Athlete Compliance Research Articles

Post Pandemic Assessment of Availability and Compliance with Covid-19 Preventive Protocols by Athletes, Coaches and Spectators in Sport Arenas in Southwestern, Nigeria.

The study investigated the availability and the level of compliance of athletes, officials, and coaches with the Covid-19 preventive in sports arena in Southwestern Nigeria. The study adopted the descriptive survey research design. The population for the study comprised all officials, athletes and spectators in sport arenas South-west Nigeria. Sample size comprised 220 respondents. The multi-stage sampling procedure was adopted for the study. Two questionnaires, titled: “State Athletes Welfare and COVID-19 Preventive Protocol Questionnaire” (SAWCPPQ) and the State Sports Administrators Questionnaire (SSAQ) were used to elicit information on the athletes’ welfare and compliance with COVID-19 preventive protocols. Data collected were analysed using appropriate descriptive and inferential statistics The findings also showed that there was moderate level of compliance with the Covid-19 preventive protocols among the athletes (63.1%), sports officials (61.9%) and spectators (61.1%), as 69 (31.36%) complied with the protocol all the time, while 151 (68.64%) only complied sometimes. The study concluded that there were preventive protocols in place at various sports arenas to ensure prevention of Covid-19. However, there were low level of compliance with the preventive protocols among the sportsmen and sportswomen during training and competitions in South West, Nigeria

Educational intervention promotes injury prevention adherence in club collegiate men's lacrosse athletes.

Club sports are intercollegiate athletics that are student-led and not university-funded, many of which are without professional credentialing. Collegiate club athletes have an increased rate of injury compared to their NCAA counterparts. Education and implementation of stretching and strength training have demonstrated decreased rates of noncontact injuries. Educational intervention was given to club collegiate athletes to determine its effect on injury rates, perceived pain, and compliance toward injury-prevention practices. Intramural collegiate athletes were educated on injury prevention that focused on targeted stretching. Surveys designed to assess the impact of the education were distributed to three men's club lacrosse teams in Utah at the beginning and end of the season. The questions measured pain and time missed due to noncontact injury. Two-tailed unpaired t tests demonstrated p values <0.05 for: overall decreased levels of pain (p<0.0001); increased range of motion (ROM, p<0.0001); increased frequency of stretching the muscle groups psoas (p<0.0001), calves (p=0.0081), and piriformis (p<0.0001); decreased pain levels for the hamstring (p=0.0274); and increased frequency of stretching after practice (p<0.0001). The increased frequency of stretching suggests increased compliance toward injury prevention practices. Decreased self-reported levels of overall pain, and decreased pain in the hamstring, show that the subjects surveyed in the sample reported less pain and increased time stretching at the end of the season compared with the beginning of the season. Educational intervention offers an affordable measure to provide club collegiate athletes with resources to reduce injury rates through athlete compliance to targeted stretches.

Evaluation of Plyometric Exercise, Strength Training on Physical Capabilities

Objectives: The aim of this study is to compare a 10-week period, in which strength training (five weeks) was followed by plyometric training (five weeks) or the other way around among handball players. Hypothesis: Performing strength training first and then plyometric training will improve lower body strength and performance more than the reverse training sequence. Methods: Thirty-six young handball players voluntarily participated in this research. Pre and post test data (running, changing direction, jumping, strength, throwing, and endurance) were compared between groups using one-way analysis of variance (ANOVA). The level of statistical significance was set at p < 0.05. SPSS was used for the statistical analysis. Results: The results imply that a precise training regime for plyometric and strength training in young handball players is not required. Thus, strength and conditioning training plans created for the youth handball group can be effective regardless of the training regimen. Furthermore, when boosting back squat performance is the main objective, the outcomes of the contemporary research imply that completing plyometric training before a strength-centered training phase may be useful. Conclusion: It is concluded that professionals arrange training schedules to enhance athlete compliance and concentrate on the most important results.

