Incidence rate and burden of illness at the Pyeongchang 2018 Paralympic Winter Games

Incidence of injury and illness at the Beijing 2022 Paralympic Winter Games held in a closed-loop environment: a prospective cohort study of 7332 athlete days

OBJECTIVE

To describe the epidemiology of injuries and illnesses sustained during the Beijing 2022 Paralympic Winter Games, organised in a closed-loop environment to adhere with COVID-19 restrictions.

METHODS

Injuries and illnesses from all teams were recorded on a daily basis by team medical staff on a web-based form and by local organising committee medical (polyclinic) facilities and venue medical support. Duplicates recorded on both systems were removed. Incidence of injuries and illnesses are reported per 1000 athlete days (95% CI).

RESULTS

564 athletes (426 male and 138 female) representing 46 countries were monitored for the 13-day period of the Beijing 2022 Paralympic Winter Games (7332 athlete days). The overall incidences were 13.0 injuries (10.6-15.8) and 6.1 illnesses (4.5-8.4) per 1000 athlete days. The incidence of injury in alpine skiing (19.9; 15.2-26.1) was significantly higher compared with Nordic skiing, ice hockey and wheelchair curling (p<0.05), while the incidence of respiratory illness was significantly higher in Nordic skiing (1.6; 0.9-2.9) compared with alpine skiing, ice hockey and snowboarding (p<0.05).

CONCLUSION

The incidence of both injury and illness at the Beijing 2022 Games were the lowest yet reported in the Paralympic Winter Games. The incidence of injury was highest in alpine skiing. These findings underscore the importance of ongoing vigilance and continued injury risk mitigation strategies to safeguard the well-being of athletes in these high-risk competitions. Respiratory illnesses were most commonly reported in Nordic skiing, which included the three cases of COVID-19 recorded at the games.

High rates of respiratory illnesses upon arrival: lessons from Team USA at the Santiago 2023 Pan American and Parapan American Games

OBJECTIVE

To describe the incidence and characteristics of injuries and illnesses among Team USA athletes competing at the Santiago 2023 Pan American Games (PAG) and Parapan American Games (PPAG), with a particular focus on the incidence of respiratory illnesses and on injuries for sports new to the Olympic and Paralympic programmes.

METHODS

Illnesses and injuries occurring among the 870 Team USA athletes competing in the Santiago 2023 PAG or PPAG were documented within Team USA's Injury and Illness Surveillance system. Illness and injury incidence per 1000 athlete-days (ADs) and incidence ratios (IR) were calculated, both with 95% CIs.

RESULTS

Illness (IR 2.5, 95% CI 1.6, 3.9) and injury (IR 1.8, 95% CI 1.3, 2.5) rates were greater during PPAG compared with PAG. Illness rates were higher in the pre-opening ceremony period compared with the competition period for both PAG (IR 2.7, 95% CI 1.1, 5.9) and PPAG (IR 1.9, 95% CI 0.9, 3.8). Respiratory illness was the most common illness with 3.2% and 8.9% of all Team USA athletes reporting a respiratory illness during the PAG and PPAG, respectively. Sports that are relatively new to the Olympic/Paralympic programmes exhibited the highest injury rates during the Games: breaking (250.0 (91.7, 544.2) per 1000 ADs), Para taekwondo (93.8 (19.3, 274.0) per 1000 ADs) and surfing (88.9 (24.2, 227.6) per 1000 ADs).

CONCLUSION

Respiratory illness rates were the most common type of illness during both PAG and PPAG and were more likely to occur prior to competition starting. Our data have identified high injury risk populations (breaking, surfing, Para taekwondo) and timing (pre-opening ceremony period) for further risk factor analysis.

Year-round injury and illness surveillance in UK summer paralympic sport athletes: 2016-2019

OBJECTIVE

To identify the priority injuries and illnesses across UK summer Paralympic World Class Programmes (WCP).

METHODS

Four years (2016-2019) of electronic medical records from 360 athletes across 17 Paralympic WCP sports were analysed. Methods were based on the 2021 International Paralympic Committee translation of the original 2020 International Olympic Committee consensus statement for epidemiological recording and reporting. This included reporting incidence (count of injury per athlete year) and burden (time loss days per athlete year) of injuries by impairment category.

