Objective To identify subgroups of former National Football League (NFL) players using latent profile analysis (LPA) and examine their associations with total years of participation (TYP) and self-reported lifetime sport-related concussion history (SR-CHx).
Methods Former NFL players (N=686) aged 50–70 years, with an average 18.0 TYP (±4.5) completed a questionnaire. SR-CHx distributions included: low (0–3; n=221); intermediate (4–8; n=209) and high (9+; n=256). LPA measures included: Quality of Life in Neurological Disorders Emotional–Behavioral Dyscontrol, Patient Reported Outcomes Measurement Information System Cognitive Function, Emotional Support, Self-Efficacy, Meaning and Purpose, Physical Function, Pain Interference, Participation in Social Roles and Activities, Anxiety, Depression, Fatigue, and Sleep Disturbance. Demographic, medical/psychiatric history, current psychosocial stressors, TYP and SR-CHx were compared across latent profiles (LPs).
Results A five profile solution emerged: (LP1) global higher functioning (GHF; 26.5%); (LP2) average functioning (10.2%); (LP3) mild somatic (pain and physical functioning) concerns (22.0%); (LP4) somatic and cognitive difficulties with mild anxiety (SCA; 27.5%); LP5) global impaired functioning (GIF; 13.8%). The GIF and SCA groups reported the largest number ofe- medical/psychiatric conditions and higher psychosocial stressor levels. SR-CHx was associated with profile group (χ2(8)=100.38, p<0.001); with a higher proportion of GIF (72.6%) and SCA (43.1%) groups reporting being in the high SR-CHx category, compared with GHF (23.1%), average (31.4%) and somatic (27.8%) groups. TYP was not significantly associated with group (p=0.06), with greater TYP reported by the GHF group.
Conclusions Five distinct profiles of self-reported functioning were identified among former NFL players. Several comorbid factors (ie, medical/psychiatric diagnoses and psychosocial stressors) and SR-CHx were associated with greater neurobehavioural and psychosocial dysfunction.
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Contributors BLB: designed and conceptualised study; major role in acquisition of the data; analysed data; drafted and revised the manuscript for intellectual content. SW: major role in acquisition of the data; analysed data; revised the manuscript for intellectual content. ZK: major role in acquisition of the data; analysed data; revised the manuscript for intellectual content. LDN: designed and conceptualised study; analysed data; drafted the manuscript for intellectual content. AC: revised the manuscript for intellectual content. JDD: revised the manuscript for intellectual content. RE: major role in acquisition of the data; revised the manuscript for intellectual content. KMG: major role in acquisition of the data; analysed data; revised the manuscript for intellectual content. WM: major role in acquisition of the data; analysed data; revised the manuscript for intellectual content. MM: designed and conceptualised study; major role in acquisition of the data; analysed data; revised the manuscript for intellectual content.
Funding This study (NFL-LONG) was funded by the National Football League (NFL).
Competing interests RE is a paid consultant for the NHL and co-chair of the NHL/NHLPA Concussion Subcommittee. He is also a paid consultant for Major League Soccer and Princeton University Athletic Medicine and occasionally provides expert testimony in matters related to MTBI and sports concussion.
AC reports funding from the National Collegiate Athletic Association (NCAA) as the Director of the NCAA Injury Surveillance Program
WM receives royalties from (1) ABC-Clio publishing for the sale of his books, Kids, Sports, and Concussion: A Guide for Coaches and Parents, and Concussions; (2) Springer International for the book Head and Neck Injuries in Young Athlete and (3) Wolters Kluwer for working as an author for UpToDate. His research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and a grant from the National Football League. MM acknowledges researching funding from the NIH, Department of Defense, CDC, NCAA and NFL to the Medical College of Wisconsin.
Patient consent for publication Not required.
Ethics approval This study was approved by an Institutional Review Board (IRB) at the Medical College of Wisconsin and University of North Carolina at Chapel Hill #19-1065 and participants provided written informed consent prior to any study activities.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. The data used as part of this study that support the reported findings are available from the corresponding author (BB), upon reasonable request.
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