A mixed methods investigation into athletic trainer and dietitian's nutrition practices for sport-related concussion patients

Background Nutrients may have implications following concussion, such as inflammation reduction or neuroprotection. The purpose of this study was to describe nutrition practices of athletic trainers (AT) and dietitians for patients regarding sport-related concussion, with respect to prevention, recommendations, and barriers to implementation. Hypotheses Due to the descriptive nature of this study, hypotheses were not warranted. Study Design Mixed methods. Level of Evidence Level 3. Methods A survey was distributed through professional memberships and included multiple-choice and open-ended items about nutritional practices regarding concussions. Participants included 1465 ATs and 51 dietitians accessing the survey (AT: age = 35.7 ± 11.4 years, females = 43.1%; dietitians: age = 31.8 ± 8.17 years, females = 45.1%). Open-ended survey responses regarding nutritional practices for concussion prevention, recommendations, and changes following concussion were analyzed by identifying key words or repeating phrases, theme development and categories into an initial codebook, using the codebook on responses, and coding all responses with the finalized codebook. Barriers to implementation was analyzed with descriptive statistics. Results Themes were identified for prevention strategies, and recommendations and changes following concussion. For concussion prevention, ATs noted overall health, specific target nutrients, barriers and limited research support, while dietitians identified overall health, specific target nutrients, recommendations/guidelines as themes. Post-injury themes for patient recommendations and changes were noted as overall health, specific target nutrients, resources, interprofessional collaboration by ATs, whereas dietitians identified overall health, specific target nutrients, interprofessional collaboration. ATs and dietitians noted numerous barriers including the lack of clinician knowledge and athlete compliance. Conclusions and Clinical Relevance ATs and dietitians are utilizing nutritional practices regarding concussion in numerous ways by focusing on use for whole body, brain health and specific targets such as omega fatty acids, hydration, micronutrients/supplements, and macronutrients. With these findings and the barriers listed by respondents, we can use this information to design focused research to influence evidence-based nutritional practices and concussion.

Evaluation of a Vitamin D Screening and Treatment Protocol Using a Seasonal Calculator in Athletes.

Vitamin D is important in musculoskeletal health, and low serum vitamin D concentration is common in athletes. This study implemented a vitamin D screening and supplementation protocol in a cohort of National Collegiate Athletic Association Division I athletes using summer 25-hydroxyvitamin D concentration and a seasonal variation calculator to achieve sufficient vitamin D concentration year-round. After implementation of the Vitamin D Protocol, there was a nonsignificant difference in athletes with sufficient winter vitamin D concentrations (72.6%) compared with summer vitamin D concentrations (66.1%) (P = 0.40). The Seasonal Variation Calculator predicted winter vitamin D concentrations (8 ± 18 ng·mL-1) higher than actual winter vitamin D concentrations (P < 0.01). While most athletes (78%) believed vitamin D was important for athletic performance, athlete compliance to the Vitamin D Protocol was inconsistent. In the future, adjustment of vitamin D screening and supplementation protocols may help athletes achieve sufficient vitamin D status year-round.

The Effect of Exercise Compliance on Risk Reduction for Hamstring Strain Injury: A Systematic Review and Meta-Analyses.

Eccentric strength training can reduce the risk of hamstring strain injury (HSI) occurrence; however, its implementation can be impacted by athlete compliance and prescription. The aim of this review was to investigate the effects of intervention compliance, consistency and modality, on the prevention of HSIs among athletes. A literature search was conducted. 868 studies were identified prior to the application of the exclusion criteria which resulted in 13 studies identified. Random effects models were used to produce log odds ratios and 95% confidence intervals. Very high (>75.1%), moderate-high (50.1–75%), low-moderate (25.1–50%) and very low (<25%) and <1-, 1.01–3.00-, >3.01-weeks/session were used as thresholds of compliance and consistency, respectively. Modality was also observed. A positive effect on HSI incidence -0.61 (−1.05 to −0.17), favoring the intervention treatments (Z = −2.70, p = 0.007). There were non-significant, large differences between compliance (p = 0.203, Z = −1.272) and consistency (p = 0.137, Z = −1.488), with increased compliance and consistency showing greater effectiveness. A significant difference between intervention modalities was observed (p < 0.001, Z = −4.136), with eccentric interventions being superiorly effective. Compliance of >50.1% and consistent application with <3 weeks/session having positive effects on HSI incidence. Training interventions that can achieve high levels of compliance, and can be consistently performed, should be the objective of future practice.

