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Crunkhorn ML, Toohey LA, Charlton P, Drew M, Watson K, Etxebarria N. Injury incidence and prevalence in elite short-course triathletes: a 4-year prospective study. Br J Sports Med 2024:bjsports-2023-107327. [PMID: 38331566 DOI: 10.1136/bjsports-2023-107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To characterise the prevalence, incidence rate (IR) and burden of injuries in elite short-course triathletes over a 4-year training and competition period. METHODS Fifty elite Australian triathletes were prospectively monitored for injury during four consecutive seasons (2018-2021). Injuries requiring medical attention were prospectively recorded and further subcategorised according to time loss. The IR and burden (injury IR×mean injury severity) were calculated per 365 athlete days, with sex differences in IR compared using IR ratios (IRR) from negative binomial regression models. RESULTS Two hundred and sixty-six injuries were reported in 46 (92.0%) athletes, of which 67.3% resulted in time loss. The injury IR was 1.87 injuries per 365 athlete days (95% CI 1.70 to 2.80), and comparable between sexes (IRR 0.82, 95% CI 0.64 to 1.04, p=0.109). Most injuries (70.7%) were training related. The most frequently injured body sites were the ankle (15.8%), foot (12.4%) and lower leg (12.0%). Bone stress injuries (BSIs) were the most burdensome injury type with 31.38 days of time loss per 365 days (95% CI 24.42 to 38.34). Twenty athletes (40.0%) reported at least one bone stress injury (BSI) (range 0-3). The rate of BSIs in female athletes was three times greater compared with male athletes (IRR 2.99, 95% CI 1.26 to 7.07, p=0.013). CONCLUSION Two-thirds of injuries reported in elite short-course triathletes resulted in time loss, with the majority occurring during training activities. Foot, ankle and other lower leg injuries had the highest incidence, with BSIs carrying the highest injury burden. The considerably higher rate of BSI observed in female athletes warrants consideration for future prevention strategies in female triathletes.
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Affiliation(s)
- Melissa Leith Crunkhorn
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
- Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Liam Anthony Toohey
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
- AIS Performance, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
| | - Paula Charlton
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
- Triathlon Australia, Gold Coast, Queensland, Australia
| | - Michael Drew
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
| | - Kate Watson
- Performance Health, Queensland Academy of Sport, Nathan, Queensland, Australia
| | - Naroa Etxebarria
- University of Canberra Research Institute for Sport and Exercise, Canberra, Australian Capital Territory, Australia
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Veith S, Whalan M, Gibson N, Sampson JA. Exploring the true burden of a time-loss injury: full vs partial time-loss in elite academy football (soccer). SCI MED FOOTBALL 2024; 8:6-14. [PMID: 36473725 DOI: 10.1080/24733938.2022.2156587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
In football, the number of days without full participation in training/competition is often used as a surrogate measure for time-loss (TL) caused by injury. However, injury management and return-to-play processes frequently include modified participation, which to date has only been recorded through self-reports. This study aims to demonstrate the differentiation between 'full' (no participation in team football) and 'partial' (reduced/modified participation in team football) burden. Injury and exposure data were collected from 118 male elite footballers (U13-U18) over 3 consecutive seasons according to the Football Consensus Statement. TL injury burden was calculated separately as the number of total, 'full' and 'partial' days lost per 1000 h of exposure. Injury burden (137.2 days lost/1000 h, 95% CI 133.4-141.0) was comprised of 23% (31.9 days lost/1000 h, 95% CI 30.1-33.8) partial TL and 77% (105.3 days lost/1000 h, 95% CI 102.0-108.6) full TL burden. Injuries of moderate severity (8-28 days lost) showed 40% of partial TL. TL injury incidence rate (6.6 injuries/1000 h, 95% CI 5.8-7.5), the number of severe injuries (16%), and the distribution of TL and non-TL injuries (56% and 44%) were comparable to other reports in elite youth footballers. Almost one-quarter of the TL injury burden showed that injured players were still included in some team football activities, which, for injuries with TL >7 days, was likely related to the return to play process. Therefore, reporting on partial TL provides insight into the true impact of injury on participation levels.
