tr><td /><td>Average score</td><td>Normalized score</td><td>Power score</td><td>Average score</td><td>Normalized score</td><td>Power score</td></tr><tr><td>Test</td><td>Re-test</td><td>Test</td><td>Re-test</td><td>Test</td><td>Re-test</td><td>Test</td><td>Re-test</td><td>Test</td><td>Re-test</td><td>Test</td><td>Re-test</td></tr></thead><tbody><tr><td>Female</td><td>15.84 (4.14)</td><td>17.54 (4.93)</td><td>11.95 (2.35)</td><td>13.23 (2.96)</td><td>24.95 (11.44)</td><td>27.67 (13,64)</td><td>9.39 (3.86)</td><td>10.59 (4.32)</td><td>7.09 (2.59)</td><td>7.99 (2.99)</td><td>14.67 (8.74)</td><td>16.67 (9.76)</td></tr><tr><td>Male</td><td>7.80 (4.80)</td><td>7.85 (4.49)</td><td>5.68 (3.30)</td><td>5.76 (3.06)</td><td>12.87 (8.95)</td><td>12.77 (8.44)</td><td>11.01 (3.66)</td><td>11.53 (4.17)</td><td>8.21 (2.58)</td><td>8.61 (3.00)</td><td>17.13 (7.43)</td><td>17.71 (7.36)</td></tr><tr><td>Total</td><td>12.66 (5.90)</td><td>13.70 (6.72)</td><td>9.47 (4.13)</td><td>10.27 (4.74)</td><td>20.16 (12.02)</td><td>21.77 (13.87)</td><td>10.03 (3.83)</td><td>10.96 (4.24)</td><td>7.54 (2.62)</td><td>8.24 (2.98)</td><td>15.6 (8.26)</td><td>17.08 (8.82)</td></tr></tbody></table> </ephtml> </p> <p>2 Abbreviations: CKCUEST= Closed kinetic chain upper extremity stability test.</p> <p>The test–retest ICC<subs>3,1</subs> reliability (CI %95) of the CKCUEST scores (average, normalized, and power score) showed excellent reliability with 0.96, 0.95, 0.97, respectively. The SEM values were calculated as 1.24 touches for average score, 0.95 touches for normalized score, and 2.09 touches for power score. The MDC values were calculated as 3.46, 2.64 and 5.80 touches for average, normalized, and power scores, respectively.</p> <p>Since the starting position of the CKCUES test differs according to gender, test–retest reliability of average, normalized, and power scores were calculated separately according to gender. The average, normalized, and power scores for females were 0.89, 0.80, 0.96, respectively, with excellent reliability (CI 95%). For males, the ICC<subs>3,1</subs> test–retest reliability (CI 95%) was found to have excellent reliability, with 0.97 on the average score, 0.97 in the normalized score and 0.97 in the power score. The gender-specific SEM and MDC values of the participants for each of the three scorings are presented in Table 3.</p> <p>Table 3. Intraclass correlation coefficients (confidence intervals of 95%), standard error of measurement and minimal detectable change of each CKCUEST score.</p> <p> <ephtml> <table><thead><tr><td /><td>Total</td><td>Female</td><td>Male</td></tr><tr><td /><td>ICC (CI %95)</td><td>SEM</td><td>MDC</td><td>ICC (CI %95)</td><td>SEM</td><td>MDC</td><td>ICC (CI %95)</td><td>SEM</td><td>MDC</td></tr></thead><tbody><tr><td>Average score</td><td>0.96 (0.91–0.98)</td><td>1.24</td><td>3.46</td><td>0.89 (0.64–0.95)</td><td>1.51</td><td>4.19</td><td>0.97 (0.93–0.99)</td><td>0.73</td><td>2.03</td></tr><tr><td>Normalized score</td><td>0.95 (0.90–0.97)</td><td>0.95</td><td>2.64</td><td>0.80 (0.46–0.91)</td><td>1.18</td><td>3.29</td><td>0.97 (0.93–0.98)</td><td>0.52</td><td>1.45</td></tr><tr><td>Power score</td><td>0.97 (0.94–0.98)</td><td>2.09</td><td>5.80</td><td>0.96 (0.87–0.98)</td><td>2.48</td><td>6.89</td><td>0.97 (0.94–0.99)</td><td>1.34</td><td>3.73</td></tr></tbody></table> </ephtml> </p> <p>3 Abbreviations: ICC= intraclass correlation coefficient; CI= confidence interval; SEM= standard error of measurement; MDC= minimal detectable change.</p> <p>In the modified CKCUEST scores, ICC<subs>3,1</subs> values were found 0.94 for the average score, 0.92 for the normalized score and 0.96 for the power score, showing an excellent level of reliability. The SEM values of the average, normalized, and power scores of the modified CKCUES test were 0.98, 0.76, and 1.50 touches, respectively. The MDC values were determined as 2.72 touches for the mean score, 2.10 touches for the normalized score, and 4.17 touches for the power score.</p> <p>As with CKCUEST scores, test–retest reliability of modified CKCUEST scores was also calculated according to gender. The modified CKCUEST ICC<subs>3,1</subs> test–retest reliability values for females were found to be 0.92 in the average score, 0.90 in the normalized score and 0.96 in the power score. ICC<subs>3,1</subs> test–retest reliability values were determined as 0.96 in the average score, 0.95 in the normalized score, and 0.98 in the power score for males. The gender-specific SEM and the MDC values of the participants for each of the three scorings are shown in Table 4.