Movement Competency Training Delivery: At School or Online? A Pilot Study of High-School Athletes

Movement competency (MC) development of high-school athletes can prepare them for the requirements of physical preparation training and the demands of sport. The aim of this study was to explore the physical effects of and athlete compliance to coach-led versus self-directed training approaches in this population. Thirty-nine high-school athletes (19 male, 14.5 ± 0.3 years old; 20 female, 14.6 ± 0.3 years) were allocated into two groups for a physical preparation program to improve MC. Groups were prescribed either (i) one face-to-face and one online (F2F, n = 18), or (ii) two online (OL, n = 21) sessions per week for 16-weeks. Before and after the intervention, the Athlete Introductory Movement Screen (AIMS) was used to assess MC alongside common physical capacity measures (triple-hop, star-excursion balance, medicine ball throw, 40 m sprint and countermovement jump). Dropout left 22 participants with pre-post physical scores. Compliance with online training was low and F2F session attendance moderate. Semi-structured interviews were conducted to assess participant perceptions following the intervention. Assessing individual responses, the F2F group had a higher proportion of positive responders to AIMS scores, yet capacity measures were inconclusive across groups. Face-to-face coaching when acquiring MCs as part of physical preparation, may provide greater positive perceptions towards training compared to self-directed online prescriptions, and thereby greater compliance.

A comprehensive assessment of impact of aerobic exercise on vascular and liver function in 50 male athletes: A 2-year follow-up

Int roduc t ion: Regular physical activity is associated with a lower risk for all- -cause mortality, and the increase in death risk reduction was largest for vigorous exercise. However, vascular adaption to excessive training could alter normal physiology and promote an increased cardiovascular risk in elite athletes. Aim:In this study we investigated standardized surrogate markers of cardiovascular risk and subclinical atherosclerosis, such as IMT, pulse wave velocity, augmentation index, assessed at carotid and femoral arteries, and endothelial function, in 50 elite male athletes, before and after sport seasons, on a 2-year follow-up. Material and me thods : The study population consisted of 50 healthy Caucasian male elite athletes and 40 healthy male controls. We performed ultrasound vascular assessment to assess carotid and femoral intima media thickness and compliance during a 2-year follow up. Results and discussion: We reported a slower increase of carotid IMT of athletes in comparison to controls. Femoral compliance of athletes was higher than control compliance after 2 year follow up. Conclusions : The worsening of femoral pulse-wave velocity and stiffness values at femoral arteries could be the result of a sport specific phenomenon. Physical activity differentially affects vascular beds in elite athletes, and in elicited district by strenuous exercise, we reported the progression of early markers of atherosclerosis.

Achievements and Challenges in Anti-Doping Research.

The most important element in achieving athlete compliance with anti-doping rules is the certainty of detection. Thus, scientific research plays a mission critical role in achieving clean competition. Many factors contribute to the advances in detection. Incremental advances in the ability to detect prohibited substances and methods, and identification of long-lived metabolites continue to lengthen detection windows. While the athlete biological passport hematological and steroidal modules hold great promise, experience shows that new research is needed to improve the sensitivity and specificity of the approach for current doping techniques. Indirect detection strategies using biomarkers or transcriptomic techniques have been increasingly investigated. The incorporation of more cost-effective sampling strategies using dried blood and plasma spots, oral fluid, and breath analysis show great promise toward increasing the number of tests while remaining within testing budget constraints. Despite the importance of research to ensuring rule compliance, a major challenge for anti-doping research is achieving and maintaining sufficient funding in the reality of the myriad of new substances introduced for disease treatment but abused for performance enhancement. In addition, obtaining metabolism and population reference range data, particularly for new drugs or designer drugs that have not obtained approval for administration to human subjects, remains a significant problem. Nevertheless, research continues to contribute important data to support anti-doping efforts.

Preventive Neuromuscular Training for Young Female Athletes: Comparison of Coach and Athlete Compliance Rates.

