German translation and content validation of the OSTRC Questionnaire on overuse injuries and health problems

Slovenian Translation, Cross-Cultural Adaptation, and Content Validation of the Updated Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2)

Background

The updated Oslo Sports Trauma Research Questionnaire on Health Problems (OSTRC-H2) has been translated into a limited set of languages and lacks full validation of its new measures.

Purpose

To (1) translate, cross-culturally adapt, and evaluate the measurement properties of the OSTRC-H2 for the Slovenian population and (2) investigate the construct validity for the severity score and time lost due to a health problem.

Study Design

Cohort study (diagnosis); Level of evidence, 3.

Methods

The OSTRC-H2 was translated from English to Slovenian (OSTRC-H2-SLO) according to international guidelines. A 15-week study was conducted among 188 elite athletes, with a test-retest performed in the 10th week. Internal consistency, reliability, content validity, feasibility, and potential ceiling effects were investigated. Internal consistency was measured using the Cronbach alpha coefficient, while reliability was measured with the intraclass correlation coefficient (ICC). Construct validity was measured with the Spearman rank correlation coefficient (r S).

Results

There was a 95% response rate and an 18% mean weekly prevalence of health problems. The OSTRC-H2-SLO showed excellent test-retest reliability (ICC, 0.94 [95% CI, 0.67-0.99]), with a Cronbach α of .93. A strong positive correlation was found between the OSTRC-H2-SLO severity score and days lost due to an acute injury (r S = 0.754), overuse injury (r S = 0.785), and illness (r S = 0.894) (P < .001 for all). Moderate to strong negative correlations were observed between severity score and total load (training and competition load in hours) as well as between days lost and total load (P < .001 for all).

Conclusion

The OSTRC-H2-SLO was found to be valid, reliable, and well accepted among Slovenian athletes. The authors confirmed the questionnaire's construct validity and identified total load as an indicator of an increase in the severity score.

Registration

NCT05471297 (ClinicalTrials.gov identifier).

The validity and reliability of a Japanese version of the web-based hamstring outcome score

This study aimed to translate a web-based hamstring outcome score (HaOS) questionnaire to the Japanese context. First, the validity and reliability of the translated questionnaires were examined among Japanese athletes. Second, the association between the previous history of hamstring strain and HaOS was examined. The translation was performed according to internationally recognized methodologies. A total of 233 athletes were asked to complete the HaOS questionnaire, and four questions were added to examine the content validity of the questionnaire. Intraclass correlation coefficient (ICC) was calculated to evaluate the test-retest reliability. Internal consistency was determined by calculating Cronbach's alpha values. The translated questionnaires had high acceptance and compliance rates, with a response rate of 84.4%. The ICC for each scale ranged from 0.80 to 0.93, and Cronbach's α from 0.72 to 0.96, confirming good reliability and high internal consistency. HaOS of the previous injury group (93.4 [78.9, 100]) was significantly lower than that of the healthy group (86.2 [68.1, 100]) (p < 0.05). The translated HaOS questionnaires were valid, reliable, and acceptable for monitoring hamstring conditions in Japanese athletes.

Types, frequencies and burden of health problems in elite luge athletes: a 46-week prospective cohort study

Background

There is a research gap in the survey of injuries and illnesses in the sport of luge.

Objective

To analyse the type, frequency and burden of injuries and illnesses that occurred over a preparation period and a competition period in elite luge athletes.

Methods

In total 40 elite luge athletes, who were all part of a national team and competed internationally, self-reported acute injuries, overuse injuries and illnesses weekly using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems.

Results

The most frequently stated health problems were illnesses with 41.9% (n=75), followed by acute injuries at 31.9% (n=57). Overuse injuries accounted for 24.0% (n=43). Illnesses represented the greatest burden with a median severity score of 60.0 (IQR: 23.63), followed by acute injuries with 42.0 (IQR: 26.83) and overuse injuries with 35.0 (IQR: 23.95). In the case of acute injuries, the anatomical regions most affected were the hand (n=8, 14.0 %), foot (n=8, 14.0 %), head (n=7, 12.3 %) and neck (n=6, 10.5 %). In the case of overuse injuries, the shoulder (n=9, 20.9 %) and lumbar spine (n=7, 16.3 %) were most frequently reported. Strains (n=15, 26.3 %) and contusions (n=14, 24.6 %) were the predominant types of acute injuries. Four concussions were recorded, with none of the athletes taking a break from normal training of more than 3 days. This stands in contrast to the current recommendations for the return to sport after concussion.

Conclusion

The results of this study represent the current incidence rates and health burden of acute and chronic injuries in this constantly evolving sport. 95% of all athletes reported at least one health problem during the observation period. These findings support the need for specific prevention programmes. The establishment of a concussion protocol should be considered.

Malay Translation and Validation of the Oslo Sports Trauma Research Center Questionnaire on Health Problems

Background

The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H) is a proven surveillance method to register acute injury, overuse injury, or illness in athletes. However, it has not yet been translated into Malay.

Purpose

To translate, culturally adapt, and validate the OSTRC-H into Malay using internationally established guidelines.

Study Design

Cohort study (diagnosis); Level of evidence, 3.

Methods

The Malay translation of the OSTRC-H (OSTRC-H.M) was distributed to 54 elite (ie, professional) and recreational athletes. Face validity, content validity, and construct validity were assessed for the validity measurement properties, while test-retest and internal consistency were used for reliability measurement properties.

Results

The content validity index was satisfactory at 0.93. The OSTRC-H.M showed good internal consistency, with a Cronbach α value of .84. Confirmatory factor analysis showed a good model for construct validity, with values of 0.99 and 0.04 for comparative fit index and root mean square error of approximation, respectively. Per-item intraclass correlation coefficients (ICCs) for test-retest reliability ranged from 0.55 to 0.80. The overall test-retest reliability of the questionnaire was good (ICC, 0.8; 95% CI, 0.63-0.88; P < .001).

Conclusion

The OSTRC-H.M was found to be valid and reliable and therefore acceptable for application among Malay-speaking athletes.

Health problems occurring in national-level female soccer players are different between leagues and throughout the season: a 6-month prospective cohort study

Objectives

This study investigated the prevalence and severity of health problems in national-level female soccer players with respect to league and seasonality.

Methods

In a prospective cohort study, 46 female soccer players aged 22.8±3.9 years playing in the three highest leagues in Switzerland were surveyed biweekly using the Oslo Sports Trauma Research Centre health problem (OSTRC-H) questionnaire. All definitions and measures followed the OSTRC-H-specific recommendations. The 6-month observation period included parts of the off-season and one half of the match season.

