Risk of Injuries in Paralympic Track and Field Differs by Impairment and Event Discipline: A Prospective Cohort Study at the London 2012 Paralympic Games

Sports Injury Surveillance Systems: A Scoping Review of Practice and Methodologies

Background: Injury prevention/reduction strategies are driven by data collected through injury surveillance systems. The aim of this review was to describe injury surveillance systems that are used for ongoing surveillance in either a professional or amateur sporting environment. This was an update to a review done in 2015 to determine the gaps in injury surveillance. Methods: A systematic search process of five databases (MEDLINE, CINAHL, EMBASE, SCOPUS and ProQuest) was used to discover published research that presented methodological data about the injury surveillance systems implemented by clubs and organisations for ongoing surveillance. Inclusion criteria centred on the population under surveillance and the ongoing nature of that activity. Data extracted and summarised included the level of athlete under surveillance, the data collection mechanism and the personnel involved, the injury definitions applied and the date and country of origin to provide a comprehensive picture of the systems. Results: A total of 21 systems were documented as being used in ongoing injury surveillance, with 57% of these exclusively in the professional/elite landscapes and 33% at the amateur level. Surveillance systems cater for one sport per athlete entry so there is a gap in research for multi-sport athletes at the amateur level, especially where there is no early specialisation in a multi-sport participation environment. Conclusions: Research in this area will lead to a better understanding of subsequent injury risk for multi-sport athletes who have a higher athlete exposure than single-sport athletes.

Injury incidence according to athlete impairment type during the 2012 and 2016 Summer Paralympic Games: a combined analysis of 101 108 athlete days

OBJECTIVES

The relationship between sport-related injuries and Para athlete impairment type has not yet been comprehensively studied. This study aimed to describe injury incidence according to athlete impairment type during the London 2012 and Rio 2016 Summer Paralympic Games, by sex, age, Games period, chronicity and anatomical area.

METHODS

A combined analysis of 7222 athletes was conducted comprising 101 108 athlete days, using pooled data. Internet sources were used to identify impairments of registered athletes. Impairment types: brain disorders (BD), limb deficiency, neuromuscular disorders (NMD), spinal cord-related disorders, visual impairment (VI) and 'all others' (OTH: impaired passive range of movement, intellectual impairment, leg length difference, short stature and unknown impairments). Results by impairment type are reported as univariate unadjusted incidences (injuries/1000 athlete days; 95% CIs). Statistical significance between impairment types was determined when 95% CIs did not overlap.

RESULTS

The overall crude unadjusted incidence of injury was 11.1 (95% CI 10.4 to 11.9), significantly higher in VI (13.7 (95% CI 11.0 to 15.7)) and NMD (13.3 (95% CI 11.1 to 16.1)) compared with BD (9.1 (95% CI 7.7 to 10.8)). Acute (sudden onset) (8.6 (95% CI 7.3 to 10.1)) and lower limb (6.6 (95% CI 5.4 to 8.1)) injuries were higher among athletes with VI, while athletes with NMD had a higher incidence of repetitive (gradual onset) (5.9 (95% CI 4.3 to 8.0)) and upper limb (6.9 (95% CI 5.2 to 9.0)) injuries compared with other impairments.

CONCLUSIONS

Incidence and type of injuries differed between athlete impairment types. Athletes with VI or NMD sustained the highest incidence of injury, and athletes with BD had the lowest. Findings of this study can inform the management of competition-related injuries in Para athletes.

Sports-Related Health Problems in Para-Sports: A Systematic Review With Quality Assessment

CONTEXT

Participation in sports is associated with a risk of sports-related health problems. For athletes with an impairment, sports-related health problems further burden an already restricted lifestyle, underlining the importance of prevention strategies in para-sports.

OBJECTIVE

To provide a comprehensive overview with quality assessment of the literature on sports-related health problems, their etiology, and available preventive measures in para-sports following the steps of the Sequence of Prevention.

DATA SOURCES

A literature search (in PubMed, Embase, SPORTDiscus, CINAHL and the Cochrane Library) was performed up to December 8, 2021, in collaboration with a medical information specialist.

STUDY SELECTION

The search yielded 3006 articles, of which 64 met all inclusion criteria.

STUDY DESIGN

Systematic review with quality assessment.

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Two independent researchers carried out the screening process and quality assessment. One researcher extracted data, and the Sequence of Prevention categorized evidence.

RESULTS

A total of 64 studies were included, of which 61 reported on the magnitude and risk factors of sports-related health problems, while only 3 reported on the effectiveness of preventive measures. Of these, 30 studies were of high quality. Most studies (84%) included elite-level athletes. The reported injury incidence varied widely between sports (0-91 per 1000 athlete days) and impairment categories (1-50 per 1000 athlete days). The same applies to illness incidence with regard to different sports (3-49 per 1000 athlete days) and impairment categories (6-14 per 1000 athlete days).

CONCLUSION

This review shows the current vast range of reported sport-related health problems in para-sports. There is limited evidence concerning the severity of these sports-related health problems and inconclusive evidence on the risk factors. Lastly, the evidence regarding the development and effectiveness of preventive measures for para-athletes is sparse.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

"Knowing the Noise That Surrounds the Athlete": A Qualitative Study Exploring the Health-Seeking Behaviors of Athletes With Limb Deficiency Drawing on the Experiences and Perceptions of the Medical Staff and Athletes

OBJECTIVE

The aim of the study is to explore the health-seeking behaviors of athletes with limb deficiency, drawing on the experiences and perception of the sports medicine team and athletes.

