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Schulz JM, Pohlod L, Myers S, Chung J, Thornton JS. Are female athlete specific health considerations being assessed and addressed in preparticipation examinations? A scoping review and proposed framework. JOURNAL OF SPORT AND HEALTH SCIENCE 2024:100981. [PMID: 39244153 DOI: 10.1016/j.jshs.2024.100981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/24/2024] [Accepted: 04/23/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Preparticipation examinations (PPEs) are unstandardized screening tools routinely used to collect an athlete's baseline health information prior to the start of a new competitive season. However, many PPEs include minimal and often nonspecific questions related to the health concerns of female athletes. A lack of female athlete specific health questions could result in missed red flags and subsequent injury or illness. As such, the objectives of this scoping review were to (a) determine what female athlete specific health questions currently exist in PPEs in the scientific literature to prevent injury and illness, and (b) map the results against the health domains outlined in the International Olympic Committee (IOC) consensus statement supplement on the female athlete. METHODS We searched Embase, Scopus, CINAHL, Medline Ovid, and SPORTDiscus from inception to December 2022. Any study with female athlete specific health PPE questions or recommendations for questions (i.e., menstrual health, eating habits, musculoskeletal health, etc.) was included. Three reviewers independently screened titles and abstracts, followed by full text articles for eligibility and data extraction, with conflicts resolved by a third-party reviewer. Extracted data were summarized into 3 determined groupings. RESULTS Of the 1356 studies screened, 41 were included in this study. Forty studies (98%) included questions/recommendations related to menstrual health. Thirty-one studies (76%) had questions/recommendations concerning disordered eating/eating habits. Twenty-four studies (59%) referred to body weight/image, and 16 studies (39%) referred to musculoskeletal health. No studies included questions on all IOC female athlete health domains. CONCLUSION There is currently a gap in female athlete specific health content included in PPEs. A more comprehensive, standardized PPE with a focus on inclusion of female athlete specific health questions and considerations should be developed to improve health and optimal participation of female athletes around the world.
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Affiliation(s)
- Jenna M Schulz
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6G 2M1, Canada; Fowler-Kennedy Sport Medicine Clinic, Western University, London, ON N6A 3K7, Canada; Bone & Joint Institute, Western University, London, ON N6A 3K7, Canada.
| | - Lois Pohlod
- Clinical Masters in Sport and Exercise Medicine, Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Samantha Myers
- Fowler-Kennedy Sport Medicine Clinic, Western University, London, ON N6A 3K7, Canada; Clinical Masters in Sport and Exercise Medicine, Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Jason Chung
- Clinical Masters in Sport and Exercise Medicine, Faculty of Health Sciences, Western University, London, ON N6A 5B9, Canada
| | - Jane S Thornton
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON N6G 2M1, Canada; Fowler-Kennedy Sport Medicine Clinic, Western University, London, ON N6A 3K7, Canada; Bone & Joint Institute, Western University, London, ON N6A 3K7, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON N6G 2M1, Canada; School of Kinesiology, Faculty of Health Sciences, Western University, London, ON N6A 3K7, Canada
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Turska-Kmieć A, Neunhaeuserer D, Mazur A, Dembiński Ł, del Torso S, Grossman Z, Barak S, Hadjipanayis A, Peregud-Pogorzelski J, Kostka T, Bugajski A, Huss G, Kowalczyk-Domagała M, Wyszyńska J. Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes. Front Pediatr 2023; 11:1125958. [PMID: 37425260 PMCID: PMC10323832 DOI: 10.3389/fped.2023.1125958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.
