Perceptual Decision Efficiency Is Modifiable and Associated with Decreased Musculoskeletal Injury Risk Among Female College Soccer Players

<b>Background:</b> Prevention and clinical management of musculoskeletal injuries have historically focused on the assessment and training of modifiable physical factors, but perceptual decision-making has only recently been recognized as a potentially important capability. Immersive virtual reality (VR) systems can measure the speed, accuracy, and consistency of body movements corresponding to stimulus-response instructions for the completion of a forced-choice task. <b>Methods</b>: A cohort of 26 female college soccer players (age 19.5 ± 1.3 years) included 10 players who participated in a baseline assessment, 10 perceptual-response training (PRT) sessions, a post-training assessment that preceded the first soccer practice, and a post-season assessment. The remaining 16 players completed an assessment prior to the team's first pre-season practice session, and a post-season assessment. The assessments and training sessions involved left- or right-directed neck rotation, arm reach, and step-lunge reactions to 40 presentations of different types of horizontally moving visual stimuli. The PRT program included 4 levels of difficulty created by changes in initial stimulus location, addition of distractor stimuli, and increased movement speed, with ≥90% response accuracy used as the criterion for training progression. Perceptual latency (PL) was defined as the time elapsed from stimulus appearance to initiation of neck rotation toward a peripheral virtual target. The speed-accuracy tradeoff was represented by Rate Correct per Second (RCS) of PL, and inconsistency across trials derived from their standard deviation for PL was represented by intra-individual variability (IIV). Perceptual Decision Efficiency (PDE) represented the ratio of RCS to IIV, which provided a single value representing speed, accuracy, and consistency. Statistical procedures included the bivariate correlation between RCS and IIV, dependent <i>t</i>-test comparisons of pre- and post-training metrics, repeated measures analysis of variance for group X session pre- to post-season comparisons, receiver operating characteristic analysis, and Kaplan-Meier time to injury event analysis. <b>Results:</b> Statistically significant (<i>p</i> < 0.05) results were found for pre- to post-training change, and pre-season to post-season group differences, for RCS, IIV, and PDE. An inverse logarithmic relationship was found between RCS and IIV (Spearman's Rho = -0.795). The best discriminator between injured and non-injured statuses was PDE ≤ 21.6 (93% Sensitivity; 42% Specificity; OR = 9.29). <b>Conclusions:</b> The 10-session PRT program produced significant improvement in perceptual decision-making that appears to provide a transfer benefit, as the PDE metric provided good prospective prediction of musculoskeletal injury.