Current Health-Related Quality of Life in Former National Collegiate Athletic Association Division I Collision Athletes Compared With Contact and Limited-Contact Athletes

Relationship between Workload, Psychological State and Recovery in Female Soccer Athletes

This study assessed the multifaceted relations between measures of workload, psychological state, and recovery throughout an entire soccer season in female collegiate soccer athletes (19.8±1.2 yrs, 132±12.3 lbs, 63±3.2 in). A prospective longitudinal study was utilized to measure workload (GPS training load, Rate of Perceived Exertion (RPE), psychological state (mental stress, mental fatigue, and mood), and recovery (sleep duration, sleep quality, and soreness), during 90 observations (59 training sessions and 21 games). Separate linear-mixed effect models were used to assess outcomes of RPE, soreness, and sleep duration. A linear mixed-effects model explained 59% of the variance in RPE following each session. Specifically, each standard deviation increase in GPS load and mental stress in the morning prior to training increased RPE by 1.46 (SE=0.08) and 0.29 (SE=0.07), respectively, following that day's training. Furthermore, a significant interaction was found between several predictor variables and chronological day in the season while predicting RPE. Specifically, for each standard deviation increase in GPS load, RPE went up by 0.0055 per day during the season suggesting that load had a higher impact on RPE as the season progressed. In contrast, the interaction of day by mental stress, sleep duration, and soreness continued to be stronger as the season progressed. Each linear mixed-effect model predicted a larger amount of variance when accounting for individual variations in the random effects.

Activity levels across the intensity spectrum in athletes: a systematic review protocol

Physical activity (PA) promotes better cardiometabolic health, physical function, brain health and longevity. In contrast, prolonged sedentary behaviour (SB) is a risk factor for many chronic diseases and poor health. Limited research has evaluated or synthesised how competitive sports participation influences PA across the lifespan. Some evidence suggests, ironically, that former competitive athletes may be insufficiently active and current athletes may be highly sedentary away from sport. This study describes the protocol for a systematic review and meta-analysis on activity levels across the intensity spectrum in athletes, addressing the primary research question: is sports participation significantly associated with PA and/or SB among current and former competitive athletes? PubMed, Embase, Cochrane Database of Systematic Reviews, Web of Science and SPORTDiscus databases will be searched. Two reviewers will independently screen titles/abstracts and full texts of selected abstracts. Data will be extracted regarding the study population, sport played, PA measures and protocols, outcomes of interest and findings. Primary outcomes will include step counts, daily activity across the intensity spectrum (ie, sedentary, light, moderate and vigorous PA), metabolic equivalent of task and whole-day energy expenditure. Secondary outcomes will include additional accelerometry measures of PA, activity patterns and self-reported PA. The risk of bias will be assessed using the National Institutes of Health Study Quality Assessment Tools. Extracted data will be presented using narrative synthesis and tabular presentation. Meta-analyses will be conducted to determine outcomes with sufficient data.PROSPERO registration number: CRD42024469267.https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=469267.

Long-term function, body composition and cardiometabolic health in midlife former athletes: a scoping review

While sports medicine has traditionally focused on recovering from injury and returning athletes to sport safely after injury, there is a growing interest in the long-term health of athletes. The purpose of this scoping review was to (1) summarise the literature (methodologies and findings) on physical function, body composition and cardiometabolic health in midlife (age 40-65 years) former competitive athletes compared with non-athlete controls, (2) identify areas for future study in long-term health in athletes and (3) determine outcomes that could be evaluated in a future systematic review(s). We searched PubMed, CINAHL, Web of Science and SPORTDiscus for studies published between 2000 and 2022 evaluating former athletes and controls on physical function, body composition and/or cardiometabolic measures using MeSH terms. We identified 20 articles that met our criteria. Outcomes varied considerably across studies, most of which were cross-sectional and evaluated only males. Limited data suggest that former endurance athletes have leaner body compositions, higher aerobic capacity and better cardiometabolic indicators than controls; former athletes who maintain higher physical activity (ie, self-reported exercise) are healthier than those who do not; and former team sport athletes, who have higher injury prevalence, may have poorer functional performance than controls who were recreationally active in college. Studies rarely evaluated functional performance, did not control for prior injury or diet and seldom assessed current physical activity levels. Future research should include females and evaluate sex differences, control for prior sports-related injury(ies), quantify physical activity, use standardised outcome measures including performance-based functional assessments and incorporate longitudinal designs.