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Affiliation(s)
- Anna Turska-Kmieć
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
- Polish PaediatricSociety, Warsaw, Poland
- Working Group on Sports Cardiology, Polish Cardiac Society, Warsaw, Poland
| | - Daniel Neunhaeuserer
- Sports and Exercise Medicine Division, University of Padova Department of Medicine, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Artur Mazur
- Polish PaediatricSociety, Warsaw, Poland
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - Łukasz Dembiński
- Polish PaediatricSociety, Warsaw, Poland
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Department of Paediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Stefano del Torso
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Childcare Worldwide, Padova, Italy
| | - Zachi Grossman
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Maccabi Health Services, Pediatric Clinic, Tel Aviv, Israel
| | - Shimon Barak
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adamos Hadjipanayis
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Paediatric Department, Larnaca General Hospital, Larnaca, Cyprus
| | - Jarosław Peregud-Pogorzelski
- Polish PaediatricSociety, Warsaw, Poland
- Department of Paediatrics, Paediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Medical University of Lodz, Lodz, Poland
- The Polish Society of Sports Medicine, Wroclaw, Poland
| | - Andrzej Bugajski
- The Polish Society of Sports Medicine, Wroclaw, Poland
- Department of Physiotherapy, College of Physiotherapy, Wroclaw, Poland
| | - Gottfried Huss
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Kinder-Permanence Hospital Zollikerberg, Zollikerberg, Switzerland
| | - Monika Kowalczyk-Domagała
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
- Working Group on Paediatric Cardiology, Polish Cardiac Society, Warsaw, Poland
| | - Justyna Wyszyńska
- Institute of Health Sciences, Medical College of Rzeszów University, Rzeszów, Poland
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Abstract
Pre-participation physical exams (PPEs) hold great potential for addressing adolescents’ health-risk behaviors. School nurses may be well positioned to assist with PPEs, yet little is known about their involvement. In this mixed methods study conducted in 2015, we collected data from school nurses in Texas (surveys, n = 208; key informant interviews, n = 10) to explore their roles and attitudes toward being involved in PPEs and addressing health-risk behaviors. Most respondents described minimal involvement in PPEs or were not involved to their full scope of practice. Most (69%) felt that school nurses are an untapped resource for addressing health-risk behaviors among student athletes. Interview participants felt that student athletes saw nurses as a “safe space” to talk about health-risk behaviors. Barriers included a lack of time, resources for follow-up, parental approval, and legal concerns. Study findings identify potential opportunities to support nurses’ involvement in addressing health-risk behaviors among student athletes.
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Affiliation(s)
- Karen E. Johnson
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Marian Morris
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN, USA
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Kroshus E. Variability in Institutional Screening Practices Related to Collegiate Student-Athlete Mental Health. J Athl Train 2016; 51:389-97. [PMID: 27111587 DOI: 10.4085/1062-6050-51.5.07] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Universal screening for mental health concerns, as part of the preparticipation examination in collegiate sports medicine settings, can be an important and feasible strategy for facilitating early detection of mental health disorders. OBJECTIVE To assess whether sports medicine departments at National Collegiate Athletic Association (NCAA) member colleges have policies related to identifying student-athlete mental health problems, the nature of preparticipation examination screening related to mental health, and whether other departmental or institutional screening initiatives are in place. I also aimed to characterize the variability in screening by institutional characteristics. DESIGN Cross-sectional study. SETTING College sports medicine departments. PATIENTS OR OTHER PARTICIPANTS Team physicians and head athletic trainers at NCAA member colleges (n = 365, 30.3% response rate). MAIN OUTCOME MEASURE(S) Electronic survey of departmental mental health screening activities. RESULTS A total of 39% of respondents indicated that their institution had a written plan related to identifying student-athletes with mental health concerns. Fewer than half reported that their sports medicine department administers a written or verbal screening instrument for symptoms of disordered eating (44.5%), depression (32.3%), or anxiety (30.7%). The strongest predictors of mental health screening were the presence of a written plan related to identifying student-athlete mental health concerns and the employment of a clinical psychologist. Additionally, Division I institutions and institutions with a greater ratio of athletic trainers to student-athletes tended to engage in more screening. CONCLUSIONS The substantial among-institutions variability in mental health screening suggests that opportunities exist to make these practices more widespread. To address this variability, recent NCAA mental health best-practice guidelines suggested that institutions should screen for a range of mental health disorders and risk behaviors. However, at some institutions, staffing deficits may need to be addressed to allow for implementation of screening-related activities.