DESIGN

The study used an interpretive hermeneutic phenomenological methodology with a subtle realist paradigmatic view to investigate commonality in unique experiences within reality. Data collection was completed with two focus groups in December 2019 and March 2020. Thirteen participants took part including athletes and sports medicine team members (physiotherapists, doctors, and strength and conditioning coaches) working in parasports. Focus group manuscripts were transcribed verbatim from audio recordings. An inductive, iterative process was used to identify themes and subthemes, with processes in place to establish rigor.

RESULTS

Two themes and five subthemes emerged in relation to the "internalization and adjustment to social identity" and "the importance and impact of factors, which impact the athlete social identity."

CONCLUSIONS

Health-seeking behaviors of athletes with limb deficiency were influenced by a unique blend of personal and environmental factors that contribute toward social identity. The sports medicine team require specific awareness of factors that may diminish health-seeking behaviors to deliver a personalized approach and negate consequences.

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

OBJECTIVE

To describe the epidemiology of injuries at the Tokyo 2020 Paralympic Games, including injuries sustained in the new sports of badminton and taekwondo.

METHODS

Injury data were obtained daily via the established web-based injury and illness surveillance system (WEB-IISS; 81 countries, 3836 athletes) and local organising committee medical facilities (81 countries, 567 athletes). Univariate unadjusted incidences (injuries per 1000 athlete days with 95% CIs), injury proportion (IP, %) and injury burden (days lost per 1000 athlete days) are reported.

RESULTS

A total of 4403 athletes (1853 women, 2550 men) from 162 countries were monitored prospectively during the 3-day pre-competition and 12-day competition periods (66 045 athlete days). 386 injuries were reported in 352 athletes (IP=8.0%) with an incidence of 5.8 per 1000 athlete days (95% CI 5.3 to 6.5). Football 5-a-side (17.2), taekwondo (16.0), judo (11.6) and badminton (9.6) had the highest incidence. There was a higher incidence of injuries in the pre-competition period than in the competition period (7.5 vs 5.4; p=0.0053). Acute (sudden onset) injuries and injuries to the shoulder (0.7) and hand/fingers (0.6) were most common. Injury burden was 10.9 (8.6-13.8), with 35% of injuries resulting in time loss from training and competition.

CONCLUSION

Compared with previous Paralympic Games, there was a reduction in injury incidence but higher injury burden at the Tokyo 2020 Paralympic Games. The new sports of taekwondo and badminton had a high injury incidence, with the highest injury burden in taekwondo, compared with other sports. These findings provide epidemiological data to inform injury prevention measures for high-risk sports.

Parasport: Effects on Musculoskeletal Function and Injury Patterns

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Sports participation can improve gait, muscle strength, and functional abilities in patients with a wide variety of disabilities. Para athletes are also at substantial risk for injury during sports participation.

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Ambulant athletes with cerebral palsy are at risk for soft-tissue injuries about the knee as well as foot and ankle injuries. Wheelchair athletes are at risk for osteoporotic fractures and shoulder girdle injuries. Limb-deficient athletes are prone to low back pain and overuse injuries of the contralateral extremity.

➤

Para athletes are vulnerable to abuse during sports participation, and physicians should promptly report any possible abuse or mistreatment.

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Orthopaedic surgeons should understand disability and sport-specific risk factors for injury in para athletes in order to initiate early management and injury prevention protocols.

Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21st century

Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.

Shoulder Pain, Function, and Ultrasound-Determined Structure in Elite Wheelchair-Using Para Athletes: An Observational Study

PURPOSE

This study aimed to determine the relationship between shoulder pain, physical examination, and tissue pathology in manual wheelchair users competing in elite sport.

METHODS

Eighty elite para athletes who used a manual wheelchair for daily mobility were recruited from international track (n = 40), field (n = 19), and powerlifting (n = 21) competitions. Athletes were surveyed regarding shoulder pain history and symptoms (Wheelchair User's Shoulder Pain Index (WUSPI)), whereas independent blind observers measured signs (Physical Examination of the Shoulder Scale (PESS)) and tissue pathology (Ultrasound Shoulder Pathology Rating Scale (USPRS)). Relationships between measures for the total cohort and for subgroups defined by sporting discipline were calculated.

RESULTS

A large proportion of athletes reported a history of upper limb pain (39% dominant and 35% nondominant). For the total cohort, WUSPI score was 22.3 ± 26.9, PESS score was 7.4 ± 6.7, and USPRS score was 5.2 ± 4.0. There were no USPRS score differences between athlete subgroups; however, track athletes had lower WUSPI and PESS scores, especially compared with field athletes. The first principal component explained most of the variance in the WUSPI and PESS, which were strongly correlated (r = 0.71), and the second orthogonal component explained the USPRS, which did not correlate with either the PESS (r = 0.21) or WUSPI (r = 0.20). Subgroup analysis showed that track athletes had lower symptom scores for a given physical examination score.