Sport culture and communication among middle school athletes, parents, and staff: A qualitative study

Middle school (MS) is an intermediary level of education between elementary and secondary school that typically includes students aged 10-15 years. There is limited research within the MS sport setting, particularly related to sport-related injury prevention. This qualitative study aimed to better understand the sport culture within MS sports and the communication strategies used among invested groups (i.e., athletes, parents, staff inclusive of coaches and school nurses). Semi-structured interviews were conducted with 19 athletes, 20 parents, and 18 staff (e.g., coaches, school nurses) from seven MS in two school districts during the 2018/19 and 2019/20 school years. Topics focused on understanding school- and sport-related factors related to education, safety, and communication. Analysis used a consensual qualitative research tradition, in which the research team discussed individually developed themes and categories from transcribed interviews, with the goal of coming to a consensus and creating a codebook. Throughout the coding process, the research team would reconvene to discuss coding decisions until consensus was reached. This study focuses on the themes of sport culture and communication. Dominant categories identified within sport culture related to participants noting why they were interested in MS sports, and their struggles with their perceived roles and engagement (e.g., helping parents stay engaged, finding coaches, oversight of school nurses). Competitiveness and safety could have conflicting roles and priority. Dominant categories identified within communication centered around limited communication between coaches and parents. Technological assistance (e.g., phone apps, websites) was available, but often varied by school and sport. Concussions were seldom discussed unless during the preseason meeting or when one occurred. Findings highlight that the MS sport settings may struggle with incorporating primary prevention into their cultures and ensuring reliable communication among individuals. Novel and tailored approaches to injury prevention are needed to help ensure buy-in and proper implementation.

Estimating the effects of physical violence and serious injury on health-related quality of life: Evidence from 19 waves of the Household, Income and Labour Dynamics in Australia Survey

OBJECTIVE

This study aims to investigate the effect of physical violence and serious injury on health-related quality of life in the Australian adult population.

METHODS

This study utilised panel data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. HRQoL was measured through the physical component summary (PCS), mental component summary (MCS), and short-form six-dimension utility index (SF-6D) of the 36-item Short-Form Health Survey (SF-36). Longitudinal fixed-effect regression models were fitted using 19 waves of the HILDA Survey spanning from 2002 to 2020.

RESULTS

This study found a negative effect of physical violence and serious injury on health-related quality of life. More specifically, Australian adults exposed to physical violence and serious injury exhibited lower levels of health-related quality of life. Who experienced physical violence only had lower MCS (β = -2.786, 95% CI: -3.091, -2.481) and SF-6D (β = -0.0214, 95% CI: -0.0248, -0.0181) scores if switches from not experiencing physical violence and serious injury. Exposed to serious injury had lower PCS (β = -5.103, 95% CI: -5.203, -5.004), MCS (β = -2.363, 95% CI: -2.480, -2.247), and SF-6D (β = -0.0585, 95% CI: -0.0598, -0.0572) score if the adults not experiencing physical violence and serious injury. Further, individuals exposed to both violence and injury had substantially lower PCS (β = -3.60, 95% CI: -4.086, -3.114), MCS (β = -6.027, 95% CI: -6.596, -5.459), and SF-6D (β = -0.0716, 95% CI: -0.0779, -0.0652) scores relative to when the individuals exposed to none.

CONCLUSION

Our findings indicate that interventions to improve Australian adults' quality of life should pay particular attention to those who have experienced physical violence and serious injury. Our findings suggest unmet mental health needs for victims of physical violence and serious injuries, which calls for proactive policy interventions that provide psychological and emotional therapy.

Prior Injury, Health-Related Quality of Life, Disablement, and Physical Activity in Former Women's Soccer Players

CONTEXT

Former collegiate athletes may be at risk for negative health outcomes such as lower health-related quality of life (HRQoL), greater disablement, and lower lifetime physical activity (PA) participation. A history of severe sport injury may play a role in these outcomes.

OBJECTIVE

To assess the role of prior sport injury in self-reported HRQoL, levels of disablement, and PA behaviors of former National Collegiate Athletic Association Division I women's soccer players.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

Former Division I women's soccer players (n = 382, age = 36.41 ± 7.76 years) provided demographics and injury history and completed the Patient-Reported Outcomes Measurement Information System (HRQoL), the Disablement in the Physically Active Scale (disablement), and the Godin Leisure Time Physical Activity Questionnaire (PA).