Results

The average 2-weekly health problem prevalence was 37.3% (illnesses: 8.8%; sudden onset injuries-both acute and repetitive mechanisms: 19.7%; repetitive gradual onset injuries: 12.4%) and 25.1% for substantial problems as defined in the OSTRC-H context (7.3%; 12.0% and 7.3%, respectively). The absolute injury rates amounted to 148 injuries per 100 players per half season, of which 96 injuries per 100 players per half season were substantial. Female players in the 2nd and 3rd highest national leagues showed more gradual onset injuries (p<0.001) and fewer illnesses than those in the top league (p<0.05). At the same time, there were no league-specific differences in sudden onset injuries. Such injuries had a higher cumulative severity score than gradual onset injuries. Among sudden onset injuries, the ankle was the most affected body part, while the thigh was affected by for gradual onset injuries. The average 2-weekly health problem prevalence values steadily increased during the match season.

Conclusion

Among national-level female soccer players, the risk of health problems is relatively high and differs between leagues and across seasons.

Epidemiology of injuries and illnesses in elite wheelchair basketball players over a whole season - a prospective cohort study

BACKGROUND

Wheelchair basketball is an adaptation of pedestrian basketball and one of the most popular Paralympic sports worldwide. The epidemiology of health problems in wheelchair basketball has been prospectively studied only during the Paralympic Games, the 2018 World Championships, the 2021 South America Wheelchair Basketball Championship, and one season of two American intercollegiate wheelchair basketball teams. The objective of the study was to prospectively monitor and analyze the prevalence, incidence, burden, and characteristics of injuries and illnesses in a wheelchair basketball league during an entire season for the first time.

METHODS

All players of the highest German wheelchair basketball league (Bundesliga) were invited to participate in the study. Included players completed the Oslo Sports Trauma Research Center Questionnaire once a week during the entire season 2020/21 to report health problems. Exposure was captured by self-reported training time and officially-recorded competition time.

RESULTS

Sixty of 117 players (51%, 47 male, 13 female) of the national league participated with an average response of 93%. Seventy health problems (5.5/1000 exposure hours [95% CI: 4.9-6.1]) were reported, including 54 injuries and 16 illnesses. Prevalence of health problems was 60% (95% CI: 48-72). Most injuries affected the shoulder (32% of all injuries), cervical spine/neck (17%), and hand (13%). More overuse injuries (2.9/1000 exposure hours [95% CI: 2.5-3.3]) than acute injuries (1.3/1000 exposure hours [95% CI: 1.0-1.6]) occurred. Of all health problems, 53% were associated with time-loss. The incidences of all health problems, illnesses, injuries, and overuse injuries were higher in women than in men.

CONCLUSIONS

Characteristics and frequency of injuries and illnesses during wheelchair basketball season differed from those during major wheelchair basketball tournaments. The high proportion of overuse injuries and the higher injury rates in women should be regarded in the development of individualized prevention measures. Since results from previous studies during major tournaments are only partially comparable to wheelchair basketball league play, further studies should follow.

The feasibility of a randomized controlled crossover trial to assess the effect of probiotic and prebiotic supplementation on the health of elite wheelchair athletes

BACKGROUND

Gastrointestinal (GI) problems represent a health burden in Para athletes and can ultimately reduce athletic performance. This study aimed to evaluate the feasibility of a randomized controlled crossover trial (RCCT) assessing the effects of probiotic and prebiotic supplementation on the health of Swiss elite wheelchair athletes.

METHODS

The RCCT was conducted between March 2021 and October 2021. Athletes were randomized to receive either a daily probiotic (3 g of probiotic preparation, including eight bacterial strains), or a daily prebiotic (5 g of oat bran) supplementation first. After the first supplementation phase (4 weeks), a washout period (4 weeks) and the second crossover supplementation phase (4 weeks) followed. Data were collected at four study visits (every 4 weeks) and included 3-day training and nutrition diaries, the Gastrointestinal Quality of Life Index (GIQLI) questionnaire, stool samples, and fasting blood samples. The study assessed the feasibility criteria such as recruitment rate, retention rate, success of data collection, adherence to the protocol, willingness to participate, and safety.

RESULTS

This pilot study met the majority of the predefined minimum requirements for the feasibility criteria. Out of 43 invited elite wheelchair athletes, 14 (33%) consented (mean (standard deviation) age: 34 (9) years, eight females, 11 with a spinal cord injury). The desired sample size was not reached, but the achieved recruitment rate was modest, especially considering the population studied. All participating athletes completed the study. With the exception of one missing stool sample and two missing diaries, data were successfully collected for all athletes at all four visits. Most athletes adhered to the daily intake protocol for at least 80% of the days, both for probiotics (n = 12, 86%) and prebiotics (n = 11, 79%). Ten (71%) athletes would be willing to participate in a similar study again. No serious adverse events occurred.

CONCLUSION

Despite the limited number of elite wheelchair athletes in Switzerland and the modest recruitment rate, the implementation of a RCCT in elite wheelchair athletes is feasible. The data collected in this study provide essential information for the design of the subsequent study which will include a larger cohort of physically active wheelchair users.

TRIAL REGISTRATION

Swiss Ethics Committee for Northwest/Central Switzerland (EKNZ), 2020-02337).

CLINICALTRIALS

gov, NCT04659408.

French Translation and Validation of the OSTRC-H2 Questionnaire on Overuse Injuries and Health Problems in Elite Athletes

Background

To evaluate the burden of overuse injuries, the Oslo Sports Trauma Research Centre (OSTRC) questionnaire on health problems (OSTRC-H2) was developed in English in 2013.

Purpose

To translate and culturally adapt the OSTRC-H2 into French and investigate the reliability and validity of this new version.

Study Design

Cohort study (diagnosis); Level of evidence, 3.

Methods

The OSTRC-H2 was translated from English to French according to international guidelines. A total of 80 elite athletes were then invited to complete the OSTRC-H2 weekly for 3 months. Potential ceiling effects, construct validity, and reliability were investigated. Convergent validity was measured using Pearson correlations for continuous items and kappa coefficients for binary items; internal consistency was measured using the Cronbach alpha coefficient; and test-retest reliability was measured using the intraclass correlation coefficient (ICC). Separate analyses were performed on the entire cohort of athletes (population 1 [P1]) and on athletes who reported a health problem during the follow-up (P2).

Results

A total of 80 elite athletes took part in this study. The response rate was very high, with 909 of 960 questionnaires returned (95%). The mean weekly prevalence of health problems was 19.6% during the follow-up period. Nineteen participants reported a health problem during the follow-up (P2). The OSTRC-H2 showed very good test-retest reliability for both populations (ICC, 0.85 [95% CI, 0.77-0.90] for P1; ICC, 0.90 [95% CI, 0.68-0.98] for P2). Internal consistency was very good for P2 (Cronbach α = .94). The OSTRC-H2 demonstrated high concordance with the visual analog scale of symptom intensity (r = 0.52; P < .05), and low concordance with the overtraining questions from the Questionnaire de la Société Française de Médecine du Sport (κ from -0.01 to 0.12; P > .05).

