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5/26/2013
1
WELCOME TO DAY II
SCHEDULE OF EVENTS
� Current Topics in PPE Administration
� Predictive Injury Modeling
� Strategic Planning in Sports Medicine
� Lunch
� BOC Facilities Principles
� Program Profile: Temple
� Concussion Management
� Personal and Professional Time Management
� Social
� Dinner Availability for 4 (Free of Charge)
5/26/2013
2
Institute for Collegiate Sports Medicine
CURRENT TOPICS IN PPE
ADMINISTRATION
CURRENT TOPICS IN PPE
ADMINISTRATION
5/26/2013
3
PRE-PARTICIPATION PHYSICAL
EXAMINATION – 4TH EDITION
� American Academy of Family Physicians
� American Academy of Pediatrics
� American College of Sports Medicine
� American Medical Society for Sports Medicine
� American OrthopaedicSociety for Sports Medicine
� American Osteopathic Academy of Sports Medicine
American Academy
of Pediatrics
DISCUSSION TOPICS
� Goals and Objectives
� Team Physician vs Family Physician
� Ethical and Legal Considerations
� Cardiac Screening Considerations
� Sickle Cell
� Governing Body Requirements
� Special Populations in Athletics
� Medical Disqualification Processes
� Central Nervous System / Brain
� Clearance and Referrals
� Minimizing Risk of Injury with PPE
5/26/2013
4
GOALS AND OBJECTIVES
WHAT IS THE “PRIMARY”
GOAL OF YOUR PHYSICALS?
47%
33%
20%
Screen for... Screen for... Promote He...
1. Screen for Life-
threatening
Conditions
2. Screen for
Conditions that
Predispose
Athletes to Injury
3. Promote Health &
Safety
5/26/2013
5
GOALS
� Promote the health and safety of the
athlete in training and competition
� More Standardized Approach =
Provide a tool to facilitate care of the
athlete and set the stage for data
collection leading to future changes
based off of outcomes data.
� Effectiveness
� Identify diseases or processes that
will affect student athletes
� Sensitive and Accurate
� Practical and Affordable
FACTS ABOUT PPES
� Goal is not to exclude
participation
� 0.3% - 1.3% of athletes
are denied clearance to
participate
� 3.2% - 13.9% require
further evaluation
� 75% of medical and
orthopedic conditions are
detected by history alone
Just a Thought: If 100% of
SAs pass physical without
any further evaluation was
your physical detailed
enough?
5/26/2013
6
IN THE LAST 3 YEARS HOW MANY STUDENT ATHLETES
HAVE YOU DISQUALIFIED DUE TO THE PPE?
36%
57%
7%0%
0 1-2 3-4 5+
1. 0
2. 1-2
3. 3-4
4. 5+
PRIMARY OBJECTIVES OF PPE
� Screen for Life-Threatening Conditions
� Screen for Conditions that May Predispose to
Injury or Illness
� Of Athletes, 66% believed that the PPE was not
absolutely necessary to participate safely in
sports
� 90% believed that the PPE could prevent injury
Just a Thought: What do we do during the PPE that
could assist in preventing injury?
5/26/2013
7
ASK JEROME HARRISON
� Jerome Harrison’s failed physical turned up a brain tumor
� The Philadelphia Eagles and Detroit Lions agreed to a trade
on Tuesday that would've sent Harrison to Philadelphia. A day
later, however, the trade was voided when Harrison did not
pass a physical.
SECONDARY OBJECTIVES
� Determine Good Health
� Society for Adolescent Medicine: 5 -10% of adolescents have a chronic condition that requires ongoing care / monitoring
� Asthma, Anemia, ADD, ADHD, Apena,
� Serve as an Entry Pointing in Healthcare
� PPE is not intended to replace routine medical exams
� 1/3 of student athletes indicate that the PPE is their only contact with healthcare system
� Consequently follow-up becomes a critical component of PPE
� Provide an Opportunity for Discussion on Health and Lifestyle
� 70% of adolescents express more desire for additional information: risk behaviors, substance use, sexuality, weight, diet,
� Many times not possible in a station to station exam.
5/26/2013
8
FOR WHAT % OF YOUR ATHLETES IS YOUR PPE
THE ONLY POINT OF CONTACT WITH THE
HEALTHCARE SYSTEM
0%8%
15%
31%
46%
0%
100% 75 – 99% 50 – 74%
25 – 49% 1 – 24% 0%
1. 100%
2. 75 – 99%
3. 50 – 74%
4. 25 – 49%
5. 1 – 24%
6. 0%
LOGISTICS
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9
WHO PERFORMS PPES OF YOUR SAS
ON ENTRANCE INTO YOUR PROGRAM?