RESULTS

836 injuries and 453 illnesses were recorded during the surveillance period, accounting for 34 638 and 10 032 time-loss days, respectively. 216 (60%) athletes reported at least one injury, while 171 (47.5%) reported at least one illness. There were 0.9 injuries per athlete year, resulting in a mean injury burden of 38.1 days per athlete year. The lumbar/pelvis, shoulder and thoracic/ribs body region had the greatest incidence whereas the shoulder, lumbar/pelvis and wrist had the greatest injury burden. All impairment categories had shoulder or lumbar/pelvis as the body region with the greatest incidence, however the burden of body areas did not always reflect the incidence. Athletes reported 0.5 illnesses per athlete year, resulting in an average illness burden of 11.3 days per athlete year. The respiratory, gastrointestinal, dermatological and genitourinary organ systems had the greatest illness incidence.

CONCLUSIONS

To optimise health and performance in Paralympic sport athletes, system-wide mitigation initiatives should target priority injury problems occurring in the lumbar/pelvis, shoulder, thoracic spine/ribs and wrist. Illness types causing the greatest burden vary with impairment group, and illness mitigation initiatives should consider athlete impairment types in their design, while continuing to note the high incidence of respiratory and gastrointestinal illness across all impairments. Further research should examine associated risk factors and the influence of impairment categorisation.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Team USA injury and illness incidence at the 2022 Beijing Winter Olympic and Paralympic Games

OBJECTIVE

The purpose of this study was to determine the injury and illness incidence from Team USA athletes from the 2022 Beijing Winter Olympic and Paralympic Games and assess any sex-based differences or differences between Olympic and Paralympic athletes.

METHODS

Team USA Olympic (n=231, 48.5% female) and Team USA Paralympic (n=63, 22.2% female) athletes had medical encounters documented during the Games. Injuries and illnesses were defined according to the 2020 International Olympic Committee Consensus Statement and reviewed for accuracy by a physician. Incidence rates were calculated per 1000 athlete-days and further analysed by sex, sport, anatomical location, type of illness, injury event and injury mechanism, with incident rate ratios (IRRs) used for group comparisons.

RESULTS

There were no differences in illness (Olympic illness, IRR=0.99 (95% CI 0.48 to 2.07), p=0.998; Paralympic illness, IRR=1.43 (95% CI 0.41 to 4.97), p=0.572) or injury rates (Olympic injury, IRR=0.63 (95% CI 0.39 to 1.03), p=0.062; Paralympic injury, IRR=1.01 (95% CI 0.43 to 2.35), p=0.988) between male and female (reference group) athletes. However, Olympic athletes had significantly lower illness (IRR=0.41 (95% CI 0.22 to 0.76), p=0.003) and injury (IRR=0.56 (95% CI 0.37 to 0.87), p=0.009) risks compared with Paralympic athletes.

CONCLUSION

No significant sex-related differences in injury or illness were detected in Team USA Olympic or Paralympic participating in the 2022 Beijing Winter Games. However, Paralympic athletes exhibited higher rates of injury and illness compared with their Olympic counterparts. This study highlights delegation-specific epidemiological data which may facilitate more focused approaches for injury and illness prevention.

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

INTRODUCTION

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

OBJECTIVE

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

DESIGN

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

SETTING

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSION

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

Incidence and burden of illness at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days

OBJECTIVE

To describe the incidence and burden of illness at the Tokyo 2020 Paralympic Games, which was organised with strict COVID-19 countermeasures.

METHODS

Daily illnesses were recorded via the web-based injury and illness surveillance system (teams with their own medical staff; n=81), and local polyclinic services (teams without their own medical staff; n=81). Illness proportion, incidence and burden were reported for all illnesses and in subgroups by sex, age, competition period, sports and physiological system.

