Paralympic athletes’ perceptions of their experiences of sports-related injuries, risk factors and preventive possibilities

Sports-Related Health Problems in Para-Sports: A Systematic Review With Quality Assessment

CONTEXT

Participation in sports is associated with a risk of sports-related health problems. For athletes with an impairment, sports-related health problems further burden an already restricted lifestyle, underlining the importance of prevention strategies in para-sports.

OBJECTIVE

To provide a comprehensive overview with quality assessment of the literature on sports-related health problems, their etiology, and available preventive measures in para-sports following the steps of the Sequence of Prevention.

DATA SOURCES

A literature search (in PubMed, Embase, SPORTDiscus, CINAHL and the Cochrane Library) was performed up to December 8, 2021, in collaboration with a medical information specialist.

STUDY SELECTION

The search yielded 3006 articles, of which 64 met all inclusion criteria.

STUDY DESIGN

Systematic review with quality assessment.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Two independent researchers carried out the screening process and quality assessment. One researcher extracted data, and the Sequence of Prevention categorized evidence.

RESULTS

A total of 64 studies were included, of which 61 reported on the magnitude and risk factors of sports-related health problems, while only 3 reported on the effectiveness of preventive measures. Of these, 30 studies were of high quality. Most studies (84%) included elite-level athletes. The reported injury incidence varied widely between sports (0-91 per 1000 athlete days) and impairment categories (1-50 per 1000 athlete days). The same applies to illness incidence with regard to different sports (3-49 per 1000 athlete days) and impairment categories (6-14 per 1000 athlete days).

CONCLUSION

This review shows the current vast range of reported sport-related health problems in para-sports. There is limited evidence concerning the severity of these sports-related health problems and inconclusive evidence on the risk factors. Lastly, the evidence regarding the development and effectiveness of preventive measures for para-athletes is sparse.

Occurrence of injuries and illnesses in athletes with a physical impairment; a forty-week prospective cohort study

OBJECTIVES

Currently, the knowledge about the epidemiology of sport-related health problems of athletes with a physical impairment is limited. Therefore, this study aims to describe the prevalence, incidence and severity of sport-related health problems of athletes with a physical impairment in the Netherlands over a one sport season.

DESIGN

Prospective cohort study.

METHODS

Athletes (n = 99) with a physical impairment participated in this study. After completing a baseline questionnaire, athletes started a 40-week health monitoring period, during which they completed the Dutch translation of the OSTRC Questionnaire on Health Problems every week. Based on the reported information, injury and illness prevalence, incidence, weekly cumulative severity score, weekly time loss from sport and the total burden were calculated.

RESULTS

A total of 368 health problems were reported by 95 athletes. These health problems consisted of 258 injuries and 110 illnesses. The average weekly prevalence of health problems was 48.0 %; for injuries 34.6 %, and illnesses 13.4 %. Differences were found when considering injury severity, with the highest severity scores for athletes with a limb deficiency. Furthermore, recreational athletes reported the highest injury severity scores, followed by athletes who competed nationally and athletes who competed internationally.

CONCLUSIONS

Data from this study show a high average weekly prevalence of health problems, and differences amongst various impairment categories and sport levels when considering the severity of injuries. These results add to the knowledge regarding sport-related health problem epidemiology in this population, indicating that impairment category and sport level should be taken into account when developing injury prevention strategies.

Sports-related dental injuries and oral health status among Malaysian para-athletes: A cross-sectional study

BACKGROUND

Athletes with disabilities may be at an even greater risk of orofacial trauma than their counterparts, and the risk may vary depending on the type of sports. This study aimed to assess the incidence of sports-related dental injuries and oral health status among Malaysian para-athletes.

METHODS

A questionnaire survey was conducted to assess self-reported dental injuries and knowledge of their management. An intraoral examination was performed using the decayed, missing, and filled teeth (DMFT) index following the World Health Organization guidelines.

RESULTS

A total of 61 para-athletes (men = 90.16%, n = 55; women = 9.84%, n = 6) from different sports categories with different disabilities randomly participated in this study. The incidence of self-reported dental injuries was 18.0% (n = 11), with the most common injury being crown tooth fracture (72.7%) and lip laceration (63.6%). However, the majority of the athletes (70.5%, n = 43) did nothing after experiencing dental trauma, and 82.0% (n = 50) were unaware of the immediate management of dental trauma. Based on the intraoral examination, only 9.8% (n = 6) of the athletes had perfectly sound teeth. The mean total DMFT index was 3.49 ± 2.371, while the mean DMFT index for decayed, missing, and filled teeth was 1.28 ± 1.293, 0.74 ± 0.705, and 1.48 ± 1.120, respectively. The mean DMFT index for decayed, missing, and filled teeth and total DMFT index significantly differed among the types of disabilities (P < .05) but not between the sexes (P > .05).

CONCLUSION

The most commonly reported injuries among para-athletes are crown tooth fractures and lip lacerations. The total DMFT index among para-athletes is moderate, emphasising the need for improvements.

Prevalence and incidence of health problems and their characteristics in Brazilian para athletes: A one-season single-center prospective pilot study

BACKGROUND

Para athletes experience high prevalence and incidence of health problems related to sport. Despite this, there are few longitudinal studies.

OBJECTIVE

To describe the characteristics, prevalence, incidence, and severity of health problems in para athletes from one of the Brazilian Paralympic Reference Centers during a sports season and to compare the prevalence of health problems between para athletics, para powerlifting, and para swimming.

