In a perfect world, the RSB / BwP assessment process would be standardized, predictable, unform, consistent and there would be no variables. However, the good news is that we do not live in a perfect world. So, when it comes to assessments within the RSB network, we need to recognize the variables we have no control over.
Rock Steady Boxing HQ: Sixteen years ago, Rock Steady Boxing choose 4 widely accepted assessment tools to be administered at each new boxer intake and again at 6-month intervals. The main objective was to assist RSB coaches in determining the correct placement of boxers in RSB workout groups… levels 1 & 2 or 3 & 4. Knowing each boxer’s capabilities and limitations would help keep them safe and help coaches design workouts that supported individual boxer needs. The chosen tools were the PDQ-39, the Fullerton Advanced Balance series (FAB), the 30-second Sit to Stand (S2S), and the Timed Up & Go (TUG).
RSB HQ provides minimal assessment training in how to administer the tests or how to read and interpret the tests results during new affiliate training, during coach training, or on an ongoing basis. Assessments are rarely mentioned and there is no RSB program to verify assessment use, compliance or standards in administration. Left to each affiliate and coach to figure it out leaves too much room for inconsistent and misinformed administration of the tests and in the interpreting of the results.
In talking with RSB affiliates, many RSB affiliates do not do reassessments at all, some do not use the PDQ-39, some use the BERG or Mini-Best instead of the FAB, sometimes. Consistency and standardization is not a RSB HQ priority. Affiliates are all over the board on reassessment intervals which RSB recommends at 6-months. It is not clear what assessment policy and implementation is used in RSB’s own gym with over 250 boxers.
There is no RSB HQ field level insight into what the affiliates are doing, no emphasis on compliance and no promotion on the importance and value of assessments to the affiliate, coach or boxer.
Affiliates and coaches do their best, however there is great inconsistency in the administration of assessments. Different gym floors, different height stools for the Step Over a Bench (FAB 4), the rules for how coaches measure the standing jump (FAB 8) are measured (toe to heel or toe to toe) or the starting position for boxers in the TUG (sitting forward or sitting back).
There is existing boxer records and assessments in 800+ gyms for over 40,000 boxers on paper going back years. Even though the assessments may have been administered at inconsistent intervals and they may be sloppy and somewhat illegible, they may contain abbreviations or side notes and they were definitely administrated inconsistently, they do have value for individual boxers. The value of this data for casual reporting on a national basis is yet to be evaluated but will certainly be limited. The value on an academic or research basis is zero.
The assessment tools: The greatest deficiency in using these specific 4 assessment tools, the PDQ-39, the FAB, the 30-second Sit to Stand, and the Timed Up & Go, is that they were designed for use by medical professionals for patients when indicated by a loss of balance or fall risk, basically PD Levels 3 and 4. They do not adequately measure the state of the PD Level 1 or most Level 2 patients nor do they work well for PD Level 4 patients. They apply mostly to late state PD Level 2’s and Level 3s. Most of the boxers in our test gyms are PD Level 1a & 2s and can do all the tests receiving the maximum score. These tests are not effective in assessing about half of the boxers in my 2 gyms.
The target population for the tests has changed significantly. The general fitness and conditioning for seniors, even PD Level 3s, has changed over the last 30 years. Test targets for a 70 year old in 1990 should be different for a 70 year old in 2023. Examples:
· In the case of the 30-second S2S, the 30 year-old gender/age results reference chart is clearly obsolete. The standards that may have been relevant to a previous generation do not apply to today’s population. In general, we are fitter, more active and live longer so a relevant S2S chart for today’s population would likely have higher targets.
· The forward reach, FAB 2, where the boxer stands with their arm outstretched and the coach holds a pencil out at 10 inches and asks the boxer to take the pencil without moving their feet. There are 3 problems with the official version of this test: 1) a 6’2” boxer has an natural height/arm length advantage over a 5’2” boxer; 2) the test instructions do not specify whether to take the pen between the thumb and forefinger or between the middle 2 fingers… about a full inch difference; and,3) it is not distance sensitive so the actual reach distance and any improvement or declines are recorded.
· Technology has changed over the last 30 years as well. The deployment of these tests on paper in 2023 is obsolete due to the computing power, accelerometers and gyroscopic capabilities of today’s cheapest tablets.
· The official instructions for the FAB 8 Standing Jump, do not tell coaches how to measure… toe to heel or toe to toe. In conversations with affiliates around the country and even RSB HQ, some do it each way.
· They do not allow for advances in scoring made possible by a standardized tablet application and centralized data storage. The migration to a tablet opens the door to so many new ways to look at a test result and to do averages, means or other calculations in real time. To the academic or researcher, any deviation from the paper-based scoring and results interpretation is not permitted.
To the coach and boxer, fresh, innovative ways of looking at test results is welcome and valuable. That the academics and researchers have not declared these tests obsolete and made an attempt to update them is interesting.