RESULTS

4403 athletes (1853 female and 2550 male) from 162 countries were monitored for the 15-day period of the Tokyo Paralympic Games (66 045 athlete days). The overall incidence of illnesses per 1000 athlete days was 4.2 (95% CI 3.8 to 4.8; 280 illnesses). The highest incidences were in wheelchair tennis (7.1), shooting (6.1) and the new sport of badminton (5.9). A higher incidence was observed in female compared with male athletes (5.1 vs 3.6; p=0.005), as well as during the precompetition versus competition period (7.0 vs 3.5; p<0.0001). Dermatological and respiratory illnesses had the highest incidence (1.1 and 0.8, respectively). Illness burden was 4.9 days per 1000 athlete days and 23% of illnesses resulted in time loss from training/competition>1 day.

CONCLUSION

The incidence of illness at the Tokyo 2020 Paralympic Games was the lowest yet to be recorded in either the summer or winter Paralympic Games. Dermatological and respiratory illnesses were the most common, with the burden of respiratory illness being the highest, largely due to time loss associated with COVID-19 cases. Infection countermeasures appeared successful in reducing respiratory and overall illness, suggesting implementation in future Paralympic Games may mitigate illness risk.

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 1: acute respiratory infections

Acute illnesses affecting the respiratory tract are common and form a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. Acute respiratory illness (ARill) can broadly be classified as non-infective ARill and acute respiratory infections (ARinf). The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to ARinf in athletes. The International Olympic Committee (IOC) Medical and Scientific Commission appointed an international consensus group to review ARill (non-infective ARill and ARinf) in athletes. Six subgroups of the IOC Consensus group were initially established to review the following key areas of ARill in athletes: (1) epidemiology/risk factors for ARill, (2) ARinf, (3) non-infective ARill including ARill due to environmental exposure, (4) acute asthma and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport and (6) acute nasal/vocal cord dysfunction presenting as ARill. Several systematic and narrative reviews were conducted by IOC consensus subgroups, and these then formed the basis of sections in the consensus documents. Drafting and internal review of sections were allocated to 'core' members of the consensus group, and an advanced draft of the consensus document was discussed during a meeting of the main consensus core group in Lausanne, Switzerland on 11 to 12 October 2021. Final edits were completed after the meeting. This consensus document (part 1) focusses on ARinf, which accounts for the majority of ARill in athletes. The first section of this consensus proposes a set of definitions and classifications of ARinf in athletes to standardise future data collection and reporting. The remainder of the consensus paper examines a wide range of clinical considerations related to ARinf in athletes: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of infection during exercise, effects of infection on exercise/sports performance and return-to-sport guidelines.

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 2: non-infective acute respiratory illness

Acute respiratory illness (ARill) is common and threatens the health of athletes. ARill in athletes forms a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to non-infective ARill in athletes. The International Olympic Committee (IOC) Medical and Scientific Committee appointed an international consensus group to review ARill in athletes. Key areas of ARill in athletes were originally identified and six subgroups of the IOC Consensus group established to review the following aspects: (1) epidemiology/risk factors for ARill, (2) infective ARill, (3) non-infective ARill, (4) acute asthma/exercise-induced bronchoconstriction and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport (RTS) and (6) acute nasal/laryngeal obstruction presenting as ARill. Following several reviews conducted by subgroups, the sections of the consensus documents were allocated to 'core' members for drafting and internal review. An advanced draft of the consensus document was discussed during a meeting of the main consensus core group, and final edits were completed prior to submission of the manuscript. This document (part 2) of this consensus focuses on respiratory conditions causing non-infective ARill in athletes. These include non-inflammatory obstructive nasal, laryngeal, tracheal or bronchial conditions or non-infective inflammatory conditions of the respiratory epithelium that affect the upper and/or lower airways, frequently as a continuum. The following aspects of more common as well as lesser-known non-infective ARill in athletes are reviewed: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations and risks of illness during exercise, effects of illness on exercise/sports performance and RTS guidelines.

Injuries in Judo Athletes With Disabilities: Prevalence, Magnitude, and Sport-Related Mechanisms

CONTEXT

The participation of judo athletes with disabilities in competitions has increased over the years as well as the burden of sports-related injuries and illnesses in this population. However, there is limited knowledge about sports-related injuries in judo athletes with different disabilities.

OBJECTIVE

To investigate the prevalence of injuries in judo athletes with disabilities, considering the different impairment groups, magnitude of injury (ie, mechanism, nature, and severity of injury), and specific body parts.

DESIGN

Cross-sectional study (level of evidence, 3).