METHODS

This prospective pilot study was conducted from October 2019 to March 2020. The Oslo Sports Trauma Research Center Questionnaire on Health Problems was used to record injuries and illnesses every week for 24 weeks. The characteristics, prevalence, incidence, and severity of health problems were described for each modality. The prevalence of health problems was compared among the three sport modalities.

RESULTS

Thirty-five para athletes participated. Most of the injuries occurred in the shoulder, and most illnesses caused respiratory and gastrointestinal symptoms. The average weekly prevalence and the incidence rate of health problems were 40.6% (95% CI 17.0-64.4) and 12.7 (95% CI 9.6-15.9) per 1000 athlete hours, respectively. Para powerlifting had the highest prevalence of all and substantial health problems; para swimming had the lowest prevalence of injuries; and para athletics had the lowest prevalence of illnesses.

CONCLUSIONS

This group of Brazilian para athletes showed a high prevalence and incidence of health problems throughout the season. Para athletics, para powerlifting, and para swimming each had a different prevalence of injuries and illnesses.

Mental health, sleep, and pain in elite Para athletes and the association with injury and illness-A prospective study

INTRODUCTION

The interest in the health of Para athletes continues to increase. Still, there are few studies that have evaluated health parameters beyond injury and illness in this athlete population.

OBJECTIVE

To assess (1) the weekly proportion of elite Para athletes reporting anxiety/depression, low sleep levels (≤7 hours), and pain over 52 weeks; (2) and to explore whether these health parameters are associated with the risk for a sports injury or illness.

DESIGN

A 52-week prospective study, part of the Sports-related Injury and Illness in Paralympic Sport Study (SRIIPSS).

SETTING

A total of 107 Swedish elite Para athletes with physical, visual, and intellectual impairment participated.

MAIN OUTCOME MEASURES

Data on self-reported anxiety/depression, sleep levels, pain, and injuries/illnesses were collected weekly. Comparisons of these parameters preceding an injury/illness were made using Friedman's analysis of variance (ANOVA).

RESULTS

The proportion of athletes reporting weekly anxiety/depression was 34.1%; 60.9% of athletes reported sleeping ≤7 hours and 49.9% reported pain. In exploratory analyses, there were no significant differences between weeks before an injury for any of the variables. There were significant differences in levels of sleep over the weeks, where sleep levels were significantly higher (>10 hours) 4 weeks prior to an illness (p = .016).

CONCLUSION

This cohort of elite Para athletes reported relatively high levels of anxiety/depression, low sleep levels, and pain, which is a concern. High sleep levels and the risk for illness might be an indication of overtraining, which commonly leads to persistent fatigue and an increased susceptibility to infections. Monitoring of the health of elite Para athletes is recommended to be able to improve performance and health in this population.

The Underlying Mechanisms of Sports Injuries in Paralympic Goalball: A Mixed-Method Study

OBJECTIVE

Data from the Paralympic Games indicate a fluctuating injury incidence in the Paralympic sport goalball, but the mechanisms behind have not been explored. The aims of this study are to (1) quantitatively analyze goalball injuries reported in the London 2012 and Rio 2016 Paralympic Games, (2) qualitatively explain the differences between both games, and (3) qualitatively assess general injury mechanisms and prevention opportunities of injuries in Goalball.

DESIGN

This is a mixed-method study. Injury incidence rates were analyzed from data collected during the 2012 and 2016 Paralympic Games. Then, semistructured interviews of games participants qualitatively explored injury mechanisms and prevention opportunities.

RESULTS

A reduction of injuries occurred from 2012 (incidence rate, 19.5; 95% confidence interval, 12.5-26.5) to 2016 (incidence rate: 5.6; 95% confidence interval, 1.7-9.5). In both games, acute traumatic injuries were most common. Female athletes reported higher rate of injuries compared with males ( P = 0.05). Qualitative data revealed that causes of injuries were collisions, overuse, and poor physical conditioning. The differences between the two games were explained by equipment, environment, and preparations.

CONCLUSIONS

The result from this study indicates that injuries in goalball are multifactorial. Ultimately, the mixed-method data from this study can help the sports context develop prevention measures.

Concussion through my eyes: a qualitative study exploring concussion experiences and perceptions of male English blind footballers

OBJECTIVES

Athletes with impairments play sports with a risk of sustaining head injuries and concussions. However, the scientific knowledge needed to improve care is lacking. This qualitative study explores English blind 5-a-side footballers' perceptions of concussion, concussion risks and prevention to improve para concussion care.

METHODS

Nine semi-structured interviews were conducted with male English blind footballers (six current and three retired). Data were analysed by thematic analysis using a six-stage approach.

RESULTS

Blind footballers were not sure about the number of concussions they had sustained. They lacked an understanding of what to experience when concussed, and they perceived the diagnosis and experience of a concussion to be different for a person without vision. Perceived concussion severity and previous concussion experiences were key concepts affecting their concussion reporting behaviours. Participants mentioned spatial orientation and sleep are important to function in daily life and were affected by concussions. However, these factors are not adequately included in current assessment tools or clinical guidance for sports-related concussions.

CONCLUSION

Blind footballers suggested the quality and accuracy of reported concussions were impacted by lack of concussion experience, knowledge and concomitant impairment. A better understanding of concussion symptoms and injury mechanisms will improve concussion reporting for athletes with visual impairments. These athlete insights should guide future studies and para sports governing body initiatives to improve concussion reporting, diagnosis and management in para athletes.