MAIN OUTCOME MEASURE(S)

The dependent variables were the physical and mental component summary scores for HRQoL and disablement and the frequency of moderate-to-vigorous PA. Means, SDs, and correlations among the main outcome variables were examined for those who reported a severe injury (n = 261) and those who did not (n = 121). To address our primary aim, we conducted multiple regression analyses to predict HRQoL, disablement, and PA based on a history of severe injury, accounting for age.

RESULTS

Having a severe injury significantly predicted worse physical HRQoL and worse physical disablement. Severe injury predicted a >2-point decrease and 5-point increase on the respective scales. Injury status did not predict mental HRQoL, mental disablement, or PA.

CONCLUSIONS

Most participants reported sustaining a prior severe soccer-related injury, which may have had a negative long-term effect on health outcomes for former women's soccer players. Athletic trainers should be aware of the risk for decreased HRQoL and increased disablement with injury and encourage continued monitoring of relevant patient-reported outcomes.

Health-Related Quality of Life in Former National Collegiate Athletic Association Division I Collegiate Athletes Compared With Noncollegiate Athletes: A 5-Year Follow-Up

CONTEXT

The effect of athletic participation on lifelong health among elite athletes has received increasing attention, as sport-related injuries can have a substantial influence on long-term health.

OBJECTIVE

To determine the current health-related quality of life (HRQoL) of former National Collegiate Athletic Association Division I athletes compared with noncollegiate athletes 5 years after an initial assessment.

DESIGN

Cohort study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

From the former Division I athletes, 193 responses were received (response rate = 83.2%; 128 men, 65 women; age = 58.47 ± 6.17 years), and from the noncollegiate athletes, 169 surveys were returned (response rate = 75.1%; 80 men, 89 women; age = 58.44 ± 7.28 years).

MAIN OUTCOME MEASURE(S)

The independent variables were time (baseline, 5 years later) and group (former Division I athlete, noncollegiate athlete). Participants completed 7 Patient-Reported Outcomes Measurement Information System scales: sleep disturbance, anxiety, depression, fatigue, pain interference, physical function, and satisfaction with participation in social roles.

RESULTS

Sleep disturbance, depression, fatigue, pain, and physical function were significant for time × group interactions (P values < .05), with the largest differences seen in pain and physical function between groups at time point 2 (22.19 and 13.99 points, respectively). Former Division I athletes had worse scores for depression, fatigue, pain, and physical function at follow-up (P values < .05), with the largest differences seen on the depression, fatigue, and physical function scales (8.33, 6.23, and 6.61 points, respectively).

CONCLUSIONS

Because of the competitive nature of sport, the long-term risks of diminished HRQoL need to become a priority for health care providers and athletes during their athletic careers. Additionally, physical activity transition programs need to be explored to help senior student-athletes transition from highly structured and competitive collegiate athletics to lifestyle physical activity, as it appears that individuals in the noncollegiate athlete cohort engaged in more physical activity, weighed less, and had increased HRQoL.

Physical Activity and Health-Related Changes During Transition Out of Collegiate Football: A Case Series

Two American collegiate football linemen completed physical activity surveys, anthropometric assessments, dietary recalls, and blood draws across a 20-month period during which Player A continued training professionally in football while Player B transitioned out of the sport after his final collegiate season. Few changes were observed for Player A, whereas notable changes in physical activity, body mass, and endocrine factors associated with metabolic regulation were noted in Player B. Considerable alterations in physical activity and biomarkers occurred in the immediate transition out of competitive football, suggesting the possibility of long-term health consequences in the absence of future positive lifestyle behavioral changes. Alternatively, the adoption or maintenance of health behaviors could reverse risks. With a greater emphasis on lifespan wellness, this level 2 exploratory case series illustrates a key opportunity for athletic trainers to monitor athletes' cardiometabolic risks over an extended period and implement transitional care strategies to promote postcompetitive health.

Health-Related Quality of Life Among Middle-Aged Adults With Chronic Ankle Instability, Copers, and Uninjured Controls

CONTEXT

People with chronic ankle instability (CAI) display a lower regional and global health-related quality of life (HRQoL). Examinations of HRQoL outcomes associated with CAI have addressed younger adults, restricting our understanding of the long-term consequences of CAI.

OBJECTIVE

To compare ankle regional and global HRQoL in middle-aged participants with and those without CAI.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 59 middle-aged volunteers, consisting of 18 with CAI (age = 50.2 ± 9.3 years), 17 who were ankle-sprain copers (age = 54.5 ± 8.7 years), and 24 uninjured controls (age = 56.7 ± 10.0 years).