Fewer athletic injuries and lower anterior cruciate ligament injury incidence rates were noted in studies of neuromuscular-training (NMT) interventions that had high compliance rates. However, several groups have demonstrated that preventive NMT interventions were limited by low compliance rates. To descriptively analyze coach and athlete compliance with preventive NMT and compare the compliance between study arms as well as among school levels and sports. Randomized, controlled clinical trial. Middle and high school athletic programs. Participants or Other Participants: A total of 52 teams, comprising 547 female athletes, were randomly assigned to the experimental or control group and followed for 1 athletic season. The experimental group (n = 30 teams [301 athletes]: 12 basketball teams [125 athletes], 6 soccer teams [74 athletes], and 12 volleyball teams [102 athletes]) participated in an NMT program aimed at reducing traumatic knee injuries through a trunk-stabilization and hip-strengthening program. The control group (n = 22 teams [246 athletes]: 11 basketball teams [116 athletes], 5 soccer teams [68 athletes], and 6 volleyball teams [62 athletes]) performed a resistive rubber-band running program. Compliance with the assigned intervention protocols (3 times per week during the preseason [mean = 3.4 weeks] and 2 times per week in-season [mean = 11.9 weeks] of coaches [coach compliance] and athletes [athlete compliance]) was measured descriptively. Using an independent t test, we compared coach and athlete compliance between the study arms. A 2-way analysis of variance was calculated to compare differences between coach and athlete compliance by school level (middle and high schools) and sport (basketball, soccer, and volleyball). The protocols were completed at a mean rate of 1.3 ± 1.1 times per week during the preseason and 1.2 ± 0.5 times per week in-season. A total of 88.4% of athletes completed 2/3 of the intervention sessions. Coach compliance was greater in the experimental group than in the control group (P = .014). Coach compliance did not differ by sport but was greater at the high school than the middle school (P = .001) level. Athlete compliance did not differ by study arm, sport, or school level. Athletes received instruction in about 50% of each protocol. Nearly 90% of athletes performed more than 2/3 of the assigned NMT interventions. The assigned intervention was performed more often in the experimental arm compared with the control arm. Coaches at the high school level complied with the given protocol more than middle school coaches did. Athletes complied well with the protocol, but coaches did not, especially at the middle school level.

VO2Max and VO2AT: athletic performance and field role of elite soccer players

Maximal oxygen consumption (VO2max) and oxygen consumption at anaerobic threshold (VO2AT) are commonly measured parameters to test elite soccer players; however, studies relating metabolic parameters of professional soccer players with performance and best fitting to the field role are scarce. Our aim was to study the relations of VO2max and VO2AT with the field role of elite soccer players to generate a robust dataset with a solid statistical analysis. Over a 12-year period we performed 953 field evaluation tests of VO2 max and VO2AT on 450 elite soccer players of 13 professional teams by incremental, continuous and exhausting test modified from Conconi’s test. Statistical analysis was performed by one-way ANOVA followed—when appropriate—by Tukey post hoc test. Effect size was evaluated by the Cohen D test and η partial squared test. Statistical significance was set for p < 0.05. VO2max mean values increased at the beginning of season by 1.073 ± 0.06 respect to pre-season then decreased again up to pre-season levels and remained stable, while VO2AT did not change during time. VO2max differences were also related to players’ field role. VO2max mean value for Goalkeeper was 50.85 ± 4.2, for central Defender was 57.58 ± 4.3, for Winger-sides back was 60.53 ± 5.02, for Midfielder was 59.53 ± 5.08, for Forward was 56.52 ± 4.14. On the contrary, as expected, VO2AT percentage variations among the roles were not significant. VO2max is the choice parameter to consider for the metabolic compliance of athletes to the field role requirements, consequently influencing training programs, recovery and injury prevention strategies.

Doping control, providing whereabouts and the importance of privacy for elite athletes