Safe and Healthy Para sport project (SHAPE): a study protocol of a complex intervention within Para sport

Elite Para athletes report a high incidence of sports injuries, illnesses and other health issues. Despite this, there are few prevention programmes in Para sport, and many of the existing prevention programmes are not adapted to Para athletes. To improve the success of preventive measures, it has been suggested that sports safety work should facilitate health promotion, including athlete health education. Therefore, the overarching aim of this project is to evaluate an accessible health promotion web platform as part of a complex intervention that aims to improve knowledge of athlete health in Para sport. In this protocol, the development, future implementation and evaluation of the intervention are described. To inform the implementation and use of such interventions, it is recommended to involve end users in the development and implementation process. Therefore, a participatory design process, including athletes and the sports organisation, was used to develop an accessible health promotion web platform. To evaluate this complex intervention, a process evaluation combining quantitative evaluation assessing causal pathways with qualitative methods assessing multifaceted pathways will be used. The primary outcomes are injury/illness incidence, athlete health parameters, health literacy and user behaviour. A cohort of elite Para athletes (n=150) from Sweden and South Africa will be invited to participate. This project will be the first that aims to improve athlete health in Para sport through pragmatic and accessible health promotion. It is a boundary-crossing project that will be conducted in a real-world sport setting, including athletes with different socioeconomic backgrounds.

Injury and Injury Prevention in United States Para Swimming: A Mixed-Methods Approach

BACKGROUND

Para swimming has experienced increased participation in recent years. Injury and injury prevention research on Para swimmers is lacking compared to swimmers without impairment.

PURPOSE

This study aimed to gather data in Para swimmers on typical injuries, injury prevention programs, and attitudes toward injury and injury prevention in this population.

STUDY DESIGN

Cross-sectional, mixed-methods design evaluating injuries, injury management, and injury prevention in elite Para swimmers in United States (U.S.).

METHODS

Para swimmers on the U.S. Paralympics Swimming National teams at multiple competition levels were invited to complete an online survey. Qualitative interviews with six U.S. Paralympics National team Para swimmers were conducted to provide detail on athlete experiences with injury and prevention.

RESULTS

Twenty-one of 56 surveys were returned: 11 of 21 participants (52.4%) reported experiencing an injury that altered their weekly training. All (21/21) reported participating in strength training and 19 of 21 (90.5%) reported incorporating stretching into their training regimen, although strengthening/stretching regimens included routines that may not have been specifically targeted toward injury prevention. Six of 21 (28.6%) reported participation in an injury prevention program. Qualitative interview themes included the impact of swimmers' compensated body mechanics on injury risk, the value of individualized injury prevention programs, and the importance of knowledgeable coaching and rehabilitation staff.

CONCLUSIONS

Injury prevention programs are important components in Para swimming training although they are underutilized based on responses in this study. These programs should be individualized to address swimming biomechanics and athlete-specific impairments. Increasing coaching knowledge and access to individualized programs may reduce injury prevalence among this at-risk population.

LEVEL OF EVIDENCE

3.

U.S. Paralympic Hopeful's Athletic Identity and How It Has Been Affected by the Sport Disruption of COVID-19

The purpose of this study was to explore the status of Paralympic hopefuls' athletic identity and how this identity was impacted by the training and competition cessation resulting from the COVID-19 pandemic. Researchers conducted in-depth semi-structured interviews that explored the experiences of 29 Paralympic hopefuls who compete in thirteen different Paralympic sports. A thematic analysis yielded two superordinate themes: a) Prominent athletic identity, multiplicity over exclusivity; b) Various Impact on AI: Mental adaptation helps overcome the lack of sport participation. Participants in this study possessed prominent strong athletic identities from the benefits of sport participation. Their prioritized athletic role still remains despite setbacks due to the pandemic. However, athletes identified with multiple roles rather than an exclusive athletic identity during COVID-19. As for the impacts on identity, the severity of challenges are determined by the mindset of the athletes. All of the athletes experienced a decreased amount of time and physical participation in their sport. Paralympians whose sole focus was on the loss of physical participation were impacted the most. Athletes who felt unchallenged did so because of their mental adaptation. Through a positive outlook and mentality, athletes were able to effectively cope and not dwell on the negative aspects brought on by the pandemic. In conclusion, having a strong AI did not necessarily coincide with a negative impact on identity from COVID-19, and those who do not possess a strong AI felt their AI was unchallenged by the pandemic. More importantly, Paralympians' mindset of how they view and interpret their AI is crucial to how the individual's AI is affected by the sport disruption of COVID-19.

The podium illusion: a phenomenological study of the influence of social support on well-being and performance in elite para swimmers

Background

The value of social support in enhancing performance is well established in non-impaired and sub-international level athletes with impairments. Despite this, no research to date has explored the experiences of social support in elite para-athletes. The aim of this study was to explore the experiences of social support in elite British para-swimmers and the influence on their wellbeing and performance.

Methods

A hermeneutic phenomenological study involving semi-structured interviews was undertaken with 8 elite British para-swimmers (3 male, 5 female, mean age 24.9 years). Participants represented 5 para-swimming classes and all 10 of the International Paralympic Committee impairment categories. Data were analysed following a modified version of the Framework Method. Research quality and trustworthiness were ensured through employing techniques including data triangulation, member checking and reflexivity.