Some assessment tests used in PARS have been modified by BwP to clarify the instructions or to reduce variables in administration. BwP is already working on an advanced assessment series to lift the test floor so they apply to a wider subject audience including PD L1s & 2s. The FAB is designed for use by med pro when indicated by balance issues or fall risk primarily in PD level 3 people. BwP has designed a modified and enhanced version of several tests so they are applicable for PD L 1& 2 people. BwP is working on modifications for PD L4 people. Initially, academics and researches will say that these new tests are not be evidence based, have not been validated by professional research studies and will not have published MDCs.
The bottom line is that in the time since the current assessment tools were created and with the advent of tablet technology, it is time for a new generation of assessment tools to be developed. It will take time to develop, test for validity and develop minimum detectable change values for each new test earning academic and research credibility and validation. In the meantime, it has to start somewhere with someone… and boxers with Parkinson’s is accepting the challenge. In the spirit of prioritizing the quality of life of the boxer and providing meaningful reports and insights today, BwP will support the use of the current assessment tools overlaying fresh, conservative yet innovative ways of looking at the results. Even though these insights are not recognized by academic and research bodies.
BwP has already started the design and development of the next generation of advanced, full-spectrum assessment tools.
BwP will work with universities and other groups to test the new tests, however, in the meantime, the use of them with individual boxers will improve a coaches impact improving the information available to coach individual boxers.
The Boxers: There are several problems with the RSB assessment methods with an expectation that they would be administered by professional and lay persons to get exact same results on the same day much less when administered 6 months apart by the same coach or by a different coach, possibly in a different RSB gym.
The boxers may be at different points in their medicine cycles, on different recommended dosages or even on different medicines (even DBS) when comparing against themselves at 6 months intervals. Add variables such as time since diagnosis, age, gender, and non-PD medical conditions such as arthritis, bad backs and knees, diabetes or strokes.
An additional concern is what we call the Superman Effect. Basically, there are 10 tests which at 30 seconds each take about 5 minutes to administer. Many boxers, specially men, can do anything for 5 minutes. However, they don’t go through their normal day at this intensity and would be exhausted by the end of day if they did. When assessing to place a boxer in the appropriate workout group, they can rarely elevate their results enough to fall into the wrong level or stage. And, this is only a concern for a new intake where the coach does not know the boxer.
As far as assessment integrity goes for a Super Boxer, as long as all they participate in all their assessments with the same competitive energy, the results will maintain their relevance. You would be comparing Super Bob against Super Bob.
The Coaches: A case could be made that 16 years ago, considering the organizational maturity of RSB and the missing minimum qualifications to be a RSB affiliate and head coach, the choice to use these 4 assessment tools was smart. It would have been an unreasonable expectation that intended academic and research standards would be upheld.
RSB coaches love their boxers and many have a personal connection to Parkinson’s. The discomfort expressed by coaches regarding assessments is from the lack of training and education in how to administer and how to interpret them.
Boxers with Parkinson’s: BwP’s tests are relevant only when used within the BwP system to measure progression for each subjectwhen compared against their own previous assessments.
Moving RSB assessments from paper to tablet, BwP tries to improve on the paper-based RSB-level assessment reliability (minimal) by overlaying a higher level of assessment standardization in the tablet version through better instructions and training.
Conclusion: The PARS implementation of the PDQ, FAB, S2S & TUG is solely a migration of these tests from paper to tablet. A coach could do for themselves everything PARS does with a pencil, calculator and paper. As an intermediate step BwP used Excel spreadsheets.
The use of computer power to sort, organize, sum, average or in any other way analyze the results is not an attempt to meet the academic, research or medical standards established by the boards of professional analysts and reviewers. The RSB paper-based assessment process and the PARS tablet-based implementations of these tests are specifically for use in RSB environments by RSB coaches in consultation with boxers and their families.
PARS insights could be duplicated by any coach using the same data with a pencil and a piece of paper. The tablet just does it instantly. To that end, BwP uses a standard of “Coach Intelligence” and “Boxer Common Sence” in the assessment administration, recording, scoring, reporting and insights. New cars have tire pressure sensors that do automatically what a driver used to do with a manual tire gauge. It does not change the construction of the tire or the tire’s safety.
In the time since the current assessment tools were created (30+ years ago) and with the advent of tablet technology, it is time for a new generation of computer-based assessment tools.
It will take time to develop the new assessment tools, submit them to independent third-party academic and research bodies for validation, and to develop minimum detectable change (MDC) values for each new test.
In the meantime, with a historical base of assessment data for over 40,000 RSB boxers, with an intrinsic network of experienced RSB assessment coaches, and in the spirit of providing meaningful testing, scoring and insights impacting the quality of life of the RSB boxer today, PARS is a powerful interim solution.