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Use of the Preparticipation Physical Examination Form to Screen for the Female Athlete Triad in Canadian Interuniversity Sport Universities

Rumball, Jane S MSc; Lebrun, Constance M MDCM, MPE, CCFP, DipSportMed

Clinical Journal of Sport Medicine: September 2005 - Volume 15 - Issue 5 - pp 320-325
Original Research

Objective: The purpose of this study was to survey universities affiliated with Canadian Interuniversity Sport on existing screening protocols for the female athlete triad, and to identify any potential areas for improvement of this system.

Design: Surveys were faxed or e-mailed to Canadian Interuniversity Sport-affiliated universities in Canada, and preparticipation physical examination (PPE)/medical history forms from each institution were analyzed.

Setting: The Fowler Kennedy Sports Medicine Clinic at the University of Western Ontario.

Participants: In 2000, of the 48 universities, 35 responded (73.0% response rate). In 2002, 39 of 49 universities responded (79.6%).

Main Outcome Measurements: Although the majority of institutions surveyed implement a PPE form (80.0% in 2000, 87.2% in 2002), only 70.6% to 75.0% of these institutions actually conduct a follow-up when deemed necessary. However, the number of forms including a specific female section increased from 46.4% in 2000 to 61.8% in 2002. Also encouraging is the percentage of universities attempting to increase awareness of the triad disorders (33.3% in 2002 vs. 14.3% in 2000). It is interesting to note that in over half of the institutions surveyed both years, the athletic therapist or trainer is responsible for analyzing the completed PPE forms.

Conclusions: This study has shown substantial improvement from 2000 to 2002 in the development of the PPE across Canada, even in a relatively short period of 2 years. However, this study also demonstrates the lack of uniformity within Canada of the PPE forms.

There remains a need to improve the PPE form to target a section of the form specifically to female athletes, or else cases may be missed. The triad is also not found solely in sports where leanness is associated with better performance. Better efforts need to made to increase awareness of the triad and its risks among female athletes, as well as provide educational opportunities for athletic therapists, who are the first line of intervention in many cases.

Clinical Relevance: The key to successful prevention and intervention is education. This study demonstrates the need for education for all people directly involved with the athlete, and the need to work together to promote a healthy and realistic body image and increase awareness of the female athlete triad among athletes.

From the Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.

Received for publication November 2004; accepted June 2005.

Reprints: Jane S. Rumball, MSc, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada N6A 3K7 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.