Planning the diffusion of a neck-injury prevention programme among community rugby union coaches

BACKGROUND

This paper describes the development of a theory-informed and evidence-informed, context-specific diffusion plan for the Mayday Safety Procedure (MSP) among community rugby coaches in regional New South Wales, Australia.

METHODS

Step 5 of Intervention Mapping was used to plan strategies to enhance MSP adoption and implementation.

RESULTS

Coaches were identified as the primary MSP adopters and implementers within a system including administrators, players and referees. A local advisory group was established to ensure context relevance. Performance objectives (eg, attend MSP training for coaches) and determinants of adoption and implementation behaviour (eg, knowledge, beliefs, skills and environment) were identified, informed by Social Cognitive Theory. Adoption and implementation matrices were developed and change-objectives for coaches were identified (eg, skills to deliver MSP training to players). Finally, intervention methods and specific strategies (eg, coach education, social marketing and policy and by-law development) were identified based on advisory group member experience, evidence of effective coach safety behaviour-change interventions and Diffusion of Innovations theory.

CONCLUSIONS

This is the first published example of a systematic approach to plan injury prevention programme diffusion in community sports. The key strengths of this approach were an effective researcher-practitioner partnership; actively engaging local sports administrators; targeting specific behaviour determinants, informed by theory and evidence; and taking context-related practical strengths and constraints into consideration. The major challenges were the time involved in using a systematic diffusion planning approach for the first time; and finding a planning language that was acceptable and meaningful to researchers and practitioners.

The 'impact' of force filtering cut-off frequency on the peak knee abduction moment during landing: artefact or 'artifiction'?

BACKGROUND

Joint moments computed using inverse dynamic techniques are important estimators of net joint loads. Joints moments computed from marker position and ground reaction force data filtered using different cut-off frequencies may capture changes in moment magnitudes at a single joint that exceed normal physiological response. Peak external knee abduction moment (KAM) generated during landing (ie, the drop vertical jump, DVJ) predicts anterior cruciate ligament injury risk using marker and force data filtered at different cut-off frequencies. The purpose of the current investigation was to determine the effects of using the same low cut-off frequencies versus different cut-off frequencies on joint moment magnitudes to evaluate if artificial smoothing attenuates actual resultant joint loads related to injury risk.

METHODS

Twenty-two female, high school volleyball players performed three maximum DVJs in a laboratory setting. The average peak KAM was computed for each knee using marker and force data filtered with the same low cut-off frequencies and different cut-off frequencies.

RESULTS

Peak KAMs were significantly larger using different cut-off frequencies. The order of athletes ranked based on the magnitude of their peak KAMs did not significantly change across all filtering cut-off frequencies.

CONCLUSIONS

The magnitude of peak KAM may differ when the same low or different higher cut-off frequencies are used to filter marker and ground reaction forces (GRF) data collected using standard motion capture equipment. It is not clear to what extent the decrease in peak KAM reported when the same low cut-off frequencies were used was solely due to attenuation of the GRF signal.

Is your hospital safe for children? Applying home safety principles to the hospital setting

OBJECTIVES

To review the risks of injury to children in the hospital setting and to provide an overview of the factors which influence the approach to hospital safety, including institutional liability, hospital accreditation, patient safety and risk management issues.

METHODS

Fatal and nonfatal injuries to children in the hospital setting were identified using searches of the published literature and searches of incident, complaint and claims data sources, including regulatory agency databases, litigation and claims data, and medical device hazard databases. Canadian hospital law, accreditation, patient safety and risk management literature was reviewed and summarized.

RESULTS

Injuries occur in over 1% of hospitalized children, and are typically due to falls. Serious injuries are infrequent; however, a significant number of fatal injuries have been reported, mostly involving entrapment in beds and cribs, but also due to choking, strangulation and electrocution. Hospitals are liable for injuries to patients and visitors occurring on their premises. Canadian accreditation standards include provisions for the safety of equipment, supplies, medical devices and space, but do not provide specific guidance for children. Addressing injury hazards to children is an important aspect of the new patient safety movement, and falls within the scope of existing risk management and quality improvement programs.

CONCLUSIONS

Most hazards to children in the hospital setting can be easily corrected by proactively incorporating basic child safety principles. Paediatricians can play an important role in advocating for a safe hospital environment and should encourage administrators to consider child safety in routine hospital operation and policies.