Perceptual Decision Efficiency and Optimal Sleep Quality Are Associated with Female College Soccer Injury Avoidance

Sport-related injuries are common, and often recurrent, among female college soccer players. This exploratory cohort study investigated whether perceptual decision efficiency and sleep quality could discriminate between injured and uninjured players.

Twenty-seven NCAA Division I women's soccer players (19.5 ± 1.3 years) completed a perceptual response training program, administered through an immersive virtual reality system, across a 13-week season. Players completed 11 training sessions progressing through four levels of task difficulty, with conjugate eye movements, neck rotation, and whole-body lunge-reach responses measured for each trial. Four metrics, elapsed time, rate correct per second, across-trials variability, and an efficiency index, were calculated for each of three defined time segments: perceptual decision, action initiation, and perceptual-motor response. The Pittsburgh Sleep Quality Index (PSQI) and Global Well-Being Index (GWBI) were administered prior to the first practice session, and all subsequent time-loss injuries were documented. Receiver operating characteristic analyses, Kaplan-Meier survival analysis, and classification tree modeling were used to evaluate injury discrimination.

Twelve time-loss injuries, including five concussions and seven lower extremity musculoskeletal injuries, were sustained by 10 of the 27 players. Optimal discrimination between injured and uninjured players was derived from the perceptual decision efficiency (PDE) metric for the most difficult perceptual response training task (AUC = 0.682-0.794), with a binary cut point of ≤6.02 yielding an odds ratio of 5.60 (95% CI: 1.02, 30.90; Mantel-Cox log rank p = 0.025). All five concussions occurred in players classified as high-risk by a suboptimal PDE value. Pre-participation PSQI demonstrated an AUC of 0.735. Notably, no player with both an optimal PDE value and a favorable sleep quality score (PSQI < 4) sustained a time-loss injury. Moderate-to-large training-related improvements in perceptual decision metrics were observed for the least challenging task from early- to late-season sessions.

Optimal values for PDE and sleep quality together characterized female college soccer players who avoided injury. Both factors appear to be modifiable, suggesting that perceptual response training combined with interventions to enhance sleep quality may enhance injury resistance. Independent validation in larger, diverse athlete cohorts is warranted.