See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/355949521

Evidence-Based Classification in Powerchair Football:

Determining the Determinants

Article  in  Adapted physical activity quarterly: APAQ · November 2021

DOI: 10.1123/apaq.2021-0081

CITATIONS READS

0 38

4 authors, including:

Jp Barfield
Emory & Henry College
64 PUBLICATIONS   625 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Measurement View project

Exercise in Persons with Physical and Sensory Impairments View project

All content following this page was uploaded by Jp Barfield on 11 November 2021.

The user has requested enhancement of the downloaded file.

Adapted Physical Activity Quarterly, (Ahead of Print)
https://doi.org/10.1123/apaq.2021-0081
© 2021 Human Kinetics, Inc. ORIGINAL RESEARCH
First Published Online: Nov. 5, 2021

Evidence-Based Classification
in Powerchair Football: Determining
the Determinants
J.P. Barfield,1 Stephanie Williams,1 Madison R. Currie,2
and Xiuyan Guo3
1
School of Health Sciences, Emory & Henry College, Marion, VA, USA;
2
Lakeshore Foundation, Birmingham, AL, USA; 3Office of Institutional Research
and Institutional Effectiveness, Emory & Henry College, Emory, VA, USA

The purpose of this study was to initiate the development of an evidence-based

sport classification system for powerchair football, a sport that serves athletes with
physical impairments. Sport classification is designed to increase participation by
minimizing the impact of impairment on competition outcome, and powerchair
football lacks an evidence-based system of classification which is required of
Paralympic sports. A number of approaches were used to build the theoretical
model of sport performance (Step 2 of the International Paralympic Committee
model). Key sport activities were identified through surveys of stakeholders and
underlying determinants of those key activities were identified through game and
database analyses. Current findings support drive control, ball control, commu-
nication, and adjustment to the ball as key activities in powerchair football with
joint-specific strength and range of motion, sensory, and neurological variables
identified as underlying determinants.

Keywords: disability sport, paralympic movement, physical impairment

Evidence-Based Classification in Powerchair Soccer

Derived from the Greek word para, meaning next to, the Paralympic Games were
established in Rome during the Summer Olympics of 1960. What began as a sport-
based rehabilitation program for veterans and civilians in the late 1940s soon
flourished into the internationally recognized multisport event that is now one of
the world’s largest competitions (Beckman et al., 2016; Tweedy & Vanlandewijck,
2011). The Paralympic Games is the signature event for the broadly-scoped
Paralympic Movement whose mission is to develop Paralympic sports and
advocate for social inclusion through sport (van Dijk et al., 2017). The Interna-
tional Paralympic Committee (IPC) is the governing body of the Paralympic
Movement and oversees all international competitions for 28 Paralympic sports,
27 of which currently compete in the Paralympic Games.

Barfield (jpbarfield@ehc.edu) is corresponding author, https://orcid.org/0000-0003-1692-9650

1
2 BARFIELD ET AL.

Athlete classification is a cornerstone of Paralympic competition (Tweedy &

Vanlandewijck, 2011). Classification is designed to increase sport participation
among persons with disabilities by minimizing the effect of impairment on
competition outcome (Beckman et al., 2014; Tweedy et al., 2010). Conceptually,
this model ensures that (a) athletes have enough sport-specific impairment to
qualify for the sport and (b) competition victors are athletes with the greatest skill
and competitive attributes, not simply those with the least amount of impairment to
sport performance (Tweedy & Vanlandewijck, 2011; Tweedy et al., 2010; van Dijk
et al., 2017). Since the first Paralympic Games in 1960, sport classification has
relied heavily on subjective assessments, such as manual muscle testing and rater
opinion (Beckman et al., 2016). It was not until 2007 that the IPC mandated all
Paralympic sports move to a system supported by empirical evidence, a process
that is now called evidence-based classification (Beckman et al., 2014; Tweedy &
Bourke, 2009). In this system, sport classes (or athlete groupings) are data driven.
Characteristics of evidence-based assessments include test items that are ratio-
scaled (allow for quantitative assessment), are parsimonious (measure independent
constructs), and have empirical evidence of their reliability and validity (Tweedy &
Bourke, 2009; Tweedy et al., 2010).

Powerchair Football: The Sport

Powerchair football (PF) is the original team sport designed specifically for
individuals who use a power (or motorized) wheelchair for mobility. Although
not currently included in the Olympic Games, the sport is part of the Paralympic
Movement and is played competitively by over 3,500 athletes across 27 countries
(Cottingham et al., 2015; Jeffress & Brown, 2017; Richard et al., 2019). The game
is the primary competitive opportunity for athletes unable to participate in manual
wheelchair sports and functional or structural limitations dictate the console used to
drive the chair (e.g., joystick, head rest, sip, and puff). Currently, subjective
assessments of head, trunk, and drive control are used to assign players to one
of three sport classes (PF1 = high impairment, PF2 = low impairment, and PF3 =
noneligible). Maximum wheelchair speed is governed to prevent an equipment
advantage (limit of 10 km·hr−1) and players travel approximately 1 km during a
match (two 20-min halves) with most time spent at an average speed above
3.6 km·hr−1 (Kumar et al., 2012).

