Kinematics of 90° change of direction in young football players: Insights for ACL injury prevention from the CUTtheACL study on 6008 trials

PURPOSE

To investigate the 90° change of direction (COD) task in an extensive cohort of competitive healthy football players within the CUTtheACL study and to provide normative values and differences between males and females for full-body kinematics based on two-dimensional (2D) video analysis and scoring system.

METHODS

One-thousand-and-two competitive football (soccer) players (age 16.3 ± 2.8 years, 264 females) were prospectively enroled. Each player performed three preplanned 90° COD tasks per limb. The 2D evaluation was performed through objective measures (collected through three high-speed cameras) of frontal and sagittal plane joint kinematics at the cut initial foot contact (IC) and maximum knee flexion angle. A previously published scoring system was adopted to measure the movement quality of the COD task. The scoring system included five criteria (limb stability [LS], pelvis stability [PS], trunk stability [TS], shock absorption [SA], movement strategy [MS]) ranked from 0/2 (nonadequate) to 2/2 (adequate) with a maximum score of 10/10. Normative data were provided for all the variables; statistical differences between male and female players were investigated (p < 0.05).

RESULTS

A total of 6008 valid attempts were included. Frontal plane knee projection angle (FPKPA) at initial contact was 24.4 ± 9.8° (95th percentile: FPKPA > 40°). The total score was ≤4/10 in 71.2% of the trials, the lowest subscores were LS and PS. Female players showed different movement patterns with lower hip and trunk flexion both at IC and maximum knee flexion angle (p < 0.01, ES = 0.41-0.64). Female players also showed worse scores than males in SA, MS and total score (p < 0.01).

CONCLUSION

Female players seem more prone to stiffer lower limb strategy and greater pelvis-trunk frontal plane instability than males. Clinicians could adopt normative data and sex-specific differences in players' movement techniques to improve ACL injury risk mitigation protocols.

LEVEL OF EVIDENCE

Level IV.

Grill-Related Burn Injuries: A Matched Cohort Study

Barbequing can result in devastating burn injuries with unsafe practices. This study aims to characterize the demographics, injury characteristics, and outcomes of grill-related burns and identify ways of burn prevention. A retrospective review of patients admitted to a single-institution, metropolitan burn center from January 1, 2017, to July 1, 2023. Data included demographics, burn injury characteristics, and outcomes. Each Grill Cohort patient was matched to 3 nongrill controls by mBaux score and burn location. Of 2355 patients, 69 (2.9%) met Grill Cohort inclusion criteria. The Grill Cohort had 55 (79.7%) males and an average age of 41.7 ± 17.5 years old. In the Grill Cohort, 25 (36.2%) patients had positive blood alcohol, 8 (11.6%) tested positive for amphetamines, and 5 (7.2%) for cocaine at the time of admission. A total of 61 (88.4%) Grill Cohort burns involved the upper extremity, 43 (62.3%) the head/neck, 34 (49.3%) the lower extremity, and 30 (43.5%) the trunk. Compared with the Control Cohort, the Grill Cohort had smaller proportions of patients who were undomiciled (P < .01) or had a history of mental illness (P < .001). Grill-related burns had a greater proportion of flash/flame burns (P < .001). This study suggests that middle-aged, domiciled males without psychiatric comorbidities are more likely to make preventable grilling errors resulting in burn injuries. Prevention strategies targeting this demographic group should emphasize the risks of grilling while intoxicated, proper handling of propane tanks and lighter fluid, and the use of flash/flame-resistant gear protecting the upper extremities and head/neck.

Prevalence and associated factors of non-traumatic knee pain in high school volleyball players: a cross-sectional study

OBJECTIVES

This study aimed to determine the prevalence of knee pain among high school volleyball attackers, identify associated factors, and explore the relationship between knee pain and lower back pain (LBP).

METHODS

A cross-sectional study involving 82 high school volleyball attackers (15-17 years) used questionnaires, interviews, and field-based assessments to collect data on demographics, volleyball-specific factors, flexibility, and jumping ability. Logistic regression analysis was used to identify factors associated with knee pain.

RESULTS

The prevalence of knee pain was 19.5%. Factors significantly associated with knee pain were a history of LBP (OR, 4.64; 95% CI, 1.28 to 16.8; p = 0.019) and flexibility determined by the absolute difference in heel-buttock distance (OR, 1.37; 95% CI, 1.02 to 1.83; p = 0.037). Participants with knee pain had more volleyball experience and a higher proportion of players who competed as starters in the previous year. Both groups reported approximately 18 hours of practice per week during the school year and around 27 hours during school holidays, with no significant difference observed.

CONCLUSION

Factors associated with knee pain include a history of LBP and reduced flexibility on the heel-buttock distance test. The study highlights the need for a comprehensive approach, considering the coexistence of LBP and focusing on improving anterior thigh flexibility.

Weakening and factors of medial elbow dynamic stabilizers against elbow valgus laxity after repetitive pitching in high school baseball players

BACKGROUND

Overhead throwing activity induces elbow valgus loading. The medial elbow dynamic stabilizers are thought important for medial elbow joint protection, but the effects of repetitive pitching on stabilizing function are largely unknown. This study aimed to investigate changes in the dynamic stabilizers during repetitive pitching, as well as factors related to dynamic stabilizing ability. Our hypothesis was that repetitive pitching would reduce dynamic stabilizer function, hence reducing the ability to minimize elbow valgus load.

METHODS

Thirty high school baseball pitchers (age, 16.6 ± 0.5 years) participated. Each participant pitched 100 times (5 blocks of 20 pitches). Prior to and after 100 pitches, medial elbow joint width and strain ratios, indicating the hardness of the ulnar collateral ligament (UCL) and forearm flexor-pronator muscles (FPMs), were measured using ultrasound at rest (non-contraction) and during gripping (contraction). Pre- and post-pitching data were compared using the paired t test. Multiple regression analysis was used to investigate factors related to the change rate of medial elbow joint width during gripping.

RESULTS

Medial elbow joint width during gripping significantly increased from before pitching to after pitching (P < .001). Both the UCL and FPM strain ratios after pitching significantly decreased (ie, softer tissue) compared with those before pitching (P = .001 and P = .006, respectively). The ratio of the UCL and FPM strain ratios (UCL/FPM) during gripping prior to pitching was significantly and independently correlated with the change rate of medial elbow joint width during gripping (β = 0.44, P = .016).

CONCLUSION

Pitching 100 balls induces a significant reduction in dynamic stabilizing ability against elbow valgus laxity. High school baseball pitchers should limit themselves to <100 pitches per game or should rest after 100 pitches before resuming. Furthermore, the ratio of hardness (UCL/FPM) during dynamic stabilization associated with gripping prior to pitching was significantly related to the change rate of elbow valgus laxity during dynamic stabilization. Maintaining the FPMs harder relative to the UCL during gripping prevents elbow valgus laxity associated with repetitive pitching and may protect the medial elbow joint during repetitive pitching.

The effect of changes in fundamental skill complexity on upper limb loading and biomechanical characteristics of performance in female gymnastics

Aims of this study were to investigate if changes in elbow and wrist joints loading and biomechanical characteristics of performance existed as a function of (a) different hand placement and (b) fundamental skills development in female gymnastics. Ten female gymnasts performed 54 successful trials of round-off skills (cartwheel [18], round-off [18], round-off to back handspring [18]), with three different hand positions (parallel, T-shape and reverse). Kinematic and kinetic data were collected for each trial. A two-way repeated measures ANOVA was used to analyse the injury risk factors. Findings of the current study showed that an increase in RO skill difficulty level significantly influences the mechanical load on the upper extremities. With the increase in mechanical load on the upper extremities during the reverse and parallel hand positions, this study suggests that that T-shape hand position should be used as the primary technique for the young female. Differences in vertical velocity from touchdown to take-off between the three hand positions for the RO and RO-BH suggested that the reverse position was less effective for young female gymnasts. The findings of the current study demonstrated no clear performance benefits between hand position selection.

Rotator Cuff Injuries in the Pediatric Population: A Retrospective Review of Patient Characteristics and Treatment at a Single Center

BACKGROUND

As youth participation in contact and overhead sports has increased in recent decades, so has the occurrence of injuries of the shoulder. Rotator cuff injury (RCI) is an infrequent shoulder pathology in pediatric patients and its description in the literature has been scarce. A greater understanding of RCI characteristics and treatment outcomes in children and adolescents would improve our understanding of this pathology and help to better guide clinical decision-making.

HYPOTHESIS

To identify pediatric patients with magnetic resonance imaging-confirmed RCI treated at a single center to summarize injury characteristics, treatment, and outcomes. It was hypothesized that injuries would occur predominantly in overhead throwing athletes and would demonstrate good outcomes among both operatively and nonoperatively treated patients.

STUDY DESIGN

Cross-sectional study.

LEVEL OF EVIDENCE

Level 4.

