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Bullock G, Thigpen C, Collins G, Arden N, Noonan T, Kissenberth M, Shanley E. Development of an Injury Burden Prediction Model in Professional Baseball Pitchers. Int J Sports Phys Ther 2022; 17:1358-1371. [PMID: 36518836 PMCID: PMC9718727 DOI: 10.26603/001c.39741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2023] Open
Abstract
Background Baseball injuries are a significant problem and have increased in incidence over the last decade. Reporting injury incidence only gives context to rate but not in relation to severity or injury time loss. Hypothesis/Purpose The purpose of this study was to 1) incorporate both modifiable and non-modifiable factors to develop an arm injury burden prediction model in Minor League Baseball (MiLB) pitchers; and 2) understand how the model performs separately on elbow and shoulder injury burden. Study Design Prospective longitudinal study. Methods The study was conducted from 2013 to 2019 on MiLB pitchers. Pitchers were evaluated in spring training arm for shoulder range of motion and injuries were followed throughout the season. A model to predict arm injury burden was produced using zero inflated negative binomial regression. Internal validation was performed using ten-fold cross validation. Subgroup analyses were performed for elbow and shoulder separately. Model performance was assessed with root mean square error (RMSE), model fit (R2), and calibration with 95% confidence intervals (95% CI). Results Two-hundred, ninety-seven pitchers (94 injuries) were included with an injury incidence of 1.15 arm injuries per 1000 athletic exposures. Median days lost to an arm injury was 58 (11, 106). The final model demonstrated good prediction ability (RMSE: 11.9 days, R2: 0.80) and a calibration slope of 0.98 (95% CI: 0.92, 1.04). A separate elbow model demonstrated weaker predictive performance (RMSE: 21.3; R2: 0.42; calibration: 1.25 [1.16, 1.34]), as did a separate shoulder model (RMSE: 17.9; R2: 0.57; calibration: 1.01 [0.92, 1.10]). Conclusions The injury burden prediction model demonstrated excellent performance. Caution should be advised with predictions between one to 14 days lost to arm injury. Separate elbow and shoulder prediction models demonstrated decreased performance. The inclusion of both modifiable and non-modifiable factors into a comprehensive injury burden model provides the most accurate prediction of days lost in professional pitchers. Level of Evidence 2.
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Affiliation(s)
- Garrett Bullock
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis University of Oxford
- Department of Orthopaedic Surgery & Rehabilitation Wake Forest University School of Medicine
| | - Charles Thigpen
- University of South Carolina Center for Rehabilitation and Reconstruction Sciences
- ATI Physical Therapy
| | - Gary Collins
- Centre for Statistics in Medicine University of Oxford
- Oxford University Hospitals NHS Foundation Trust
| | - Nigel Arden
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis University of Oxford
- Department of Orthopaedic Surgery & Rehabilitation Wake Forest University School of Medicine
| | - Thomas Noonan
- Department of Orthopaedic Surgery University of Colorado School of Medicine
- University of Colorado Health, Steadman Hawkins Clinic
| | | | - Ellen Shanley
- University of South Carolina Center for Rehabilitation and Reconstruction Sciences
- ATI Physical Therapy
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Bullock GS, Shanley E, Thigpen CA, Arden NK, Noonan TK, Kissenberth MJ, Wyland DJ, Collins GS. Improving Clinical Utility of Real-World Prediction Models: Updating Through Recalibration. J Strength Cond Res 2022; 37:1057-1063. [PMID: 36730571 DOI: 10.1519/jsc.0000000000004369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
ABSTRACT Bullock, GS, Shanley, E, Thigpen, CA, Arden, NK, Noonan, TK, Kissenberth, MJ, Wyland, DJ, and Collins, GS. Improving clinical utility of real-world prediction models: updating through recalibration. J Strength Cond Res XX(X): 000-000, 2022-Prediction models can aid clinicians in identifying at-risk athletes. However, sport and clinical practice patterns continue to change, causing predictive drift and potential suboptimal prediction model performance. Thus, there is a need to temporally recalibrate previously developed baseball arm injury models. The purpose of this study was to perform temporal recalibration on a previously developed injury prediction model and assess model performance