Normative SF-36 values in competing NCAA intercollegiate athletes differ from values in the general population

Health-related quality of life in young Norwegian survivors of out-of-hospital cardiac arrest related to pre-arrest exercise habits

Aim

To compare health-related quality of life (HRQoL) in young survivors of out-of-hospital cardiac arrest (OHCA) in Norway with an age and sex-matched reference population and to assess the associations between exercise volume prior to OHCA and HRQoL after.

Methods

We present data from survivors aged 18-50 years registered with OHCA in the Norwegian Cardiac Arrest Registry between January 1st 2015 and December 31st 2017. Survivors were invited to answer two questionnaires; (1) the Short Form 36 (SF-36) Health Survey Version 1, and (2) about exercise habits prior to OHCA. Respondents were randomly matched 1:1 for age and sex with a reference population (data were available from the Norwegian Centre for Research Data).

Results

Of the 175 survivors invited, 95 (54%) responded, median age was 44 (range 35-48) years, 26 (27%) females. Valid results for SF-36 were available for 91 survivors, of whom 87 reported pre-OHCA exercise-volume. Prior to OHCA, 21 did no regular exercise, 44 exercised 1-4 hours/week and 22 exercised ≥5 hours/week. Compared to the reference population survivors had significantly (p < 0.01) poorer SF-36 scores for scales relating to physical- and mental health. SF-36 scale scores were similar in survivors who did and did not exercise regularly. Within the regular exercisers, survivors reporting ≥5 hours of exercise/week had better SF-36 scores than those exercising less.

Conclusion

Poorer HRQoL in survivors compared to the reference population should prompt us to explore how treatment and rehabilitation could be improved and adapted. More exercise before OHCA favoured better HRQoL after, which aligns well with the recognised positive association between HRQoL and physical activity in general.

Interpreting patient-rated outcome measures in adolescent patients following concussion

OBJECTIVE

To estimate scale scores for patient-reported outcome (PRO) measures that classify patients as improved or unimproved at days 3 and 10 post-concussion.

METHODS

Data from 187 adolescent patients who sustained a concussion (150 males, 32 females, 5 not reported) were analyzed. Patients completed the Pediatric Quality of Life Inventory (PedsQL), PedsQL Multidimensional Fatigue Scale (MFS), Headache Impact Test (HIT-6), and Global Rating of Change (GROC) on days 3 and 10 post-concussion. Dependent variables: PedsQL total score, 3 MFS subscale scores [general (MFS-GF), sleep (MFS-SLF), cognitive (MFS-CF) fatigue], and HIT-6 total score. Higher scores on PedsQL and MFS indicate better health; lower scores on HIT-6 indicate less impact on headache-related health. GROC ascertained patient-perceived magnitude of change in health status since concussion. Receiver Operating Characteristic Curve analyses estimated PRO cut-point scores that classified patients as improved or unimproved.

RESULTS

Day 3 PRO cut-points: PedsQL total = 90; MFS-GF = 73; MSF-CF = 85; MFS-SLF = 81; and HIT-6 total = 54. Day 10 PRO cut-points: PedsQL total = 91; MFS-GF = 85; MFS-CF = 85; MFS-SLF = 90; and HIT-6 total = 51.

CONCLUSIONS

Our results define PedsQL, MFS, and HIT-6 scores as they relate to perceived improvement following concussive injuries. Cut-point scale scores help clinicians interpret concussion PROs and make informed decisions during the management of patients with concussion.

Knee Injury Detection Using Deep Learning on MRI Studies: A Systematic Review

The improved treatment of knee injuries critically relies on having an accurate and cost-effective detection. In recent years, deep-learning-based approaches have monopolized knee injury detection in MRI studies. The aim of this paper is to present the findings of a systematic literature review of knee (anterior cruciate ligament, meniscus, and cartilage) injury detection papers using deep learning. The systematic review was carried out following the PRISMA guidelines on several databases, including PubMed, Cochrane Library, EMBASE, and Google Scholar. Appropriate metrics were chosen to interpret the results. The prediction accuracy of the deep-learning models for the identification of knee injuries ranged from 72.5–100%. Deep learning has the potential to act at par with human-level performance in decision-making tasks related to the MRI-based diagnosis of knee injuries. The limitations of the present deep-learning approaches include data imbalance, model generalizability across different centers, verification bias, lack of related classification studies with more than two classes, and ground-truth subjectivity. There are several possible avenues of further exploration of deep learning for improving MRI-based knee injury diagnosis. Explainability and lightweightness of the deployed deep-learning systems are expected to become crucial enablers for their widespread use in clinical practice.

High School Athletes’ Health-Related Quality of Life Across Recovery After Sport-Related Concussion or Acute Ankle Injury: A Report From the Athletic Training Practice-Based Research Network

Background:

Evaluating adolescent athletes’ perceived health status after a sport-related injury can provide important direction for health promotion strategies and preparation for a successful return to play. Furthermore, comparing specific injury types regarding their impact on athletes' perspectives of their global and domain-specific health perceptions allows for a more detailed understanding of an athlete's experience while also providing avenues for targeted treatment strategies.

Purpose:

To compare health-related quality of life (HRQOL) between high school athletes who had sustained either a concussion or an acute ankle injury and compare how these injury types related to their global and domain-specific HRQOL across recovery.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Electronic medical records created by athletic trainers working in 32 high school facilities were examined, and records from 1749 patients who sustained either a sport-related concussion (n = 862) or ankle sprain (n = 887) were screened for inclusion. HRQOL was assessed by self-reported scores on the Pediatric Quality of Life Inventory (PedsQL) at 2 time points after injury (T₁ = 0-2 days; T₂ = 11-29 days). A 2-way group by time analysis of variance was conducted to examine differences in trajectories and disrupted areas of HRQOL.

Results:

Overall, 85 patient cases (46 concussion, 39 ankle sprain) fit the inclusion criteria. Each injury group exhibited improved global and domain-specific PedsQL scores between their 2 measured time points (P < .05), indicating recovery. However, domain-specific comparisons revealed that at T₂, patients who had sustained an ankle sprain reported significantly lower PedsQL physical functioning scores (78.3 ± 19.3 vs 86.2 ± 15.7 for concussion; P = .005), whereas patients who had sustained a concussion reported lower scores related to their school functioning (80.0 ± 20.0 vs 90.8 ± 12.7 for ankle sprain; P = .006).

Conclusion:

The study results indicated that in high school athletes, the trajectories and disrupted areas of HRQOL stemming from a sport-related injury may be influenced differentially when comparing concussions with ankle sprains.

Searching for the Holy Grail: A Systematic Review of Health-Related Quality of Life Measures for Active Youth

OBJECTIVE

To identify the most suitable existing generic and condition-specific health-related quality of life (HRQoL) patient-reported outcome measures (PROMs) for active youth with and without a musculoskeletal injury, based on measurement properties, interpretability, and feasibility.

DESIGN

Systematic review of clinimetrics.

LITERATURE SEARCH

We searched MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and Scopus from inception to April 30, 2020.

STUDY SELECTION CRITERIA

Records with original data describing the evaluation of a PROM or PROM subscale in active youth (15-24 years old) with or without a musculoskeletal injury were included. Non-English studies and those including individuals with a cognitive, developmental, or systemic condition were excluded.

DATA SYNTHESIS

This review was conducted according to the COSMIN user manual for systematic reviews of PROMs and the PRISMA guidelines. The COSMIN user manual guided our measurement property evaluation and interpretability and feasibility description.

RESULTS

Of 6931 potential records, 21 studies were included. Eleven generic and 7 condition-specific PROMs were identified. No PROM received a final COSMIN recommendation of "A" because all lacked sufficient content validity. The 8-item Disablement in the Physically Active scale-mental summary component Short Form (DPA-MSC SF-8), Quality of Life Survey, and Functional Arm Scale for Throwers (FAST) were the most suitable existing PROMs, given their high-quality evidence for sufficient structural validity and internal consistency.