Results

Five themes and 11 sub-themes were generated. The five themes were: ‘the coach-athlete relationship’, ‘team bond’, ‘tangible aid’, ‘The Podium Illusion’ and ‘British para-swimming’. The overall findings and the magnitude of support mentioned in the fourth theme led to the development of a new model called ‘The Podium Illusion’ which reflects the magnitude of support that is available to elite para-swimmers to help maximise their performance and wellbeing.

Conclusion

Social support is essential for athlete wellbeing and performance. Findings underpin a new model, ‘The Podium Illusion’.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-021-00269-1.

Para sport translation of the IOC consensus on recording and reporting of data for injury and illness in sport

In 2020, the IOC proposed a universal methodology for the recording and reporting of data for injury and illness in sport. Para sport is played by individuals with impairment, and they have a unique set of considerations not captured by these recommendations. Therefore, the aim of this addendum to IOC consensus statement was to guide the Para sport researcher through the complexities and nuances that should be taken into consideration when collecting, registering, reporting and interpreting data regarding Para athlete health. To develop this translation, experts in the field of Para sports medicine and epidemiology conducted a formal consensus development process, which began in March 2020 with the formation of a consensus group that worked over eight phases, incorporating three virtual consensus meetings to finalise the translation. This translation is consistent with the IOC consensus statement, yet provides more detailed Para athlete specific definitions and recommendations on study population, specifically, diagnostic and eligible impairment categorisation and recording of adaptive equipment, and defining and classifying health problems in the context of Para sport. Additionally, recommendations and Para athlete specific examples are described with regards to injury mechanism, mode of onset, injury and illness classification, duration, capturing and reporting exposure and risk. Finally, methods and considerations are provided to cater to the varied needs of athletes with impairment with respect to data collection tools. This harmonisation will allow the science to develop and facilitate a more accurate understanding of injury and illness patterns for tailoring evidence-informed prevention programmes and enabling better planning of medical services for Para sport events.

Concussion in para sport: the first position statement of the Concussion in Para Sport (CIPS) Group

Concussion is a frequent injury in many sports and is also common in para athletes. However, there is a paucity of concussion research related to para sport, and prior International Concussion in Sport (CIS) consensus papers have not substantively addressed this population. To remedy this and to improve concussion care provided to para athletes, the concussion in para sport (CIPS) multidisciplinary expert group was created. This group analysed and discussed in-depth para athlete-specific issues within the established key clinical domains of the current (2017) consensus statement on CIS. Due to the onset of the COVID-19 pandemic, the group held all meetings by video conferencing. The existing Sport Concussion Assessment Tool 5 (SCAT5) for the immediate on-field and office-based off-field assessment of concussion was evaluated as part of this process, to identify any para athlete-specific concerns. Regular preparticipation and periodic health examinations are essential to determine a baseline reference point for concussion symptoms but pose additional challenges for the interpreting clinician. Further considerations for concussion management for the para athlete are required within the remove, rest, reconsider and refer consensus statement framework. Considering return to sport (RTS), the 2017 CIS consensus statement has limitations when considering the RTS of the para athlete. Case-by-case decision making related to RTS following concussion is imperative for para athletes. Additional challenges exist for the evaluation and management of concussion in para athletes. There is a need for greater understanding of existing knowledge gaps and attitudes towards concussion among athlete medical staff, coaches and para athletes. Future research should investigate the use and performance of common assessment tools in the para athlete population to better guide their clinical application and inform potential modifications. Concussion prevention strategies and sport-specific rule changes, such as in Para Alpine Skiing and Cerebral Palsy Football, also should be carefully considered to reduce the occurrence of concussion in para athletes.

Étude sur la perception des blessures par les athlètes et leurs influences sur la réalisation de mesures de prévention des blessures en athlétisme

Introduction

Mieux comprendre les conséquences psychologiques d’une blessure et l’influence de celle-ci sur les modifications de comportement et la réalisation d’un programme de prévention semble pertinent pour la prise en charge thérapeutique et dans une optique de prévention. Ainsi, l’objectif de cette présente étude a donc été (1) d’analyser la perception des blessures par les athlètes, et (2) d’analyser l’influence de celles-ci sur la réalisation de mesures de prévention.

Méthodes

Nous avons conduit une étude observationnelle quantitative rétrospective nationale de recueil du ressenti des athlètes de compétition licenciés à la Fédération française d’athlétisme vis-à-vis de leurs antécédents de blessures, leur perception de la blessure et les programmes de prévention des blessures, par un questionnaire informatique envoyé aux athlètes au printemps 2020.

Résultats

Au total, 7712 réponses d’athlètes ont été incluses dans cette analyse, incluant 37 % de femmes et 63 % d’hommes, âgés de 37,9 ± 14,8 ans (de 18 à 87 ans), allant de niveau international à départemental, couvrant toutes les disciplines de l’athlétisme. Soixante-dix pour cent des athlètes n’avaient jamais réalisé de programme de prévention des blessures durant leur carrière, alors que 30 % estimaient en avoir suivi un de manière partielle ou totale. Quatre-vingt dix pour cent des athlètes avaient eu au moins une blessure depuis le début de leur pratique. Les sportifs rapportaient qu’une blessure engendrait une tristesse, une frustration, un dégoût et une préoccupation de se refaire mal au même endroit. Ils étaient conscients qu’une mauvaise prise en charge pouvait entraîner une récidive ou une nouvelle blessure. Les athlètes avec antécédent de blessure réalisaient significativement plus un programme de prévention des lésions que ceux ne s’étant jamais blessés. Ceux s’étant déjà blessés croyaient en l’efficacité des programmes de prévention, davantage que ceux sans antécédent de blessure. En revanche, il n’y avait pas de différence de perception de l’intérêt de mesures préventives telles que l’hygiène de vie, l’écoute de son corps, de ses douleurs et de sa fatigue entre les athlètes avec et sans antécédent de blessures.