CONCLUSIONS

Elite para athletes who use manual wheelchairs for daily mobility have a high prevalence of shoulder symptoms, positive signs on physical examination, and ultrasound-determined tissue pathology. Ultrasound-determined tissue pathology does not correlate with symptoms or signs. This information can help to guide clinicians in managing shoulder problems in this athlete population at high risk of injury.

Shoulder pain and ultrasound findings: A comparison study of wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users

BACKGROUND

Shoulder pain is one of the most common musculoskeletal concerns in manual wheelchair users including among athletes. However, there is a paucity of research characterizing both shoulder pain and shoulder pathology in this population.

OBJECTIVE

To characterize and compare the prevalence of current shoulder pain and ultrasound metrics of shoulder pathology between wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users.

DESIGN

Cross-sectional.

SETTING

Chicago-area adaptive sport teams/programs and musculoskeletal clinics.

PARTICIPANTS

Thirty-four wheelchair athletes, six nonathletic wheelchair users, and 12 nonwheelchair users.

METHODS

Self-reported shoulder pain was assessed by questionnaire and Wheelchair User Shoulder Pain Index (WUSPI). Shoulder physiology and pathology were assessed by physical and ultrasound evaluation of both shoulders by a sports medicine physician.

MAIN OUTCOME MEASURES

Questionnaire outcomes: Prevalence of current shoulder pain, total WUSPI score. Physical examination outcomes: total Physical Examination of Shoulder Scale (PESS) score. Sonographic outcomes: Acromiohumeral distance (AHD) and presence of shoulder pathology.

RESULTS

The majority of wheelchair athletes (68%) and nonathletic wheelchair users (67%) experienced shoulder pain since using a manual wheelchair. Wheelchair basketball players had a mean WUPSI score of 17.2 (SD = 21.8), and athletes participating in handcycling, sled hockey, and quad rugby had mean scores of 4.91 (SD = 8.32), 7.76 (SD = 13.1), and 4.29 (SD = 7.75), respectively. Shoulder pathology was observed in 14 of 31 (45%) wheelchair athletes and 4 of 6 (67%) nonathletic wheelchair users (p = .41).

CONCLUSIONS

Although wheelchair use is a risk factor for shoulder pain, participation in amateur wheelchair sports may not be associated with increased risk of shoulder pain. It is possible that overhead sports such as wheelchair basketball may define a unique high-risk group. Further study is needed to examine this relationship and to determine whether there are differences between specific wheelchair sports.

Electromyography, Wavelet Analysis and Muscle Co-Activation as Comprehensive Tools of Movement Pattern Assessment for Injury Prevention in Wheelchair Fencing

The aim of the study was to determine the correct movement patterns of fencing techniques in wheelchair fencers. Through a comprehensive analysis, the key muscles in the kinematic chain exposed to potential injuries were identified. The study participants were 16 wheelchair fencers, divided into two groups representing two categories of disability: Group A (N = 7) comprising fencers with mild paraplegia, having freedom of movement of the trunk and arms; and Group B (N = 9) comprising fencers with a spinal cord injury and partial paresis of the arms. EMG and an accelerometer were used as the main research tools. The EMG electrodes were placed on the muscles of the sword arm as well as on the left and right sides of the abdomen and torso. The EMG signal was transformed using wavelet analysis, and the muscle activation time and co-activation index (CI) were determined. In Group A fencers, first the back and abdominal muscles were activated, while in Group B, it was the deltoid muscle. The wavelet coherence analysis revealed intermuscular synchronization at 8–20 Hz for Group A fencers and at 5–15 Hz for Group B fencers. In Group A fencers, the co-activation index was 50.94 for the right-side back and abdominal muscles, 50.75 for the ECR-FCR, and 47.99 for the TRI-BC pairs of upper limb muscles. In contrast, Group B fencers demonstrated higher CI values (50.54) only for the postural left-side muscle pairs. Many overload injuries of the shoulder girdle, elbow, postural muscles, spine, and neck have been found to be preventable through modification of current training programs dominated by specialist exercises. Modern wheelchair fencing training should involve neuromuscular coordination and psychomotor exercises. This will facilitate the individualization of training depending on the fencer’s degree of disability and training experience.

Sports Injuries Among Players of the Polish National Team in Amputee Football in the Annual Training Cycle

The aim of the study was to determine the frequency, type and origin of the occurrence of injuries in amputee football. The studied group comprised all members of the Polish national amputee football team (n = 25). During the 9-month observation period, 13 players incurred 22 injuries. The incidence proportion was 48.0 per 100 athletes (95% Cl, 28.4-67.6) and the incidence rate was 5.73 per 1000 athlete-days (95% Cl, 3.33-8.12). The study showed that 32.8% of the injuries were to the thigh, 13.6% to the ankle, and 9.1% to the knee. The obtained results indicate that amputee football players rather frequently incur play-related injuries, but a single athlete incurs relatively few of them, with the lower limb being most commonly injured.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Understanding Injury and Injury Prevention in Para Sport Athletes

CONTEXT

Training loads, injury, and injury prevention in the Para sports population has not been well established.

