The validity of a four week self-recall of sports injuries

Data Collection Procedures and Injury Definitions in Badminton: A Consensus Statement According to the Delphi Approach

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.

Internet Survey Evaluation of Iliopsoas Injury in Dogs Participating in Agility Competitions

Objective

To describe risk factors associated with demographics, training, and competition for iliopsoas injury in dogs participating in agility competitions, as well as describe owner reported treatment and return to sport following injury.

Procedures

An internet-based survey of agility handlers collected risk factor data for dogs participating in agility. Owners were asked questions about demographics, training, and competition as well as injury treatment and recovery if applicable. Associations between variables of interest and iliopsoas injury were estimated with logistic regression. The final risk factor model was built via modified backward selection, with all variables in the final model showing significant associations at p < 0.05.

Results

Of the 4,197 dogs in the sample, 327 (7.8%) reported iliopsoas injury. The final model identified six risk factors for iliopsoas injury. A higher risk of iliopsoas injury was observed for the Border Collie breed, dogs with handlers who are veterinary assistants, dogs competing on dirt, dogs competing on artificial turf 6+ times a year, and dogs that trained with the 2 × 2 method for weave poles. Dogs that were not acquired with agility in mind were observed to have a decreased risk of injury. Factors like number of competition days and jump height were not significantly associated with risk of iliopsoas injury. Owners sought veterinary care for 88% of dogs with iliopsoas injury, including specialty care for 63%. Treatment most often included rest, home rehabilitation, formal rehabilitation, and/or oral medications. Most dogs (80%) were able to return to sport within 6 months, while 20% were out for longer than 6 months, or retired.

Conclusion and Clinical Relevance

Iliopsoas injury can necessitate a significant amount of time off from training and competition, and even lead to retirement of dogs competing in agility. Some of the risk factors identified in this study can inherently not be modified (breed, intended use, and handler profession), but can be taken into consideration for injury prevention strategies. Competition and training risk factors that can be modified, such as weave training, may help to inform guidelines for best practices in management of the agility athlete.

More people more active, but there is a counter site. Novice athletes are at highest risk of injury in a large population-based retrospective cross-sectional study

Objectives

To evaluate whether in fitness-related activities and recreational running over time, there is an increase in the number of novice sports athletes and whether these novice athletes have an increased injury rate compared with their experienced counterparts.

Methods

Data were collected from a large population-based retrospective cross-sectional study, ‘Injuries and Physical Activity in the Netherlands’ (IPAN). Athletes aged ≥18 years were included. We used descriptive statistics to describe the characteristics of athletes and their injuries. The number of athletes and injuries were calculated for each year and, where applicable, for each sport separately. The injury incidence rate was expressed as the number of injuries per 1000 hours of exposure. Logistic regression analyses were performed with non-extrapolated data to analyse the differences in injury risk for novice and experienced athletes included in this study, separate for fitness-related activities and running.

Results

Over the 5 years, 9209 fitness athletes reported 370 fitness-related injuries, 5426 runners reported 537 running-related injuries. Weighted data showed that, in 2010–2014, the inflow of novice fitness athletes slightly decreased, whereas the inflow of novice runners slightly increased. In each year, injury risk was higher in novice athletes compared with experienced athletes for both fitness-related activities and running. The injury incidence rates in running are much higher than in fitness-related activities.

Conclusions

Over the years 2010–2014, the absolute number of novice athletes in fitness-related activities and running together increased. Although most injuries occurred in experienced athletes, injury risk was higher in novice athletes in both sports.

Exploring the association between recent concussion, subconcussive impacts and depressive symptoms in male Australian Football players

Objectives

To explore the association between depressive symptoms and recent head-related trauma (diagnosed concussion, subconcussive impacts) in semiprofessional male Australian Football (AF) players.

Methods

Sixty-nine semiprofessional male players from a West Australian Football League (WAFL) club participated in the study (M_age=21.81, SD=2.91 years). Depressive symptoms were measured using the Centre for Epidemiological Studies Depression Scale. Injuries and potential confounding variables (eg, pre-existing mental health condition; alcohol or drug hangovers; experiencing a stressful event) were self-reported anonymously using the WAFL Injury Report Survey. Both tools were administered every 2-weeks over the first 22-weeks of the WAFL season. Controlling for potential confounding variables and other injuries, a repeated measures generalised estimating equations model assessed the risk of clinically relevant depressive symptoms occurring, when diagnosed concussion or subconcussive impacts were experienced.

Results

A total of 10 concussions and 183 subconcussive impacts were reported. Players who experienced a concussion were almost nine times more likely to experience clinically relevant depressive symptoms (OR 8.88, 95% CI 2.65 to 29.77, p<0.001). Although elevated, depressive symptoms following subconcussive impacts were not statistically significant (OR 1.13, 95% CI 0.67 to 1.92, p=0.641).

Conclusion

These findings indicate that semiprofessional AF athletes may be at risk of experiencing depressive symptoms after concussion. Severity (concussion vs subconcussive impacts) and dose (number of impacts) appear to have an important relationship with depressive symptom outcomes in this cohort and should be considered for further research and management of player welfare.

Improved reporting of overuse injuries and health problems in sport: an update of the Oslo Sport Trauma Research Center questionnaires

In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses-The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data.

Shared social identification in mass gatherings lowers health risk perceptions via lowered disgust

Previous research concerning mass gathering‐associated health risks has focused on physical factors while largely neglecting the role of psychological factors. The present research examined the effect of experiencing shared social identification on perceptions of susceptibility to health risks in mass gatherings. Participants in Study 1 were asked to either recall a crowd in which they shared a social identity with other crowd members or a crowd in which they did not. Participants subsequently completed measures assessing shared social identity, disgust, and health risk perceptions. Study 2 involved administering the same measures as part of a survey to participants who had recently attended a music festival. The results from both studies indicated that sharing a social identity lowered health risk perceptions; this effect was indirect and mediated via disgust. This highlights the importance of considering social identity processes in the design of health communication aimed at reducing mass gathering‐associated health risks.

Elite Ice Hockey Goalkeepers Have a High Prevalence of Hip and Groin Problems Associated With Decreased Sporting Function: A Single-Season Prospective Cohort Study

BACKGROUND

The modern style of goalkeeping in ice hockey is thought to predispose athletes to hip and groin problems. However, little is known about the magnitude of these problems in elite goalkeepers.