Conclusion

Une blessure peut entraîner des conséquences psychologiques non négligeables pour l’athlète. Ses répercussions sont importantes à prendre en compte dans la prise en charge globale des lésions.

Lived experiences of social support in Paralympic swimmers: A protocol for a qualitative study

INTRODUCTION

Over the past decade, there has been an increase in awareness of and investment into disability sport as a result of the 'Paralympic Movement'. The provision of personal and professional support to elite athletes is important for the well-being and success of the athlete, with various studies advocating a holistic approach to performance enhancement. However, little is known about social support experiences in elite para-swimming. Swimming is a popular Paralympic sport and the British para swimmers have been very successful in recent years, most recently winning 47 medals at Rio 2016. This study will be the first to explore the lived experiences of British Paralympic swimmers with respect to the personal and professional support available, perceived use of the support network and the influence it has on well-being and performance.

METHODS AND ANALYSIS

A hermeneutic phenomenological study will be undertaken using a subtle-realist paradigmatic view. A purposive sample of British Paralympic swimmers will be recruited to enable exploration of social support experiences. In-depth semistructured interviews will explore participants' experiences of being an elite para-athlete, their support network, the social support available and how they perceive it relates to their well-being and performance. Strategies including reflexivity and member checking will be used to ensure trustworthiness. Data will be analysed following the Framework Method; a seven-stage process used for qualitative data analysis.

ETHICS AND DISSEMINATION

This study has ethical approval (ERN_20-0344) granted by the University of Birmingham in April 2020. The findings of this study will be published in a peer-reviewed journal and disseminated to key stakeholders in elite para-sport to inform support services and improve athlete well-being and performance.

An exploration of the organisational stressors encountered by international disability footballers

Presently, disability athletes remain under-represented in organisational stressor research. Our study sought to bring novel insights to this area by determining the organisational stressors experienced by international disability footballers. Twelve current international disability footballers (10 male, 2 female) from a range of UK impairment squads took part in the study. Semi-structured interviews were completed with each participant, and data were analysed by content analysis procedures. Organisational stressors data were abstracted into Arnold, Wagstaff, Steadman and Pratt's (2017) concepts, and Arnold and Fletcher's (2012) four general dimensions: leadership and personnel issues, cultural and team issues, logistical and environmental issues, and performance and personal issues, revealing a series of football-specific nuances. Our study is the first exploration of the prevalence of organisational stressors within international disability football. Our study also provides practitioners with an understanding of the common and unique organisational stressors faced by international disability footballers. Finally, we suggest a series of practical recommendations for policy development within disability football organisations to aid athletes to effective manage organisational stressors.

Prevalence of Sports-Related Injuries and Illnesses in Paralympic Athletes

BACKGROUND

With increased participation in Paralympic sports, the burden of sports-related injuries and illnesses may increase. However, there is limited knowledge about the epidemiology of sports-related injuries and illnesses in Paralympic sports (SRIIPS).

OBJECTIVE

To describe among Swedish Paralympic athletes the 1-year retrospective period prevalence of severe SRIIPS and the point prevalence of all SRIIPS and to examine differences in prevalence proportions between athletes with different impairments, behaviors, and sport characteristics.

DESIGN

Cross-sectional study.

SETTING

Swedish Paralympic Programme.

PARTICIPANTS

One hundred and four Paralympic athletes with visual, physical, and intellectual impairment.

METHODS

An eHealth application adapted to Paralympic athletes was used to collect self-report data on existing and previous SRIIPS, as well as impairment, behavior, and sport characteristics.

MAIN OUTCOME MEASUREMENTS

One-year retrospective period prevalence and point prevalence.

RESULTS

The period prevalence of severe injuries was 31% (95% CI 23-40) and the point prevalence 32% (95% CI 24-41). The period prevalence of severe illnesses was 14% (95% CI 9-23), and 13% of the athletes (95% CI 8-22) reported a current illness. More severe injuries (P <.05) were reported by athletes aged 18 to 25 years, not using assistive device, having pain during sport, using analgesics, continuing training injured, and feeling guilt when missing exercise. Athletes who reported a previous severe injury, having pain in daily life and during sport, using analgesics, and being upset when unable to exercise had a higher prevalence of current injuries (P <.05). Being female, reporting previous severe illness, using prescribed medication, and feeling anxious/depressed were features associated with ongoing illnesses (P <.05).

CONCLUSION

Paralympic athletes report a high prevalence of SRIIPS. Behavioral and psychological aspects as well as pain and use of medication appear to be associated with the occurrence of SRIIPS. The results imply that factors leading to SRIIPS are complex and call for a broad biopsychosocial approach when developing preventive measures.

LEVEL OF EVIDENCE

III.

Letting the cat out of the bag: athletes, coaches and physiotherapists share their perspectives on injury prevention in elite sports

Objectives

To explore how sports injury prevention takes place in elite sport practice and to describe the perspectives of athletes, coaches and physiotherapists regarding the most critical factors that help prevent injury in the elite sports context.