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Affiliation(s)
- Stella Veith
- Centre of Medical and Exercise Science, University of Wollongong, Wollongong, NSW, Australia
- Medical Department, Sydney Football Club, Sydney, NSW, Australia
| | - Matthew Whalan
- Centre of Medical and Exercise Science, University of Wollongong, Wollongong, NSW, Australia
- Medical Department, Football Australia, Sydney, NSW, Australia
| | - Neil Gibson
- Centre of Medical and Exercise Science, University of Wollongong, Wollongong, NSW, Australia
| | - John A Sampson
- Centre of Medical and Exercise Science, University of Wollongong, Wollongong, NSW, Australia
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Gijon-Nogueron G, Ortega-Avila AB, Kaldau NC, Fahlstrom M, Felder H, Kerr S, King M, McCaig S, Marchena-Rodriguez A, Cabello-Manrique D. Data Collection Procedures and Injury Definitions in Badminton: A Consensus Statement According to the Delphi Approach. Clin J Sport Med 2022; 32:e444-e450. [PMID: 35588081 DOI: 10.1097/jsm.0000000000001048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/12/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Previous studies involving injury surveillance in badminton players have used nonstandardized injury definitions and data collection methodologies. The purpose of this study was to apply a Delphi method to (1) reach a consensus on an injury definition in badminton and (2) develop a standardized badminton injury report form. An Injury Consensus Group was established under the auspices of the Badminton World Federation, and initial injury definitions and injury report form were developed. An internal panel was formed from the Injury Consensus Group, and an external panel was selected based on a combination of profession, experience in the field, sport-specific knowledge/expertise, and geographical location to obtain a widely representative sample. Through 2 rounds of voting by the external panel, consensus was reached on both the definition of an injury in badminton and a standardized injury report form. The agreed injury definition was "Any physical injury sustained by a player during a match or training regardless if further diagnostic tests were done or if playing time was lost" and the injury report form contained the following 7 sections: Injury record, Diagnosis, Injury mechanism, Regarding pain, Pain and return to play/training after injury, Grade of severity, and Recurrence. We recommend the use of the definitions and methods presented in this consensus statement for the reporting of injury in all international and domestic badminton players. This should make future injury surveillance reports directly comparable and hence more informative in recognizing trends over time and differences between countries.
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Affiliation(s)
- Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing and Podiatry, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Niels Christian Kaldau
- Sports Orthopedic Research Center-Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager & Hvidovre Hospital, Hvidovre, Denmark
| | - Martin Fahlstrom
- Department of Clinical Science, Professional Development, Umeå University, Umeå, Sweden
| | - Hanno Felder
- Department of Biomechanics, Olympic Training Center, Saarbrücken, Germany
| | - Stewart Kerr
- Life Fit Wellness, Healthcare & Exercise Centre, Falkirk, Scotland, United Kingdom
| | - Mark King
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Steve McCaig
- English Institute of Sport, EIS/L'Boro Performance Centre, Loughborough University, Loughborough, United Kingdom
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Establishing the incidence and prevalence of injury and illness in Australian sailing athletes over a full year of training and competition to help determine prevention priorities. J Sci Med Sport 2022; 25:726-731. [DOI: 10.1016/j.jsams.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 11/19/2022]
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Jeffries AC, Wallace L, Coutts AJ, Cohen AM, McCall A, Impellizzeri FM. Injury, Illness, and Training Load in a Professional Contemporary Dance Company: A Prospective Study. J Athl Train 2020; 55:967-976. [PMID: 32818965 DOI: 10.4085/1062-6050-477-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Professional dance is a demanding physical activity with high injury rates. Currently, no epidemiologic data exist regarding the incidence of injury and illness together with training load (TL) over a long period of time. OBJECTIVE To provide a detailed description of injury, illness, and TL occurring in professional contemporary dancers. DESIGN Descriptive epidemiology study. SETTING A single professional contemporary dance company during a 1-year period. PATIENTS OR OTHER PARTICIPANTS A total of 16 male and female professional contemporary dancers. MAIN OUTCOME MEASURE(S) Injury data consisted of medical-attention injury (Med-Inj) and time-loss injury (Time-Inj). Illness was measured using the Wisconsin Upper Respiratory Tract Infection Survey. Training load was collected for each dance session using the session rating of perceived exertion and classified into 3 groups based on individual and group percentiles: low, medium, or high. RESULTS Reported injuries totaled 79 (86.1% new, 6.3% reinjury, and 7.6% exacerbation). The Med-Inj incidence rate was 4.6 per 1000 hours (95% confidence interval [CI] = 3.8, 5.8), and the Time-Inj rate was 1.4 per 1000 hours (95% CI = 0.8, 2.1). The median time until injury for Med-Inj and Time-Inj was 3 months. The number of days dancers experienced illness symptoms was 39.9 ± 26.9 (range = 1-96), with an incidence rate of 9.1 per 1000 hours (95% CI = 7.7, 10.7). Mean weekly TL was 6685 ± 1605 (4641-10 391; arbitrary units). Inconsistent results were found for the incidence of injury and illness based on individual and group categorizations of TL. CONCLUSIONS Professional dancing is associated with high injury and illness rates. This is worrying from a health perspective and underlines the need for further studies to understand how to decrease the risk. The TL is higher than in other sport disciplines, but whether the high incidence of injuries and illnesses is related to high training demands needs additional investigation, possibly conducted as international, multicenter collaborative studies.
