Prospective Assessment of Return to Pre-Injured Levels of Activity

OF DISSERTATION PROSPECTIVE ASSESSMENT OF RETURN TO PRE-INJURED LEVELS OF ACTIVITY Determining return to pre-injured levels of play following athletic injury can be challenging. The current practice of making decisions following rehabilitation as to whether or not a patient has returned to pre-injured levels of activity is potentially inaccurate because initial assessments of perceived physical capability are performed at a time of relative dysfunction or are based on patient recall. Since there is no true baseline of perceived and physical function prior to injury it is difficult to determine if an athlete has return to baseline or is simply better than they were at the time of injury. Therefore, it is unclear whether a true link can be established between rehabilitation and the restoration of pre-injured physical function. Therefore, the purpose of this dissertation was to obtain values of perceived and demonstrable physical function in collegiate prior to the occurrence of injury and following rehabilitation to determine if physical function was restored prior to permitting the athletes to return to activity. Patient opinion about the ability to perform athletic maneuvers is important following injury; however, prospective assessment of self-perceived physical function for athletes prior to the beginning of a season before injury occurrence is lacking. Baseline values of self-reported physical function relative to the perceived state of the knee, shoulder, and elbow in a wide array of athletes before the commencement of injury exposure were obtained. It was determined that 1) overall, collegiate athletes report upper level scores on selected knee, shoulder, and elbow outcome questionnaires and 2) athletes with previous injury to these joints have perceived lower physical function prior to a competitive season although they were medically cleared to participate in sport. Previous reports have noted that the closed kinetic chain upper extremity stability test (CKCUEST) and traditional strength testing maneuvers have excellent test/re-test reliability in asymptomatic individuals but no information existed for individuals with shoulder symptoms. Therefore, subjects with and without current shoulder symptoms were recruited to determine if the CKCUEST and traditional strength testing maneuvers had similar reliability and if the CKCUEST could distinguish between persons with and without shoulder symptoms. Using traditional strength measures and the CKCUEST did not reveal meaningful differences although there was a trend towards a difference with the CKCUEST. This area certainly needs further study to identify functional measures of strength specific to the upper extremity. The findings from the first and second study guided me to the primary purpose of this dissertation which was to assess perceived and demonstrable physical function in collegiate athletes in a longitudinal manner in order to trace the natural history of physical function from a pre-injured time point to a post-injured time point. It was determined that not all athletes perceive their physical function as restored to baseline levels when discharged from rehabilitation to return to sport. Additionally, previous injury history negatively affects perceived physical function at both baseline and postrehabilitation time points for persons who previously sustained a knee injury but not persons who previously sustained an ankle injury. Demonstrable physical function was not back to baseline at time of discharge but was restored within 1 month after return to activity was permitted and was not affected by a previous injury history with this sample of subjects.