PURPOSE

To describe the incidence, prevalence, and severity of hip and groin problems in elite ice hockey goalkeepers over the course of a single season.

STUDY DESIGN

Descriptive epidemiology study.

METHODS

We invited all elite Swedish ice hockey goalkeepers (n = 128) to participate in this prospective cohort study. Every second week, players reported hip and groin problems experienced within the past 14 days on the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O), classifying problems into "all" and "substantial" hip and groin problems. Three times during the season (pre-, mid-, and end-season), players reported hip and groin function on the Hip and Groin Outcome Score (HAGOS) as well as on the OSTRC-O.

RESULTS

A total of 101 goalkeepers participated in the study (83.3% male [seniors, 44.1%; juniors, 39.2%], 16.7% female). The cumulative incidences of all hip and groin problems and substantial hip and groin problems were 69% (95% CI, 59%-79%) and 36% (95% CI, 26%-46%), respectively. The average biweekly prevalence for all hip and groin problems and substantial hip and groin problems was 28.1% (95% CI, 25.0%-31.3%) and 10% (95% CI, 8.7%-11.4%), respectively. Among all the reported hip and groin problems, 16.9% (n = 70) were acute, 83.1% (n = 343) were because of overuse, and 15.5% (n = 64) led to time loss. HAGOS did not differ in the pre-, mid-, or end-season. Players reporting hip and groin problems on the OSTRC-O had significantly worse HAGOS scores than players without problems (P < .01).

CONCLUSION

Hip and groin problems are highly prevalent in elite ice hockey goalkeepers. During a competitive season, 69% of players experienced hip and groin problems and 36% of players suffered from substantial problems. The vast majority of problems were because of overuse, not leading to time loss but related to reduced self-reported hip and groin function.

Accuracy of self-reported injuries compared to medical record data

BACKGROUND

Self-reported injury data are frequently used in epidemiologic investigations. These data provide useful information about the activities and mechanisms of injuries because injury cause-coding is often not required for outpatient medical visits.

OBJECTIVES

The purpose of this evaluation is to determine the accuracy of self-reported military injuries when compared to injuries in outpatient medical records.

METHOD

Injuries reported by survey were compared to diagnoses for injuries (International Classification of Diseases (ICD-9-CM 800-999)) and injury-related musculoskeletal disorders (selected ICD-9-CM 710-739) obtained from medical records. Self-reported injury responses from military personnel were matched to diagnoses by date and body part. A new methodology for including secondary matching body parts was proposed and implemented.

RESULTS

Infantry Soldiers (n = 5490) completed surveys that requested details about their most recent injury. About one-quarter (24%, n = 1336) reported injuries on the survey and had an injury diagnosis in their medical record in a six month period. Seventy-five percent of the self-reported injuries (n = 996 of 1336) were confirmed by medical records with a date match within 3 months and an identical or nearby body part. Common self-reported injuries were ankle sprains (10%), knee sprains (9%), lower back strains (4%), shoulder strains (3%), and lower back pain (3%).

CONCLUSIONS

A high percentage of self-reported injuries were accurate when compared with medical records, substantiating the use of survey data for the evaluation of injury outcomes. This is the first effort to validate self-reported injuries and musculoskeletal disorders with medical records in a large military population.

The Incidence of Injury in Amateur Male Rugby Union: A Systematic Review and Meta-Analysis

Background

Rugby union is a physically demanding, full-contact team sport that has gained worldwide popularity. The incidence of injury in rugby union has been widely reported in the literature. While comprehensive injury surveillance and prevention programmes have been implemented within the professional game, there is a need for similar strategies in the amateur game. Despite recent increases in the volume of research in rugby, there is little consensus regarding the true incidence rate of match and training injuries in senior amateur male rugby union players.

Objective

The aim of the current review was to systematically review the available evidence on the epidemiology of time-loss injuries in senior amateur male rugby union players and to subsequently conduct a meta-analysis of the findings.

Methods

A comprehensive search of the PubMed, Scopus, SportDiscus and Google Scholar electronic databases was performed using the following keywords; (‘rugby’ OR ‘rugby union’) AND (‘amateur’ OR ‘community’) AND (‘injur*’ OR ‘pain*’). Six articles regarding the incidence of injury in senior amateur male rugby union players, in both matches and training, were retrieved and included in the meta-analysis to determine the overall incidence rate of match injury, with descriptive analyses also provided for other reported variables.

Results

The overall incidence rate of match injuries within senior amateur rugby union players was 46.8/1000 player hours [95% confidence interval (CI) 34.4–59.2]. Contact events accounted for the majority of injuries, with the tackler more at risk than the player being tackled, and with respective incidence rates of 15.9/1000 player hours (95% CI 12.4–19.5) and 12.2/1000 player hours (95% CI 9.3–15.1).

Conclusion

This meta-analysis found that the incidence rate of injury in amateur rugby union players was lower than that in professional players, but higher than the incidences reported in adolescent and youth rugby players. By understanding the true incidence and nature of injuries in rugby, injury prevention strategies can best be implemented. Future prevention strategies may best be aimed towards the tackle area, specifically to the tackler, in order to minimize injury risk.

Differences in injury risk and characteristics of injuries between novice and experienced runners over a 4-year period

OBJECTIVES

Running is increasingly popular, but also carries a high injury risk, especially in novice runners. This study investigates differences in incidence and characteristics of running-related injuries (RRIs) between novice and experienced runners in the open population, in order to adapt to more specific needs for future prevention programs.

METHODS

Data were obtained from Injuries and Physical Activity in the Netherlands (IPAN), a Dutch questionnaire on injuries, physical activity, and sports. A representative sample of runners (n = 4621) from IPAN, including 1405 novice runners, was used to assess injury incidence rates, anatomical site, onset and need for medical attention of RRIs. Participants who started running during the past 12 months were defined as 'novice' runners. 'Experienced' runners are participants who had been running for more than 1 year.

RESULTS

Of the 4621 runners, 41,8% were female. The average age was 34.2 years. From 2010 to 2013, a total of 416 injuries were reported. The incidence of RRIs was significantly higher in novice runners compared with experienced runners: 8.78 (8.59-8.96) vs. 4.24 (4.11-4.37) per 1000 h running. In both novice and experienced runners, most RRIs were located at the knee (30.5%) and lower leg (17.8%), with the Achilles' tendon less frequently injured in novice runners (2.3% vs. 8.4%, p = 0.031). Novice runners sustained more medical attention injuries (36.8%) than experienced runners (29.2%) (p > 0.132).