OBJECTIVE

The purpose of this study was to survey elite-level swimming, cycling, and athletic Para sport athletes in the United States who were competing in the 2016 US Paralympic trials to better understand common injuries among athletes in each sport and to determine whether injury prevention programs were being utilized.

DESIGN

Cross-sectional, survey study.

SETTING

The 2016 US Paralympic trials for swimming, cycling, and athletics.

PARTICIPANTS

Athletes who competed in swimming, cycling, and/or athletics at the 2016 US Paralympic trials (N = 144; 83 males and 61 females).

MAIN OUTCOME MEASURES

Participants completed electronic survey using Qualtrics XM (Qualtrics, Provo, UT) with questions pertaining to average number of hours trained per week, number of cross-training hours performed each week, descriptive information regarding sport-related injuries, pain, whether athletes received treatment for injuries, and descriptive information regarding whether the athletes had participated in an injury prevention program.

RESULTS

Over 64% of respondents reported training greater than or equal to 11 hours per week, and 45% of athletes reported spending greater than or equal to 6 hours per week cross-training. Forty-two percent of athletes reported currently having pain with 34% reporting missing a competition because of injury. Only 24% of respondents reported having participated in an injury prevention program.

CONCLUSIONS

Many Para sport athletes train at similar durations as able-bodied counterparts and have pain that interferes with their ability to train and compete, however, only a small percentage consistently perform injury prevention programs.

Investigating environmental factors and paralympic sports: an analytical study

PURPOSE

Few studies have reported the influence of environmental factors that may act as barriers or facilitators to participation in parasports. The aim of this study was to describe and analyse the relationship between environmental factors present in parasports (attitudes, support, services, assistive technology and policies). In addition, we present the concurrent validation of the Assistive Technology Device Predisposition Assessment (ATD PA-Br).

MATERIALS AND METHODS

Sixty-three adult Paralympic athletes with physical and/or visual impairment who practiced goalball, wheelchair tennis, table tennis, sitting volleyball, rugby, swimming, equestrianism, weightlifting, track and field, archery, bocce ball and parabadminton were analysed. Sociodemographic questionnaires, ATDPA-Br and QUEST B were used for data collection and analysed by 5% significance level (p < 0.05).

RESULTS

The findings showed a predominance of athletes with spinal cord injury playing rugby (11) and parabadminton (9), 25.4% exhibited low sociodemographic levels, 36.5% required a wheelchair and 9.6% used prostheses. Although 90.5% of participants reported that assistive technology helped them in their sport, they also expressed dissatisfaction with the services provided. There was a significant correlation between satisfaction with the device in the QUEST instrument and the positive psychosocial factors of the ATDPA-Br, meaning the larger the number of positive factors, the greater the satisfaction with the device.

CONCLUSION

This study showed the predominance of low-income parathletes and that environmental factor as access to the benefits of public policies, it may be a barrier to participation in parasports. Also, the technology and the services provided should act as facilitators to parasport performance.Implications for rehabilitationUnderstand the objectives of assistive technology in paralympic sports.Identify the environmental factors present in parasports (attitudes, support, services, assistive technology, and policies).Analyze the relationship between environmental factors present in parasports (attitudes, support, services, assistive technology, and policies).Have access to the concurrent validation of the Assistive Technology Device Predisposition Assessment (ATD PA-Br).

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

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

Prevalence and incidence of injuries in para athletes: a systematic review with meta-analysis and GRADE recommendations

OBJECTIVE

To investigate prevalence, incidence and profile of musculoskeletal injuries in para athletes.

DESIGN

Systematic review.

DATA SOURCES

Searches were conducted in MEDLINE, EMBASE, AMED, SPORTSDiscus, CINAHL and hand searching.

ELIGIBILITY CRITERIA

Studies were considered if they reported prevalence or incidence of musculoskeletal injuries in para athletes. Study selection, data extraction and analysis followed the protocol. Meta-analyses were conducted to estimate the prevalence and incidence rate among studies and subgroup analyses investigated whether methodological quality and sample size of the studies influenced on the estimated injury prevalence and incidence. The Grading of Recommendations Assessment, Development and Evaluation system determined the strength of evidence.

RESULTS

Forty-two studies were included. The prevalence of musculoskeletal injuries was 40.8% (95% CI 32.5% to 49.8%). Because of imprecision, indirectness and inconsistency, the strength of evidence was very low quality. The incidence of musculoskeletal injuries was 14.3 injuries per 1000 athlete-days (95% CI 11.9 to 16.8). The strength of evidence was low quality because of imprecision and indirectness. The subgroup analyses revealed that the sample size influenced on estimated injury prevalence and methodological quality influenced on estimated incidence. Injuries were more prevalent in the shoulder, for non-ambulant para athletes, and in the lower limbs, for ambulant para athletes.

SUMMARY/CONCLUSION

Para athletes show high prevalence and incidence of musculoskeletal injuries. Current very low-quality and low-quality evidence suggests that future high-quality studies with systematic data collection, larger sample size and specificities of para athletes are likely to change estimates of injury prevalence and incidence in para athletes.

PROSPERO REGISTRATION NUMBER

CRD42020147982.

Sport Injuries in Elite Paralympic Judokas: Findings From the 2018 World Championship

BACKGROUND

To provide information regarding injury incidence, injury pattern, and associated injury risk factors in elite Paralympic judokas.