Comparison With Other Types of Football

Although PF is a four-on-four match played on a regulation indoor basketball
court, it is similar to other iterations of football in that athletes demonstrate a
sustained exercise stress during competition. Exercise metabolism has been shown
to increase by 34% during gameplay and follows a dose–response pattern as aver-
age exercise intensity increases from rest to practice to actual gameplay (Barfield
et al., 2005, 2016; Jeffress & Brown, 2017). However, unlike other football
variations that serve one primary population (e.g., five-a-side for athletes with
visual impairment), PF embraces the Paralympic mission toward social inclusion
by empowering persons with varied physical impairments to compete together,
including athletes with arthrogryposis, cerebral palsy, muscular dystrophy, spinal

(Ahead of Print)
 EVIDENCE-BASED CLASSIFICATION 3

cord injury, and spinal muscular atrophy. In addition, the use of a powerchair
reduces sex- and age-related advantages; therefore, athletes of all ages (8 years and
older) and genders compete together.

Player Experiences
To complement what can be observed during gameplay, it is also important to
recognize what players experience through participation. Across multiple
qualitative investigations, there are stable themes that emerge. One, athletes
report that PF is the only sport that allows them to compete independently
(Cottingham et al., 2015; Jeffress & Brown, 2017; Richard et al., 2019; Wessel
et al., 2011). Many in the PF community note that most activity opportunities are
recreational in nature and require assistance from support staff (e.g., challenger
baseball). Because the use of a powerchair offsets impairment limitations, PF
allows players to perform all gameplay movements independently. Whereas
manual wheelchair athletes have varied options that allow independent partici-
pation, PF is one of the only competitive opportunities for individuals with
severe physical impairments where competition outcome is dictated by athletic
skill. In addition, PF contributes to positive affect and social wellness among
players. It is clear that PF players overwhelmingly recognize the improved
confidence, enhanced interpersonal relations, increased social capital, and sense
of athletic identify that occur through participation (Jeffress & Brown, 2017;
Richard et al., 2019; Wessel et al., 2011; Barfield & Malone, 2013).

Research Problem
The Federation Internationale de Powerchair Football Association (FIPFA) is the
sport federation that governs PF. As with all wheelchair sports, performance is
influenced by the athlete, the chair, and the athlete–chair interface (Cooper, 1990).
Although a motorized wheelchair does mitigate some physical disadvantages for
players in terms of mobility, it does not ameliorate all athlete or athlete–chair
interface differences that lead to performance advantages. For example, a player
with orthopedic impairments that limit cervical range of motion may be unable to
view gameplay behind their chair which would be a distinct disadvantage
compared with other players. Similarly, an athlete with spasticity or dyskinesia
may not have the ability to react to a change in ball direction and therefore be at a
disadvantage in the sport. Because the goal of Paralympic sport is to ensure that
skill and competitive attributes, rather than level of impairment, dictate competi-
tion outcome, it is clear that PF requires a system of classification. Although FIPFA
has a rulebook outlining its current classification system (Federation Internationale
de Power Football Association, 2019), the process is reliant upon manual muscle
tests and ordinal assessments; hence, it is not currently evidence-based. Fortu-
nately, the IPC has a five-step model that sport organizations should follow to
develop an evidence-based classification system. The FIPFA has completed Step 1
of this process by identifying eligible impairment categories. The purpose of the
current study was to complete Step 2 in the development of an evidence-based
classification system, namely developing the theoretical model of sport perfor-
mance determinants through an evidence-based process (Tweedy et al., 2016;
Tweedy & Vanlandewijck, 2011).

(Ahead of Print)
4 BARFIELD ET AL.

Determining the Determinants

To develop a model of sport performance, it is recommended that a sport
federation: (a) identify key activities an athlete must perform in the sport and
(b) identify underlying determinants that contribute to these key activities
(Ravensbergen et al., 2018; Tweedy et al., 2016). Determinants are the variables
that are related to, or predictive of, the performance of key activities. If impairment
affects a determinant, it impacts how a player performs sport skills (key activities)
which in turn places them at a competitive disadvantage.

Identifying Key Activities

Key activities are the attributes needed for the specific sport and may include factors
such as speed, acceleration, or the ability to brake and turn (de Witte et al., 2018;
van der Slikke et al., 2017). Determining activities for team sports is complex because
individuals have distinct player roles but have to be classified by the same series of
tests (Altmann et al., 2014, 2017; Vanlandewijck et al., 2001). The IPC recommends a
process-focused approach to identify key activities through stakeholder feedback
(Tweedy & Vanlandewijck, 2011). Surveys have been the predominant methodo-
logical tool used to establish a sport performance model for a variety of sports
including basketball for persons with intellectual impairments (Polo et al., 2017),
wheelchair rugby (Wu, 2001), swimming (Ravensbergen et al., 2018), and sitting
volleyball (Marszalek et al., 2019). Surveys are an effective process-based approach
because they easily enable stakeholders to be part of the decision-making process.

Identifying Determinants That Contribute to Key Activities

Once activities have been identified, a sport federation must then determine the
“determinants” or physical and psychological elements that underlie performance.
When examining team sports, a number of determinants may explain one’s ability to
perform key activities, such as reaction time, reasoning, visual–spatial ability, strength
of specific muscle groups, visual acuity, and spatial ability factors (Tweedy et al.,
2016; van Dijk et al., 2017). If impairment affects these underlying determinants, it
will consequently limit performance of key activities, thereby relegating the player
to a permanent disadvantage. As such, a theoretical model of sports performance
determinants must identify critical elements that should be assessed during classifi-
cation to limit the effect of impairment on performance. A game analysis is a process-
focused approach that is effective at identifying determinants in sport. This process of
identifying essential performance elements, sometimes called critical analysis or
tactical game analysis, has proved to be an effective strategy to identify determinants
(Garganta, 2009; McLean et al., 2017). Specific to evidence-based classification,
researchers have used game analysis to identify determinants in sitting volleyball
(Marszalek et al., 2019) and wheelchair basketball (Seron et al., 2019).
In addition to process-focused approaches, a standard product-focused
approach is the empirical examination of performance differences between sport
classes. This strategy of determining underlying domains is a deductive process.
Examining performance differences allows researchers to determine which factors
distinguish among players on a variable of interest (e.g., speed) or underlying
characteristic (e.g., reaction time). If a factor distinguishes among players with
varied function, one can deduce that impairment affects sport-specific performance