CONCLUSIONS

In total, over 30% of all (novice and experienced) runners, suffered from RRI within 1 year. Novice runners reported more injuries per 1000 h of running in comparison to experienced runners. A tendency toward receiving medical attention more frequently was found in novice runners compared to experienced runners. In view of this higher injury incidence of RRIs and healthcare consumption in novice runners, more studies are needed to develop effective injury prevention programs for novice runners.

Overuse injuries in Swedish elite athletics- a study protocol for a prospective multifactorial cohort study

BACKGROUND

Overuse injuries (OI) are common in elite athletics. Previous studies have had athletes self-report injuries rather than having a medical professional provide a clear diagnosis. This might be a major reason for the inconsistencies in reported incident proportions of OI in elite athletics, in addition to the varying definitions of OI in current literature. Risk factors or combinations of risk factors (biomechanical, clinical, and training-related) have been shown to be important in the developmental process of OI. However, no studies have examined these relationships using a multifactorial and prospective approach in elite athletics. The purpose of this study protocol is to describe OI incidence proportion, injury severity, location, and occurrence during a complete athletics season. Moreover, possible discipline specific and injury specific risk factors that might be associated with OI will be examined.

METHODS

This study will be an explorative prospective cohort study including approximately 120 elite athletes. All athletes will be screened twice during one complete athletics season. The screening will consist of a body composition scan to measure muscle mass, fat free mass, lean mass, bone density, and bone mineral content. In addition, clinical examination will measure range of motion for the lower back, hip, knee, shoulder, and elbow and ankle joints. A running analysis will measure the 3D motions of the hip, knee, and ankle joints. Finally, maximal isometric strength tests of the main core and lower extremity muscles will be carried out. To record injuries, each athlete will consult a physiotherapist or sports medicine doctor affiliated with the study to get a clear diagnosis. Injury data will be recorded according to the previously published athletics consensus statement.

DISCUSSION

Results from this study protocol will contribute more insight and detailed knowledge regarding the extent of OI occurrence among elite athletes during a complete athletics season. It will also provide further insights into which risk factors are associated with the development of OI in elite athletics.

Validity of injury self-reports by novice runners: comparison with reports by sports medicine physicians

This study examined the criterion validity of self-reported running-related injuries (RRI) by novice runners. Fifty-eight participants (41 females; age 46 ± 11 yrs) of the "Start-to-Run" program provided self-reports on their RRIs using an online questionnaire. Subsequently, they attended injury consultations with sports medicine physicians who provided physician-reports (blinded for the self-reports) as a reference standard. Self-reports and physician-reports included information on injury location (i.e., hip/groin, upper leg, knee, lower leg, and ankle/foot) and injury type (i.e., muscle-tendon unit, joint, ligament, or bone). Sensitivity, specificity, and positive predictive values were 100% for all five injury locations. For injury type, sensitivity was low (66% for muscle-tendon unit, 50% for ligament, and 40% for bone) and lowest for joint injuries (17%). In conclusion, the validity of self-reported RRIs by novice runners is good for injury locations but not for injury types. In particular for joint injuries, the validity of novice runners' self-reports is low. Abbreviations: RRI: Running Related Injury; SMC: Sports Medicine Centre; MTU: Muscle Tendon Unit; PPV: Positive Predictive Value.

From which level of competition in clubs are adolescents at greater risk of injury compared with outside-of-clubs athletes? A school-based study

OBJECTIVES

Sport practice is a key factor in a person's physical and mental health but, for adolescent athletes, some injuries lead to health problems in the long term. The literature provides multiple factors for understanding injury but does not give information about injury risk related to each level of play in a large sample of multisport athletes. This study investigates this relationship in 14- to 19-year-old adolescents.

METHODS

The survey on adolescents and health was conducted in classrooms of France, from February to March 2015. Only sports players were included in the analyses (n = 986). The levels of play were divided into five categories: outside of a club/no competition, club player/no competition, club player/local level, club player/state level and club player/national and higher level. A three-step binary logistic regression analysis with age, sex, type of sport, weekly hours of exposure, and level of play was used.

RESULTS

During the past year, 48.1% of the adolescents were injured. Age and sex were not risk factors. The injury risk associated with the increases in level of play is higher than those related to the hours of exposure per week or the type of sport. In clubs, adolescents who do not compete or play at a local level showed no evidence of greater injury risk whereas state-level and national- and higher-level athletes were at greater risk than outside-of-club players (OR = 2.18, 95%CI = 1.13-3.94 and OR = 3.89, 95%CI = 2.07-7.31, respectively).

CONCLUSION

Adolescents who play sports in clubs are clearly more exposed to injury than those who play outside of a club, mainly from state level. Age and sex are not related to injury. Future epidemiological studies should control adolescents' level of play. Special attention should be accorded to the injury risk of athletes playing at these levels of competition.

Accuracy of recall of musculoskeletal injuries in elite military personnel: a cross-sectional study

BACKGROUND

Self-reported data are often used in research studies among military populations.

OBJECTIVE

The accuracy of self-reported musculoskeletal injury data among elite military personnel was assessed for issues with recall.

DESIGN

Cross-sectional study.

SETTING

Applied research laboratory at a military installation.

PARTICIPANTS

A total of 101 subjects participated (age 28.5±5.6 years). Study participants were active duty military personnel, with no conditions that precluded them from full duty.

PRIMARY AND SECONDARY OUTCOME MEASURES

Self-reported and medical record reviewed injuries that occurred during a 1-year period were matched by anatomic location, injury side (for extremity injuries), and injury year and type. The accuracy of recall was estimated as the per cent of medical record reviewed injuries correctly recalled in the self-report. The effect of injury anatomic location, injury type and severity and time since injury, on recall, was also assessed. Injuries were classified as recent (≤4 years since injury) or old injuries (>4 years since injury). Recall proportions were compared using Fisher's exact tests.

RESULTS

A total of 374 injuries were extracted from the subjects' medical records. Recall was generally low (12.0%) and was not different between recent and old injuries (P=0.206). Injury location did not affect recall (P=0.418). Recall was higher for traumatic fractures as compared with less severe non-fracture injuries (P values 0.001 to <0.001). Recall for non-fracture injuries was higher for recent as compared with old injuries (P=0.033). This effect of time since injury on recall was not observed for fractures (P=0.522).

