Sports Medicine Research: In the Lab & In the Field: Athletes with Previous Injury Report Less Physical Capability at Preseason (Sports Med Res)


Monday, October 26, 2015

Athletes with Previous Injury Report Less Physical Capability at Preseason

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

Related Posts:

Sciascia A, Haegele LE, Lucas J, & Uhl TL (2015). Preseason Perceived Physical Capability and Previous Injury. Journal of Athletic Training, 50 (9), 937-43 PMID: 26287492


Mark Colapietro said...

During my brief career as a clinician, I have not seen the use of patient-reported quality of life/pain/function taken at the beginning of the season. The only time I have seen the use of patient-reported outcomes was post-acute injuries, especially post-surgical repair. The outcome measurements were valuable in determining how the patients were responding to treatments and use the outcomes as another source for goal setting.

Objectively, athletic trainers can get a past medical history detailing what their injuries were and how long it took to recover. Although a simple injury history would be swift, it will leave out how the athlete perceives their recovery and sense of where they are competitively. It would be beneficial for clinicians who are entering a new setting to have their athletes fill out patient-reported outcomes such as those used in this study. It would give additional information regarding each individual’s perceived confidence and physical capabilities. By knowing their perceived capabilities, one can modify how they handle an athlete by either pushing them more or being more cautious.

Do you think differences in patient-reported perceived ability at initial evaluation in athletes with and without history of injuries would be in other populations than the one used in the above study, such as populations consisting of high school athletes or professional athletes?

Jane McDevitt said...

I agree, I have not taken baseline patient-reported quality of life measures; however, I do think it would be helpful. I do believe that in a population of professional athletes this would be very helpful. Though, I am not sure if we would be able to see differences in high school. I think it will depend on their years of experience in the sport. A freshman who is in their first year of playing soccer may not truly know their capabilities. However, a senior who started playing soccer in elementary school may have a very good idea of their confidence and capabilities. I would be very interested to see if it is helpful in both of those populations.

Caroline L. said...

This article further solidifies the need for athletic trainers to incorporate patient reported outcomes (PROs) into their practice. As an athletic trainer at a college, I believe this article has important implications to consider for athletic trainers in the collegiate setting. In settings where athletic trainers have more 1 on 1 time with their athletes, these findings potentially have the ability to help identify athletes who are not completely rehabilitated from their previous injury. Although more research is needed to define threshold measurements to establish a minimal detectable difference between healthy and injured athletes, it provides a foundation for future research. By choosing and modifying the specific KOOS and KJOC PROs, the article was able to specify results to an athletic population. Other patient reported outcomes are applicable and useful but more focused on generalized populations and lower level activities than athletes are used to performing. I believe it is not only important to utilize PRO in practice, but also choose the best and most applicable ones. This article also provides an innovative technique beyond the normal application of PROs. As stated in the discussion, PROs are often utilized for for analyzing progress throughout rehabilitation. However as athletic trainers, we often go through periods of limited contact with our athletes where they obtain rehabilitative services through other resources. If an athlete is cleared to return to participation, it is still important to evaluate his or her subjective input on specific athletic abilities. This is an interesting perspective to consider further.

Jane McDevitt said...

I agree with you, specific PROs should be implemented when feasible. Some PROs cost money for license, can be time consuming to the patient and to the clinician when interpreting the data; however, there are many PRO that are free and are straightforward to interpret and implement. I would like to see more research like this discuss the MCIDs and other specific populations.

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