(Ahead of Print)
 EVIDENCE-BASED CLASSIFICATION 5

and therefore should be included in the assessment of sport class. This approach
has been used to support the development of an evidence-based system in both
wheelchair basketball (de Witte et al., 2018; Gil et al., 2015; Marszałek et al., 2019;
Saltan & Ankarali, 2017) and wheelchair rugby (Altmann et al., 2006, 2016;
Morgulec-Adamowicz et al., 2011). Whereas most studies have addressed single
discrete skills or activities separately, Altmann et al. (2006) analyzed the entire
international wheelchair rugby classification database to identify groupings of
determinants that distinguished among athletes with high and low levels of
function. Examining existing classification databases allows researchers to either
confirm or refute key activities and associated determinants which makes this
analysis useful when developing the theoretical model.
The sport of PF lacks an evidence-based system of athlete classification. The
purpose of this study was to initiate the development of an evidence-based system
through completion of Step 2 of the IPC process, namely identifying sport-specific
determinants. This study was undertaken to empirically: (a) determine the key
activities critical to the sport through survey of game stakeholders and (b) identify
the underlying determinants essential to these activities through critical game and
database analyses.

Method
Participants
Key Activities
One-hundred PF stakeholders completed a qualitative survey on key activities.
Eighty-two surveys were fully completed and reflected responses from 54 players
(66% of sample), 13 coaches (16%), eight international classifiers (10%), and seven
other stakeholders. Participants represented six different countries (Argentina,
Canada, Denmark, England, United States, and Uruguay) and averaged 30.0 ±
15.2 years of age and 6.2 ± 5.3 years of PF experience. The largest percentage of
participants (42%) were involved at the national level with 39% and 19% involved
at the local and international level, respectively. All participants signed an informed
consent and IRB approval was obtained from Emory & Henry College prior to
survey distribution. Because international competition is open to participants as
young as 8 years of age, parental consent and player assent were required for all
individuals under the age of 18 years.

Determinants That Contribute to Key Activities

Three internationally-certified FIPFA classifiers completed the game analysis.
Classifiers were recruited through FIPFA’s chief of classification, and three
responses represented a 43% response rate (three of seven internationally cre-
dentialed). The participants all had at least 10 years of international classification
experience and represented two FIPFA nations (Canada and United States).
Following process-focused approaches, database cases delimited to 353 interna-
tionally-classified PF players were analyzed. Athletes were primarily male (n =
313), represented 16 different countries, and reflected a similar distribution of
players with greater sport-specific impairment (PF1 = 193; 54.7%) and lesser

(Ahead of Print)
6 BARFIELD ET AL.

sport-specific impairment (PF2 = 155; 43.9%) with five athletes classified as not
eligible (1.4%). Participants had been diagnosed with one of seven sport-specific
impairments (https://fipfa.org/lawsofthegame/) with a sufficient number of players
for statistical analysis among athletes with impaired muscular power (n = 246;
69.7%), hypertonia (n = 50; 14.2%), and impaired range of motion (n = 26; 7.4%).
The majority of participants used a traditional joystick for powerchair control
(n = 272; 77.1%), and the remaining players used a modified hand, head, or foot
control depending on the athlete. Approval from the governing body, FIPFA (the
Federation de Internationale Power Football Assocation), and the Institutional
Review Board were obtained before the study.

Instruments
Key Activities
The research team piloted an authentic qualitative survey on 50 PF players. Results
demonstrated that questions did not prompt sufficient responses about key activi-
ties. To improve the instrument, we used the Delphi method to develop a “sports
performance” survey based on the models used for wheelchair basketball (Polo
et al., 2017) and swimming (Ravensbergen et al., 2018). The research team
identified and recruited 10 current and former PF players, coaches, or classifiers
to review the draft survey to better encapsulate sport domains. After information
from the first round of feedback was integrated, the panel reviewed the draft survey
a second time to ensure the changes were consistent with their recommendations.
The survey was finalized after the second panel review and included both forced-
choice and open-ended questions on key activities (Table 1).

Determinants That Contribute to Key Activities

Classifiers completed a standardized activity analysis to identify factors that
contribute to key activities (Thomas, 2015). The analysis included aspects of
mental processing (e.g., problem-solving, sequencing, safety, judgment, and
memory); physical skills (e.g., range of motion, strength in the upper extremities,
trunk, and hands, control of the wheelchair, and endurance to complete a 40-min
match); and sensory functions (visual acuity, visual tracking, communication with
players and coaches, and proprioception). Specific factors and components
examined during gameplay are reported in Table 2.
The FIPFA’s international database consisted of 27 medical and 13 technical
skills. Most medical (or impairment) variables consisted of assessments of manual
muscle strength (1–5 scoring options), whereas most technical (or sport) skills
were assessed on subjective performance criteria (1–3 options). The FIPFA
rulebook (FIPFA, 2019) categorizes tests as representing one of four domains,
namely head control, trunk control, drive control, and secondary factors.