60%
40%
Family Phy... Team / Uni...
1. Family
Physician /
Student Is
Responsible
for getting PPE
2. Team / Univ.
Physician
LOGISTICS
� Time: At least 6 weeks prior to start of season
� Person: Ideally with Personal Physician / Information Obtained From
� Why?
� Established Relationship?
� Previous Documentation
� Continuity of Care
� Privacy and Time
� Then using that information with the Team Physician Evaluation
� NCAA Requirements: Beginning initial season, physician administered medical examination prior to start of activity and be conducted within six (6) months of the activity with subsequent annual follow-up.
5/26/2013
10
HOW FREQUENT DO YOU PROVIDE / REQUIRE A
COMPLETE PHYSICAL ON YOUR STUDENT ATHLETES?
60%13%
27%
On Entranc... Every Year Every Othe...
1. On Entrance
Into Program
Only
2. Every Year
3. Every Other
Year
FREQUENCY CONSIDERATIONS
� American Academy of Pediatrics: Recommends
Annual Screening of Athletes from age 6 to 21
� PPE Consensus: Recommends PPE performed
every 2 years in “younger” student athletes and
every 2 to 3 years on “older athletes with
intermittent “Annual Updates”
� Annual Updates: Comprehensive History
Questionnaire and a problem-focused exam of
red flags
5/26/2013
11
COMPLICATIONS OF ANNUAL PPES
ON ALL STUDENT ATHLETES
� Man Power
� Timing of Getting All PPEs done and follow-ups prior to start of activity (Thus 6 Week Recommendation When Possible)
� Possible Solution: Provide PPEs on All Returning Student Athletes at End of Previous Year (i.e. Spring)
� Could also serve as an exit physical on those that don’t return.
� Potentially eliminates 2/3 of PPEs that would need to be done at start of school.
TIPS TO IMPROVE COORDINATED
MEDICAL TEAM APPROACH TO
PPE
� Preparation
� Early and Accurate Information
� Privacy
� Counseling / Discussion of Sensitive Issues
� Continuity of Care
� Referrals
� Protocol for Referral
� Financial Responsibility???
� Disqualification
� Typically Require Further Evaluation at Time of PPE
5/26/2013
12
EXIT PHYSICALS
� Purpose
� Continuation of Care and Disclosure of Ongoing
Injuries
� Minimize risk of claims that may not be university
responsibility
� Responsibility
� Student Athlete Responsibility
DO YOU PERFORM EXIT
PHYSICALS / SCREENINGS?
67%
27%
7%
Yes No No, but co...
1. Yes
2. No
3. No, but
considering
5/26/2013
13
RECRUITING PHYSICALS
� Must be conducted on an official visit
� Must be performed in the presence of a physician
� May not include testing not normally conducted in a
physical (i.e bench press, 40 yard dash, etc.,)
� Should not be used to determine offer letter
� Purpose: Identify those at risk therefore after signing
day, acquisition of additional information or follow-up
may occur
� Underage considerations
ADMINISTRATIVE CONSIDERATIONS
5/26/2013
14
PPE POLICY CONSIDERATIONS /
STATEMENTS
� All information contained within is complete and
correct to the best of my ability
� In the event that a student athlete leaves a team for
voluntary or involuntary reasons, it is the
responsibility and right of the student athlete to
report for exit physical
� Team physician has final authority over all medical
clearance processes
� In the event that additional test are warranted for
participation, financial responsibility falls upon the
student athlete and / or their health insurance
ADDITIONAL ADMINISTRATIVE
CONSIDERATIONS
� Timely acquisition of information (Medical
History, Sickle Cell Results, etc.,)
� 17 Year Olds / Signature Forms
� Financial Responsibility Considerations
� Referral Processes
5/26/2013
15
IF A STUDENT ATHLETE NEEDED A “CARDIAC WORK-UP”
WOULD YOUR UNIVERSITY PAY FOR IT?