CONCLUSION

No definitively robust PROM for measuring generic or condition-specific HRQoL of active youth was identified. Until one exists, we recommend the DPA-MSC SF-8, the Quality of Life Survey, or the FAST and applying mixed methods to best characterize the HRQoL of active youth. J Orthop Sports Phys Ther 2021;51(10):478-491. doi:10.2519/jospt.2021.10412.

Measuring psychological pain: psychometric analysis of the Orbach and Mikulincer Mental Pain Scale

Background

Suicide is a public health concern, with an estimated 1 million individuals dying each year worldwide. Individual psychological pain is believed to be a contributing motivating factor. Therefore, establishing a psychometrically sound tool to adequately measure psychological pain is important. The Orbach and Mikulincer Mental Pain Scale (OMMP) has been proposed; however, previous psychometric analysis on the OMMP has not yielded a consistent scale structure, and the internal consistency of the subscales has not met recommended values. Therefore, the primary purpose of this study was to assess the psychometric properties of the OMMP in a diverse sample.

Methods

A confirmatory factor analysis (CFA) on the 9-factor, 44-item OMMP was conducted on the full sample (n = 1151). Because model fit indices were not met, an exploratory factor analysis (EFA) was conducted on a random subset of the data (n = 576) to identify a more parsimonious structure. The EFA structure was then tested in a covariance model in the remaining subset of participants (n = 575). Multigroup invariance testing was subsequently performed to examine psychometric properties of the refined scale.

Results

The CFA of the original 9-factor, 44-item OMMP did not meet recommended model fit recommendations. The EFA analysis results revealed a 3-factor, 9-item scale (i.e., OMMP-9). The covariance model of the OMMP-9 indicated further refinement was necessary. Multigroup invariance testing conducted on the final 3-factor, 8-item scale (i.e., OMMP-8) across mental health diagnoses, sex, injury status, age, activity level, and athlete classification met all criteria for invariance.

Conclusions

The 9-factor, 44-item OMMP does not meet recommended measurement criteria and should not be recommended for use in research and clinical practice in its current form. The refined OMMP-8 may be a more viable option to use; however, more research should be completed prior to adoption.

Supplementary Information

The online version contains supplementary material available at 10.1186/s42409-021-00025-8.

Invariance Testing of the Disablement in the Physically Active Scale

CONTEXT

The increased emphasis on implementing evidence-based practice has reinforced the need to more accurately assess patient improvement. Psychometrically sound, patient-reported outcome measures are essential for evaluating patient care. A patient-reported outcome instrument that may be useful for clinicians is the Disablement in the Physically Active Scale (DPAS). Before adopting this scale, however, researchers must evaluate its psychometric properties, particularly across subpopulations.

OBJECTIVE

To evaluate the psychometric properties of the DPAS in a large sample using confirmatory factor analysis procedures and assess structural invariance of the scale across sex, age, injury status, and athletic status groups.

DESIGN

Observational study.

SETTING

Twenty-two clinical sites.

PATIENTS OR OTHER PARTICIPANTS

Of 1445 physically active individuals recruited from multiple athletic training clinical sites, data from 1276 were included in the analysis. Respondents were either healthy or experiencing an acute, subacute, or persistent musculoskeletal injury.

MAIN OUTCOME MEASURE(S)

A confirmatory factor analysis was performed on the full sample, and multigroup invariance testing was conducted to assess differences across sex, age, injury status, and athletic status. Given the poor model fit, alternate model generation was used to identify a more parsimonious factor structure.

RESULTS

The DPAS did not meet contemporary fit index recommendations or the criteria to demonstrate structural invariance. We identified an 8-item model that met the model fit recommendations using alternate model generation.

CONCLUSIONS

The 16-item DPAS did not meet the model fit recommendations and may not be the most parsimonious or reliable measure for assessing disablement and quality of life. Use of the 16-item DPAS across subpopulations of interest is not recommended. More examination involving a true cross-validation sample should be completed on the 8-item DPAS before this scale is adopted in research and practice.

The Impact of a Previous Ankle Injury on Current Health-Related Quality of Life in College Athletes

CONTEXT

There has been an increased interest in understanding how ankle injuries impact patient outcomes; however, it is unknown how the severity of a previous ankle injury influences health-related quality of life (HRQOL).

OBJECTIVE

To determine the impact of a previous ankle injury on current HRQOL in college athletes.

DESIGN

Cross-sectional study.

SETTING

Athletic training clinics.

PARTICIPANTS

A total of 270 participants were grouped by the severity of a previous ankle injury (severe = 62, mild = 65, and no injury = 143).

MAIN OUTCOME MEASURES

Participants completed the Foot and Ankle Ability Measure (FAAM) and the Short Form 12 (SF-12).

METHODS

A 2-way analysis of variance with 2 factors (injury group and sex) was used to identify interaction and main effects for the FAAM and SF-12.

RESULTS

No interactions were identified between injury group and sex. Significant main effects were observed for injury group, where the severe injury group scored lower than athletes with mild and no injuries on the FAAM activities of daily living, FAAM Global, and SF-12 mental health subscale scores. In addition, a main effect was present for sex in the SF-12 general health, social functioning, and mental health subscales in which females reported significantly lower scores than males.

CONCLUSIONS

Our findings suggest that a severe ankle injury impacts HRQOL, even after returning back to full participation. In addition, females tended to report lower scores than males for aspects of the SF-12, suggesting that sex should be considered when evaluating HRQOL postinjury. As a result, clinicians should consider asking athletes about their previous injury history, including how much time was lost due to the injury, and should mindful of returning athletes to play before they are physiologically and psychologically ready, as there could be long-term negative effects on the patients' region-specific function as well as aspects of their HRQOL.

An Updated Model of Chronic Ankle Instability

Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.

SF-36 normative values according to level of functioning in older women

PURPOSE

The 36-item Medical Outcome Study Short Form (SF-36) survey measures health-related quality of life. Age and disease-specific normative values have been published, but a focus on level of functioning may be more meaningful in case of multimorbidity. We estimated normative values for Australian women aged 79-90 years according to levels of functioning.

METHODS

Data were from 6127 (aged 79-84 in 2005) and 3424 (aged 85-90 in 2011) participants in the Australian Longitudinal Study on Women's Health. Surveys included the SF-36 and information on housing. Record linkage to assessment data for access to the national program for aged care support was used to obtain information on participants' need for assistance with 10 activities. Normative values were calculated for physical component (PCS), mental component (MCS), and subscale scores for subsamples defined by types of assistance needed.

RESULTS

At the ages of 79-84, the mean (95% confidence interval) PCS and MCS values for women not any needing assistance were 37.5 (37.2-37.9) and 53.0 (52.8-53.3) compared to 29.0 (27.8-30.2) and 45.9 (44.4-47.4) for women needing any assistance. At ages 85-90, the corresponding PCS values were 34.9 (34.5-35.4) vs. 28.2 (27.4-29.0) and the corresponding MCS values were 53.2 (52.8-53.6) vs. 48.7 (47.8-49.6). Values were higher for participants living in the community or retirement village vs. nursing homes/hostels. The PCS, MCS and 8 subscale values decreased as the need for assistance with more basic activities increased.

CONCLUSIONS

These normative values facilitate meaningful interpretation of SF-36 scores from the perspective of level of functioning.

The Impact of Knee Injury History on Health-Related Quality of Life in Adolescent Athletes

CONTEXT

Current evidence suggests that, despite returning to full participation, physically active adults with a previous knee injury experience lower health-related quality of life (HRQOL) than those with no knee injury history. It is unknown if this relationship is present in adolescent athletes.

OBJECTIVE

To determine the impact of knee injury history on HRQOL in adolescent athletes who were medically cleared for full participation.

DESIGN

Cross-sectional.

SETTING

Athletic training clinics.

PARTICIPANTS

A convenience sample of 183 adolescent athletes, who were medically cleared for full participation, were grouped by self-report of a previous knee injury: positive knee injury history (HIS; n = 36, age = 15.7 [1.4] y, height = 168.0 [11.9] cm, and weight = 71.8 [11.9] kg) and no knee injury history (NO-HIS; n = 147, age = 15.5 [1.4] y, height = 166.0 [10.5] cm, and weight = 67.6 [14.6] kg).