SETTING

Brazilian Judo athletes with disabilities.

PATIENTS

Fifty-one judo athletes with disabilities (15 men and 36 women) participated in this study.

MAIN OUTCOME MEASURES

Data were obtained from an adapted injury report form. The prevalence of injuries was assessed, considering type of impairment, body parts, mechanisms, and severity as well as differences between male and female athletes, with the significance level set at P < .05.

RESULTS

The results demonstrated a high prevalence of injuries in female athletes with visual impairment (n = 11, 73.3%) and male athletes with amputations (n = 14, 38.8%). A high prevalence was found in the national group, especially for male athletes (n = 29, 80.5%). Among athletes who had injuries, 69.4% (n = 12) of male and 80.0% (n = 25) of female athletes' injuries occurred due to direct contact with other athletes, and 72.2% (n = 26) of male and 86.6% (n = 13) of female athletes' injuries were in the training environment. The magnitude of injuries ranged from moderate to severe for male and female athletes. The knee (n = 25, 49.0%) and shoulder (n = 12, 23.5%) were the body parts most affected by injuries in both male and female athletes.

CONCLUSION

A large percentage of judo athletes with disabilities reported experiencing an injury during the previous 2 years; percentages were greater in athletes with visual and physical impairment. Moreover, most injuries occurred in the knee or shoulder, during training, and in direct contact with other athletes and were of severe magnitude.

Lessons from the Winter Paralympic Games disclosing the epidemiology of winter sports injury in paralytic athletes: a meta-analysis

BACKGROUND

In this study, the incidence rate of the injury in Winter Paralympic Games was summarized. Besides, to testify the underlying factors of injury incidence heterogeneity, the difference of these events incidence between different Paralympic Winter Games was investigated by meta regression analysis.

METHODS

Electronic databases were searched for full-text publications on sports related injury in Winter Paralympic Games. And meta-regression was used to analyze the heterogeneity.

RESULTS

Four studies were included. The incidence of sports related injury was 0.21 (95% CI 0.15-0.31) in all items, 0.22 in female athletes (95% CI 0.12-0.32), and 0.21 in male athletes (95% CI 0.11-0.30), respectively. The incidence of sports related injury was 0.10 (95% CI 0.08-0.12) in alpine skiing, 0.01 (95% CI 0-0.02) in Nordic skiing, and 0.22 in sledge hockey (95% CI 0.05-0.40). Meta-regression suggested the year and the host country couldn't influence the injury incidence.

CONCLUSION

The present study summarized the incidence of sports related injury in Winter Paralympic Games, indicated similar injury risk between female athletes and male athletes, and accentuated the careful protection on sledge hockey. This study pointed out that sledge hockey with the highest risk of sports related injury should draw great attention to improve the corresponding protective measures to decrease its injury probability.

Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'

OBJECTIVE

To determine the incidence of acute respiratory illness (ARill) in athletes and by method of diagnosis, anatomical classification, ages, levels of performance and seasons.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Electronic databases: PubMed-Medline, EbscoHost and Web of Science.

ELIGIBILITY CRITERIA

Original research articles published between January 1990 and July 2020 in English reporting the incidence of ARill in athletes, at any level of performance (elite/non-elite), aged 15-65 years.

RESULTS

Across all 124 studies (n=1 28 360 athletes), the incidence of ARill, estimated by dividing the number of cases by the total number of athlete days, was 4.7 (95% CI 3.9 to 5.7) per 1000 athlete days. In studies reporting acute respiratory infections (ARinf; suspected and confirmed) the incidence was 4.9 (95% CI 4.0 to 6.0), which was similar in studies reporting undiagnosed ARill (3.7; 95% CI 2.1 to 6.7). Incidences of 5.9 (95% CI 4.8 to 7.2) and 2.8 (95% CI 1.8 to 4.5) were found for studies reporting upper ARinf and general ARinf (upper or lower), respectively. The incidence of ARinf was similar across the different methods to diagnose ARinf. A higher incidence of ARinf was found in non-elite (8.7; 95% CI 6.1 to 12.5) vs elite athletes (4.2; 95% CI 3.3 to 5.3).