58%
42%
Yes No
1. Yes
2. No
REFERRAL PROCESSES
� Student Athletes Primary Care Physician / Insurance
� Positive:
� Decreased Cost
� Negative:
� Time
� Opinion: PCP may not agree are allow for a cardiac work-up
� Limited to Specialist on Insurance Plan
� University Responsibility
� Positive:
� Decreased Time
� Consistency of Specialist
� Negative:
� Cost
� Fee for Service
� Retainer
5/26/2013
16
MEDICAL DISQUALIFICATION
PROCESS
� Role of “Team Physician”
� Reasonable Accommodations
� Knapp v. Northwestern
� Waivers
� Impact on Catastrophic Injury Claim
CLINICAL CONSIDERATIONS
5/26/2013
17
CARDIAC SCREENING
ROUTINE SCREENING TEST
� PPE Work Group: Doesn’t
Recommend Routine
Screening for
Asymptomatic Athletes
� Value of Screening Test
� Predictive Value
� Ability to Reduce
Morbidity and Mortality
by Identifying the
Condition
5/26/2013
18
DO YOU PROVIDE ANY OF THE FOLLOWING
WITH “ROUTINE” SCREENING?
7%0%0%
93%
EKGs Echo Cardi... Both None of th...
1. EKGs
2. Echo
Cardiograms
3. Both
4. None of the
Above
CARDIAC SCREENING
DILEMMA
� Support for Not Routine Screening
� American Heart Association
� 36th Bethesda Conference
� PPE Work Group
� Support for Routine Screening
� Media / Parent Groups
� Italy Project
� Cardiovascular disorders account for 75% of sudden death in athletes
� 1:65,000 to 1:69,000
5/26/2013
19
AMERICAN HEART ASSOCIATION
RECOMMENDATIONS
� Medical History*
� Personal history
� 1. Exertional chest pain/discomfort
� 2. Unexplained syncope/near-syncope†
� 3. Excessive exertional and unexplained
dyspnea/fatigue, associated with exercise
� 4. Prior recognition of a heart murmur
� 5. Elevated systemic blood pressure
AMERICAN HEART ASSOCIATION
RECOMMENDATIONS
� Family history
� 6. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in ≥1 relative
� 7. Disability from heart disease in a close relative <50 years of age
� 8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long-QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias
5/26/2013
20
AMERICAN HEART ASSOCIATION
RECOMMENDATIONS
� Physical examination
� 9. Auscultation for Heart murmur
� 10. Palpation of Femoral pulses to exclude aortic
coarctation
� 11. Physical stigmata of Marfan syndrome
� 12. Brachial artery blood pressure (sitting
position)§
DURING YOUR PHYSICAL ARE ALL 12 POINTS OF THE AHA
GUIDELINES COMPLETED?
10%
90%
Yes No
1. Yes
2. No
5/26/2013
21
SICKLE CELL SCREENING
DIVISION I / II & III?
� Student athletes present with SCT Result from
Birth
� School provides / requires SCT Result
� Student athlete waives right and signs release of
liability
5/26/2013
22
HOW DO YOU ANTICIPATE /
PAY FOR TESTING?
� Student Responsibility
� University Provide
� NCAA Lab Agreement
� Student Health
� Local Labs
� Self Draw
BIGGER PICTURE OF SICKLE
CELL “KNOWLEDGE”
� Who Knows?
� Athlete Education
� Genetic Counseling
� Participation Education / Awareness
� Acclimation Process
� Co-existing Conditions
� Air Quality, Asthma, Etc.,
5/26/2013
23
BASELINE TESTING
CONCUSSION BASELINE
TESTING
� Symptomalogy
� Balance
� Neuropsychological Testing
5/26/2013
24
IDENTIFICATION OF ATHLETES
WITH SPECIAL CONDITIONS
� Mental Health
� Learning Disabilities
� Risk of Suicide
� Disordered Eating
� Single Paired Organ
� Nutritional and Supplementation
� Performance Enhancing Medications
MEDICATION AND
SUPPLEMENTATION
5/26/2013
25
MEDICATION CONSIDERATIONS
� Know Drug Allergies
� Other Allergies
� Football Player Allergic to Grass
� Bee Stings vs. Bees
� Current Medications and Reason
� Any Banned or Special Exemption Considerations
DO YOU OBTAIN A LISTING OF
SUPPLEMENTS?
100
%
0%0%
Yes No No, but co...
1. Yes
2. No
3. No, but
considering
5/26/2013
26
IF YES?
� Do you obtain the information only at the PPE?
� Do you “Approve” the supplement?
� Consult with nutritionist / physician?
DO YOU THINK A “DRUG TEST WOULD
BE OF VALUE ON A PPE?
