Activity Measures in Pediatric Athletes: A Comparison of the Hospital for Special Surgery Pediatric Functional Activity Brief Scale and Tegner Activity Level Scale

Background: In young athletes, patient-reported activity level is frequently used to determine return to the same level of sport after treatment. Purpose: To evaluate the validity and score distributions of the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) compared with the Tegner Activity Level Scale (Tegner) in pediatric athletes. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: A retrospective review of 517 consecutive youth athletes who came to a sports medicine specialty clinic for a knee evaluation was performed. Patients completed the HSS Pedi-FABS, Tegner, and a sports participation survey before evaluation. Scores were compared with reported hours, days, and weeks of participation in sports as well as level of competition. Floor or ceiling effects were identified, and finally, the means and distributions of scores in the 8 most common primary sports were analyzed. Results: A total of 398 participants (54.0% female) with an average age of 14.5 years (range, 10.0-18.8 years) were included in the study. The HSS Pedi-FABS demonstrated correlations with hours per week ( r = 0.302; P < .001), days per week ( r = 0.278; P < .001), and weeks per year ( r = 0.136; P = .014) playing a primary sport. The Tegner only demonstrated a correlation with days per week ( r = 0.211; P = .001). Additionally, club/select-level athletes scored higher than junior high/high school–level athletes on the HSS Pedi-FABS (23.8 vs 21.0; P = .004), but no difference was observed with the Tegner. No floor or ceiling effect was observed for the HSS Pedi-FABS, but a ceiling effect was present for the Tegner (32.8%). The HSS Pedi-FABS demonstrated a varied score distribution between the 8 most common primary sports ( P < .001), with soccer players scoring the highest, on average (23.5). Conclusion: The HSS Pedi-FABS, compared with the Tegner, demonstrated more correlations with an athlete’s participation in sport with no floor or ceiling effect and had a wide distribution of scores even among same-sport athletes. The HSS Pedi-FABS may be a more valuable activity measure than the Tegner in pediatric athletes.

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The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS): Normative Data

The American Journal of Sports Medicine ◽

10.1177/0363546518756349 ◽

2018 ◽

Vol 46 (5) ◽

pp. 1228-1234 ◽

Cited By ~ 10

Author(s):

Peter D. Fabricant ◽

Joash R. Suryavanshi ◽

Jacob G. Calcei ◽

Robert G. Marx ◽

Roger F. Widmann ◽

...

Keyword(s):

Functional Activity ◽

Normative Data ◽

Linear Regression Analysis ◽

Population Sample ◽

Sports Participation ◽

Activity Level ◽

Future Research ◽

Cross Sectional ◽

Special Surgery ◽

Hospital For Special Surgery

Background: Recent data have shown an increase in youth sports participation at younger ages, which may be linked to greater musculoskeletal injury risk. The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) is a validated 8-item instrument designed to quantify the activity of children between 10 and 18 years old. Normative data on pediatric and adolescent activity level are unknown. Purpose: To establish normative activity-level data for American youth and to determine if there is a natural decrease in activity level during adolescence. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A cross-sectional investigation was performed among 2002 US children and adolescents equally split by sex and age and representing census-weighted distributions of state of residency, race/ethnicity, and health insurance status. Respondents completed the HSS Pedi-FABS, as well as survey questions on demographics and sports participation. Normative data were reported with descriptive statistics. Linear regression analysis was performed to determine if there was an effect of age on activity level during adolescence. Results: A total of 2002 respondents completed the survey; the mean age of the respondents at the time of survey completion was 14.0 ± 2.6 years. Mean weekly amount of reported physical activity was 9.3 ± 8.4 hours. HSS Pedi-FABS scores were normally distributed with a mean of 15.4 ± 8.5 points (out of 30 possible points). There was a modest but statistically significant decrease in HSS Pedi-FABS activity scores with increasing age ( r = −0.175, P < .001), corresponding to a linear decrease in activity scores by 27% on average from age 10 to 18 years. Conclusion: The current study provides baseline normative data for activity level in a census-weighted representative population sample of 2002 American youth through the use of a validated activity score (HSS Pedi-FABS). There was a modest but statistically significant decrease in activity scores with increasing age. These results will aid future research by providing normative, representative population-level activity data and will help to quantify the natural rate of decreased activity during adolescence.

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An electronic patient-reported outcomes measurement system in paediatric orthopaedics

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.13.190053 ◽

2019 ◽

Vol 13 (4) ◽

pp. 431-437 ◽

Cited By ~ 7

Author(s):

M. J. Sabatino ◽

C. V. Gans ◽

A. J. Zynda ◽

J. S. Chung ◽

S. M. Miller ◽

...

