Valid self-reported outcome measures can contribute to a greater understanding of the impact of illness and injury on athletic performance. |
There is currently no universally accepted self-reported outcome measure of athlete performance. |
The Oslo Sports Trauma Research Centre overuse injury questionnaire has potential for development for use across different sports. |
1 Background
2 Methods
2.1 Search Methods for Identification of Studies
2.1.1 Electronic Searches
2.1.2 Searching Other Resources
2.2 Data Extraction
2.3 Quality Assessment
2.3.1 Validity
2.3.2 Reproducibility (Agreement and Reliability)
2.3.3 Responsiveness (Longitudinal Validity)
2.4 Data Synthesis and Reporting
3 Results
3.1 Characteristics of Included Studies
No. of references | |
---|---|
Country | |
7 | |
4 | |
4 | |
2 | |
Nigeria [26] | 1 |
Switzerland [47] | 1 |
Sweden [45] | 1 |
Germany [37] | 1 |
Sport | |
Soccer | 8 |
Athletics | 7 |
Volleyball, aquatic, baseball, American Football, lacrosse, basketball | 4 |
Equestrian, cycling, handball, skiing, swimming, wrestling, hockey, tennis, ice hockey | 3 |
Gymnastics, rugby, floor ball, archery, beach volleyball, shooting, taekwondo, weightlifting, table tennis | 2 |
Cricket, boxing, fitness, golf, judo, water polo, badminton, fencing | 1 |
Health problem | |
6 | |
4 | |
4 | |
4 | |
3 | |
Eye [46] | 1 |
Lower back [29] | 1 |
3.2 Characteristics of the Athlete-Reported Outcome Measures
Athlete-reported outcome measure | Domains/no. of items | Question asked to measure impact on performance | Scale | Time to complete/setting | Population in which measure has been validated |
---|---|---|---|---|---|
Oral health surveillance Study-specific questionnaire [26] | Demographics Health behaviours History of oral health problems Impact on performance (32 items) | Have you experienced a dental problem during competition? If yes did it affect your performance in the competition? | Yes or no | 8 min at pilot Self-administered during competition | None |
Injury surveillance Structured interview OSTRC injury questionnaire [27] | History of training/playing Presence of injury | Did you participate fully in first team training and available for match selection each week? Were you selected for the match squad? | Yes or no | Professional administered End of season | Based on questionnaire developed for use in other elite sport groups |
Knee injury and repair Qualitative Pre-designed diary and 5 semi-structured in-depth interviews [28] | Confidence building Anticipation Anxiety Physical preparation Psychological preparation Social support Dealing with fears | Not fully described e.g. feelings returning to competition? How did you feel after your first game? Was the injury still a concern? Do you feel ready to return to competition? | None | 5 separate interviews each lasting 30–45 min During rehabilitation | None |
OSTRC overuse injury questionnaire [29] | History of injury Impact on performance (4 items) × 3: shoulder, knee, lower back | Have you had any problems participating during past week? To what extent have you reduced your training volume over the past week? To what extent have problems reduced your performance during the past week? To what extent have you experienced pain related to your sport during the past week? | Q1: 4 categories Full participation no problems Full participation but with problems Reduced participation Unable to participate Q 2, Q 3: 5 categories None Minor Moderate Major Unable to participate Q 4 (pain): 4 categories None Minor Moderate Severe | Self-administered e-mail During training period | Elite athlete population |
OSTRC questionnaire on health problems [30] | History of illness/injury Impact on performance (4 items) | Have you had any problems participating during past week due to illness/injury/other health problem? To what extent have you reduced your training volume over the past week due to illness/injury/other health problem? To what extent have injury/illness/other problems reduced your performance during the past week? To what extent have you experienced symptoms/health complaints related to your sport during the past week? | As above | Self-administered e-mail, followed up by telephone for clarification if needed During training/pre competition | Based on OSTRC overuse injury questionnaire |
Shoulder injury and repair Study specific questionnaire [31] L’Insalata shoulder questionnaire ASES | Returning to pre-injury level of athletics (1 item) | Level of return to play | 3 categories: Return to pre-injury level Return in a limited capacity Unable to play at all | Professional/self-administered | None L’Insalata shoulder questionnaire ASES Validity in the general population |