METHODS

A retrospective review of pediatric patients (<18 years old) diagnosed with and treated for an RCI between January 1, 2011 and January 31, 2021. Patient demographics, injury mechanism and type, treatment, and outcomes were collected. Descriptive statistics were performed. Bivariate testing was used to compare operatively and nonoperatively treated cohorts.

RESULTS

A total of 52 pediatric patients treated for a rotator cuff avulsion, partial tear, or complete tear were identified. Mean age was 15 years and 67% of patients were male. Injuries were related most commonly to participation in throwing sports. Operative management occurred in 23% of patients, while 77% were managed nonoperatively. Treatment cohorts differed based on tear type, with all complete tears being managed operatively (P < 0.01). Associated shoulder pathology was common, with the most frequent finding being anterior shoulder instability pathology. Return to play was longer for operatively managed patients (7.1 vs 4.5 months; P < 0.01).

CONCLUSION

The present study expands the limited data available regarding RCIs in pediatric patients. Most injuries are associated with sports and involve the supraspinatus tendon. RCIs were associated with good outcomes and low rates of reinjury in patients managed both nonoperative and operatively. RCI should be considered in throwing athletes with shoulder pain, even in skeletally immature patients.

CLINICAL RELEVANCE

This retrospective study fills the hole in the literature by detailing the patterns associated with RCI characteristics and treatment outcomes. In contrast to studies of adult RCIs, our results suggest that outcomes are good regardless of treatment type.

Exploring the interplay of trunk and shoulder rotation strength: a cross-sport analysis

Introduction: Trunk and shoulder strength are consistently shown to be involved in performance limitations, as well as contributing to stability, power output, and reducing the risk of injury. Although their biomechanical interaction is a critical aspect for athletes, there is limited research on the relationship between trunk and shoulder strength in sports where upper body mechanics are critical for optimal performance. Purpose: This study examined the differences and relationships between trunk rotational strength and shoulder rotational strength among athletes participating in mixed martial arts (MMA), tennis, swimming, and baseball. Methods: Maximal voluntary contraction tests were performed to evaluate strength of 39 professional adult male athletes from disciplines of MMA (n = 6), tennis (n = 11), swimming (n = 11) and baseball (n = 11). Peak force data were used in sports comparison and relationship analysis between trunk and shoulder rotation strength parameters. Results: The findings revealed a complex and significant relationship between trunk and shoulder strength, with unique patterns for each athletic discipline. Tennis players exhibited a strong correlation between trunk bilateral differences and internal shoulder rotation, while other disciplines demonstrated a more balanced use of trunk asymmetry. Swimmers displayed the best interactions between trunk and shoulder overall, emphasizing the aquatic environment's biomechanical demands. In MMA, the strongest correlation was between shoulder internal and external rotation with the trunk, mainly due to the number of defensive movements in addition to offensive ones. Baseball pitchers showed a significant correlation between internal/external shoulder rotation strength ratio and trunk asymmetry. Conclusion: While no differences in peak force variables were found, unique relationships between trunk and shoulder rotational performance were discovered. The results suggest a long-term sport-specific adaptation of the trunk-shoulder interaction in sports that require upper limb power movements. It seems, that the relationship between the various parameters of trunk and shoulder was influenced by the movement stereotype of each sport. Therefore, recognition of sport-specific interactions is critical to the development of effective training programs that enhance performance and potentially reduce injury risk in different sports. Researchers and practitioners should focus on longitudinally monitoring fluctuations in TRS and SRS relationships throughout each sport season and examining potential associations with injury incidence.

Work-Related Musculoskeletal Injury Rates, Risk Factors, and Ergonomics in Different Endoscopic Specialties: A Review

Endoscopy-related musculoskeletal injuries (ERIs) are frequent among gastrointestinal, pulmonary, nasal, and urologic endoscopists, impacting the healthcare system. The present review aims to compare the ERI rates, risk factors, and ergonomic recommendations in the different endoscopic fields. A review was conducted using PubMed and Cochrane Library for articles based on surveys and published until 10 January 2024. Demographic, work, and ERI data from 46 publications were included, covering 10,539 responders. The ERI incidence ranged between 14% and 97%, highlighting the need of intervention independent of the specialties. The neck, back, and shoulder were the most frequent ERI locations, while gender, age, years of experience, and procedure volume the most common risk factors. Ergonomic recommendations suggest concentrating on endoscope design changes, especially in gastrointestinal endoscopy, to increase the comfort, adaptability of the equipment in the operating room, and workflow/institutional policy changes. The inclusion of an ergonomic timeout guarantees the correct equipment positioning, the neutralisation of the endoscopist's posture, and an indirect break between procedures. Ergonomic training to increase awareness and best practice should be promoted, also using new technologies. Future research should concentrate on intervention and comparative studies to evaluate to which extent prevention measures and newly designed equipment could reduce ERI incidence.

Performance and healthcare analysis in elite sports teams using artificial intelligence: a scoping review

Introduction

In competitive sports, teams are increasingly relying on advanced systems for improved performance and results. This study reviews the literature on the role of artificial intelligence (AI) in managing these complexities and encouraging a system thinking shift. It found various AI applications, including performance enhancement, healthcare, technical and tactical support, talent identification, game prediction, business growth, and AI testing innovations. The main goal of the study was to assess research supporting performance and healthcare.

Methods

Systematic searches were conducted on databases such as Pubmed, Web of Sciences, and Scopus to find articles using AI to understand or improve sports team performance. Thirty-two studies were selected for review.

Results

The analysis shows that, of the thirty-two articles reviewed, fifteen focused on performance and seventeen on healthcare. Football (Soccer) was the most researched sport, making up 67% of studies. The revised studies comprised 2,823 professional athletes, with a gender split of 65.36% male and 34.64% female. Identified AI and non-AI methods mainly included Tree-based techniques (36%), Ada/XGBoost (19%), Neural Networks (9%), K-Nearest Neighbours (9%), Classical Regression Techniques (9%), and Support Vector Machines (6%).

Conclusions

This study highlights the increasing use of AI in managing sports-related healthcare and performance complexities. These findings aim to assist researchers, practitioners, and policymakers in developing practical applications and exploring future complex systems dynamics.

The associated factors for physical activity-related injuries among first-year university students in southern China from a biopsychosocial perspective

Background

Understanding the diverse factors influencing physical activity-related injuries is crucial for developing effective interventions that enable individuals to participate in physical activity (PA) while minimizing injury risk. Currently, research evidence on the multiple factors associated with PA-related injuries is inadequate. This study aimed to examine the associations between PA-related injuries and various biological, psychological, and social factors among first-year university students in China.

Methods

We recruited first-year university students from Shantou University in Guangdong Province, China, to participate in our study. Data collection employed a structured self-administered questionnaire, gathering information on PA-related injuries, as well as relevant biological, psychological, and social factors. Binary logistic regression, using a stepwise modeling approach, was employed for the data analysis.

Results

Among 1,051 first-year university students, 28.16% reported having experienced PA-related injuries in the past year. Most of the injuries reported were minor, with the knee or lower leg being the most frequently injured part of the body. Improper posture, environmental conditions, and excessive physical load were the leading causes of PA-related injuries. Multiple logistic regression analysis revealed that female students (OR = 0.67, 95% CI: 0.47-0.94, p = 0.022) had reduced odds of PA-related injuries. Conversely, high neuroticism (OR = 1.61, 95% CI: 1.07-2.41, p = 0.022), being a member of a sports team (OR = 2.09, 95% CI: 1.34-3.27, p < 0.001), PA on the wet ground (OR = 1.73, 95% CI: 1.18-2.54, p = 0.005) increased the odds of PA-related injuries.

Conclusion

Our findings underscore the intricate interplay of various factors contributing to PA-related injuries. Identifying high-risk individuals based on physiological and psychological characteristics, coupled with targeted interventions addressing modifiable risk factors, is crucial for effective prevention.

The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

BACKGROUND

Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD.

PURPOSE/HYPOTHESIS

The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls.

STUDY DESIGN

Cohort study (diagnosis); Level of evidence, 3.

METHODS

A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia).

RESULTS

The LPD group demonstrated reduced medial patellar width (Δ = -3.6 mm; P < .001) and medial facet length (Δ = -3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = -3.2 mm; P = .009), decreased patellar volume (Δ = -0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%.

CONCLUSION

The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.

Effects of Nontraditional Division III Lacrosse Participation on Movement Pattern Quality and Dynamic Postural Control

Background/Purpose

No studies have observed the effects of a collegiate lacrosse season on movement pattern quality, dynamic postural control, or the accuracy of athletes' perceived movement pattern quality. The purpose was to examine the effects of a nontraditional fall season on movement pattern quality, perceived movement pattern quality, and dynamic postural control in collegiate lacrosse athletes.

Design

Cross-sectional laboratory study.