INTERVENTIONS

Participants completed the Pediatric International Knee Documentation Committee form and Pediatric Quality of Life Inventory during their preparticipation examination.

MAIN OUTCOME MEASURES

Generalized linear models were used to compare group differences for the total and subscale scores of the Pediatric International Knee Documentation Committee and Pediatric Quality of Life Inventory.

RESULTS

Main effects of injury group indicated that the HIS group reported significantly lower scores than the NO-HIS group for the Pediatric International Knee Documentation Committee total score (P < .001; HIS = 79.2 [21.7], NO-HIS = 95.8 [8.6]) and for the Pediatric Quality of Life Inventory total (P = .001; HIS = 85.7 [10.9], NO-HIS = 90.9 [7.3]), physical functioning (P = .002; HIS = 86.7 [13.6], NO-HIS = 92.1 [8.2]), school functioning (P = .01; HIS = 80.6 [12.4], NO-HIS = 86.8 [12.2]), and social functioning (P = .01; HIS = 89.3 [12.4], NO-HIS = 94.6 [8.9]) scores. No group differences were reported for the emotional functioning subscale (P = .13; HIS = 85.7 [17.7], NO-HIS = 89.7 [13.1]). No interactions or main effects of sex were reported (P > .05).

CONCLUSIONS

Our findings suggest that, despite returning to full sport participation, adolescent athletes with a previous knee injury generally experience lower HRQOL than their peers with no knee injury history, specifically for knee-specific HRQOL, physical functioning, school functioning, and social functioning. Our results are similar to previous findings reported in college athletes and military cadets.

The Long-Term Impact of Osteoarthritis Following Knee Surgery in Former College Athletes

CONTEXT

Individuals who sustain a knee surgery have been shown to have an increased likelihood to develop osteoarthritis (OA).

OBJECTIVE

Identify the consequences of knee surgery in a cohort of former college athletes.

DESIGN

Cross-sectional.

SETTING

Research laboratory.

PARTICIPANTS

A group of 100 former Division I college athletes aged 40-65 years (60 males and 40 females) participated in the study.

INTERVENTIONS

All individuals self-reported whether they sustained a knee injury during college requiring surgery and if they have been diagnosed with knee OA by a medical physician post knee injury. Individuals were categorized into 3 groups: no history of knee injury requiring surgery (33 males and 24 females; 54.53 [5.95] y), history of knee surgery in college with no diagnosis of OA later in life (4 males and 6 females; 51.26 [7.29] y), and history of knee surgery in college with physician diagnosed OA later in life (23 males and 10 females; 54.21 [7.64] y). All individuals completed the knee injury and osteoarthritis outcome score (KOOS) and short form-36 version 2.

MAIN OUTCOME MEASURES

Scores on the KOOS and short form-36 version 2.

RESULTS

A majority (76.7%) of individuals who had a knee surgery in college did develop OA. The largest mean differences were between the healthy knee and surgical knee/OA groups on the KOOS-quality of life scale (mean difference: 49.76; χ2(3) = 44.65; P < .001) and KOOS-sports scale (mean difference: 43.69; χ2(3) = 28.69; P < .001), with the surgical knee/OA group scoring worse.

CONCLUSIONS

Later in life functional limitations were observed in individuals who sustained a knee injury requiring surgery and developed OA. These findings support increased efforts toward prevention of knee injuries and consideration of the long-term implication when making treatment and return to activity decisions.

Health-related quality of life is decreased in middle-aged adults with chronic ankle instability

OBJECTIVES

The purpose of this study was to determine whether health-related quality of life and region-specific outcomes differ between middle-aged adults with and without chronic ankle instability.

DESIGN

Cross-sectional.

METHODS

Two hundred middle-aged individuals (40 years or older) volunteered to participate in the study. There were 75 individuals classified as having chronic ankle instability (51.5±7.3years, 175.8±3.7cm, 86.5±18.9kg) and 125 classified as not having chronic ankle instability (53.2±7.3years, 176.2±5.4cm, 81.3±17.6kg). Participants completed the Identification of Functional Ankle Instability as the inclusionary survey and the Internal Ankle Consortium guidelines were followed to classify individuals. Following the inclusionary survey participants completed the American Academy of Orthopaedic Surgeons Lower Limb Questionnaire and the Short Form-36 v2.

RESULTS

The Academy of Orthopaedic Surgeons Lower Limb Questionnaire, and the Physical Component Summary score of the Short Form-36 v2 were statistically different between groups (p<0.05). Specifically, the mean difference was 16.7 points and 12.3 points for the Academy of Orthopaedic Surgeons Lower Limb Questionnaire and the Physical Component Summary score, respectively, with the CAI participants scoring worse.

CONCLUSIONS

Individuals with CAI displayed decreased generic health-related quality of life and reduced region-specific ankle function.

Improving ACL Reconstruction Outcomes

Anterior cruciate ligament (ACL) reconstruction is a common and predominantly successful surgical intervention. But are there specific preoperative patient characteristics or intraoperative surgeon decisions that lead to better or worse outcomes? And can understanding brain function changes of patients after ACL reconstruction reveal insights into the ways that postsurgical rehabilitation can be improved to further enhance outcomes? These intriguing and clinically applicable questions are addressed in this webinar titled "Improving ACL Reconstruction Outcomes," hosted jointly by JOSPT and JBJS. The webinar is based on 2 published research articles-one from JBJS and the other from JOSPT. Participants in this continuing education activity are asked to read both articles carefully before watching the webinar. JBJS co-author Kurt Spindler, MD, discusses findings from a longitudinal analysis that identified certain baseline patient characteristics and intraoperative choices that predicted higher and lower SF-36 Physical Component scores after ACL reconstruction. JOSPT co-author Dustin Grooms, PhD, ATC, shares recently published results of a controlled laboratory study that employed functional MRI to investigate brain-activation differences between patients who did and did not undergo ACL reconstruction. Moderated by Kevin Wilk, PT, DPT, FAPTA, a leading authority on rehabilitation of sports injuries, the webinar includes additional insights from expert commentators Eric McCarty, MD, and Karin Grävare Silbernagel, PT, PhD, ATC.

The Cost-Effectiveness of Anterior Cruciate Ligament Reconstruction in Competitive Athletes

BACKGROUND

Competitive athletes value the ability to return to competitive play after the treatment of anterior cruciate ligament (ACL) injuries. ACL reconstruction has high success rates for return to play, but some studies indicate that patients may do well with nonoperative physical therapy treatment.

PURPOSE

To evaluate the cost-effectiveness of the treatment of acute ACL tears with either initial surgical reconstruction or physical therapy in competitive athletes.

STUDY DESIGN

Economic and decision analysis; Level of evidence, 2.

METHODS

The incremental cost, incremental effectiveness, and incremental cost-effectiveness ratio (ICER) of ACL reconstruction compared with physical therapy were calculated from a cost-effectiveness analysis of ACL reconstruction compared with physical therapy for the initial management of acute ACL injuries in competitive athletes. The ACL reconstruction strategy and the physical therapy strategy were represented as Markov models. Costs and quality-adjusted life-years (QALYs) were evaluated over a 6-year time horizon and were analyzed from a societal perspective. Quality of life and probabilities of clinical outcomes were obtained from the peer-reviewed literature, and costs were compiled from a large academic hospital in the United States. One-way, 2-way, and probabilistic sensitivity analyses were used to assess the effect of uncertainty in variables on the ICER of ACL reconstruction.

RESULTS

The ICER of ACL reconstruction compared with physical therapy was $22,702 per QALY gained. The ICER was most sensitive to the quality of life of returning to play or not returning to play, costs, and duration of follow-up but relatively insensitive to the rates and costs of complications, probabilities of return to play for both operative and nonoperative treatments, and discount rate.

CONCLUSION

ACL reconstruction is a cost-effective strategy for competitive athletes with an ACL injury.

The Effect of Cold Showering on Health and Work: A Randomized Controlled Trial

Purpose

The aim of this study was to determine the cumulative effect of a routine (hot-to-) cold shower on sickness, quality of life and work productivity.

