Many states currently require a medical screening prior to participation in organized sports. The purpose of this study was to examine the adequacy of the existing pre-participation examination form in Hawaii. One hundred forty-eight physicians who perform school health/pre-participation physical examinations were surveyed. The results indirectly suggest that these physicians agreed that the form should be modified and improved (p, .001)

Buxton, B P

Hiller, W D

Ho, K W

McCarthy, M R

Nichols, A W

English

eVols at University of Hawaii at Manoa

Adequacy of a Pre-Participation Examination Form: A Study of Hawaii Physicians Barton P. Buxton EdD, ATC*, Kwok W. Ho, PhD**, Andrew W. Nichols MOt, Michael R. McCarthy EdOtt, PT, ATC, W. Douglas B. Hiller MOttt Many states currently require a medical screening prior to partici-pation in organized sports. The purpose of this study was to examine the adequacy of the existing pre-participation examina-tion form in Hawaii. One hundred forty-eight physicians who perform school health/pre-participation physical examinations were surveyed. The results indirectly suggest that these physi-cians agreed that the form should be modified and improved (p, .001). Introduction It is generally believed that the pre-participation physical examination serves as a useful tool in the detection and preven-tion of unnecessary injury and illness in athletics. 1 Goldberg et aF reported that 15% of the 701 student athletes evaluated during a pre-participation examination study had 'Assistant Professor Department of Health, Physical Education, and Recreation Athletic Training Education Program Director Associate Professor, Department of Family Practice and Community Health John A. Burns School of Medicine, University of Hawaii at Manoa "Associate Professor Chairman, Health, Physical Education, and Recreation Department Founder and co-director of Hawaii Youth Sports and Fitness Program University of Hawaii at Manoa tAssociate Professor Department of Family Practice and Community Health, John A. Burn School of Medicine Team Physician, University of Hawaii at Manoa ttMcCarthy Orthopedic Rehabilitation and Sports Medicine Clinical Instructor Athletic Training Education Program University of Hawaii at Manoa tttQrthopedic Associates of Hawaii Assistant Clinical Professor, Department of Surgery John A. Burns of School of Medicine, University of Hawaii at Manoa For Reprints: Bart Buxton, EdD, ATC University of Hawaii at Manoa PE/A Complex, 225 1337 Lower Campus Road Honolulu, Hawaii 96822 (E-Mail: buxton@hawaii.edu medical problems that warranted further evaluation or exclusion from sport participation. Among them, 9 students were prohibited from participation because of medical or orthopedic problems. Pre-participation examinations are required for both scholastic and community-based sports programs in many states.3 This practice becomes imperative with the continually increasing numbers of participants in organized athletic activity. In fact, current estimates of national participation in youth sports pro-grams is in excess of20 million.4•5 Furthermore, more than half of the boys and a third of the girls at the high school level participate in organized athletic competition in various geographic areas.3 In fact, in the small state of Hawaii, there are more than 21,000 high school athletes who are participating in organized high school athletics. In 1988, a national survey was conducted to assess the require-ments for high school pre-participation physical examinations.3 The results of this study indicated that of the 45 states that replied, only 36 states have an official examination form and 35 states required a yearly examination. Among those 36 states that have an official examination form, only 25 included a medical history as part of the examination and only 3 of these 25 states list contraindications to participation. This study also showed that the High School Athletic Association of Hawaii requires a yearly pre-participation examination, has an official state form, has estab-lished examination guidelines, and requires a medical history as a part of the examination. However, in the Hawaii form, there were no criteria for exclusion from sports participation, such as hypertension, body fat content, heart murmur, etc.3 Furthermore, it was unclear from this study whether the physicians administer-ing these examinations were satisfied with the existing format and guidelines for screening the athletes for sports participation. The purpose of this study was to examine the adequacy of the existing pre-participation examinations form and guidelines in the state of Hawaii. Methods Four hundred fifty physicians were randomly selected from the Hawaii Medical Association