METHODS

Participants in this observational research were elite judokas taking part in the IBSA 2018 World Judo Championship. The entire championship was videotaped, and all injuries were prospectively documented using an all-complaints definition.

RESULTS

The tournament featured 267 judokas, (B1 = 58; B2 = 105; B3 = 104). The injury proportion was estimated at 18.9 injuries/100 fighters (B1 = 13.8; B2 = 22.3; B3 = 18.5). A total of 745 athletic exposures were registered. The overall injury rate was 68.5 (95% CI, 52.5-89.2); 62.5 (95% CI, 32-122.3); 79.6 (95% CI, 53.8-17.8); and 61.2 (95% CI, 40-93.5) for the total sample, B1, B2, and B3 judokas, respectively. When only injuries resulting in medical attention were analyzed, the overall injury rate was calculated to be 22.8 (95% CI, 14.3-36.5), and the injury proportion was estimated at 6.3 injuries/100 fighters. No significant differences were found for sex, weight, and visual class regarding injury proportion and injury rates.

CONCLUSION

Paralympic judokas show a high injury rate. However, when only injuries that needed medical attention were taken into account, the proportion of athletes injured was low. The degree of visual impairment was not considered as an injury risk factor.

[Injuries in German Paralympic alpine skiing over 25 years]

INTRODUCTION

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

PATIENTS AND METHODS

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

RESULTS

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

DISCUSSION

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

CONCLUSIONS

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

Analysis of team-sport wheelchair falls during the Rio 2016 Summer Paralympic Games: a video-based cross-sectional observational study

OBJECTIVES

To present the fall characteristics of athletes playing wheelchair rugby (WR) and wheelchair basketball (WB) using official videos from the Rio 2016 Paralympic Games and compare the key fall characteristics among the team wheelchair sports event.

METHODS

Eighteen WR and 10 WB game videos for men (MWB) and women (WWB), including 8 teams per sport, were obtained from the official International Paralympic Committee of the Rio 2016 Paralympic Games. The videos were analysed to assess the number of falls, playing time of fall, playing phase, contact with other athletes, the direction of the fall and the body part first in contact with the floor during the fall.

RESULTS

In total, 359 falls (96 for WR, 172 for MWB and 91 for WWB) occurred with a mean of 5.3, 17.2 and 9.1 falls per match, respectively (p<0.05). Significant differences among the three sports were detected in the playing time (p=0.011), presence of contact (p=0.037), direction (p<0.001) and body part first in contact with the floor (p<0.001). For WR, the falls were primarily lateral and caused by contact, occurring in the second half of the match. WB falls tended to be in the first half for women and the second half for men. Most falls were contact falls in the forward direction.

CONCLUSION

By observing the situational details, we described that a number of falls due to contact occurred during these team sports events, especially MWB. In addition, each sport exhibited characteristics attributable to differences in gender, degree of impairment and game rules. The directions of the falls and characteristics of the affected body parts indicate differences in impairments depending on the sport. A fall to the side or back may indicate a risk of injury.

Sports participation related to injuries and illnesses among ambulatory youth with chronic diseases: results of the health in adapted youth sports study

Background

Although sports participation leads to important health enhancement for youth with chronic diseases or physical disabilities (CDPD), it may pose an increased risk for injury or illness. This study investigated the incidence, type, severity and risks to (sports-related) injuries and illnesses among ambulatory youth with CDPD.

Methods

Over a 12-month period, every 2 weeks, the characteristics of injuries and illnesses were registered by an online questionnaire and phone-based interview. Physical activity level was measured with the Activ8 during 1 week. Complete data was available of 103 youngsters with CDPD (61 boys, 42 girls), with a mean age of 14.4 (SD = 2.7) years. The personal characteristics, the injury and illness rates per 1000 h of PA were investigated per group of organized sports participation per week (0, 1 or ≥ 2 times p/wk).

Results

Almost half of the youngsters sustained one or more injuries (46%) or illnesses (42%) during 1 year. The injury rate per 1000 h of PA between 0, 1 and ≥ 2 times per week of sports participation was 0.84, 1.88, 133 respectively and the illness rate were 1.87, 1.88 and 1.18 respectively. Differences between the rates were not statically significant. Most reported health problems had no subsequent restriction (49%) or other minor consequences (21%) in school, physical education or sports participation. Most reported health problems were contusions (41%) at the lower extremity (74%) and flu plus fever (58%).

Conclusions

Participation in sports ≥2 times per week does not pose a significant increased risk in the incidence of injury or illness per 1000 h of PA in youth with CDPD compared to their peers who participate less frequent (once weekly) and compared to non-sports participants. Athletes who participate in sports at least twice weekly get injured mostly during their sporting activities, while peers who do participate in sports once a week or not at all, get injured during less intense physical activities during physical eduction lessons, ADL or non-organized sports and play in leisure time. The social impact of injuries or illnesses was limited.

Injury and Illness Surveillance During the 2016 Department of Defense Warrior Games: Review of Methods and Results

INTRODUCTION

Surveillance systems have become a valuable tool to capture epidemiological data at multi-sport events, with findings serving to predict and prevent injury, reduce illness, and guide efficient utilization of medical resources. In 2016, the first injury and illness surveillance tool for the Department of Defense (DoD) Warrior Games was established to inform the required medical footprint. The purpose of this paper is to describe the methods and findings from the 2016 DoD Warrior Games surveillance system, which included a database of injuries and illness.