MAIN OUTCOME MEASURE(S)

Participants completed the Foot and Ankle Disability Index (FADI) and the Patient-Reported Outcomes Measurement Information System Adult Profile. Regional HRQoL was assessed using the FADI Activities of Daily Living and Sport subscales. Global HRQoL was measured using the 43-item Patient-Reported Outcomes Measurement Information System Adult Profile, which contains 7 short forms-Physical Function, Pain Interference, Fatigue, Depression, Sleep Disturbance, Anxiety, and Ability to Participate in Social Roles and Activities. Separate Kruskal-Wallis tests were used to determine between-groups differences.

RESULTS

Middle-aged participants with CAI had lower scores on both subscales of the FADI than the coper and control groups (all P values <.001). Participants with CAI scored lower on the Physical Function (U = 116.0, z = -2.78, P = .005) and Ability to Participate in Social Roles and Activities (U = 96.0, z = -3.09, P = .002) subscales but higher on the Pain Interference (U = 144.0, z = -2.36, P = .02), Fatigue (U = 110.0, z = -2.72, P = .006), and Depression (U = 110.5, z = -2.91, P = .004) subscales than the control group. Participants with CAI also scored lower on the Physical Function (U = 74.5, z = -2.79, P = .005) and Ability to Participate in Social Roles and Activities (U = 55.0, z = -3.29, P = .001) subscales but higher on the Fatigue (U = 90.0, z = -2.09, P = .04) and Depression (U = 96.5, z = -1.97, P = .048) subscales than the coper group.

CONCLUSIONS

Middle-aged participants with CAI displayed worse ankle regional and global HRQoL than their age-matched healthy counterparts and copers. These results demonstrated that CAI can affect HRQoL outcomes in middle-aged adults.

THE GAP BETWEEN RESEARCH AND CLINICAL PRACTICE FOR INJURY PREVENTION IN ELITE SPORT: A CLINICAL COMMENTARY

As clinicians strive to apply evidence-based principles, team-based practitioners have identified a large gap as it relates to published research, ideal applications of evidence-based practice, and actual clinical practice related to injury prevention in elite sport within the United States. For rehabilitation professionals, especially those intimately involved in the research of injury prevention, the solution often seems quite clear and defined. However, preventing injury by implementing the latest recommendation from the most recent prospective study on the using the FIFA 11 + warm-up, a Copenhagen Adduction exercise, or a plyometric drill with elite athletes may not be as effective as was seen among the cohort used in the study. In addition to extrapolating research, clinicians face additional challenges such as variance among professions, schedule density, and off-season contacts with athletes. There is an inherent difficulty in the application of research to practice in elite sport as it relies on the teamwork of not only the practitioner and athlete, but the entire sporting organizational structure and those involved in athlete participation. The purpose of this clinical commentary is to explore the difficulty with application of research in clinical practice and to discuss potential strategies for improving carry over from research to clinical practice.

Global and region-specific patient-reported outcomes pre and post a division I football season

OBJECTIVE

Determine the change in global and region-specific PROMs among athletes from one NCAA Division I football team during one season.

DESIGN

Prospective cross-sectional study.

SETTING

Athletic training facility.

PATIENTS OR OTHER PARTICIPANTS

Fifty-three Division I collegiate football athletes (n = 54) were eligible (20.1 ± 1.4 years, 187.7 ± 8.3 cm, and 113.5 ± 25.6 kg) for analyses. Participants completed five PROMs (Disablement in the Physically Active Scale [DPA], Epworth Sleep Score [ESS], Headache Impact Test [Hit-6], Disabilities of the Arm, Shoulder, and Hand [DASH], and the Lower Extremity Functional Scale [LEFS]) before the season and the same five PROMs after the season.

MAIN OUTCOME MEASURES

A multivariate repeated measure analysis of variance (ANOVA) was conducted for all dependent variables. Alpha level was set at ɑ = 0.05.

RESULTS

The overall multivariate repeated measures ANOVA was significant for time (p = 0.01). Follow up one-way ANOVA's indicated the DPA (p < 0.01, mean decrease/worse of 6.6 points) and LEFS (p = 0.01, mean decrease/worse of 4.1 points) were statistically significant between time points.

CONCLUSION

Division I football can be detrimental to the physical, mental, and emotional health of the athletes. From these data, global and one region-specific PROM decreased over one season in one NCAA Division I football team.

