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de Pablo Marquez B, Subirana I, Quintana M, Rodas G, Casals M. Time-loss Injuries among Female and Male Spanish Rink Hockey Players. Int J Sports Med 2023; 44:906-912. [PMID: 37739009 DOI: 10.1055/a-2123-2600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
The present study describes the time-loss injuries among female and male athletes of the Spanish rink hockey league during the 2021/22 season.We performed a retrospective cohort study on time-loss injuries, whereby the athlete is prevented from participating in a training session or game because of the injury.A total of 463 athletes were included, with 326 (70.4%) senior male and 137 (29.6%) female. Two hundred and eighty-two time-loss injuries were recorded, the most common form being muscle injuries (112 episodes, 39.7%), especially those affecting the hip adductor muscles (52 episodes, 46.4% of muscle injuries). Most injuries were classified as mild (1-7 days of time-loss) and the median return-to-play was 9.5 days (range 1-180).Injury patterns were compared according to gender, position and moment: the results showed significant differences between senior males and females, between field players and goalkeepers, as well as between training and game, in terms of injury nature and type. The injury incidence proportion was significantly higher for field players compared to goalkeepers), and senior males had a significantly higher risk than senior females.The present study provides a starting point for studying and preventing injuries in rink hockey athletes.
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Affiliation(s)
| | - Isaac Subirana
- Biomedical research, Consortium for Biomedical Research in Epidemiology and Public Health, Barcelona, Spain
- Biomedical research, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Marcos Quintana
- Department of functional biology, University of Oviedo, Oviedo, Spain
| | - Gil Rodas
- Barça Innovation Hub, FC Barcelona, Barcelona, SPAIN
| | - Marti Casals
- National Institute of Physical Education of Catalonia (INEFC), University of Barcelona, Barcelona, Spain
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2
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Farhart P, Beakley D, Diwan A, Duffield R, Rodriguez EP, Chamoli U, Watsford M. Intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers in cricket: a systematic review. BMC Sports Sci Med Rehabil 2023; 15:114. [PMID: 37730648 PMCID: PMC10512628 DOI: 10.1186/s13102-023-00732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/12/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Lumbar spine injuries in fast bowlers account for the greatest missed playing time in cricket. A range of extrinsic and intrinsic variables are hypothesised to be associated with low back pain and lumbar spine injury in fast bowlers, and an improved understanding of intrinsic variables is necessary as these may alter load tolerance and injury risk associated with fast bowling. This review critically evaluated studies reporting intrinsic variables associated with low back pain and lumbar spine injury in fast bowlers and identified areas for future investigation. METHODS OVID Medline, EMBASE, SPORTDiscus, CINAHL, Web of Science and SCOPUS databases were last searched on 3 June 2022 to identify studies investigating intrinsic variables associated with low back pain and lumbar spine injury in cricket fast bowlers. Terms relevant to cricket fast bowling, and intrinsic variables associated with lumbar spine injury and low back pain in fast bowlers were searched. 1,503 abstracts were screened, and 118 full-text articles were appraised to determine whether they met inclusion criteria. Two authors independently screened search results and assessed risk of bias using a modified version of the Quality in Prognostic Studies tool. RESULTS Twenty-five studies met the inclusion criteria. Overall, no included studies demonstrated a low risk of bias, two studies were identified as moderate risk, and twenty-three studies were identified as high risk. Conflicting results were reported amongst studies investigating associations of fast bowling kinematics and kinetics, trunk and lumbar anatomical features, anthropometric traits, age, and neuromuscular characteristics with low back pain and lumbar spine injury. CONCLUSION Inconsistencies in results may be related to differences in study design, injury definitions, participant characteristics, measurement parameters, and statistical analyses. Low back pain and lumbar spine injury occurrence in fast bowlers remain high, and this may be due to an absence of low bias studies that have informed recommendations for their prevention. Future research should employ clearly defined injury outcomes, analyse continuous datasets, utilise models that better represent lumbar kinematics and kinetics during fast bowling, and better quantify previous injury, lumbar anatomical features and lumbar maturation. TRIAL REGISTRATION Open Science Framework https://doi.org/10.17605/OSF.IO/ERKZ2 .
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Affiliation(s)
- Patrick Farhart
- School of Sport, Exercise and Rehabilitation, Faculty of Health, Human Performance Research Centre, Moore Park Precinct, University of Technology Sydney, Broadway, NSW, 2007, Australia.
- Spine Labs, Discipline of Surgery, St. George and Sutherland Campus of the Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, 2217, Australia.
- Cricket New South Wales, 161 Silverwater Road, Sydney Olympic Park, Sydney, NSW, 2127, Australia.
- Delhi Capitals, JSW GMR Cricket Private Limited, Bahadurshah Zafar Marg, New Delhi, 110002, India.