CONCLUSIONS

The results of this study highlight the importance of weighing the advantages and disadvantages of self-reported injury data before their use in research studies in military populations and the need for future research to identify modifiable factors that influence recall.

Self-reported worst injuries in women's Australian football identify lower limb injuries as a prevention priority

BACKGROUND

Increasing participation by women in Australian football (AF) has made understanding their specific injury prevention needs a priority. In other sports, men and women have different injury profiles. This study aims to provide the first overview of self-reported injuries in women's AF.

METHODS

Nationwide survey of women aged 17+ years who played in an AF competition was conducted following the 2014 playing season. The players' self-reported worst injury from the 2014 season is presented according to injury type, body part injured, treatment sought and games/training missed.

RESULTS

Three-quarters of 553 respondents (n=431, 78%) reported at least 1 injury. Over half (n=235, 55%) of injuries were to the lower limb. Ankle ligament tears/sprains (n=50, 12% of all injuries) and knee ligament tears/sprains (n=45, 10%) were most frequent lower limb injuries reported. Two-thirds (65%) of all lower limb injuries led to at least 1 missed game. Of 111 (26% of all injuries) upper limb injuries reported, over half (n=57, 62%) were to the hand/fingers/thumb, including fractures (n=28, 6% of all injuries), ligament tears/sprains (n=18, 4%) and dislocations (n=11, 3%). Half of the upper limb injuries (51%) resulted in players missing matches/training.

CONCLUSIONS

The most frequent self-reported worst injuries for women playing AF were joint damage to the ankle and knee. A prospective injury study is needed to confirm the causes and rate of these lower limb injuries to identify the most suitable prevention interventions.

Analyses of Landing Mechanics in Division I Athletes Using the Landing Error Scoring System

BACKGROUND

Injury to the anterior cruciate ligament (ACL) can be detrimental to any athlete, having both short- and long-term health consequences. Examining preseason screening landing mechanics can indicate the likelihood of injury during the season. Furthermore, previous injury is also commonly referred as a predisposing factor for reinjury.

HYPOTHESIS

Players with a history of lower extremity injury would have higher Landing Error Scoring System (LESS) scores than those with no previous injury, and healthy soccer athletes who sustained an injury during the 2014 season would have higher LESS scores than those who remained uninjured.

STUDY DESIGN

Prospective cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Thirty-four Division I male and female soccer athletes (19 men, 15 women; mean age, 19.6 ± 1.2 years; mean height, 172.4 ± 8.7 cm; mean weight, 70.8 ± 9.1 kg). An a priori sample size estimation for a power of 0.80 (80%) and an alpha error of 0.05 with an estimated effect size of 0.6 for a sample of 30 participants was attained. Participants performed a drop-landing task and were scored on their landing mechanics using the LESS. Lower extremity injuries were tracked during the season. LESS scores between those with and without a history of injury and those who were injured and uninjured during the season were compared using 2 separate 1-way analyses of variance.

RESULTS

No statistically significant differences (F(1,33) = 0.47, P = 0.50) existed between LESS scores in athletes who had a previous injury history compared with those with no injury history. No statistically significant differences (F(1,20) = 0.05, P = 0.83) existed between LESS scores in healthy athletes who were injured during the 2014 season compared with those healthy athletes who were uninjured.

CONCLUSION

No differences were present between athletes with and without a history of lower extremity injury. The majority of healthy participants who were injured during the season had similar LESS scores to those who remained uninjured, suggesting that the LESS may not be able to identify atypical landing mechanics in this group of athletes.

Increased patterns of risky behaviours among helmet wearers in skiing and snowboarding

BACKGROUND

There has been an ongoing debate as to whether wearing helmets in skiing and snowboarding increases the risk tolerance of participants.

OBJECTIVE

To investigate the roles of demographic and personality variables, and helmet usage in predicting risk taking behaviours in a cross-sectional sample of intermediate and proficient skiers and snowboarders.

METHODS

Risk taking in skiing was measured using a validated 10-item self-report measure which was designated as the outcome variable in a three step hierarchical regression. Independent predictors included age, sex, education, sport, ability, helmet usage, and personality traits that have been associated with risk taking: impulsivity and sensation seeking.

RESULTS

In the final regression model, helmet use significantly predicted variance in risk taking (standardized β=.10, p=.024), and the relationship remained after accounting for variance due to demographic variables and general trait measures. The partial relationship between risk taking and sex, ability, impulsivity, and sensation seeking were also significant (p<.05).

CONCLUSION

High sensation seeking, high impulsivity, male sex, and proficiency were associated with increased patterns of risky behaviours in skiers and snowboarders, and after accounting for these factors, helmet use was a significant predictor of risk taking. The relationship between helmet use and risk taking was modest suggesting that the costs of increased risk taking is not likely to outweigh the protective benefits of a helmet.

Differences in long-term medical consequences depending on impact direction involving passenger cars

OBJECTIVE

There is limited knowledge of the long-term medical consequences for occupants injured in car crashes in various impact directions. Thus, the objective was to evaluate whether injuries leading to permanent medical impairment differ depending on impact direction.

METHODS

In total, 36,743 injured occupants in car crashes that occurred between 1995 and 2011 were included. All initial injuries (n = 61,440) were classified according to the Abbreviated Injury Scale (AIS) 2005. Injured car occupants were followed for at least 3 years to assess permanent medical impairment. The data were divided into different groups according to impact direction and levels of permanent impairment. The risk of permanent medical impairment was established for different body regions and injury severity levels, according to AIS.

RESULTS

It was found that almost 12% of all car occupants sustained a permanent medical impairment. Given an injury, car occupants involved in rollover crashes had the highest overall risk to sustain a permanent medical impairment. Half of the head injuries leading to long-term consequences occurred in frontal impacts. Far-side occupants had almost the same risk as near-side occupants. Occupants who sustained a permanent medical impairment from cervical spine injuries had similar risk in all impact directions (13%) except from rollover (17%). However, these injuries occurred more often in rear crashes. Most of the injuries leading to long-term consequences were classified as minor injuries by AIS for all impact directions.

CONCLUSIONS

Studying crash data from a perspective of medical impairment is important to identify injuries that might not be prioritized only considering the AIS but might lead to lower quality of life for the occupant and also costs for society. These results can be used for road transport system strategies and for making priority decisions in vehicle design.