Conclusion

The French version of the OSTRC-H2 was found to be valid and reliable when applied to French-speaking elite athletes.

Spanish Cross-Cultural Adaptation and Validation of the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire in Handball Players

OBJECTIVES

The aim of this study was the cultural adaptation, Spanish translation and validation of the Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire in an adult population.

DESIGN

In this study, a cross-sectional design was used.

METHODS

This study was divided into two phases: (1) cross-cultural adaptation of the original version of the OSTRC to a Spanish version (OSTRC-Sp) and (2) analysis of the psychometric properties of the OSTRC-Sp. A total of 427 handball players of both sexes and over 18 years of age participated in the study.

RESULTS

The translated version of the questionnaire showed a very high internal consistency (Cronbach's α = 0.954), while the subscales showed an internal consistency between 0.832 and 0.961, with the endmost values being for shoulder and low back pain, respectively. On the other hand, when analysing item responses, the OSTRC-Sp showed ICC values ranging from 0.844 to 0.956, the former being for the first back question (back_1), and the latter for the fourth shoulder question (shoulder_4), in line with most published versions.

CONCLUSION

The Spanish version of the OSTRC is a reliable and valid tool that can be used by researchers and clinicians in a Spanish-speaking population with musculoskeletal disorders.

Training load, sports performance, physical and mental health during the COVID-19 pandemic: A prospective cohort of Swiss elite athletes

BACKGROUND

The COVID-19 pandemic and associated restrictions have led to abrupt changes in the lives of elite athletes.

OBJECTIVES

The objective of this prospective cohort study was to examine training load, subjective sports performance, physical and mental health among Swiss elite athletes during a 6-month follow-up period starting with the first Swiss lockdown.

METHODS

Swiss elite athletes (n = 203) participated in a repeated online survey evaluating health, training, and performance related metrics. After the first assessment during the first lockdown between April and May 2020, there were monthly follow-ups over 6 months.

RESULTS

Out of 203 athletes completing the first survey during the first lockdown, 73 athletes (36%) completed all assessments during the entire 6-month follow-up period. Sports performance and training load decreased during the first lockdown and increased again at the beginning of the second lockdown in October 2020, while symptoms of depression and financial fears showed only a transient increase during the first lockdown. Self-reported injuries and illnesses did not change significantly at any timepoint in the study. Stricter COVID-19 restrictions, as measured by the Government Stringency Index (GSI), were associated with reduced subjective sports performance, as well as lower training intensity, increased financial fears, poorer coping with restrictions, and more depressive symptoms, as measured by the 9-item module of the Patient Health Questionnaire-9 (PHQ-9).

CONCLUSION

This study revealed a negative impact of the COVID-19 restrictions on sports performance, training load and mental health among Swiss elite athletes, while the rate of self-reported injuries and illnesses remained unaffected.

Influence of Surveillance Methods in the Detection of Sports Injuries and Illnesses

Background

Epidemiological data on sports injuries and illnesses depend on the surveillance methodology and the definition of the health problems. The effect of different surveillance methods on the data collection has been investigated for overuse injuries, but not for other health problems such as traumatic injuries and illnesses.

Purpose

The purpose of this study was to investigate the new surveillance method developed by the Oslo Sports Trauma Research Center (OSTRC), which is based on any complaint definition (new method), to identify health problems compared with the traditional surveillance method, which is based on time loss definition.

Study design

Descriptive epidemiology study.

Methods

A total of 62 Japanese athletes were prospectively followed-up for 18 weeks to assess differences in health problems identified by both new and traditional methods. Every week, the athletes completed the Japanese version of the OSTRC questionnaire (OSTRC-H2.​JP), whereas the teams' athletic trainers registered health problems with a time loss definition. The numbers of health problems identified via each surveillance method were calculated and compared with each other to assess any differences between their results.

Results

The average weekly response rate to the OSTRC-H2.​JP was 82.1% (95% CI, 79.8-84.3). This new method recorded 3.1 times more health problems (3.1 times more injuries and 2.8 times more illnesses) than the traditional method. The difference between both surveillance methods' counts was greater for overuse injuries (5.3 times) than for traumatic injuries (2.5 times).

Conclusions

This study found that the new method captured more than three times as many health problems as the traditional method. In particular, the difference between both methods' counts was greater for overuse injuries than for traumatic injuries.

Level of evidence

2b.

The feasibility of a crossover, randomized controlled trial design to assess the effect of probiotics and prebiotics on health of elite Swiss para-athletes: a study protocol

BACKGROUND

Spinal cord injury (SCI) may cause an autonomic imbalance in the gastrointestinal tract, leading to deficits in colonic motility, mucosal secretions, vascular tone, and an increase of intestinal barrier permeability. Autonomic denervation and factors such as age, physical activity, antibiotic use and stress may cause intestinal bacterial translocation, decreased microbiota diversity, known as gut dysbiosis and thus increase susceptibility to experiencing gastrointestinal discomfort. Probiotic treatment in individuals with SCI may normalize the gut microbiota and improve overall health. We aim to assess the feasibility of probiotic and prebiotic intervention in athletes with SCI and collect information necessary for sample size calculation of a definite trial on improving health outcomes in para-athletes.

METHODS AND ANALYSIS

Elite Swiss para-athletes (aged> 18 years), being shortlisted for the Paralympic Games 2021 in Tokyo or a member of a national team (n = 43), will be invited to participate in this single-center randomized crossover trial. Athletes suffering from chronic inflammatory bowel diseases, those currently taking antibiotics or other medication to alleviate gastro-intestinal complaints will not be eligible to be included in the study. Athletes will be randomized (1:1) to receive for 4 weeks a daily dose of either 3 g of probiotic preparation or 5 g of prebiotic (organic oat bran) supplementation in addition to usual diet, followed by a 4-week washout period or vice versa. The primary outcome is the feasibility of the study, measured by recruitment and dropout rates, feasibility of the measurements, acceptability and adherence to the intervention. Secondary outcomes include gastrointestinal health assessment, diet and training information, handgrip strength, blood diagnostic parameters, and intestinal microbiome characterization. The changes in clinically relevant secondary outcome values will be used to make a power calculation for definite trial.