BackgroundTo improve anti-doping efforts in sports, the World Anti-Doping Agency (WADA) introduced the World Anti-Doping Program, in which (among others) regulations for providing athletes’ whereabouts are described. Because the effectiveness and efficiency of this system depends on the co-operation and compliance of athletes, the perspective of elite athletes is important. This paper answers the following research questions: What is the perspective of Dutch elite athletes on the current whereabouts system in general and how important is their privacy in providing whereabouts in particular? In addition, this study explores how far the whereabouts system can be developed in the future. Are athletes willing to accept greater invasions of their privacy in order to reduce administrative effort and whereabouts failures? MethodA structured questionnaire was completed by 129 Dutch elite athletes registered in the national and/or international testing pool. ResultsThe results of this study indicate widespread dissatisfaction with the whereabouts system. Most respondents support anti-doping testing in general, but many athletes feel that WADA's whereabouts system is unacceptable in several respects. In terms of physical privacy, there was a great dissatisfaction. Nearly half of the athletes felt that the ‘1-hour time slot’ limits their freedom, but on the other hand, most athletes disagreed with the statement that the distinction between their sport and private life is disturbed. For almost one in three respondents, the whereabouts system has a negative influence on the pleasure they experience in being an elite athlete. In terms of informational privacy, almost all athletes had confidence in the confidential treatment of their whereabouts information.Almost all athletes would accept giving their phone number to Doping Control Officials, but only half of the athletes would accept sharing their location on their mobile phone. Furthermore, almost two in ten of the athletes would accept wearing a permanent wrist or ankle bracelet or accept being implanted with a GPS chip in order to facilitate future anti-doping testing. ConclusionThe current whereabouts system needs to be improved in order to increase athletes’ satisfaction with the anti-doping rules. The athletes themselves need to be engaged in this process. The results of this study indicate that a majority of the athletes are not likely to accept a greater violation of their privacy than the current whereabouts regulations already entail.

A Training Program to Improve Neuromuscular and Performance Indices in Female High School Soccer Players

The purpose of this study was to determine if a sports-specific anterior cruciate ligament injury prevention training program could improve neuromuscular and performance indices in female high school soccer players. We combined components from a published knee ligament intervention program for jump and strength training with other exercises and drills to improve speed, agility, overall strength, and aerobic fitness. We hypothesized that this program would significantly improve neuromuscular and athletic performance indices in high school female soccer players. The supervised 6-week program was done 3 d·wk(-1) for 90-120 minutes per session on the soccer fields and weight room facilities in area high schools. In phase 1, 62 athletes underwent a video drop-jump test, t-test, 2 vertical jump tests, and a 37-m sprint test before and upon completion of the training program. In phase 2, 62 other athletes underwent a multistage fitness test before and after training. There were significant improvements in the mean absolute knee separation distance (p < 0.0001), mean absolute ankle separation distance (p < 0.0001), and mean normalized knee separation distance (p < 0.0001) on the drop-jump, indicating a more neutral lower limb alignment on landing. Significant improvements were found in the t-test (p < 0.0001), estimated maximal aerobic power (p < 0.0001), 37-m sprint test (p = 0.02), and in the 2-step approach vertical jump test (p = 0.04). This is the first study we are aware of that demonstrated the effectiveness of a knee ligament injury prevention training program in improving athletic performance indices in high school female soccer players. Future studies will determine if these findings improve athlete compliance and team participation in knee ligament injury intervention training.

Benefits of Neuromuscular Training Program for Knee Injury Prevention and Perfromance Enhancement in High School Female Basketball Players