Physical activity and health-related quality of life in former elite and recreational cricketers from the UK with upper extremity or lower extremity persistent joint pain: a cross-sectional study

OBJECTIVE

To evaluate and compare physical activity (PA) and health-related quality of life (HRQoL) in former elite and recreational cricketers with upper extremity (UE), lower extremity (LE) or no joint pain.

STUDY DESIGN

Cross-sectional cohort.

SETTING

Despite the high prevalence of joint pain in former athletes, the impact of UE pain and LE pain on PA and HRQoL and potential differences between former recreational and elite athletes are poorly understood.

PARTICIPANTS

703 former cricketers aged ≥18 years (mean age 58.7, SD 12.9, played an average of 30 (IQR 20-40) seasons, 72% of whom had played at a recreational level) were recruited through the Cricket Health and Wellbeing Study and met eligibility requirements (UE pain, LE pain or no joint pain (defined as pain on most days of the past month)).

PRIMARY AND SECONDARY OUTCOMES

The International Physical Activity Questionnaire-Short Form collected weekly metabolic equivalents (METS), while the Short-Form 8 collected physical (PCS) and mental (MCS) component scores. Kruskal-Wallis tests with Dunn's post-hoc and multivariable linear regressions were performed.

RESULTS

Weekly METS were similar in former cricketers with UE pain (median (IQR) 2560 (722-4398)), LE pain (2215 (527-3903)) and no pain (2449 (695-4203), p=0.39). MCS were similar between groups (UE pain 56.0 (52.1-60.0); LE pain 55.2 (51.1-59.4); no pain 54.7 (50.7-58.7), p=0.38). PCS were more impaired in former cricketers with UE pain (49.8 (44.9-54.8)) or LE pain (46.7 (41.0-51.9)) compared with no pain (54.2 (51.5-56.9), p<0.0001). Former cricketers with LE pain reported worse PCS than those with UE pain (p=0.04). Similar relationships were observed in former elite and recreational cricketers.

CONCLUSION

Despite impaired physical components of HRQoL in former cricketers with UE pain or LE pain, pain was not related to PA levels or mental components of HRQoL. Physical components of HRQoL were most impaired in those with LE pain, and findings were similar among former elite and recreational cricketers.

Quality of Life and Life Satisfaction in Former Athletes: A Systematic Review and Meta-Analysis

BACKGROUND

Sport participation has many physical and psychosocial benefits, but there is also an inherent risk of injury, subsequent osteoarthritis and psychological challenges that can negatively impact quality of life (QOL). Considering the multifaceted impacts of sport participation on QOL across the lifespan, there is a need to consolidate and present the evidence on QOL in former sport participants.

OBJECTIVE

To evaluate QOL and life satisfaction in former sport participants, and determine what factors are associated with QOL and life satisfaction in this population.

METHODS

Eight electronic databases were systematically searched in July 2018 to retrieve all articles that evaluated QOL or life satisfaction in former sport participants. Two authors independently screened titles/abstracts and full texts, extracted data, and appraised methodological quality using a modified Downs and Black Checklist. Random-effects meta-analysis estimated pooled mean and 95% confidence intervals (Cis) for Mental Component Scores (MCS) and Physical Component Scores (PCS) derived from the SF-12, SF-36, VR-12 and VR-36 measures. MCS and PCS were pooled for all former sport participants, as well as professional- and collegiate-athlete subgroups. Data that were inappropriate for meta-analysis (i.e. EQ-5D, PROMIS and life-satisfaction outcomes) were collated and reported descriptively.

RESULTS

Seventeen articles evaluated QOL or life satisfaction in a total of 6692 former athletes [eight studies (n = 4255) former professional athletes; six studies (n = 1946) former collegiate athletes; two studies (n = 491) included both] with a mean age ranging from 21 to 66 years. Most studies were cross-sectional (15 of 17 articles) and 12 studies had a moderate risk of bias (n = 1 high-risk, n = 4 low-risk). Unpublished data were provided for five studies. Meta-analysis of seven studies resulted in a pooled PCS mean (95% CI) of 50.0 (46.6-53.3) [former professional athletes from two studies: 46.7 (42.1-51.2), former collegiate athletes from five studies: 51.2 (48.4-53.9)] and a pooled MCS of 51.4 (50.5-52.2) [former professional athletes: 52.7 (51.3-54.2), former collegiate athletes: 50.9 (50.0-51.8)]. Factors associated with worse QOL or life satisfaction in former athletes included involuntary retirement from sport (three studies), collision/high-contact sport compared with low/no-contact sport (three studies), three or more concussions compared with no/fewer concussions (two studies), increased body mass index (BMI) (worse PCS, three studies), and osteoarthritis or musculoskeletal issues (worse PCS and MCS, three studies; worse PCS but not MCS, two studies).

