Insurance claims data: a possible solution for a national sports injury surveillance system? An evaluation of data information against ASIDD and consensus statements on sports injury surveillance

Swedish Olympic athletes report one injury insurance claim every second year: a 22-year insurance registry-based cohort study

PURPOSE

To describe injury incidence, time trends in injury incidence, and injury characteristics among Swedish Olympic athletes over 22 years based on insurance data, as a first step to inform injury preventive measures among Olympic athletes.

METHODS

The cohort comprised 762 elite athletes (54% males; age 26.5 ± 5.9 years) in 38 sports in the Swedish Olympic Committee support program 'Top and Talent' between 1999 and 2020, with total 3427 athlete-years included. Acute and gradual onset injuries were reported to the insurance registry by the athletes' medical staff.

RESULTS

A total of 1635 injuries in 468 athletes were registered. The overall injury incidence was 47.7 injuries/100 athlete-years (one injury per athlete every second year). An increasing trend in injury incidence was observed in the first decade 2001 to 2010 (annual change 6.0%, 95% CI 3.3-8.8%), while in the second decade 2011 to 2020 no change was evident (0.4%, 95% CI - 1.9 to 2.7%). Gymnastics, tennis, and athletics had the highest incidence (100.0, 99.3, and 93.4 injuries/100 athlete-years, respectively). Among sport categories, mixed and power sports had the highest incidence (72.8 and 69.5 injuries/100 athlete-years, respectively). Higher incidences were seen in the younger age groups (≤ 25 years) in mixed and skill sports. The injury incidence was comparable between male and female athletes, and summer and winter sports. Most injuries occurred in the lower limb, and specifically the knee (24%), foot/ankle (15%) and spine/pelvis (13%).

CONCLUSION

The results on injury patterns in different sports and age groups may guide preventive focus for health and performance teams working with Olympic athletes.

LEVEL OF EVIDENCE

II.

Systematic Review and Meta-Analysis of the Y-Balance Test Lower Quarter: Reliability, Discriminant Validity, and Predictive Validity

BACKGROUND

Deficits in dynamic neuromuscular control have been associated with post-injury sequelae and increased injury risk. The Y-Balance Test Lower Quarter (YBT-LQ) has emerged as a tool to identify these deficits.

PURPOSE

To review the reliability of the YBT-LQ, determine if performance on the YBT-LQ varies among populations (i.e., sex, sport/activity, and competition level), and to determine the injury risk identification validity of the YBT-LQ based on asymmetry, individual reach direction performance, or composite score.

STUDY DESIGN

Systematic Review.

METHODS

A comprehensive search was performed of 10 online databases from inception to October 30, 2019. Only studies that tested dynamic single leg balance using the YBT-LQ were included. Studies were excluded if the Y-Balance Test kit was not utilized during testing or if there was a major deviation from the Y-Balance test procedure. For methodological quality assessment, the modified Downs and Black scale and the Newcastle-Ottawa Scale were used.

RESULTS

Fifty-seven studies (four in multiple categories) were included with nine studies assessing reliability, 36 assessing population differences, and 16 assessing injury prediction were included. Intra-rater reliability ranged from 0.85-0.91. Sex differences were observed in the posteromedial direction (males: 109.6 [95%CI 107.4-111.8]; females: 102.3 [95%CI 97.2-107.4; p = 0.01]) and posterolateral direction (males: 107.0 [95%CI 105.0-109.1]; females: 102.0 [95%CI 97.8-106.2]). However, no difference was observed between sexes in the anterior reach direction (males: 71.9 [95%CI 69.5-74.5]; females: 70.8 [95%CI 65.7-75.9]; p=0.708). Differences in composite score were noted between soccer (97.6; 95%CI 95.9-99.3) and basketball (92.8; 95%CI 90.4-95.3; p <0.01), and baseball (97.4; 95%CI 94.6-100.2) and basketball (92.8; 95%CI 90.4-95.3; p=0.02). Given the heterogeneity of injury prediction studies, a meta-analysis of these data was not possible. Three of the 13 studies reported a relationship between anterior reach asymmetry reach and injury risk, three of 10 studies for posteromedial and posterolateral reach asymmetry, and one of 13 studies reported relationship with composite reach asymmetry.