Shoulder injury and repair Study-specific questionnaire [32] | Playing status Post-op complications Impact on performance (5 items) | Seasons played since surgery Time needed to return to competition Competitive level of return Pitch velocity compared with pre-injury levels Pitch control compared with pre-injury levels | 3 categories: Increase in pitch quality No change in pitch quality Decrease in pitch quality | Telephone interview | None |
Hip groin injury and repair Study-specific questionnaire [34] | Demographics History of complaint Impact on daily activities Impact on sport Perception of fitness (5 items) | Time to return to training Time to return to sport competitively | Time in weeks 4 categories: Light training, full training Competition Fully match fit | Self- administered and telephone interview | None |
KJOC shoulder and elbow questionnaire [33] | Playing with pain Impact on performance Relationship with coach (10 items) | How difficult is it to get loose or warm prior to competition or practice? How much pain do you experience in your shoulder or elbow? How much fatigue do you experience? How unstable is your shoulder/elbow? How much have problems affected your relationship with coach/management? How much has your velocity or power suffered? What limitation do you have in endurance? How much has your control suffered? How much do you feel your arm affects your current level of competition? | 10-point VAS score | Self-administered At beginning and end of playing season | Overhead throwing athletes |
Illness surveillance Athlete diary [35] | Demographics Training load Illness behaviour | Did you train? Are you ill or injured? | 3 categories to score impact on training: Score 1 minimal = normal training Score 2 moderate = modified training Score 3 severe = discontinued training Yes or no | Self-administered | Based on questionnaire developed by Australian Institute for Sport |
Hip groin injury and repair Study-specific questionnaire [37] | Return to play Pain (5 items) | Resumption of sport within 28 days Time to resumption of sport (days) Full return to sport within 28 days Time to full return to sport (days) | Time: in days Level of performance | Telephone interview | None |
Knee injury and repair Study-specific questionnaire [36] | Return to sport (3 items) | Self -reported time to return to sport Self-assessment of level of performance Level of competitive sport achieved after college | Time in months Percentage of pre-injury level of performance | Telephone interview | None |
Hip groin injury and repair Study-specific questionnaire [38] SF-12 HOS HSAS | Quality of performance Return to play (3 items) | Athlete perception of percentage of pre-injury level Time to return to play Level of play | Percentage of pre-injury performance Time: months 2 categories: major league, minor league | Self-administered | None SF-12 HOS HSAS Validity for use in general population |
Oral health surveillance | Health behaviours History of oral problems Impact on performance (3 items) | To what extent have you been “bothered” by your mouth, teeth or gums over the past 12 months? To what extent have your mouth, teeth or gums affected your quality of life over the past 12 months? To what extent have your mouth, teeth or gums affected your athletic training or performance over the past 12 months? | 5 categories: Not at all A little Somewhat A fair amount A great deal | Professional administered During competition During training | Derived from global questions Validity for use in the general population |
Hip groin injury and repair Study-specific questionnaire [41] MHHS HOS UCLA VAS for pain | Return to sport Time to return to sport Level of competition Pain (4 items) | Return to sport Time to return to sport Level of competition | 2 categories: Same level Not at all Time in months 3 categories: Varsity high school College Professional | Telephone interview | None MHHS HOS Validity for use in the general population |
Injury surveillance [42] | Time lost from training/competition (3 items) | How many minutes of match play did you do last week? How many hours of training did you do last week? Have you had any illness/injury that has restricted you from full participation in one or more training sessions and/or matches last week? | Time in minutes and/or hours Yes or no | Self- administered Text message | Based on questionnaire developed for use in other elite sport groups |
Knee injury and repair Study-specific questionnaire [43] IKDC Lysholm knee scale VISA-P | Return to sport (2 items) | Time to return to play Level of return to play | 3 categories: Return to same level Return to lower level Not competing | Professional/self-administered | None IKDC, Lysholm validity in general population VISA-P validity in active populations |
Hip/groin injury and repair Study-specific questionnaire [44] MHHS Patient satisfaction | Return to play (2 items) | Time to return to skating drills Number of NHL games played | Time in months Number of games | Self-administered | None MHHS Validity for use in general population |