Methods

Fifty men's (age=19.38±1.24 years, height=182.63±6.16 cm, mass=82.37±8.46 kg) and 22 women's (age=19.68±1.17 years, height=165.10±6.88 cm, mass=64.09±8.72 kg) lacrosse players were recruited. Outcome measures included individual Functional Movement Screen™ (FMS™) scores, self-reported perceived movement pattern quality scores, lower and upper extremity Y-Balance Test (YBT) measurements, and active dorsiflexion range of motion (ROM) before the start and again at the end of the fall lacrosse season. Pre- and post-season measurements were assessed using paired t-tests and chi-squared analyses.

Results

FMS™ composite scores did not significantly change from preseason to postseason for males (p=0.74) or females (p=0.07). Male perceived movement pattern quality was significantly higher than measured for 10 of 12 movements (p<0.05). Female perceived movement pattern quality was significantly higher than measured for four of 12 movements (p<0.05). Asymmetry frequency significantly increased in males in the hurdle step from two individuals to nine (χ 2 1=25.52, p<0.01), inline lunge from 10 to 20 (χ 2 1=12.50, p<0.01), and shoulder mobility from 4 to 21 (χ 2 1=78.53, p<0.01). Asymmetries in male athletes significantly decreased in the active straight leg raise from 26 to 8 (χ 2 1=25.96, p<0.01). YBT composite scores increased in males for the right leg (p=0.001) and left leg (p<0.03). Right dorsiflexion ROM (p<0.001) and left dorsiflexion ROM (p<0.001) significantly decreased in males from preseason to postseason. YBT scores for the right leg significantly increased in females from preseason to postseason (p=0.01). YBT scores for females for the right arm significantly increased from preseason to postseason (p=0.045).

Conclusions

A 5-week season may not change overall movement pattern quality of men's or women's lacrosse players, but some individual movement scores diminished. Athletes may overestimate self-reported movement pattern quality and are therefore unlikely to individually address movement deficits. Male dynamic postural control may change throughout a season, resulting in a potential increased risk of injury later in the season due to compensatory patterns or changes in mobility, proprioception, or balance.

Level of Evidence

3b.

Association of malignant hyperthermia and exertional heat illness in young athletes: An analysis of awareness among clinical and athletic first responders

Background

Malignant hyperthermia (MH), a rare inherited condition seen almost exclusively in the perioperative setting, is triggered by volatile anesthetics or an intravenous paralytic drug, succinylcholine. It can, however, occur without any exposure to anesthetic drugs, being associated with heat illness and rhabdomyolysis, thus presenting a little-known risk to young athletes exercising in hot environments.

Objective

This study aimed to determine the first responder awareness of MH and its association with heat illness in young athletes within athletic and clinical environments.

Methods

Awareness within the clinical milieu was assessed by an institutional chart review of 3296 charts. The identified heat illness cases were examined for treatment consistent with the management of a suspected episode of MH. Awareness among first responders in an athletic setting was examined by a survey administered to a total of 1,500 coaches and athletic trainers at the high school level along with emergency medical services providers across the United States.

Results

No treatment consistent with the suspicion of MH was noted among clinical first responders, suggesting a lack of awareness. Survey administration also revealed a limited amount of knowledge of MH and its potential role in heat illness.

Conclusion

The results point to lack of awareness among pre-hospital and hospital-based first responders of the relationship between MH and heat illness in young athletes. An effort to educate these members of the healthcare community can contribute to an expeditious and life-saving intervention.

Clinical Relevance

First responders who may interact with a young athlete have low knowledge of MH and its relationship to heat illness. Similar lack of awareness exists among hospital personnel who care for young individuals with heat illness. Educating the first responders about this condition can speed up the time to intervene and save lives.

Epidemiology, etiology and prevention of injuries in competitive ice speed skating-limited current evidence, multiple future priorities: A scoping review

Long-track and short-track ice speed skating are integral to the Winter Olympics. The state of evidence-based injury prevention in these sports is unclear. Our goals were to summarize the current scientific knowledge, to determine the state of research, and to highlight future research areas for injury prevention in ice speed skating. We conducted a scoping review, searching all injury and injury prevention studies in competitive ice speed skaters. The six-stage Translating Research into Injury Prevention Practice (TRIPP) framework summarized the findings. The systematic search yielded 1109 citations. Nineteen studies were included, and additional searches yielded another 13 studies, but few had high-quality design. TRIPP stage 1 studies (n = 24) found competition injury rates from 2% to 18% of participants with various injury locations and types. Seasonal prevalence of physical complaints was up to 84% (for back pain) in long- and short-track. Ten studies covered information on TRIPP stage 2, with two small etiological studies linking injuries to functional strength deficits (short-track) and training load (long-track). Questionnaire studies identified various perceived risk factors for injuries but lacked further scientific evidence. Most TRIPP stage 3 studies (five out of eight) focused on developing protective measures, while two studies found short-track helmets performed poorly compared to helmets used in other sports. No study evaluated the efficacy, the intervention context, or the effectiveness (TRIPP stages 4-6) of the measures. Scientific knowledge on injury prevention in ice speed skating is limited. Future research should prioritize high-quality studies on injury epidemiology and etiology in the sports.

Concussion history and virtual reality metrics predict core or lower extremity injury occurrence among high school athletes

Introduction

A history of concussion is recognized as a risk factor for musculoskeletal injury, which is likely associated with physiological effects that warrant better understanding. This study aimed to assess the potential of measurements obtained from an immersive virtual reality (VR) test to identify a subtle perceptual-motor impairment that may be prospectively associated with the occurrence of a core or lower extremity sprain or strain.

Methods

A cohort of 68 high school athletes (41 female soccer players and 27 male football players) provided survey responses and completed an immersive VR test several days prior to the initiation of preseason practice sessions. Measurements of eye, neck, arm, and whole-body displacements were obtained during 40 successive lunging/reaching responses to visual stimuli moving horizontally across the VR headset display. Injury occurrences were electronically documented from the initial preseason practice session to the final game of the season.

Results

A statistically significant and intrinsically credible two-factor prediction model for core or lower extremity injury occurrence included an interaction between female sex and a self-reported history of two or more concussions, along with slow response time (RT) for arm reach (OR = 4.67; 95% CI, 1.51-14.43). Follow-up analyses identified sex-specific cut points for arm reach RT associated with elevated injury risk, which were ≥1.385 s for females and ≥1.257 s for males.

Discussion

High school female soccer players who have sustained more than one concussion appear to be highly vulnerable to core or lower extremity sprain or strain, with the risk of injury compounded by a slow arm reach RT. Male football players as a group demonstrated significantly faster arm reach RT than that of female soccer players, but slow perceptual-motor RT for arm reach was also identified as a potentially important injury risk factor for male players. Immersive VR appears to provide precise measurements of behavioral performance characteristics that depend on brain processing efficiency. Given that the speed, accuracy, and consistency of perceptual-motor responses may be modifiable, future research should explore the potential benefits of VR training for reducing the risk of sport-related injuries.

Prevalence of musculoskeletal pain and dysfunction in electrical utility workers: Practical considerations for prevention and rehabilitation in the workplace

INTRODUCTION

This study assessed the prevalence and associations of musculoskeletal pain and dysfunction in electrical utility workers, with the aim of applying the findings to better prevent and rehabilitate workplace musculoskeletal disorders.

METHODS

Employees completed an online survey recording their musculoskeletal symptoms across nine anatomical locations for the preceding 12 months. A total of 565 employees, working across eight different electrical utility organisational work units, completed the survey.

CONSUMER AND COMMUNITY INVOLVEMENT

The study was collaborative and conducted in Australia's largest, wholly government owned electricity company. The study originated from the participating organisation wanting to better understand their musculoskeletal disorder (MSD) risks.

RESULTS

Employees who experienced high job stress were 4.06 times (95% confidence interval [CI] = 1.78-9.29) more likely to report musculoskeletal symptoms in the shoulder compared with employees with lower reported job stress. Employees that perceived their work to have high physical demands report lower back musculoskeletal symptoms at 2.64 times the rate of those perceiving their job to be of low physical demand (95% CI = 1.44-4.84). There were significant differences in the lower back musculoskeletal symptoms according to work unit membership.

CONCLUSIONS

Understanding the prevalence of MSDs is critical to implementing practical prevention and rehabilitation strategies in the workplace. This anonymous survey highlighted that a large proportion of electrical utility workers reported that musculoskeletal symptoms had impacted their ability to perform their job, housework and/or hobbies in the preceding 12 months. Early access to rehabilitation services is essential. However, many workers report barriers to disclosing MSDs; therefore, workplace rehabilitation services may need to be broadened to account for these barriers.

A 2D video-based assessment is associated with 3D biomechanical contributors to dynamic knee valgus in the coronal plane

Introduction

Adolescent athletes involved in sports that involve cutting and landing maneuvers have an increased risk of anterior cruciate ligament (ACL) tears, highlighting the importance of identifying risky movement patterns such as dynamic knee valgus (DKV). Qualitative movement screenings have explored two-dimensional (2D) scoring criteria for DKV, however, there remains limited data on the validity of these screening tools. Determining a 2D scoring criterion for DKV that closely aligns with three-dimensional (3D) biomechanical measures will allow for the identification of poor knee position in adolescent athletes on a broad scale. The purpose of this study was to establish a 2D scoring criterion that corresponds to 3D biomechanical measures of DKV.

