Description
Objectives: To evaluate if return to play is an appropriate benchmark of successful injury recovery and present a set of questions that provide an improved mechanism for determining if activity resumption is related to injury or external factors.
Methods: A set of questions (Minnesota Activity Scale - 5 item questionnaire) was developed and administered through multiple iterations. It was used to determine if the sport or activity participated in at the conclusion of injury recovery was the same as before injury. In negative instances it was used to determine if the change was tied to the injury or to external life factors. Six iterations of survey development confirmed content validity and patient comprehension. Once the questions were considered stable, they underwent test re-test evaluation on a subset of patients and then were deployed in a longitudinal study of 248 patients with patella dislocations undergoing MPFL reconstruction.
Results: The questions of the Minnesota Activity Scale identify the preferred activity, length of time and frequency of participation, current limitations to participation and reason for those limitations. For the group of chronic patella dislocators at time of MPFL reconstruction 44% reported active participation in their preferred sport while 13% reported complete limitation to participation and 5% reporting no limitation. At the pre-surgical treatment time point 97% reported the limiting factor to their activity participation was their injury. At one year follow-up 32 (22%) reported no limitations to activity participation. 111 reported limitations in participation with 61% attributing that limitation to their injury but 34% attributed their limitation or cessation of sport participation due to factors unrelated to their injury.
The survey did not include carry forward of the baseline sport so only 87 listed the same preferred sport/activity from baseline to one year. 35 of these patients no longer participated in their preferred sport with 34% claiming their lack of participation in the same activity due to factors unrelated to their injury. Test/re-test demonstrated 92% accuracy with 37 subjects over a 1-week recall period.
Conclusions: Return to play may not be the best benchmark of successful injury recovery as multiple factors may enter the return to play decision. At one year after surgical care 34% of the population tied their limitation of participation to factors unrelated to their injury and its treatment. Some sports may have limited participation opportunities due to age (gymnastics, American football). Life changes such as families or home location may impact the decision. In addition, there are psycho-social factors such as fear of re-injury. For chronic injuries there may also be the resumption of more strenuous activities with the stability and security resulting from injury treatment. Thus, return to play in isolation is not a good benchmark of successful injury recovery and should be evaluated in conjunction with other factors.