Methods

Between January and March 2015, 3018 participants between 18 and 65 years without severe comorbidity and no routine experience of cold showering were randomized (1:1:1:1) to a (hot-to-) cold shower for 30, 60, 90 seconds or a control group during 30 consecutive days followed by 60 days of showering cold at their own discretion for the intervention groups. The primary outcome was illness days and related sickness absence from work. Secondary outcomes were quality of life, work productivity, anxiety, thermal sensation and adverse reactions.

Results

79% of participants in the interventions groups completed the 30 consecutive days protocol. A negative binomial regression model showed a 29% reduction in sickness absence for (hot-to-) cold shower regimen compared to the control group (incident rate ratio: 0.71, P = 0.003). For illness days there was no significant group effect. No related serious advents events were reported.

Conclusion

A routine (hot-to-) cold shower resulted in a statistical reduction of self-reported sickness absence but not illness days in adults without severe comorbidity.

Trial Registration

Netherlands National Trial Register NTR5183

Late correction of neck deformity in healed severe slipped capital femoral epiphysis: short-term clinical outcomes

PURPOSE

Contemporary methods for the management of neck deformity following a healed severe slipped capital femoral epiphysis (SCFE) include subcapital neck osteotomy.

METHODS

18 patients with chronic severe SCFE in the oblique plane (mean slip angle = 70°) constituted the study group. 6 patients with an open physis underwent modified Dunn capital realignment and 12 patients with a closed physis underwent surgical dislocation with a corrective neck osteotomy. 10 patients already had an in-situ pinning.

RESULTS

The mean follow-up was 4.5 years (3-6 years). The mean preoperative modified Harris Hip Score (mHHS) and nonarthritic hip score (NAHS) were 24 and 40 respectively, followed by a score of 89 and 92 respectively at the last follow-up (p = 0.0002). Radiologically, all the parameters showed a significant correction. The mean pre- and postoperative values of alpha angle were 79.8 and 34.5 respectively (p = 0.0002); AP slip angle being 36.7 and 14.8 (p = 0.002); lateral slip angle being 54.2 and 13.6 (p = 0.0002); oblique plane slip angle being 70.7 and 20.8 (p = 0.0002) and centre trochanter distance being -6.9 and 1.2 (p = 0.002). The major complications seen were nonunion of the neck osteotomy (n = 1/12) and chondrolysis (n = 1/6) in the modified Dunn's group. The overall complication rate was 11%. There was no statistically significant difference in outcome between the 2 groups clinically and radiologically.

CONCLUSIONS

Femoral neck osteotomy is a potentially rewarding technique to correct severe neck deformities and restoring hip function in the short term.

Health-Related Quality of Life in Athletes: A Systematic Review With Meta-Analysis

CONTEXT

Assessment of health-related quality of life (HRQOL) after injury is important. Differences in HRQOL between nonathletes and athletes and between injured and uninjured athletes have been demonstrated; however, the evidence has not been synthesized.

OBJECTIVE

To answer the following questions: (1) Does HRQOL differ among adolescent and collegiate athletes and nonathletes? (2) Does HRQOL differ between injured adolescent and collegiate athletes or between athletes with a history of injury and uninjured athletes or those without a history of injury?

DATA SOURCES

We systematically searched CINAHL, MEDLINE, SPORTDiscus, and PubMed. A hand search of references was also conducted.

STUDY SELECTION

Studies were included if they used generic instruments to compare HRQOL outcomes between athletes and nonathletes and between uninjured and injured athletes. Studies were excluded if they did not use a generic instrument, pertained to instrument development, or included retired athletes or athletes with a chronic disease.

DATA EXTRACTION

We assessed study quality using the modified Downs and Black Index Tool. Bias-corrected Hedges g effect sizes and 95% confidence intervals (CIs) were calculated. The Strength of Recommendation Taxonomy (SORT) was used to determine the overall strength of the recommendation. A random-effects meta-analysis was performed for all studies using the composite or total score.

DATA SYNTHESIS

Eight studies with modified Downs and Black scores ranging from 70.6% to 88.4% were included. For question 1, the overall random-effects meta-analysis was weak (effect size = 0.27, 95% confidence interval = 0.14, 0.40; P < .001). For question 2, the overall random-effects meta-analysis was moderate (effect size = 0.68, 95% confidence interval = 0.42, 0.95; P < .001).

CONCLUSIONS

Grade A evidence indicates that athletes reported better HRQOL than nonathletes and that uninjured athletes reported better HRQOL than injured athletes. However, the overall effect for question 1 was weak, suggesting that the differences between athletes and nonathletes may not be clinically meaningful. Clinicians should monitor HRQOL after injury to ensure that all dimensions of health are appropriately treated.

Quality of life in anterior cruciate ligament-deficient individuals: a systematic review and meta-analysis

BACKGROUND

Physical and psychological impairments impacting quality of life (QOL) are common following ACL reconstruction. Rehabilitation alone is an effective alternative to reconstruction for some patients, warranting the investigation of QOL in ACL-deficient individuals.

PURPOSE

To report and compare QOL in ACL-deficient individuals with population norms and ACL-reconstructed groups, and investigate relationships between participant characteristics and QOL.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

We systematically identified and methodologically appraised all studies reporting QOL in ACL-deficient individuals ≥5 years following ACL rupture. Knee-related and health-related QOL scores in ACL-deficient cohorts were compared to ACL-reconstructed groups using a random-effects meta-analysis. Descriptive comparisons were made with population norms.

RESULTS

Eleven studies reported QOL in 473 ACL-deficient individuals, a mean of 10 (range 5-23) years following ACL rupture. Eight studies reported knee-related QOL using the Knee injury and Osteoarthritis Outcome Score QOL subscale (KOOS-QOL); scores (mean±SD) ranging from 54±17 to 77±22 were impaired compared to population norms. Health-related QOL, measured with the SF-36 domain scores in five studies, was similar to population norms, but impaired compared to physically active populations. Meta-analysis revealed no significant differences in KOOS-QOL (mean difference (95% CI) 2.9 (-3.3 to 9.1)) and SF-36 scores (for all SF-36 domains except Vitality) between ACL-deficient and ACL-reconstructed groups.

CONCLUSIONS

This systematic review found impaired knee-related QOL in ACL-deficient individuals ≥5 years after ACL rupture, compared to population norms. Meta-analysis revealed similar knee-related QOL in ACL-deficient and ACL-reconstructed groups, and no difference in health-related QOL scores for seven of the eight SF-36 domains.

Activity preferences, lifestyle modifications and re-injury fears influence longer-term quality of life in people with knee symptoms following anterior cruciate ligament reconstruction: a qualitative study

QUESTIONS

How do people with knee symptoms describe their quality of life and experiences 5 to 20 years after anterior cruciate ligament reconstruction (ACLR)? What factors impact upon the quality of life of these people?

DESIGN

Qualitative study.

PARTICIPANTS

Seventeen people with knee symptoms 5 to 20 years after ACLR and high (n=8) or low (n=9) quality of life scores were recruited from a cross-sectional study.

METHODS

Semi-structured telephone interviews were conducted and transcribed. The data obtained from the interventions underwent inductive coding and thematic analysis.

RESULTS

Four consistent themes emerged from the interviews as common determinants of quality of life following ACLR: physical activity preferences; lifestyle modifications; adaptation and acceptance; and fear of re-injury. All participants described the importance of maintaining a physically active lifestyle and the relationship between physical activity and quality of life. Participants who avoided sport or activity reported experiencing reduced quality of life. Participants who suppressed or overcame re-injury fears to continue sport participation described experiencing a satisfactory quality of life while taking part in sport despite knee symptoms. For some participants, resuming competitive sport resulted in subsequent knee trauma, anterior cruciate ligament re-rupture or progressive deterioration of knee function, with negative impacts on quality of life following sport cessation. Participants who enjoyed recreational exercise often adapted their lifestyle early after ACLR, while others described adapting their lifestyle at a later stage to accommodate knee impairments; this was associated with feelings of acceptance and satisfaction, irrespective of knee symptoms.