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Affiliation(s)
- Annie C Jeffries
- Human Performance Research Centre, Faculty of Health, University of Technology Sydney, Australia
| | - Lee Wallace
- Human Performance Research Centre, Faculty of Health, University of Technology Sydney, Australia
| | - Aaron J Coutts
- Human Performance Research Centre, Faculty of Health, University of Technology Sydney, Australia
| | | | - Alan McCall
- Human Performance Research Centre, Faculty of Health, University of Technology Sydney, Australia.,Arsenal Performance and Research Team, Arsenal Football Club, London, United Kingdom
| | - Franco M Impellizzeri
- Human Performance Research Centre, Faculty of Health, University of Technology Sydney, Australia
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Buckley TA, Howard CM, Oldham JR, Lynall RC, Swanik CB, Getchell N. No Clinical Predictors of Postconcussion Musculoskeletal Injury in College Athletes. Med Sci Sports Exerc 2020; 52:1256-1262. [PMID: 31972629 DOI: 10.1249/mss.0000000000002269] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to identify clinical predictors of postconcussion subsequent musculoskeletal (MSK) injuries. METHODS We recruited 66 National Collegiate Athletic Association intercollegiate student-athletes with a diagnosed concussion as well as 36 National Collegiate Athletic Association student-athletes without a concussion. All participants completed a multifaceted concussion baseline consisting of 1) 22-item 0-6 self-reported symptom checklist with outcomes including both the number of symptoms endorsed (0-22) and 2) total symptom score (0-132), 3) Standard Assessment of Concussion, 4) Balance Error Scoring System, 5) Immediate Post-Concussion Assessment and Cognitive Testing, 6) clinical reaction time, and 7) the King-Devick as well as demographic and injury characteristics. The concussion participants completed the same examination acutely postconcussion, and binary logistic regression was used to identify predictors of subsequent MSK from the change scores (acute minus baseline). From the 66 concussed student-athletes, a subset 36, matched with the healthy athletes, compared the risk of subsequent MSK in the year before and year after their concussion. RESULTS The concussion participants were 1.78 times (95% confidence interval, 1.12-2.84; P = 0.015) more likely to suffer a lower extremity MSK in the year after their concussion than the control participants. The participant demographics and injury characteristics (P = 0.318) and concussion clinical outcomes (P = 0.461) did not predict subsequent MSK. CONCLUSION The concussion participants were 1.78 times more likely to sustain a subsequent MSK; however, no demographic, injury characteristic, or concussion assessments predicted the MSK. Thus, clinicians are not able to utilize common neurological measures or participant demographics to identify those at risk for subsequent lower extremity MSK. Injury prevention strategies should be considered for collegiate student-athletes upon premature return to participation after a concussion to reduce the subsequent MSK.
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Affiliation(s)
| | - Caroline M Howard
- Department of Intercollegiate Athletics, University of Delaware, Newark, DE
| | - Jessie R Oldham
- Micheli Center for Sports Injury Prevention, Boston Children's Hospital, Waltham, MA
| | - Robert C Lynall
- Department of Kinesiology, University of Georgia, Athens, GA
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Injuries across a pre-professional ballet and contemporary dance tertiary training program: A retrospective cohort study. J Sci Med Sport 2020; 23:1166-1171. [PMID: 32703722 DOI: 10.1016/j.jsams.2020.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/15/2020] [Accepted: 06/14/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The study aims to analyse the incidence of medical attention injuries, subsequent injuries, and the median time to injury, across tertiary ballet and contemporary dance training programs. DESIGN Retrospective cohort. METHODS Consenting ballet and contemporary dance students completing the third/final year of two tertiary programs were included. The three-year programs consisted of six semesters. Access was granted to onsite physiotherapy notes, timetables, and academic enrolment. Injury was defined as requiring medical attention. Injury and exposure data were extracted, injuries coded for location and tissue, and subsequent injuries, occurring after an initial index injury, categorised. Mean, standard deviation, range, injury incidence, risk and rate ratios, proportions and Kaplan-Meier curves were calculated to report participant characteristics, and injury patterns across three years of the dance program. RESULTS All 17 students (mean age=20.7 years; standard deviation=1.32) from one program consented to participate, of which all were injured across the three-year program, with 2.71 (95% confidence interval: 2.22, 3.20) injury incidence rate per 1000h, and increasing injury incidences seen across the program. The most injured site and tissue were the ankle (17.65%) and muscle (23.53%) respectively. 74.86% of subsequent injuries were different (affecting a different location and tissue), and 4.88% reinjuries (affecting the same location, tissue, and structure after recovery). The median time to the first injury was seven weeks in the first semester, and later in subsequent year levels. CONCLUSIONS Increasing injury incidences were seen across the program. Most subsequent injuries were different from previous injuries in this cohort. Future research should use exposure measures beyond hours (i.e. intensity) and consider subsequent injuries.