Methods

Qualitative study. Semistructured interviews with 19 international level athletes, coaches and physiotherapists, from different Olympic sports. Interviews were transcribed verbatim and analysed using comparative data analysis based on Grounded Theory.

Results

The participants perceived injury risk as an inherent part of elite sports, because athletes try to enhance performance by pushing their limits. Participants described injury prevention as a learning process that changed over time, based on their sports experience and the injuries that they had sustained along their career. Communication among the athletes, coaches and physiotherapists was described as a key component of the injury prevention process. Study participants emphasised the relevance of teamwork and shared responsibility. Performance was presented as the core of the athlete’s daily practice, indicating that injury prevention can be a means to that end but is not a goal in itself for this community.

Conclusion

Participants perceive injury prevention as part of elite sports and thus embrace the need for injury prevention. Injury prevention strategies in elite sports were described as a learning process, following the dynamic nature of training for maximal performance. Performance is the participants’ main goal.

Context Matters: Revisiting the First Step of the 'Sequence of Prevention' of Sports Injuries

It is possible to prevent sports injuries. Unfortunately, the demonstrated efficacy and effectiveness of injury prevention approaches are not translated into lasting real-world effects. Contemporary views in sports medicine and injury prevention suggest that sports injuries are ‘complex’ phenomena. If the problem we aim to prevent is complex, then the first step in the ‘sequence of prevention’ that defines the ‘injury problem’ already needs to have considered this. The purpose of this paper is to revisit the first step of the ‘sequence of prevention’, and to explore new perspectives that acknowledge the complexity of the sports injury problem. First, this paper provides a retrospective of the ‘sequence of prevention’, acknowledging contemporary views on sports injuries and their prevention. Thereafter, from the perspective of the socioecological model, we demonstrate the need for taking into account the complex nature of sports injuries in the first step. Finally, we propose an alternative approach to explore and understand injury context through qualitative research methods. A better understanding of the injury problem in context will guide more context-sensitive studies, thus providing a new perspective for sports injury prevention research.

Влияние психофизиологических показателей на результат бега на 200 м у спринтеров высокой квалификации с нарушением зрения на примере элитной спортсменки

Цель работы – выявить влияние психофизиологических факторов на индивидуальную результативность в легкоатлетическом спринте у атлетов высокой квалификации с нарушением зрения на примере элитной спортсменки. Материал и методы. В исследовании приняла участие спортсменка высокой квалификации, специализируется в беге на короткие дистанции и прыжках в длину среди спортсменов с нарушениями зрения чемпионка Европы по лёгкой атлетике 2010 года; призёр чемпионатов мира среди паралимпийцев и Паралимпийских игр среди спортсменов с нарушениями зрения (категория T12) 2016 года. Психофизиологическое тестирование спортсменка проходила близко к экрану. Ход исследования. Были проанализированы индивидуальные особенности психофизиологического состояния и результаты в беге на 200 м в течение пяти месяцев. Результаты в беге на 200 м фиксировались на официальных и неофициальных соревнованиях. Всего проанализировано 36 результатов. Результаты. Составлены модели множественной линейной регрессии между результатами в беге на 200 м у элитной спортсменки с нарушением зрения и психофизиологическими показателями. Выбранная модель множественной регрессии представлена следующими переменными: время простой зрительно-моторно-реакции (мс), общее время выполнения теста с обратной связью при 120 сигналах (с), время выхода на минимальную экспозицию сигнала в тесте с обратной связью при 30 сигналах (с), время выхода на минимальную экспозицию сигнала в тесте с обратной связью при 120 сигналах (с). Выводы. Выявлены компенсаторные механизмы недостаточности зрительной функции для поддержания высокой скорости в беге на 200 м в качестве психофизиологических функций: показатели, характерные для спринтеров (скорость простой реакции и подвижность нервной системы) и специфические показатели (работоспособность, сила нервной системы).

A Descriptive Study of Self-Reported Injury in Non-elite Adaptive Athletes

BACKGROUND

Adaptive sports programs are increasing across the country and there is a paucity of research investigating the epidemiology and sports injury risk factors in non-elite athletes.

OBJECTIVE

To assess the demographics, training regime, and injuries incurred by adaptive athletes participating in local adaptive sports clubs and to assess the athletes' type of medical care and prevalence of those with spasticity.

DESIGN

Descriptive cross-sectional study.

SETTING

Local area adaptive sports teams and programs.

PARTICIPANTS

Sixty-one athletes participating in wheelchair basketball, wheelchair rugby, sled hockey, and adaptive rowing were surveyed, with a response rate of 70.5%.

INTERVENTIONS

Completion of self-report survey.

OUTCOME

Report of injury prevalence, injury characteristics, type of medical care, and assessment of frequency and severity of spasticity using the Penn Spasm Frequency Scale.

RESULTS

Most athletes (86%) trained or competed in their main sport 9-12 months per year. Most athletes (79.1%) trained at least 4 hours per week. In the past 12 months, 39.5% of athletes surveyed sustained an injury that required them to miss practice or a competition, with 58.8% of these athletes having sustained a significant injury. Many of those injured (64.7%) had never participated in an injury prevention or conditioning program. Injury prevalence by sport was 42.9% in wheelchair rugby, 60% in sled hockey, 44% wheelchair basketball, and 0% in adaptive rowing. The most commonly injured body parts were the shoulder (52.9%) and wrist (52.9%).

CONCLUSIONS

This study shows that non-elite adaptive sports athletes sustain similar types of injuries as noted in published reports of elite athletes but could be provided with less injury prevention education and access to medical care. This area will require future study, especially investigating injury risk factors within specific sports and diagnoses.