CONCLUSIONS

Former athletes had similar PCS and better MCS, compared to general-population norms. Former athletes with impaired PCS reported better MCS than population norms, highlighting the need to use an instrument that differentiates between physical and mental components of QOL in former sport participants. Factors associated with worse QOL that may explain between-study variation include involuntary retirement, collision/high contact sports, concussion, BMI and osteoarthritis.

PROSPERO

CRD42018104319.

The Epidemiology of Injuries in Middle School Football, 2015-2017: The Advancing Healthcare Initiatives for Underserved Students Project

BACKGROUND

Although data exist on injuries in youth football leagues, there are limited recent data on injury incidence in middle school football. Updated injury incidence estimates can help drive the development of injury prevention strategies.

PURPOSE

Describe the epidemiology of injuries in middle school football during school years 2015-2016 to 2017-2018.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

Data originated from 9 public middle schools in Virginia during school years 2015-2016 to 2017-2018. Certified athletic trainers collected injury and athlete-exposure (AE) data from school-sanctioned games and practices in boys', football. Injury counts and rates per 1000 AEs were calculated. Injury rate ratios with 95% CIs compared rates between games and practices.

RESULTS

Overall, 664 middle school boys', football injuries were reported, leading to an overall injury rate of 20.54 per 1000 AEs (95% CI, 18.98-22.11). The time loss injury rate (inclusive of injuries with participation restriction time ≥24 hours) was 9.28 per 1000 AEs (95% CI, 8.23-10.33). The injury rate was higher in competition than practice (36.19 vs 17.97 per 1000 AEs; injury rate ratio, 2.01; 95% CI, 1.69-2.40). Most injuries were to the head/face (competition, 20.6%; practice, 15.8%) and hand/wrist (competition, 18.8%; practice, 16.4%) and were diagnosed as contusions (competition, 30.9%; practice, 25.9%) and sprains (competition, 19.4%; practice, 12.6%). Competitions also had a large proportion of concussions (10.3%). Overall, 80.0% and 66.9% of injuries were due to contact in competition and practice, respectively; of these contact-related injuries, 62.1% and 41.6% were specifically player contact.

CONCLUSION

Injury distributions parallel those found in previous research from middle school and other sport settings. Injury rates in middle school football were higher than those reported in previous findings in high school and college. However, caution must be taken when interpreting findings in relation to other surveillance systems with varying methodologies. Still, the findings highlight the need for injury prevention strategies within middle school football, particularly as related to contact-related mechanisms.

A History of Previous Severe Injury and Health-Related Quality of Life Among Former Collegiate Athletes

CONTEXT

Empirical evidence supports the idea that previous severe injuries in former collegiate athletes may adversely affect their ability to participate in daily activities later in life, which may then decrease their health-related quality of life (HRQOL).

OBJECTIVE

To assess the influences of previous severe injuries on the HRQOL of former National Collegiate Athletic Association (NCAA) athletes.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 171 former NCAA collegiate athletes (69 men, 102 women; age = 29.7 ± 3.9 years, height = 171.5 ± 10.4 cm, mass = 76.4 ± 12.9 kg) participated. All individuals completed a demographics questionnaire and the Short Form-36 version 2 (SF-36v2) Health Survey via Qualtrics.

MAIN OUTCOME MEASURE(S)

The dependent variables were the physical composite and mental composite summary scores and the 8 subscales of the SF-36v2. The independent variable was the presence of previous severe injury (history of a severe injury or no history of a severe injury during collegiate athletics). Two multivariate analyses of variance were conducted. The first multivariate analysis of variance was conducted for the 8 SF-36v2 subscales and the second for the 2 summary scores.

RESULTS

For the summary scores and all 8 SF-36v2 subscales, the responses were worse for the 103 former collegiate athletes who sustained a previous severe injury compared with the 68 who did not sustain a severe injury. The largest difference between groups was for the physical composite score, with a mean difference of 15.8 points (1.5 standard deviations worse than the US population); the physical functioning subscale demonstrated a mean difference of 12.9 points (1.3 standard deviations worse than the US population).