Procedures
Key Activities
The survey was administered at two different settings. With the help of coaches,
researchers recruited 50 participants at a tournament competition. Prospective

(Ahead of Print)
Table 1 Evidence-Based Classification for Powerchair Football
Survey Questions
1. Participation:
○ Athlete ○ Referee
○ Coach ○ Other
○ Classifier

2. Age:
3. Powerchair football (soccer) experience (years):
4. Current level of play:
○ Club or local ○ International
○ National

5. Current nation of participation:

6. Current classification:
○ PF1: a player who has highly significant levels of physical difficulty which
affects their overall performance
○ PF2: a player who has moderate to mild levels of physical difficulty which
affects their overall performance, but who still meets the minimum
eligibility criteria.
○ Ineligible
○ Uncertain/Not yet classed
○ Unclassified

7. Report your primary disability or impairment:

Physical Determinants of Powerchair Football (Soccer)
8. Which physical components are necessary to play powerchair football?
Choose all that apply.
○ Finger control/coordination ○ Drive control
○ Vision (visual tracking and visual ○ Trunk control
field) ○ Range of Motion
○ Head and neck control/coordination ○ Other _________
○ Endurance

9. Ranking from most to least important, what physical abilities are necessary
to play powerchair football?
○ Finger control/coordination ○ Drive control
○ Vision (visual tracking and visual ○ Trunk control
field) ○ Range of motion
○ Head and neck control/coordination ○ Other _________
○ Endurance

10. What muscles are required in order to successfully play powerchair football?
Choose all that apply.
○ Hand and wrist muscles ○ Chest, back, and abdominal muscles
○ Elbow muscles (ie, trunk)
○ Shoulder muscles ○ Other ________
○ Head and neck muscles

(continued)

(Ahead of Print) 7
8 BARFIELD ET AL.

Table 1 (continued)
11. Ranking from most to least important, what muscles are necessary for playing
powerchair football?
○ Hand and wrist muscles ○ Chest, back, and abdominal muscles
○ Elbow muscles (ie, trunk)
○ Shoulder muscles ○ Other __________
○ Head and neck muscles

12. Are there any impairment types that you have noticed provide a disadvantage to
athletes?
○ Yes (if yes, which ones) ○ Unsure
○ No

Skill Determinants of Powerchair Football (Soccer)

13. Ranking from most to least important, which of the following skill bases are most
important for powerchair football?
○ Drive control ○ Vocal Volume control

○ Adjustment to the ball ○ Communication

○ Breathing control ○ Tone in the chair

14. Ranking from most to least important, what cognitive abilities are necessary to play
powerchair football?
○ Safety/Judgement ○ Attention
○ Problem-solving ○ Coping skills
○ Sequencing of steps to hit the ball ○ Communication

15. What are your top three determinants of sport performance that make someone a
great player for powerchair football? (Example, reverse spin kick, finger dexterity,
cognition, etc.) Please list.
16. With continued practice, what kind of improvements do you see in players
(Example, skills after playing for 6 months, most players have improved driving
ability, etc.) Please list.
General
17. Are there any other considerations that we should be aware of that have a profound
impact on power chair football performance that were not mentioned on this
questionnaire? Please list.
18. Have you been classified, or are aware of the classification system?
○ Yes, I am classified and know about the classification system

○ No, I am not classified but I know about the classification system

○ Yes, I am classified but I do not know about the classification system

○ No, I am classified and I do not know about the classification system

19. If you could change the current classification process, what changes would you
make? Please explain.
Note. PF1 = high impairment; PF2 = low impairment.

participants were asked to complete the survey during nongame times, and research
assistants entered survey responses into Qualtrics software (Qualtrics, Inc; Provo,
UT). Participants were required to provide consent (or assent with parent consent)
prior to participating. To increase sample size, 50 additional participants were also

(Ahead of Print)
 EVIDENCE-BASED CLASSIFICATION 9

Table 2 Factors Examined in Critical Game Analysis

Functions and movements required Component
Specific mental functions Higher level cognitive (e.g., judgment)
Attention
Perception
Thought
Sequencing complex movement
Global mental functions Consciousness (awareness and alertness)
Orientation
Processing skills Attends
Chooses
Initiates
Sequences
Searches
Sensory functions Visual (quality and acuity)
Hearing
Vestibular (position and balance)
Proprioception
Neuromusculoskeletal functions Joint mobility
Joint stability
Muscle functions Muscle tone
Movement functions Involuntary movement reactions (postural)
Control of voluntary movement
Muscular analysis of movements required Wrist supination/pronation
Wrist flexion/extension
Thumb flexion/abduction
Finger flexion/extension
Trunk rotation
Motor skills Aligns
Positions
Grips
Manipulates
Coordinates
Body structures required Nervous system
Eyes, ears, and related structure
Cardiovascular system
Respiratory system
Social interaction skills Looks
Times response

recruited through national teams that were members of FIPFA. The survey link
was electronically sent to interested parties with a 2-week submission deadline.
All survey responses were collected in the same Qualtrics survey database.
Because game and database analyses can also be used to examine key activities,
we reviewed results from each in order to identify any key activities that were
potentially missed by the survey.

(Ahead of Print)
10 BARFIELD ET AL.