Definition and usage of the term "overuse injury" in the US high school and collegiate sport epidemiology literature: a systematic review

BACKGROUND

A number of epidemiologic and surveillance-based studies of sports injury provide statistics on, and sometimes discussion of, overuse injuries. However, there is no consensus on the definition of "overuse." Some studies consider "overuse" as a mechanism of injury while others use a diagnosis-based definition.

OBJECTIVE

The objective of this study was to describe variation between studies in the definition and use of the term "overuse."

METHODS

PubMed and SPORTDiscus databases were searched between May and November 2012 to find articles published or online ahead of printing pertaining to US high school or collegiate athletics, which were epidemiologic in nature. Inclusion criteria required that the article present data collected on athlete exposure and provided statistics pertaining to overuse injuries. PRISMA guidelines were adhered to, to the best ability of the authors.

RESULTS

The initial search resulted in 5,182 articles with potential for inclusion. After review of titles or abstracts where appropriate, 232 studies were read in entirety to determine if they were appropriate for inclusion. Of the 35 articles included, 13 used data from the National Collegiate Athletics Association's Injury Surveillance System, 12 used data from the High School Reporting Information Online (RIO) injury surveillance system, and one used data from both of these systems. The remaining nine articles used data from distinct surveillance systems or prospectively collected data. All of these articles included data on overuse injuries, although not all provided definitions for overuse. A major finding from the literature is that the term "overuse" has been used both as a mechanism of injury and as an injury diagnosis (or a category of diagnoses). Specifically, of 35 articles, 14 used "overuse" as a mechanism of injury, seven used it as a category of injury diagnoses, eight used it as both a category of injury diagnoses and a mechanism of injury, and it was unclear in one how the term is used. Only one of the 35 articles provided a biomechanical definition for overuse injuries. Twelve of 35 articles combined "overuse" with other terms such as "chronic," "gradual onset," and "repetitive stress." Use of the term "no contact" was investigated in relation to "overuse." Four of 35 articles define overuse in the context of no contact injuries. Only one of 35 articles define "no contact" as a specific acute mechanism of injury, while all other mentions of "no contact" do not specifically distinguish whether "no contact" was limited to acute injuries only, or has potential to include "overuse" injuries.

CONCLUSION

There is a great deal of inconsistency in the use of the term "overuse" both within and between data sources. This is further complicated by the multiple uses of the term "no contact." We recommend that the term "overuse" only be used in regard to the mechanism of injury in order to enhance interpretation and understanding of the literature regarding overuse injuries and enhance the ability to compare results between studies. We also recommend the adoption of a common working definition of overuse injuries within injury surveillance. This definition should emphasize that overuse injuries are characterized by (1) a mechanism of gradual onset, and (2) an underlying pathogenesis of repetitive microtrauma.

Assessment of musculoskeletal symptoms and their impacts in the adolescent population: adaptation and validation of a questionnaire

Background

Valid and reliable instruments measuring musculoskeletal symptoms prevalence and their impacts in the adolescent population are scarce. The Extended Nordic Musculoskeletal Questionnaire (NMQ-E) is a reliable instrument that measures the prevalence, severity and impact of musculoskeletal symptoms. The purpose of this study was: (1) to develop a musculoskeletal symptom screening tool for younger populations derived from the NMQ-E and NMQ French versions and (2) to assess the validity and reliability of the adapted version of the instrument.

Methods

Based on the results of a translated (French) and adapted NMQ-E administered to 61 adolescents, a final 27-item dichotomous questionnaire was developed. The questionnaire measured the 6-month prevalence of musculoskeletal symptoms and the impact of these symptoms on school attendance as well as on sports and leisure activity participation. Among the adolescents who agreed to participate, thirty-nine (mean age: 13.7 ± 1.8) formed the reliability cohort and thirty-four (mean age: 14.2 ± 2.3) formed the criterion validity cohort. Reliability was measured by test-retest with a mean time interval of 28 hours. Criterion validity was assessed by comparing the answers to the questionnaires to the participants’ clinical records. Statistical tests used were proportions of observed agreement (Po) and the Cohen kappa statistic (k).

Results

The mean Po for the test-retest was 0.92 for the 6-month symptom prevalence items, 0.99 for the impact of symptoms on school items and 0.96 for the impact on sports and leisure activities items. Kappa values for the reliability assessment ranged between 0.57 and 1.00 for the 27 dichotomous variables. The criterion validity kappa obtained for the agreement between participants’ clinical records and questionnaires was k = 0.76.

Conclusions

Kappa values for the reliability and the criterion validity are of moderate to perfect agreement beyond chance, indicating that there are only minor variations between tests, and good agreement between questionnaire items and clinical records. These results indicate that the adapted version of the NMQ-E is an appropriate self-administered musculoskeletal symptom screening tool for the adolescent population. Items related to the impacts of symptoms would benefit from additional validation using school and sport attendance records.

Supervision and risk of unintentional injury in young children

OBJECTIVE

Assess the association between caregiver supervision and acute unintentional injury in young children; evaluate whether lower levels of supervision result in more severe injury.

METHODS

A case cross-over study was conducted. Parents of children aged ≤4 years whose injuries required emergency department (ED sample) treatment or admission to the hospital (inpatient sample) were interviewed. Information on supervision (3 dimensions: proximity, attention, continuity) at the time of injury and 1 h before the injury (control time) was collected. An overall supervision score was created; a higher score indicates closer supervision. Hospital admission served as a proxy for injury severity. ORs and 95% CIs were calculated.

RESULTS

Interviews were completed by 222 participants; 50 (23%) were in the inpatient sample. For each supervision dimension the inpatient sample had higher odds of injury, indicating effect modification requiring separate analyses for inpatient and ED samples. For both samples, proximity 'beyond reach' was associated with the highest odds of injury; compared with 1 h before injury, children were more likely to be beyond reach of their caregiver at the time of injury (inpatient sample: OR 11.5, 95% CI 2.7 to 48.8; ED sample: OR 2.9, 95% CI 1.8 to 4.9). Children with lower supervision scores had the greatest odds of injury (inpatient sample: OR 8.0, 95% CI 2.4 to 26.6; ED sample: OR 3.3, 95% CI 1.9 to 5.6).

