Copyright © 2008 by The Journal of Bone and Joint Surgery, Inc.
Commentary & Perspective
Commentary & Perspective by
Lyle J. Micheli, MD*,
Children's Hospital, Boston, Massachusetts
Posted March 2008
Huffman et al. have contributed a very important study that I
believe will be of special benefit to orthopaedic surgeons who practice sports medicine.
This is a large study of athletes who have been "cleared" to participate in intercollegiate
sports at United States National Collegiate Athletic Association (NCAA) Division-I
and II levels. The findings are important because they serve as a baseline for
normative values for an athletically active population at this relatively elite
level. They also provide some interesting insights into the self-perceived
health of this population.
When compared with the general population and with age-matched
samples of their population, these athletes scored significantly higher (p <
0.05) in seven of the eight health-related domains of the Short Form-36 (SF-36)
and scored close to significance (p = 0.051) in the eighth domain. This could
perhaps reflect the truism that athletes are relatively healthy in comparison
with the general population and age-matched cohorts. The extent of this
perception of a healthier athletic population has now been documented.
Of great interest, however, is the observation that athletes
who had sustained a previous injury scored significantly lower (p < 0.05) in
all health categories except role limitations due to emotional problems, which
also showed a trend toward a lower score (p = 0.057). Even though the athletes
had sufficiently recovered from their injuries to participate in athletics and had
been fully cleared to do so, their history of injuries still contributed to a
self-perceived lower health status.
In sports medicine, it is well known that athletes may be
more tentative or at least wary in the short term after sustaining any substantial
injury. This state, often referred to as "hearing hoofbeats behind you," has
been a frequent observation of coaches and sometimes of team physicians. The
extent to which this state may persist (it is possible that even remote childhood
injuries can produce this result) might well influence our approach to
rehabilitation and "return to play" criteria in this athletic population.
There is now great interest in outcomes of treatments or
operative interventions1,2. This area of outcome studies has been
identified as an important area of clinical concern, particularly in the field
of sports trauma3. There are three general types of outcome measures:
generic (e.g., the SF-36 or the Pediatric Evaluation of Disability Inventory [PEDI]
in children), condition specific (e.g., the International Knee Documentation
Committee [IKDC] subjective score for knees or the American Shoulder and Elbow
Surgeons [ASES] score for shoulders), and patient satisfaction scales4.
It is clear from the present study that the normative values
for the SF-36 obtained in this large group of athletes should be the basis for
comparison with other sports-treatment or sports-injury specific studies.
Further validation of these findings is needed, of course. We would certainly
look forward to similar projects at other large universities with extensive
sports programs.
Of equal interest is the question of whether this apparent
benefit for health from sports training and participation is also demonstrated
at other levels of sports participation, such as at the club sports level, the
amateur sports federation level, or the recreational sports level. The authors
have set a standard for comparison and opened the door for a number of other
related but equally interesting studies on this topic. We look forward to
further work on this important and emerging field of sports-medicine study.
*The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.
References
1. Kocher MS, Zurakowski D. Clinical epidemiology and biostatistics: a primer for orthopaedic surgeons. J Bone Joint Surg Am. 2004;86:607-20.
2. Wennberg JE. Outcomes research: the art of making the right decision. Internist. 1990;31:26, 28.
3. Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ. Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am. 2002;84:1560-72.
4. Kane RL. Outcome Measures. In: Kane RL, editor. Understanding health care outcomes research. Gaithersburg, MD: Aspen; 1997. p 17-8.
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