DISCUSSION

This pilot trial will address two common challenges in SCI research: the difficulty to recruit enough participants for a sufficiently powered study and the ability to collect data within the limits of a realistic budget and time frame. Upon demonstrated feasibility of the intervention and study procedures, the intervention will be evaluated in a definitive controlled trial comprising a larger sample of para-athletes (elite, engaged, or recreationally active) individuals with a SCI.

TRIAL REGISTRATION

NCT04659408.

A machine learning approach to identify risk factors for running-related injuries: study protocol for a prospective longitudinal cohort trial

BACKGROUND

Running is a very popular sport among both recreational and competitive athletes. However, participating in running is associated with a comparably high risk of sustaining an exercise-related injury. Due to the often multifactorial and individual reasons for running injuries, a shift in thinking is required to account for the dynamic process of the various risk factors. Therefore, a machine learning approach will be used to comprehensively analyze biomechanical, biological, and loading parameters in order to identify risk factors and to detect risk patterns in runners.

METHODS

The prospective longitudinal cohort study will include competitive adult athletes, running at least 20 km per week and being free of injuries three months before the start of the study. At baseline and the end of the study period, subjective questionnaires (demographics, injury history, sports participation, menstruation, medication, psychology), biomechanical measures (e.g., stride length, cadence, kinematics, kinetics, tibial shock, and tibial acceleration) and a medical examination (BMI, laboratory: blood count, creatinine, calcium, phosphate, parathyroid hormone, vitamin D, osteocalcin, bone-specific alkaline phosphatase, DPD cross-links) will be performed. During the study period (one season), continuous data collection will be performed for biomechanical parameters, injuries, internal and external load. Statistical analysis of the data is performed using machine learning (ML) methods. For this purpose, the correlation of the collected data to possible injuries is automatically learned by an ML model and from this, a ranking of the risk factors can be determined with the help of sensitivity analysis methods.

DISCUSSION

To achieve a comprehensive risk reduction of injuries in runners, a multifactorial and individual approach and analysis is necessary. Recently, the use of ML processes for the analysis of risk factors in sports was discussed and positive results have been published. This study will be the first prospective longitudinal cohort study in runners to investigate the association of biomechanical, bone health, and loading parameters as well as injuries via ML models. The results may help to predict the risk of sustaining an injury and give way for new analysis methods that may also be transferred to other sports.

TRIAL REGISTRATION

DRKS00026904 (German Clinical Trial Register DKRS), date of registration 18.10.2021.

Multicomponent stretching and rubber band strengthening exercises do not reduce overuse shoulder injuries: a cluster randomised controlled trial with 579 handball athletes

Objectives

Handball is associated with a high risk of overuse shoulder injury. This study investigated if an injury prevention programme effectively reduces overuse injury to the throwing shoulder of handball athletes.

Methods

61 men’s and women’s handball teams (u-19 and senior athletes) were cluster-randomised into an intervention and a control group in the 2019–2020 season. Players of the intervention group regularly carried out an injury prevention programme. Both groups documented overuse shoulder injuries via an online questionnaire every second week. The primary endpoint was the prevalence of overuse injury to the throwing shoulder. Secondary endpoints were the influence of compliance on the primary endpoint and intensity of overuse shoulder symptoms measured by a shortened, handball-specific Western Ontario Shoulder Index (WOSI).

Results

31 teams (295 players) in the intervention group and 30 teams (284 players) in the control group were included for analyses. The overall questionnaire response rate was 61%. The average prevalence of overuse shoulder injury did not significantly differ between the intervention group (n=109, 38.4% (95% CI 32.9% to 44.2%)) and the control group (n=106, 35.9% (95% CI 30.7% to 41.6%), p=0.542). Compliance with the intervention programme did not significantly affect overuse shoulder injury (p=0.893). Using generalised estimating equations for WOSI, the estimated mean for the intervention group was 44.6 points (95% CI 42.0 to 47.1) and 47.6 points for the control group (95% CI 44.9 to 50.3, p=0.111).

Conclusions

A multicomponent exercise programme using rubber bands and stretching did not significantly reduce the prevalence or symptoms of overuse throwing shoulder injury in handball athletes of both sexes. Randomised controlled study; level of evidence I.

Trial registration number

ISRCTN99023492.

Methodological implications of adapting and applying a web-based questionnaire on health problems to adolescent football players

BACKGROUND

The Oslo Sport Trauma Research Centre Questionnaire on Health Problems (OSTRC-H) has become a popular tool to monitor health status in athletes. Originally developed for adult athletes, the tool is today also being used in adolescent athletes. However, little is known on the suitability of the questionnaire for the adolescent age group and the methodological implications of applying the tool to prospectively monitor illness and injury. To address this gap in methodological knowledge, the aim of this study is to outline and discuss the adaption and application process of the OSTRC-H to adolescent football players.

METHOD

The adaption process included a slightly modified back-translation method to translate the questionnaire. The application process included a web-based version of the Swedish OSTRC-H sent out once a week over 23 weeks to 115 adolescent football players aged 10-19 attending two football schools in Sweden. The response rate and prevalence of health problems over 23 weeks were calculated as feasibility indicators. Additionally, comprehensibility questions were added to the questionnaire in the end of the study.

RESULT

No major disagreement was found between the original and translated versions of the questionnaire. However, significant changes to the wording of the questions and answer categories were necessary to adapt it to adolescents. A visual body figure was also added. The average weekly response rate was 38% (SD 13.5). To increase this rate, questionnaire data was gathered retrospectively through telephone and email contact with the participants and their parents, elevating the response rate to 53% (SD 15.5). The adolescents experienced the questionnaire as easy to understand and to cover all relevant health problems.

CONCLUSION

Our study demonstrates the importance of adapting the questionnaire to the adolescent target group through translation, pre-tests, adjustments of wording and the facilitation of answering the questionnaire using a visual body figure. The study further shows the importance of keeping close and personal contact with the participants, their parents, teachers, and coaches throughout data collection. Future studies should take into account the age group and study context when adapting and applying the OSTRC-H to adolescents.

Prevalence and Risk Factors of Psychiatric Symptoms among Swiss Elite Athletes during the First Lockdown of the COVID-19 Pandemic

The COVID-19 pandemic and the associated first lockdown measures may have had a relevant impact on the mental health of competitive athletes. This study aimed to evaluate the prevalence of various mental health issues in a Swiss elite athletes' cohort during the first lockdown of the pandemic, and to assess their association with different potential risk factors. Elite athletes from different disciplines were interviewed during the first lockdown in spring 2020 by means of an online questionnaire on symptoms of existing anxieties, depression and sleep disorders, as well as on training circumstances and physical performance before and during the lockdown. Additionally, the economic situation, secondary occupations and current physical health problems were surveyed. A total of 203 (92 female, 111 male) athletes met the inclusion criteria and participated in the survey. Training volume and intensity decreased significantly during lockdown from 3.1 to 2.7 h/day. Financial existential fears increased and were associated with higher training volumes and higher trait anxiety scores. Depressive symptoms and insomnia were present but not exceptionally frequent during the lockdown. Depressive symptoms were associated with higher anxiety scores, higher insomnia severity scores, lower training intensity and worse coping with the measures taken by the authorities against the pandemic. Changes in training and daily habits due to the first lockdown may have affected the mental health of elite athletes. Longitudinal studies should, however, further investigate the long-term effects of the pandemic on mental health.