MATERIALS AND METHODS

A total of 245 wounded warrior (WW) athletes were followed over 19 days, to include train-up and competition periods, as they competed for their respective teams of Army, Navy, Air Force, Marines, Special Operations, and United Kingdom. Medical personnel recorded injuries and illnesses treated utilizing a standardized surveillance form and data were entered into a daily tracker to examine patterns or areas for prevention. Reports included sex, age, event discipline, previous injury or illness, reason for presentation, and treatment provided.

RESULTS

From June 3 to June 21, 2016, 114 individual encounters were recorded on the standard form and entered into the surveillance database. Athletes accounted for 67% of all encounters. Illness accounted for 30.7% of all visits, while injuries accounted for 69.2%. The incident proportion of injuries in athletes was 23.3 injuries per 100 athletes (95% CI 17.6, 30.1) and incident rate of 12.2 injuries per 1000 athlete days. Integrative medicine treatments including acupuncture, osteopathic manipulative treatment (OMT), massage therapy, and gua sha accounted for the largest forms of treatment (31%).

CONCLUSIONS

From the surveillance data, staff levels and treatment supplies can be adjusted. In addition an improved surveillance tool can be created. Continuous surveillance is required to provide information on trends in injury and illness to support prevention strategies.

Adaptive Sports, Arts, Recreation, and Community Engagement

Adaptive sports and recreation have an important role in the lifestyle of individuals with cerebral palsy (CP). This article discusses the history of adaptive sports and the benefits of adaptive sports and recreation. Barriers and medical challenges are also thoroughly discussed, including common musculoskeletal issues, methods to prevent musculoskeletal injury, pain, fatigue, maximal exertion, and other medical comorbidities and illness. The role of health care providers such as physiatrists is emphasized to provide support to individuals with CP who either are interested in starting exercise or a sport or are already an athlete.

Summer Adaptive Sports Technology, Equipment, and Injuries

As adaptive sports grow in popularity, it is increasingly important to understand the injuries for which their athletes are at risk. This population is challenging to study given its small size and diversity of its participants; accordingly, research is mostly low quality because of limited sample sizes and study durations. Summer adaptive sports account for 22 of 28 Paralympic sports, with the most frequently studied being wheelchair basketball, rugby, tennis, athletics, swimming, and soccer. Injuries vary by sport because of differences in contact level, limbs utilized, and athlete impairments. Equipment changes and technological advances, especially within wheelchair and amputee sports, have increased the level of competition and reduced injury rates. Fortunately, the majority of injuries across adaptive sports are minor and do not result in significant time off from sport. Still, even minor injuries can negatively impact these athletes' mobility and activities of daily living compared to the nondisabled population.

Adaptive Sports Injury Epidemiology

The benefit of sport for athletes with impairments is well established. However, sport participation is not without risk. The existing literature informs us that injury patterns are sport and disability specific. Further research is needed to study injuries in this population.

Shoulder Pain and the Weight-bearing Shoulder in the Wheelchair Athlete

Shoulder pain is one of the most common complaints amongst wheelchair athletes. There are many debated potential risk factors for shoulder pain in this population including inherent anatomy, increased loading forces, overuse, age, wheelchair use duration, trunk control, and sport played. Proper identification of etiology of shoulder pain with a thorough history and physical examination is important for management purposes. Treatment can be challenging as complete rest from exacerbating activities is often difficult as upper extremity use is necessary for everyday life activities such as mobility and transfers. Addition of shoulder maintenance strengthening program focusing on strengthening adductors, external rotators, and scapular retractors is important to keep shoulder muscles well-balanced to prevent injury.

Incidence of Shoulder Injury in Elite Wheelchair Athletes Differ Between Sports: A Critically Appraised Topic

Clinical Scenario: Until recently, injury epidemiology data on elite Paralympic athletes were limited. Current data suggest high rates of shoulder injury in wheelchair athletes. Differences in shoulder injury rates between sports have not been reported in this population. Clinical Question: Is the incidence of shoulder injury in elite wheelchair athletes different between sports? Summary of Key Findings: Shoulder injury rates are high in elite wheelchair athletes, particularly in sports such as field events and fencing that require a stable base (eg, trunk, core control) from which to perform. Wheelchair racing requires repetitive motions that contribute to shoulder injuries, but rates are lower than field sports and fencing. Wheelchair curling and sledge hockey have low shoulder injury risk. Clinical Bottom Line: Shoulder injury rates vary based on sport in elite wheelchair athletes. In addition to incorporating shoulder complex specific rehabilitation for overuse shoulder injuries, clinicians should focus on core and trunk stabilization in elite wheelchair athletes competing in sports, such as field events and fencing. Strength of Recommendation: Grade C evidence exists that reports shoulder injury rates among elite wheelchair athletes differ based on sport participation.

High incidence of injuries at the Pyeongchang 2018 Paralympic Winter Games: a prospective cohort study of 6804 athlete days

Objective

To describe the epidemiology of sports injury at the Pyeongchang 2018 Paralympic Winter Games.