SUMMARY/CONCLUSIONS

These findings suggest: (1) the incidence of ARill equates to approximately 4.7 per athlete per year; (2) the incidence of upper ARinf was significantly higher than general (upper/lower) ARinf; (3) elite athletes have a lower incidence of ARinf than non-elite athletes; (4) if pathogen identification is not available, physicians can confidently use validated questionnaires and checklists to screen athletes for suspected ARinf. For future studies, we recommend that a clear diagnosis of ARill is reported.

PROSPERO REGISTRATION NUMBER

CRD42020160472.

Patterns of Athlete Medication Use at the 2018 PyeongChang Paralympic Games: A Descriptive Cohort Study

OBJECTIVE

Medication use among elite athletes has received growing attention over the past decades. However, only limited studies have focused on para athletes, and trends in medication use among this cohort remain unclear. The aims of this study were (1) to describe the pattern of medication use in elite Paralympic athletes, with a particular focus on analgesics, (2) to analyze whether medications declared by athletes were included in the 2018 World Anti-Doping Agency's prohibited list and monitoring program, (3) to report on a variety of novel supplements, and (4) to review whether athlete analgesic needs will be met by the new Olympic & Paralympic Model Formulary.

DESIGN

This is a retrospective, descriptive cohort study.

RESULTS

Of all athletes who underwent doping control, 21% declared the use of an analgesic medication. Athletes with limb deficiency and para snowboarders declared the most analgesic medications in their respective categories. It was determined that 84% of the athletes' analgesic medication needs were provided from the new Olympic & Paralympic Model Formulary.

CONCLUSIONS

Analgesic use among athletes who participated at the 2018 PyeongChang Winter Paralympics was high. Para snowboarders and athletes with limb deficiency declared the most analgesics. The new Olympic & Paralympic Model Formulary adequately addressed the medication needs of the athletes attending the 2018 games.

Acute respiratory illness and return to sport: a systematic review and meta-analysis by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'

OBJECTIVE

To determine the days until return to sport (RTS) after acute respiratory illness (ARill), frequency of time loss after ARill resulting in >1 day lost from training/competition, and symptom duration (days) of ARill in athletes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, EBSCOhost, Web of Science, January 1990-July 2020.

ELIGIBILITY CRITERIA

Original research articles published in English on athletes/military recruits (15-65 years) with symptoms/diagnosis of an ARill and reporting any of the following: days until RTS after ARill, frequency (%) of time loss >1 day after ARill or symptom duration (days) of ARill.

RESULTS

767 articles were identified; 54 were included (n=31 065 athletes). 4 studies reported days until RTS (range: 0-8.5 days). Frequency (%) of time loss >1 day after ARill was 20.4% (95% CI 15.3% to 25.4%). The mean symptom duration for all ARill was 7.1 days (95% CI 6.2 to 8.0). Results were similar between subgroups: pathological classification (acute respiratory infection (ARinf) vs undiagnosed ARill), anatomical classification (upper vs general ARill) or diagnostic method of ARinf (symptoms, physical examination, special investigations identifying pathogens).

CONCLUSIONS

In 80% of ARill in athletes, no days were lost from training/competition. The mean duration of ARill symptoms in athletes was 7 days. Outcomes were not influenced by pathological or anatomical classification of ARill, or in ARinf diagnosed by various methods. Current data are limited, and future studies with standardised approaches to definitions, diagnostic methods and classifications of ARill are needed to obtain detailed clinical, laboratory and specific pathogen data to inform RTS.

PROSPERO REGISTRATION NUMBER

CRD42020160479.

Illness and injury among Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles: prevailing high illness burden on the road from 2012 to 2020

OBJECTIVE

To describe the illness and injury pattern of Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles and to identify which health problems should be targeted in risk management plans with respect to impairment types.

METHODS

We monitored athletes from 12 to 18 months prior to each Game using a weekly online questionnaire (Oslo Sports Trauma Research Center-H2 (OSTRC-H2)). We asked them to report all health problems they had experienced in the preceding 7 days, irrespective of their consequences on their sports participation or performance and whether they had sought medical attention.