CONCLUSION

Activity preferences, lifestyle modifications and fear of re-injury influenced quality of life in people with knee symptoms up to 20 years following ACLR. People with a preference for competitive sport who do not enjoy recreational exercise might be at heightened risk of poor quality of life outcomes and could benefit from support to facilitate a transition to a physically active, satisfying lifestyle.

Previous Knee Injury and Health-Related Quality of Life in Collegiate Athletes

CONTEXT

  Patient-rated outcome measures (PROMs) capture changes that are important and meaningful to patients, such as health-related quality of life (HRQOL). Although group differences in HRQOL have been reported, little is known about the effect of injury history on HRQOL in collegiate athletes.

OBJECTIVE

  To determine whether knee-specific function (International Knee Documentation Committee Subjective Knee Evaluation Form [IKDC]) and HRQOL (Short Form 12 [SF-12]) differs in collegiate athletes based on sex and the severity of a previous knee injury.

DESIGN

  Cross-sectional study.

SETTING

  Athletic training facilities.

PATIENTS OR OTHER PARTICIPANTS

  Healthy collegiate athletes (n = 263) were grouped based on self-report of a previous knee injury: severe (n = 47), mild (n = 40), and no (n = 176) knee injury.

INTERVENTION(S)

  Participants completed the IKDC and SF-12 during their preparticipation examinations.

MAIN OUTCOME MEASURE(S)

  Generalized linear models were used to assess interactions and main effects of all scores.

RESULTS

  An interaction effect was observed for the SF-12 role physical subscale (P = .02), with men in the mild- and severe-injury groups reporting worse scores than men with no injury history. We noted a main effect for injury group for the IKDC total score (P < .001) and SF-12 physical functioning (P = .04) and role emotional (P = .04) subscales, with the severe-injury group reporting worse scores than the mild- and no-injury groups. No main effects of sex were reported (P > .05).

CONCLUSIONS

  Despite returning to full participation, collegiate athletes who previously sustained severe knee injuries tended to report worse knee-specific function and less ability to complete activities due to physical health. In addition, individuals with a history of severe knee injury tended to report more emotional concerns than athletes with a history of mild or no knee injury. Region-specific PROMs may be more sensitive in detecting deficits than generic PROMs after return to full participation. Researchers should investigate the role of PROMs, particularly region-specific PROMs, as potential screening tools for clinical care.

Patient-Reported Outcome Measures in Individuals With Chronic Ankle Instability: A Systematic Review

CONTEXT

A comprehensive systematic literature review of the health-related quality-of-life (HRQOL) differences among individuals with chronic ankle instability (CAI), ankle-sprain copers, and healthy control participants has not been conducted. It could provide a better indication of the self-reported deficits that may be present in individuals with CAI.

OBJECTIVE

To systematically summarize the extent to which HRQOL deficits are present in individuals with CAI.

DATA SOURCES

We searched for articles in the electronic databases of EBSCO Host and PubMed Central using key words chronic, functional, mechanical, coper, instability, sprains, and patient-assessed. We also performed a hand search of reference lists, authors, and patient-reported outcomes (PROs) of the articles screened for inclusion.

STUDY SELECTION

Studies were included if they (1) incorporated a PRO as a participant descriptor or as a study outcome to compare adults with CAI to ankle-sprain copers or healthy controls, (2) were written in English, and (3) were published in peer-reviewed journals.

DATA EXTRACTION

Two authors independently assessed methodologic quality using the modified Downs and Black Index. Articles were filtered into 3 categories based on between-groups comparisons: CAI and copers, CAI and healthy control participants, copers and healthy participants. We calculated Hedges g effect sizes and 95% confidence intervals to examine PRO group differences.

DATA SYNTHESIS

Of the 124 studies assessed for eligibility, 27 were included. A total of 24 articles compared PROs in individuals with CAI and healthy controls, 7 compared individuals with CAI and copers, and 4 compared copers and healthy controls. Quality scores on the modified Downs and Black Index ranged from 52.9% to 88.2%, with 8 high-, 16 moderate-, and 3 low-quality studies. Overall, we observed moderate to strong evidence that individuals with CAI displayed deficits on generic and region-specific PROs compared with copers and healthy controls. However, evidence that differences exist between copers and healthy controls was conflicting. In addition, for dimension-specific outcomes, evidence to suggest that fear of reinjury is heightened in individuals with CAI was limited.

CONCLUSIONS

The evidence suggested that CAI is associated with functional and HRQOL deficits, particularly when examined with region-specific PROs. However, PROs do not appear to differ between copers and healthy controls.

Quality of life perception of basketball master athletes: association with physical activity level and sports injuries

This study aimed to verify the prevalence and characteristics of sports injuries (SI) and determine the association between the physical activity level (PA) and SI with perception of health-related quality of life (HRQoL) in Brazilian basketball master athletes. A cross-sectional study was conducted with 410 male master athletes, between 35 and 85 years of age (mean 52.26, SD ±11.83). The HRQoL was assessed using the Medical Outcomes Study - Short Form-36. The PA was evaluated using the International Physical Activity Questionnaire. Information regarding SI was collected using the Reported Morbidity Survey. Poisson regression, as estimated by the prevalence ratio (PR), was used as a measure of the association of PA and SI with HRQoL. The majority of athletes showed a high SI prevalence (58.3%) and reported one injury (67.8%) that occurred during training (61.1%) and primarily affected a lower limb (74.6%). The adjusted regression models showed a positive association of PA with the Functional Capacity (PR = 1.46, 95% confidence interval [CI] = 1.12-1.90) and Physical Component (PR = 1.32, 95% CI = 1.03-1.70) of HRQoL. Furthermore, the SI were negatively associated with HRQoL in Functional Capacity (PR = 1.85, 95% CI = 1.51-2.27), Physical Aspects (PR = 3.99, 95% CI = 3.08-5.18), Pain (PR = 1.65, 95% CI = 1.26-2.16), Social Functioning (PR = 1.79, 95% CI = 1.41-2.27), Emotional Aspects (PR = 4.40, 95% CI = 3.35-5.78), Mental Health domains (PR = 1.37, 95% CI = 1.06-1.68), Physical Component (PR = 2.35, 95% CI = 1.90-2.90) and Mental Component (PR = 2.65, 95% CI = 2.14-3.29). These results highlighted that master athletes showed a high SI prevalence, primarily in the lower limbs. PA positively correlates with the physical HRQoL domain, whereas SI may decrease the HRQoL levels of both physical and mental domains.

Patient-Reported Outcomes in Male and Female Collegiate Soccer Players During an Athletic Season

CONTEXT

Clinicians are urged to document patient-based outcomes during rehabilitation to measure health-related quality of life (HRQOL) from the patient's perspective. It is unclear how scores on patient-reported outcome instruments (PROs) vary over the course of an athletic season because of normal athletic participation.

OBJECTIVE

Our primary purpose was to evaluate the effect of administration time point on HRQOL during an athletic season. Secondary purposes were to determine test-retest reliability and minimal detectable change scores of 3 PROs commonly used in clinical practice and if a relationship exists between generic and region-specific outcome instruments.

DESIGN

Cross-sectional study.

SETTING

Athletic facility.

PATIENTS OR OTHER PARTICIPANTS

Twenty-three collegiate soccer athletes (11 men, 12 women).

MAIN OUTCOME MEASURE(S)

At 5 time points over a spring season, we administered the Disablement in the Physically Active Scale (DPA), Foot and Ankle Ability Measure-Sport, and Knee Injury and Osteoarthritis Outcome Score (KOOS).

RESULTS

Time effects were observed for the DPA (P = .011) and KOOS Quality of Life subscale (P = .027). However, the differences between individual time points did not surpass the minimal detectable change for the DPA, and no post hoc analyses were significant for the KOOS-Quality of Life subscale. Test-retest reliability was moderate for the KOOS-Pain subscale (intraclass correlation coefficient = 0.71) and good for the remaining KOOS subscales, DPA, and Foot and Ankle Ability Measure-Sport (intraclass correlation coefficients > 0.79). The DPA and KOOS-Sport subscale demonstrated a significant moderate relationship (P = .018).