</p> <p>Table 4. Intraclass correlation coefficients (confidence intervals of 95%), standard error of measurement and minimal detectable change of each modified CKCUEST score.</p> <p> <ephtml> <table><thead><tr><td /><td>Total</td><td>Female</td><td>Male</td></tr><tr><td /><td>ICC (CI %95)</td><td>SEM</td><td>MDC</td><td>ICC (CI %95)</td><td>SEM</td><td>MDC</td><td>ICC (CI %95)</td><td>SEM</td><td>MDC</td></tr></thead><tbody><tr><td>Average score</td><td>0.94 (0.85–0.97)</td><td>0.98</td><td>2.72</td><td>0.92 (0.77–0.97)</td><td>1.09</td><td>3.04</td><td>0.96 (0.90–0.98)</td><td>0.76</td><td>2.12</td></tr><tr><td>Normalized score</td><td>0.92 (0.83–0.96)</td><td>0.76</td><td>2.10</td><td>0.90 (0.72–0.96)</td><td>0.85</td><td>2.37</td><td>0.95 (0.89–0.98)</td><td>0.57</td><td>1.59</td></tr><tr><td>Power score</td><td>0.96 (0.92–0.98)</td><td>1.50</td><td>4.17</td><td>0.96 (0.87–0.98)</td><td>1.70</td><td>4.73</td><td>0.98 (0.95–0.99)</td><td>1.04</td><td>2.90</td></tr></tbody></table> </ephtml> </p> <p>4 Abbreviations: ICC= intraclass correlation coefficient; CI= confidence interval; SEM= standard error of measurement; MDC= minimal detectable change.</p> <p>The distribution of the answers (females and males) given to the question ''Which test version was easier and more suitable (or preferable) for you?" is as follows. About 53.13% (<emph>n</emph> = 17) of the females preferred the modified CKCUES test, and 46.88% (<emph>n</emph> = 15) preferred the CKCUES test. 76.19 (<emph>n</emph> = 16) of the males preferred the modified CKCUES test and 23.81 (<emph>n</emph> = 5) preferred the CKCUES test. Both gender stated that the modified CKCUEST was more suitable as a test position. According to the evaluator's observations during the implementations of the test, males had difficulty in maintaining the test position performed in the form of push-ups and developed different compensatory movements in order to maintain trunk stabilization during the test.</p> <hd id="AN0186774323-11">Discussion</hd> <p>This study demonstrated that both versions of the CKCUEST reliable to evaluate the upper extremity stabilitation of the 7–10 aged children. Additionally, this study provided reliability data for the two CKCUEST positions in children. It was concluded that CKCUEST has a very high reliability in the relevant age group and the modified CKCUES test position is more tolerated and appropriate by both females and males.</p> <p>The modified CKCUEST values were relatively lower than the CKCUEST values for females. When examining this situation from the perspective of females, it was thought that they might tolerate the test better due to the reduced load on their upper extremities during the CKCUEST performed in a kneeling position, compared to the modified CKCUEST performed in a push-up position. The CKCUEST values were relatively lower than the modified CKCUEST values for males. In males, it was thought that they performed the modified CKCUES test faster and more comfortably because the distance between the upper extremities was shorter in the modified CKCUES (biacromial) test compared to the CKCUEST (91.4 cm).</p> <p>In our study, it was determined that female's all CKCUEST scores (average, normalized, and power) were higher than male's. In this test, the center of mass is transferred alternately between the upper extremities. Since the females performed the test in the kneeling position, it was easier to keep the center of mass within the support surface (Torabi et al., [<reflink idref="bib20" id="ref41">20</reflink>]). Females tolerated the center of mass more easily because the weight arm was also shorter in the kneeling position. This difference in test position was thought to be the reason why females touch more than males. Males had to transfer more body weight to their upper extremities (because of taller weight-arm), therefore they were slower to transfer weight to their upper extremities during the target touching task (Torabi et al., [<reflink idref="bib20" id="ref42">20</reflink>]). It was also thought that the distance between the extremities (approximately 91.4 cm) in the test procedure may have created difficulties, particularly for males performing the test in the push-up position, thus it may change the advantage/disadvantage balance. Although these results affected the number of touches in the test for males, they did not cause a negative situation in terms of reliability. As a matter of fact, during the CKCUEST performing, it was observed that male individuals had problems with the ability to maintain the test position (push-up). During the test, individuals tended to make compensatory movements such as excessively abducting their lower extremities, moving their lower extremities with the upper extremity simultaneously when the upper extremity started to move and performing excessive trunk rotation in order to keep their trunk in a stable position. For the male children with the anthropometric characteristics in our study, carrying weight in a push-up position with a distance of 91.4 cm between the extremities may have been challenging.