Preseason perceived physical capability and previous injury
Sciascia A, Haegele LE, Lucas J, Uhl TL. J Athl Train 2015; 50(9):937-943.
Take Home Message: Athletes that report a previous injury at preseason examination also reported lower physical capabilities related to the knee or upper extremity before the competitive season. Patient-reported joint-specific perceived capability assessments might supplement preseason physical examination and aid in return to play decisions following injury.
Clinicians can collect patient-reported outcomes at initial evaluation and throughout treatment to assess various outcomes, including an athlete’s perceived ability to perform activities. However, clinicians lack data on preseason patient-reported outcomes. This information could help clinicians determine how an athlete perceived himself/herself before an injury. Therefore, the authors collected perceived measures of physical capability for the knee, shoulder, and elbow during preparticipation physical examinations and determined potential differences in scores between collegiate athletes with and without history of injuries. Overall, 738 athletes (486 men; ~19 years of age; 19 sports) from 5 collegiate institutions were medically cleared to participate in sport following a physical examination. They then completed a general health history questionnaire, which asked about history of knee, shoulder, or elbow injuries. Next, athletes completed 2 questionnaires that assess an athlete’s perceived physical capability: Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Kerlean-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC) Score. Three hundred and fifty athletes reported a history of 445 injuries. Athletes reported 208 knee injuries, 180 shoulder injuries, and 57 elbow injuries. Athletes with no history of injury reported nearly perfect preseason physical capabilities. Athletes with previous injuries reported less perceived physical capability related to the knee and upper extremity. Median values for perceived physical capability of athletes with a history of injury were 3 to 12 points lower for each questionnaire during preseason.
Returning an athlete to their perceived preinjury capabilities is the goal of his/her rehabilitation. Therefore, it is necessary to know what their preinjury capabilities were. Overall, athletes reported high scores, on both KOOS and KJOC, which was not surprising since these were healthy athletes. This highlights that during rehabilitation and before return to play clinicians should aim for a patient to report very high levels of perceived function. While scores were generally high, the authors found that athletes with a history of injury reported lower preseason physical capabilities. This finding suggests that previous injury can adversely affect an athlete’s perceived physical capability. The authors suggest that these simple patient-reported outcomes may supplement preseason physical examinations and help identify athletes needing additional care or monitoring. Future research will need to determine if these differences are clinically meaningful and if they predict who is susceptible to new injuries during an upcoming season. Presently, clinicians should use joint-specific patient-reported outcomes during preseason to identify athletes who need additional attention and to assist rehabilitation and return to play decisions.
Questions for Discussion: Do you assess patient-reported quality of life, pain, or function at preseason to compare pre and post injury levels to return to play?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban