Physical and Mental Health Scores Worsen Over Division I Collegiate Sports Season and Decline Further Following Mid-Season Injury or Illness

BACKGROUND/OBJECTIVES: Collegiate athletes commonly report higher physical function and lower pain interference than the average population. However, limited information is available regarding how patient-reported outcome scores change across a sports season or following a mid-season injury or illness. It was hypothesized that collegiate athletes would report higher scores in Patient-Reported Outcomes Measurement Information System (PROMIS) physical, mental, and social health domains compared to the general population, and mid-season injury/illness would be associated with worsened post-season scores compared to pre-season. METHODS: Collegiate athletes across all varsity sports from one Division I institution were surveyed pre-season and post-season in this prospective cohort study. Mid-season injury/illness was self-reported and defined as an event interrupting in-season participation. Pre- and post-season PROMIS Physical Function (PF), Pain Interference (PI), Ability to Participate in Social Roles and Activities (APSRA), and Depression (D) were collected. Change from pre-season was compared between non-injured/non-ill and injured/ill athletes with paired non-parametric tests. RESULTS: A total of 211 athletes were included, consisting of 117 (55%) males and a similar distribution across collegiate year (26%, 28%, 22%, 23%, respectively). Team field sports including football (42%), female lacrosse (12%) and female soccer (9%) made up a majority of respondents. Pre-season PROMIS PF (59.9±7.8) and APSRA (60.1±7.1) scores were nearly one standard deviation higher than the US population T-score (50±10). PI (48.6±7.6) and Depression (45.5±8.4) were within typical range. Athletes sustaining a mid-season injury/illness reported worse post-season scores in PF (-3.9±9.0, p<0.001, r=0.396), PI (2.5±10.7, p=0.034, r=0.213), APSRA (-2.6±7.5, p=0.003, r=0.325), and Depression (1.9±7.5, p=0.011, r=0.276) compared to their pre-season. Non-injured/ill athletes also demonstrated mildly worsened scores in PF (-2.3±7.3, p<0.001, r=.312) and APSRA (-1.3±7.9, p=0.049, r=0.183) compared to their pre-season. CONCLUSIONS: Mid-season injury/illness was associated with worsened PROMIS scores across all measured physical and mental health domains. Athletes without an injury/illness also reported worsened PF and APSRA, indicating a potential impact from the sports season. However, the clinical significance of these score changes remains uncertain. The declines were modest and athlete-specific minimal clinically significant difference thresholds are needed to better define clinical significance in this population. LEVEL OF EVIDENCE: Level 2.