Patient Reported Outcomes and Symptomatic Impingement in US Women’s Professional Soccer

Abstract

Objectives:The purpose of this study was to determine: 1) normative data of multiple general health-, activity-, hip and groin-, and depression-specific patient-reported outcome (PRO) questionnaires; 2) if any PRO's were able to predict a positive anterior impingement test, in female professional soccer players. Methods: An IRB-approved cross-sectional investigation of adult female US professional soccer players was performed at the team pre-season physical examination day. Adult (>18 years of age) female players without prior hip surgery were eligible. Hip impingement physical examination was performed (anterior, subspine, lateral, posterior) and recorded. Multiple questionnaires were administered to each player, including Short-Form-12 (Mental Component and Physical Component Scores [MCS, PCS]), Tegner activity score, Non-Arthritic Hip Score (NAHS), Hip and Groin Outcome Score (HAGOS), international Hip Outcome Tool-12 (iHOT-12), and Zung Depression Index. Descriptive statistics were calculated. Kolmogorov-Smirnov analysis was performed for data normality and Pearson's (parametric) or Spearman's (non-parametric) to assess correlation of ROM and radiographs. Binary logistic regression was performed to ascertain the effects of each PRO questionnaire score and prediction of a positive anterior impingement test. Results: Twenty-four players (48 hips) were analyzed (25.4+/-3.0 years of age; 2.8+/-2.2 years professional experience). Scores were collected: Tegner 9.9+/-0.3; SF-12 PCS 52.9+/-7.4; SF-12 MCS 54.3+/-7.0; iHOT-12 96.6+/-5.4%; NAHS Total 97.9+/-4.9; HAGOS symptoms 90.5+/-10.5, pain 97.8+/-3.4, activities of daily living 99.4+/-2.2, sports 97.1+/-4.2, physical activity 97.9+/-7.1, and quality of life 95.8+/-8.7; Zung 27.6+/-5.9. The iHOT-12 was able to correctly predict 71% of cases of positive anterior impingement test for the left hip and the logistic regression model was statistically significant, (5.2)1, p=0.02. For the right hip, the iHOT-12 was able to correctly predict 79% of cases of positive anterior impingement and the logistic regression model was statistically significant, χ 2 (9.1)1, p=0.003. SF-12 MCS and PCS scores were able to correctly predict 83% of cases for the left hip and the logistic regression model was statistically significant, χ 2 (11)2, p=0.005. The Zung score was able to correctly predict 83% of cases for the left hip and the logistic regression model was statistically significant, χ 2 (4.1)1, p=0.04. Conclusion: Multiple general health-, activity-, hip and groin-, and depression-specific patient reported outcome scores were collected and normative data established in a US women's professional soccer club, showing that iHOT-12, SF-12 MCS and PCS, and Zung depression scores were able to correctly predict symptomatic impingement.