Determinants That Contribute to Key Activities

After collection and analysis of survey data, classifiers were asked to complete the
critical game analysis and return to the research team within 2 weeks. Factors that
were identified through game analysis were matched to corresponding activities
ascertained through the survey. Once the initial list of contributing factors was
tallied, the database was analyzed for potential underlying domains not identified
through game analysis. Because there were over 40 potential independent variables
in the database, we examined relationships among variables in similar domains
and associated levels of measurement and were able to condense scores into 10
predictor variables that were used to predict sport class (Table 3). Predictor models
were then run on separate impairment groups with sufficient number of cases
(i.e., impaired range of motion, hypertonia, and impaired muscular power). Because
survey data can also be used to examine underlying factors, we reviewed stakeholder
data to identify any contributing factors missed by the game and database analyses.

Analyses
Descriptive statistics were used to report key activities extracted from the survey.
Prevalence of open-ended responses as well as ranking on most important physical
abilities (1–7, with 1 being the most important) and most important sport skills
(1–6) were used to identify key activities. To identify determinants that contrib-
uted, agreement among all three classifiers on the “greatly challenged” constructs

Table 3 Independent Variables for Logistic Regression

Independent variable Test items included in score Scoring
Head control strength Sum of head rotation strength scores (left and MMT
right combined)
Head control stability Independent head control Yes/no
Trunk strength Sum of trunk flexion/extension and side MMT
flexion strength
Trunk stability Independent trunk control, uses head to return Yes/no
to midline
Trunk rotation Z score of trunk rotation degrees Continuous
Upper limb function Sum of shoulder flexion/extension, shoulder MMT
abduction/adduction, elbow flexion/extension,
wrist flexion/extension, wrist pronation/
supination, and hand grip strength
Visual field Degrees of impaired vision Ratio
Technical skills Sum of scores on head rest, drive skills, and Ordinal
joystick recovery (1–3)
Bivariate technical skills Seating, joystick grip, impact, range, and ball Yes/no
adjustment affected by impairment
Secondary factors Endurance, breathing, volume, Yes/no
communication, and tone affected
Note. MMT = manual muscle test.

(Ahead of Print)
 EVIDENCE-BASED CLASSIFICATION 11

were extracted from the game analysis. Logistic regression was used to predict
sport class from 10 factors, and this analysis was selected based on the type of
dependent variable (dichotomous), the lack of normality in some variables, and
potentially unequal variances across groups (Mertler & Vennatta, 2005).

Results
Key Activities
Survey participants identified three key activities through open-ended responses:
drive control (n = 60), ball control (including kicking, dribbling, and passing;
n = 48), and communication (n = 34). These responses were unprompted and
demonstrate the consistency of importance that stakeholders felt about their im-
portance to the sport. When asked to rank the most important PF skills from a
forced entry list, stakeholders confirmed drive control as the most essential (M =
1.45 ± 1.02 on a 1–6 scale) and added a fourth key activity, namely adjustment
to the ball (M = 2.78 ± 1.01). Although game analysis was not the primary method
to identify key activities, review of results supported the previously mentioned
variables (Table 4).

Determinants That Contribute to Key Activities

Underlying determinants that were identified as greatly challenged (or high
need for skill) included strength and range of motion that affected a player’s

Table 4 Evidence-Based Model of Sport Performance

and Underlying Determinants
Key activities Underlying determinants
Drive control Head/neck strength
Trunk strength
Wrist and finger strength
Head and trunk range of motion
Visual field
Reaction time
Ball control (dribbling, passing, and striking) Head/neck strength
Trunk strength
Wrist and finger strength
Communication Speaking volume
Hearing
Adjustment to the ball Head/neck strength
Trunk strength
Wrist and finger strength
Head and trunk range of motion
Visual field
Reaction time
Reflex activity

(Ahead of Print)
12 BARFIELD ET AL.

independent head, trunk, and wrist function. These findings were supported by
the survey analysis as participants reported that visual field (n = 70), hand and
wrist muscles (n = 70), and head/neck muscles (n = 58) were necessary to play PF
with hand and wrist muscles overwhelmingly considered the most important.
However, game analysis revealed that shoulder and arm function were not
essential. This finding was supported by stakeholders as few survey participants
reported that elbow, shoulder, or chest/back/abdominal muscles were important.
Table 4 outlines all underlying domains identified and their relation to key
activities.
Complete data sets were available for 317 of the 353 database cases. The
10-factor model (Table 3) was effective at predicting group class in persons with
hypertonia (χ2 = 36.65, Nagelkerke R2 = .73, p < .001); impaired muscular power
(χ2 = 199.67, R2 = .75 p < .001); and impaired range of motion (χ2 = 34.6, R2 =
1.00, p < .001). These regression models correctly predicted sport class in 90% of
players with hypertonia (n = 50), 88.8% of players with impaired muscular power
(n = 241), and 100% of players with impaired range of motion (n = 26). When
examining coefficients (B) and associated ability to improve odds of a higher sport
class (exp [B]), likelihood of being classified as PF2 (higher functioning) increased
among players with hypertonia with good head strength, trunk strength, trunk
rotation, and technical skills. For players with impaired muscular power, indepen-
dent head control, trunk rotation, and scores on secondary factors were greater in
PF2 cases.

Discussion
The purpose of this study was to continue the development of an evidence-based
classification system for PF. Specifically, the project was completed to develop an
evidence-based model of sport performance determinants. To develop this model,
the IPC recommends that each sport federation: (a) identify key activities an athlete
must perform and (b) identify their underlying determinants. Results of the current
study identified drive control, ball control, communication, and adjustment to the
ball as key activities. Most critical to classification, we identified multiple joint-
specific measures of strength and range of motion, in addition to sensory and
neurological factors, that affect performance of key activities. Table 4 highlights
the evidence-based model of sport performance and identifies the underlying
determinants that must be measured during classification to ensure impairment
does not cause an inherent disadvantage.