Methods

A total of 41 adolescent female club volleyball athletes performed a three-task movement screen consisting of a single-leg squat (SLS), single-leg drop landing (SLDL), and double-leg vertical jump (DLVJ). A single rater scored 2D videos of each task using four criteria for poor knee position. A motion capture system was used to calculate 3D joint angles, including pelvic obliquity, hip adduction, knee abduction, ankle eversion, and foot progression angle. Receiver operating characteristic curves were created for each 2D scoring criterion to determine cut points for the presence of movement faults, and areas under the curve (AUC) were computed to describe the accuracy of each 2D criterion compared to 3D biomechanical data.

Results

3D measures indicated knee abduction angles between 2.4°-4.6° (SD 4.1°-4.3°) at the time point when the center of the knee joint was most medial during the three tasks. AUCs were between 0.62 and 0.93 across scoring items. The MEDIAL scoring item, defined as the knee joint positioned inside the medial border of the shoe, demonstrated the greatest association to components of DKV, with AUCs ranging from 0.67 to 0.93.

Conclusion

The MEDIAL scoring criterion demonstrated the best performance in distinguishing components of DKV, specifically pelvic obliquity, hip adduction, ankle eversion, and foot progression. Along with the previously published scoring definitions for trunk-specific risk factors, the authors suggest that the MEDIAL criterion may be the most indicative of DKV, given an association with 3D biomechanical risk factors.

Identifying and Validating Alcohol Diagnostics for Injury-Related Trauma in South Africa: Protocol for a Mixed Methods Study

BACKGROUND

The burden of alcohol use among patients with trauma and the relative injury risks is not routinely measured in South Africa. Given the prominent burden of alcohol on hospital trauma departments, South Africa needs practical, cost-effective, and accurate alcohol diagnostic tools for testing, surveillance, and clinical management of patients with trauma.

OBJECTIVE

This study aims to validate alcohol diagnostics for injury-related trauma and assess its use for improving national health practice and policy.

METHODS

The Alcohol Diagnostic Validation for Injury-Related Trauma study will use mixed methods across 3 work packages. Five web-based focus group discussions will be conducted with 6 to 8 key stakeholders, each across 4 areas of expertise (clinical, academic, policy, and operational) to determine the type of alcohol information that will be useful for different stakeholders in the injury prevention and health care sectors. We will then conduct a small pilot study followed by a validation study of alcohol diagnostic tools (clinical assessment, breath analysis, and fingerprick blood) against enzyme immunoassay blood concentration analysis in a tertiary hospital trauma setting with 1000 patients. Finally, selected alcohol diagnostic tools will be tested in a district hospital setting with a further 1000 patients alongside community-based participatory research on the use of the selected tools.

RESULTS

Pilot data are being collected, and the protocol will be modified based on the results.

CONCLUSIONS

Through this project, we hope to identify and validate the most appropriate methods of diagnosing alcohol-related injury and violence in a clinical setting. The findings from this study are likely to be highly relevant and could influence our primary beneficiaries-policy makers and senior health clinicians-to adopt new practices and policies around alcohol testing in injured patients. The findings will be disseminated to relevant national and provincial government departments, policy experts, and clinicians. Additionally, we will engage in media advocacy and with our stakeholders, including community representatives, work through several nonprofit partners to reach civil society organizations and share findings. In addition, we will publish findings in scientific journals.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52949.

Firearm screening and secure storage counseling among home visiting providers: a cross-sectional study of SafeCare® providers in the U.S

Background

Firearms used in pediatric firearm deaths are most often obtained from the child's home, making secure firearm storage initiatives imperative in prevention efforts. Evidence-based home visiting (EBHV) programs are implemented with over 277,000 families annually, providing an opportunity for secure firearm storage counseling. The purpose of this study was to assess EBHV providers' experiences with firearm screening ("assessment"), secure storage counseling, and their perceptions for related training needs.

Methods

Providers in the U.S. from SafeCare®, an EBHV program often implemented with families experiencing increased risk of child neglect and physical or emotional abuse, were invited to participate in a survey to examine firearm assessment and attitudes toward and experiences with firearm safety counseling. Survey items were primarily Likert scale ratings to indicate level of agreement, with some open-ended follow-up questions. Descriptive statistics (i.e., frequencies and percentages) were used to report item-level agreement. A post hoc analysis was conducted using Spearman correlation to examine the association between assessment and counseling and provider-level factors.

Results

Sixty-three SafeCare providers consented to and completed the survey items. Almost three-quarters (74.6%) agreed/strongly agreed that they assess in-home firearm availability. However, 66.7% agreed/strongly agreed that they have not been adequately trained to discuss firearm safety topics. A substantial proportion (80.6%) indicated they would counsel more if materials and training on this topic were available. Response variability emerged by level of urbanicity. A post hoc analysis found that providers' self-reported frequency of assessment and counseling were associated with their comfort level discussing firearm safety and whether or not they had worked with families impacted by firearm injury.

Conclusion

SafeCare providers report a need for materials and training on secure firearm storage, and a willingness to provide more counseling with proper training to the families they serve. Findings illuminate the need for secure storage initiatives for EBHV programs, which have broad service reach to a substantial number of at-risk U.S. families annually.

NCAA football players are at higher risk of upper extremity injury after first-time concussion

BACKGROUND

Previous research has demonstrated that concussions increase the risk of subsequent lower extremity musculoskeletal injury in athletes. However, the risk of upper extremity injury in athletes' post-concussion is poorly understood.

METHODS

All concussed football players within a National Collegiate Athletic Association (NCAA) Division I conference athletic database were identified between 2017 and 2021. After exclusions, each athlete experiencing their first concussion was then retrospectively reviewed for upper extremity injuries in the year prior to their concussion and in the year beginning at 90 days after their concussion. All upper extremity injuries were identified and the odds ratio, 95% confidence interval, and statistical significance between groups were calculated in Microsoft Excel.

RESULTS

160 de-identified football players from a single conference who were first diagnosed with concussions in the seasons from 2017 through 2021 met inclusion criteria. In these athletes the odds of upper extremity injury in year following first diagnosed concussion were 2.36 times higher than in the year prior (95% CI 1.13-4.95, p = 0.02). Shoulder was the most common site of injury with 57.7% of injuries compared to 19.2% in the hand, 15.4% in the elbow, 7.7% in the forearm, and 0% in the wrist.

CONCLUSION

This study demonstrates that collegiate football players are at a 2.36 times greater risk of upper extremity injury in the year following their first diagnosed concussion compared to the year preceding it. The most common site of upper extremity injury after concussion was the shoulder.

LEVEL OF EVIDENCE

III.

Limited total arc range of motion increases sheer stress in the shoulder while pitching in collegiate baseball pitchers

CONTEXT

Upper extremity injuries in baseball pitchers cause significant time-loss from competing and decreased quality of life. Although shoulder range of motion (ROM) is reported as a key factor to prevent potential injury, it remains unclear how limited glenohumeral ROM affects pitching biomechanics which may contribute to upper extremity injuries.

OBJECTIVE

To investigate how pitchers with decreased total arc glenohumeral ROM of the throwing arm differed in upper extremity pitching kinematics and kinetics as well as ball velocity compared to pitchers with greater levels of glenohumeral ROM.

DESIGN

Cross-sectional Study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Fifty-seven baseball pitchers (ages 18-24) were divided into either control (≧160° total arc) or lower ROM (<160° total arc) groups.

MAIN OUTCOME MEASURE(S)

The mean glenohumeral ROM deficits, pitching kinematic and kinetic outcomes, and ball velocity were compared between groups.

RESULTS

The control group demonstrated significantly less deficit in total arc ROM between arms than the lower ROM (Control: -1.5±10.0°, Lower ROM: -12.4±13.9°, p<.001). While, the lower ROM group displayed less maximal shoulder external rotation (ER) while pitching, the control group had significantly less difference in ROM between maximal shoulder ER while pitching and clinically-measured ER (Lower ROM: 64.4±12.1°, Control: 55.8±16.6°, p=.025). The control group had significantly faster ball velocity compared to the lower ROM group (Control: 85.0 ± 4.3mph, Lower ROM: 82.4 ± 4.8mph, p=.024).

CONCLUSION

Pitchers with decreased total arc glenohumeral ROM (<160° total arc) may undergo over-stretching toward ER in the shoulder during the late cocking phase. Pitchers with higher total arc ROM can pitch the same or faster ball without increasing loading in the upper extremity. Total arc glenohumeral ROM measurement can be a clinical screening tool to monitor shoulder condition over the time, and pitchers with limited total arc ROM might be at higher risk of shoulder injury.