| | - David Beakley
- Deakin University, Burwood Highway, Burwood, VIC, 3125, Australia
| | - Ashish Diwan
- Spine Labs, Discipline of Surgery, St. George and Sutherland Campus of the Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, 2217, Australia
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Kogarah, NSW, 2217, Australia
| | - Rob Duffield
- School of Sport, Exercise and Rehabilitation, Faculty of Health, Human Performance Research Centre, Moore Park Precinct, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - Elizabeth Pickering Rodriguez
- School of Sport, Exercise and Rehabilitation, Faculty of Health, Human Performance Research Centre, Moore Park Precinct, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - Uphar Chamoli
- Spine Labs, Discipline of Surgery, St. George and Sutherland Campus of the Clinical School, Faculty of Medicine, University of New South Wales, Kogarah, NSW, 2217, Australia
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Broadway, NSW, 2007, Australia
| | - Mark Watsford
- School of Sport, Exercise and Rehabilitation, Faculty of Health, Human Performance Research Centre, Moore Park Precinct, University of Technology Sydney, Broadway, NSW, 2007, Australia
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Mansournia MA, Nazemipour M, Etminan M. P-value, compatibility, and S-value. GLOBAL EPIDEMIOLOGY 2022; 4:100085. [PMID: 37637018 PMCID: PMC10446114 DOI: 10.1016/j.gloepi.2022.100085] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022] Open
Abstract
Misinterpretations of P-values and 95% confidence intervals are ubiquitous in medical research. Specifically, the terms significance or confidence, extensively used in medical papers, ignore biases and violations of statistical assumptions and hence should be called overconfidence terms. In this paper, we present the compatibility view of P-values and confidence intervals; the P-value is interpreted as an index of compatibility between data and the model, including the test hypothesis and background assumptions, whereas a confidence interval is interpreted as the range of parameter values that are compatible with the data under background assumptions. We also suggest the use of a surprisal measure, often referred to as the S-value, a novel metric that transforms the P-value, for gauging compatibility in terms of an intuitive experiment of coin tossing.
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Affiliation(s)
- Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nazemipour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahyar Etminan
- Department of Ophthalmology, Medicine and Pharmacology, University of British Columbia, Vancouver, Canada
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4
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Clement D, Tranaeus U, Johnson U, Stenling A, Ivarsson A. Profiles of psychosocial factors: Can they be used to predict injury risk? Scand J Med Sci Sports 2021; 32:782-788. [PMID: 34862984 DOI: 10.1111/sms.14110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 11/30/2022]
Abstract
The creation of risk profiles using the model of stress and athletic injury (J Appl Sport Psychol. 1998;10(1):5) represents a proposed shift from the reductionism paradigm to the complex sport approach in an attempt to formulate prevention strategies to combat the increasing number of injuries being reported in sporting populations. As a result, the primary purpose of this study was to: (a) identify different risk profiles based on psychosocial factors associated with the Williams and Andersen's model of stress and athletic injury model; and (b) examine potential differences in the frequency of injuries across these risk profiles. A prospective research design was utilized with a sample of 117 competitive soccer players (81 males and 36 females) from Sweden and the United States of America. Data was collected at two time points over the course of three months. At time 1 (beginning of the season) - a demographic information sheet, the Life Event Survey for Collegiate Athletes (LESCA), Sport Competitive Anxiety Test (SCAT), and Brief Cope were administered. At time two (T2), three months after the initial data collection, participants' traumatic injuries were recorded. Latent profile analysis (LPA) showed that 3 profiles solution showed best fit to data. Players in profile 1 and 2 reported fewer injuries compared to players in profile 3. However, whereas individuals in profile 1 had a lower predictive risk of sustaining an injury when compared to those in profile 3, both profiles had similar anxiety levels and use of coping strategies with differing stress levels. These findings suggest that the interaction between different proposed risk factors might influence injury risk.
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Affiliation(s)
| | - Ulrika Tranaeus
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | | | | | - Andreas Ivarsson
- Halmstad University, Halmstad, Sweden.,Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
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5
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Mansournia MA, Collins GS, Nielsen RO, Nazemipour M, Jewell NP, Altman DG, Campbell MJ. A CHecklist for statistical Assessment of Medical Papers (the CHAMP statement): explanation and elaboration. Br J Sports Med 2021; 55:1009-1017. [PMID: 33514558 PMCID: PMC9110112 DOI: 10.1136/bjsports-2020-103652] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 12/23/2022]
Abstract
Misuse of statistics in medical and sports science research is common and may lead to detrimental consequences to healthcare. Many authors, editors and peer reviewers of medical papers will not have expert knowledge of statistics or may be unconvinced about the importance of applying correct statistics in medical research. Although there are guidelines on reporting statistics in medical papers, a checklist on the more general and commonly seen aspects of statistics to assess when peer-reviewing an article is needed. In this article, we propose a CHecklist for statistical Assessment of Medical Papers (CHAMP) comprising 30 items related to the design and conduct, data analysis, reporting and presentation, and interpretation of a research paper. While CHAMP is primarily aimed at editors and peer reviewers during the statistical assessment of a medical paper, we believe it will serve as a useful reference to improve authors' and readers' practice in their use of statistics in medical research. We strongly encourage editors and peer reviewers to consult CHAMP when assessing manuscripts for potential publication. Authors also may apply CHAMP to ensure the validity of their statistical approach and reporting of medical research, and readers may consider using CHAMP to enhance their statistical assessment of a paper.
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Affiliation(s)
- Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Rasmus Oestergaard Nielsen
- Department of Public Health, Section for Sports Science, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Aarhus, Denmark
| | - Maryam Nazemipour
- Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Nicholas P Jewell
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, California, USA
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Patel AD, Bullock GS, Wrigley J, Paterno MV, Sell TC, Losciale JM. Does sex affect second ACL injury risk? A systematic review with meta-analysis. Br J Sports Med 2021; 55:873-882. [PMID: 34001504 DOI: 10.1136/bjsports-2020-103408] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine sex-based differences in risk of a second ACL injury (overall and by laterality) following primary ACL reconstruction in athletes who are attempting to return to sport. DESIGN Systematic review with meta-analysis. DATA SOURCES Systematic search of five databases conducted in August 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting sex-based differences in the incidence of second ACL injury in athletes attempting to return-to-sports and who were followed for at least 1 year following primary ACL reconstruction. RESULTS Nineteen studies were included in this review, with seven studies excluded from the primary meta-analysis due to high risk of bias. The remaining 12 studies (n=1431 females, n=1513 males) underwent meta-analysis, with all 19 studies included in a sensitivity analysis. Total second ACL injury risk was 21.9% (females: 22.8%, males: 20.3%). Females were found to have 10.7% risk of an ipsilateral ACL injury and 11.8% risk of a contralateral ACL injury. Males were found to have 12.0% risk of an ipsilateral ACL injury and 8.7% risk of a contralateral ACL injury. No statistically significant differences were observed for total second ACL injury risk (risk difference=-0.6%, 95% CI -4.9 to 3.7, p=0.783, I2=41%) or contralateral ACL injury risk (risk difference=1.9%, 95% CI -0.5% to 4.4%, p=0.113, I2=15%) between sexes. Females were found to have a 3.4% absolute risk reduction in subsequent ipsilateral ACL injury risk compared with males (risk difference=-3.4%, 95% CI -6.7% to -0.02%, p=0.037, I2=35%). CONCLUSION Both sexes have >20% increased risk of experiencing a second ACL injury. Any difference in the absolute risk of either a subsequent ipsilateral or contralateral ACL injury between sexes appears to be small. REGISTRATION PROSPERO (CRD42020148369).