Running-related injury: How long does it take? Feasibility, preliminary evaluation, and German translation of the University of Wisconsin running and recovery index

OBJECTIVE

The University of Wisconsin Running Injury and Recovery Index (UWRI) was developed as an evaluative patient-reported outcome measure of perceived running ability and recovery after running-related injuries. To date, the questionnaire was not translated into German language and studies on its clinical feasibility and validity are sparse.

DESIGN

Prospective cohort study.

SETTING

Outpatient sports medicine clinic.

PARTICIPANTS

The UWRI questionnaire was translated to German language using a state-of-the art back-translation method including three translators and two back-translators. Clinical feasibility and validation were assessed in 14 injured runners.

MAIN OUTCOME MEASURES

UWRI total score, running volume.

RESULTS

The translation process was completed without major discrepancies. Feasibility and preliminary evaluation were demonstrated in a cohort of 14 injured runners. The UWRI total score significantly improved throughout 12 weeks of recovering from running-related injuries (p < 0.001). Relative running volume significantly correlated with UWRI score (p < 0.001).

CONCLUSION

The University of Wisconsin Running Injury and Recovery Index was successfully translated into the German language. Its usage may hold promise for better rehabilitation surveillance following running-related injuries.

Psychological Factors Change During the Rehabilitation of an Achilles Tendon Rupture: A Multicenter Prospective Cohort Study

OBJECTIVE

The authors sought to gain insight into the changes in psychological factors during rehabilitation after Achilles tendon rupture (ATR) and to explore the association between psychological factors during rehabilitation and functional outcome 12 months after ATR.

METHODS

Fifty patients clinically diagnosed with ATR were invited to visit the hospital 3, 6, and 12 months after injury for data collection. They completed questionnaires assessing psychological factors: psychological readiness to return to sport (Injury Psychological Readiness to Return to Sport Questionnaire); kinesiophobia (Tampa Scale for Kinesiophobia); expectations, motivation, and outcome measures related to symptoms and physical activity (Achilles Tendon Total Rupture Score); and sports participation and performance (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire). To determine whether psychological factors changed over time, generalized estimating equation analyses were performed. Multivariate regression analyses were used to study the association between psychological factors at 3, 6, and 12 months and outcome measures at 12 months after ATR.

RESULTS

Psychological readiness to return to sport improved, and kinesiophobia decreased significantly during rehabilitation. Psychological readiness at 6 and 12 months showed significant associations with sports participation and performance. Kinesiophobia at 6 months was significantly associated with symptoms and physical activity. Motivation remained high during rehabilitation and was highly associated with symptoms and physical activity, sports participation, and performance.

CONCLUSION

Psychological factors change during rehabilitation after ATR. Patients with lower motivation levels during rehabilitation, low psychological readiness to return to sports, and/or high levels of kinesiophobia at 6 months after ATR need to be identified.

IMPACT

According to these results, psychological factors can affect the rehabilitation of patients with ATR. Physical therapists can play an important role in recognizing patients with low motivation levels and low psychological readiness for return to sport and patients with high levels of kinesiophobia at 6 months post-ATR. Physical therapist interventions to enhance motivation and psychological readiness to return to sport and to reduce kinesiophobia need to be developed and studied in the post-ATR population.

LAY SUMMARY

With Achilles tendon rupture, level of motivation, psychological readiness for return to sport, and fear of movement can affect rehabilitation outcome. A physical therapist can help recognize these factors.

Brazilian version of the OSTRC Questionnaire on health problems (OSTRC-BR): translation, cross-cultural adaptation and measurement properties

BACKGROUND

The Oslo Sports Trauma Research Center - Questionnaire on Health Problems (OSTRC-QHP) has been shown to be a valid and reliable questionnaire for monitoring athletes with acute, overuse, and illness problems.

OBJECTIVES

To translate and cross-culturally adapt the OSTRC-QHP into Brazilian-Portuguese (OSTRC-BR), and investigate the measurement properties of this version.

METHODS

The original (Norwegian) questionnaire was translated and culturally adapted following existing guidelines. Measurement properties of the OSTRC-BR were investigated in 134 athletes followed for 13 weeks. Reliability was analyzed via internal consistency and test-retest reliability. Responsiveness was assessed by effect size (ES) estimations, correlation of the OSTRC-BR severity score with the Global Perceived Effect scale (GPE) and the Numeric Pain Rating Scale (NPRS), and by the Receiver Operating Characteristic (ROC) Curve test based on the area under the curve (AUC).

RESULTS

The OSTRC-QHP has been translated and cross-culturally adapted successfully. The Cronbach's alpha was 0.93 (95% CI: 0.92, 0.94). Intrarater reliability (ICC_2,1) of 0.96 (95% CI: 0.94, 0.98) was classified as excellent. ES estimation showed large effects (1.14 to 1.39). OSTRC-BR correlation was moderate (0.58 to 0.72) with the GPE and substantial (0.84 to 0.89) with the NPRS. The AUC values were above 0.70 when analysing all types of health problems.

CONCLUSIONS

The OSTRC-BR presented adequate measurement properties. The OSTRC-BR is a valid, reliable, responsive, and, therefore, an adequate tool for monitoring Brazilian athletes from different sports during training and competitions.

Psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy: a cross-sectional study

OBJECTIVE

to examine psychological factors during rehabilitation of patients with Achilles or patellar tendinopathy as well as the association between psychological factors and tendinopathy severity, sport participation, and satisfaction with activity level and tendon function.

DESIGN

cross-sectional study.

SETTING

online survey platform.

PARTICIPANTS

119 patients (mean age: 44 years (SD 14)) diagnosed with Achilles or patellar tendinopathy.

MAIN OUTCOME MEASURES

A range of patient-reported psychological and outcome measures were recorded. Multivariate regression analyses were performed to establish the association between each psychological factor and outcome measures, adjusted for relevant confounders.

RESULTS

Psychological readiness and confidence to return to sports (I-PRRS) and pain catastrophizing (PCS) were significantly associated with tendinopathy severity (modified VISA), sport participation(OSTRC-O), and satisfaction. Kinesiophobia (TSK) and the importance to patients of returning to pre-injury activity level were significantly associated with sports participation and satisfaction.