Injury Pattern Analysis to Optimize Burn Injury Prevention in the Unhoused Community

Unhoused patients are an overrepresented group in burn injury, and are a uniquely vulnerable population. Current research focuses on the consequences of homelessness on burn outcomes, with little known about the specific circumstances and behaviors leading to burn injury that may represent specific targets for injury prevention efforts. The burn registry at an urban regional burn center was queried for burn admissions in unhoused adults from 2019 to 2022. Registry data pulled included demographics, urine toxicology, mechanism of injury, and injury subjective history. Subjective injury history was reviewed to determine more specific injury circumstances and activities during which accidental burns occurred. Demographic and mechanistic trends in burn admissions were explored via descriptive statistics. Among 254 admissions for burns from the unhoused community, 58.1% of patients were positive for stimulants on admission. Among accidental injuries (69.7%), common circumstances included preparing food or beverages, cooking or using methamphetamine, smoking cannabis or tobacco, bonfires, and candles. A specific common circumstance was lighting a cigarette while handling accelerants (6.7%). Interventions for stimulant abuse, as well as outreach efforts to educate unhoused patients about situational awareness, safe handling of accelerants, safe smoking practices, and safe cooking practices, may be effective tools in reducing burn admissions in this vulnerable population.

Global knee function rating more strongly influences adolescent athletes that sustain a sports-related surgical ACL re-injury or contralateral ACL injury

PURPOSE

This study evaluated differences between adolescent athletes who sustained a surgical anterior cruciate ligament (ACL) re-injury, or contralateral ACL injury following return to sports bridge programme participation (Group 1) compared to those that did not (Group 2).

METHODS

At 19.9 ± 7 years of age, 198 athletes participated in this study. Groups were compared for time postsurgery, preprogramme and postprogramme Knee Outcome Survey Sports Activity Scale (KOS-SAS) and global rating of knee function (GRKF) during sports activities, postprogramme lower extremity physical function test performance and perceived sports performance compared to preinjury level.

RESULTS

By 6.0 ± 3.2 years postsurgery, 11 (5.6%) sustained another ACL injury. Group 1 was younger (17.3 ± 1.7 years vs. 20.1 ± 6.8 years, p < 0.001). Postprogramme re-evaluation revealed that Group 1 had a greater GRKF compared to their programme initiation GRKF than Group 2 (32.6 ± 38 vs. 20.0 ± 23, p = 0.04). Group 1 also had a greater mean preprogramme to postprogramme GRKF change than Group 2 (51.3 ± 31 vs. 35.5 ± 21, p = 0.02) (effect size = 0.73). More Group 1 subjects also had a GRKF difference that exceeded the overall mean than Group 2 (p = 0.04). Group 1 had moderately strong relationships between preprogramme and postprogramme GRKF score change and the postprogramme GRKF score (r = 0.65, p = 0.04) and between preprogramme and postprogramme KOS-SAS score change and postprogramme GRKF score (r = 0.60, p = 0.04).

CONCLUSION

Global rating scores had a stronger influence among adolescent athletes that sustained either surgical ACL re-injury or contralateral ACL injury. Since group physical function and neuromuscular control factors were similar, clinicians need to increase their awareness and understanding of other factors that may influence surgical ACL re-injury or contralateral ACL injury risk.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Video Analysis of Anterior Cruciate Ligament Injuries in Male Professional Basketball Players: Injury Mechanisms, Situational Patterns, and Biomechanics

Background

Improving our understanding of the situations and biomechanics that result in an anterior cruciate ligament (ACL) injury in basketball players may support the design of more effective programs to mitigate the risk of injury.

Purpose

To (1) describe the mechanisms, situational patterns, and gross biomechanics (kinematics) of ACL injuries in professional basketball matches using video analysis and (2) document the distribution of ACL injuries according to player position, phase of the match, and location on the court.

Study Design

Case series; Level of evidence, 4.

Methods

A total of 38 ACL injuries in professional male European basketball leagues from the 2013-2014 to 2019-2020 seasons were identified. There were 36 (95%) injury videos analyzed for injury mechanisms and situational patterns, while biomechanical analysis was possible in 32 cases. Overall, 3 independent reviewers evaluated each video. Data according to player position (n = 38), phase of the match (n = 38), and location on the court (n = 36) were evaluated.

Results

More injuries occurred while attacking (n = 25 [69%]) than defending (n = 11 [31%]). There was 1 (3%) direct contact injury, 21 (58%) indirect contact injuries, and 14 (39%) noncontact injuries. Most injuries (83%) occurred during 3 main situations: offensive cut (n = 17 [47%]), landing from a jump (n = 8 [22%]), and defensive cut (n = 5 [14%]). Injuries generally involved knee flexion (with minimal hip/trunk flexion and reduced plantarflexion) in the sagittal plane and knee valgus loading in most cases (75%). A similar number of injuries occurred during the first (53%) and second (47%) halves of the match, with a higher prevalence in the second (37%) and fourth (34%) quarters. Half of the injuries occurred during the first 10 minutes of effective playing time. More injuries occurred in guards (58%), and 73% of all injuries occurred in the scoring zone.

Conclusion

Indirect contact was the main injury mechanism found in male professional basketball players. The offensive cut was the most common situational pattern. Biomechanical analysis confirmed a multiplanar mechanism, with knee loading in the sagittal plane accompanied by dynamic valgus. More injuries occurred in the first 10 minutes of a player's effective playing time, within the scoring zone, and among guards.

25-Year fatal workplace suicide trends in North Carolina: 1992-2017

BACKGROUND

Suicide is a serious public health problem in the United States, but limited evidence is available investigating fatal suicides at work. There is a substantial need to characterize workplace suicides to inform suicide prevention interventions and target high-risk settings. This study aims to examine workplace suicide rates in North Carolina (NC) by worker characteristics, means of suicide used, and industry between 1992 and 2017.

METHODS

Fatal workplace suicides were identified from records of the NC Office of the Chief Medical Examiner system and the NC death certificate. Sex, age, race, ethnicity, class of worker, manner of death, and industry were abstracted. Crude and age-standardized homicide rates were calculated as the number of suicides that occurred at work divided by an estimate of worker-years (w-y). Rate ratios and 95% confidence intervals (CIs) were calculated, and trends over calendar time for fatal workplace suicides were examined overall and by industry.

RESULTS

81 suicides over 109,464,430 w-y were observed. Increased rates were observed in workers who were male, self-employed, and 65+ years old. Firearms were the most common means of death (63%) followed by hanging (16%). Gas service station workers experienced the highest fatal occupational suicide rate, 11.5 times (95% CI: 3.62-36.33) the overall fatal workplace suicide rate, followed by Justice, Public Order, and Safety workers at 3.23 times the overall rate (95% CI: 1.31-7.97).

CONCLUSION

Our findings identify industries and worker demographics that were vulnerable to workplace suicides. Targeted and tailored mitigation strategies for vulnerable industries and workers are recommended.

Neurocognitive Errors and Noncontact Anterior Cruciate Ligament Injuries in Professional Male Soccer Players

CONTEXT

Evidence is emerging that core neurocognitive functions such as working memory and inhibitory control (ie, motor-response and attentional inhibition) are linked to the anterior cruciate ligament (ACL) injury risk. Research has been conducted in laboratory settings, but the contribution of neurocognition to actual ACL injuries under real-world conditions is unknown.

OBJECTIVE

To describe the possible neurocognitive errors involved in noncontact ACL injury mechanisms.

DESIGN

Case series.

SETTING

Soccer matches.

PATIENTS OR OTHER PARTICIPANTS

A total of 47 professional male soccer players.

MAIN OUTCOME MEASURE(S)

Three independent reviewers evaluated 47 videos of players sustaining noncontact ACL injuries. Neurocognitive errors in inhibitory control were operationalized as follows: (1) motor-response inhibition was scored when a player demonstrated poor decision-making and approached the opponent with high speed that reduced the ability to stop or change the intended action and (2) an attentional error was scored when a player shifted his selective attention away from the relevant task to irrelevant stimuli.

RESULTS

Of 47 noncontact ACL injuries, 26 (55%) were related to a pressing-type injury, 19 (73%) of which involved a deceiving action made by the opponent, suggesting poor inhibitory control of the defender. Of the remaining 21 noncontact ACL injuries (45%), 16 (76%) could be attributed to attentional errors. Agreement among the 3 raters was very good for all items except poor decision-making, which showed fair to good agreement (Fleiss κ = 0.71). Interrater reliability was excellent (intraclass correlation coefficient = 0.99-1.00).

CONCLUSIONS

Errors in motor-response inhibitory control and attentional inhibition were common during noncontact ACL injury events in professional male soccer players. The interrater agreement in detecting neurocognitive errors in general was very good.

Models of Video Feedback for Youth Athletes Performing an American Football Tackle

CONTEXT

Video feedback is an expeditious method for improving athlete safety when performing activities with an inherent risk of injury. Providing appropriate and validated feedback during tackling training in American football may be a mechanism for athletes to learn safe tackling performance.

OBJECTIVE

To determine the effect of video feedback in the instruction of tackling form.