Methods

567 athletes from 49 countries were monitored daily for 12 days over the Pyeongchang 2018 Paralympic Winter Games (6804 athlete days). Injury data were obtained daily from teams with their own medical support (41 teams and 557 athletes) and teams without their own medical support (8 teams and 10 athletes) through two electronic data capturing systems.

Results

112 of 567 athletes (19.8%) reported a total of 142 injuries, with an injury incidence rate (IR) of 20.9 per 1000 athlete days (95% CI 17.4 to 25.0). The highest IR was reported for para snowboard (IR of 40.5 per 1000 athlete days [95% CI 28.5 to 57.5]; p<0.02), particularly in the lower limb and head/face/neck anatomical areas. Across all sports at the Games, acute traumatic injuries (IR of 16.2 per 1000 athlete days [95% CI 13.2 to 19.8]) and injuries to the shoulder/arm/elbow complex (IR of 5.7 per 1000 athlete days [95% CI 4.2 to 7.8]) were most common. However, most injuries (78.9%) did not require time loss.

Conclusion

The new Paralympic Winter Games sport of Para snowboard requires attention to implement actions that will reduce injury risk. The shoulder was the most injured single joint—a consistent finding in elite para sport.

A Descriptive Study of Self-Reported Injury in Non-elite Adaptive Athletes

BACKGROUND

Adaptive sports programs are increasing across the country and there is a paucity of research investigating the epidemiology and sports injury risk factors in non-elite athletes.

OBJECTIVE

To assess the demographics, training regime, and injuries incurred by adaptive athletes participating in local adaptive sports clubs and to assess the athletes' type of medical care and prevalence of those with spasticity.

DESIGN

Descriptive cross-sectional study.

SETTING

Local area adaptive sports teams and programs.

PARTICIPANTS

Sixty-one athletes participating in wheelchair basketball, wheelchair rugby, sled hockey, and adaptive rowing were surveyed, with a response rate of 70.5%.

INTERVENTIONS

Completion of self-report survey.

OUTCOME

Report of injury prevalence, injury characteristics, type of medical care, and assessment of frequency and severity of spasticity using the Penn Spasm Frequency Scale.

RESULTS

Most athletes (86%) trained or competed in their main sport 9-12 months per year. Most athletes (79.1%) trained at least 4 hours per week. In the past 12 months, 39.5% of athletes surveyed sustained an injury that required them to miss practice or a competition, with 58.8% of these athletes having sustained a significant injury. Many of those injured (64.7%) had never participated in an injury prevention or conditioning program. Injury prevalence by sport was 42.9% in wheelchair rugby, 60% in sled hockey, 44% wheelchair basketball, and 0% in adaptive rowing. The most commonly injured body parts were the shoulder (52.9%) and wrist (52.9%).

CONCLUSIONS

This study shows that non-elite adaptive sports athletes sustain similar types of injuries as noted in published reports of elite athletes but could be provided with less injury prevention education and access to medical care. This area will require future study, especially investigating injury risk factors within specific sports and diagnoses.

LEVEL OF EVIDENCE

III.

Pain Management in Athletes With Impairment: A Narrative Review of Management Strategies

OBJECTIVE

To review the literature related to different treatment strategies for the general population of individuals with amputation, spinal cord injury, and cerebral palsy, as well as how this may impact pain management in a correlated athlete population.

DATA SOURCES

A comprehensive literature search was performed linking pain with terms related to different impairment types.

MAIN RESULTS

There is a paucity in the literature relating to treatment of pain in athletes with impairment; however, it is possible that the treatment strategies used in the general population of individuals with impairment may be translated to the athlete population. There are a wide variety of treatment options including both pharmacological and nonpharmacological treatments which may be applicable in the athlete.

CONCLUSIONS

It is the role of the physician to determine which strategy of the possible treatment options will best facilitate the management of pain in the individual athlete in a sport-specific setting.

Preserving the Shoulder Function of an Elite Paratriathlete

Shoulder pain in wheelchair users that participate in competitive adaptive sports can be a troublesome condition. Shoulder pain not only affects athletic performance but also affects functional activities such as wheelchair propulsion and weight bearing during transfers. Managing pain in these athletes thus presents a unique challenge because of the difficulty in achieving relative rest and the need to modify athletic shoulder-focused rehabilitation strategies. In all athletes, it is vital to establish an early, accurate diagnosis and optimize conservative treatment before considering surgical interventions to avoid excessive shoulder-related morbidity, loss of function, and, worse, loss of independence.

An eHealth Application of Self-Reported Sports-Related Injuries and Illnesses in Paralympic Sport: Pilot Feasibility and Usability Study

Background

Sport participation is associated with a risk of sports-related injuries and illnesses, and Paralympic athletes’ additional medical issues can be a challenge to health care providers and medical staff. However, few prospective studies have assessed sports-related injuries and illnesses in Paralympic sport (SRIIPS) over time. Advances in mobile phone technology and networking systems offer novel opportunities to develop innovative eHealth applications for collection of athletes’ self-reports. Using eHealth applications for collection of self-reported SRIIPS is an unexplored area, and before initiation of full-scale research of SRIIPS, the feasibility and usability of such an approach needs to be ascertained.