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Affiliation(s)
- Akash D Patel
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Garrett S Bullock
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jordan Wrigley
- Duke University Medical Center, Durham, North Carolina, USA
| | - Mark V Paterno
- Division of Occupational Therapy and Physical Therapy, Division of Sports Medicine, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Timothy C Sell
- Atrium Health Musculoskeletal Institute, Charlotte, North Carolina, USA
| | - Justin M Losciale
- Faculty of Medicine, Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada .,Arthritis Research Canada, Vancouver, British Columbia, Canada
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7
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Impellizzeri FM, McCall A, Ward P, Bornn L, Coutts AJ. Training Load and Its Role in Injury Prevention, Part 2: Conceptual and Methodologic Pitfalls. J Athl Train 2021; 55:893-901. [PMID: 32991699 DOI: 10.4085/1062-6050-501-19] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In part 2 of this clinical commentary, we highlight the conceptual and methodologic pitfalls evident in current training-load-injury research. These limitations make these studies unsuitable for determining how to use new metrics such as acute workload, chronic workload, and their ratio for reducing injury risk. The main overarching concerns are the lack of a conceptual framework and reference models that do not allow for appropriate interpretation of the results to define a causal structure. The lack of any conceptual framework also gives investigators too many degrees of freedom, which can dramatically increase the risk of false discoveries and confirmation bias by forcing the interpretation of results toward common beliefs and accepted training principles. Specifically, we underline methodologic concerns relating to (1) measure of exposures, (2) pitfalls of using ratios, (3) training-load measures, (4) time windows, (5) discretization and reference category, (6) injury definitions, (7) unclear analyses, (8) sample size and generalizability, (9) missing data, and (10) standards and quality of reporting. Given the pitfalls of previous studies, we need to return to our practices before this research influx began, when practitioners relied on traditional training principles (eg, overload progression) and adjusted training loads based on athletes' responses. Training-load measures cannot tell us whether the variations are increasing or decreasing the injury risk; we recommend that practitioners still rely on their expert knowledge and experience.
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Affiliation(s)
- Franco M Impellizzeri
- Faculty of Health, Human Performance Research Centre and School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Australia
| | - Alan McCall
- Arsenal Football Club, London, United Kingdom
| | | | | | - Aaron J Coutts
- Faculty of Health, Human Performance Research Centre and School of Sport, Exercise and Rehabilitation, University of Technology Sydney, Australia
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8
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Pourahmadi M, Koes BW, Nazemipour M, Mansournia MA. It is Time to Change Our Mindset and Perform More High-quality Research in Low Back Pain. Spine (Phila Pa 1976) 2021; 46:69-71. [PMID: 32991518 DOI: 10.1097/brs.0000000000003712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mohammadreza Pourahmadi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Bart W Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Maryam Nazemipour
- Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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9
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Limited Support for Trunk and Hip Deficits as Risk Factors for Athletic Knee Injuries: A Systematic Review With Meta-analysis and Best-Evidence Synthesis. J Orthop Sports Phys Ther 2020; 50:476-489. [PMID: 32741330 DOI: 10.2519/jospt.2020.9705] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether neuromuscular deficits in trunk and hip-related function are risk factors for athletic knee injuries. DESIGN Etiology systematic review with meta-analysis. LITERATURE SEARCH Six online databases (MEDLINE, Web of Science, Embase, CINAHL, Scopus, and SPORTDiscus) were searched up to April 2019. STUDY SELECTION CRITERIA Studies assessing trunk and hip neuromuscular function as risk factors for knee injuries in healthy athletic populations were included. DATA SYNTHESIS Outcomes were synthesized quantitatively using meta-analysis of odds ratios, and qualitatively using best-evidence synthesis. RESULTS Twenty-one studies met the inclusion criteria. There was very low-certainty evidence that greater hip external rotation strength protected against knee injuries (odds ratio = 0.78; 95% confidence interval: 0.70, 0.87; P<.05). There was limited evidence that deficits in trunk proprioception and neuromuscular control, and the combination of excessive knee valgus and ipsilateral trunk angle when landing unilaterally from a jump, may be risk factors for knee injuries. CONCLUSION Most variables of trunk and hip function were not risk factors for injuries. Further research is required to confirm whether hip external rotation strength, trunk proprioception and neuromuscular control, and the combination of knee valgus angle and ipsilateral trunk control are risk factors for future knee injuries. J Orthop Sports Phys Ther 2020;50(9):476-489. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9705.