CONCLUSIONS

Lower levels of adult supervision are associated with higher odds of more severe injury in young children. Proximity is the most important supervision dimension for reducing injury risk.

Ankle injuries in the Netherlands: Trends over 10-25 years

Ankle injuries are a common health problem; data on ankle injury rates and time trends in the population at large are scarce. Our aim was to investigate the incidence of and time trends in population-based and emergency department-treated ankle injuries related to sports activities and other activities related to daily living. Data were obtained from one national survey on accidents and injuries (2000-2010) and one based on emergency department data (1986-2010). Linear regression was used to determine linear trends in ankle injuries per 1000 person-years. The number of ankle injuries related to sports activities and other activities of daily living increased from 19.0 to 26.6 per 1000 person-years (P = 0.002). The number of sports-related ankle injuries treated in emergency departments decreased from 4.2 to 1.5 per 1000 person-years (P < 0.001), and from 3.2 to 2.1 per 1000 person-years (P < 0.001) for other activities of daily living. According to our data, the incidence rates of all ankle injuries are around 5.5 times higher than those registered at emergency departments. The high incidence rates of ankle injuries highlight the need for proper ankle injury treatment and prevention.

Changes in Health-Related Quality of Life and Knee Function After Knee Injury in Young Female Athletes

Background:

Recent literature has called for greater attention to evidence-based practice in sports medicine with the documentation of overall status and impairments following injury. The prospective documentation of impairments associated with knee injuries in female athletes regarding their health-related quality of life (HRQoL) and knee function (KF) of high school and collegiate athletes is limited. Assessing the effect knee injuries have on young female athletes may allow clinicians to better understand the perspectives of the athletes who sustain these injuries.

Purpose:

To document the changes over 12 months in self-reported HRQoL and KF in young females who have sustained a knee injury.

Study Design:

Case series; Level of evidence, 4.

Methods:

A convenience sample of 242 females (mean age, 17.4 ± 2.4 years) who injured their knee participating in sport or recreational activities was utilized. Injuries were categorized as anterior cruciate ligament tears (ACL), anterior knee pain (AKP), patellar instability (PAT), meniscus tear (MNT), iliotibial band syndrome (ITB), collateral ligament sprain (COL), and other (OTH). HRQoL was assessed with the Short Form–12 v 2.0 survey (SF-12) physical component summary (PCS) and mental component summary (MCS). KF was assessed with the 2000 International Knee Documentation Committee survey (IKDC). Dependent variables included the paired differences in the 2000 IKDC as well as SF-12 composite scores from preinjury through 12 months postdiagnosis. Paired differences were assessed with repeated-measures analyses of variance (P ≤ .05).

Results:

IKDC scores were lower through 12 months for ACL, AKP, and PAT; through 6 months for MNT; and through 3 months for COL and OTH. HRQoL PCS and MCS scores were lower through 3 to 12 months depending on the type of injury classification.

Conclusion:

Knee injuries can negatively affect KF and HRQoL for up to 12 months in young females. Sports medicine providers need to be aware of these impacts as they work to effectively treat individuals with these injuries.

Internet-based survey of the nature and perceived causes of injury to dogs participating in agility training and competition events

OBJECTIVE

To characterize injuries (on the basis of type and severity of injury and affected region of the body) among dogs participating in agility training and competition events and examine associations between injury characteristics and perceived causes of injury.

DESIGN

Internet-based, retrospective, cross-sectional survey.

ANIMALS

3,801 privately owned dogs participating in agility training or trials.

PROCEDURES

A retrospective electronic survey was developed to investigate demographic factors for dogs and handlers, frequency of participation in agility training and competition, and perceived causes and characteristics of injuries acquired by dogs during agility-related activities. Respondents were handlers recruited through member lists of large canine agility associations in Canada and the United Kingdom and through promotion on an agility blog site. Associations between cause and anatomic site or type of injury and between injury severity (mild vs severe) and setting (competition vs practice) were investigated.

RESULTS

Surveys were received from 1,669 handlers of 3,801 agility dogs internationally. Handler-reported data indicated 1,209 of 3,801 (32%) dogs had ≥ 1 injury; of 1,523 analyzed injuries, the shoulder (349 injuries), back (282), and neck (189) regions and phalanges (202) were predominantly affected. Soft tissue injuries (eg, strain [muscle or tendon injury; 807], sprain [ligament injury; 312], and contusion [200]) were common. Injuries were most commonly incurred during interactions with bar jumps, A-frames, and dog walk obstacles (260, 235, and 177 of 1,602 injuries, respectively). Anatomic site and type of injury were significantly associated with perceived cause of injury.

CONCLUSIONS AND CLINICAL RELEVANCE

These findings provided a basis for further experimental studies to identify specific mechanisms of various types of injury in dogs that participate in agility activities.

Validity of soccer injury data from the National Collegiate Athletic Association's Injury Surveillance System

CONTEXT

Few validation studies of sport injury-surveillance systems are available.

OBJECTIVE

To determine the validity of a Web-based system for surveillance of collegiate sport injuries, the Injury Surveillance System (ISS) of the National Collegiate Athletic Association's (NCAA).

DESIGN

Validation study comparing NCAA ISS data from 2 fall collegiate sports (men's and women's soccer) with other types of clinical records maintained by certified athletic trainers.

SETTING

A purposive sample of 15 NCAA colleges and universities that provided NCAA ISS data on both men's and women's soccer for at least 2 years during 2005-2007, stratified by playing division.

PATIENTS OR OTHER PARTICIPANTS

A total of 737 men's and women's soccer athletes and 37 athletic trainers at these 15 institutions.

MAIN OUTCOME MEASURE(S)

The proportion of injuries captured by the NCAA ISS (capture rate) was estimated by comparing NCAA ISS data with the other clinical records on the same athletes maintained by the athletic trainers. We reviewed all athletic injury events resulting from participation in NCAA collegiate sports that resulted in 1 day or more of restricted activity in games or practices and necessitated medical care. A capture-recapture analysis estimated the proportion of injury events captured by the NCAA ISS. Agreement for key data fields was also measured.

RESULTS

We analyzed 664 injury events. The NCAA ISS captured 88.3% (95% confidence interval = 85.9%, 90.8%) of all time-lost medical-attention injury events. The proportion of injury events captured by the NCAA ISS was higher in Division I (93.8%) and Division II (89.6%) than in Division III (82.3%) schools. Agreement between the NCAA ISS data and the non-NCAA ISS data was good for the majority of data fields but low for date of full return and days lost from sport participation.