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Bahr R, Clarsen B, Derman W, Dvorak J, Emery CA, Finch CF, Hägglund M, Junge A, Kemp S, Khan KM, Marshall SW, Meeuwisse W, Mountjoy M, Orchard JW, Pluim B, Quarrie KL, Reider B, Schwellnus M, Soligard T, Stokes KA, Timpka T, Verhagen E, Bindra A, Budgett R, Engebretsen L, Erdener U, Chamari K. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)). Br J Sports Med 2020; 54:372-389. [PMID: 32071062 PMCID: PMC7146946 DOI: 10.1136/bjsports-2019-101969] [Citation(s) in RCA: 385] [Impact Index Per Article: 96.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2020] [Indexed: 12/16/2022]
Abstract
Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
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Affiliation(s)
- Roald Bahr
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ben Clarsen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Jiri Dvorak
- Spine Unit, Swiss Concussion Center and Swiss Golf Medical Center, Schulthess Clinic, Zurich, Switzerland
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Caroline F Finch
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Martin Hägglund
- Department of Medical and Health Sciences, Division of Physiotherapy, Linköping University, Linköping, Sweden
| | - Astrid Junge
- Medical School Hamburg, Hamburg, Germany
- Swiss Concussion Centre, Schulthess Clinic, Zurich, Switzerland
| | - Simon Kemp
- Rugby Football Union, London, UK
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Karim M Khan
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- British Journal of Sports Medicine, London, UK
| | - Stephen W Marshall
- Injury Prevention Research Center and Department of Epidemiology at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Willem Meeuwisse
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
- National Hockey League, Calgary, Alberta, Canada
| | - Margo Mountjoy
- Department of Family Medicine (Sport Medicine), McMaster University, Hamilton, Ontario, Canada
- FINA Bureau (Sport Medicine), Lausanne, Switzerland
| | - John W Orchard
- School of Public Health, University of Sydney, New South Wales, Sydney, Australia
| | - Babette Pluim
- Department of Sports Medicine, Royal Netherlands Lawn Tennis Association, Amstelveen, The Netherlands
- Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center of Excellence, Amsterdam, The Netherlands
- Faculty of Health Sciences, University of Pretoria, Hatfield, South Africa
| | - Kenneth L Quarrie
- New Zealand Rugby, Wellington, New Zealand
- Sports Performance Research Institute New Zealand, AUT University, Auckland, New Zealand
| | - Bruce Reider
- Department of Orthopaedic Surgery and Rehabilitation, University of Chicago, Chicago, Illinois, USA
| | - Martin Schwellnus
- Sport, Exercise Medicine and Lifestyle Research Institute (SEMLI), University of Pretoria, Hatfield, South Africa
| | - Torbjørn Soligard
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK
- Rugby Football Union, Twickenham, UK
| | - Toomas Timpka
- Athletics Research Center, Linköping University, Linköping, Sweden
- Centre for Healthcare Development, Region Östergötland, Linköping, Sweden
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC, Amsterdam, The Netherlands
| | - Abhinav Bindra
- Athlete Commission, International Olympic Committee, Lausanne, Switzerland
| | - Richard Budgett
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Uğur Erdener
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | - Karim Chamari
- Aspetar Sports Medicine and Orthopedic Hospital, Doha, Qatar
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Bahr R, Clarsen B, Derman W, Dvorak J, Emery CA, Finch CF, Hägglund M, Junge A, Kemp S, Khan KM, Marshall SW, Meeuwisse W, Mountjoy M, Orchard JW, Pluim B, Quarrie KL, Reider B, Schwellnus M, Soligard T, Stokes KA, Timpka T, Verhagen E, Bindra A, Budgett R, Engebretsen L, Erdener U, Chamari K. International Olympic Committee Consensus Statement: Methods for Recording and Reporting of Epidemiological Data on Injury and Illness in Sports 2020 (Including the STROBE Extension for Sports Injury and Illness Surveillance (STROBE-SIIS)). Orthop J Sports Med 2020; 8:2325967120902908. [PMID: 32118084 PMCID: PMC7029549 DOI: 10.1177/2325967120902908] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date. OBJECTIVE To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. STUDY DESIGN Consensus statement of the International Olympic Committee (IOC). METHODS The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019. RESULTS This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). CONCLUSION The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
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Affiliation(s)
| | - Roald Bahr
- Roald Bahr, MD, PhD, Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, PB 4014 Ullevål Stadion, 0806 Oslo, Norway ()