DESIGN

Controlled laboratory study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 32 youth football athletes (28 boys, 4 girls; age = 11.8 ± 0.8 years) participated in 1 day of training. Of those, 14 participants completed 2 additional days of training and a 48-hour retention and transfer test.

INTERVENTION(S)

Video feedback using self as model, expert as model, combined self and expert model, and oral feedback to promote safe tackling performance in a laboratory environment.

MAIN OUTCOME MEASURE(S)

Shoulder extension, cervical extension, trunk angle, pelvis height, and step length by training block and over time.

RESULTS

For the 1-day training group, main effects for time were observed for shoulder extension (P < .01), cervical extension (P = .01), pelvis height (P < .01), and step length (P < .01), with better performance for pelvis height and step length after combined feedback. For the 3-day training group, main effects of time were identified in pelvis height (P < .01) and step length (P < .01), with combined feedback showing better performance than other methods in shoulder extension and pelvis height. Combined feedback resulted in better performance compared with its component parts and oral feedback alone. In the combined model, participants viewed both their performance and the expert model, enabling them to see the difference between current and required performance.

CONCLUSIONS

Combined feedback may be superior to other forms of feedback in improving movement performance. This effect can be generalized across disciplines that provide instruction and feedback in movement.

An increase in animal-related occupational injuries at a veterinary medical center (2008-2022)

OBJECTIVE

To characterize animal-related injuries in veterinary medical center staff at a veterinary medical center.

SAMPLE

706 hospital staff injuries.

METHODS

Deidentified injury reports were submitted to Human Resources from 2008 through 2022. Injury data collected included the injury description, date of injury, occupation, and worker's compensation claim information. Data were summarized by year, cause of injury, total cost associated with injury, and occupation.

RESULTS

There was an increase in injuries reported in recent years when compared to past years, with the plurality of injuries being bite injuries, specifically occurring on the hand, finger, and wrist area. Bite injuries had a higher average total worker's compensation cost paid to staff than striking injuries. There were more injuries reported by staff who had less experience working with animals. More injuries occurred during the summer months (June through September). There was not an unusual trend in the reporting of injuries due to COVID-19. Other injuries (eg, needlesticks and falls) were reported from only 2019 to 2022, but constituted a substantial burden for staff.

CLINICAL RELEVANCE

These findings can help stakeholders at teaching hospitals and veterinary clinics to take steps toward creating a safer workplace environment for employees. It is important to identify work hazards and provide proper training and prevention methods to reduce the risk of injuries, especially among less experienced employees. Proper prevention methods will help reduce worker's compensation costs for the teaching hospital and reduce the number of workdays missed by staff.

Newspaper framing of motor vehicle crashes and road safety in Argentina

The media plays a key role in shaping the public's perception of road safety. This study analyzes the newspaper coverage and framing of motor vehicle crashes (MVCs) and road safety in Argentina, South America. The content of 304 articles published by 15 newspapers in November 2020 was reviewed. The results show that episodically framed news stories (focused on a single event or incident) prevail over thematically framed articles. MVCs are presented primarily as 'police' events and tend to receive more coverage when fatalities are involved. There is limited information provided on contextual and risk factors, and road safety advice is rarely included. Speeding, infrastructure, alcohol and other human-related variables are the most cited risk factors. Very few articles mention the use of protective devices (seat-belt, helmet and child restraint system). Although motorcyclists represent 40% of RTC deaths in Argentina, only 20% of the news coverage was about them. News coverage was quite similar in national and regional newspapers. There is an opportunity for the media to help build a better road safety culture, but significant changes in news framing are required. Practical recommendations for editors, journalists and road safety practitioners are provided.

Impact of a Parent Education Program Delivered by Nurses and Health Care Providers in Reducing Infant Physical Abuse Hospitalization Rates in British Columbia, Canada

BACKGROUND

The Period of PURPLE Crying Program® (PURPLE) is a universal parent education program that is delivered by nurses and health care providers to all parents/caregivers of newborns in British Columbia (B.C.). The aim of the program is to reduce the incidence of Traumatic Head Injury -Child Maltreatment (THI-CM), a form of child physical abuse.

OBJECTIVE

To determine if the PURPLE program had an impact on the rate of physical abuse hospitalizations for children less than or equal to 24 months of age in B.C. since implementation in 2009.

METHODS

The analysis measured physical abuse hospitalization rates for the period January 1, 1999 to December 31, 2019 and excluded any cases of confirmed Traumatic Head Injury-Child Maltreatment. Data were divided into pre-implementation period January, 1999 to December, 2008, and post-implementation period January, 2009 to December, 2019. Data were obtained from the Discharge Abstract Database and B.C. THI-CM Surveillance System to capture information on infant child abuse. Poisson regression and ANCOVA was applied to model the change in rates pre and post program implementation.

RESULTS

Physical abuse hospitalization rates decreased by 30% post-implementation period (95% CI: -14%, 57%, p  =  0.1561). The decreasing linear trend in the post-implementation period was significantly different than the increasing linear trend in the pre-implementation period (F1,17  =  4.832, p  =  0.042).

CONCLUSIONS

Nurses' role in engaging parents in conversations about PURPLE messages over multiple timepoints within a structured universal program model resulted in a decrease in physical abuse hospitalization rates since the implementation of PURPLE.

An Urgent Call for Concussion Incidence Measures in Para Sport for Athletes with Vision Impairment: A Narrative Review

Concussion in para athletes with vision impairment (VI) is poorly understood. Recently published studies have suggested that athletes with VI may be more likely to sustain sport-related concussions compared to non-disabled athletes and athletes with other impairment types. There is a critical need for objective concussion incidence measures to determine concussion injury rates and risks more accurately. The aim of this review was to examine the limited available evidence of concussion incidence rates across six different para sports for athletes with VI and encourage the future collection of concussion incidence data and the adoption of injury prevention strategies in VI para sport. A literature search was conducted using four unique databases, which formed the basis of this narrative review. Injury prevention strategies such as modifying sport rules, introducing protective equipment, and incorporating additional safety measures into the field of play have been introduced sporadically, but the effectiveness of most strategies remains unknown. More prospective, sport-specific research examining mechanisms of injury and risk factors for concussion injuries in athletes with VI in both training and competition is needed. This research will help inform the development of targeted injury prevention strategies to reduce the likelihood of concussion for athletes with VI.

Effects of Proprioceptive Insoles and Specific Core Training on Postural Stability for Preventing Injuries in Tennis

Tennis is a complex sport based on unpredictability that requires adequate physical and psychological preparation to prevent injuries. The aim of this study was to investigate the effects of 8-week specific core stability training on postural stability in competitive adolescent tennis players, aged between 14 and 19 years old. Sixty-one participants were randomly allocated into two groups: experimental (n = 32) and control (n = 29) groups. The first group wore proprioceptive insoles 8 h a day and performed a detailed training 3 times a week for 8 weeks; the second group only received proprioceptive insoles to wear 8 h a day for 8 weeks. The postural stability parameters (center-of-pressure length, center-of-pressure velocity, and 95% confidence ellipse sway area) included three assessment times: baseline (T0), intermediate test (T1), post-test (T2), and retention test (T3). Data analysis showed a significant improvement in the experimental group compared with the control group, indicating a large effect size in center-of-pressure length, ellipse sway area, and center-of-pressure velocity at T2 and T3 (p < 0.05). In conclusion, our results suggest that a specific and detailed core stability training plays a significant role in improving balance and postural stability in young tennis players, especially in terms of preventing the risk of injury.

Effect of a Mobile Game-Based Intervention to Enhance Child Safety: Randomized Controlled Trial

BACKGROUND

Evidence supports the effectiveness of serious games in health education, but little is known about their effects on the psychosocial well-being of children in the general population.

OBJECTIVE

This study aimed to investigate the potential of a mobile game-based safety education program in improving children's safety and psychosocial outcomes.

METHODS

Safe City is a mobile roleplaying game specifically designed to educate children in Hong Kong about safety. This randomized controlled trial included 340 children in grades 4 through 6. Intervention arm participants (n=170) were instructed to play the Safe City mobile game for 4 weeks, whereas control arm participants (n=170) received a safety booklet. All participants completed a survey on safety knowledge and behaviors and psychosocial problems at baseline (T1), 1 month postintervention (T2), and 3 months postintervention (T3). Cumulative game scores and mini-game performance were analyzed as a proxy for the extent of exposure to the game. Outcome data were analyzed using 2-sample 2-tailed t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. The association of game use with outcome changes postintervention was analyzed using generalized additive models.

RESULTS

No significant differences were found in mean changes between the intervention and control arms. However, use analyses showed that higher game scores were associated with improvements in safe behavior (P=.03) and internalizing problems (P=.01) at T3. Matching and Spot the Danger mini-game performance significantly predicted improvements in safety knowledge at T2 and T3.

CONCLUSIONS

Analysis of use has shown that playing the Safe City mobile game can result in significant improvements in safety knowledge and reductions in unsafe behavior and internalizing problems. These findings provide evidence for the positive impact of serious games on psychological and social well-being, highlighting the potential of technology-driven interventions to assist children in learning about safety and preventing injuries.