CONCLUSION

The current study provides evidence of impairments in psychological factors during rehabilitation of patients with Achilles and patellar tendinopathy. Most investigated psychological factors were associated with tendinopathy severity, function, participation, and satisfaction. Physical therapists should recognize patients with lack of psychological readiness to return to sports and also patients with kinesiophobia or catastrophizing thoughts when experiencing pain.

Prevalence and Burden of Physical Problems in Female College Basketball Athletes: A 135-Day Prospective Cohort Study

Introduction

The purpose of this prospective cohort study was to investigate the prevalence and burden of “any physical complaint” in college female basketball athletes using a daily questionnaire.

Methods

Fifty-four female college basketball players were recruited and followed up for 135 days using the Oslo Sports Trauma Research Centre questionnaire.

Results

The questionnaire response rate was 96.4% (95% confidence interval: 95.7–97.1). The average daily prevalence of any problem was 44.4%, whereas that of substantial problems was 16.0%. The anatomical areas found to be most frequently affected by physical problems were the ankle (average daily prevalence: 14.5%, 95% confidence interval: 13.4–15.7), lower back (14.4%, 95% confidence interval: 13.7–15.2), and knee (9.6%, 95% confidence interval: 9.0–10.2). The cumulative severity score, calculated by summing severity scores and dividing by number of respondents, showed that ankle, knee, and lower back problems exhibited greater relative burden.

Discussion

Injuries common in basketball athletes, such as ankle sprain, anterior cruciate ligament injury, overuse knee pain, and low-back pain, are reflected in the present data.

An update of the Japanese Oslo Sports Trauma Research Center questionnaires on overuse injuries and health problems

Monitoring the health of athletes is important for their protection, and questionnaires such as those produced by the Oslo Sports Trauma Research Center (OSTRC) are a valuable tool in this process. In 2020, several changes were made to the OSTRC questionnaires (OSTRC-O, OSTRC-H), including changes to the wording, structure, and logic of the original questionnaires. In the present study, the Japanese versions of the OSTRC questionnaires (OSTRC-O.JP, OSTRC-H.JP) were revised to meet the requirements of the updated versions and to analyse new and previously collected data to illustrate the impact of the changes on Japanese athletes. Proposed changes were categorized as minor or more substantial; minor changes were effected to the questionnaire instructions and to the wording of all four questions, and more substantial changes were made to the wording of question 2. The updated questionnaires also included changes to questionnaire logic and answer categories. To assess the consequences of the changes to the wording of question 2, 101 athletes were asked to complete the OSTRC-H.JP, which included both the original and updated versions of question 2, over 10 consecutive weeks. We calculated the number of health problems identified when new gatekeeper logic was and was not applied, using 1585 OSTRC-H.JP responses to assess the consequences of the changes to the questionnaire logic. The kappa coefficient, which measures the level of agreement between the responses to question 2 of the original and updated versions, was high. By applying gatekeeper logic, there was a remarkable reduction in the number of injuries and illnesses among all health problems but less reduction in substantial health problems and time loss health problems. These changes will make it easier for Japanese athletes to complete the questionnaires and improve the quality of collected data.

Personalized machine learning approach to injury monitoring in elite volleyball players

ABSTRACTWe implemented a machine learning approach to investigate individual indicators of training load and wellness that may predict the emergence or development of overuse injuries in professional volleyball. In this retrospective study, we collected data of 14 elite volleyball players (mean ± SD age: 27 ± 3 years, weight: 90.5 ± 6.3 kg, height: 1.97 ± 0.07 m) during 24 weeks of the 2018 international season. Physical load was tracked by manually logging the performed physical activities and by capturing the jump load using wearable devices. On a daily basis, the athletes answered questions about their wellness, and overuse complaints were monitored via the Oslo Sports Trauma Research Center (OSTRC) questionnaire. Based on training load and wellness indicators, we identified subgroups of days with increased injury risk for each volleyball player using the machine learning technique Subgroup Discovery. For most players and facets of overuse injuries (such as reduced sports participation), we have identified personalized training load and wellness variables that are significantly related to overuse issues. We demonstrate that the emergence and development of overuse injuries can be better understood using daily monitoring, taking into account interactions between training load and wellness indicators, and by applying a personalized approach.Highlights With detailed, athlete-specific monitoring of overuse complaints and training load, practical insights in the development of overuse injuries can be obtained in a player-specific fashion contributing to injury prevention in sports.A multi-dimensional and personalized approach that includes interactions between training load variables significantly increases the understanding of overuse issues on a personal basis.Jump load is an important predictor for overuse injuries in volleyball.

The Value of the Patient History in the Periodic Health Evaluation: Patient Interviews Capture 4 Times More Injuries Than Electronic Questionnaires

OBJECTIVE

To assess the value of the patient interview and electronic questionnaire methods of health history data collection in elite athletes.

DESIGN

Cohort study.

METHODS

A retrospective chart review compared health history data collected by questionnaire and by interview in a cohort of 142 athletes who participated in a periodic health evaluation at the US Olympic & Paralympic Training Center sports medicine clinic. The main outcome measure was number of injuries reported by either interview or written questionnaire.

RESULTS

Six hundred twenty-six injuries were reported by interview and 157 by questionnaire. The mean ± SD number of injuries reported per participant was 4.4 ± 4.2 by interview and 1.1 ± 1.3 by questionnaire (difference, 3.3; P<.001). Capture rate by method was similar across sexes and for both Olympic and Paralympic athletes. More injuries were reported by interview than by questionnaire for all injury categories, except for concussions and surgeries.

CONCLUSION

Patient interviews capture 4 times as many past or current injuries than electronic questionnaires in athletes training for the Olympic and Paralympic Games. Questionnaires provide incomplete health history information in this patient population. J Orthop Sports Phys Ther 2021;51(1):46-51. Epub 11 Dec 2020. doi:10.2519/jospt.2021.9821.

Japanese translation and validation of web-based questionnaires on overuse injuries and health problems

This study aimed to translate and culturally adapt the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) and the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H) into the Japanese context. The validity and reliability of these translated questionnaires examining overuse injuries and health problems among Japanese university athletes were also examined. The translation was performed following an internationally recognized methodology. A total of 145 athletes were tracked over 10 consecutive weeks and four questions were added in the 10th week to examine the questionnaires’ content validity. Test-retest analysis for reliability was performed 24–72 hours after the 10th week of registration. Internal consistency was determined by calculating Cronbach’s a during the cohort study. No major disagreements were found in the translation process. The translated questionnaires had high acceptance and compliance, with an average response rate of over 80% throughout the 10-week cohort study. Most participants reported that the questionnaires were not difficult to complete, there were no items they wanted to change or add, and that the web-based technique worked effectively. Good test-retest reliability and high internal consistency was observed in the translated questionnaires. The translated questionnaires were found to be valid, reliable, and acceptable for medically monitoring Japanese athletes.