Hip/groin injury and repair Study-specific questionnaire [45] iHOT-12 HAGOS HSAS EQ-5D VAS for hip function | Return to play (1 item) | Return or not to pre-injury sport | Yes or no | Self-administered Web-based | None iHOT and HAGOS have validity in athletic population EQ-5D for general population |
Eye injury surveillance Study-specific questionnaire [46] | Playing history Circumstances of injury Medical behaviour/intervention Consequences of injury (34 items) | How much playing time did you miss because of the injury? Do you have any continuing problems from your eye injury? | 6 categories: 0, sat out some of game/practice 1–3 days 3–5 days 5–7 days >7 days Yes or no | Self-administered During competition | None |
3.3 Evaluation of Athlete-Reported Outcome Measures Used in Health Surveillance
Athlete-reported outcome | Content validity | Internal consistency | Construct validity | Reproducibility (agreement) | Reproducibility (reliability) | Responsiveness | Floor and ceiling effects | Interpretability |
---|---|---|---|---|---|---|---|---|
+ Clear description of target aim. Target population and experts involved in item selection and development | + Factor analysis Cronbach’s alpha 0.861 | + Correlates well with established PROMs for upper limb (DASH and DASH for performing arts); Pearson r 0.84 and 0.86 respectively | + Data presented and discussed regarding meaningful clinical change | + Test-retest data reported | + Differentiates between players with pain and without pain Change in scores reported for different subgroups | + Maximum average scores reported | + Score of 100 indicates maximum function | |
OSTRC overuse injury questionnaire [29] | + Clear description of target aim. Target population and experts involved in item selection and development | + Factor analysis using a principle component analysis extraction method Cronbach’s alpha 0.91 | + Correlates with time loss recorded by conventional measures | 0 | 0 | ? Severity score can be plotted for each athlete | − >15% of respondents achieve highest or lowest scores | + Severity score can be calculated out of 100 |
OSTRC questionnaire on health problems [30] | ? Developed from OSTRC overuse injury questionnaire | ? Factor analysis Cronbach’s alpha 0.96 For non-injury cases 0.97 | + Correlates with time loss recorded by conventional measures | 0 | 0 | ? Severity score can be plotted for each athlete | − >15% of respondents achieve highest or lowest scores | + Severity score can be calculated out of 100 Subgroups of illness, overuse injury and acute injury reported |
− Target group not involved in item selection | − No factor analysis Cronbach’s alpha not calculated | + Tooth decay associated with self-reported impact on performance | 0 | 0 | 0 | 0 | 0 |
3.4 Athlete- Versus Patient-Reported Outcomes to Evaluate Medical Interventions
Athlete-reported outcome measure | No. of questions | Study population | Advantages | Disadvantages |
---|---|---|---|---|
KJOC shoulder and elbow questionnaire [33] | 10 | Professional baseball players (203) | Validity, reliability and responsiveness in elite sport population [10] | Functional measure, region-specific Specific to overhead throwing athletes |
OSTRC overuse injury questionnaire [29] | 4 (for each specified region) | Elite athletes (313): cycling, floorball, handball, volleyball, cross-country skiing | Validity in elite sporting population, severity score to measure impact Useful across different athlete groups | Problem must be specified in advance |
OSTRC questionnaire on health problems [30] | 4 | Olympic candidates (313): archery, athletics, beach volleyball, boxing, cycling, handball, kayak, rowing, sailing, shooting, swimming, taekwondo, weightlifting, wrestling | Validity in elite sport population. Useful across different athletes groups | Athlete will only record problems they feel relevant |
iHOT-12 [45] | 12 | High level athletes (32): soccer, hockey, long distance running | Validity in younger active population [49] | Functional PROM Region-specific |
HAGOS [45] | 37 | High level athletes (32): soccer, hockey, long distance running | Validity in younger active population [50] Comprehensive | Functional PROM Region-specific Lengthy |
VISA-P [43] | 8 | Professional athletes (28): volleyball, soccer, basketball | Validity in younger active population [48] | Functional PROM Condition-specific |
10 | Professional athletes (22): ice hockey, soccer, table tennis, floorball High level athletes (32): soccer, hockey, long distance running | Validity in sport population [47] Useful to clarify level of sport performance | Self-reported measure Region-specific | |
3 | Olympic athletes (278) Professional footballers (187) | Suitable for use across different athlete groups | Validity in the general population only [51] Region-specific |