64%
36%
Yes No
1. Yes
2. No
5/26/2013
27
POTENTIAL BENEFITS OF
DRUG SCREENING
� Identification of
� Diuretics / Energy /
Weight Loss / Weight
Gain
� Depression Medication
� Banned Substances
� ADD / ADHD
Medications
MENTAL HEALTH CONSIDERATIONS
5/26/2013
28
MENTAL HEALTH
CONSIDERATIONS
� IMPORTANT: If your going to ask the question, be prepared to handle the answer.
� i.e. Have you ever attempted suicide
� Risk Behaviors?
� Sexual, Drug Use, Etc.,
� Disordered Eating
� Depression
� Performance
PPE Q&A
5/26/2013
29
TIME FOR A BREAK!
PREDICTIVE INJURY MODELING:
PRELUDE TO PREVENTION
5/26/2013
30
GRADE HOW WELL YOUR PROGRAM DOES
WITH INJURY PREVENTION
0%0%0%0%0%
A B C D F
1. A
2. B
3. C
4. D
5. F
PREDICATIVE INJURY
MODELING
� Objective #2: Screening for Conditions that May
Predispose Athletes to Injury
� Remember: 90% of athletes believe that the PPE
can help prevent injury. ??????
� Domain #1 of Athletic Training: Prevention
� How do you go about prevention in your
programs?
� How does your PPE assist you in prevention?
5/26/2013
31
WHAT DO YOU DO IN THE AREA OF
INJURY PREVENTION?
� ????
� Education
� Jump / Landing Training
� Strength and Conditioning?
� Brace and Tape
� Core Stability
� Flexibility Assessment and Enhancement
� Can it be validated that it works?
� Do you validate that it works?
WHO IS INVOLVED IN INJURY
PREVENTION?
� ????
� ????
� Coaches
� Strength and Conditioning
� Athletic Training Staff
� Team Physicians
� Where does your PPE fit into the process of injury prevention?
5/26/2013
32
INJURY PREVENTION
�Do you and your athletic
training staff have time
for Injury Prevention for
ALL Student Athletes?
�Can we target athletes at
High Risk for Injury?
PURPOSES OF PREDICTIVE
INJURY MODELING
� Identify Athletes at Risk of Injury
� Identify where the athlete is deficient
� Provide a basis / criteria for corrective exercise
programs.
� Improve performance while minimizing risk
5/26/2013
33
INJURY PREVENTION
� High-force collisions make football injuries inevitable,
but some portion may be prevented
� Very little high-quality research evidence is available to
guide injury prevention
� Rapid fatigue of the core musculature may relate to
poor neuromuscular control of the core & LE joints
� Pre-season screening procedures can identify
individual players who have modifiable injury risk
EVIDENCE-BASED APPROACH TO INJURY
PREVENTION
Documentation of Injury Incidence Rate (Injuries/Exposures)
Identification of Injury Risk Factors (Predictive Model for Injury Occurrence)
Development and Implementation of Strategies to Reduce Injury Risk
Confirmation that Risk Reduction Program Decreases Injury Incidence Rate
5/26/2013
34
WHAT STANDARDIZED TEST WOULD
YOU PERFORM TO IDENTIFY ATHLETES
AT RISK FOR INJURY?
IDENTIFICATION OF INJURY
RISK FACTORS
� Foot & Ankle Assessment Measure
� Int. Knee Doc. Comm. (IKDC) Survey
� Oswestry Disability Questionnaire
� Body Mass Index
� Navicular Drop
� Q-Angle
� Hip ER & IR ROM
� Shoulder ER & IR ROM
� Sit & Reach
� 1.5 Mile Run Time
� Vertical Jump
� Triple Hop for Distance
� Functional Movement Screen
� Tuck Jump Assessment
� Balance Error Scoring System
� Cogsport Neurocognitive Test Score
� Back Extension Hold
� Side Bridge Hold
� Trunk Flexion Hold
� Wall Sit
� Isokinetic Peak Torque
� Hand-Held Dynamometer Force
68
5/26/2013
35
TEST FOR INJURY PREDICTION
OSWESTRY
D I SABIL ITY
INDEX(0-100
SCORE)
Pain Intensity Standing
0 I have no low back pain at the moment. 0 I can stand as long as I want without pain.
1 My low back pain is very mild at the moment. 1 I can stand as long as I want, but it causes pain.
2 My low back pain is moderate at the moment. 2 Pain prevents me from standing for more than one hour.
3 My low back pain is fairly severe at the moment. 3 Pain prevents me from standing for more than 30 minutes.
4 My low back pain is very severe at the moment. 4 Pain prevents me from standing for more than 10 minutes.
5 My low back pain is the worst imaginable at the moment. 5 Pain prevents me from standing at all.
Personal Care (Washing, Dressing, etc.) Sleeping
0 I can take care of myself normally without pain. 0 Pain does not prevent me from sleeping well.
1 I can take care of myself normally, but it causes pain. 1 I can sleep well only by using pain medication.
2 It is painful to care for myself, and I am slow and careful. 2 Even when I take pain medication, I sleep less than 6 hours.