TRIAL REGISTRATION

ClinicalTrials.org NCT04096196; https://clinicaltrials.gov/show/NCT04096196.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/17756.

Consumer Perceptions of Home-Based Percussive Massage Therapy for Musculoskeletal Concerns: Inductive Thematic Qualitative Analysis

BACKGROUND

Musculoskeletal pain is a prevalent concern among diverse populations, from the average individual to the elite athlete. Handheld percussive massage therapy devices like massage guns have gained much popularity in both medical and athletic settings. Its application has been prominently recognized in injury prevention and rehabilitation. The expansion of the market to provide handheld percussive therapy devices with varying features and price points has encouraged professional and novice use. While percussive therapy holds similarities to more studied therapeutic modalities, like vibration therapy and soft tissue mobilization, there is limited evidence-based information on the indications and contraindications.

OBJECTIVE

This study aims to use a qualitative analysis of consumer perceptions to understand the perceived therapeutic potential of percussive massage therapy as a home-based intervention for musculoskeletal concerns of everyday users and elite athletes. Additionally, we aim to gain insight on valuable characteristics supporting its therapeutic potential as well as pertinent limitations.

METHODS

The TOLOCO massage gun (TOLOCO) was identified as the best-selling percussive massage therapy device on Amazon. We performed an inductive thematic qualitative analysis on the top 100 positive comments and the top 100 critical comments of the device between June 2020 and April 2023 to determine 4 relevant themes.

RESULTS

The 4 themes identified upon qualitative analysis were pain management, versatility, accessibility, and safety and user education. Consumer reviews indicated use for this percussive therapy device in adolescents, adults, and older people across a spectrum of activity levels. Consumers reported the therapeutic potential of percussive massage therapy in managing wide-ranging musculoskeletal concerns like acute pain, chronic pain, nonsurgical injury rehabilitation, postsurgical injury rehabilitation, and injury prevention. Consumers highlighted the versatility of the device to address person-specific needs as a key feature in supporting its perceived therapeutic benefits. Additionally, consumers frequently commented on the affordability and availability of this device to increase accessibility to home-based care. Some critical reviews emphasized a concern for the quality of the device itself. However, this concern did not translate to the overall modality of percussive massage therapy. Of note, despite strong approval for its therapeutic potential, consumer reviews lacked evidence-based insights on appropriate usage.

CONCLUSIONS

Home-based percussive massage therapy holds value with its perceived efficacy in pain management for acute and chronic conditions, as well as in injury prevention and rehabilitation. As a low-cost and readily available device for everyday users and high-performing athletes, percussive massage therapy works toward establishing increased health care accessibility and optimizing health care usage. This home-based intervention can serve to reduce the significant personal and economic burden of prevalent musculoskeletal concerns. However, the limited scientific research on percussive massage therapy raises concerns about the lack of evidence-based care and indicates the need for future studies.

Relationships of lower extremity and trunk asymmetries in elite soccer players

In light of previous research highlighting the prevalence of asymmetries in soccer players and possible links to injury risks, there is a crucial gap in the biomechanical understanding of complex relationships between lower extremity and trunk asymmetries in elite soccer players. The purpose of this study was to investigate the level, relationships, and differences among twelve different parameters of strength, morphological, and neuromuscular asymmetries in elite soccer players. Methods: Elite male soccer players (n = 25, age 21.7 ± 3.9 years) were tested in the following tests: bilateral fluid distribution, hip flexor range of motion, postural stability, isokinetic strength of knee extensors and flexors, isometric lateral trunk rotation strength, eccentric strength of knee flexors, isometric bilateral strength of hip adductors, and vertical ground reaction force in counter-movement jump-free arms, counter-movement jump, squat jump, and drop jump tests. One-way ANOVA, Pearson's coefficient (r), and partial eta squared (η p 2) were used for data analysis. Results: Significant differences in asymmetries were found in elite soccer players (F11,299 = 11.01, p < .01). The magnitude of asymmetry over 10% was in postural stability and drop jump parameters. The lowest magnitudes of asymmetries were in the fluid distribution of the lower limbs and the vertical ground reaction force during the take-off phase in squat jumps. The highest asymmetries between the dominant and non-dominant sides were found in postural stability and drop jump. A total of eleven significant correlations (p < 0.05, r = 0.41-0.63, R2 = 0.17-0.40) were detected between the analyzed asymmetries in elite soccer players. The lateral trunk rotation asymmetries were significantly correlated to vertical ground reaction force asymmetries and knee extensors. Conclusion: Long-term exposure in elite soccer leads to unilateral biomechanical loading that induces abnormal strength and morphological adaptations in favor of the dominant side while linking lower limb and trunk strength asymmetries. By unraveling these complex relationships, we strive to contribute novel methods that could inform targeted training regimens and injury prevention strategies in the elite soccer community. The data should encourage future researchers and coaches to monitor and develop trunk strength linked to lower body kinematics.

Beyond drowning: Characteristics, trends, the impact of exposure on unintentional non-drowning coastal fatalities between 2012 and 22

OBJECTIVES

Drowning has been the focus of coastal safety, but a notable proportion of coastal mortality is due to other causes of death. This study describes that burden and quantifies the impact of exposure on Australian unintentional coastal fatalities not due to drowning.

METHODS

Analyses of Australian non-drowning coastal fatalities (NDCF) between July 2012 and June 2022 were conducted. Population and exposure-based rates were calculated for Australians 16+ years and compared to all-cause mortality rates. Time series analysis was performed using Joinpoint regression.

RESULTS

616 NDCFs were recorded (0.27/100,000 pop.), with a decreasing average annual percent change of -5.1% (95% CI:-9.5 to -0.4). Cardiac conditions were the primary causal factor, involved in 52% of deaths. Higher fatality rates were seen among men and for incidents occurring in rural and remote areas. Fatality rates were disproportionately high among young adults when compared to all-cause mortality.

CONCLUSIONS

Men, young adults, and those living in/visiting regional and remote areas represent high-risk populations. Proximity to emergency services and extended response times represent major determinants of NDCF.

IMPLICATIONS FOR PUBLIC HEALTH

Due to the high prevalence of NDCF, coastal safety practitioners should expand their attention beyond drowning to consider the broader range of coastal hazards and fatality types.

Factors Associated With a Lateral Ankle Sprain in Young Female Soccer Players: A Prospective Cohort Study

Background

Previous studies have attempted to determine if certain risk factors can predict the occurrence of a lateral ankle sprain (LAS) in female soccer players. Unfortunately, there is limited evidence with regard to risk factors associated with an LAS in female soccer players.

Purpose

To identify intrinsic risk factors for an LAS among young female soccer players.

Study Design

Cohort study; Level of evidence, 2.

Methods

Participants were 161 young female soccer players in Japan who were evaluated for LAS risk factors during a preseason medical assessment. The assessment included anthropometric, joint laxity, joint range of motion, muscle flexibility, muscle strength, and balance measurements. Each athlete's history of LASs was also collected. The participants were monitored during a single-yearseason for LASs, as diagnosed by physicians.

Results

There were 26 instances of an LAS in 25 players (15.5%) during the season. Injured players were significantly more likely to have sustained a previous ankle sprain (P = .045) and demonstrated significantly worse balance than their peers without an LAS during the double- and single-leg balance tests (P = .008 for both). Athletes with lower hamstring-to-quadriceps muscle strength ratios were also significantly more likely to sustain an LAS (P = .02).

Conclusion

Poor balance, a low hamstring-to-quadriceps ratio, and a history of ankle sprains were associated with an increased risk of LASs in young female soccer players in the current study. These findings may be useful for developing a program to prevent LASs in this population.

Balance Training Under Fatigue: A Randomized Controlled Trial on the Effect of Fatigue on Adaptations to Balance Training

ABSTRACT

Keller, M, Lichtenstein, E, Roth, R, and Faude, O. Balance training under fatigue: a randomized controlled trial on the effect of fatigue on adaptations to balance training. J Strength Cond Res 38(2): 297-305, 2024-Balance training is an effective means for injury prevention in sports. However, one can question the existing practice of putting the balance programs at the start of a training session (i.e., train in an unfatigued state) because the occurrence of injuries has been associated with fatigue. Therefore, the aim of this study was to assess the influence of balance training in a fatigued or an unfatigued state on motor performance tested in fatigued and unfatigued conditions. Fifty-two, healthy, active volunteers (28.0 years; 19 women) were randomly allocated to 1 of 3 different training groups. The BALANCE group completed 6 weeks of balance training. The other 2 groups completed the identical balance tasks either before (BALANCE-high-intensity interval training [HIIT]) or after (HIIT-BALANCE) a HIIT session. Thus, these groups trained the balance tasks either in a fatigued or in an unfatigued state. In PRE and POST tests, balance (solid ground, soft mat, wobble board) and jump performance was obtained in fatigued and unfatigued states. Balance training resulted in reduced sway paths in all groups. However, the linear models revealed larger adaptations in BALANCE-HIIT and BALANCE when compared with HIIT-BALANCE ( d = 0.22-0.71). These small to moderate effects were-despite some uncertainties-consistent for the "unfatigued" and "fatigued" test conditions. The results of this study revealed for the first time that balance training under fatigue results in diminished adaptations, even when tested in a fatigued state. Therefore, the data indicate that balance training should be implemented at the start of a training session or in an unfatigued state.