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Toohey LA, Drew MK, Bullock N, Caling B, Fortington LV, Finch CF, Cook JL. Epidemiology of elite sprint kayak injuries: A 3-year prospective study. J Sci Med Sport 2019; 22:1108-1113. [PMID: 31239203 DOI: 10.1016/j.jsams.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To analyse the characteristics of injuries sustained by elite sprint kayak athletes, to investigate relationships between initial and subsequent injuries, and to examine injury differences between male and female athletes. DESIGN Descriptive epidemiology study. METHODS Data from 63 athletes (37 male, 26 female) of the Australian national sprint kayak squad were prospectively collected over three continuous years (September 2014-August 2017). All medical attention injuries were recorded irrespective of time-loss and modality of training. Descriptive analyses were performed, and frequency comparisons across genders assessed with chi squared tests. RESULTS Forty-nine athletes (78%) sustained 146 injuries (median=2, interquartile range=1-4, range=0-12). Most injuries were to the upper limb (48%), with the shoulder being the most common body site injured (27%). Thirty-one athletes (49%) sustained at least one subsequent injury, equating to 97 subsequent injuries. The majority (68%) of subsequent injuries occurred at a different site and nature to previous injuries. Male athletes were more likely to sustain an injury than remain injury free compared to female athletes (Chi2(1)=6.75, p=0.009), but there was no difference between males and females who thereafter sustained a subsequent injury (Chi2(1)=0.84, p=0.359). CONCLUSIONS Injury occurrence is common in sprint kayak, with many athletes experiencing more than one injury. Small variations in injury characteristics exist between male and female athletes in sprint kayak. This study identifies upper limb and trunk, and joint and muscle injuries as the most prevalent sprint kayak injuries, providing a focus for the development of future injury prevention strategies.
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Affiliation(s)
- Liam A Toohey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia; Athlete Availability Program, Australian Institute of Sport, Australia.
| | - Michael K Drew
- Athlete Availability Program, Australian Institute of Sport, Australia
| | - Nicola Bullock
- Paddle Australia, Australia; Physiology, Australian Institute of Sport, Australia; Bond Institute of Health and Sport, Bond University, Australia
| | | | - Lauren V Fortington
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Caroline F Finch
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia; Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Australia
| | - Jill L Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Australia
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11
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Toohey LA, Drew MK, Finch CF, Cook JL, Fortington LV. A 2-Year Prospective Study of Injury Epidemiology in Elite Australian Rugby Sevens: Exploration of Incidence Rates, Severity, Injury Type, and Subsequent Injury in Men and Women. Am J Sports Med 2019; 47:1302-1311. [PMID: 30779880 DOI: 10.1177/0363546518825380] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries are common in rugby sevens, but studies to date have been limited to short, noncontinuous periods and reporting of match injuries only. PURPOSE To report the injury incidence rate (IIR), severity, and burden of injuries sustained by men and women in the Australian rugby sevens program and to provide the first longitudinal investigation of subsequent injury occurrence in rugby sevens looking beyond tournament injuries only. STUDY DESIGN Descriptive epidemiology study. METHODS Ninety international rugby sevens players (55 men and 35 women) were prospectively followed over 2 consecutive seasons (2015-2016 and 2016-2017). All medical attention injuries were reported irrespective of time loss. Individual exposure in terms of minutes, distance, and high-speed distance was captured for each player for matches and on-field training, with the use of global positioning system devices. The IIR and injury burden (IIR × days lost to injury) were calculated per 1000 player-hours, and descriptive analyses were performed. RESULTS Seventy-three players (81.1%) sustained 365 injuries at an IIR of 43.2 per 1000 player-hours (95% CI, 43.0-43.3). As compared with male players, female players experienced a lower IIR (incidence rate ratio, 0.91; 95% CI, 0.90-0.91). Female players also sustained a higher proportion of injuries to the trunk region (relative risk, 1.75; 95% CI, 1.28-2.40) but a lower number to the head/neck region (relative risk, 0.58; 95% CI, 0.37-0.93; P = .011). The majority (80.7%) of subsequent injuries were of a different site and nature than previous injuries. A trend toward a reduced number of days, participation time, distance, and high-speed distance completed before the next injury was observed after successive injury occurrence. CONCLUSION Female players have a lower IIR than male players, with variation of injury profiles observed between sexes. With a surveillance period of 2 years, subsequent injuries account for the majority of injuries sustained in rugby sevens, and they are typically different from previous types of sustained injuries. After each successive injury, the risk profile for future injury occurrence appears to be altered, which warrants further investigation to inform injury prevention strategies in rugby sevens.