3 I need some help, but can manage most of my personal care. 3 Even when I take pain medication, I sleep less than 4 hours.
4 I need help every day in most aspects of personal care. 4 Even when I take pain medication, I sleep less than 2 hours.
5 I do not get dressed, wash with difficulty, and stay in bed. 5 Pain prevents me from sleeping at all.
Lifting Social Life
0 I can lift heavy weights without pain. 0 My social life is normal and does not cause pain.
1 I can lift heavy weights, but it causes pain. 1 My social like is normal, but it increases my level of pain.
2 Pain prevents me from lifting heavy weights off the floor. 2 Pain prevents me from participating in energetic activities.
3 I can lift light to medium weights if conveniently positioned. 3 Pain prevents me from going out very often.
4 I can lift only very light weights. 4 Pain has restricted my social life to my home.
5 I cannot lift or carry anything. 5 I have hardly any social life because of my pain.
Walking Travel
0 Pain does not prevent me from walking any distance. 0 I can travel anywhere without pain.
1 Pain prevents me from walking more than one mile. 1 I can travel anywhere, but it increases my pain.
2 Pain prevents me from walking more than 1/2 mile. 2 Pain is bad, but I can manage journeys of two hours or more.
3 Pain prevents me from walking more than 1/4 mile. 3 Pain restricts me to journeys of one hour or less.
4 I can only walk using a cane or crutches. 4 Pain restricts me to short necessary journeys under 30 minutes.
5 I am in bed most of the time. 5 Pain prevents me from travelling, except to receive treatments.
Sitting Sports & Work
0 I can sit in any chair as long as I like. 0 My normal activities do not cause pain.
1 I can only sit in my favorite chair as long as I like. 1 My normal activities increase pain, but I can still perform all.
2 Pain prevents me from sitting for more than one hour. 2 I can perform most activities, but pain prevents some of them.
3 Pain prevents me from sitting for more than 30 minutes. 3 Pain prevents me from doing anything but light activities.
4 Pain prevents me from sitting for more than 10 minutes. 4 Pain prevents me from doing even light activities.
5 Pain prevents me from sitting at all. 5 Pain prevents me from performing any work/sports activities.
5/26/2013
36
OSWESTRY DISABILITY INDEX N=171
Core + LE Strains & Sprains
Injury No Injury
≥ 6 points 28 13
< 6 points 50 80
Total 78 93
Fisher’s exact p = .001
Sensitivity: .36 Specificity: .86
95% CI: .26 - .47 95% CI: .78 -.92
+LR: 2.57 Odds Ratio: 3.45
95% CI: 1.43 - 4.61 95% CI: 1.63 - 7.27
−−−−LR: .75 Relative Risk: 1.78
95% CI: .62 - .90 95 % CI: 1.31 - 2.40
Scale using pain with: Sleeping, Travel,
Social, Lifting, Sitting, Personal Care,
Standing, Sports / Activities, Pain
Scale,
COMBINED ANALYSIS
WALL-SIT HOLD N=171
Injury No Injury
Z ≤ −0.58 30 22
Z > −0.58 48 71
Total 78 93
Fisher’s exact p = .031
Sensitivity: .39 Specificity: .76
95% CI: .28 - .50 95% CI: .67 -.84
+LR: 1.63 Odds Ratio: 2.02
95% CI: 1.03 - 2.58 95% CI: 1.06 - 8.50
−−−−LR: .81 Relative Risk: 1.43
95% CI: .65 - .99 95 % CI: 1.04 - 1.97
90°
90°
5/26/2013
37
GAMES AS STARTER (N=171)
Core + LE Strains & Sprains
Injury No Injury
≥ 1 game 63 11
None 15 82
Total 78 93
Fisher’s exact p < .001
Sensitivity: .81 Specificity: .88
95% CI: .71 - .88 95% CI: .80 -.93
+LR: 6.83 Odds Ratio: 31.31
95% CI: 3.88 - 12.02 95% CI: 13.46 - 72.85
−−−−LR: .22 Relative Risk: 5.51
95% CI: .14 - .35 95 % CI: 3.42 - 8.85
Mostly interested in the number of reps
one would receive in both games and
practice.
