Research Unit for Sport and Physical Activity

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Intra-observer reproducibility and inter-observer agreement of Fels skeletal age assessments among male tennis players 8–16 years

Publication . Sousa-e-Silva, Paulo; Coelho-e-Silva, Manuel J.; Celis-Moreno, Jorge M.; Costa, Daniela C.; Martinho, Diogo V.; Ribeiro, Luís Pedro; Oliveira, Tomas; Gonçalves-Santos, João; Tavares, Oscar M.; Castanheira, Joaquim M.; Pereira, Telmo; Conde, Jorge; Cayolla, Ricardo R.; Duarte-Mendes, Pedro; Myburgh, Gillian K.; Cumming, Sean P.; Malina, Robert M.

Background Skeletal age (SA) is an estimate of biological maturity status that is commonly used in sport-related medical examinations. This study considered intra-observer reproducibility and inter-observer agreement of SA assessments among male tennis players. Methods SA was assessed with the Fels method in 97 male tennis players with chronological ages (CA) spanning 8.7–16.8 years. Radiographs were evaluated by two independent trained observers. Based on the difference between SA and CA, players were classified as late, average or early maturing; if a player was skeletally mature, he was noted as such as an SA is not assigned. Results The magnitude of intra-individual differences between repeated SA assessments were d = 0.008 year (observer A) and d = 0.001 year (observer B); the respective coefficients of variation were 1.11% and 1.75%. Inter-observer mean differences were negligible (t = 1.252, p = 0.210) and the intra-class correlation coefficient was nearly perfect (ICC = 0.995). Concordance of classifications of players by maturity status between observers was 90%. Conclusion Fels SA assessments were highly reproducible and showed an acceptable level of inter-observer agreement between trained examiners. Classifications of players by skeletal maturity status based on assessments of the two observers were highly concordant, though not 100%. The results highlight the importance of experienced observers in skeletal maturity assessments.

2023-04-26Journal article

Open access

The effect of smoking on lung function changes during a 16-week combined exercise program in middle-aged workers: a latent growth curve analysis

Publication . Silva, Manuela Fernanda Gomes Moreira da; Ferreira, José P.; Teixeira, Ana M.; Monteiro, Diogo; Duarte-Mendes, Pedro

Purpose To investigate the longitudinal changes in lung function of sedentary middle-aged workers over a 16-week combined exercise training program. Methods Thirty-six sedentary workers (53.70±6.92 years old) were randomly allocated to either a combined aerobic and resistance training program (n=18) or a control group (n=18). Lung function was evaluated through spirometry using a portable fow spirometer (Spiropalm 6MWT, Cosmed, Italy). Predicted percentages of forced vital capacity (FVC), forced expiratory volume in the frst second (FEV1), FEV1/FVC ratio, and mean forced expiratory fow between 25 and 75% of exhaled FVC (FEF25–75) were analyzed. Assessments were performed at baseline (M1), after 8-week (M2) and 16-week follow-up (M3). The changes in lung function were analyzed using the Latent Growth Curve Modeling that estimated interindividual and intraindividual growth paths. Results Smoking status revealed a signifcant efect on lung function growth with signifcant paths to intercept and slope for all models in both groups. The exercise group participants who are non-smokers revealed higher increases in FVC% (β=.22), FEV1% (β=.08), FEV1/FVC% ratio (β=.19), and FEF25–75% (β=.06) compared to those who are smokers from M1 to M3. The control group revealed a lower growth in lung function from M1 to M3, with a lower slope observed in smokers compared to non-smokers for FVC% (β=−.44), FEV1% (β=−.41), FEV1/FVC% (β=−.98), and FEF25–75% (β=−.52). Conclusion Our fndings suggest that a 16-week combined training program is an efective strategy to improve lung function among sedentary workers, with a higher magnitude of improvement for non-smokers compared to smokers. Trial registration Clinicaltrials.gov, NCT04868240. Registered April 30, 2021.

2025-05-31Journal article

Restricted access

Skeletal age assessed by Greulich-Pyle: intra-observer and inter-observer agreement among male pubertal tennis players

Publication . Celis-Moreno, Jorge M.; Martinho, Diogo V.; Coelho-e-Silva, Manuel J.; Fragoso, Isabel; Ribeiro, Luís Pedro; Gouveia, Élvio R.; Oliveira, Tomas; Gonçalves-Santos, João; Tavares, Oscar M.; Cayolla, Ricardo R.; Duarte-Mendes, Pedro; Konarski, Jan M.; Malina, Robert M.; Myburgh, Gillian K.; Cumming, Sean P.; Sherar, Lauren B.; Roberto Scendoni

The assessment of biological maturation is a central topic in pediatric exercise sciences. Skeletal age (SA) reflects changes in each bone of the hand and wrist from initial ossification to the adult state. This study examined intra-observer and inter-examiner agreement is Greulich-Pyle (GP) assessments of SA in 97 male tennis players 8.6–16.8 years of age. Two observers independently examined all films on two occasions using the GP method. The SA of each bone was evaluated. The mean and median of SAs assigned for each bone was the individual SA for each participant. The calculation was exclusively based on the bones that were not skeletally mature. Intra-observer mean differences were significant for several bones with better results by the experienced examiner (observer B). Comparisons between SA values of the two independent observers indicated significant differences for the ulna, metacarpals II and III, and distal phalanx V. Nevertheless, the magnitude of the bone-specific differences was small, perhaps trivial. Differences in individual SA values of the tennis players based on the non-mature bones of the hand-wrist were negligible based on the mean (0.04±0.39, t = 0.321, p = 0.749) or the median (0.05±0.58, t = 0.007, p = 0.994). Nevertheless, the current study confirmed examiners as a source of error in the estimation of SA using the Greulich-Pyle method and highlighted the importance of calculating SAs based on non-mature bones among adolescent players.

2025-01-22Journal article

Open access