Objective

The aim of this study was to perform a 4-week pilot study and (1) evaluate the monitoring feasibility and system usability of a novel eHealth application for self-reported SRIIPS and (2) report preliminary data on SRIIPS.

Methods

An eHealth application for routine collection of data from athletes was developed and adapted to Paralympic athletes. A 4-week pilot study was performed where Paralympic athletes (n=28) were asked to weekly self-report sport exposure, training load, general well-being, pain, sleep, anxiety, and possible SRIIPS. The data collection was followed by a poststudy use assessment survey. Quantitative data related to the system use (eg, completed self-reports, missing responses, and errors) were analyzed using descriptive statistics. The qualitative feasibility and usability data provided by the athletes were condensed and categorized using thematic analysis methods.

Results

The weekly response rate was 95%. The athletes were of the opinion that the eHealth application was usable and feasible but stated that it was not fully adapted to Paralympic athletes and their impairments. For example, it was difficult to understand how a new injury or illness should be identified when the impairment was involved. More survey items related to the impairments were requested, as the athletes perceived that injuries and illnesses often occurred because of the impairment. Options for description of multifactorial incidents including an injury, an illness, and the impairment were also insufficient. Few technical issues were encountered, but athletes with visual impairment reported usability difficulties with the speech synthesizer. An incidence rate of 1.8 injuries and 1.7 illnesses per 100 hours of athlete exposure were recorded. The weekly pain prevalence was 56% and the impairment contributed to 20% of the reported incidents.

Conclusions

The novel eHealth-based application for self-reported SRIIPS developed and tested in this pilot study was generally feasible and usable. With some adaptation to accommodate Paralympic athletes’ prerequisites and improved technical support for athletes with visual impairment, this application can be recommended for use in prospective studies of SRIIPS.

Trial Registration

ClinicalTrials.gov NCT02788500; https://clinicaltrials.gov/ct2/show/NCT02788500 (Archived by WebCite at http://www.webcitation.org/6v56OqTeP)

High precompetition injury rate dominates the injury profile at the Rio 2016 Summer Paralympic Games: a prospective cohort study of 51 198 athlete days

Objectives

To describe the incidence of injury in the precompetition and competition periods of the Rio 2016 Summer Paralympic Games.

Methods

A total of 3657 athletes from 78 countries, representing 83.4% of all athletes at the Games, were monitored on the web-based injury and illness surveillance system over 51 198 athlete days during the Rio 2016 Summer Paralympic Games. Injury data were obtained daily from teams with their own medical support.

Results

A total of 510 injuries were reported during the 14-day Games period, with an injury incidence rate (IR) of 10.0 injuries per 1000 athlete days (12.1% of all athletes surveyed). The highest IRs were reported for football 5-a-side (22.5), judo (15.5) and football 7-a-side (15.3) compared with other sports (p<0.05). Precompetition injuries were significantly higher than in the competition period (risk ratio: 1.40, p<0.05), and acute traumatic injuries were the most common injuries at the Games (IR of 5.5). The shoulder was the most common anatomical area affected by injury (IR of 1.8).

Conclusion

The data from this study indicate that (1) IRs were lower than those reported for the London 2012 Summer Paralympic Games, (2) the sports of football 5-a-side, judo and football 7-a-side were independent risk factors for injury, (3) precompetition injuries had a higher IR than competition period injuries, (4) injuries to the shoulder were the most common. These results would allow for comparative data to be collected at future editions of the Games and can be used to inform injury prevention programmes.

High incidence of injury at the Sochi 2014 Winter Paralympic Games: a prospective cohort study of 6564 athlete days

Objective

To describe the epidemiology of injuries at the Sochi 2014 Winter Paralympic Games.

Methods

A total of 547 athletes from 45 countries were monitored daily for 12 days during the Sochi 2014 Winter Paralympic Games (6564 athlete days). Daily injury data were obtained from teams with their own medical support (32 teams, 510 athletes) and teams without their own medical support (13 teams, 37 athletes) through electronic data capturing systems.

Results

There were 174 total injuries reported, with an injury incidence rate (IR) of 26.5 per 1000 athlete days (95% CI 22.7% to 30.8%). There was a significantly higher IR recorded in alpine skiing/snowboarding (IR of 41.1 (95% CI 33.7% to 49.6%) p=0.0001) compared to cross-country skiing/biathlon, ice sledge hockey or wheelchair curling. Injuries in the shoulder region were the highest single-joint IR (IR of 6.4 (95% CI 4.6% to 8.6%)), although total upper and lower body IR were similar (IR 8.5 vs 8.4 (95% CI 6.4% to 11.1%)). Furthermore, the IR of acute injuries was significantly higher than other types of injury onset (IR of 17.8 (95% CI 14.7% to 21.4%)).

Conclusions

In a Winter Paralympic Games setting, athletes report higher injury incidence than do Olympic athletes or athletes in a Summer Paralympic Games setting. The highest incidence of injury was reported in the alpine skiing/snowboarding sporting category. There was a similar incidence of injury in the upper and lower limbs. The joint with the greatest rate of injury reported was the shoulder joint. Our data can inform injury prevention programmes and policy considerations regarding athlete safety in future Winter Paralympic Games.