Keyword(s):

International Knee Documentation Committee ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Activity Level ◽

Level Of Evidence ◽

Assess Patient Satisfaction ◽

Patient Reported ◽

Group 2 ◽

Level Scale ◽

Tegner Activity Level

Purpose The purpose of the study was to evaluate the reliability, review differences and assess patient satisfaction of electronic patient-reported outcome measures (PROMs) compared with paper PROMs. Methods Participants between 12 and 19 years of age with a knee-related primary complaint were randomized into two groups. Group 1 completed paper PROMs followed by electronic, while Group 2 received the electronic followed by paper. PROMs included the Pediatric International Knee Documentation Committee (Pedi-IKDC), Hospital for Special Surgery (HSS) Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), Tegner Activity Level Scale, Visual Analogue Scale (VAS), PedsQL Teen and a satisfaction survey. Results In all, 87 participants were enrolled with one excluded due to incomplete PROMs. Of the 86 participants, 54 were female and 32 were male with an average age of 14.3 years (12 to 18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC (0.946; p < 0.001), HSS Pedi-FABS (0.923; p < 0.001), PedsQL Teen (0.894; p < 0.001), Tegner Activity Level Scale before injury (0.848; p < 0.001) and the Tegner Activity Level Scale after (0.930; p < 0.001). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 versus 4.6; p < 0.001). While not significant, a trend was noted in which electronic PROMs took, overall, less time than paper (10.0 mins versus 11.2 mins; p = 0.096). Of all participants, 69.8% preferred the electronic PROMs, 67.4% felt they were faster, 93.0% stated they would complete forms at home prior to appointments and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion PROMs captured electronically were reliable when compared with paper. Electronic PROMs may be quicker, will not require manual scoring and are preferred by patients. Level of Evidence II

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A COMPARISON OF THE MARX ACTIVITY RATING SCALE AND THE HOSPITAL FOR SPECIAL SURGERY PEDIATRIC FUNCTIONAL ACTIVITY BRIEF SCALE

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00196 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0019

Author(s):

Niv Marom ◽

William Xiang ◽

Madison R. Heath ◽

Caroline Boyle ◽

Peter D. Fabricant ◽

...

Keyword(s):

Physical Activity ◽

Physical Activity Level ◽

Functional Activity ◽

Rating Scale ◽

Knee Injuries ◽

Random Order ◽

Activity Level ◽

Special Surgery ◽

Activity Rating ◽

Hospital For Special Surgery

Background: The Marx Activity Rating Scale (MARS) and the Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) are both validated activity scales. While the MARS examines greatest physical activity level within the last year, the HSS Pedi-FABS assesses the greatest level of physical activity within the last month. Purpose: To determine whether the different time frames used in MARS and HSS Pedi-FABS affect scores on common items in both scales, and if so, to determine whether age or injury status affect this difference. Methods: The MARS and 4 analogous items on the HSS Pedi-FABS were administered sequentially in random order to patients being evaluated at two sports surgeons’ clinic for knee injuries in addition to their healthy companions in order to enroll an uninjured comparison group. Responses to each question were scored from 0-4 for a maximum overall score of 16. Participant demographics were also recorded. Paired and independent sample t-tests were used to determine mean differences between the two scales and between healthy and injured adults and children, respectively. Results: The final cohort included 88 participants of which 47% were children (ages 10-17) and 51% had a knee injury. All participants except for healthy adults scored significantly lower on the HSS Pedi-FABS than the MARS (p < 0.05, Table 1). On the HSS Pedi-FABS activity scale, healthy participants scored significantly higher than injured participants (p<0.01), but there were no significant differences based on age, Figure 1A. Conversely, on the MARS scale, children scored higher than adults (p≤0.001), but there were no significant differences based on injury, Figure 1B. Conclusion: Physical activity level is significantly different when evaluated by either MARS or its analogue portion of HSS Pedi-FABS. Because the only difference between the scales is the timeframe, the lower scores on the Pedi-FABS than the MARS are likely due to seasonal changes in activity which are not captured in the MARS. Because the Pedi-FABS analyzes a shorter window, it is more likely to capture acute changes in physical activity due to a recent injury than the MARS scale while the MARS scale is better suited for examining general physical activity unaffected by seasonality. Understating the differences between these scales can guide clinicians in using them appropriately when evaluating patient activity level. Tables: [Table: see text] Figures: [Figure: see text]

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VALIDITY, MEANS, AND DISTRIBUTION OF THE HSS PEDI-FABS IN PEDIATRIC ATHLETES AND IN COMMON SPORTS

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00043 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0004 ◽

Cited By ~ 1

Author(s):

K. John Wagner ◽

Catherine V. Gans ◽

Aaron J. Zynda ◽

Meagan J. Sabatino ◽

Charles W. Wyatt ◽

...