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Affiliation(s)
- Liam A Toohey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia.,Athlete Availability Program, Australian Institute of Sport, Bruce, Australia
| | - Michael K Drew
- Athlete Availability Program, Australian Institute of Sport, Bruce, Australia
| | - Caroline F Finch
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Jill L Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia
| | - Lauren V Fortington
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia.,Federation University Australia, Ballarat, Australia
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12
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Toohey LA, Drew MK, Fortington LV, Menaspa MJ, Finch CF, Cook JL. Comparison of subsequent injury categorisation (SIC) models and their application in a sporting population. Inj Epidemiol 2019; 6:9. [PMID: 31245258 PMCID: PMC6582673 DOI: 10.1186/s40621-019-0183-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 02/01/2019] [Indexed: 11/28/2022] Open
Abstract
Background The original subsequent injury categorisation (SIC-1.0) model aimed to classify relationships between chronological injury sequences to provide insight into the complexity and causation of subsequent injury occurrence. An updated model has recently been published. Comparison of the data coded according to the original and revised subsequent injury categorisation (SIC-1.0 and SIC-2.0) models has yet been formally compared. Methods Medical attention injury data was prospectively collected for 42 elite water polo players over an 8 month surveillance period. The SIC-1.0 and SIC-2.0 models were retrospectively applied to the injury data. The injury categorisation from the two models was compared using descriptive statistics. Results Seventy-four injuries were sustained by the 42 players (median = 2, range = 0–5), of which 32 injuries (43.2%) occurred subsequent to a previous injury. The majority of subsequent injuries were coded as occurring at a different site and being of a different nature, while also being considered clinically unrelated to the previous injury (SIC-1.0 category 10 = 57.9%; SIC-2.0 clinical category 16 = 54.4%). Application of the SIC-2.0 model resulted in a greater distribution of category allocation compared to the SIC-1.0 model that reflects a greater precision in the SIC-2.0 model. Conclusions Subsequent injury categorisation of sport injury data can be undertaken using either the original (SIC-1.0) or the revised (SIC-2.0) model to obtain similar results. However, the SIC-2.0 model offers the ability to identify a larger number of mutually exclusive categories, while not relying on clinical adjudication for category allocation. The increased precision of SIC-2.0 is advantageous for clinical application and consideration of injury relationships. Electronic supplementary material The online version of this article (10.1186/s40621-019-0183-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Liam A Toohey
- 1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, School of Allied Health (Physiotherapy), Bundoora, VIC 3086 Australia.,2Athlete Availability Program, Applied Technology and Innovation, Australian Institute of Sport, Leverrier Street, Bruce, ACT 2617 Australia
| | - Michael K Drew
- 2Athlete Availability Program, Applied Technology and Innovation, Australian Institute of Sport, Leverrier Street, Bruce, ACT 2617 Australia
| | - Lauren V Fortington
- 1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, School of Allied Health (Physiotherapy), Bundoora, VIC 3086 Australia.,4School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA Australia.,5Federation University Australia, Ballarat, Australia
| | - Miranda J Menaspa
- 3Physical Therapies, Australian Institute of Sport, Bruce, ACT Australia
| | - Caroline F Finch
- 1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, School of Allied Health (Physiotherapy), Bundoora, VIC 3086 Australia.,4School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA Australia
| | - Jill L Cook
- 1La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, School of Allied Health (Physiotherapy), Bundoora, VIC 3086 Australia
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Moita JP, Gomes A, Xarez L, Coelho C. The role of prediagnostic data in injury epidemiology in preprofessional dancers. Scand J Med Sci Sports 2019; 29:606-614. [PMID: 30634200 DOI: 10.1111/sms.13382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/31/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION preprofessional dance training starts at very early ages, on a highly demanding environment placing students at significant risk for injury. Injury management and prevention are a matter of concern. Given the constant interchangeability of risk factors, identifying injury patterns may prove to be equally as important. Data looking back from the time of injury through context-specific approaches are missing. OBJECTIVES To identify activity-related injury patterns based on prediagnostic data. METHODS Prospective, non-randomized, observational study, over a 3 years period on a full-time preprofessional dance school featuring both gender students aged 9-21 years old. Non-parametric statistics were used. RESULTS A total of 625 dance injury records from 209 students, n = 68 males and n = 141 females, were analyzed. Season injury risk probability was identified, proving different for each skill level (SkL). Multiple individual injuries revealed a trend toward prevalence rates in advanced level, while index injuries incidence becomes more noticeable in entry level students. Overall incidence rates had no significant differences within SkL. Anatomical location was in line with previous research, although differences were found between gender and SkL. Most injuries occurred in classes, with jumps standing out as the main motor action associated with injury symptoms of gradual onset mechanism. CONCLUSION Dance injuries happen because of dance practice. Knowing the context of injury history from the injured dancer perspective is determinant for management and prevention. prediagnostic data are an umbrella term encompassing several aspects of injury background and represents fertile ground for research. Context-specific methodological approaches are recommended.