in professional baseball pitchers. An arm injury prediction model was developed on data from a prospective cohort from 2009 to 2019 on minor league pitchers. Data for the 2015-2019 seasons were used for temporal recalibration and model performance assessment. Temporal recalibration constituted intercept-only and full model redevelopment. Model performance was investigated by assessing Nagelkerke's R-square, calibration in the large, calibration, and discrimination. Decision curves compared the original model, temporal recalibrated model, and current best evidence-based practice. One hundred seventy-eight pitchers participated in the 2015-2019 seasons with 1.63 arm injuries per 1,000 athlete exposures. The temporal recalibrated intercept model demonstrated the best discrimination (0.81 [95% confidence interval [CI]: 0.73, 0.88]) and R-square (0.32) compared with original model (0.74 [95% CI: 0.69, 0.80]; R-square: 0.32) and the redeveloped model (0.80 [95% CI: 0.73, 0.87]; R-square: 0.30). The temporal recalibrated intercept model demonstrated an improved net benefit of 0.34 compared with current best evidence-based practice. The temporal recalibrated intercept model demonstrated the best model performance and clinical utility. Updating prediction models can account for changes in sport training over time and improve professional baseball arm injury outcomes.
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Affiliation(s)
- Garrett S Bullock
- Department of Orthopaedic Surgery and Rehabilitation, Wake Forest School of Medicine, North Carolina.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, United Kingdom
| | - Ellen Shanley
- University of South Carolina Center for Rehabilitation and Reconstruction Sciences, Greenville, South Carolina.,ATI Physical Therapy, Greenville, South Carolina.,Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina
| | - Charles A Thigpen
- University of South Carolina Center for Rehabilitation and Reconstruction Sciences, Greenville, South Carolina.,ATI Physical Therapy, Greenville, South Carolina
| | - Nigel K Arden
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, United Kingdom
| | - Thomas K Noonan
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Boulder, Colorado.,Steadman Hawkins Clinic, University of Colorado Health, Englewood, Colorado
| | | | - Douglas J Wyland
- Steadman Hawkins Clinic of the Carolinas, Greenville, South Carolina
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; and.,Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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Schowalter S, Le B, Creps J, McInnis KC. Rib Fractures in Professional Baseball Pitchers: Mechanics, Epidemiology, and Management. Open Access J Sports Med 2022; 13:89-105. [PMID: 36248020 PMCID: PMC9563740 DOI: 10.2147/oajsm.s288882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Pitching is a complex kinetic chain activity requiring the transfer of energy from the lower body, through the core and trunk, and finally through the arm to generate explosive acceleration of the baseball. As a result, large forces are generated in the trunk musculature and rib attachments from the late cocking phase of pitching through deceleration. The repetitive cumulative load and high pitch velocities put professional pitchers at risk of rib stress fracture. Given the potential for a prolonged recovery course and high rate of recurrence, early recognition of rib bone stress injury is critical to optimize care. Identifying torso strength imbalances, suboptimal pitching biomechanics (such as late or inadequate pelvic rotation), as well as metabolic deficiencies that may adversely affect bone health are essential to expedite safe return to play and prevent future injury. In this review, we discuss risk factors, mechanism of injury, typical clinical presentation, diagnostic imaging findings, and propose treatment and prevention strategies for rib stress fractures in overhand pitchers.
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Affiliation(s)
- Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Correspondence: Sean Schowalter, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 1st Avenue, Charlestown, MA, 02129, USA, Tel +1 617 952 5000, Email
| | - Bryan Le
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - James Creps
- Sports Medicine Service, Boston Red Sox, Boston, MA, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Division of Sports Medicine, Massachusetts General Hospital, Boston, MA, USA
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