membership directory. According to their similarities in practice type, each of the physicians was categorized in one of the following groups: Pediatricians (PD, n=90), family and general practitioners (FP, n=90), internists (IM, n=180), orthopedic and general surgeons (OGS, n=45), and physical and emergency medicine physicians (EM, n=45). A pamphlet-type survey was constructed to include a cover letter, the health examination form, and a questionnaire. The cover letter requested that the respondent review and evaluate the -HAWAII MEDICAL JOURNAL, VOL. 54, FEBRUARY 1995 410 health examination form (Fig 1) and respond to the 9 questions concerning the form (Table 1). The health examination form was a copy of the health examination form currently being utilized in Hawaii for the pre-participation examination. The form was identified as a "suggested" health form to eliminate subject bias. Respondents also were asked if they currently are performing school health/pre-participation physical examinations. The over-all return rate was 43% (193/450). However, among these 193 physicians, only 148 actually perform school health/pre-partici-pation physical examinations. Therefore, only the data from these 148 subjects were analyzed; chi-square contingency tests were used for statistical data analysis, the alpha level was set at p < .001. Results The chi-square statistical analysis showed that there were sig-nificant differences in response for 5 out of 9 questions regard-ing the possible changes in the health examination form (P < .001) (Table 1). Although these physicians did not indicate that the form should be more comprehensive, they significantly indicated that certain portions of the examination should be expanded. Specifically, they suggested that the musculoskeletal examination and laboratory work should be expanded and the maturational status should be included in the examination. It is of interest that although these physicians agreed to have modi-fications of the existing pre-participation examination, they did not believe that the improved form would contribute to injury prevention or would decrease injury exposure (P < .001). With occasional minor differences of opinion, the response for each of the questions was very similar between physician groups. Table 1 shows the responses for each of the 9 questions between physician groups. Discussion The results of this simple survey support the findings of other previous studies in the literature. 1•3•6·7•9•11 The benefits of a complete and properly administered medical history are well established. 2.6-7 In fact, the American Academy of Pediatrics had developed a pre-participation physical examination form which included an extensive health history and interim health history. 8 As a result of a pre-participation examination study in Washing-ton state, Smilkstein9 in 1981 suggested that a pre-participation examination, which includes a medical history, a functional examination for the cardiovascular and respiratory systems, and a sports-specific physical examination be given to the athletes. In 1982 Harvey10 also concluded that the pre-participation examination could be a useful tool in injury prevention if performed by a primary care physician and complemented with a cardiovascular and musculoskeletal fitness assessment. In 1985, McKeag1 summarized that the essential components of a pre-participation examination should include a complete medi-cal history, a thorough physical examination completed with a musculoskeletal, cardiovascular and psychological component, laboratory testing, and a maturation status. Feinstien et aP3 also recommended that the pre-participation examination should focus on the cardiovascular and musculoskeletal systems fol-lowing a complete medical history and that the examination contain an assessment of physical maturity and be applicable to both genders. The responding physicians in this study agreed that the mus-culoskeletal portion of the examination should be expanded (p< -0.001). This is congruous with the findings and recommenda-tions of previous authors which suggest that assessment of joint laxity, range of motion and strength assessment be included in the pre-participation examination.1·3•6•9•11 The physicians also noted that laboratory work needed to be expanded. The labora-tory work on the existing form contained only one line for urinalysis. Some studiesl.3·9 have concluded that the inclusion of blood work is an equally important aspect for screening for anemia and possible platelet disorders in certain populations. Maturational assessment also was suggested to be included in the examination portion of the present study. This assessment would allow the physician to properly advise the participants as to the type and level of sports activity (weightlifting, collision! contact, or endurance) that may be suitable for the individual participant's level of maturity .1•3 The results of this study further show that although these physicians agreed that modifications are needed for the existing pre-participation examination, they did not believe that an improved form would make significant contributions to injury prevention and/or decrease injury exposure. These data suggest )11-- Continued on Page 416 Table 1.