Perception of Pain and Function Among Athletes and Parents: A PROMIS Dyad Study

Background: Athletes can be profoundly impacted by their environment and support system. For young, injured athletes, parents may wield significant influence over their treatment and recovery, yet may hold divergent perceptions of the athletes’ condition. Hypothesis: When using the Patient-Reported Outcomes Measurement Information System (PROMIS) metrics, parents and athletes will have differing perceptions about how the athletes are affected by their injury. Study Design: Cohort study; Level of evidence, 3. Methods: This study was approved by our institutional review board. In our clinics, each child (age, 8-17 years) routinely takes a series of PROMIS questionnaires. For study purposes, at 1 sports clinic visit per child, we had an accompanying parent independently complete the same PROMIS metrics on the child’s behalf. We then formed dyads from each athlete/parent response and used these dyads for analysis to quantify differences in their understanding. Generalized estimating equations were used to analyze differences between members of the dyads (correlated data). Results: The total number of dyads examined was 387. There were 201 female athletes, 186 male athletes, 302 female parents, and 85 male parents. The mean age of both male and female athletes was 14 years. Across all dyads, parents rated pain interference as worse than patients did, by a mean of 5 points (mean score, 50.03 vs 45.46, respectively; P < .001). Significant differences were also noted in peer relationships, mobility, and upper-extremity PROMIS domains. In all domains, parents rated the patients as doing worse than the athletes did themselves. When examined by sport, parents of athletes in football, soccer, gymnastics, and basketball rated pain interference as worse. Parents of athletes treated both operatively and nonoperatively rated pain interference as higher, and parents of both sexes rated pain interference as higher. Conclusion: Parents of injured athletes perceive their children to be more affected by pain than the athletes themselves. Parents also perceive injured athletes to have worse function across all domains than the athletes themselves do.