Cross-Cultural Adaptation and Validation of the Oslo Sports Trauma Research Center Questionnaires on Overuse Injury and Health Problems (2nd Version) in Spanish Youth Sports

BACKGROUND

The Oslo Sports Trauma Research Center Questionnaires on Health Problems (OSTRC-H) and Overuse Injury (OSTRC-O) have shown a greater ability to identify athletes with health problems and to estimate the severity of those problems compared with traditional surveillance methods. Despite the numerous language adaptations of these questionnaires and their extended use, some of their measurement properties remain unknown. Moreover, these questionnaires are not available for Spanish-speaking athletes, and the validity and reliability of these questionnaires in youth athletes are unknown.

PURPOSE

To cross-culturally adapt and investigate the measurement properties of the second version of the OSTRC-H (OSTRC-H2) and OSTRC-O (OSTRC-O2) questionnaires in Spanish youth athletes.

STUDY DESIGN

Cohort study (diagnosis); Level of evidence, 2.

METHODS

Following international guidelines, we developed Spanish cross-cultural adaptations of the questionnaires, including a comprehensibility analysis with 30 participants from the target population. In the second phase, 73 athletes (age range, 12-18 years) were invited to participate in an 11-week prospective study. The reliability (internal consistency and test-retest reliability) of both questionnaires was assessed through use of Consensus-Based Standards for the Selection of Health Measurement Instruments recommendations. The construct validity and responsiveness of the OSTRC-H2 were evaluated using the convergence of the OSTRC-H2 severity score and the number of days of time loss. The response rate after 11 weeks was calculated as a feasibility indicator.

RESULTS

Equivalent Spanish versions were developed. A total of 63 athletes (age range, 12-17 years) participated in the prospective study. The Cronbach alpha was 0.93 (95% CI, 0.92-0.94) for OSTRC-H2 and 0.88 (95% CI, 0.86-0.90) for OSTRC-O2. The intraclass correlation coefficient was 0.87 (95% CI, 0.79-0.92) and 0.85 (95% CI, 0.81-0.89), and the Cohen kappa was 0.80 (95% CI, 0.71-0.89) and 0.87 (95% CI, 0.78-0.96), respectively, for OSTRC-H2 and OSTRC-02. Correlations between the severity score and time loss (Spearman rho = 0.61) and between the changes in both scores over time (Spearman rho = 0.78) were within our expected range. The response rate was 95.5% for the OSTRC-O2 and 99.6% for the OSTRC-H2.

CONCLUSION

These results present equivalent, reliable, and feasible Spanish versions of both questionnaires as well as evidence of the validity and responsiveness of the OSTRC-H2.

Minimally important change and smallest detectable change of the OSTRC questionnaire in half- and full-marathon runners

The purpose of this study was to evaluate the smallest detectable change (SDC), minimally important change (MIC), and factor structure of the Oslo Sports Trauma Research Center (OSTRC) questionnaire severity score in half‐ and full‐marathon runners. Data came from a prospective cohort study, the SUcces Measurement and Monitoring Utrecht Marathon (SUMMUM) 2017 study. Two external anchors, the global rating of change (GRC) and global rating of limitations (GRL), were used to classify the running‐related injuries (RRI) as truly improved, unchanged, or truly worsened. SDC values were calculated at individual and group levels. MIC values were calculated using the visual anchor‐based MIC distribution and mean change methods. Confirmatory factor analysis (CFA) was used to study the a priori hypothesized factor structure. A total of 132 runners who reported the same RRI on two occasions 2 weeks apart were included in the analysis. SDC values at individual and group levels were ≤35.06 and ≤9.30, respectively. With the visual anchor‐based MIC distribution method, the MIC values for RRIs that truly improved according to the GRC and GRL anchors were 13.50 and 18.50, respectively. With the mean change method, the MIC values for RRIs that truly improved according to the GRC and GRL anchors were 15.49 and 45.38, respectively. The CFA confirmed that the OSTRC was a unidimensional questionnaire. The change score of the OSTRC severity score can be used to distinguish between important change and measurement error at a group level using the MIC value 18.50. Because the SDC of the OSTRC severity score was larger than the MIC, it is not advised to use the MIC at an individual level.

Epidemiology of Traumatic and Overuse Injuries in Swiss Professional Male Ice Hockey Players

Background:

Ice hockey injury patterns in Europe were last evaluated in the 1990s.

Purpose:

The aim of this study was to assess the frequency, type, location, and incidence of traumatic injuries, as well as the prevalence and relative effect of overuse injuries in professional male ice hockey players.

Study Design:

Descriptive epidemiology study.

Methods:

Traumatic injuries were assessed using a standardized injury report form over a 1-year period (including the preparatory phase and season). The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire was used to determine overall and substantial overuse injuries and their relative effect on ice hockey players.

Results:

Five Swiss National League teams participated in the study. From a total of 321 recorded injuries, 179 led to time loss from sport. The game-related time-loss injury incidence during the season was 88.6/1000 player-game hours.Time-loss injuries affected mainly the hip/groin/thigh region (23%), followed by the head (17%). Most time-loss injuries were classified as muscle strains (24%), followed by concussions (18%). The most common injury mechanism involved collision with an opponent’s body (31%), and right forward players (23%) were most likely to report a game-related injury. Most injuries (27%) occurred within the defending zone along the boards. The average prevalence rates of all overuse and substantial overuse injuries were 49% and 13%, respectively. The hip/groin displayed the highest average prevalence for all overuse problems (16%), translating to the highest relative effect.

Conclusion:

Muscle strains and concussions were the most frequent time-loss injuries in Swiss professional ice hockey players. The hip/groin was the most affected region for both traumatic and overuse injuries.

Remarkably high prevalence of overuse-related knee complaints and MRI abnormalities in youth competitive alpine skiers: a descriptive investigation in 108 athletes aged 13-15 years

Background/aim

Competitive alpine skiing is known to be associated with a high risk of traumatic knee injuries. However, little is known about the exact prevalence of knee overuse injuries and their associations with structural changes, particularly in youth skiers. Accordingly, the aim of the present study was to describe the overuse-related knee complaints and MRI abnormalities in a cohort of youth skiers around the growth spurt.

Methods

108 youth competitive alpine skiers aged 13–15 years were examined using an MRI of both knees, an interview on existing knee complaints and a physical examination. As a common baseline for these assessments, skiers were prospectively monitored by the use of the Oslo Sports Trauma Research Centre questionnaire on health problems over a period of 12 months preceding the major investigations.