CONCLUSIONS

The overall capture rate of the NCAA ISS was very good (88%) in men's and women's soccer for this period.

Risk factors for self-reported exercise-related leg pain in high school cross-country athletes

CONTEXT

Prevention of exercise-related leg pain (ERLP) has not been successful because ERLP risk factors are not well known.

OBJECTIVE

To determine the percentage of high school cross-country (XC) athletes who reported a history of ERLP in their running careers, to identify the percentage of athletes who reported an occurrence of ERLP during 1 XC season, and to investigate the association of selected factors (age, high school year, years of high school running, sex, ERLP history, body mass index [BMI], foot type, and training distance) and the occurrence of ERLP.

DESIGN

Prospective cohort study.

SETTING

Six local high schools.

PATIENTS OR OTHER PARTICIPANTS

One hundred twenty-five high school XC athletes (62 females, 63 males).

MAIN OUTCOME MEASURE(S)

All athletes completed an initial ERLP questionnaire, and foot type was visually assessed. After the season, athletes were asked to complete a Web-based questionnaire regarding the seasonal occurrence of ERLP. Statistical analyses of differences (t tests) and associations (chi(2), relative risk) were conducted.

RESULTS

A total of 103 of the 125 athletes (82.4%) reported a history of ERLP, with 81 athletes reporting ERLP occurrence within the month preceding completion of the initial questionnaire. Bilateral medial leg pain was the most common ERLP presentation. More than half of the athletes (58.4%) with an ERLP history reported that the pain had interfered with XC participation. Ninety-three athletes responded to the postseason questionnaire, and 45 (48.0%) reported ERLP seasonal occurrence. Most athletes (97.8%) who experienced the seasonal occurrence of ERLP had a history of ERLP. No associations were noted between ERLP history or seasonal occurrence and age, high school year, years of high school running, sex, BMI, foot type, or training distance.

CONCLUSIONS

Both a history of ERLP and the seasonal occurrence of ERLP were common among these XC athletes. The only risk factor identified for ERLP season occurrence was ERLP history.

Physical activity and injuries during pregnancy

BACKGROUND

Although physical activity can provide health benefits to pregnant women, population-based research on the circumstances surrounding injuries from physical activity during pregnancy is lacking.

METHODS

Physical activity and subsequent injuries among a cohort of 1469 pregnant women in North Carolina were examined prospectively from the third phase of the Pregnancy, Infection, and Nutrition Study between 2001 and 2005. Chi-square analyses were used to compare distributions of maternal characteristics among women who sustained injuries from physical activity and women who reported no injuries during pregnancy. Injury incidence rates were calculated.

RESULTS

Few pregnant women (N = 34) reported a physical activity-related injury during pregnancy. The rates of physical activity-related and exercise-related injuries during pregnancy were 3.2 per 1000 physical activity hours and 4.1 per 1000 exercise hours, respectively. The most common types of injuries were bruises or scrapes (55%). Among all injuries, 33% resulted from exercise and 67% resulted from nonexercise physical activities. Sixty-four percent of all injuries were due to falls.

CONCLUSIONS

The incidence of injury from physical activity was low during pregnancy. Women should continue to be encouraged to maintain involvement in physical activity during pregnancy, while being aware of the potential for injury, particularly falls, from these activities.

Evaluation of injury and fatality risk in rock and ice climbing

Rock and ice climbing are widely considered to be 'high-risk' sporting activities that are associated with a high incidence of severe injury and even death, compared with more mainstream sports. However, objective scientific data to support this perception are questionable. Accordingly, >400 sport-specific injury studies were analysed and compared by quantifying the injury incidence and objectively grading the injury severity (using the National Advisory Committee for Aeronautics score) per 1000 hours of sporting participation. Fatalities were also analysed. The analysis revealed that fatalities occurred in all sports, but it was not always clear whether the sport itself or pre-existing health conditions contributed or caused the deaths. Bouldering (ropeless climbing to low heights), sport climbing (mostly bolt protected lead climbing with little objective danger) and indoor climbing (climbing indoors on artificial rock structures), showed a small injury rate, minor injury severity and few fatalities. As more objective/external dangers exist for alpine and ice climbing, the injury rate, injury severity and fatality were all higher. Overall, climbing sports had a lower injury incidence and severity score than many popular sports, including basketball, sailing or soccer; indoor climbing ranked the lowest in terms of injuries of all sports assessed. Nevertheless, a fatality risk remains, especially in alpine and ice climbing. In the absence of a standard definition for a 'high-risk' sport, categorizing climbing as a high-risk sport was found to be either subjective or dependent on the definition used. In conclusion, this analysis showed that retrospective data on sport-specific injuries and fatalities are not reported in a standardized manner. To improve preventative injury measures for climbing sports, it is recommended that a standardized, robust and comprehensive sport-specific scoring model should be developed to report and fully evaluate the injury risk, severity of injuries and fatality risk in climbing sports.

A comparison of high school sports injury surveillance data reporting by certified athletic trainers and coaches

CONTEXT

High school athletes sustain more than 1.4 million injuries annually. National high school sports injury surveillance forms the foundation for developing and evaluating preventive interventions to reduce injury rates. For national surveillance, individuals must report consistently and accurately with little one-on-one interaction with study staff.

OBJECTIVE

To examine the feasibility of relying on high school coaches as data reporters in a national, Internet-based sports injury surveillance study, using the same methods that have already proven successful in the National High School Sports-Related Injury Surveillance Study, which calls on certified athletic trainers (ATs) as reporters.

DESIGN

Prospective injury surveillance study.

SETTING

Eighteen United States high schools

PARTICIPANTS

Athletic trainers and varsity coaches for football, boys' and girls' soccer, and boys' and girls' basketball.

MAIN OUTCOME MEASURE(S)

Quantity and quality of exposure and injury reports.

RESULTS

All enrolled ATs participated, compared with only 43.0% of enrolled coaches. Participating ATs submitted 96.7% of expected exposure reports, whereas participating coaches submitted only 36.5%. All ATs reported athlete exposures correctly, compared with only 2 in 3 coaches. Participating ATs submitted 338 injury reports; participating coaches submitted only 55 (16.3% of the 338 submitted by ATs). Injury patterns differed between AT-submitted and coach-submitted injury reports, with ATs reporting a higher proportion of ankle injuries and coaches reporting a higher proportion of knee injuries. The reports submitted by ATs and coaches for the same injury had low agreement for diagnosis and time loss, with only 63.2% and 55.3% of pairs, respectively, providing the same response. The ATs lacked more responses for demographic questions, whereas coaches lacked more responses regarding the need for surgery.