RESULTS

Between 2011 and 2020, 94 candidate athletes were included in this monitoring programme and prepared to represent Norway; of these, 66 (71%) were finally selected for multiple Paralympic Games. The overall response rate to the weekly questionnaires was 87%. At any given time during the five observation cycles, 37% of the athletes (95% CI 36% to 38%) reported having at least one health problem. Athletes with neurological impairments (n=51) lost 10 days per year due to respiratory problems (95% CI 9 to 11) compared with 9 days (8-10) among those with musculoskeletal impairments (n=37). Gastrointestinal problems caused a time loss of on average 4 days per year in athletes with neurological impairments versus 1 day in athletes with musculoskeletal impairments (mean difference 2.7 days, 2.1-3.3). Musculoskeletal injuries generated a high burden for both athlete groups, in particular, to the elbow, shoulder and lumbosacral regions.

CONCLUSION

At any given time, nearly two out of five elite Norwegian Para athletes reported at least one health problem. Respiratory tract and other infections; gastrointestinal problems, injuries to the shoulder, elbow and lumbosacral regions represented the greatest health burden. Our findings can help guide the allocation of clinical resources, which should include a broad network of medical specialists, together with dieticians and physiotherapists, to meet the health challenges in Para athletes.

Injuries and Illnesses Observed in Athletes from Beginner to Elite Levels at the 18th National Sports Festival for Persons with Disabilities in Japan

Objectives

: This study aimed to describe the injuries and illnesses that occurred at the 18th National Sports Festival for Persons with Disabilities in Japan, which was attended by more than 3000 athletes from beginner to elite levels.

Methods

: Records from medical stations set up at the venues for each sport were reviewed. The incidence rates (IRs) were calculated as the number of medical station visits per 1000 athlete-days. The backgrounds of injuries and illnesses were investigated.

Results

: In total, 3277 athletes attended the festival, and 134 eligible medical station visits were analyzed. Overall, 102 athletes complained of injuries. For the whole schedule of the festival, IRs were 15.5 for injuries and illnesses and 11.8 for injuries alone. For injuries and illnesses, high IRs were seen in soccer (39.8), basketball (25.6), and foot baseball (22.4); for injuries alone, high IRs were also seen in soccer (33.6), basketball (25.6), and foot baseball (16.8). The most frequent symptoms were internal symptoms (n=32), contusions (n=30), and wounds (n=24). Joint sprains occurred in various sports, whereas muscle strains happened mainly in disciplines demanding sprinting or high agility. Of the 55 cases that occurred during events or public rehearsals, 45 were traumatic, whereas the relation to sports activities was not described in 51 cases. Of participants with internal symptoms, 11 were suggested to have viral infections. We identified 21 injuries caused by falls.

Conclusions

: Minor trauma and viral infection were the most frequently observed symptoms among injuries and illnesses, respectively. Structured medical records and organized surveillance systems should be utilized to improve data collection and understand the onset of injury and illness.

Incidence of sports-related concussion in elite para athletes - a 52-week prospective study

Objective: To assess the 52-week incidence proportion and incidence rate of sports-related concussion (SRC) among elite Para athletes, and to analyze the injury mechanisms.Method: In total, 70 male and 37 female Swedish elite Para athletes (median age 29 years) with vision, physical and intellectual impairment, weekly self-reported sports-related injuries including concussion in an eHealth application adapted to Para athletes. Descriptive statistics were used to assess the incidence rate and incidence proportion. Chi-square statistics were used to analyze differences in the proportion of SRC.Results: A total of 13 SRC were reported: three athletes each sustained two SRC. The incidence proportion was 9.3% (95% CI 4.8-16.7), and the incidence rate 0.5 SRC/1000 hours (95% CI 0.3-0.9) of sports exposure. Athletes with vision impairment and female athletes reported a significantly higher proportion of SRC. A majority of the injuries (n = 9; 69%) occurred during sport-specific training. The injury mechanisms were collision with object (n = 7; 54%), collision with person (n = 4; 31%), and poor playing field conditions (n = 2; 16%).Conclusion: The incidence of concussion among elite Paralympic athletes is comparable to sports for able-bodied athletes. Athletes with vision impairment and female athletes reported a significantly higher incidence of SRC, and collisions were the most common injury mechanism. These results can form the basis for future preventive research studies.