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Nielsen RO, Shrier I, Casals M, Nettel-Aguirre A, Møller M, Bolling C, Bittencourt NFN, Clarsen B, Wedderkopp N, Soligard T, Timpka T, Emery C, Bahr R, Jacobsson J, Whiteley R, Dahlstrom O, van Dyk N, Pluim BM, Stamatakis E, Palacios-Derflingher L, Fagerland MW, Khan KM, Ardern CL, Verhagen E. Statement on methods in sport injury research from the 1st METHODS MATTER Meeting, Copenhagen, 2019. Br J Sports Med 2020; 54:941. [PMID: 32371524 PMCID: PMC7392492 DOI: 10.1136/bjsports-2019-101323] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2020] [Indexed: 01/08/2023]
Abstract
High quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best practice methods—methods matter (greatly!). The 1st METHODS MATTER Meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting.
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Affiliation(s)
- Rasmus Oestergaard Nielsen
- Department of Public Health, Section for Sports Science, Aarhus University, Aarhus, Denmark .,Research Unit for General Practice, Aarhus, Denmark
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Marti Casals
- Sport and Physical Activity Studies Centre (CEEAF), Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Barcelona, Spain.,Medical Department, Futbol Club Barcelona, Barça Innovation Hub, Barcelona, Spain
| | | | - Merete Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Caroline Bolling
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Natália Franco Netto Bittencourt
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Sports Physical Therapy Department, Minas Tenis Clube, Belo Horizonte, Brazil.,Physical Therapy, Centro Universitário UniBH, Belo Horizonte, Brazil
| | - Benjamin Clarsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway.,Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway
| | - Niels Wedderkopp
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,The Orthopedic department, Hospital of Southwestern Jutland, Esbjerg, Denmark
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Toomas Timpka
- Health and Society, Linköping University, Linköping, Sweden
| | - Carolyn Emery
- Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Roald Bahr
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway
| | - Jenny Jacobsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Orjan Dahlstrom
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
| | - Babette M Pluim
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Section Sports Medicine, Faculty of Health Science, University of Pretoria, Pretoria, South Africa.,Medical Department, Royal Netherlands Lawn Tennis Association, Amstelveen, The Netherlands
| | - Emmanuel Stamatakis
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,University College London, London, UK
| | - Luz Palacios-Derflingher
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Morten Wang Fagerland
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway
| | - Karim M Khan
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada.,British Journal of Sports Medicine, London, United Kingdom
| | - Clare L Ardern
- Division of Physiotherapy, Linköping University, Linköping, Sweden.,Division of Physiotherapy, Department of Neurobiology, Karolinska Institute, Stockholm, Sweden
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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11
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Statement on Methods in Sport Injury Research From the First METHODS MATTER Meeting, Copenhagen, 2019. J Orthop Sports Phys Ther 2020; 50:226-233. [PMID: 32354314 DOI: 10.2519/jospt.2020.9876] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High-quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best-practice methods-methods matter (greatly!). The first METHODS MATTER meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting. Meeting participants agreed that the definition of sport injury depends on the research question and context. It was considered essential to be explicit about the goal of the research effort and to use frameworks to illustrate the assumptions that underpin measurement and the analytical strategy. Complex systems were discussed to illustrate how potential risk factors can interact in a nonlinear way. This approach is often a useful alternative to identifying single risk factors. Investigating changes in exposure status over time is important when analyzing sport injury etiology, and analyzing recurrent injury, subsequent injury, or injury exacerbation remains challenging. The choice of statistical model should consider the research question, injury measure (eg, prevalence, incidence), type and granularity of injury data (categorical or continuous), and study design. Multidisciplinary collaboration will be a cornerstone for future high-quality sport injury research. Working outside professional silos in a diverse, multidisciplinary team benefits the research process, from the formulation of research questions and designs to the statistical analyses and dissemination of study results in implementation contexts. This article has been copublished in the British Journal of Sports Medicine and the Journal of Orthopaedic & Sports Physical Therapy. J Orthop Sports Phys Ther 2020;50(5):226-233. doi:10.2519/jospt.2020.9876.
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Jungmalm J, Nielsen RØ, Desai P, Karlsson J, Hein T, Grau S. Associations between biomechanical and clinical/anthropometrical factors and running-related injuries among recreational runners: a 52-week prospective cohort study. Inj Epidemiol 2020; 7:10. [PMID: 32234070 PMCID: PMC7110719 DOI: 10.1186/s40621-020-00237-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this exploratory study was to investigate whether runners with certain biomechanical or clinical/anthropometrical characteristics sustain more running-related injuries than runners with other biomechanical or clinical/anthropometrical characteristics. METHODS The study was designed as a prospective cohort with 52-weeks follow-up. A total of 224 injury-free, recreational runners were recruited from the Gothenburg Half Marathon and tested at baseline. The primary exposure variables were biomechanical and clinical/anthropometrical measures, including strength, lower extremity kinematics, joint range of motion, muscle flexibility, and trigger points. The primary outcome measure was any running-related injury diagnosed by a medical practitioner. Cumulative risk difference was used as measure of association. A shared frailty approach was used with legs as the unit of interest. A total of 448 legs were included in the analyses. RESULTS The cumulative injury incidence proportion for legs was 29.0% (95%CI = 24.0%; 34.8%). A few biomechanical and clinical/anthropometrical factors influence the number of running-related injuries sustained in recreational runners. Runners with a late timing of maximal eversion sustained 20.7% (95%CI = 1.3; 40.0) more injuries, and runners with weak abductors in relation to adductors sustained 17.3% (95%CI = 0.8; 33.7) more injuries, compared with the corresponding reference group. CONCLUSIONS More injuries are likely to occur in runners with late timing of maximal eversion or weak hip abductors in relation to hip adductors.