CONCLUSIONS

There was moderate to high quality evidence demonstrating that the YBT-LQ is a reliable dynamic neuromuscular control test. Significant differences in sex and sport were observed. If general cut points (i.e., not population specific) are used, the YBT-LQ may not be predictive of injury. Clinical population specific requirements (e.g., age, sex, sport/activity) should be considered when interpreting YBT-LQ performance, particularly when used to identify risk factors for injury.

LEVEL OF EVIDENCE

1b.

Collision with opponents-but not foul play-dominates injury mechanism in professional men's basketball

Background

To identify injury patterns and mechanisms in professional men’s basketball by means of video match analysis.

Methods

In Germany, injuries are registered with the statutory accident insurance for professional athletes (VBG) by clubs or club physicians as part of occupational accident reporting. Moderate and severe injuries (absence of > 7 days) sustained during basketball competition in one of four seasons (2014–2017 and 2018–2019) in the first or second national men’s league in Germany were prospectively analyzed using a newly developed standardized observation form. Season 2017–2018 was excluded because of missing video material.

Results

Video analysis included 175 (53%) of 329 moderate and severe match injuries. Contact patterns categorized according to the different body sites yielded eight groups of typical injury patterns: one each for the head, shoulders, and ankles, two for the thighs, and three for the knees. Injuries to the head (92%), ankles (76%), shoulders (70%), knees (47%), and thighs (32%) were mainly caused by direct contact. The injury proportion of foul play was 19%. Most injuries (61%) occurred in the central zone below the basket. More injuries occurred during the second (OR 1.8, p = 0.018) and fourth quarter (OR 1.8, p = 0.022) than during the first and third quarter of the match.

Conclusion

The eight identified injury patterns differed substantially in their mechanisms. Moderate and severe match injuries to the head, shoulders, knees, and ankles were mainly caused by collision with opponents and teammates. Thus, stricter rule enforcement is unlikely to facilitate safer match play.

Short-term recovery of physical activity and knee function after an acute knee injury

Objectives

To describe self-reported knee function, participation in physical activity and the number of knee surgeries at 3 and 6 months following acute knee injury.

Methods

Prospective cohort study. Participants, aged 15–40 years with an acute knee injury sustained no more than 6 weeks prior to inclusion, were recruited. There were 279 participants with ACL injury and 101 participants with other acute knee injuries included. Follow-up questionnaires were sent at 3 and 6 months after injury. Demographic information, activity participation, International Knee Documentation Committee subjective knee form (IKDC-SKF) and the Single Assessment Numeric Evaluation (SANE) score were collected. Additional knee injuries were obtained from self-report and medical charts.

Results

The IKDC-SKF, SANE and physical activity participation were reduced at 3-month and 6-month follow-up. The number of participants who achieved health-promoting physical activity levels was reduced by 50% at 6-month follow-up compared with before injury. Seventeen per cent of participants with ACL injury and 41% of participants with other acute knee injuries had returned to their preinjury physical activity at 6 months. Participants with ACL injury reported worse knee function, lower physical activity participation and had more surgeries (128 surgeries, including 109 ACL-reconstructions) compared with participants with other acute knee injuries (six surgeries).

Conclusion

Acute knee injuries, including ACL injuries, affected self-reported knee function and physical activity participation for at least 6 months after index injury. More research is needed to understand how best to help people with acute knee injuries return to physical activity and achieve satisfactory knee function.

Contact - but not foul play - dominates injury mechanisms in men's professional handball: a video match analysis of 580 injuries

AIM

We aimed to identify patterns and mechanisms of injury situations in men's professional handball by means of video match analysis.

METHODS

Moderate and severe injuries (absence of >7 days) sustained in competition in one of six seasons (2010 to 2013 and 2014 to 2017) in men's professional handball were prospectively analysed with a newly developed standardised observation form. Season 2013 to 2014 was excluded because of missing video material.