CONCLUSIONS

Athletic participation during a nontraditional, spring soccer season did not affect HRQOL. All 3 PROs were reliable and could be used clinically to monitor changes in health status throughout an athletic season. Our results demonstrate that significant deviations in scores were related to factors other than participation, such as injury. Finally, both generic and region-specific instruments should be used in clinical practice.

The development of summary components for the Disablement in the Physically Active scale in collegiate athletes

PURPOSE

The Disablement in the Physically Active scale (DPA) is a generic patient-reported outcome designed to evaluate constructs of disability in physically active populations. The purpose of this study was to analyze the DPA scale structure for summary components.

METHODS

Four hundred and fifty-six collegiate athletes completed a demographic form and the DPA. A principal component analysis (PCA) was conducted with oblique rotation. Factors with eigenvalues >1 that explained >5 % of the variance were retained.

RESULTS

The PCA revealed a two-factor structure consistent with paradigms used to develop the original DPA. Items 1-12 loaded on Factors 1 and Items 13-16 loaded on Factor 2. Items 1-12 pertain to impairment, activity limitations, and participation restrictions. Items 13-16 address psychosocial and emotional well-being. Consideration of item content suggested Factor 1 concerned physical function, while Factor 2 concerned mental well-being. Thus, items clustered around Factor 1 and 2 were identified as physical (DPA-PSC) and mental (DPA-MSC) summary components, respectively. Together, the factors accounted for 65.1 % of the variance.

CONCLUSIONS

The PCA revealed a two-factor structure for the DPA that resulted in DPA-PSC and DPA-MSC. Analyzing the DPA as separate constructs may provide distinct information that could help to prescribe treatment and rehabilitation strategies.

Baseline predictors of health-related quality of life after anterior cruciate ligament reconstruction: a longitudinal analysis of a multicenter cohort at two and six years

BACKGROUND

Limited information exists regarding predictors of general quality of life following anterior cruciate ligament (ACL) reconstruction with up to six-year follow-up. We hypothesized that certain variables evaluated at the time of ACL reconstruction will predict the general quality of life as measured by the Short Form-36 (SF-36).

METHODS

All unilateral ACL reconstructions from 2002 to 2004 in patients currently enrolled in a prospective multicenter cohort were evaluated. Patients preoperatively completed the SF-36 validated outcome instrument. Surgeons documented intra-articular pathological conditions and treatment, as well as the ACL reconstruction surgical technique. At baseline and at a minimum of two and six years postoperatively, patients completed the SF-36. Longitudinal analysis was performed for the two-year and six-year end points.

RESULTS

Of the initial 1512 subjects, at least one follow-up questionnaire was obtained from 1411 subjects (93%). The cohort was 44% female, and the median patient age at enrollment was twenty-three years. The mean scores were 41.9 points for the Physical Component Summary (PCS) and 51.7 points for the Mental Component Summary (MCS) at baseline, 53.6 points for the PCS and 52.0 points for the MCS at two years, and 54.0 points for the PCS and 52.4 points for the MCS at six years. Significant predictors of a higher PCS score were a higher baseline PCS score, younger age, lower baseline body mass index, having >50% of the lateral meniscus excised, or having no treatment done on a lateral meniscal tear. In contrast, significant predictors of a lower PCS score were a shorter follow-up time since surgery, revision ACL reconstruction, smoking at baseline, fewer years of education, and chondromalacia of the lateral tibial plateau. The mean utility gained at six years after ACL reconstruction was 5.3 quality-adjusted life years (QALYs).

CONCLUSIONS

Large improvements in the PCS (with an effect size of 1.2) were noted at two years and were maintained at six years after ACL reconstruction. Lower education and smoking were significant predictors of lower PCS and MCS scores. ACL reconstruction resulted in a relatively high gain of QALYs.

The Trojan Lifetime Champions Health Survey: development, validity, and reliability

CONTEXT

Self-report questionnaires are an important method of evaluating lifespan health, exercise, and health-related quality of life (HRQL) outcomes among elite, competitive athletes. Few instruments, however, have undergone formal characterization of their psychometric properties within this population.

OBJECTIVE

To evaluate the validity and reliability of a novel health and exercise questionnaire, the Trojan Lifetime Champions (TLC) Health Survey.

DESIGN

Descriptive laboratory study.

SETTING

A large National Collegiate Athletic Association Division I university.

PATIENTS OR OTHER PARTICIPANTS

A total of 63 university alumni (age range, 24 to 84 years), including former varsity collegiate athletes and a control group of nonathletes.

INTERVENTION(S)

Participants completed the TLC Health Survey twice at a mean interval of 23 days with randomization to the paper or electronic version of the instrument.

MAIN OUTCOME MEASURE(S)

Content validity, feasibility of administration, test-retest reliability, parallel-form reliability between paper and electronic forms, and estimates of systematic and typical error versus differences of clinical interest were assessed across a broad range of health, exercise, and HRQL measures.

RESULTS

Correlation coefficients, including intraclass correlation coefficients (ICCs) for continuous variables and κ agreement statistics for ordinal variables, for test-retest reliability averaged 0.86, 0.90, 0.80, and 0.74 for HRQL, lifetime health, recent health, and exercise variables, respectively. Correlation coefficients, again ICCs and κ, for parallel-form reliability (ie, equivalence) between paper and electronic versions averaged 0.90, 0.85, 0.85, and 0.81 for HRQL, lifetime health, recent health, and exercise variables, respectively. Typical measurement error was less than the a priori thresholds of clinical interest, and we found minimal evidence of systematic test-retest error. We found strong evidence of content validity, convergent construct validity with the Short-Form 12 Version 2 HRQL instrument, and feasibility of administration in an elite, competitive athletic population.

CONCLUSIONS

These data suggest that the TLC Health Survey is a valid and reliable instrument for assessing lifetime and recent health, exercise, and HRQL, among elite competitive athletes. Generalizability of the instrument may be enhanced by additional, larger-scale studies in diverse populations.

Holistic life-span health outcomes among elite intercollegiate student-athletes

CONTEXT

Competitive sports are recognized as having unique health benefits and risks, and the effect of sports on life-span health among elite athletes has received increasing attention. However, supporting scientific data are sparse and do not represent modern athletes.

OBJECTIVE

To assess holistic life-span health and health-related quality-of-life (HRQL) among current and former National Collegiate Athletic Association student-athletes (SAs).

DESIGN

Cross-sectional study.

SETTING

A large Division I university.

PATIENTS OR OTHER PARTICIPANTS

Population-based sample of 496 university students and alumni (age 17-84 years), including SAs and an age-matched and sex-matched nonathlete (NA) control group.

MAIN OUTCOME MEASURE(S)

Participants completed anonymous, self-report questionnaires. We measured the Short-Form 12 (SF-12) physical and mental component HRQL scores and cumulative lifetime experience and relative risk of treatment for joint, cardiopulmonary, and psychosocial health concerns.

RESULTS

Older alumni (age 43+ years) SAs reported greater joint health concerns than NAs (larger joint summary scores; P = .04; Cohen d = 0.69; probability of clinically important difference [pCID] = 77%; treatment odds ratio [OR] = 14.0, 95% confidence interval [CI] = 1.6, 126). Joint health for current and younger alumni SAs was similar to that for NAs. Older alumni reported greater cardiopulmonary health concerns than younger alumni (summary score P < .001; d = 1.05; pCID = 85%; OR = 5.8, 95% CI = 2.0, 16) and current students (P < .001; d = 2.25; pCID >99.5%; OR = 7.1, 95% CI = 3.3, 15), but the risk was similar for SAs and NAs. Current SAs demonstrated evidence of better psychosocial health (summary score P = .006; d = -0.52; pCID = 40%) and mental component HRQL (P = .008; d = 0.50; pCID = 48%) versus NAs but similar psychosocial treatment odds (OR = 0.87, 95% CI = 0.39, 1.9). Psychosocial health and mental component HRQL were similar between alumni SAs and NAs. No differences were observed between SAs and NAs in physical component HRQL.