Key Activities
The most common method used to identify Paralympic sport activities has been
through collection of feedback from experts (e.g., classifiers, coaches, referees) and
competitive participants via surveys and/or interviews. Empirical evidence through
this method has been collected for a number of sports including basketball (Polo
et al., 2017), sitting volleyball (Marszalek, et al., 2019), swimming (Ravensbergen
et al., 2018), wheelchair rugby (Altmann et al., 2014), and multisports (Mason
et al., 2010). Our results indicated that drive control; ball control (i.e., dribbling,

(Ahead of Print)
 EVIDENCE-BASED CLASSIFICATION 13

passing, striking); communication; and adjustment to the ball are all key perfor-
mance activities in PF. These skills allow a player to participate in all phases of the
sport, and they form the initial pillars of the determinants model. The PF is a
dynamic sport, and the previously mentioned activities capture players’ ability to
complete the required open skill activities.

Determinants That Contribute to Key Activities

Our findings support the inclusion of muscle strength and range of motion as they
relate to independent control of the head, trunk, and hand/wrist. These variables
underlie multiple key activities and can be affected by impairment, which in turn
affects a player’s ability to perform. For example, a player must be able to turn their
trunk and head to position themselves on the court and move in response to
opponents. If impairment limits a player’s ability to turn their head or to grip their
joystick, then their drive control, ball control, and adjustment to the ball will all be
negatively affected. Our findings also support the need to include communication
variables, visual field, and reaction time in the performance determinants model as
these factors impact multiple key activities (Table 4). However, it is important to
note that key stakeholders (i.e., players, coaches, classifiers) delimited the need for
musculoskeletal function to the head/neck, trunk and hand, not the shoulder and
upper arm structures. One explanation may be due to the fact that players are able to
use adaptive equipment during gameplay, thereby alleviating some of the physical
requirements of manual wheelchair sport. In an open-ended section of the survey, it
was noted that support belts and alternative drive mechanisms enable mobility
through a variety of methods which may mitigate the need for much upper limb
strength; therefore, shoulder and arm strength assessments included in the current
rulebook are not necessary (not evidence based) and should be excluded from the
development of an evidence-based classification system moving forward (Step 3).
The benefit of removing nonconsequential domains is that efficiency of testing can
increase through reducing the testing burden on players, a goal that was reported by
players in open-ended survey responses.
Analysis of the database reinforces the need for an evidence-based system for
PF. The determinants used in the current classification system make it likely that at
least one competitor will be misclassified. Assuming a classification accuracy of
88% for the largest impairment group, it is probable that at least one player will not
be scored correctly. (Eight players on a court at a time × 0.88 accuracy reveals that
only seven players are likely to be in the correct sport class.) Our analysis was
based on the work of Altmann et al. (2006), who also used logistic regression to
predict sport class. These authors combined levels of strength scores (e.g., 1–3 and
4–5 on manual muscle tests) to better distinguish between players with high and
low levels of impairment in order to help with prediction accuracy. Database
variables that did not contribute to the regression models included upper limb
strength and nonbinary technical skills. It seems likely that the observations
identified through the surveys (i.e., players are able to accommodate gameplay
with different adaptations) may explain why strength scores in the shoulders and
arms are not essential to performance of the sport. Empirical evidence from this
study supports the notion that manual muscle test scores on limb strength are not
essential to classification.

(Ahead of Print)
14 BARFIELD ET AL.

One variable that the players did emphasize as important to PF play was
tactical strategy, especially as it related to positioning and problem-solving.
Strategy can be developed with experience and therefore is not an underlying
determinant itself. The current FIPFA rulebook does mention cognition as an
optional secondary factor to consider in classification and it seems possible that
problem-solving and mental processing may impact a key activity, namely player
adjustment to the ball. Despite the fact that several eligible PF impairment
categories have associated comorbidities related to mental processing, such as
problem-solving, intellectual impairment is not currently included in the eligible
criteria for the sport (Step 1). Future work is needed to determine how processing
skills may fit into the determinants model without interfering with impairment
eligibility.

Implications of Findings
The next step in the development of an evidence-based classification system is
to develop or identify reliable and valid assessments that can be used to
measure key activities and their underlying domains in PF (Tweedy et al.,
2016). The deduction of key activities only sets the next stage for research.
Investigators and/or FIPFA must now identify appropriate medical and tech-
nical assessments as well as empirically examine reliability and validity
evidence of these tests in actual PF athletes. The IPC mandate is clear that
classification assessments must be objective, parsimonious, and ratio scaled.
For the sport’s governing body to continue the development of an evidence-
based system, identification of sound measurements that can be used to assess
determinants must now occur.
There is one major limitation of the current study. The database analysis was
conducted on previously assigned sport classes. The assignment of sport classes
was made primarily through methodology that is no longer supported by the IPC
(i.e., ordinal scoring, manual muscle tests); therefore, the certainty that each
sport class was correctly assigned cannot be assumed. It is important to note,
however, that the same chief of classification has been in place since the
inception of the rulebook which, theoretically, should ensure errors in class
are unidirectional. We considered using a third process-focused approach to
examine natural breaks among athletes’ scores on database constructs but felt
the subjectivity of this analysis would be less internally valid than logistic
regression for the current study.