CONCLUSIONS

A majority of the athletes in our sample had experienced a severe injury. Based on these data, previous severe injuries had a negative influence on the HRQOL of former NCAA collegiate athletes.

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.

The First Decade of Web-Based Sports Injury Surveillance: Descriptive Epidemiology of Injuries in United States High School Football (2005-2006 Through 2013-2014) and National Collegiate Athletic Association Football (2004-2005 Through 2013-2014)

CONTEXT:

The advent of Web-based sports injury surveillance via programs such as the High School Reporting Information Online system and the National Collegiate Athletic Association Injury Surveillance Program has aided the acquisition of football injury data.

OBJECTIVE:

To describe the epidemiology of injuries sustained in high school football in the 2005-2006 through 2013-2014 academic years and collegiate football in the 2004-2005 through 2013-2014 academic years using Web-based sports injury surveillance.

DESIGN:

Descriptive epidemiology study.

SETTING:

Online injury surveillance from football teams of high school boys (annual average = 100) and collegiate men (annual average = 43).

PATIENTS OR OTHER PARTICIPANTS:

Football players who participated in practices and competitions during the 2005-2006 through 2013-2014 academic years in high school or the 2004-2005 through 2013-2014 academic years in college.

MAIN OUTCOME MEASURE(S):

Athletic trainers collected time-loss injury (≥24 hours) and exposure data. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs) with 95% confidence intervals (CIs), and injury proportions by body site and diagnosis were calculated.

RESULTS:

The High School Reporting Information Online system documented 18 189 time-loss injuries during 4 539 636 AEs; the National Collegiate Athletic Association Injury Surveillance Program documented 22 766 time-loss injuries during 3 121  476 AEs. The injury rate was higher among collegiate than high school (7.29 versus 4.01/1000 AEs; IRR = 1.82; 95% CI = 1.79, 1.86) athletes. Most injuries occurred during competitions in high school (53.2%) and practices in college (60.9%). The competition injury rate was higher than the practice injury rate among both high school (IRR = 5.62; 95% CI = 5.46, 5.78) and collegiate (IRR = 6.59; 95% CI = 6.41, 6.76) players. Most injuries at both levels affected the lower extremity and the shoulder/clavicle and were diagnosed as ligament sprains and muscle/tendon strains. However, concussion was a common injury during competitions among most positions.

CONCLUSIONS:

Injury rates were higher in college than in high school and higher for competitions than for practices. Concussion was a frequent injury sustained during competitions, which confirms the need to develop interventions to mitigate its incidence and severity.

Prevalence and Correlates of Psychological Distress among Retired Elite Athletes: A Systematic Review

This article presents results of a systematic review of the literature (2000-2017) examining the prevalence and correlates of psychological distress among retired elite athletes. Forty articles were selected and included. Our review suggests the prevalence of psychological distress among retired athletes is similar to that found in the general population. However, subgroups reporting medical comorbidities, significant pain, a greater number of concussions, less social support, and adverse psychosocial factors were at greater risk for psychological distress. Additionally, athletes experiencing psychological distress in retirement often do not seek treatment for their distress. Based on the existing literature, there is a need for greater standardization and use of reliable measures, as well as use of diagnostic interviews in order to assess the most accurate prevalence of psychological distress among these athletes. Longitudinal designs, matched control groups, more heterogeneous samples, and use of multivariate analyses would also help to more accurately determine the prevalence and risk factors of psychological distress in this population. This review suggests a number of different clinical implications and highlights directions for future research to enhance our understanding of the long-term psychological health of former elite athletes.

The Impact of Previous Athletic Experience on Current Physical Fitness in Former Collegiate Athletes and Noncollegiate Athletes

Background:

Physical activity performed at moderate intensity is associated with reduced risk of mortality, cardiovascular disease, hypertension, and some types of cancers. However, vigorous physical activity during participation in college athletics may increase the risk of injury, which might limit future physical activity levels.

Purpose:

To evaluate differences in current physical fitness levels between former Division I athletes and noncollegiate athletes.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 3.

Methods:

The sample was recruited from a large midwestern university alumni database and consisted of 2 cohorts: (1) former Division I athletes (n = 100; mean age, 53.1 ± 7.4 years) and (2) nonathletes who were active in college (n = 100; age, 51.4 ± 7.3 years). Individuals answered a demographics questionnaire and completed a physical fitness assessment consisting of 7 measures: percent body fat, 1-mile walk, sit-to-stand test, push-up, half sit-up test, sit and reach test, and back scratch test.