RESULTS

580 injuries were identified: 298 (51.4%) contact injuries, 151 (26.0%) indirect contact injuries and 131 (22.6%) non-contact injuries. Head (87.5%), hand (83.8%), shoulder (70.2%) and ankle (62.9%) injuries were mainly sustained during direct contact. Typical contact injuries included collision with an opponent's upper extremity or torso, and ankle injuries mainly consisted of foot-to-foot collisions. A large proportion (41.7%) of knee injuries were caused by indirect contact, whereas thigh injuries mainly occurred (56.4%) through non-contact mechanism. Wing (56.9%) and pivot (58.4%) players had the highest proportion of contact injuries, whereas backcourt players had a high proportion of indirect contact injuries (31.5%) and goalkeepers of non-contact injuries (48.9%). The injury proportion of foul play was 28.4%. Most injuries occurred in the central zone between the 6-metre and 9-metre lines (26.1%) and during the last 10 min of each match half (OR 1.71, p=0.016).

CONCLUSIONS

In men's professional handball in a league setting, contact - but not foul play - was the most common mechanism associated with moderate and severe injuries. Head, hand, shoulder and ankle injury were mainly sustained during direct contact.

Australian netball injuries in 2016: An overview of insurance data

OBJECTIVES

The objective of this study is to profile the netball-specific sporting injuries from in a national community-level insurance claim database.

DESIGN

An audit of insurance injury claims.

METHODS

An electronic dataset containing successful injury insurance claim data from the 2016 netball season was retrospectively coded. Data were de-identified and coded to meet the Orchard Sports Injury Classification System. Descriptive data reported included age, injury date, activity type, anatomical injury location, nature of injury, weather conditions, indoor/outdoor surface, quarter injury occurred, and open text for injury description.

RESULTS

The dataset contained 1239 claims that were approved for payment by the insurance company. The overall incidence rate was 2.936 successful injury claims per 1000 participants. The average age of players with claims was 34years. The majority of successful claims came from players aged 22 to 29years (n=328; 27%) and 30-39years (n=279; 23%) age groups. Of the successful claims for injury, most occurred during matches (n=1116; 92%), and were for injuries to the knee (n=509; 42%) and ankle (n=356; 29%) and for sprains/ligament damage (n=687; 57%) or fractures (n=182; 15%).

CONCLUSIONS

Netball injuries profiled by an injury insurance dataset of successful claims mostly occurred to the knee and ankle. Sprains and ligament damage were the most common type of injury. This study strengthens the evidence for national injury prevention policies and strategies. Findings from the current study could be used in future to expand into mechanisms of injury, and injury diagnoses.

CAN INJURY RISK CATEGORY BE CHANGED IN ATHLETES? AN ANALYSIS OF AN INJURY PREVENTION SYSTEM

BACKGROUND AND PURPOSE

Researchers have used an injury risk algorithm utilizing demographic data, injury history, the Functional Movement Screen™ (FMS™) and Lower Quarter Y Balance Test™ (YBT™) scores to categorize individual injury risk. The purpose of this study was to identify if a group-based hybrid injury prevention program utilizing key factors from previous research with the addition of an individualized approach can modify the injury risk category of athletes.

STUDY DESIGN

Cohort Study.

METHODS

Forty-four female subjects (ages 14-17) were recruited from a local high school soccer team. Pre-participation testing included demographic data, injury history, FMS™ and YBT™ to determine if each athletes' injury risk category using the Move2Perform algorithm. Post-testing took place after an eight-week exercise-based intervention program was completed. McNemar analysis was utilized to assess changes in the injury risk categories.

RESULTS

A significant number of athletes (21 of 44) moved to lower risk categories at posttest (p=0.000; Z=-3.869). Of the 32 athletes in the High Risk category at pretest, 16 were Low Risk after the intervention (p=0.002).

CONCLUSIONS

A preseason, group injury prevention training program with individually prescribed corrective exercises, resulted in a significant number of subjects decreasing their injury risk category. The primary statistically significant decrease of injury risk category was seen in the Moderate Risk individuals moving down to Slight. There were three athletes that moved from the Substantial Risk category to Slight, however, this change was not statistically significant.

LEVEL OF EVIDENCE

2.

National injury prevention measures in team sports should focus on knee, head, and severe upper limb injuries

PURPOSE

To examine acute injuries in licensed floorball, football, handball, and ice hockey players in all ages nationwide in Sweden, and to identify the most common and severe injuries in each body location and recommend injury prevention measures.

METHODS

Using national sport insurance data from years 2006-2015 was the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), calculated in the four team sports. The most common injury type and injured body part was identified, with a particular focus of the severe injuries. Comparison between sexes was made.