Conclusion
We have constructed an evidence-based model of sport determinants for PF.
Current findings support four key activities (drive control, ball control, commu-
nication, and adjustment to the ball) and their underlying determinants (e.g.,
head, trunk, and hand strength, range of motion, visual field, reaction time, and
reflex activity). The next step in the continued development of an evidence-based
PF classification system is to identify reliable and valid assess-ments of these
determinants.

(Ahead of Print)
 EVIDENCE-BASED CLASSIFICATION 15

Acknowledgment
The authors would like to thank Lakeshore Foundation for assistance with data collection.

References
Altmann, V.C., Groen, B.E., Hart, A.L., Vanlandewijck, Y.C., & Keijsers, N.L.W. (2017).
Classifying trunk strength impairment according to the activity limitation caused in
wheelchair rugby performance. Scandinavian Journal of Medicine & Science in Sports,
28(2), 649–657. https://doi.org/10.1111/sms.12921
Altmann, V.C., Groen, B.E., Hart, A.L., Vanlandewijck, Y.C., van Limbeek, J., & Keijsers,
N.L.W. (2016). The impact of trunk impairment on performance-determining activities
in wheelchair rugby. Scandinavian Journal of Medicine & Science in Sports, 27(9),
1005–1014. https://doi.org/10.1111/sms.12720
Altmann, V.C., Hart, A., & Parkinson, A. (2006). Wheelchair rugby classification database:
Aid to the improvement of classification. Presented at the 4th IPC Vista Conference.
Altmann, V.C., Van Limbeek, J., Hart, A.L., & Vanlandewijck, Y.C. (2014). Improvement
of the classification system for wheelchair rugby: Athlete priorities. Adapted Physical
Activity Quarterly, 31(4), 377–389. https://doi.org/10.1123/apaq.2013-0064
Barfield, J.P., & Malone, L.A. (2013). Perceived exercise benefits and barriers among power
wheelchair soccer players. Journal of Rehabilitation Research & Development, 50(2),
231–238. https://doi.org/10.1682/JRRD.2011.12.0234
Barfield, J.P., Malone, L.A., Collins, J.M., & Ruble, S.B. (2005). Disability type
influences heart rate response during power wheelchair sport. Medicine &
Science in Sports & Exercise, 37(5), 718–723. https://doi.org/10.1249/01.MSS.
0000161807.77552.8B
Barfield, J.P., Newsome, L., & Malone, L.A. (2016). Exercise intensity during power wheel-
chair soccer. Archives of Physical Medicine and Rehabilitation, 97(11), 1938–1944.
https://doi.org/10.1016/j.apmr.2016.05.012
Beckman, E., Connick, M., & Tweedy, S.M. (2016). The 2016 Paralympic Games: A
classification primer. Palaestra, 30(3), 16–21.
Beckman, E.M., Newcombe, P., Vanlandewijck, Y.C., Connick, M.J., & Tweedy, S.M.
(2014). Novel strength test battery to permit evidence-based Paralympic classification.
Medicine, 93(4), e31. https://doi.org/10.1097/MD.0000000000000031
Cooper, R. (1990). Wheelchair racing sports science: A review. Journal of Rehabilitation
Research & Development, 27(3), 295–312. https://doi.org/10.1682/JRRD.1990.
07.0297
Cottingham, M., Pate, J.R., & Gearity, B. (2015). Examining ‘inspiration’: Perspectives of
stakeholders attending a power wheelchair soccer tournament. Canadian Journal of
Disability Studies, 4(1), 59. https://doi.org/10.15353/cjds.v4i1.188
de Witte, A.M.H., Hoozemans, M.J.M., Berger, M.A.M., van der Slikke, R.M.A., van der
Woude, L.H.V., & Veeger, D. (2018). Development, construct validity and test–retest
reliability of a field-based wheelchair mobility performance test for wheelchair
basketball. Journal of Sports Sciences, 36(1), 23–32. https://doi.org/10.1080/
02640414.2016.1276613
Federation Internationale de Power Football Association. (2019). Classification model rules
for FIPFA: Model rules consistent with the 2015 IPC player classification code and
accompanying international standards. https://fipfa.org/classification/
Garganta, J. (2009). Trends of tactical performance analysis in team sports: Bridging the
gap between research, training and competition. Revista poruguesa de Ciencias Do
Desporto, 9(1), 81–89.

(Ahead of Print)
16 BARFIELD ET AL.