Instead of starter, might use and
objective way of determining significant
playing time.
Additional other sports, starting one
game would not be very significant
unless they played significant minutes.
COMBINED ANALYSIS
3-FACTOR PREDICTION MODEL N=171
Core + LE Strains & Sprains (78)3-Factor Model
Injury No Injury
≥ 2 Factors 39 5
0 or 1 Factor 39 88
Total 78 93
Fisher’s Exact p < .001
Sensitivity: .50 Specificity: .95
95% CI: .27 - .57 95% CI: .86 -.99
+LR: 10.05 Odds Ratio: 17.60
95% CI: 2.46 - 41.11 95% CI: 3.46 - 77.20
−−−−LR: .62 Relative Risk: 2.89
95% CI: .47 - .80 95 % CI: 1.86 - 3.92
AUC = .8495% CI: .78 - .90
1) Starter (≥1 game) 2) Hi ODI (≥6) 3) Lo WSH-Z (≤−0.58)*
≥2
≥1
Sensitivity: .50
Specificity: .95
Relative Risk: 2.89
Sensitivity: .94
Specificity: .57
Relative Risk: 7.49
*Bilateral ≤60 sec & Unilateral Avg. ≤45 sec
5/26/2013
38
COMBINED ANALYSIS
N=171
Starter ≥1 Game AND
Either Hi ODI* OR Lo WSH†
Injury No Injury
≥ 1 game 38 3
None 40 90
Total 78 93
Fisher’s exact p < .001
Sensitivity: .49 Specificity: .97
95% CI: .38 - .60 95% CI: .91 - .99
+LR: 15. 10 Odds Ratio: 28.50
95% CI: 4.85 - 47.05 95% CI: 8.31 - 97.80
−−−−LR: .53 Relative Risk: 3.01
95% CI: .43 - .66 95 % CI: 2.29 - 3.95
*Hi ODI
≥6
†Lo WSH
≤60 sec Bilateral
≤45 sec Unilateral Avg.
2009 + 2010 COMBINED ANALYSIS
N=17176
Starter ≥1 Game AND Hi ODI*
Injury No Injury
≥ 1 game 25 1
None 53 92
Total 78 93
Fisher’s exact p < .001
Sensitivity: .32 Specificity: .99
95% CI: .23 - .43 95% CI: .94 -.99
+LR: 29.81 Odds Ratio: 43.40
95% CI: 4.13 - 215.03 95% CI: 5.72 - 329.48
−−−−LR: .69 Relative Risk: 2.63
95% CI: .59 - .80 95 % CI: 2.10 - 3.30
Starter ≥1 Game AND Lo WSH†
Injury No Injury
≥ 1 game 22 3
None 56 90
Total 78 93
Fisher’s exact p < .001
Sensitivity: .28 Specificity: .97
95% CI: .19 - .39 95% CI: .91 -.99
+LR: 8.74 Odds Ratio: 11.79
95% CI: 2.72 - 28.12 95% CI: 3.37 - 41.20
−−−−LR: .74 Relative Risk: 2.29
95% CI: .64 - .86 95 % CI: 1.79 - 2.95
*Hi ODI ≥6 †Lo WSH ≤60 sec Bilateral; ≤45 sec Unilateral Avg.
5/26/2013
39
KEEP IT SIMPLE
� Disability Survey
� Wall Sit
� Exposures
� Logistics
� Performed Multiple
Time Per Year
� PPE, Prior to “Off-
Season” and Prior to
End of School
� Note: This only identifies
athletes at high risk of
injury, once identified a
corrective exercise
program would need to be
developed and executed.
WHAT IF I WANTED TO
PARTICIPATE IN PROJECT?
� Do you keep track of injuries and exposures?
� Electronic Database
� Are you interested in reducing injuries to student athletes?
� Can you add a ODI questionnaire to your PPE?
� Can you add a single leg wall sit to your PPE?
� Note: We will perform the statistical analysis to determine risk.
5/26/2013
40
INTERESTED IN GETTING INVOLVED
WITH PREDICTIVE INJURY MODELING?