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Affiliation(s)
- Jonatan Jungmalm
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Box 300, SE405 30 Gothenburg, Sweden
| | - Rasmus Østergaard Nielsen
- Section of Sport Science, Department of Public Health, Aarhus University, Dalgas Avenue 4, 8000 Aarhus, Denmark
| | - Pia Desai
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Box 426, SE415 30 Gothenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Box 426, SE415 30 Gothenburg, Sweden
| | - Tobias Hein
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Box 300, SE405 30 Gothenburg, Sweden
| | - Stefan Grau
- Center for Health and Performance, Department of Food and Nutrition and Sport Science, University of Gothenburg, Box 300, SE405 30 Gothenburg, Sweden
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13
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Losciale JM, Bullock G, Cromwell C, Ledbetter L, Pietrosimone L, Sell TC. Hop Testing Lacks Strong Association With Key Outcome Variables After Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review. Am J Sports Med 2020; 48:511-522. [PMID: 31063403 DOI: 10.1177/0363546519838794] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Single-legged hop tests are commonly used assessments in return to sport (RTS) testing after anterior cruciate ligament reconstruction (ACLR). Although these tests are commonly used, their predictive validity has not yet been established. PURPOSE To determine the strength of association between hop testing and RTS, knee reinjury, subjective report of knee function, and posttraumatic knee osteoarthritis (PTOA) after primary ACLR. Secondarily, to determine whether hop testing is able to predict a favorable result on the same outcome variables. STUDY DESIGN Systematic review. METHODS A systematic, computer-assisted literature search was performed in PubMed/MEDLINE, CINAHL, EMBASE, SPORTDiscus, Cochrane Library, and ClinicalTrials.gov. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed when conducting and reporting this review. Primary outcome variables for this review were self-report of knee function, return to preinjury level of activity, presence of reinjury, and presence of PTOA. The Oxford Centre for Evidence-Based Medicine Levels of Evidence tool was used to assess the level of evidence for each included study. Quality assessment of each included study was performed through use of a modified Downs and Black scale. Available metrics were tabulated based on outcome variables. RESULTS Overall, 21 studies (4476 patients) met inclusion for this review. The majority of evidence (95.2%) was of moderate to high methodologic quality. The most commonly associated outcome measure was the International Knee Documentation Committee (IKDC) score, with Pearson correlation coefficients ranging from 0.20 to 0.60. The strength of association between the Knee injury and Osteoarthritis Outcome Score (KOOS) and hop testing ranged from -0.10 to 0.62 in 4 studies. In all, 10 studies examined the relationship between hop testing and RTS, with variable association statistics reported. No meaningful association was found between hop testing and knee reinjury in 2 studies. Worse preoperative hop testing was associated with PTOA in 1 study. CONCLUSION Hop testing appears to possess fair association to subjective report of knee function measured by the KOOS and IKDC and a patient's ability to RTS after ACLR. Insufficient evidence is available to determine the relationship between hop testing and PTOA and knee reinjury. Predictive validity cannot be established based on available literature.
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Affiliation(s)
| | - Garrett Bullock
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Oxford, UK
| | - Christina Cromwell
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Leila Ledbetter
- Duke University Medical Center Library, Durham, North Carolina, USA
| | - Laura Pietrosimone
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, USA
| | - Timothy C Sell
- Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, USA.,Michael W. Krzyzewski Human Performance Laboratory, Duke Sports Medicine, James R. Urbaniak Sports Sciences Institute, Duke University Health System, Duke University, Durham, North Carolina, USA
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14
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Ghaderi A, Banafshe HR, Mirhosseini N, Motmaen M, Mehrzad F, Bahmani F, Aghadavod E, Mansournia MA, Reiter RJ, Karimi M, Asemi Z. The effects of melatonin supplementation on mental health, metabolic and genetic profiles in patients under methadone maintenance treatment. Addict Biol 2019; 24:754-764. [PMID: 29949232 DOI: 10.1111/adb.12650] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 04/24/2018] [Accepted: 05/21/2018] [Indexed: 12/11/2022]
Abstract
This investigation was designed to determine the effect of melatonin supplementation on mental health parameters, metabolic and genetic profiles in patients under methadone maintenance treatment (MMT). This randomized, double-blind, placebo-controlled, clinical trial was conducted among 54 patients under MMT. Participants were randomly allocated to receive either 10 mg melatonin (2 melatonin capsules, 5 mg each) (n = 26) or placebo (n = 28) once a day, 1 hour before bedtime for 12 weeks. Melatonin supplementation significantly decreased Pittsburgh Sleep Quality Index (β -4.08; 95 percent CI, -5.51, -2.65; P < 0.001), Beck Depression Inventory index (β -5.46; 95% CI, -8.92, -2.00; P = 0.003) and Beck Anxiety Inventory index (β -3.87; 95% CI, -5.96, -1.77; P = 0.001) and significantly increased International Index of Erectile Functions (β 5.59; 95% CI, 1.76, 9.42; P = 0.005) compared with the placebo. Subjects who received melatonin supplements had significantly lower serum insulin levels (β -2.53; 95% CI, -4.48, -0.59; P = 0.01), homeostasis model of assessment-insulin resistance (β -0.56; 95% CI, -1.03, -0.09; P = 0.01) and higher quantitative insulin sensitivity check index (β 0.01; 95% CI, 0.004, 0.02; P = 0.009) and HDL-cholesterol levels (β 3.71; 95% CI, 1.77, 5.64; P = 0.002) compared to placebo. Additionally, melatonin intake resulted in a significant reduction in serum high sensitivity C-reactive protein (β -0.15; 95% CI, -0.27, -0.02; P = 0.02), malondialdehyde (β -0.31; 95% CI, -0.57, -0.05; P = 0.02) and protein carbonyl (β -0.06; 95% CI, -0.09, -0.04; P < 0.001). This trial indicated that taking melatonin supplements for 12 weeks by patients under MMT had beneficial effects on their mental health metabolic profiles.