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Affiliation(s)
- Emily Kroshus
- Department of Pediatrics, University of Washington; Seattle Children's Research Institute, Center for Child Health, Behavior, and Development
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Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers' Association position statement: Preparticipation physical examinations and disqualifying conditions. J Athl Train 2015; 49:102-20. [PMID: 24499039 DOI: 10.4085/1062-6050-48.6.05] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To present athletic trainers with recommendations for the content and administration of the preparticipation physical examination (PPE) as well as considerations for determining safe participation in sports and identifying disqualifying conditions. BACKGROUND Preparticipation physical examinations have been used routinely for nearly 40 years. However, considerable debate exists as to their efficacy due to the lack of standardization in the process and the lack of conformity in the information that is gathered. With the continuing rise in sports participation at all levels and the growing number of reported cases of sudden death in organized athletics, the sports medicine community should consider adopting a standardized process for conducting the PPE to protect all parties. RECOMMENDATIONS Recommendations are provided to equip the sports medicine community with the tools necessary to conduct the PPE as effectively and efficiently as possible using available scientific evidence and best practices. In addition, the recommendations will help clinicians identify those conditions that may threaten the health and safety of participants in organized sports, may require further evaluation and intervention, or may result in potential disqualification.
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Kennedy MD, Fischer R, Fairbanks K, Lefaivre L, Vickery L, Molzan J, Parent E. Can pre-season fitness measures predict time to injury in varsity athletes?: a retrospective case control study. Sports Med Arthrosc Rehabil Ther Technol 2012; 4:26. [PMID: 22824555 PMCID: PMC3439385 DOI: 10.1186/1758-2555-4-26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 07/23/2012] [Indexed: 11/29/2022]
Abstract
Background The ability to determine athletic performance in varsity athletes using preseason measures has been established. The ability of pre-season performance measures and athlete’s exposure to predict the incidence of injuries is unclear. Thus our purpose was to determine the ability of pre-season measures of athletic performance to predict time to injury in varsity athletes. Methods Male and female varsity athletes competing in basketball, volleyball and ice hockey participated in this study. The main outcome measures were injury prevalence, time to injury (based on calculated exposure) and pre-season fitness measures as predictors of time to injury. Fitness measures were Apley’s range of motion, push-up, curl-ups, vertical jump, modified Illinois agility, and sit-and-reach. Cox regression models were used to identify which baseline fitness measures were predictors of time to injury. Results Seventy-six percent of the athletes reported 1 or more injuries. Mean times to initial injury were significantly different for females and males (40.6% and 66.1% of the total season (p < 0.05), respectively). A significant univariate correlation was observed between push-up performance and time to injury (Pearson’s r = 0.332, p < 0.01). No preseason fitness measure impacted the hazard of injury. Regardless of sport, female athletes had significantly shorter time to injury than males (Hazard Ratio = 2.2, p < 0.01). Athletes playing volleyball had significantly shorter time to injury (Hazard Ratio = 4.2, p < 0.01) compared to those playing hockey or basketball. Conclusions When accounting for exposure, gender, sport and fitness measures, prediction of time to injury was influenced most heavily by gender and sport.
