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

Abstract

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 ¼ .011) and KOOS Quality of Life subscale (P ¼ .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 ¼ 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 ¼ .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.Key Words: health-related quality of life, patient-centered outcomes, injury history, evidence-based practice Key PointsThe Disablement in the Physically Active Scale, Foot and Ankle Ability Measure-Sport, and Knee Injury and Osteoarthritis Outcome Score scales are reliable instruments that have been used clinically to assess activity limitations and participation restrictions in collegiate athletes. Significant changes in health-related quality of life are likely to be associated with an injury that restricts athletic participation or another factor rather than participation itself. To capture all dimensions of health-related quality of life, clinicians should use both a generic and a region-specific instrument.

Confirmatory Factor Analysis of the Disablement in the Physically Active Scale and Preliminary Testing of Short-Form Versions: A Calibration and Validation Study

“…14,15 The DPA scale is a 16-item instrument, scored on a 1 (no problem) to 5 (severely affected) Likert scale, with a total score floor of 0 and a ceiling of 64 points. 15 The scale has been reported to have acceptable model fit (v 2 15 high test-retest reliability (intraclass correlation coefficient ¼ 0.943) and internal consistency (a ¼ .890-.908), 23 and concurrent validity (À0.751 [acute] and À0.710 [persistent] relationship with global functioning scores). 15 The DPA scale also has similar summary components as the SF-36.…”

“…24 The design and results of early psychometric measurement evaluation have led to the scale being recommended for use in research and practice. 15,23,24 Yet certain potential limitations should be considered when using the DPA scale in clinical research and practice. The confirmatory factor analysis (CFA) was performed with data from only 125 participants who were all currently injured (ie, 43 reported injury at baseline, 28 were postacute injury, and 54 reported persistent injury), coming from the same geographic regions (5 sites), and in a similar age range (ie, high school and collegiate athletes).…”

“…However, the scale has primarily been assessed by studying collegiate athletes in similar geographic locations. 14,15,23,24 Therefore, the construct validity of the DPA scale must be assessed among a more diverse sample of the physically active population that can be expected to use the scale across multiple health care disciplines. 25,26 Further psychometric testing is justified for refining the DPA scale, and caution should be used when interpreting the findings of the instrument until further assessment has been completed.…”

Patient-Reported Outcomes Measurement Information System Physical Function Item Bank, Version 1.0: Physical Function Assessment for Athletic Patient Populations

“…Second, researchers have recommended that clinicians administer both generic and region-specific PRO instruments throughout the course of a patient's treatment protocol to accurately assess all dimensions of health-related quality of life. 6 So, instead of 1 lengthy questionnaire, clinicians are now asked to administer a number of instruments, further contributing to time constraints in the clinic. Ultimately, administering lengthy questionnaires that cannot adapt to a patient's level of functional ability or individual injury places an excessive burden on both the patient and the clinician.…”

“…2,5,6 First, many of the assessment instruments used in athletic training environments are based on classical test theory, which limits the adaptability of the instrument and forces patients to answer lengthy questionnaires, regardless of their current physical function levels. 3,5,7 For example, a patient who is using crutches during the early stages of rehabilitation will answer questions related to walking up stairs and jogging.…”