Gil, S.M., Yanci, J., Otero, M., Olasagasti, J., Badiola, A., Bidaurrazaga-Letona, I.,
Iturricastillo, A., & Granados, C. (2015). The functional classification and field
test performance in wheelchair basketball players. Journal of Human Kinetics, 46(1),
219–230. https://doi.org/10.1515/hukin-2015-0050
Jeffress, M.S., & Brown, W.J. (2017). Opportunities and benefits for powerchair users
through power soccer. Adapted Physical Activity Quarterly, 34(3), 235–255. https://
doi.org/10.1123/apaq.2016-0022
Kumar, A., Karmarkar, A.M., Collins, D.M., Souza, A., Oyster, M.L., Cooper, R., &
Cooper, R.A. (2012). Pilot study for quantifying driving characteristics during power
wheelchair soccer. The Journal of Rehabilitation Research and Development, 49(1),
75–82. https://doi.org/10.1682/JRRD.2010.09.0191
Marszałek, J., Gryko, K., Kosmol, A., Morgulec-Adamowicz, N., Mróz, A., & Molik, B.
(2019). Wheelchair basketball competition heart rate profile according to players’
functional classification, tournament level, game type, game quarter and playing time.
Frontiers in Psychology, 10, 773. https://doi.org/10.3389/fpsyg.2019.00773
Marszalek, J., Molik, B., Gomez, M.-A., Skucas, K., Pokvytyte, V., Mucha, J., & Rekowski,
W. (2019). Sitting volleyball classification system: The athletes’ perspective. Revista
de Psicologia Del Deporte, 28(1), 25–32.
Mason, B., Porcellato, L., van der Woude, L., & Goosey-Tolfrey, V. (2010). A qualitative
examination of wheelchair configuration for optimal mobility performance in wheel-
chair sports: A pilot study. Journal of Rehabilitation Medicine, 42(2), 141–149. https://
doi.org/10.2340/16501977-0490
McLean, S., Salmon, P.M., Gorman, A.D., Read, G.J.M., & Solomon, C. (2017). What’s in
a game? A systems approach to enhancing performance analysis in football. PLOS
ONE, 12(2), e0172565. https://doi.org/10.1371/journal.pone.0172565
Mertler, C.A., & Vannatta, R.A. (2005). Advanced and multivariate statistical methods:
Practical application and interpretation. Pyrczak.
Morgulec-Adamowicz, N., Kosmol, A., Molik, B., Yilla, A.B., & Laskin, J.J. (2011).
Aerobic, anaerobic, and skill performance with regard to classification in wheelchair
rugby athletes. Research Quarterly for Exercise and Sport, 82(1), 61–69. https://doi.
org/10.1080/02701367.2011.10599722
Polo, I., Perez-Tejero, J., Pinilla, J., & Coteron, J. (2017). Impact of intellectual impairment
on basketball performance through coaches and referees’ opinion: A qualitative
approach. Revista de Psicologia Del Deporte, 26(Suppl. 1), 149–154.
Ravensbergen, H.J.C., Genee, A.D., & Mann, D.L. (2018). Expert consensus to guide the
classification of Paralympic swimmers with vision impairment: A Delphi study.
Frontiers in Psychology, 9, 1756. https://doi.org/10.3389/fpsyg.2018.01756
Richard, R., Perera, E., & Le Roux, N. (2019). The bodily experience of disabled athletes.
A phenomenological study of powerchair football. Sport in Society, 23(7), 1186–1201.
https://doi.org/10.1080/17430437.2019.1609948
Saltan, A., & Ankarali, H. (2017). The role of trunk stabilization in functional-classification
levels in wheelchair basketball. Journal of Sport Rehabilitation, 26(4), 287–293.
https://doi.org/10.1123/jsr.2016-0054
Seron, B.B., Oliveira de Carvalho, E.M., & Greguol, M. (2019). Analysis of physiological
and kinematic demands of wheelchair basketball games—A review. Journal of
Strength and Conditioning Research, 33(5), 1453–1462. https://doi.org/10.1519/
JSC.0000000000003069
Thomas, H. (2015). Occupation-based activity analysis. Slack Incorporated.
Tweedy, S.M., & Bourke, J. (2009). IPC athletics classification project for physical
impairments: Final report—Stage 1. IPC Athletics.
Tweedy, S.M., & Vanlandewijck, Y.C. (2011). International Paralympic Committee posi-
tion stand—Background and scientific principles of classification in Paralympic sport.

(Ahead of Print)
 EVIDENCE-BASED CLASSIFICATION 17

British Journal of Sports Medicine, 45(4), 259–269. https://doi.org/10.1136/bjsm.

2009.065060
Tweedy, S.M., Mann, D., & Vanlandewijck, Y.C. (2016). Research needs for the develop-
ment of evidence-based systems of classification for physical, vision, and intellectual
impairments. In Y. Vanlandewijck & W.R. Thompson (Eds.), Training and coaching
the Paralympic athlete. John Wiley & Sons.
Tweedy, S.M., Williams, G., & Bourke, J. (2010). Selecting and modifying methods of
manual muscle testing for classification in Paralympic sport. European Journal of
Adapted Physical Activity, 3(2), 7–16. https://doi.org/10.5507/euj.2010.005
van der Slikke, R.M.A., Mason, B.S., Berger, M.A.M., & Goosey-Tolfrey, V.L. (2017).
Speed profiles in wheelchair court sports; comparison of two methods for measuring
wheelchair mobility performance. Journal of Biomechanics, 65, 221–225. https://doi.
org/10.1016/j.jbiomech.2017.10.040
van Dijk, A., Dadova, K., & Martinkova, I. (2017). Intellectual disability sport and
Paralympic classification. AUC Kinanthropologica, 53(1), 21–34. https://doi.org/10.
14712/23366052.2017.2
Vanlandewijck, Y., Theisen, D., & Daly, D. (2001). Wheelchair propulsion biomechanics:
Implications for wheelchair sports. Sports Medicine, 31(5), 339–367. https://doi.org/
10.2165/00007256-200131050-00005
Wessel, R., Wentz, J., & Markle, L. (2011). Power soccer: Experiences of students using
power wheelchairs in a collegiate athletic club. Journal of Postsecondary Education
and Disability, 24(2), 147–159.
Wu, S.K. (2001). Classifiers and social control in wheelchair rugby. The Kaohsiung Journal
of Medical Sciences, 17(2), 90–98.

(Ahead of Print)

View publication stats