Hughes, T, Riley, R, Callaghan, MJ and Sergeant, JC (2020) The value of pre-season screening for injury prediction: The development and internal validation of a multivariable prognostic model to predict indirect muscle injury risk in elite football (soccer) players. Sports Medicine, 6 (1). ISSN 0112-1642

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Background: In elite football (soccer), periodic health examination (PHE) could provide prognostic factors to predict injury risk. Objective: To develop and internally validate a prognostic model to predict individualised indirect (non-contact) muscle injury (IMI) risk during a season in elite footballers, only using PHE-derived candidate prognostic factors. Methods: Routinely collected preseason PHE and injury data were used from 152 players over 5 seasons (1st July 2013 to 19th May 2018). Ten candidate prognostic factors (12 parameters) were included in model development. Multiple imputation was used to handle missing values. The outcome was any time-loss, index indirect muscle injury (I-IMI) affecting the lower extremity. A full logistic regression model was fitted, and a parsimonious model developed using backward-selection to remove factors that exceeded a threshold that was equivalent to Akaike’s Information Criterion (alpha 0.157). Predictive performance was assessed through calibration, discrimination and decision-curve analysis, averaged across all imputed datasets. The model was internally validated using bootstrapping and adjusted for overfitting. Results: During 317 participant-seasons, 138 I-IMIs were recorded. The parsimonious model included only age and frequency of previous IMIs; apparent calibration was perfect but discrimination was modest (C-index = 0.641, 95% confidence interval (CI) = 0.580 to 0.703), with clinical utility evident between risk thresholds of 37-71%. After validation and overfitting adjustment, performance deteriorated (C-index = 0.589 (95% CI = 0.528 to 0.651); calibration-in-the-large = -0.009 (95% CI = -0.239 to 0.239); calibration slope =0.718 (95% CI= 0.275 to 1.161). Conclusion: The selected PHE data were insufficient prognostic factors from which to develop a useful model for predicting IMI risk in elite footballers. Further research should prioritise identifying novel prognostic factors to improve future risk prediction models in this field.

Item Type: Article
Additional Information: Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit
Uncontrolled Keywords: Athlete, Athletic Injury, Injury prevention, Risk, Sport, Sprains and strains
Subjects: Q Science > Q Science (General)
R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine > RC1200 Sports Medicine
R Medicine > RC Internal medicine > RC475 Therapeutics. Psychotherapy
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Depositing User: Symplectic
Date Deposited: 04 May 2020 11:52
Last Modified: 18 Aug 2020 11:05

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