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Affiliation(s)
- João Paulo Moita
- Escola Superior de Saúde Atlântica, Barcarena, Portugal.,Escola de Dança do Conservatório Nacional, Lisboa, Portugal
| | - António Gomes
- Departamento de Cirurgia, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
| | - Luís Xarez
- Faculdade de Motricidade Humana, Laboratório do Comportamento Motor, Universidade de Lisboa, Cruz Quebrada, Portugal
| | - Constança Coelho
- Universidade de Lisboa, Faculdade de Medicina de Lisboa, Laboratório de Genética, Instituto de Saúde Ambiental, Lisboa, Portugal
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Schneuer FJ, Bell JC, Adams SE, Brown J, Finch C, Nassar N. The burden of hospitalized sports-related injuries in children: an Australian population-based study, 2005-2013. Inj Epidemiol 2018; 5:45. [PMID: 30556103 PMCID: PMC6295440 DOI: 10.1186/s40621-018-0175-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 11/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is concern about recent increase and severity of sports-related injuries in children. Despite the benefits of sports participation, injuries may carry long-term health consequences. We aimed to evaluate the prevalence, characteristics and types of hospitalized sports-related injuries in children. Methods Population-based study of all acute sports-related injuries requiring hospitalization in children 5 to 15 years of age in New South Wales (NSW), Australia, 2005–2013. Health information was obtained from the NSW Admitted Patient Data Collection, a census of all hospital admissions from public and private hospitals. Children with a recorded ICD10-AM injury code (S00-T79) and sport-related activity code (U50-U70) were included. Prevalence and trend in injuries by age group, sporting code, body region affected and type of injury were assessed. Results There was a total of 20,034 hospitalizations for sports-related injuries (2.7% of all hospitalizations in children aged 5–15 years), involving 21,346 recorded injuries in 19,576 children. The overall population hospitalization period prevalence was 227 per 100,000 children aged 5–15 years in 2005–2013, remaining stable over time (RR 0.99; 95% CI 0.98–1.00). Football codes such as rugby league/union and soccer combined represented nearly two thirds of the total (60%). The most common body regions affected were the forearm (31%) head (15%) and hand injuries (13%). Fractures accounted for 65% of injuries followed by dislocations (10%) and traumatic brain injury (10%). Compared to other age groups, children aged 5–8 years had double the proportion of shoulder (15% vs. 7%) while 13–15 year olds had higher proportion of lower-leg (14% vs. 8%) and knee (6% vs.2%) injuries. One in seven injuries sustained while playing rugby league/union, baseball and hockey were traumatic brain injuries. A total of 444 (2.2%) of children had more than one hospitalization for sports-related injuries. Conclusion On average, six children were hospitalized every day for sports-related injuries in the last decade with trends remaining stable. The most common sports involved were football codes, one in three injuries involved the forearm and two thirds were fractures. These findings can be used to inform health policy and sporting governing bodies to target preventive interventions and promote safe sports participation in children. Electronic supplementary material The online version of this article (10.1186/s40621-018-0175-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francisco J Schneuer
- Child Population and Translational Health Research, The Children's Hospital at Westmead Clinical School, Level 2 The Hub, Charles Perkins Centre D17, The University of Sydney, Westmead, NSW, 2006, Australia.