</p> <p>When the modified CKCUEST results were examined, It was observed that the touch counts for the two genders were closer to each other in the Modified CKCUEST compared to the CKCUEST. It was thought that the touch counts of the modified CKCUEST were similar between genders due to both the similarity in anthropometric characteristics between genders (according to the difference between groups in terms of descriptive data) and the same test position. The CKCUEST is closely related to muscle strength (Silva et al., [<reflink idref="bib16" id="ref43">16</reflink>]). It is also known that there is little gender-specific difference in pre-adolescent individuals in terms of muscle strength (Faigenbaum & L, [<reflink idref="bib6" id="ref44">6</reflink>]. Although CKCUEST is significantly related to muscle strength, the impact of muscle strength on this test for the age group in our study should be more comprehensively addressed in future research, given the similarity in touch counts observed in the Modified CKCUEST.</p> <p>The modified CKCUEST test–retest ICC<subs>3,1</subs> values demonstrated excellent reliability in females and males. When the literature is examined, in a study conducted with basketball players older than 18 years of age, the test–retest reliability of the number of touches performed within 15 s of the modified CKCUES test has been shown to be 0.79 for females and 0.88 for males (Hollstadt et al., [<reflink idref="bib10" id="ref45">10</reflink>]). In a study investigating inter-rater reliability, it has been reported that the modified CKCUEST had good inter-rater reliability (Lee & Kim, [<reflink idref="bib13" id="ref46">13</reflink>]). In a randomized observational study with only male participants and examining the reliability of four different starting positions of the CKCUES test, the test scores reliability has been shown 0.90 for average score, 0.91 for normalized score, and 0.89 for power score in the position where the hands are placed at a distance of 36 inches (approximately 91.4 cm) (Callaway et al., [<reflink idref="bib1" id="ref47">1</reflink>]). In the position where the hands are directly under the shoulders and the touches are made to 36 inch distances (the preferred modified position in our study), the test scores reliability has found 0.89 for average score, 0.91 for normalized score, and 0.89 for power score (Callaway et al., [<reflink idref="bib1" id="ref48">1</reflink>]). In our study, when two different test positions used were compared, it was seen that CKCUEST was more reliable in terms of average, normalized, and power score according to higher values of ICCs when compared to modified CKCUEST.</p> <p>When compared ICCs according to gender, it was concluded that the modified CKCUEST was more reliable for each of the three scorings in females according to ICC values. On the other hand, in males, it was concluded that CKCUEST was more reliable in average score and normalized score values, while modified CKCUEST in power score values according to higher values of ICCs. The results obtained from the values of ICCs showed that different versions of the CKCUES test (CKCUEST for males, modified CKCUEST for females) were reliable for different genders. This result also suggest that gender-specific test positions may affect reliability. These results support that it will be important to consider different testing types and positions, taking into account "gender-specific" characteristics. In addition to gender-specific characteristics, when managing performance-based assessments, it should be ensured that the participant understands, maintains, and protects the test position.</p> <p>The results obtained from the study led to the idea that the effect of the distance between the extremities on the number of touches and the quality of the movement should be investigated in more detail with other studies in the relevant age group. The advantages and disadvantages of test positions according to gender are seen as issues that need to be addressed significantly especially when working in younger age groups.