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Affiliation(s)
- Amir Ghaderi
- Department of Addiction Studies, School of MedicineKashan University of Medical Sciences Kashan Iran
| | - Hamid Reza Banafshe
- Department of Addiction Studies, School of MedicineKashan University of Medical Sciences Kashan Iran
- Department of Pharmacology, School of MedicineKashan University of Medical Sciences Kashan Iran
| | | | - Maryam Motmaen
- Department of Psychiatry, School of MedicineKashan University of Medical Science Kashan Iran
| | - Fatemeh Mehrzad
- Department of Psychiatry, School of MedicineKashan University of Medical Science Kashan Iran
| | - Fereshteh Bahmani
- Research Center for Biochemistry and Nutrition in Metabolic DiseasesKashan University of Medical Sciences Kashan Iran
| | - Esmat Aghadavod
- Research Center for Biochemistry and Nutrition in Metabolic DiseasesKashan University of Medical Sciences Kashan Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public HealthTehran University of Medical Sciences Tehran Iran
| | - Russel J. Reiter
- Department of Cellular and Structural BiologyUniversity of Texas Health Science, Center San Antonio TX USA
| | - Mohammad‐Amin Karimi
- Department of Educational Sciences, Science and Research BranchIslamic Azad University Tehran Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic DiseasesKashan University of Medical Sciences Kashan Iran
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15
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Ruddy JD, Pietsch S, Maniar N, Cormack SJ, Timmins RG, Williams MD, Carey DL, Opar DA. Session Availability as a Result of Prior Injury Impacts the Risk of Subsequent Non-contact Lower Limb Injury in Elite Male Australian Footballers. Front Physiol 2019; 10:737. [PMID: 31275159 PMCID: PMC6593276 DOI: 10.3389/fphys.2019.00737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/28/2019] [Indexed: 11/15/2022] Open
Abstract
Prior injury is a commonly identified risk factor for subsequent injury. However, a binary approach to classifying prior injury (i.e., yes/no) is commonly implemented and may constrain scientific findings, as it is possible that variations in the amount of time lost due to an injury will impact subsequent injury risk to differing degrees. Accordingly, this study investigated whether session availability, a surrogate marker of prior injury, influenced the risk of subsequent non-contact lower limb injury in Australian footballers. Data were collected from 62 male elite Australian footballers throughout the 2015, 2016, and 2017 Australian Football League seasons. Each athlete's participation status (i.e., full or missed/modified) and any injuries that occurred during training sessions/matches were recorded. As the focus of the current study was prior injury, any training sessions/matches that were missed due to reasons other than an injury (e.g., load management, illness and personal reasons) were removed from the data prior to all analyses. For every Monday during the in-season periods, session availability (%) in the prior 7, 14, 21, 28, 35, 42, 49, 56, 63, 70, 77, and 84 days was determined as the number of training sessions/matches fully completed (injury free) relative to the number of training sessions/matches possible in each window. Each variable was modeled using logistic regression to determine its impact on subsequent injury risk. Throughout the study period, 173 non-contact lower limb injuries that resulted in at least one missed/modified training session or match during the in-season periods occurred. Greater availability in the prior 7 days increased injury probabilities by up to 4.4%. The impact of session availability on subsequent injury risk diminished with expanding windows (i.e., availability in the prior 14 days through to the prior 84 days). Lesser availability in the prior 84 days increased injury probabilities by up to 14.1%, only when coupled with greater availability in the prior 7 days. Session availability may provide an informative marker of the impact of prior injury on subsequent injury risk and can be used by coaches and clinicians to guide the progression of training, particularly for athletes that are returning from long periods of injury.
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Affiliation(s)
- Joshua D. Ruddy
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | | | - Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Stuart J. Cormack
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Ryan G. Timmins
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Morgan D. Williams
- School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University of South Wales, Wales, United Kingdom
| | - David L. Carey
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - David A. Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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16
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Mansournia MA, Altman DG. Some methodological issues in the design and analysis of cluster randomised trials. Br J Sports Med 2019; 53:573-575. [PMID: 29903855 DOI: 10.1136/bjsports-2018-099628] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Mohammad A Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Douglas G Altman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
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17
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Effects of magnesium supplementation on carotid intima-media thickness and metabolic profiles in diabetic haemodialysis patients: a randomised, double-blind, placebo-controlled trial. Br J Nutr 2019; 121:809-817. [PMID: 30739626 DOI: 10.1017/s0007114519000163] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study evaluated the effects of Mg administration on carotid intima-media thickness (CIMT), glycaemic control and markers of cardio-metabolic risk in diabetic haemodialysis (HD) patients. This randomised, double-blind, placebo-controlled clinical trial was conducted in fifty-four diabetic HD patients. Participants were randomly divided into two groups to take either 250 mg/d Mg as magnesium oxide (n 27) or placebo (n 27) for 24 weeks. Mg supplementation resulted in a significant reduction in mean (P<0·001) and maximum levels of left CIMT (P=0·02) and mean levels of right CIMT (P=0·004) compared with the placebo. In addition, taking Mg supplements significantly reduced serum insulin levels (β=-9·42 pmol/l; 95% CI -14·94, -3·90; P=0·001), homoeostasis model of assessment-insulin resistance (β=-0·56; 95 % CI -0·89, -0·24; P=0·001) and HbA1c (β=-0·74 %; 95 % CI -1·10, -0·39; P<0·001) and significantly increased the quantitative insulin sensitivity check index (β=0·008; 95 % CI 0·002, 0·01; P=0·002) compared with the placebo. In addition, Mg administration led to a significant reduction in serum total cholesterol (β=-0·30 mmol/l; 95% CI -0·56, -0·04; P=0·02), LDL-cholesterol (β=-0·29 mmol/l; 95% CI -0·52, -0·05; P=0·01), high-sensitivity C-reactive protein (hs-CRP) (P<0·001) and plasma malondialdehyde (MDA) (P=0·04) and a significant rise in plasma total antioxidant capacity (TAC) levels (P<0·001) compared with the placebo. Overall, we found that taking Mg for 24 weeks by diabetic HD patients significantly improved mean and maximum levels of left and mean levels of right CIMT, insulin metabolism, HbA1c, total cholesterol and LDL-cholesterol, hs-CRP, TAC and MDA levels.