-The Number of Responses for Each Question from the Physicians who were Performing School Health/Pre· Participation Physical Examinations Total Response Physician by Group PD FP IM OGS EM Question n=148 n=42 n=37 n=57 n=6 n=6 1. Should history Yes 75 23 20 24 3 5 be expanded? No 73 19 17 33 3 1 2. Could form be Yes 72 28 16 21 2 5 better organized? No 76 14 21 36 4 1 3. Should exam be Yes 63 21 19 16 3 4 more comprehen- No 85 21 18 41 3 2 sive? 4. Should general Yes 115* 33 27 50 3 2 exam be expanded? No 33 9 10 7 3 4 5. Should musculo- Yes 133* 38 32 54 5 4 skeletal exam be No 15 4 5 3 1 2 expanded? 6. Should lab work Yes 106* 27 27 48 3 1 be expanded? No 42 15 10 9 3 5 7. Should matura- Yes 122* 34 31 50 4 3 tional status be No 26 8 6 7 2 3 added? 8. Would an improved Yes 73 27 16 23 4 3 form decrease No 75 15 21 34 2 3 injury exposure? 9. Would an improved Yes 43 17 11 8 4 3 form increase No 105* 25 26 49 2 3 injury prevention? PD=Pediatrician, FP=Family Practice, IM=Internal Medicine, OGS=Orthopedic and General Surgery, EM=Emergency Medicine. *Chi-square contingency tests significant difference at 0.001 level. HAWAII MEDICAL JOURNAL, VOL. 54, FEBRUARY1995 411 Pre-Participation Examination ~ Continued from Page 411 as to any predisposing risks of injury that have been discovered during the examination process. that injury prevention is a very complicated problem and the pre-participation examination plays the role of providing valuable information for further decision-making. Additional efforts, athlete and parent education, coaching education, and condi-tioning, are desperately needed to provide a safe environment for youth athletic participation. References 1. McKeag DB. Preseason physical examination for the prevention of sports injuries. Sports Med. 1985; 2:413-431. 2. Goldberg B, Saraniti A, Witman P, et al. Participation sports assessment-an objective evaluation. Pediatr. 1980;66:736-745. 3. Greydanus D. Pediatrics and the teenage athlete. Ado/esc Health Update. 1990;2:1-5. 4. Smith N. Some heatth care needs of young athletes. In: Oski FA, ed. Yearbook in Pediatrics. St Louis, Missouri: Mosby-Year Book: 1981:186-227. Several national medical associations, such as the American Academy of Pediatrics, the American Academy of Family Practice, the American Medical Society for Sports Medicine, and the American Orthopedic Society for Sports Medicine have developed their own more comprehensive and thorough pre-participation examination forms. The results of this study sug-gest that it might be time for other states that require school health/pre-participation physical examinations to re-evaluate the adequacy of their existing forms in order to provide better screening of student-athletes for sports activity. Furthermore, the results of this study, along with specific recommendations, have been presented to the Ha-5. Feinstein RA, Soileau EJ, Daniel WA. A national survey of pre-participation physical examination requirements. Phys Sports Med. 1988;16:51-59. 6. DuRant RH, Seymore C, Linder CW, et al. The pre-participation examination of athletes. Comparison of single and multiple examiners. Am J Dis Child. 1985;139: 657-661. 7. Linder CW, Durant RH, Seklecki RM, et al. Pre-participation heatth screening of young athletes. Resutts of 1268 examinations. Am J Sports Med. 1981 ;9:187-193. 8. American Academy of Pediatrics. Sports participation health record (form). Evanston IL, 1990. 9. Smilkstein G. Heatth evaluation of high school athletes. Phys Sports Med. 1981 ;9:73-80. 10. Harvey J. The Pre-participation examinationofthe child athlete. In: Clinic Sport Med. Symposium on Pediatric and Adolescent Sports Medicine. 1982;1 :353-368. 11. DuRant RH, Pendergrast RA, Seymore C, et al. Findings from the Pre-participation athletic examination and athletic injuries. Sports Med. 1992;146:85-91. 12. American Academy of Pediatrics Committee on Sports Medicine. Recommendations for partici-pation in competitive sports. Pediatrics. 