RESULTS

In total, there were 92,162 registered injuries in all sports together. Knee injuries were most common, and also had the highest incidence of PMI, in all ball sports and in female ice hockey players. In male ice hockey, the most common injury was a dental and face injury, and PMI injuries were mostly in the shoulder. The most severe PMI injuries were rare and most often a face/eye injury in male floorball and ice hockey, a concussion in female ice hockey, and a knee injury in female floorball, and in both sexes in football and handball.

CONCLUSIONS

To achieve the greatest impact in reducing the adverse effects of acute sport injuries nationwide in Sweden, preventive measures should focus on knee injuries in all the investigated team sports. The severe head/face and upper limb injuries also need attention. Protective equipment, neuromuscular training programs, rules enforcements, and fair-play interventions may reduce the incidence of injuries.

A Nationwide Follow-up Survey on the Effectiveness of an Implemented Neuromuscular Training Program to Reduce Acute Knee Injuries in Soccer Players

Background:

A cruciate ligament (CL) injury is a severe injury in soccer. Neuromuscular training programs have a well-documented preventive effect, but there are few studies on the effectiveness of such a program at a national level. The Swedish Knee Control Program (KCP) was found to be effective in preventing CL injuries in youth female soccer players. The KCP was implemented nationwide in Sweden in 2010.

Purpose:

To evaluate the effectiveness of the Swedish KCP in reducing acute knee injuries in soccer players at a nationwide level.

Study Design:

Descriptive epidemiology study.

Methods:

All licensed soccer players in Sweden are covered by the same insurance company. Using this insurance database, around 17,500 acute knee injuries that were reported to the insurance company between 2006 and 2015 were included in the study. By matching the number of licensed soccer players with the number of reported injuries each year, the annual incidence of knee and CL injuries was able to be calculated. To evaluate the spread of the KCP nationally, a questionnaire was sent to all 24 Swedish district football associations (FAs) with questions regarding KCP education. The number of downloads of the KCP mobile application (app) was obtained.

Results:

The incidence of CL injuries decreased during the study period for both male (from 2.9 to 2.4 per 1000 player-years) and female players (from 4.9 to 3.9 per 1000 player-years). The overall incidence of knee injuries decreased in both male (from 5.6 to 4.6 per 1000 player-years) and female players (from 8.7 to 6.4 per 1000 player-years). Comparing before and after the nationwide implementation of the KCP, there was a decrease in the incidence of CL injuries by 6% (rate ratio [RR], 0.94 [95% CI, 0.89-0.98]) in male players and 13% (RR, 0.87 [95% CI, 0.81-0.92]) in female players and a decrease in the incidence of knee injuries by 8% (RR, 0.92 [95% CI, 0.89-0.96]) and 21% (RR, 0.79 [95% CI, 0.75-0.83]), respectively (P < .01 for all). This trend corresponded to a reduction of approximately 100 CL injuries each year in Sweden. A total of 21 of 24 district FAs held organized KCP educational courses during the study period. The percentage of district FAs holding KCP courses was between 46% and 79% each year. There were 101,236 downloads of the KCP app.

Conclusion:

The KCP can be considered partially implemented nationwide, and the incidence of knee and CL injuries has decreased in both sexes at a nationwide level.

Injury Surveillance of Nonprofessional Salsa Dance

Background: The investigation sought to (1) establish the extent of injuries, (2) determine the odds of sustaining an injury, and (3) calculate the injury incidence rate in nonprofessional salsa dance.Methods: Salsa dancers completed an anonymous web-based survey containing 11 demographic background and 10 (1 y retrospective) injury history questions.Results: The response rate was 77%. The final sample of respondents included 303 women and 147 men, of which 22% and 14%, respectively, sustained ≥1 injury during salsa dance in the past year. The odds of injury was 2.00 (95% confidence interval [CI], 1.14–3.50) times greater (P < .05) for women than for men. Age, body mass index, and salsa dance experience were also found to be significant (allPs < .05) predictors of injury. The injury incidence rate for women and men was 1.1 (95% CI, 0.9–1.4) and 0.5 (95% CI, 0.3–0.7) injuries per 1000 hours of exposure, respectively.Conclusions: This is the first study to have described salsa dancers in terms of their injury history profile. Results indicate that the likelihood of sustaining an injury during this physical activity is similar to that of ballroom, but lower than that of Spanish, aerobic, and Zumba®, dance.