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18
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The Association Between Passing Return-to-Sport Criteria and Second Anterior Cruciate Ligament Injury Risk: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2019; 49:43-54. [PMID: 30501385 DOI: 10.2519/jospt.2019.8190] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is no consensus on the components of return-to-sport (RTS) testing following anterior cruciate ligament (ACL) reconstruction or whether passing RTS criteria can reduce a patient's risk of reinjury. OBJECTIVES To determine whether impartial, criteria-based RTS decisions are associated with less risk of a second ACL injury (either graft failure or contralateral ACL injury). METHODS In this systematic review with meta-analysis, the authors conducted an electronic literature search in PubMed/MEDLINE, Embase, CINAHL, SPORTDiscus, and ProQuest Dissertations and Theses Global using database-specific vocabulary related to ACL reconstruction and return to sport. Individual study quality was assessed using the modified Downs and Black checklist, and overall quality of evidence was determined with the Grading of Recommendations Assessment, Development and Evaluation scale. Pooled risk difference (passed versus failed RTS criteria), injury incidence proportion, and the diagnostic accuracy of each RTS criterion were calculated. RESULTS Four studies met the selection criteria. Overall, 42.7% (95% confidence interval [CI]: 18%, 69%) of patients passed RTS criteria, and 14.4% (95% CI: 8%, 21%) of those who passed experienced a second ACL injury (graft rupture or contralateral ACL injury). There was a nonsignificant 3% reduced risk of a second ACL injury after passing RTS criteria (risk difference, -3%; 95% CI: -16%, 10%; I2 = 74%, P = .610). The evidence rating of the Grading of Recommendations Assessment, Development and Evaluation scale was "very low quality," due to imprecision and heterogeneity of the pooled risk difference estimate. CONCLUSION Passing RTS criteria did not show a statistically significant association with risk of a second ACL injury. The quality-of-evidence rating prevents a definitive conclusion on this question and indicates an opportunity for future research. LEVEL OF EVIDENCE Prognosis, Level 2a-. J Orthop Sports Phys Ther 2019;49(2):43-54. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8190.
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19
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Nielsen RO, Bertelsen ML, Ramskov D, Møller M, Hulme A, Theisen D, Finch CF, Fortington LV, Mansournia MA, Parner ET. Time-to-event analysis for sports injury research part 1: time-varying exposures. Br J Sports Med 2019; 53:61-68. [PMID: 30413422 PMCID: PMC6317442 DOI: 10.1136/bjsports-2018-099408] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND 'How much change in training load is too much before injury is sustained, among different athletes?' is a key question in sports medicine and sports science. To address this question the investigator/practitioner must analyse exposure variables that change over time, such as change in training load. Very few studies have included time-varying exposures (eg, training load) and time-varying effect-measure modifiers (eg, previous injury, biomechanics, sleep/stress) when studying sports injury aetiology. AIM To discuss advanced statistical methods suitable for the complex analysis of time-varying exposures such as changes in training load and injury-related outcomes. CONTENT Time-varying exposures and time-varying effect-measure modifiers can be used in time-to-event models to investigate sport injury aetiology. We address four key-questions (i) Does time-to-event modelling allow change in training load to be included as a time-varying exposure for sport injury development? (ii) Why is time-to-event analysis superior to other analytical concepts when analysing training-load related data that changes status over time? (iii) How can researchers include change in training load in a time-to-event analysis? and, (iv) Are researchers able to include other time-varying variables into time-to-event analyses? We emphasise that cleaning datasets, setting up the data, performing analyses with time-varying variables and interpreting the results is time-consuming, and requires dedication. It may need you to ask for assistance from methodological peers as the analytical approaches presented this paper require specialist knowledge and well-honed statistical skills. CONCLUSION To increase knowledge about the association between changes in training load and injury, we encourage sports injury researchers to collaborate with statisticians and/or methodological epidemiologists to carefully consider applying time-to-event models to prospective sports injury data. This will ensure appropriate interpretation of time-to-event data.