LEVEL OF EVIDENCE

III.

Management of Pain in Elite Athletes: Identified Gaps in Knowledge and Future Research Directions

OBJECTIVE

For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge.

DATA SOURCES

Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified.

MAIN RESULTS

Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life.

CONCLUSIONS

The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance.

Взаимосвязь психофизиологических показателей и результативности в беге на 100 м у спортсменов высокой квалификации с нарушением зрения (на примере элитной спортсменки)

Цель работы – теоретически и экспериментально обосновать влияние психофизиологических факторов на индивидуальную результативность в легкоатлетическом спринте у атлетов высокой квалификации на примере элитной спортсменки. Материал и методы. Участники. В исследовании приняла участие спортсменка высокой квалификации, специализируется в беге на короткие дистанции и прыжках в длину, чемпионка Европы по лёгкой атлетике 2010 года; призёр чемпионатов мира среди паралимпийцев и Паралимпийских игр среди спортсменов с нарушениями зрения (категория T12) 2016 года. Психофизиологическое тестирование спортсменка проходила в соответствующих оптических линзах. Ход исследования. Были проанализированы индивидуальные особенности психофизиологического состояния и результаты в беге на 100 м в течение пяти месяцев 2015 г.  Составлены модели множественной линейной регрессии между результатами в беге на 100 м и психофизиологическими показателями. Результаты. Разработана теоретическая концепция регуляции скорости бега нервной системой у спортсменов с нарушением зрительной функции. Легкоатлетам с нарушением зрения тяжелее, чем здоровым спортсменам, развить максимальную скорость бега из-за блокировки скорости со стороны центральной нервной системы. Частичное или полное решение данной проблемы лежит в активизации компенсаторных механизмов при недостаточности зрительной функции. При развитии психофизиологических функций, характерных для конкретного человека, развиваются компенсаторные механизмы для уменьшения недостатка зрительного анализатора. Составлены модели множественной линейной регрессии между результатами в беге на 100 м у элитной спортсменки с нарушением зрения и психофизиологическими показателями. Показана высокая значимость психофизиологических показателей в индивидуальной результативности в беге на 100 м. Выводы. Выявлены компенсаторные механизмы недостаточности зрительной функции для поддержания высокой скорости в беге на 100 м в качестве психофизиологических функций: показатели, характерные для спринтеров (скорость простой реакции и подвижность нервной системы) и специфические показатели (работоспособность, сила нервной системы).

Индивидуальная структура психофизиологических функций во взаимосвязи с соревновательной результативностью в паралимпийском спринте на примере атлетки высокой квалификации с нарушением зрения

Цель работы – определить факторную структуру психофизиологических   показателей во взаимосвязи с индивидуальной результативностью в легкоатлетическом спринте у атлетов высокой квалификации с нарушением зрения на примере элитной спортсменки. Материал и методы. В исследовании приняла участие спортсменка высокой квалификации, специализируется в беге на короткие дистанции и прыжках в длину, чемпионка Европы по лёгкой атлетике 2010 года; призёр чемпионатов мира среди паралимпийцев и Паралимпийских игр среди спортсменов с нарушениями зрения (категория T12) 2016 года. Психофизиологическое тестирование спортсменка проходила в соответствующих оптических линзах. Были проанализированы индивидуальные особенности психофизиологического состояния и результаты в беге на короткие дистанции. Результаты в беге фиксировались на тренировках, а также на официальных и неофициальных соревнованиях. Всего проанализировано 36 результатов. За 1 день до старта фиксировались психофизиологические показатели с помощью компьютерной программы «Психодиагностика» и аналогичных программ для психофизиологического тестирования.  Результаты. Выявлено, что у спортсменов с нарушением зрения повышается влияние психофизиологических факторов как компенсаторных механизмов ограниченных зрительных возможностей. Полученные данные свидетельствуют о способности обследуемой спортсменки к длительной работе нервной системы. Это свидетельствует о силе нервной системы спортсменки. Это связано с развитием компенсаторных механизмов недостаточности зрительного анализатора. Данное качество особенно проявляется для дистанций 200 м и 400 м. Выводы. Выявлены компенсаторные механизмы недостаточности зрительной функции для поддержания высокой скорости в беге на короткие дистанции в качестве психофизиологических функций: показатели, характерные для спринтеров (скорость простой реакции и подвижность нервной системы) и специфические показатели (работоспособность, сила нервной системы).

An eHealth Application of Self-Reported Sports-Related Injuries and Illnesses in Paralympic Sport: Pilot Feasibility and Usability Study

Background

Sport participation is associated with a risk of sports-related injuries and illnesses, and Paralympic athletes’ additional medical issues can be a challenge to health care providers and medical staff. However, few prospective studies have assessed sports-related injuries and illnesses in Paralympic sport (SRIIPS) over time. Advances in mobile phone technology and networking systems offer novel opportunities to develop innovative eHealth applications for collection of athletes’ self-reports. Using eHealth applications for collection of self-reported SRIIPS is an unexplored area, and before initiation of full-scale research of SRIIPS, the feasibility and usability of such an approach needs to be ascertained.

Objective

The aim of this study was to perform a 4-week pilot study and (1) evaluate the monitoring feasibility and system usability of a novel eHealth application for self-reported SRIIPS and (2) report preliminary data on SRIIPS.