Increased injury rates after the restructure of Germany's national second league of team handball

PURPOSE

Scientific injury data in men's professional team handball injuries are rare and even less scientific information exists on injury prevention. In 2011, Germany's national second team handball league was restructured by merging the existing two regional leagues into one league. This study evaluates the injury patterns in professional team handball and compares the injury rates between the first and second league before and after the restructure.

METHODS

All players of Germany's national first and second men's team handball leagues have mandatory trauma insurance with the same insurance company. This retrospective cohort study analysed the injury data of three consecutive seasons 2010-2013 using standardized injury definitions.

RESULTS

1194 professional team handball players were included in this study. The majority of severe injuries affected the lower extremities, shoulders, and hands. The average injury incidence significantly differed between the first (4.9 injuries per 1000 h) and the second league (3.9 per 1000 h, p < 0.01). The injury incidence in the restructured second league had increased from 3.7 to 4.1 per 1000 h (p < 0.01) and prevalence from 67.1 to 79.3% (p < 0.001), thus almost to the same levels of the first league. The second league showed more time-loss injuries at all severity levels.

CONCLUSION

This study yielded a high injury incidence after the restructure of the national second team handball league and presents details on prevalence, incidence, and patterns of injury in professional men's team handball. This study is an important basis for developing injury prevention strategies that should focus on the shoulders, hands, and lower extremities and on reducing the number of matches and travel burden.

LEVEL OF EVIDENCE

III.

Guidance for sports injury surveillance: the 20-year influence of the Australian Sports Injury Data Dictionary

Background

Injury prevention requires information about how, why, where and when injuries occur. The Australian Sports Injury Data Dictionary (ASIDD) was developed to guide sports injury data collection and reporting. Sports Medicine Australia (SMA) disseminated associated data collection forms and an online tool to practitioners and the sports community. This paper assesses the long-term value, usefulness and relevance of the ASIDD and SMA tools.

Methods

A systematic search strategy identified both peer-reviewed and grey literature that used the ASIDD and/or the SMA tools, during 1997–2016. A text-based search was conducted within 10 electronic databases, as well as a Google Image search for the SMA tools. Documents were categorised according to ASIDD use as: (1) collected injury data; (2) informed data coding; (3) developed an injury data collection tool and/or (4) reference only.

Results

Of the 36 peer-reviewed articles, 83% directly referred to ASIDD and 17% mentioned SMA tools. ASIDD was mainly used for data coding (42%), reference (36%), data collection (17%) or resource development (14%). In contrast, 86% of 66 grey literature sources referenced, used or modified the SMA data collection forms.

Conclusions

The ASIDD boasts a long history of use and relevance. Its ongoing use by practitioners has been facilitated by the ready availability of specific data collection forms by SMA for them to apply to directly their settings. Injury prevention practitioners can be strongly engaged in injury surveillance activities when formal guidance is supported by user-friendly tools directly relevant to their settings and practice.

Incidence and body location of reported acute sport injuries in seven sports using a national insurance database

Sports with high numbers of athletes and acute injuries are an important target for preventive actions at a national level. Both for the health of the athlete and to reduce costs associated with injury. The aim of this study was to identify injuries where injury prevention should focus, in order to have major impact on decreasing acute injury rates at a national level. All athletes in the seven investigated sport federations (automobile sports, basketball, floorball, football (soccer), handball, ice hockey, and motor sports) were insured by the same insurance company. Using this insurance database, the incidence and proportion of acute injuries, and injuries leading to permanent medical impairment (PMI), at each body location, was calculated. Comparisons were made between sports, sex, and age. In total, there were 84 754 registered injuries during the study period (year 2006-2013). Athletes in team sports, except in male ice hockey, had the highest risk to sustain an injury and PMI in the lower limb. Females had higher risk of injury and PMI in the lower limb compared to males, in all sports except in ice hockey. This study recommends that injury prevention at national level should particularly focus on lower limb injuries. In ice hockey and motor sports, head/neck and upper limb injuries also need attention.