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Affiliation(s)
| | | | - Daniel Ramskov
- Section for Sports Science, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Physiotherapy, University College Northern Denmark, Aalborg, Denmark
| | - Merete Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Adam Hulme
- Centre for Human Factors and Sociotechnical Systems, Faculty of Arts, University of the Sunshine Coast, Maroochydore DC, Queensland, Australia
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Lauren Victoria Fortington
- Australian Centre for Research into Injury in Sport and its Prevention, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Faculty of Science and Technology, Federation University Australia, Ballarat, Victoria, Australia
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
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20
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CAREY DAVIDL, CROSSLEY KAYM, WHITELEY ROD, MOSLER ANDREA, ONG KOKLEONG, CROW JUSTIN, MORRIS MEGE. Modeling Training Loads and Injuries: The Dangers of Discretization. Med Sci Sports Exerc 2018; 50:2267-2276. [DOI: 10.1249/mss.0000000000001685] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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21
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Improvement of Prediction of Noncontact Injury in Elite Australian Footballers With Repeated Exposure to Established High-Risk Workload Scenarios. Int J Sports Physiol Perform 2018. [PMID: 29543079 DOI: 10.1123/ijspp.2017-0696] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the effect of multiple high-risk-scenario (HRS) exposures on noncontact injury prediction in elite Australian footballers. DESIGN Retrospective cohort study. METHODS Sessional workload data (session rating of perceived exertion, global positioning system-derived distance, sprint distance, and maximum velocity) from 1 club (N = 60 players) over 3 seasons were collated; several established HRSs were also defined. Accumulated HRS sessional exposures were calculated retrospectively (previous 1-8 wk). Noncontact injury data were documented. Univariate and multivariate Poisson regression models determined injury incidence rate ratios (IRRs) while accounting for moderating effects (preseason workload volume and playing experience). Model performance was evaluated using receiver operating characteristics (area under curve). RESULTS Very low (0-8 sessions: IRR = 5.76; 95% confidence interval [CI], 1.69-19.66) and very high (>15 sessions: IRR = 4.70; 95% CI, 1.49-14.87) exposures to >85% of an individual's maximal velocity over the previous 8 wk were associated with greater injury risk compared with moderate exposures (11-12 sessions) and displayed the best model performance (area under curve = 0.64). A single session corresponding to a very low chronic load condition over the previous week for all workload variables was associated with increased injury risk, with sprint distance (IRR = 3.25; 95% CI, 1.95-5.40) providing the most accurate prediction model (area under curve = 0.63). CONCLUSIONS Minimal exposure to high-velocity efforts (maximum speed exposure and sprint volume) was associated with the greatest injury risk. Being underloaded may be a mediator for noncontact injury in elite Australian football. Preseason workload and playing experience were not moderators of this effect.
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22
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Windt J, Nielsen RO, Zumbo BD. Picking the right tools for the job: opening up the statistical toolkit to build a compelling case in sport and exercise medicine research. Br J Sports Med 2018; 53:987-988. [DOI: 10.1136/bjsports-2018-099427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 01/08/2023]
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23
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Mansournia MA, Altman DG. Invited commentary: methodological issues in the design and analysis of randomised trials. Br J Sports Med 2018; 52:553-555. [PMID: 28756393 DOI: 10.1136/bjsports-2017-098245] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Douglas G Altman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
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24
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Nielsen RO, Chapman CM, Louis WR, Stovitz SD, Mansournia MA, Windt J, Møller M, Parner ET, Hulme A, Bertelsen ML, Finch CF, Casals M, Verhagen E. Seven sins when interpreting statistics in sports injury science. Br J Sports Med 2017; 52:1410-1412. [PMID: 29263023 DOI: 10.1136/bjsports-2017-098524] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | - Cassandra M Chapman
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Winnifred R Louis
- School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Johann Windt
- Experimental Medicine Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Merete Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Adam Hulme
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Queensland, Australia
| | | | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, Australia
| | - Marti Casals
- Sport Performance Analysis Research Group, University of Vic, Barcelona, Spain.,Research Centre Network for Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands
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Fernandes GS, Parekh SM, Moses J, Fuller C, Scammell B, Batt ME, Zhang W, Doherty M. Prevalence of knee pain, radiographic osteoarthritis and arthroplasty in retired professional footballers compared with men in the general population: a cross-sectional study. Br J Sports Med 2017; 52:678-683. [PMID: 29101102 PMCID: PMC5931242 DOI: 10.1136/bjsports-2017-097503] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2017] [Indexed: 02/06/2023]
Abstract
Objectives To determine the prevalence of knee pain, radiographic knee osteoarthritis (RKOA), total knee replacement (TKR) and associated risk factors in male ex-professional footballers compared with men in the general population (comparison group). Methods 1207 male ex-footballers and 4085 men in the general population in the UK were assessed by postal questionnaire. Current knee pain was defined as pain in or around the knees on most days of the previous month. Presence and severity of RKOA were assessed on standardised radiographs using the Nottingham Line Drawing Atlas (NLDA) in a subsample of 470 ex-footballers and 491 men in the comparison group. The adjusted risk ratio (aRR) and adjusted risk difference (aRD) with 95% CI in ex-footballers compared with the general population were calculated using the marginal model in Stata. Results Ex-footballers were more likely than the comparison group to have current knee pain (aRR 1.91, 95% CI 1.77 to 2.06), RKOA (aRR 2.21, 95% CI 1.92 to 2.54) and TKR (aRR 3.61, 95% CI 2.90 to 4.50). Ex-footballers were also more likely to present with chondrocalcinosis (aRR 3.41, 95% CI 2.44 to 4.77). Prevalence of knee pain and RKOA were higher in ex-footballers at all ages. However, even after adjustment for significant knee injury and other risk factors, there was more than a doubling of risk of these outcomes in footballers. Conclusions The prevalence of all knee osteoarthritis outcomes (knee pain, RKOA and TKR) were two to three times higher in male ex-footballers compared with men in the general population group. Knee injury is the main attributable risk factor. Even after adjustment for recognised risk factors, knee osteoarthritis appear to be an occupational hazard of professional football.
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Affiliation(s)
- Gwen Sascha Fernandes
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, UK.,Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, UK
| | - Sanjay Mukund Parekh
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, UK
| | - Jonathan Moses
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | - Colin Fuller
- Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, UK.,Colin Fuller Consultancy Ltd, Sutton Bonnington, UK
| | - Brigitte Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, UK.,Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | - Mark Edward Batt
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, UK.,Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, UK.,Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, UK
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, UK.,Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, UK
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