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. 2025 Feb;55(2):341-391.
doi: 10.1007/s40279-024-02132-y. Epub 2024 Nov 22.

Guiding Evidence-Based Classification in Para Sporting Populations: A Systematic Review of Impairment Measures and Activity Limitations

Taylor M Wileman  1 , Marnee J McKay  2 , Daniel A Hackett  2 , Timothy J Watson  3 , Jennifer Fleeton  2 , Ché Fornusek  2
Affiliations

Guiding Evidence-Based Classification in Para Sporting Populations: A Systematic Review of Impairment Measures and Activity Limitations

Taylor M Wileman et al. Sports Med. 2025 Feb.

Abstract

Background: As the focus of classification shifts towards an evidence-based approach, it is crucial to establish a robust system that relies on valid and reliable measures of impairment to ensure legitimate and competitive opportunities for all Para athletes. However, the lack of methods that possess the necessary measurement properties for assessing impairments in Para sporting populations presents significant challenges to developing an evidence-based classification system.

Objective: This review aimed to identify and evaluate measures of impairment and activity limitation measures that have been used to assess eligible impairments in Para sport athletes for potential use in evidence-based classification.

Methods: Six electronic databases (MEDLINE, Embase, SPORTDiscus, CINAHL, Scopus, Web of Science) were searched from their earliest record to December 2023.

Results: Fifty-one articles were identified, with twenty-one studies focusing on physical impairment measures. Isometric and grip strength emerged as effective measures. Coordination measures, such as tapping tasks, showed variations with performance. Additionally, six studies focused on intellectual impairments, revealing differences between impaired and non-impaired athletes through generic cognitive tests. Vision impairment measures, including visual acuity and visual field assessments, displayed varying associations with performance across sports.

Conclusions: Although research on evidence-based classification in Para sport is limited, this review provides valuable insights for sports in developing a testing battery that adheres to evidence-based protocols. Ongoing research efforts by sport governing bodies to prioritise research in this area will improve our understanding of the impairment-performance relationship, leading to better decision making and increased credibility in Para sport classification systems.

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Conflict of interest statement

Declarations. Funding: Open Access funding enabled and organized by CAUL and its Member Institutions. Taylor M. Wileman is funded by the Australian Government Research Training Program PhD scholarship. Conflicts of interest/competing interests: Taylor M. Wileman, Marnee J. McKay, Daniel A. Hackett, Timothy J. Watson, Jennifer Fleeton and Ché Fornusek have no conflicts of interest that are directly relevant to the content of this article. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Availability of data and material: The data used to inform this review have been disclosed in the article or in its accompanying Electronic Supplementary Material. Code availability: Not applicable. Authors’ contributions: TMW completed the literature search. TMW, JF and CF conducted the record screening. TMW extracted all the data, which were verified by TJW. TMW and TJW conducted the quality assessment. TMW drafted the initial manuscript, which was revised and approved for submission by all authors. All authors read and approved the final manuscript.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) flowchart for identification and inclusion of relevant studies
See this image and copyright information in PMC

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