Death in Community Australian Football: A Ten Year National Insurance Claims Report

While deaths are thought to be rare in community Australian sport, there is no systematic reporting so the frequency and leading causes of death is unknown. The aim of this study was to describe the frequency and cause of deaths associated with community-level Australian Football (AF), based on insurance-claims records. Retrospective review of prospectively collected insurance-claims for death in relation to community-level AF activities Australia-wide from 2004 to 2013. Eligible participants were aged 15+ years, involved in an Australian football club as players, coaches, umpires or supporting roles. Details were extracted for: year of death, level of play, age, sex, anatomical location of injury, and a descriptive narrative of the event. Descriptive data are presented for frequency of cases by subgroups. From 26,749 insurance-claims relating to AF, 31 cases were in relation to a death. All fatalities were in males. The initial event occurred during on-field activities of players (football matches or training) in 16 cases. The remainder occurred to people outside of on-field football activity (n = 8), or non-players (n = 7). Road trauma (n = 8) and cardiac conditions (n = 7) were the leading identifiable causes, with unconfirmed and other causes (including collapsed or not yet determined) comprising 16 cases. Although rare, fatalities do occur in community AF to both players and people in supporting roles, averaging 3 per year in this setting alone. A systematic, comprehensive approach to data collection is urgently required to better understand the risk and causes of death in participants of AF and other sports.

Injury Scheme Claims in Gaelic Games: A Review of 2007-2014

CONTEXT

Gaelic games (Gaelic football and hurling) are indigenous Irish sports with increasing global participation in recent years. Limited information is available on longitudinal injury trends. Reviews of insurance claims can reveal the economic burden of injury and guide cost-effective injury-prevention programs.

OBJECTIVE

To review Gaelic games injury claims from 2007-2014 for male players to identify the costs and frequencies of claims. Particular attention was devoted to lower limb injuries due to findings from previous epidemiologic investigations of Gaelic games.

DESIGN

Descriptive epidemiology study.

SETTING

Open-access Gaelic Athletic Association Annual Reports from 2007-2014 were reviewed to obtain annual injury-claim data.

PATIENTS OR OTHER PARTICIPANTS

Gaelic Athletic Association players.

MAIN OUTCOME MEASURE(S)

Player age (youth or adult) and relationships between lower limb injury-claim rates and claim values, Gaelic football claims, hurling claims, youth claims, and adult claims.

RESULTS

Between 2007 and 2014, €64 733 597.00 was allocated to 58 038 claims. Registered teams had annual claim frequencies of 0.36 with average claim values of €1158.4 ± 192.81. Between 2007 and 2014, average adult claims were always greater than youth claims (6217.88 versus 1036.88), while Gaelic football claims were always greater than hurling claims (5395.38 versus 1859.38). Lower limb injuries represented 60% of all claims. The number of lower limb injury claims was significantly correlated with annual injury-claim expenses (r = 0.85, P = .01) and adult claims (r = 0.96, P = .01) but not with youth claims (r = 0.69, P = .06).

CONCLUSIONS

Reducing lower limb injuries will likely reduce injury-claim expenses. Effective injury interventions have been validated in soccer, but whether such changes can be replicated in Gaelic games remains to be investigated. Injury-claim data should be integrated into current elite injury-surveillance databases to monitor the cost effectiveness of current programs.

Incidence and severity of reported acute sports injuries in 35 sports using insurance registry data

Acute injuries in sport are still a problem where limited knowledge of incidence and severity in different sports at national level exists. In Sweden, 80% of the sports federations have their mandatory injury insurance for all athletes in the same insurance company and injury data are systematically kept in a national database. The aim of the study was to identify high-risk sports with respect to incidence of acute and severe injuries in 35 sports reported to the database. The number and incidences of injuries as well as injuries leading to permanent medical impairment (PMI) were calculated during 2008-2011. Each year approximately 12,000 injuries and 1,162,660 licensed athletes were eligible for analysis. Eighty-five percent of the injuries were reported in football, ice hockey, floorball, and handball. The highest injury incidence as well as PMI was in motorcycle, handball, skating, and ice hockey. Females had higher risk of a PMI compared with males in automobile sport, handball, floorball, and football. High-risk sports with numerous injuries and high incidence of PMI injuries were motorcycle, handball, ice hockey, football, floorball, and automobile sports. Thus, these sports ought to be the target of preventive actions at national level.