</p> <p>Since there is no research conducted in the same age group on the subject in the literature, the test results could not be compared with any other study. For the CKCUES test, according to the data of the test–retest study conducted on the adolescent athletes (de Oliveira et al., [<reflink idref="bib2" id="ref49">2</reflink>]) who are the closest age group to the age of our participants, it has stated that the participants scored 26.8 in the average score, 15.5 in the normalized score and 72.5 in the power score (mean of the test–retest scores). In the results of our study, the CKCUEST test–retest means of the non-athletes but physically active children were found 13.1 in the average score, 9.8 in the normalized score, and 20.9 in the power score. In the same study, the authors reported ICCs for adolescents as 0.68 in average score, 0.68 in normalized score, and 0.87 in power score. In our study also, ICC values for children aged 7–10 years were determined to be 0.96, 0.95, 0.97 in the average, normalized, and power scores, respectively. It was thought that the study population in our study had fewer touches in the test compared to the above-mentioned study because they were younger and were not athletes (de Oliveira et al., [<reflink idref="bib2" id="ref50">2</reflink>]). When comparing the touch values measurements of the current study with those of de Oliveira et al.'s study group, it showed that the touch values obtained from individuals with different ages and growth charts were different. At the same time, the fact that our study population had smaller anthropometric values may have caused them to have more difficulty in the test. Different results obtained from different age groups can be significantly affected by anthropometric characteristics.</p> <p>During the implementation of the modified CKCUEST, the children were asked to achieve maximum touches within 15 s. However, it was observed that some children were confused when they performed the test quickly, and they touched the lines spaced 91.4 cm apart ipsilaterally instead of contralaterally. This finding obtained during the study made us think that it is necessary to discuss whether it would be appropriate to perform several trials instead of a single trial before starting the test in order to perform the test easier. However, Taylor et al. have reported that multiple sets may create better results by causing a learning effect, as well as worsening results by causing fatigue (Taylor et al., [<reflink idref="bib19" id="ref51">19</reflink>]). From this point of view, it made us think that after the test procedure was explained, practical trials should be done with a few repetitions, yet the number of repetitions should be designed in a way that would not fatigue. In performance-oriented tests such as CKCUEST, the positive effect of the number of repetitions for learning purposes on learning and test results with the negative effect of fatigue and its associated negative effects may be demonstrated by other studies in the future.</p> <p>When asked which of the test positions were more suitable (or preferable), the majority of males answered that the modified CKCUEST was easier and preferable. On the other hand, surprisingly, 53.13% of females chose the modified CKCUEST and stated that the CKCUEST was easier and boring. It is thought that the resulting choices may also be affected by anthropometric values. Because considering the age, height, weight, and shoulder width values of the participants of both genders, it was observed that the values were close to each other. Also, motivation may have made a difference in the difficulty of the tests. The fact that unevaluated factors such as motivation may have a significant effect on the results obtained has been interpreted as a factor that should be considered for performance-oriented tests in future studies.</p> <p>The strongest aspect of this study is that the reliability values obtained from the 7–10 age group of CKCUEST were determined. Significant data on the use of the test in the relevant age group have been provided, and it is a reference for future studies.</p> <hd id="AN0186774323-12">Limitations</hd> <p>This study has several limitations. The first limitation of the study is that it was studied with a healthy population. Studying individuals of the same age group with different types of upper extremity injuries will provide important data that can be obtained. Another limitation of the study is that the physical activity/exercise levels of the participants were not questioned, and they were not categorized (sedentary, as recreationally active or elite athletes). The values to be obtained from children with different physical capacities will be quite helpful (or may cause changes) in the planning of rehabilitation programs. The final limitation of the study is that in some participants the length of the upper extremities was insufficient to meet the 91.4 cm distance between the extremities in the test. This situation reveals the importance of anthropometric measurements in performance-oriented assessments in the upper extremity. It is thought that there is a need for detailed studies on the subject.