CONCLUSIONS

The SAs demonstrated significant, clinically meaningful evidence of greater joint health concerns later in life, comparable cardiopulmonary health, and differences in life-span psychosocial health and HRQL profiles compared with NAs. These data provide timely evidence regarding a compelling public issue and highlight the need for further study of life-span health among modern athletes.

Health-related quality of life after anterior cruciate ligament reconstruction: a systematic review

BACKGROUND

Anterior cruciate ligament reconstructions (ACLRs) are frequently performed on young, active patients and can result in persistent knee symptoms and activity limitations that may affect health-related quality of life (HRQoL). To date, there has been no systematic review of HRQoL outcomes after ACLR.

PURPOSE

The objectives of this study were to report HRQoL ≥5 years after ACLR, compare HRQoL outcomes with available population norms, and describe factors that may affect HRQoL in this population.

STUDY DESIGN

Systematic review.

METHODS

All studies reporting HRQoL ≥5 years after ACLR with hamstring or patellar tendon autografts were eligible for review. Common HRQoL outcomes were pooled using a random-effects meta-analysis and compared with published population norms. The Spearman rank correlation coefficient (ρ) was used to identify variables associated with HRQoL outcomes. Where insufficient data were available, outcomes were reported descriptively.

RESULTS

Fourteen studies were eligible for review, and HRQoL was reported for 2493 patients at a mean of 9 years (range, 5-16 years) after ACLR. Pooling of knee-related quality of life outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS]-QOL) found impairments after ACLR when compared with population norms. In comparison, studies using the Short Form-36 (SF-36) reported similar or better HRQoL compared with normative data. The KOOS-QOL subscores correlated strongly with KOOS-sport/recreation (ρ = .70, P = .04) and KOOS-pain (ρ = .85, P = .003) subscores. Severe radiographic osteoarthritis, meniscal injuries sustained after surgery, and revision ACLR were associated with poorer HRQoL outcomes at a minimum 5-year follow-up. The negative influence of concomitant meniscal surgery on HRQoL became apparent more than 10 years after ACLR.

CONCLUSION

This review found that patients assessed using a knee-specific measure (KOOS-QOL) were more likely to report poorer HRQoL values, compared with population norms, than those assessed using a generic HRQoL measure (SF-36). Revision surgeries, meniscal injuries, and severe radiographic osteoarthritis were associated with poorer HRQoL outcomes after ACLR. However, these relationships should be interpreted with caution, as they were only investigated in a small number of studies.

CLINICAL RELEVANCE

These results can be used by clinicians to educate patients about potential long-term outcomes after ACLR and to develop strategies for optimizing postoperative HRQoL.

Changes in Health-Related Quality of Life and Knee Function After Knee Injury in Young Female Athletes

Background:

Recent literature has called for greater attention to evidence-based practice in sports medicine with the documentation of overall status and impairments following injury. The prospective documentation of impairments associated with knee injuries in female athletes regarding their health-related quality of life (HRQoL) and knee function (KF) of high school and collegiate athletes is limited. Assessing the effect knee injuries have on young female athletes may allow clinicians to better understand the perspectives of the athletes who sustain these injuries.

Purpose:

To document the changes over 12 months in self-reported HRQoL and KF in young females who have sustained a knee injury.

Study Design:

Case series; Level of evidence, 4.

Methods:

A convenience sample of 242 females (mean age, 17.4 ± 2.4 years) who injured their knee participating in sport or recreational activities was utilized. Injuries were categorized as anterior cruciate ligament tears (ACL), anterior knee pain (AKP), patellar instability (PAT), meniscus tear (MNT), iliotibial band syndrome (ITB), collateral ligament sprain (COL), and other (OTH). HRQoL was assessed with the Short Form–12 v 2.0 survey (SF-12) physical component summary (PCS) and mental component summary (MCS). KF was assessed with the 2000 International Knee Documentation Committee survey (IKDC). Dependent variables included the paired differences in the 2000 IKDC as well as SF-12 composite scores from preinjury through 12 months postdiagnosis. Paired differences were assessed with repeated-measures analyses of variance (P ≤ .05).

Results:

IKDC scores were lower through 12 months for ACL, AKP, and PAT; through 6 months for MNT; and through 3 months for COL and OTH. HRQoL PCS and MCS scores were lower through 3 to 12 months depending on the type of injury classification.

Conclusion:

Knee injuries can negatively affect KF and HRQoL for up to 12 months in young females. Sports medicine providers need to be aware of these impacts as they work to effectively treat individuals with these injuries.

A unique patient population? Health-related quality of life in adolescent athletes versus general, healthy adolescent individuals

CONTEXT

Normative scores for patient-rated outcome (PRO) instruments are important for providing patient-centered, whole-person care and making informed clinical decisions. Although normative values for the Pediatric Quality of Life Generic Core Scale (PedsQL) have been established in the general, healthy adolescent population, whether adolescent athletes demonstrate similar values is unclear.

OBJECTIVE

To compare PedsQL scores between adolescent athletes and general, healthy adolescent individuals.

DESIGN

Cross-sectional study.

SETTING

Secondary schools.

PATIENTS OR OTHER PARTICIPANTS

A convenience sample of 2659 interscholastic athletes (males = 2059, females = 600, age = 15.7 ± 1.1 years) represented the athlete group (ATH), and a previously published normative dataset represented the general, healthy adolescent group (GEN).

INTERVENTION(S)

All participants completed the PedsQL during 1 testing session.

MAIN OUTCOME MEASURE(S)

The PedsQL consists of 2 summary scores (total, psychosocial) and 4 subscale scores (physical, emotional, social, school), with higher scores indicating better health-related quality of life (HRQOL). Groups were stratified by age (14, 15, or 16 years old). Independent-samples t tests were conducted to compare between-groups and sex differences.

RESULTS

The ATH group scored higher than the GEN group across all ages for total and psychosocial summary scores and for emotional and social functioning subscale scores (P ≤ .005). For physical functioning, scores of the 15-year-old ATH were higher than for their GEN counterparts (P = .001). Both 14- and 15-year-old ATH scored higher than their GEN counterparts for the school functioning subscale (P ≤ .013), but differences between 16-year olds were not significant (P = .228). Male adolescent athletes reported higher scores than female adolescent athletes across all scores (P ≤ .001) except for social functioning (P = .229).

CONCLUSIONS

Adolescent athletes reported better HRQOL than GEN, particularly in emotional functioning. These findings further support the notion that ATH constitutes a unique population that requires its own set of normative values for self-reported, patient-rated outcome instruments.

Functional ankle instability and health-related quality of life

CONTEXT

To our knowledge, no authors have assessed health-related quality of life (HR-QOL) in participants with functional ankle instability (FAI). Furthermore, the relationships between measures of ankle functional limitation and HR-QOL are unknown.

OBJECTIVE

To use the Short Form-36v2 Health Survey (SF-36) to compare HR-QOL in participants with or without FAI and to determine whether HR-QOL was related to functional limitation.

DESIGN

Cross-sectional study.

SETTING

Sports medicine research laboratory.

PATIENTS OR OTHER PARTICIPANTS

Sixty-eight participants with FAI (defined as at least 1 lateral ankle sprain and 1 episode of giveway per month) or without FAI were recruited (FAI group: n = 34, age = 25 ± 5 years, height = 1.71 ± 0.08 m, mass = 74.39 ± 12.78 kg, Cumberland Ankle Instability Tool score = 19.3 ± 4; uninjured [UI] group: n = 34, age = 23 ± 4 years, height = 1.69 ± 0.08 m, mass = 67.94 ± 11.27 kg, Cumberland Ankle Instability Tool score = 29.4 ± 1).

MAIN OUTCOME MEASURE(S)

All participants completed the SF-36 as a measure of HR-QOL and the Foot and Ankle Ability Measure (FAAM) and the FAAM Sport version (FAAMS) as assessments of functional limitation. To compare the FAI and UI groups, we calculated multiple analyses of variance followed by univariate tests. Additionally, we correlated the SF-36 summary component scale and domain scales with the FAAM and FAAMS scores.