Results

88.0% of the youth skiers showed at least one MRI abnormality in the knees. The most frequent findings were distal femoral cortical irregularities (63%), focal periphyseal oedema (FOPE) zones (25.0%) and cartilage lesions (18.5%). 47.2% of all skiers suffered from at least one overuse-related knee complaint during the 12 months preceding the MRI examination, mostly at the distal and proximal patellar tendon. However, despite a certain association with corresponding MRI abnormalities, the sensitivity of an MRI-based detection of such complaints was strongly limited.

Conclusion

Youth competitive alpine skiers suffer from a remarkably large number of knee overuse injuries. Accordingly, an effective prevention strategy should include a systematic screening of clinical complaints, ideally already starting around the growth spurt.

Japanese translation and modification of the Oslo Sports Trauma Research Centre overuse injury questionnaire to evaluate overuse injuries in female college swimmers

The purpose of the present study was to translate and modify the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire into Japanese and validate it among Japanese athletes through a longitudinal survey. A modified back-translation method was used to translate the questionnaire from English to Japanese. The longitudinal survey was performed in 29 female college swimmers who were followed up for more than 24 consecutive weeks. The response rate to the 24 weekly questionnaires was 88.8% (95% confidence interval [CI]: 85.2–92.3). Internal consistency was measured by using Cronbach’s alpha (0.73 (0.69–0.77)). The anatomical areas most frequently affected by overuse injuries were the lower back (average weekly prevalence: 27.6%, 95% CI: 25.1–30.1), shoulder (16.0%, 95% CI: 13.7–18.2), knee (9.9%, 95% CI: 7.7–12.0), and ankle (9.0%, 7.6–10.5). The severity score showed that knee (22.5, range: 6–65), ankle (21.5, range: 6–67), and lower back (20.7, range: 6–80) injuries had the greatest impact. The Japanese version of the modified OSTRC overuse injury questionnaire demonstrated reliability and validity based on the results of internal consistency and trend of injury of the swimmers. The participants in the present study did not have substantial injuries or time-loss injuries and continued practicing and competing, despite these minor injuries. Although knee and ankle injuries do not occur as often as lower back and shoulder injuries, these injuries often had a greater impact on swimmers when they did occur.

Epidemiology of injuries in outdoor and indoor hockey players over one season: a prospective cohort study

Objectives

To determine the incidence and characteristics of hockey (‘field hockey’) injuries over the course of one outdoor and indoor season. Comparisons of female versus male players, outdoor versus indoor season and match versus practice were performed.

Methods

Female and male teams of the first, second, third, regional and youth divisions were recruited among a local hockey association in Northern Germany, and followed over an indoor and an outdoor season. Exposure times and location, type, severity and cause of injuries during practice and matches were documented by the coaches or medical staff and collected weekly. Prevalence and incidence rates were calculated.

Results

Of the 232 players (mean±SD age 20.7±4.7 years, 68.1% male, 31.9% first division), 84 players (36.2%) suffered 108 new injuries during the season. The overall incidence rate was 3.7 injuries per 1000 player hours (95% CI 3.0 to 4.4). The injury incidence was lower in practice (2.7 per 1000 player practice hours, 95% CI 2.0 to 3.3) than in matches (9.7 per 1000 player match hours, 95% CI 6.8 to 12.7), and was similar for female and male players as well as during the outdoor and the indoor season. Most injuries affected the lower limb (thigh, knee and ankle) and occurred without contact (58.3%). Severe injuries (n=34; 31.5%) were predominantly located at the knee and hand/finger.

Conclusion

Hockey players have a high prevalence and incidence of injuries, especially at the lower limb.

Swiss (German) Version of the Actinic Keratosis Quality of Life questionnaire

BACKGROUND

Actinic keratosis (AK) is a sun-induced skin lesion that may progress to invasive squamous cell carcinoma of the skin. Recently, the Actinic Keratosis Quality of Life questionnaire (AKQoL) was designed for patients with AK in Denmark as a specific quality of life instrument for AK patients.

OBJECTIVE

The objective of this study was to adapt the AKQoL for the German language region of Switzerland and to evaluate its psychometric properties (validity, reliability).

METHODS

Translation and cultural adaptation of the questionnaire were assessed by using the technique of cognitive interviewing. During the translation process, 34 patients with AK from the Department of Dermatology, University Hospital Zurich, were interviewed in 3 sessions of cognitive interviewing. The translated questionnaire was then distributed together with the Dermatology Life Quality Index (DLQI) to a second group of 113 patients for validation and reliability testing. Within this group, we measured the internal consistency by the Cronbach coefficient α and Spearman correlation coefficient between the AKQoL and the DLQI.

RESULTS

The problems encountered during the translation process led to changes in 5 categories as described by Epstein: stylistic changes, change in breadth, change in actual meaning, change in frequency and time frame, change in intensity. We found a Cronbach α of 0.82, an acceptable internal consistency. The Spearman correlation coefficient between total scores of AKQoL and DLQI was 0.57.

CONCLUSION

We culturally adapted and validated a Swiss (German) version of the AKQoL questionnaire applicable for the population of a university center in Switzerland to measure and monitor the quality of life in patients with AK.

Prospective monitoring of health problems among recreational runners preparing for a half marathon

Objectives

While the health benefits of running are legitimately advocated, participation in running can also lead to health problems. There is a high range of reported prevalence rates especially of running-related overuse injuries in high-level athletes and during competition. Little consensus exists for acute injuries and illnesses especially in recreational runners. Therefore, the aim of this study was to record the prevalence of health problems in recreational long-distance runners preparing for an event.

Methods

Recreational runners aged 18–65 years who were registered 13 weeks prior to a half-marathon running event were invited to take part in this study. Participants were prospectively monitored weekly over 13 weeks by applying a standardised surveillance system for injuries and illnesses (Oslo Sports Trauma Research Center questionnaire). From this, prevalence and severity of acute and overuse injuries, as well as illnesses, were calculated.

Results

We received 3213 fully answered questionnaires from 327 participants (40.7% female, 40.9±11.7 years of age, 31.5±21.1 km weekly mileage, 8.3±7.8 years of running experience). At any point in time over the preparation phase, 37.3% of the participants had health problems. Overuse injuries were the major burden (18%). They were followed by illnesses (14.1%) and acute injuries (7.9%). The median weekly severity score was 56.5 (IQR 37.0–58.0).

Conclusion

The high prevalence of health problems in our cohort suggests that future efforts are needed to further specify the underlying mechanism and develop adequate prevention strategies for recreational runners.

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)