Results:

Performance was significantly worse for former Division I athletes compared with nonathletes for percent body fat (mean difference, 7.58%; F_{(1, 198)} = 59.91; P < 0.01), mile time (mean difference, 2.42 minutes; F_{(1, 198)} = 1.74; P = 0.03), sit-to-stand test (mean difference, 4.3 repetitions; F_{(1, 198)} = 6.59; P = 0.01), and push-up test (mean difference, 8.9 repetitions; F_{(1, 198)} = 7.35; P = 0.01).

Conclusion:

Former Division I athletes may be limited because of previous injury, inhibiting their ability to stay active later in life.

Clinical Relevance:

It is imperative that clinicians, coaches, and strength and conditioning specialists understand the possible future repercussions from competing at the Division I level.

Descriptive Epidemiology of Non-Time-Loss Injuries in Collegiate and High School Student-Athletes

CONTEXT

  Research on non-time-loss (NTL) injuries, which result in less than 24 hours of restriction from participation, is limited.

OBJECTIVE

  To describe the epidemiology of NTL injuries among collegiate and high school student-athletes.

DESIGN

  Descriptive epidemiology study.

SETTING

  Aggregate injury and exposure data collected from a convenience sample of National College Athletic Association varsity teams and 147 high schools in 26 states.

PATIENTS OR OTHER PARTICIPANTS

  Collegiate and high school student-athletes participating in men's and boys' baseball, basketball, football, lacrosse, soccer, and wrestling and women's and girls' basketball, field hockey, lacrosse, soccer, softball, and volleyball during the 2009-2010 through 2013-2014 and the 2011-2012 through 2013-2014 academic years, respectively, participated. Collegiate student-athletes participating in men's and women's ice hockey were also included.

MAIN OUTCOME MEASURE(S)

  Injury data from the National Collegiate Athletic Association Injury Surveillance Program and the National Athletic Treatment, Injury and Outcomes Network were analyzed. Injury counts, rates per 1000 athlete-exposures (AEs), and rate ratios were reported with 95% confidence intervals (CIs).

RESULTS

  A total of 11 899 and 30 122 NTL injuries were reported in collegiate and high school student-athletes, respectively. The proportion of NTL injuries in high school student-athletes (80.3%) was 1.61 times greater than that of collegiate student-athletes (49.9%; 95% CI = 1.59, 1.63). The NTL injury rate in high school student-athletes (8.75/1000 athlete-exposures [AEs]) was 2.18 times greater than that of collegiate student-athletes (4.02/1000 AEs; 95% CI = 2.13, 2.22). Men's ice hockey (5.27/1000 AEs) and boys' football (11.94/1000 AEs) had the highest NTL injury rates among collegiate and high school athletes, respectively. Commonly injured body parts in collegiate and high school student-athletes were the hip/thigh/upper leg (17.5%) and hand/wrist (18.2%), respectively. At both levels, contusions, sprains, and strains were the most frequent diagnoses. Contact with another player was the most cited injury mechanism (college = 38.0%, high school = 46.3%).

CONCLUSIONS

  Non-time-loss injuries compose large proportions of collegiate and high school sports injuries. However, the NTL injury rate was higher in high school than in collegiate student-athletes. Tracking NTL injuries will help to better describe the breadth of injuries sustained by athletes and managed by athletic trainers.

Coaches’ Implementation of the USA Football “Heads Up Football” Educational Program

An integral part of the Heads Up Football (HUF) educational program is the Player Safety Coach (PSC), who is responsible for teaching other coaches within a youth football league about safer blocking/tackling and injury prevention. This study examines the association between youth football coaches’ interactions with the PSC (i.e., attending the PSC clinic at the beginning of the season and seeing the PSC on-field during practices) and their subsequent implementation of the HUF educational program. Data were collected via online questionnaire completed by 1,316 youth football coaches from HUF leagues. Data were analyzed with frequencies and logistic regression. Nearly half of coaches (44.8%) did not attend the PSC clinic; 25.9% reported not seeing their league’s PSC on the field on a regular basis. The lack of PSC on-site presence was significantly associated with worse implementation for “concussion recognition and response,” “heat preparedness and hydration,” and “sudden cardiac event preparedness.” PSC clinic attendance was not associated with implementation. Opportunities exist for improvement in the HUF educational program as there appears to be inconsistent implementation. Further research is warranted to understand how to optimize the role of the PSC in the youth sports context.