RESULTS

Participants with FAI had lower scores on the SF-36 physical component summary (FAI = 54.4 ± 5.1, UI = 57.8 ± 3.7, P = .005), physical function domain scale (FAI = 54.5 ± 3.8, UI = 56.6 ± 1.2, P = .004), and bodily pain domain scale (FAI = 52.0 ± 6.7, UI = 58.5 ± 5.3, P < .005). Similarly, participants with FAI had lower scores on the FAAM (FAI = 93.7 ± 8.4, UI = 99.5 ± 1.4, P < .005) and FAAMS (FAI = 84.5 ± 8.4, UI = 99.8 ± 0.72, P < .005) than did the UI group. The FAAM score was correlated with the physical component summary scale (r = 0.42, P = .001) and the physical function domain scale (r = 0.61, P < .005). The FAAMS score was correlated with the physical function domain scale (r = 0.47, P < .005) and the vitality domain scale (r = 0.36, P = .002).

CONCLUSIONS

Compared with UI participants, those with FAI had less HR-QOL and more functional limitations. Furthermore, positive correlations were found between HR-QOL and functional limitation measures. This suggests that ankle impairment may reduce overall HR-QOL.

Recent injury and health-related quality of life in adolescent athletes

CONTEXT

Health-related quality of life (HRQOL) is a global concept that takes into account the physical, psychological, and social domains of health. Determining the extent to which injury affects HRQOL is an important aspect of rehabilitation practice, enabling comparisons of clinical outcomes across different conditions in diverse patient groups.

OBJECTIVE

To examine the extent to which a self-reported recent injury affected HRQOL in adolescent athletes using 2 generic patient self-report scales.

DESIGN

Cross-sectional study.

SETTING

High school classrooms and athletic training facilities.

PATIENTS OR OTHER PARTICIPANTS

A convenience sample of uninjured (n = 160) and injured (n = 45) adolescent athletes.

INTERVENTION(S)

THE INDEPENDENT VARIABLE WAS INJURY STATUS: uninjured versus injured. All participants completed a self-administered brief health status questionnaire and the Short Form-36 Health Survey Questionnaire (SF-36) and Pediatric Outcomes Data Collection Instrument (PODCI) in a counterbalanced manner.

MAIN OUTCOME MEASURE(S)

Dependent variables included 8 subscale and 2 composite scores of the SF-36 and 5 subscale scores and 1 global score of the PODCI. Group differences were assessed with the Mann-Whitney U test (P < or = .05) and reported as median and interquartile range.

RESULTS

On the SF-36, the injured group demonstrated lower scores (P < .008) for physical functioning, limitations due to physical health problems, bodily pain, social functioning, and the physical composite. On the PODCI, the injured group reported lower scores (P < .01) on the pain and comfort subscale and the global score.

CONCLUSIONS

Adolescent athletes with self-reported injuries demonstrated lower HRQOL than their uninjured peers. As expected, recent injury affected physical functioning and pain. Social functioning (on the SF-36) and global HRQOL (on the PODCI) also decreased, suggesting that injuries affected areas beyond the expected physical component of health. Clinicians need to recognize the full spectrum of negative influences that injuries may have on HRQOL in adolescent athletes.

The Disabilities of the Arm, Shoulder, and Hand questionnaire in intercollegiate athletes: validity limited by ceiling effect

HYPOTHESIS

The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire has been validated as an effective upper extremity specific outcome measure. Normative scores have not been established for young athletes. This study was conducted to establish normative DASH scores for intercollegiate athletes. We hypothesized that DASH scores in intercollegiate athletes differ from published values obtained from the general population.

MATERIALS AND METHODS

The DASH questionnaire was administered to 321 athletes cleared for full participation in intercollegiate sports. Their scores were compared with normative values in the general population and 2 other age-matched cohorts.

RESULTS

Intercollegiate athletes had significantly better upper extremity function compared with the general population (1.37 +/- 2.96 vs 10.10 +/- 14.68, P < .001) and an age-matched cohort of employed adults (1.37 +/- 2.96 vs 5.40 +/- 7.57, P < .0001). The DASH was 0 for 65.1%. Within this cohort, men reported better upper extremity function than women (0.98 vs 1.82, P = .010). Athletes participating in overhead sports reported worse upper extremity function than nonoverhead athletes (1.81 vs 0.98, P = .042).

DISCUSSION

We report normative DASH values for a group of intercollegiate athletes and show a significant difference between the scores of these athletes and the general population. Within our cohort of competitive athletes, overhead sports and female gender are associated with significantly lower DASH scores and sports module scores. The utility of using these results are limited by a substantial ceiling effect in this population of competitive athletes. Differences within our cohort and differences between our cohort and other populations are minimized by this ceiling effect. Various upper extremity outcome measures may be similarly limited by a ceiling effect and should be examined for appropriateness before use.

CONCLUSION

Intercollegiate athletes report significantly greater upper extremity function than the general population; however, validity of the DASH in these athletes is limited and population differences may be minimized by a substantial ceiling effect.

USA paralympic team archer with McCune Albright Syndrome: a retrospective case report

PURPOSE

This retrospective case report describes a 22-year-old woman with McCune Albright Syndrome who was an archery Bronze Medalist at the 2008 USA Paralympic Games.

METHODS

The subject completed the Medical Outcome Survey Short Form-36 (SF-36) and the Hip Dysfunction and Osteoarthritis Score (HOOS).

RESULTS

SF-36 scores met or exceeded those for National Collegiate Athletic Association (NCAA) female athletes, and age and gender matched USA norms for vitality, mental health and role emotional subscales. General health was lower than NCAA female athletes. Physical functioning, role: physical, bodily pain and social functioning subscale scores were lower than both comparison groups. HOOS symptom subscale scores revealed disabilities with walking (performed with crutches), hip abduction and stair climbing.

CONCLUSIONS

Target archery does not require the lower extremity strength and motion required by many other sports. Identifying the ideal time to undergo total hip arthroplasty is difficult. As total hip arthroplasty becomes less invasive, more durable, with greater modular options, and with lower revision rates, more young patients will likely benefit. Serial SF-36 and HOOS surveys may help patients and surgeons better delineate symptom, functional limitation and disability changes across the early lifespan assisting surgical timing decisions while balancing existing function, quality of life values and near future technological advances.

Impact of Prior Concussions on Health-Related Quality of Life in Collegiate Athletes

OBJECTIVE

To investigate how self-reported sport-related concussion history affects health-related quality of life in collegiate athletes.

DESIGN

Cross sectional.

SETTING

Division I university, Division II university, and a junior college.

PARTICIPANTS

Three hundred two collegiate athletes (210 men, 92 women).

ASSESSMENT OF RISK FACTORS

Participants completed a demographic information sheet and concussion history form; they were then grouped by number of previous self-reported concussions, designated as 0, 1-2, or 3+.

MAIN OUTCOME MEASURES

The Medical Outcomes Short Form (SF-36) and the Headache Impact Test (HIT-6).

RESULTS

Significant differences between groups were found for the bodily pain, vitality, and social functioning subscales of the SF-36. The 3+ group had significantly lower scores for bodily pain (48.1 ± 8.9) compared with the 1-2 group (P = 0.028, 52.1 ± 7.7) and 0 group (P < 0.01, 53.5 ± 8.3), for vitality (52.4 ± 8.4) compared with the 0 group (P = 0.011, 55.9 ± 8.6), and for social functioning (48.5 ± 9.4) compared with the 1-2 group (P = 0.028, 51.6 ± 7.3) and 0 group (P = 0.003, 51.9 ± 8.1). Significant differences were noted on the HIT-6 total score. The 3+ group reported greater impact of headache (46.7 ± 6.4) than the 1-2 group (P = 0.05, 44.6 ± 6.4) and 0 group (P < 0.001, 42.9 ± 5.8). The 1-2 group also had higher HIT-6 scores than the 0 group (P = 0.033).

CONCLUSIONS

Results suggest that a collegiate athlete's perception of bodily pain, vitality, social functioning, and headache is adversely affected by previous sport-related concussions. However, by incorporating general and specific outcome measures into the standard evaluation of sport-related concussion, the clinician can better determine how the athlete is responding to treatment and recovery.