Development and Content Validity of a Pre-participation Evaluation Tool for Recreational Athletes Engaged in High-Intensity Sports

BACKGROUND: Participation in high-intensity sports among recreational athletes has increased substantially, accompanied by a higher incidence of preventable cardiovascular and musculoskeletal adverse events. Existing pre-participation evaluation (PPE) tools are largely designed for elite or scholastic athletes and frequently lack rigorous psychometric validation for recreational populations. OBJECTIVE: To develop a novel PPE questionnaire tailored for recreational athletes engaged in high-intensity sports and to establish its face validity and content validity using a systematic, theory-driven methodology. METHODS: Instrument development followed a two-phase qualitative design. Phase I involved a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review and expert consultation to define relevant domains and generate an initial item pool. Phase II focused on tool development and validation, including face validity assessment by a multidisciplinary panel of 20 experts and content validity evaluation using Lawshe's content validity ratio (CVR). Pilot testing was conducted on 30 recreational athletes to assess feasibility and clarity. RESULTS: The systematic review and expert consultation yielded an initial pool of 65 items across five domains. Following face validity assessment, several items were revised or eliminated for clarity and relevance. Content validity analysis using CVR resulted in retention of 59 items, with 80% of items achieving CVR values ≥0.49. Pilot testing demonstrated high acceptability, clarity, and feasibility, with the majority of participants reporting ease of administration and reasonable completion time. CONCLUSION: The developed PPE instrument demonstrates excellent face validity and strong content validity for recreational athletes participating in high-intensity sports. The final 59-item questionnaire provides a comprehensive, context-specific screening tool and is suitable for progression to reliability testing and further psychometric evaluation in larger prospective cohorts.