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Affiliation(s)
- Michael D Kennedy
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Robyn Fischer
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kristine Fairbanks
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lauren Lefaivre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lauren Vickery
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Janelle Molzan
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eric Parent
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada
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Judge LW, Stone MH, Craig B. Reconditioning the Postcompetitive Football Lineman: Recognizing the Problem. Strength Cond J 2010. [DOI: 10.1519/ssc.0b013e3181df8963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The International Olympic Committee (IOC) consensus statement on periodic health evaluation of elite athletes: March 2009. J Athl Train 2010; 44:538-57. [PMID: 19771295 DOI: 10.4085/1062-6050-44.5.538] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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The International Olympic Committee (IOC) consensus statement on periodic health evaluation of elite athletes, March 2009. Clin J Sport Med 2009; 19:347-65. [PMID: 19741306 DOI: 10.1097/jsm.0b013e3181b7332c] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Mottram S, Comerford M. A new perspective on risk assessment. Phys Ther Sport 2008; 9:40-51. [DOI: 10.1016/j.ptsp.2007.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 11/04/2007] [Accepted: 11/09/2007] [Indexed: 10/22/2022]
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Prevalence of and risk factors associated with symptoms of depression in competitive collegiate student athletes. Clin J Sport Med 2007; 17:481-7. [PMID: 17993792 DOI: 10.1097/jsm.0b013e31815aed6b] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the prevalence of symptoms of depression among competitive collegiate student athletes and examine the factors associated with symptoms of depression among this population. DESIGN A baseline survey of a prospective cohort study. SETTING The survey was administered at the preseason team meetings. PARTICIPANTS The sample included 257 collegiate student athletes (167 males and 90 females) who participated in Division I National Collegiate Athletic Association (NCAA)-sponsored sports during the 2005-2006 academic year. MAIN OUTCOME MEASUREMENTS Symptoms of depression were measured by the Center for Epidemiological Studies Depression Scale (CESD). Anxiety was measured by the State-Trait Anxiety Inventory (STAI). The Generalized Estimating Equations (GEE) was used to assess the factors associated with symptoms of depression. RESULTS Twenty-one percent of participants reported experiencing symptoms of depression. Athletes who were female, freshmen, or with self-reported pain were associated with significantly increased odds of experiencing symptoms of depression after adjusting for sports and other covariates. In particular, female athletes had 1.32 greater odds (95% CI, 1.01 to 1.73) of experiencing symptoms of depression compared to male student athletes. Freshmen had 3.27 greater odds (95% CI, 1.63 to 6.59) of experiencing symptoms of depression than their more senior counterparts. Student athletes who reported symptoms of depression were associated with higher scores of State-Anxiety and Trait-Anxiety, respectively (P<0.0001). CONCLUSIONS Our findings provide empirical data for the future study on mental health among collegiate athletes. Further studies on why female and freshmen athletes are at increased risk of experiencing symptoms of depression are also warranted.
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McDuff DR, Morse ED, White RK. Professional and collegiate team assistance programs: services and utilization patterns. Clin Sports Med 2006; 24:943-58, x-xi. [PMID: 16169455 DOI: 10.1016/j.csm.2005.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Elite professional and collegiate athletes underuse stress control, mental health, and substance abuse treatment services. Behavioral health services use can be increased by establishing on-site, sports-specific services. Like Employee Assistance Programs of industry and government, Team Assistance Programs (TAPs) address critical issues such as substance abuse prevention, tobacco cessation, stress recognition, mental illness management, injury rehabilitation, performance enhancement, and cultural support. Strong links with the team's medical and conditioning staff can ensure a steady stream of TAP referrals and build trust with players and team staff. This article describes nine years of operation for two professional TAPs and three years for one college TAP. Use patterns and linkage strategies with team physicians, trainers, strength staff, chiropractors, and nutritionists are discussed.
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Affiliation(s)
- David R McDuff
- Division of Alcohol and Drug Abuse, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Abstract
Participation in sports is important to many college students. Student athletes come from different levels of previous sport experience as they enter collegiate athletics. The primary source of student medical care is the campus student health center. The health care providers at student health centers attend to many of the sports-related concerns of student athletes. Preparticipation evaluation provides an opportunity to assess the general health of the student athlete and to identify conditions that might increase the risk of further injury. Sudden cardiac death and sports-associated concussions have generated much interest and are reviewed in this article. Other areas reviewed here include use of drugs and supplements, ankle sprains, acute knee ligament injuries, back pain, and shoulder impingement syndrome.
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Affiliation(s)
- Dilip R Patel
- Michigan State University, Kalamazoo Center for Medical Studies, 1000 Oakland Drive, Kalamazoo, MI 49008, USA.
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