Keyword(s):

Pediatric Population ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Statistical Correlation ◽

Activity Level ◽

Sample Population ◽

Frequency Distributions ◽

Significant Difference ◽

Patient Reported ◽

Level Scale

BACKGROUND: Patient reported outcome measures (PROMs) measuring activity level can be crucial to a musculoskeletal provider in both a clinical and research setting. The HSS Pedi-FABS was developed as a generalizable measure of activity in children ages 10-18. However, existing literature validating this scale is limited by small patient populations leading to underrepresentation of multiple sports. The purpose of this study is to assess the validity of the HSS Pedi-FABS when used in a large pediatric population participating in various sports and evaluate the means and distribution of Pedi-FABS amongst common sports. METHODS: A retrospective review of 517 subjects who completed the HSS Pedi-FABS while presenting for knee evaluation was performed. Subjects were seen by one of five providers at a pediatric sport medicine center between October 2016 and June 2017. Subjects were included in analysis if they completed the HSS Pedi-FABS and had reported status as an athlete. Patient demographics, primary sport, multi-sport involvement, level of competition, frequency of play, HSS Pedi-FABS and Tegner Activity Level Scale (Tegner) scores were reviewed. The Tegner asked subjects to classify their activity level prior to injury. To determine validity, the HSS Pedi-FABS was compared to the Tegner. S-correlations were calculated between the two activity scales. Each scale was then correlated with level of activity and frequency of play. A t-test was run between the HSS Pedi-FABS scores and multi-sport involvement. Distributions of the HSS Pedi-FABS scores were calculated across the eight most frequent primary sports reported by the sample population. ANOVA analyses were performed with the HSS Pedi-FABS and Tegner Before scores of the eight primary sports. The ANOVA analyses were followed by t-tests for multiple comparisons. RESULTS: Of the 424 athletes included in the study, 227 (53.5%) were female and 197 (46.5%) were male. The mean age was 14.29 years (range: 6.48-22.35). 207 (48.8%) were multi-sport athletes while 215 (50.7%) were considered single-sport athletes. 2 (0.5%) had an unknown status. There was a significant difference between HSS Pedi-FABS scores of multi-sport athletes versus single-sport athletes (22.0 versus 20.36, respectfully, p=.027). Correlations were found between the HSS Pedi-FABS and days per week playing a primary sport (r=0.273; p<0.001), hours per week playing primary sport (r=0.292, p<0.001), and weeks NOT engaged in sports (r=-0.112, p=0.039). In this data, there was no correlation with perceived level of competition and HSS Pedi-FABS. There was no statistical correlation found between the HSS Pedi-FABS and the Tegner with a similar mean HSS Pedi FABS scores seen in each Tegner group >5. The Tegner scale did not statistically correlate with hours per week or days per week. The HSS Pedi-FABS showed a significant difference in scores between the eight most frequent primary sports (p=0.001). Subjects whose primary sport was Soccer scored significantly higher (23.57 ± 6.27) than those of Dance/Drill Team/Ballet (17.45 ± 6.38) and Track and Field/Running/Cross Country (17.47 ± 5.74, p=.001, .024). Frequency distributions of each sports are seen in Figure 1. CONCLUSION: The HSS Pedi-FABS, as compared to the Tegner, has significant correlation with time spent while playing a primary sport. Normal distribution of the HSS Pedi FABS may be different based on sports. Further analysis of multiple joints could provide a more comprehensive understanding of Pedi-FABS scoring trends in pediatric athletes. [Figure: see text]

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Revision Single-Stage Anterior Cruciate Ligament Reconstruction Using an Anterolateral Tibial Tunnel

The Journal of Knee Surgery ◽

10.1055/s-0039-1677812 ◽

2019 ◽

Vol 33 (04) ◽

pp. 410-416

Author(s):

Sohrab Keyhani ◽

Behzad Hanafizadeh ◽

René Verdonk ◽

Mohammadreza Minator Sajjadi ◽

Mehran Soleymanha

Keyword(s):

Revision Surgery ◽

Cruciate Ligament ◽

Tibial Tunnel ◽

Clinical Results ◽

Activity Level ◽

Acl Revision ◽

Anterior Cruciate ◽

Level Scale ◽

Tegner Activity Level ◽

Acl Revision Surgery

AbstractRevision anterior cruciate ligament (ACL) reconstruction is a technically demanding enterprise. Management of widened or previously malpositioned tunnels is challenging and often requires innovative approaches. The purpose of this study was to evaluate the function and clinical results of revision single-stage ACL surgery using an anterolateral tibial tunnel (ALTT). A consecutive series of knees with arthroscopic ACL revision surgery were analyzed prospectively between April 2012 and September 2015. Among the 93 patients presented with revision ACL reconstruction, 25 patients met the study inclusion criteria for the ALTT technique and were followed up for a minimum of 2 years (range: 24–51 months). The clinical results were evaluated by means of the Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity level scale, and the knee stability was assessed by the Lachman test, pivot shift test, and anterior drawer test. Magnetic resonance imaging (MRI) of the index knee before the surgery and 2 years after revision surgery was assessed. The mean IKDC subjective score, mean Tegner activity level scale, and mean Lysholm score significantly improved in all study participants. This study showed that ACL revision surgery with ALTT can reliably restore stability and provide fair functional outcomes in patients with ACL retear. One could expect acceptable lateral tibial tunnel length compared with medial tibial tunnel in classic ACL revision, intact bony surround, and good graft fixation. This technique is clinically relevant in that making an anterolateral tunnel in one-stage ACL revision surgery had a good subjective result with low complication rate in midterm follow-up.

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