PURPOSE: Various training programs have been developed for female athletes to improve neuromuscular deficiencies in order to reduce the incidence of knee ligament injuries. We developed a program for high school female basketball players designed to improve both lower limb alignment on landing from a drop-jump, as well as speed, agility and cardiovascular capacity. Thus, the purpose of this study was to investigate the effectiveness of a comprehensive neuromuscular training program on landing mechanics and selected sports-specific performance parameters in high school female basketball players. METHODS: Fifty-nine female high school basketball players aged 13 to 17 participated in a supervised 6-week neuromuscular training program. A previously published program was used, with the addition of exercises/drills to improve speed, agility, strength, and cardiovascular capacity. A battery of tests were administered before and after the training program including a video-recorded drop-jump test, multi-stage fitness test, vertical jump, and 20-yard dash test. RESULTS: Athlete compliance with training was high, as all participants attended at least 15 of the 18 training sessions. The aerobic capacity (V̇o2max) showed significant increase (34.1 ± 4.3 pre-train and 39.6 ± 7.1 ml/kg/min post-train, p < .0001), with 53 athletes demonstrating improved scores. Improvements were also found in the drop-jump test for the normalized knee separation distance (42.7 ± 16.5 pre-train and 76.0 ± 19.6 post-train, p < .0001) and the mean absolute separation distance (cm) of knees on landing (17.7 ± 7.2 pre-train and 31.7 ± 10.5 post-train, p < .0001). Further, the vertical jump performance improved from pre- to post-training (14.1 ± 2.7 pre-train and 16 ± 3.7 inches post-train, p < .0001) as well as the 20-yard dash times (3.53 ± .3 pre-train and 3.45 ± .45 post-train, p = .0374). Before training, 51 of the athletes demonstrated poor overall lower limb alignment (with less than 60% of knee separation distance) during landing compared to only 8 after training. Practical Applications: While implementing a program in an attempt to reduce the risk of frequently occurring ACL-injuries in female basketball players, it may be advantageous to combine traditional neuromuscular re-training on landing mechanics with sports-specific performance enhancement training program. This appears to result in more optimal outcome by providing not only a reduction in the risk of serious knee injuries, but also an overall improvement in athletic performance. CONCLUSIONS: This neuromuscular training program is effective in improving both the lower limb alignment during landing activity, thus reducing the risk of knee injuries, and performance parameters of maximal aerobic capacity, vertical jump height, and the 20-yard dash time in high school female basketball players.

Rehabilitation from sports injuries: from theory to practice

A great number of injuries occur in the context of recreational physical activities and competitive athletics. Adherence to sport injury rehabilitation means an injured athlete's compliance (or not) to a sports medicine/injury personnel's instructions of participating in a rehabilitation programme in a clinic, and/or doing rehabilitation exercises at home. It has emerged as an area of interest among physiotherapists and other allied professionals (i.e. sport trainers, physicians). This article reviews compliance among injured athletes in the recovery process by presenting the protection motivation theory, personal investment theory and models of cognitive appraisal. Also it reviews key research findings about these three theoretical models. In addition practical guidelines and specific strategies are offered to sport injury rehabilitation personnel to enhance an athlete's adherence to injury rehabilitation. Sports medicine/injury personnel should educate athletes about their injuries and rehabilitation and increase effective communication and active listening. Also sports medicine/injury personnel should provide social support and encourage positive beliefs of injured athletes. In addition, coping with pain and setting short-term goals help athletes to increase their compliance to programmes of rehabilitation.

Athlete compliance to therapist requested contraction intensity during proprioceptive neuromuscular facilitation

Contraction intensities between 10 and 100% maximal voluntary contraction (MVC) have been proposed in varying muscle energy technique (MET) and proprioceptive neuromuscular facilitation (PNF) post-isometric relaxation (PIR) protocols. The current study was undertaken to determine if athletes were able to comply with differing therapist requested contraction intensities during (PNF) stretching protocols. Thirty-six university athletes were recruited and MVC was established at hip extension, hip adduction, and horizontal shoulder adduction. Target PIR contractions were set at 20, 50 and 100% MVC and monitored throughout the contractions with a strain gauge dynamometer. Athletes were not able to match the target contraction values at 20 and 100% MVC ( P ≤ 0.001). When examined for consistency across the three component contractions within each of the three PIR protocols, the athletes demonstrated widely variable scores (coefficient of variation (CV) = 23.2–36.4% at 20% MVC; CV = 19.3–29.4% at 50% MVC; and, CV = 9.4–14.5% at 100% MVC). Our findings indicate that this group of athletes displayed a poor level of compliance to varying therapist requested contraction intensities with respect to both accuracy and consistency.

Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport, Prague 2004

In November 2001, the 1st International Symposium on Concussion in Sport was held in Vienna, Austria to provide recommendations for the improvement of safety and health of athletes who suffer concussive injuries in ice hockey, football (soccer), and other sports. The 2nd International Symposium on Concussion in Sport was organised by the same group and held in Prague, Czech Republic in November 2004. It resulted in a revision and update of the Vienna consensus recommendations, which are presented here.