Methods

An eHealth application for routine collection of data from athletes was developed and adapted to Paralympic athletes. A 4-week pilot study was performed where Paralympic athletes (n=28) were asked to weekly self-report sport exposure, training load, general well-being, pain, sleep, anxiety, and possible SRIIPS. The data collection was followed by a poststudy use assessment survey. Quantitative data related to the system use (eg, completed self-reports, missing responses, and errors) were analyzed using descriptive statistics. The qualitative feasibility and usability data provided by the athletes were condensed and categorized using thematic analysis methods.

Results

The weekly response rate was 95%. The athletes were of the opinion that the eHealth application was usable and feasible but stated that it was not fully adapted to Paralympic athletes and their impairments. For example, it was difficult to understand how a new injury or illness should be identified when the impairment was involved. More survey items related to the impairments were requested, as the athletes perceived that injuries and illnesses often occurred because of the impairment. Options for description of multifactorial incidents including an injury, an illness, and the impairment were also insufficient. Few technical issues were encountered, but athletes with visual impairment reported usability difficulties with the speech synthesizer. An incidence rate of 1.8 injuries and 1.7 illnesses per 100 hours of athlete exposure were recorded. The weekly pain prevalence was 56% and the impairment contributed to 20% of the reported incidents.

Conclusions

The novel eHealth-based application for self-reported SRIIPS developed and tested in this pilot study was generally feasible and usable. With some adaptation to accommodate Paralympic athletes’ prerequisites and improved technical support for athletes with visual impairment, this application can be recommended for use in prospective studies of SRIIPS.

Trial Registration

ClinicalTrials.gov NCT02788500; https://clinicaltrials.gov/ct2/show/NCT02788500 (Archived by WebCite at http://www.webcitation.org/6v56OqTeP)

Developing Mental Toughness: Lessons from Paralympians

Mental toughness (MT) is a key psychological variable related to perseverance and success in performance domains. MT and its development has been explored across a range of contexts and across different sports, but no research to date has examined MT in relation to Paralympic athletes. We sought to understand the lived-experiences of mentally tough Paralympians, aiming to conceptualize MT in a Paralympic context and investigate its development. Ten Paralympic athletes were interviewed using in-depth, semi-structured interviews. The verbatim transcripts of the interviews served as the data for an interpretative phenomenological analysis. Three broad themes and several subthemes emerged in conceptualizing Paralympian MT: characteristics (determination, defiance, pragmatic, optimistic, resilient, self-belief and independence and autonomy), cognitions (normalization, sense of escape, non-acceptance of constraints, influence perception and connection) and cognitive strategies (rational thinking, goal setting, pain management and control). In understanding MT development, two broad themes and several subthemes emerged: formative experiences (challenge, classification, setbacks, critical incident, trauma and recovery, sustained commitment, development of mind-set and perspective during challenge, failure, and acceptance), and support and coping resources (social support and significant others, external shaping, social support, overcoming problems, social comparison and reflective practice). The findings suggest that Paralympians benefited from exposure to highly demanding situations in a supportive environment and this helped develop mentally tough characteristics and behaviors and individualized cognitive coping strategies. Our findings highlight the association between the adaptive development of personal characteristics by overcoming physical and mental setbacks over a sustained time period. Overall, the findings suggest that to develop mentally tough characteristics and behaviors, athletes in general could benefit from exposure to highly demanding situations in a supportive environment.

The Sports-Related Injuries and Illnesses in Paralympic Sport Study (SRIIPSS): a study protocol for a prospective longitudinal study

BACKGROUND

Paralympic sport provides sporting opportunities for athletes with a disability, with the Paralympic Games as the main event. Participation in sport is, however, associated with a significant risk for sustaining injuries and illnesses. Our knowledge of sports-related injuries and illnesses in Paralympic sport is very limited and there are no large-scale epidemiological cohort studies. The purpose here is to present a protocol for a prospective longitudinal study: The Sports-Related Injuries and Illnesses in Paralympic Sport Study (SRIIPSS).

METHODS/DESIGN

An argument-based method for investigation of design problems was used to structure the study protocol. The primary requirement of the protocol is to allow prospective studies over time and include exposure to both training and competition. To reflect the complexity of Paralympic sport with athletes' pre-existing impairments, use of assistive equipment, pain and other and medical issues, it is required that the data collection system is specifically adapted to Paralympic sport. To allow the collection of data, at the same time as there is limited access to coaches and medical personnel, it is advantageous that data can be collected online directly from the athletes. Based on this a self-report athlete monitoring system will be developed, where the athletes can enter data weekly via their mobile phones or lap-tops. Data will be collected from around 100 Swedish Paralympic athletes for approximately 1 year, which will allow us to i) prospectively estimate the annual incidence of sports-related injuries and illnesses and ii) explore risk factors and mechanisms for sustaining sports-related injuries and illnesses based on athlete exposure and training loads.

DISCUSSION

For effective implementation of injury and illness prevention measures, comprehensive epidemiological knowledge is required. This study will be the first prospective longitudinal self-report study of sports-related injuries and illnesses in Paralympic sport over a longer period of time. The results will eventually contribute to the development of evidence-based preventive measures specifically adapted to Paralympic sport in order to provide safe and healthy sport participation. Thereby, the project will be of relevance for Paralympic athletes at all levels and to the Paralympic Movement.

TRIAL REGISTRATION

The study is registered at ClinicalTrials.gov (Identifier: NCT02788500; Registration date: 22 May 2016).