Diagnosis and management of nasal obstruction in the athlete. A narrative review by subgroup B of the IOC Consensus Group on "Acute Respiratory Illness in the Athlete"

Protection of the health of the athlete is required for high level sporting performance. Acute respiratory illness is the leading cause of illness and can compromise training and competition in athletes. To date the focus on respiratory health in athletes has largely been on acute upper respiratory infections and asthma/exercise induced bronchoconstriction (EIB), while nasal conditions have received less attention. The nose has several important physiological functions for the athlete. Nasal conditions causing obstruction to airflow can compromise respiratory health in the athlete, negatively affect quality of life and sleep, cause mouth breathing and ultimately leading to inadequate recovery and reduced exercise performance. Nasal obstruction can be broadly classified as structural (static or dynamic) or mucosal. Mucosal inflammation in the nose (rhinitis) is the most frequent cause of nasal obstruction and is reported to be higher in athletes (21-74%) than in the general population (20-25%). This narrative review provides the sport and exercise medicine physician with a clinical approach to the diagnosis and management of common nasal conditions that can cause nasal obstruction, ultimately leading to improved athlete health and better sports performance.

Methods, challenges and benefits of a health monitoring programme for Norwegian Olympic and Paralympic athletes: the road from London 2012 to Tokyo 2020

OBJECTIVE

To describe the implementation of a health monitoring programme for Norwegian Paralympic and Olympic candidates over five consecutive Olympic and Paralympic Games cycles (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and Tokyo 2020).

METHODS

Athletes were monitored for 12-18 months preparing for the games using a weekly online questionnaire (OSTRC-H2) with follow-up by physicians and physiotherapists, who provided clinical care and classified reported problems.

RESULTS

Between 2011 and 2020, 533 Olympic and 95 Paralympic athletes were included in the monitoring programme, with an overall response of 79% to the weekly questionnaire and a total observation period of 30 826 athlete weeks. During this time, 3770 health problems were reported, with a diagnosis rate of 97%. The average prevalence of health problems at any given time was 32% among Olympic athletes and 37% among Paralympic athletes. Acute traumatic injuries represented the greatest burden for Olympic team sport athletes, and illnesses represented the greatest burden for Olympic endurance and Paralympic athletes. On average, Olympic athletes lost 27 days and Paralympic athletes lost 33 days of training per year due to health problems.

CONCLUSION

Conducting long-term health monitoring of Olympic and Paralympic athletes is challenging, particularly because athletes travel frequently and often relate to many medical providers. This programme has been implemented and improved within Team Norway for five Olympic and Paralympic cycles and during this time we believe it has helped protect our athletes' health.

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

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

[Injuries in German Paralympic alpine skiing over 25 years]

INTRODUCTION

 Despite the size of the Paralympic Games and the large number of people with disabilities, there is a lack of studies on (high-performance) Paralympic sports. Major injuries in the German Paralympic Alpine Skiing Team have been recorded and presented in this retrospective cohort study.

PATIENTS AND METHODS

 All major injuries in competition and training of the German Paralympic Ski Team were recorded over 25 years. A descriptive statistic evaluation was performed.

RESULTS

 Major injuries were sustained by 22 of 94 athletes (23 %). These included 12 (55 %) "sitting" athletes, 9 (41 %) "standing" athletes and one "visually impaired" athlete (5 %). The most common injuries were upper extremity injuries (n = 9, 41 %), especially of the shoulder (n = 8, 36 %). Seated athletes were particularly prone to shoulder injuries. The most dangerous disciplines by far were the speed disciplines Downhill and Super-G (n = 17, 77 %). The average injury rate was 7 % of the athletes per year. In our cohort, the highest absolute number of athletes got injured during the 1998 Paralympic Games in Nagano (n = 4). The highest injury rate, however, was observed during the Sotchi 2014 Paralympic Games (33 %).

DISCUSSION

 The current literature indicates that, contrary to previous assumptions, the risk of sustaining an injury seems to be higher in Paralympic athletes compared with Olympic athletes. Sitting athletes, in particular, have an increased risk of injury. They should be given special consideration when implementing preventive measures. An intensified training of the core muscles seems to be essential. Technical equipment such as the mono-ski bob deserves special attention to ensure safe usage. Shoulder injuries are particularly frequent and, at the same time, particularly debilitating for seated athletes. Careful strength training of the shoulder seems to be indispensable. In order to reduce the frequency and severity of injuries, the further development of preventive measures is essential. We think that the Paralympic sport should be further professionalized.

