Validity, Means, and Distribution of the HSS Pedi-Fabs in Pediatric Athletes and in Common Sports

Abstract

BACKGROUND: Patient reported outcome measures (PROMs) measuring activity level can be crucial to a musculoskeletal provider in both a clinical and research setting. The HSS Pedi-FABS was developed as a generalizable measure of activity in children ages 10-18. However, existing literature validating this scale is limited by small patient populations leading to underrepresentation of multiple sports. The purpose of this study is to assess the validity of the HSS Pedi-FABS when used in a large pediatric population participating in various sports and evaluate the means and distribution of Pedi-FABS amongst common sports. METHODS: A retrospective review of 517 subjects who completed the HSS Pedi-FABS while presenting for knee evaluation was performed. Subjects were seen by one of five providers at a pediatric sport medicine center between October 2016 and June 2017. Subjects were included in analysis if they completed the HSS Pedi-FABS and had reported status as an athlete. Patient demographics, primary sport, multi-sport involvement, level of competition, frequency of play, HSS Pedi-FABS and Tegner Activity Level Scale (Tegner) scores were reviewed. The Tegner asked subjects to classify their activity level prior to injury. To determine validity, the HSS Pedi-FABS was compared to the Tegner. S-correlations were calculated between the two activity scales. Each scale was then correlated with level of activity and frequency of play. A t-test was run between the HSS Pedi-FABS scores and multi-sport involvement. Distributions of the HSS Pedi-FABS scores were calculated across the eight most frequent primary sports reported by the sample population. ANOVA analyses were performed with the HSS Pedi-FABS and Tegner Before scores of the eight primary sports. The ANOVA analyses were followed by t-tests for multiple comparisons. RESULTS: Of the 424 athletes included in the study, 227 (53.5%) were female and 197 (46.5%) were male. The mean age was 14.29 years (range: 6.48-22.35). 207 (48.8%) were multi-sport athletes while 215 (50.7%) were considered single-sport athletes. 2 (0.5%) had an unknown status. There was a significant difference between HSS Pedi-FABS scores of multi-sport athletes versus single-sport athletes (22.0 versus 20.36, respectfully, p=.027). Correlations were found between the HSS Pedi-FABS and days per week playing a primary sport (r=0.273; p<0.001), hours per week playing primary sport (r=0.292, p<0.001), and weeks NOT engaged in sports (r=-0.112, p=0.039). In this data, there was no correlation with perceived level of competition and HSS Pedi-FABS. There was no statistical correlation found between the HSS Pedi-FABS and the Tegner with a similar mean HSS Pedi FABS scores seen in each Tegner group >5. The Tegner scale did not statistically correlate with hours per week or days per week. The HSS Pedi-FABS showed a significant difference in scores between the eight most frequent primary sports (p=0.001). Subjects whose primary sport was Soccer scored significantly higher (23.57 ± 6.27) than those of Dance/Drill Team/Ballet (17.45 ± 6.38) and Track and Field/Running/Cross Country (17.47 ± 5.74, p=.001, .024). Frequency distributions of each sports are seen in Figure 1. CONCLUSION: The HSS Pedi-FABS, as compared to the Tegner, has significant correlation with time spent while playing a primary sport. Normal distribution of the HSS Pedi FABS may be different based on sports. Further analysis of multiple joints could provide a more comprehensive understanding of Pedi-FABS scoring trends in pediatric athletes. [Figure: see text]