| | - Jane C Bell
- Child Population and Translational Health Research, The Children's Hospital at Westmead Clinical School, Level 2 The Hub, Charles Perkins Centre D17, The University of Sydney, Westmead, NSW, 2006, Australia
| | - Susan E Adams
- Injury Prevention, Neuroscience Research Australia, Randwick, NSW, Australia.,Department Paediatric Surgery, Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Kensington, NSW, Australia
| | - Julie Brown
- Injury Prevention, Neuroscience Research Australia, Randwick, NSW, Australia
| | - Caroline Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Edith Cowan University, Perth, WA, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, The Children's Hospital at Westmead Clinical School, Level 2 The Hub, Charles Perkins Centre D17, The University of Sydney, Westmead, NSW, 2006, Australia
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15
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Toohey LA, Drew MK, Fortington LV, Finch CF, Cook JL. An Updated Subsequent Injury Categorisation Model (SIC-2.0): Data-Driven Categorisation of Subsequent Injuries in Sport. Sports Med 2018; 48:2199-2210. [PMID: 29500797 DOI: 10.1007/s40279-018-0879-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accounting for subsequent injuries is critical for sports injury epidemiology. The subsequent injury categorisation (SIC-1.0) model was developed to create a framework for accurate categorisation of subsequent injuries but its operationalisation has been challenging. OBJECTIVES The objective of this study was to update the subsequent injury categorisation (SIC-1.0 to SIC-2.0) model to improve its utility and application to sports injury datasets, and to test its applicability to a sports injury dataset. METHODS The SIC-1.0 model was expanded to include two levels of categorisation describing how previous injuries relate to subsequent events. A data-driven classification level was established containing eight discrete injury categories identifiable without clinical input. A sequential classification level that sub-categorised the data-driven categories according to their level of clinical relatedness has 16 distinct subsequent injury types. Manual and automated SIC-2.0 model categorisation were applied to a prospective injury dataset collected for elite rugby sevens players over a 2-year period. Absolute agreement between the two coding methods was assessed. RESULTS An automated script for automatic data-driven categorisation and a flowchart for manual coding were developed for the SIC-2.0 model. The SIC-2.0 model was applied to 246 injuries sustained by 55 players (median four injuries, range 1-12), 46 (83.6%) of whom experienced more than one injury. The majority of subsequent injuries (78.7%) were sustained to a different site and were of a different nature. Absolute agreement between the manual coding and automated statistical script category allocation was 100%. CONCLUSIONS The updated SIC-2.0 model provides a simple flowchart and automated electronic script to allow both an accurate and efficient method of categorising subsequent injury data in sport.
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Affiliation(s)
- Liam A Toohey
- Department of Physical Therapies, c/o AIS Physical Therapies, Australian Institute of Sport, Leverrier Street, Bruce, ACT, 2617, Australia.
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia.
- School of Allied Health (Physiotherapy), Sport and Exercise Medicine Department, La Trobe University, Bundoora, VIC, 3086, Australia.
| | - Michael K Drew
- Department of Physical Therapies, c/o AIS Physical Therapies, Australian Institute of Sport, Leverrier Street, Bruce, ACT, 2617, Australia
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
| | - Lauren V Fortington
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
- School of Allied Health (Physiotherapy), Sport and Exercise Medicine Department, La Trobe University, Bundoora, VIC, 3086, Australia
| | - Jill L Cook
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
- School of Allied Health (Physiotherapy), Sport and Exercise Medicine Department, La Trobe University, Bundoora, VIC, 3086, Australia
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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 2: time-varying outcomes. Br J Sports Med 2018; 53:70-78. [PMID: 30413427 PMCID: PMC6317441 DOI: 10.1136/bjsports-2018-100000] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Time-to-event modelling is underutilised in sports injury research. Still, sports injury researchers have been encouraged to consider time-to-event analyses as a powerful alternative to other statistical methods. Therefore, it is important to shed light on statistical approaches suitable for analysing training load related key-questions within the sports injury domain. CONTENT In the present article, we illuminate: (i) the possibilities of including time-varying outcomes in time-to-event analyses, (ii) how to deal with a situation where different types of sports injuries are included in the analyses (ie, competing risks), and (iii) how to deal with the situation where multiple subsequent injuries occur in the same athlete. CONCLUSION Time-to-event analyses can handle time-varying outcomes, competing risk and multiple subsequent injuries. Although powerful, time-to-event has important requirements: researchers are encouraged to carefully consider prior to any data collection that five injuries per exposure state or transition is needed to avoid conducting statistical analyses on time-to-event data leading to biased results. This requirement becomes particularly difficult to accommodate when a stratified analysis is required as the number of variables increases exponentially for each additional strata included. In future sports injury research, we need stratified analyses if the target of our research is to respond to the question: 'how much change in training load is too much before injury is sustained, among athletes with different characteristics?' Responding to this question using multiple time-varying exposures (and outcomes) requires millions of injuries. This should not be a barrier for future research, but collaborations across borders to collecting the amount of data needed seems to be an important step forward.
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Affiliation(s)
| | | | - Daniel Ramskov
- Department of Public Health, Section for Sports Science, 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, Business and Law, 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, Islamic Republic of Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Erik Thorlund Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
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