Diagnostic performance of the Strength and Pain Assessment (SPA) score for non-contact muscle injury screening in male soccer players

ABSTRACT

Objectives

The aims of this study were to develop a clinical-feature based scoring system for muscle injury screening and to assess its diagnostic accuracy when large number of injuries are suspected.

Methods

A prospective diagnostic accuracy study was performed according to the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. The diagnostic accuracy of the Strength and Pain Assessment (SPA) score (index test) was assessed in relation to muscle ultrasonography (reference standard). A large (n = 175) number of male soccer players met the inclusion/exclusion criteria: clinical assessment (i.e., evaluation of pain onset modality, location, distribution, impact on performance, and manual muscle strength testing) and ultrasonography were performed in all players after 48 hours from the sudden or progressive onset of muscle pain during or after a soccer competition.

Results

91 of 175 cases (52%) were classified as functional muscle disorders, while signs of muscle tear were observed in the remaining 84 of 175 (48%) cases that were classified as structural muscle injuries. The median (1st – 3rd quartile) value of the SPA score was significantly (P < 0.001) lower in the functional disorder group [9 (9–10)] compared to the structural injury group [12 (12–13)]. The area under the Receiver Operating Characteristic curve for different cutoff points of the SPA score was 0.977 (95% confidence intervals: 0.957–0.998) and the optimal cutoff value of the SPA score providing the greatest sensitivity and specificity (respectively, 99% and 89%) was 11.

Conclusion

This study found that the SPA score has high diagnostic accuracy for structural muscle injuries and could be used as a valid screening tool in soccer players presenting with sudden or progressive onset of muscle pain during or after a competition.

KEYWORDS:

• COSMIN
• muscle injury
• muscle pain
• muscle strength
• muscle tear
• ultrasonography
• STARD
• sensitivity

Acknowledgments

The Authors are grateful to Dr. Alessandro Giannini (University of Turin, Italy) for reading and commenting a preliminary version of this manuscript.

Declaration of interest

The authors report no conflict of interest.

Ethical statement

All subjects gave their consent after receiving a detailed explanation of the protocol. The study conformed to the guidelines of the Declaration of Helsinki and was approved by the local ethics committee.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was supported by the University of Turin (Fondo per la Ricerca Locale - ex-60%) and by the Italian Ministry of Education, University and Research (MIUR) under the programme ‘Dipartimenti di Eccellenza ex L. 232/2016’ to the Department of Surgical Sciences, University of Turin and to the Department of Mathematical Sciences, Politecnico di Torino (CUP E11G18000350001). Neither funding body had a role in the design of the study and in writing the manuscript.