CONCLUSIONS

Whenever possible, ATs should be the primary data reporters in large, national studies. In high schools without access to an AT, researchers must be willing to devote significant time and resources to achieving high participation and compliance from other reporters.

Rock climbing injury rates and associated risk factors in a general climbing population

The objective was to examine injury rates and associated risk factors in a representative sample of climbers. A random sample (n=606) of the Swedish Climbing Association members was sent a postal survey, with an effective response rate of 63%. Self-reported data regarding climbing history, safety practices and retrospective accounts of injury events (recall period 1.5 years) were obtained. Descriptive statistical methods were used to calculate injury incidences, and a two-step method including zero-inflated Poisson's regression analysis of re-injuries was used to determine the combination of risk factors that best explained individual injury rates. Overall, 4.2 injuries per 1000 climbing hours were reported, overuse injuries accounting for 93% of all injuries. Inflammatory tissue damages to fingers and wrists were the most common injury types. The multivariate analysis showed that overweight and practicing bouldering generally implied an increased primary injury risk, while there was a higher re-injury risk among male climbers and a lower risk among the older climbers. The high percentage of overuse injuries implies that climbing hours and loads should be gradually and systematically increased, and climbers regularly controlled for signs and symptoms of overuse. Further study of the association between body mass index and climbing injury is warranted.

Discordance in injury reporting between youth-athletes, their parents and coaches

Hiring experienced health professionals to collect data on sport injuries is expensive, limits resources, and may be prohibitive for surveillance studies. The objective of this study was to obtain pilot data on whether youth self-report deserves further study. We followed 67 recreational and elite soccer players aged 11-17 for one season and compared responses of injured players with those of their parents/coaches. We defined our main outcome of discordance as any disagreement in responses between the youth, parent and coach (triad). When one person didn't know the answer, we categorised the responses as "concordance" if the other two members agreed. We omitted data when two people responded "Don't Know". Of 10 injuries that could be analysed, 29/30 interviews occurred within 21 days. For factual questions analysed, there was 100% concordance for the type and side of injury, and place where the injury occurred. There were 1-2 discordant triads for each of time of day, activity during injury and specific body part injured. There were greater discordances for date of injury, first-aid treatment, and opinions concerning underlying reasons for the injury. Interview-report by youth themselves should be explored as a possible low cost method of documenting youth sport injuries.

Triathlon related musculoskeletal injuries: The status of injury prevention knowledge

Triathlon is a popular participation sport that combines swimming, cycling and running into a single event. A number of studies have investigated the incidence of injury, profile of injuries sustained and factors contributing to triathlon injury. This paper summarises the published literature in the context of the evidence base for the prevention of triathlon related injuries. Relevant articles on triathlon injuries were sourced from peer-reviewed English language journals and assessed using the Translating Research into Injury Prevention Practice (TRIPP) framework. This review highlights the significant knowledge gap that exists in the published literature describing the incidence of injury, the profile of injuries sustained and evidence for the prevention of injury in triathlon. Despite the number of studies undertaken to address TRIPP Stages 1 and 2 (injury surveillance, aetiology and mechanism of injury), most triathlon studies have been limited by retrospective designs with substantial, and unvalidated, recall periods, inconsistency in the definitions used for a reportable injury and exposure to injury, or a failure to capture exposure data at all. Overall, the paucity of quality, prospective studies investigating the incidence of injury in triathlon and factors contributing to their occurrence has led to an inability to adequately inform the development of injury prevention strategies (TRIPP Stages 3-6) for this sport, a situation that must be rectified if gains are to be made in reducing the burden of triathlon related injury.

Validity of self-reported periodontal status in the Florida dental care study

BACKGROUND

Our objectives were to assess the validity of self-reported periodontal status by quantifying the 1) concordance between self-reported and clinical status at baseline; and 2) validity using a multivariable regression of self-reported periodontal status and sociodemographic status.

METHODS

The Florida Dental Care Study was a prospective study that used a population-based, stratified random sample of 873 persons in four counties of north Florida who were > or = 45 years of age at baseline. Analyses used baseline data derived from in-person interviews and clinical periodontal examinations. Multivariable logistic regressions were done to quantify the relationships between the outcome (clinically determined periodontal attachment level) and predictors (self-reported dental symptoms, self-reported dental behaviors, sociodemographic circumstances, and clinically determined number of remaining teeth).

RESULTS

Self-rated "gum" health and presence of a loose tooth were the only periodontal measures that were associated significantly with clinically determined periodontal status in multivariable regressions. The validity of self-reported periodontal status improved when the threshold of severity was increased. Significant racial differences in the validity of self-reports were evident.

CONCLUSION

Self-reported measures of periodontal status were related to clinically measured periodontal attachment loss and warranted classifying their validity as "moderate" and useful for some circumstances.

Incidence and risk factors for injury in non-elite netball

This paper identifies the risk and protective factors for injury in non-elite netball. Three-hundred and sixty-eight non-elite netballers completed a baseline questionnaire at the commencement of the 1997 preseason. Participants were telephoned each month during the 1997 and 1998 playing seasons to provide details of their exposure at training and games and any injury experiences in the previous 4 weeks. The incidence of injury in this study was 14 injuries per 1000 player hours. The risk factors for injury were identified as: not warming up before a game (IRR 1.11, 95% CI 1.00-1.23) and not being open to new ideas (IRR 1.04, 95% CI 1.00-1.07). Training for 4 or more hours per week (IRR 0.66, 95% CI 0.45-0.98) and not sustaining an injury in the previous 12 months (IRR 0.58, 95% CI 0.43-0.79) were found to be protective against injury. The risk and protective factors for injury identified in this study can be used as the basis for the development of evidence-based injury prevention strategies that seek to reduce the risk of injury in sport. Injury prevention strategies should focus on the development of effective training programs that include netball-specific skills, activities and movements. Further investigation into the mechanisms associated with the risk and protective factors identified would provide further understanding of why these factors increase or decrease the risk of injury.