Sport-Specific Outcome Measures Improve Clinical Assessment of Shoulder Injury in Swimmers: A Cohort Study of Specific PROMs

Background: Swimming is among the most widely practiced sports globally. Up to 70% of swimmers report shoulder pain that impairs performance. Patient-reported outcome measures (PROMs) are effective, objective tools for assessing such injuries. The aim of this study was to develop and validate swimming-specific adaptations of established shoulder PROMs (ASES-swim and SSV-swim) and compare their psychometric properties and discriminatory ability with generic existing instruments. Hypothesis: Swimming-specific PROMs may more accurately assess shoulder condition in swimmers and monitor recovery, thereby enabling improved evaluation of health status and, ultimately, athletic performance. Study Design: Cohort study. Methods: A total of 167 athletes registered with the Portuguese Swimming Federation (FPN) during the 2023-2024 season were enrolled. Participants were stratified into asymptomatic group (AG = 92) and injured group (IG = 75). Monthly assessments included training characteristics, injury status, and responses to ASES, SSV, SSV-sport, and newly developed ASES-swim and SSV-swim questionnaires over 6 months. Results: SSV-swim correlated strongly with SSV and SSV-sport ( r = 0.769, P < 0.001 and r = 0.857, P < 0.001, respectively). ASES-swim scores were highly correlated with ASES scores ( r = 0.994, P < 0.001). Both SSV-swim and ASES-swim demonstrated higher internal consistency than the nonadapted PROMs (Cronbach alpha = 0.849 and 0.870, respectively). SSV, SSV-sport, and SSV-swim showed moderate discriminatory ability (area under the curve AUC = 0.760, 0.809, and 0.851, respectively), whereas ASES and ASES-swim showed excellent discriminatory ability for detecting injury (AUC = 0.967 and 0.970, respectively). Conclusion: ASES-swim and SSV-swim are a valid, reliable, and easy to administer tool for the assessment of shoulder injury and recovery in swimmers. Swimming-specific PROMs provide clinically meaningful improvements in shoulder injury assessment accuracy. Clinical Relevance: Swimming-specific PROMs provide clinicians with a sensitive and reliable method for assessing shoulder injury in swimmers, enabling more accurate diagnosis and individualized rehabilitation. Further research should investigate sports-specific PROM adaptations to optimize athlete care across disciplines.