</p> <hd id="AN0186774323-13">Conclusions</hd> <p>This study demonstrated that the CKCUES and modified CKCUES tests can be performed with a high level of reliability in individuals aged 7–10 years. The results also showed that upper extremity length measurements may be an important detail in performance-based tests. While making performance-based test measurements or evaluations, not only the score to be obtained from the test but also the anthropometric values, motivation, and/or test positions necessary for the performance of the test should be taken into consideration.</p> <hd id="AN0186774323-14">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <ref id="AN0186774323-15"> <title> References </title> <blist> <bibl id="bib1" idref="ref9" type="bt">1</bibl> <bibtext> Callaway, A., Peck, J., Ellis, S., & Williams, J. (2020). 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BMC Musculoskeletal Disorders, 15 (1), 1 – 1. https://doi.org/10.1186/1471-2474-15-1</bibtext> </blist> </ref> <aug> <p>By Cemre Yaren Güngörenler and Tülay Tarsuslu</p> <p>Reported by Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib12" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib11" firstref="ref2"></nolink> <nolink nlid="nl3" bibid="bib19" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib16" firstref="ref11"></nolink> <nolink nlid="nl5" bibid="bib21" firstref="ref12"></nolink> <nolink nlid="nl6" bibid="bib18" firstref="ref17"></nolink> <nolink nlid="nl7" bibid="bib14" firstref="ref25"></nolink> <nolink nlid="nl8" bibid="bib17" firstref="ref26"></nolink> <nolink nlid="nl9" bibid="bib10" firstref="ref29"></nolink> <nolink nlid="nl10" bibid="bib15" firstref="ref32"></nolink> <nolink nlid="nl11" bibid="bib20" firstref="ref41"></nolink> <nolink nlid="nl12" bibid="bib13" firstref="ref46"></nolink>
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  Label: Abstract
  Group: Ab
  Data: The aim of this study is to investigate the test-retest reliability of the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) and modified-CKCUEST in children aged 7-10 years and to compare the two test versions within the same group. The study was completed with fifty-three children. Average, normalized, and power scores were obtained from the maximum number of touches in 15 × 3 s in the tests. Tests were repeated seven days apart for test-retest reliability. Intraclass Correlation Coefficient (ICC[subscript 3,1]), Standard Error of Measurement (SEM), Minimum Detectable Change (MDC) were tested total/by gender. Children's opinions about the tests were questioned. The test-retest ICC[subscript 3,1] values for CKCUEST were 0.96 for average score, 0.95 for normalized score, 0.97 for power score. For the modified-CKCUEST, test-retest reliabilities were 0.94, 0.92, 0.96, respectively. CKCUEST and modified-CKCUEST demonstrated excellent test-retest reliability for children aged 7-10 years. Participants stated that the modified-CKCUEST was more suitable as a test position.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1477879
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1477879
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/1091367X.2024.2443860
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 10
        StartPage: 246
    Subjects:
      – SubjectFull: Test Reliability
        Type: general
      – SubjectFull: Physical Activities
        Type: general
      – SubjectFull: Performance Tests
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Human Body
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Turkey
        Type: general
    Titles:
      – TitleFull: Test-Retest Reliability of the Closed Kinetic Chain Upper Extremity Stability Test in Children Aged 7-10 Years
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Cemre Yaren Güngörenler
      – PersonEntity:
          Name:
            NameFull: Tülay Tarsuslu
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1091-367X
            – Type: issn-electronic
              Value: 1532-7841
          Numbering:
            – Type: volume
              Value: 29
            – Type: issue
              Value: 3
          Titles:
            – TitleFull: Measurement in Physical Education and Exercise Science
              Type: main
ResultId 1