The lingering impact of sport-related knee injuries on health-related quality of life in active youth
Creators: Le, Christina Y.
Publisher: name: University of Alberta Library
Year: 2023

<p>Background: It is assumed that youth who experience a knee injury while playing sports have an initial decline in health that resolves with time, leaving no lasting impact. Health-related quality of life (HRQoL) encompasses the physical, psychological, and social domains of health. It can represent overall health (generic HRQoL) or health relative to a specific condition or body part (e.g., knee-specific HRQoL). Our knowledge of how sport-related knee injuries impact HRQoL is mostly based on adults and one injury type [anterior cruciate ligament (ACL) rupture]. To appreciate the full consequence of sport-related knee injuries on active youth, a broader understanding of how these injuries impact HRQoL is needed.</p>

<p>Objectives: To improve our understanding of 1) how to measure HRQoL of active youth, 2) how HRQoL is altered by a youth sport-related knee injury at varying timepoints, and 3) what physical, psychological, and social consequences of injury are associated with HRQoL in active youth at varying timepoints.<br>
Methods: This thesis consists of 4 studies: 1) a systematic review evaluating patient-reported outcome measures (PROMs) for measuring generic and condition-specific HRQoL of active youth according to COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) guidelines; 2) a secondary analysis of a historical cohort study comparing generic and knee-specific HRQoL between individuals with and without a 3-12-year history of a youth sport-related knee injury; 3) a preliminary analysis of a prospective cohort study describing differences in knee-specific HRQoL and associated health outcomes between youth with and without a sport-related knee injury over an initial 6-month period; and 4) a prospective cohort study comparing knee-specific HRQoL between youth with and without a sport-related knee injury and assessing the influence of associated health outcomes on this relationship over a 12-month period.</p>

<p>Results: The systematic review identified and evaluated 11 generic and 7 condition-specific HRQoL PROMs used in active youth. No existing PROM was deemed robust due to lacking sufficient measurement properties. Two generic and 1 upper extremity-specific HRQoL PROMs were judged as the most suitable based on sufficient structural validity and internal consistency. The historical and prospective cohort studies reveal that a wide range of youth sport-related knee injuries are associated with reduced knee-specific HRQoL at baseline, 6-month, 12-month and 3-12 year follow-ups compared to uninjured controls, regardless of sex. Conversely, no differences in generic HRQoL were found at 3-12 year follow-up. Exploratory analyses suggest that intermittent knee pain, knee muscle strength, physical activity, kinesiophobia, injury type, and baseline HRQoL may influence the relationship between knee injury and HRQoL.</p>

<p>Conclusions: Taken together, these studies reveal that youth who experience a wide range of sport-related knee injuries – not just ACL ruptures – experience significant and persistent deficits in knee-specific HRQoL but not generic HRQoL compared to uninjured controls. Intermittent knee pain, knee extensor strength, physical activity, kinesiophobia, and injury type may be potential determinants of HRQoL in this population. Novel contributions from this thesis can guide future development and evaluation of HRQoL PROMs and inform future efforts to better understand and optimize HRQoL following a youth sport-related knee injury. </p>