1988;81 :737-739. waii High School Athletic Asso-ciation to better facilitate the screening of the high school stu-dent athletes within the state. It is hoped that a more complete and useful pre-participation examina-tion form can be developed and used in the near future. The major findings of this study suggest that the pre-participation physical examination form and guidelines, currently used in the state ofHawaii, could be improved to provide a complete and thor-ough screening of athletes for sports activity. The findings of the pre-participation history and physical examination may be used to reduce the risks of various ath-letic-related injuries by following existing "recommendations" for participation in competitive sports, such as those established by the American Academy of Pe-diatrics Committee on Sports Medicine. 12 Therefore, the exami-nation should include a complete medical health history, a general physical assessment with basic cardiovascular examination, a complete musculoskeletal evalu-ation, more comprehensive labo-ratory work, and a maturational evaluation. Further, the examiner should be prepared to make a func-tional evaluation as to the athlete's physical ability to participate in certain sports. Finally, all athletes and parents should be counseled Fig 1.-5uggested Health Examination Form (Cooperatively prepared by the National Federation of State High School Associations and the Committee on Medical Aspects of Sports of the American Medical Association.) Health examination for athletes should be rendered after August 1 preceding school year concerned. (Please print) Name of Student City and School Grade--- Age ___ Height-- Weight BloodPressure-------------SignificantPastlllnessorinjury ____________________________ _ Eyes----- R20/- ;L20/-; Ears------ Hearing ~15; L../15 Resprraroty----------------------------------Cardiovascular---------------------------------Uv~·-------------- Spleen---------Musculoskeletal----------------------Neurological------------------------Laboratory: Urinaiysis--------------------Hernia ---------Skin Genitalia -------Other: Commen.~-----------------------------------Completed Immunizations: Polio•--------- TeWIDS----------------Date Date '1 certify that I have on this date examined this student and that. on the basis of the examination requested by the school authorities and the student's medical history as furnished to me, I have found no reason which would make it medically inadvisable for this student to compete in supervised athletic activities, EXCEPI'TIIOSE CROSSED OUT BELOW." Baseball Basketball Cross Country Field Hockey Football Hockey Golf Gymnastics Rowing Skating Skiing Soccer Softball Speedball Swimming Tennis Track Volleyball *Wrestling Others *Estimate Desirable weight level ____ _,. P<ounds Date of Examination: ___ _ Signed: ________________________ _ Examining Physician ~y~i~s~~es;ss -----.....,-,-----:,--:-:=-::==-=:::-=:--------T telephonee =--=-=-==-=-==-====-==-= Student Participation And Parental Approval Form Nameofstuden,<c·----------:------ Name of School; ____________ _ Middle Initial First Last Date: _______ _ DateofBrrth: _______ _ PlaceofBirth: -----------HealthandAccidentlnsuranceCarrier: ----------------------------This application to compete in interscholastic athletics for the above high school is entirely voluntary on my part and is made with the understanding that I have not violated any of the eligibility rules and regulations of the State Association. Signature of Student: _______________ _ Parent's or Guardian's Permlssion ''I hereby give my consent for the above named student (1) to represent his school in athletic activities except those crossed out on this fonn by the examining physician. providing that such athletic activities are approved by the State Association; (2) to accompany any school team of which he is a member on any of it's local or out-of-town trips. I authorize the school to obtain. through a physician of its own course. any emergency medical care that may become reasonably necessary for the student in the course of such athletic activities or such travel. I also agree not to hold the school or anyone acting in its behalf responsible for any injury occurring to the above named student in the course of such athletic activities or such travel." Signature of Parent or Guardian ________________ __ Date: ______ Address:-,::------------------,:-:-:-----------=-:---(Street) (City) (Zip) Note: This form is to be filled out completely and filed in the office of the high school principal or superintendent of schools before student is allowed to practice and/or compete. -HAWAII MEDICAL JOURNAL, VOL. 54, FEBRUARY 1995 416 

Adequacy of a pre-participation examination form: a study of Hawaii physicians.

http://evols.library.manoa.hawaii.edu/bitstream/10524/62466/1/1995-02p410-416.pdf

Adequacy of a pre-participation examination form: a study of Hawaii physicians.

Abstract

Similar works

Full text

Available Versions

eVols at University of Hawaii at Manoa