Conservative treatment of patellar tendinopathy

Patellar tendinopathy disrupts athletic careers in several sports and is resistant to many forms of conservative treatment. Outcome after conservative treatment has been minimally investigated, and the effect of these treatments on the pathology of overuse tendinopathy are not well understood.The clinical assessment of patellar tendinopathy appears straightforward, but evidence suggests that the importance of imaging and palpation in diagnosis and ongoing assessment may be overestimated. There is a lack of clinically relevant research on which to base treatment. However, the principles of management for patellar tendinopathy derived from clinical experience include load modification, musculotendinous rehabilitation, and intervention to improve the shock absorbing capacity of the limb. The role of electrophysical agents, massage, and stretching in the treatment of patellar tendinopathy are also discussed. The progression of treatment is based on clinical grounds due to a lack of reliable subjective and objective tools to assess recovery.The failure of some conservative programs could be due to either athlete compliance or practitioner expertise. The management of patellar tendinopathy is complex, and if the physiotherapist addresses all the principles of treatment, the chance of success could be increased.

A comprehensive and cost-effective preparticipation exam implemented on the World Wide Web.

Mandatory preparticipation examinations (PPE) are labor intensive, offer little routine health maintenance and are poor predictors of future injury or illness. Our objective was to develop a new PPE for the Stanford University varsity athletes that improved both quality of primary and preventive care and physician time efficiency. This PPE is based on the annual submission, by each athlete, of a comprehensive medical history questionnaire that is then summarized in a two-page report for the examining physician. The questionnaire was developed through a search of MEDLINE from 1966 to 1997, review of PPE from 11 other institutions, and discussion with two experts from each of seven main content areas: medical and musculoskeletal history, eating, menstrual and sleep disorders, stress and health risk behaviors. Content validity was assessed by 10 sports medicine physicians and four epidemiologists. It was then programmed for the World Wide Web (http:// www.stanford.edu/dept/sportsmed/). The questionnaire demonstrated a 97 +/- 2% sensitivity in detecting positive responses requiring physician attention. Sixteen physicians administered the 1997/98 PPE; using the summary reports, 15 found improvement in their ability to provide overall medical care including health issues beyond clearance; 13 noted a decrease in time needed for each athlete exam. Over 90% of athletes who used the web site found it "easy" or "moderately easy" to access and complete. Initial assessment of this new PPE format shows good athlete compliance, improved exam efficiency and a strong increase in subjective physician satisfaction with the quality of screening and medical care provided. The data indicate a need for improvement of routine health maintenance in this population. The database offers opportunities to study trends, risk factors, and results of interventions.

DEVELOPMENT OF A COMPREHENSIVE AND COST-EFFECTIVE PRE-PARTICIPATION EXAMINATION (PPE)

1319 Mandatory PPEs are labor intensive and poor predictors of future injury or illness. Our objective was to develop a new PPE for the 850 Stanford University varsity athletes that improved both physician time efficiency and quality of primary and preventive care by addressing health issues not specifically related to clearance for participation. This PPE is based on yearly submission of an athlete completed, detailed, medical history questionnaire that is summarized in a 2 page report for the examining physician. The questionnaire was developed through review of PPEs from 15 other institutions, search of Medline from 1966-97 and discussion with 2 experts from each of 7 main content areas: medical and musculoskeletal history, eating, menstrual and sleep disorders, stress and health risk behaviors. Content validity was assessed by 10 sports medicine experts and 5 epidemiologists. It was then programmed for the World Wide Web (WWW). In 1997-98, 79% of athletes used the WWW and 21% completed a hard copy; >90% of athletes who used the web site found it `easy' or `moderately easy' to access and complete. Mean completion time was 28 min. 28% of first year athletes had not had a complete health exam in ≥3 years and 12% had never had a complete health exam; 23% of all athletes wished to speak to a physician about weight control, nutrition, stress, depression or other health concerns not addressed by the previous PPE. Sixteen physicians administered the 1997-98 PPEs; 14 stated the history report was `useful' or `very useful' in focusing their physical exam and 12 indicated it `significantly improved their opportunity to address primary and preventive care issues'; 13 physicians stated there was a `moderate' or `significant' decrease in time needed for each individual exam compared to previous years. Assessment of this new PPE format shows good athlete compliance, improved efficiency and a strong increase in subjective physician satisfaction with the quality of medical care provided. The data indicate a need for improvement of primary care in this population. The database offers opportunities to study trends, risk factors and results of interventions.