CONCLUSIONS

 Sitting athletes show an increased injury rate and tend to have shoulder injuries, which often have a debilitating effect on an athlete's everyday life. We consider the further development of preventive measures to be essential for the future of Paralympic sport.

Team illness prevention strategy (TIPS) is associated with a 59% reduction in acute illness during the Super Rugby tournament: a control–intervention study over 7 seasons involving 126 850 player days

Objectives

To determine whether a team illness prevention strategy (TIPS) would reduce the incidence of acute illness during the Super Rugby tournament.

Methods

We studied 1340 male professional rugby union player seasons from six South African teams that participated in the Super Rugby tournament (2010–2016). Medical staff recorded all illnesses daily (126 850 player days) in a 3-year control (C: 2010–2012; 47 553 player days) and a 4-year intervention (I: 2013–2016; 79 297 player days) period. A five-element TIPS was implemented in the I period, following agreement by consensus. Incidence rate (IR: per 1000 player days; 95% CI) of all acute illnesses, illness by main organ system, infectious illness and illness burden (days lost due to illness per 1000 player days) were compared between C and I period.

Results

The IR of acute illness was significantly lower in the I (5.5: 4.7 to 6.4) versus the C period (13.2: 9.7 to 18.0) (p<0.001). The IR of respiratory (C=8.6: 6.3 to 11.7; I=3.8: 3.3 to 4.3) (p<0.0001), digestive (C=2.5: 1.8 to 3.6; I=1.1: 0.8 to 1.4) (p<0.001), skin and subcutaneous tissue illness (C=0.7: 0.4 to 1.4; I=0.3: 0.2 to 0.5) (p=0.0238), all infections (C=8.4: 5.9 to 11.9; I=4.3: 3.7 to 4.9) (p<0.001) and illness burden (C=9.2: 6.8 to 12.5; I=5.7: 4.1 to 7.8) (p=0.0314) were significantly lower in the I versus the C period.

Conclusion

A TIPS during the Super Rugby tournament was associated with a lower incidence of all acute illnesses (59%), infectious illness (49%) and illness burden (39%). Our findings may have important clinical implications for other travelling team sport settings.

A Comparison of Self-Reported Unmet Healthcare Needs among Adaptive and Able-Bodied Athletes

BACKGROUND

Studies have revealed a higher incidence of injury and illness among elite adaptive athletes when compared to able-bodied athletes in competition. However, individuals with disabilities report poorer access to health care.

OBJECTIVE

The purpose of this study is to identify differences in healthcare access, satisfaction, and unmet needs between recreational adaptive and able-bodied athletes in all sports and within a single sport (hockey).

DESIGN

Cross-sectional, survey-based study.

SETTING

Recreation sports programs in Boston, MA and Chicago, IL.

PARTICIPANTS

Adult, recreational, competitive adaptive, and able-bodied athletes.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

The Short-Form Patient Satisfaction Questionnaire (PSQ-18) for healthcare access and satisfaction; percentage of athletes reporting unmet sports-related healthcare needs in the prior year.

RESULTS

Sixty adaptive athletes (78% male, age 35.7 ± 12.4 years) and 65 able-bodied athletes (40% male, age 34.9 ± 11.9 years) participated. Mean access and satisfaction scores were not significantly different between groups in all sports (P = .53 and P = .19, respectively) or hockey (P = .28 and P = .55, respectively). Unmet needs were more commonly reported among adaptive athletes (18.3% all sports, 20.0% hockey) as compared to able-bodied athletes (9.2% all sports, 4.0% hockey). This reached statistical significance in the hockey group (P = .03), but not all sports (P = .12).

CONCLUSIONS

No differences were seen between groups in healthcare access or satisfaction scores. Adaptive athletes of the same sport reported a higher rate of unmet sports-related healthcare needs but with few doctor's visits in the preceding year, suggesting discrepancies in expectations and healthcare-seeking behavior.

LEVEL OF EVIDENCE

III.