Education on Preventing Early Childhood Injuries Using a Video Game: The VirtualSafeHome Platform

Poisonings and household injuries are frequent events among toddlers. We developed VirtualSafeHome (VSH)-a novel self-contained, Internet-based home-safety learning tool-to improve awareness of household hazards. Study aims were to investigate VSH usage characteristics. A prototype, screen-based VSH kitchen was built in Unity and delivered through the web using 3DVista and Wix. Players spot and click 21 embedded hazards. A unique feature is the ability to capture the "child's perspective" in identifying hazards. We recruited a convenience sample of adults in 2021-2022. Outcomes included number of hazards discovered, session duration, and pretest/posttest knowledge scores. Twenty-four adults identified a median 15.5 hazards; median playing time was 1022 seconds. Players reported satisfaction with ease of navigation and game features. Mean pretest/posttest knowledge scores rose from 2.0 to 2.79 (P < .035). A web-enabled video game can provide easily accessed, enjoyable training on home safety.

Determinants of Intention to Disclose Musculoskeletal Injury in Adolescent Athletes

CONTEXT

Although research indicates that the key to minimizing the effect of musculoskeletal injury, improving care, and mitigating long-term effects is to improve early injury care seeking, little is known about barriers to early musculoskeletal injury disclosure and care seeking.

OBJECTIVE

To identify which determinants predicted sport-related musculoskeletal (MSK) injury disclosure by adolescent athletes.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

A total of 564 adolescent athletes (58% male, age = 15.81 ± 1.8 years).

MAIN OUTCOME MEASURE(S)

Online survey exploring determinants of age, gender, race, socioeconomic status, injury knowledge, attitudes, perceived social norms, and perceived behavioral control surrounding MSK injury disclosure, intention to disclose MSK injury, and actual behavior of disclosing MSK injury.

RESULTS

Of the respondents, 457 (80.2%) reported having sustained ≥1 (mean = 3.2 ± 2.2; range = 1-10) MSK injuries related to sport. Those who endorsed having experienced an MSK injury disclosed not reporting or purposefully hiding 77% of their suspected MSK injuries. Several factors influenced a high intention to disclose MSK injury. Specifically, for each unit increase in total MSK injury knowledge (Exp[β] = 1.061, β=0.054, P = .020, 95% CI = 1.031, 1.221) and attitude (Exp[β] = 1.070, β = 0.064, P < .001, 95% CI = 1.027, 1.115) score, 6% and 7% increases in the likelihood of a high intention to disclose an MSK injury, respectively, were observed. Moreover, for each unit increase in the social norm score (Exp[β] = 1.178, β=0.164, P < .001, 95% CI = 1.119, 1.241), an 18% increase in the likelihood of a high intention to disclose an MSK injury was noted.

CONCLUSIONS

Designing interventions geared toward increasing the knowledge of signs and symptoms of MSK injury, improving attitudes surrounding disclosure, and better understanding the social context of disclosing MSK injuries may improve MSK injury disclosure behavior and reduce the associated social and economic burdens of these injuries.

Unveiling the Surge: A Comprehensive Analysis of E-Scooter-Related Injuries at an Urban Level 1 Trauma Center in Vilnius, Lithuania (2018-2021)

Background The surge in electric scooter (e-scooter) adoption in 2019 fueled by sharing platforms has raised safety concerns, leading to an increased incidence of e-scooter-related injuries. Despite regulatory efforts, there has been a notable rise in accidents, prompting a comprehensive investigation. This study conducted at the Republican Vilnius University Hospital (RVUH), a level 1 trauma center, is one of the first in the Baltic States aiming to analyze the causes, severity, and frequency of e-scooter injuries from 2018 to 2021. This research addresses a critical gap in understanding e-scooter safety in the Baltic States, providing valuable insights for informed policy and preventive measures. Methodology This retrospective study analyzed e-scooter-related injuries in Vilnius, Lithuania, from April to September during 2018-2021. Data from the RVUH emergency department were examined. Using keywords such as "scooter" and "electric," relevant cases were extracted from the RVUH electronic health system. Included were individuals, both riders and pedestrians, with clear e-scooter involvement, excluding duplicates, those under 18, and users of other types of scooters. Extracted medical records provided data on demographics, injury specifics, helmet use, alcohol consumption, and more. Trauma severity was assessed through the New Injury Severity Score (NISS) and Abbreviated Injury Scale (AIS). Statistical analysis utilized GraphPad Prism software and Excel, adhering to ethical guidelines with RVUH Bioethics Committee approval. Results Over four years, 1,036 e-scooter-related injuries at RVUH revealed a gender-based shift, with males sustaining more injuries. The introduction of rentals in 2019 triggered a 334% surge in injuries compared to 2018. Despite an annual 208% increase from 2018 to 2021, 2021 saw a 710.93% rise. Trauma severity remained consistent, with AIS scores 1 and 2 being prevalent. Non-helmet wearers constituted 97.97%, and soft tissue damage was predominant. Ownership patterns shifted toward rentals (81.15%), reflecting the popularity of sharing platforms. Alcohol influence showed no significant change, but intoxicated patients had a higher surgery rate during four years. Mechanism analysis highlighted tripping as the primary cause. Injury characteristics revealed fractures in 34.56% of cases, primarily affecting upper limbs (53.35%). Soft tissue trauma was prominent (65.44%), with lower limbs being significantly impacted. Conclusions The surge in e-scooter injuries demands urgent preventive action. While most injuries are mild, a significant proportion is moderate to severe, even fatal. Inadequate education, lax enforcement, and uneven infrastructure contribute to the risk. Urgent measures, including road maintenance, speed reduction, and mandatory helmet use, are crucial. Clarity in government directives for designated e-scooter areas is vital. Further research is needed to understand the broader impact of informed policymaking and safer urban mobility. Expanding research to other Lithuanian regions would enhance the current study.

Screening for Youth Firearm Violence Exposure in Primary Care

Introduction

The aim of this study was to assess a modified gun violence exposure tool at a pediatric clinic on the West Side of Chicago to identify youth at high risk of future gun violence.

Methods

A modified version of the SaFETy gun violence exposure tool, studied in a community pediatric primary care setting, was implemented from June to August 2021. Patients and pediatric clinicians were surveyed after pilot.

Results

Of 508 eligible patients, 341 youth (67.1%) completed the SaFETy tool. None had a SaFETy score ≥6, the threshold for immediate referral. Over a quarter (26.4%) of youth had scores of 1-5, and of those, 7.8% were referred at the clinician's discretion. Youth (n=84) participants randomly selected to complete an anonymous survey provided feedback about the SaFETY tool, reporting that the questions were easy to understand (92%). All 6 pediatric clinicians surveyed agreed that the tool helped to identify youth exposed to gun violence.

Conclusions

Screening for gun violence exposure among youth is logistically feasible in the pediatric outpatient setting. A more sensitive validated tool to stratify low-/medium-risk patients in the primary care setting is needed.

Comparison of weekly training load and acute:chronic workload ratio methods to estimate change in training load in running

CONTEXT

Before examining the impact of training load on injury risk in runners, it is important to gain insight in the differences between methods that are used to measure change in training load.

OBJECTIVE

To investigate differences between four methods to calculate change in training load: (1) weekly training load; (2) acute:chronic workload ratio (ACWR), coupled rolling average (RA); (3) ACWR, uncoupled RA; (4) ACWR, exponentially weighted moving averages (EWMA).

DESIGN

Descriptive epidemiology study.

SETTING

This study is part of a randomized-controlled trial on running injury prevention among recreational runners. Runners received a baseline questionnaire and a request to share GPS training data.

PARTICIPANTS

Runners who registered for running events (distances 10-42.195 kilometers) in the Netherlands.

MAIN OUTCOME MEASURES

Primary outcome measure was the predefined significant increase in training load (weekly training loads ≥30% progression and ACWRs ≥1.5), based on training distance. Proportional Venn diagrams visualized the differences between the methods.

RESULTS

430 participants (73.3% men; age 44.3 years) shared their GPS training data with in total 22,839 training sessions. For the weekly training load, coupled RA, uncoupled RA, and EWMA method, respectively 33.4% (95% CI 32.8-34.0), 16.2% (95% CI 15.7-16.6), 25.8% (95% CI 25.3-26.4), and 18.9% (95% CI 18.4-19.4) of the training sessions were classified as significant increase in training load. Of the training sessions with significant increase in training load, 43.0% expressed in the weekly training load method showed a difference with the coupled RA and EWMA method. Training sessions with significant increase in training load based on the coupled RA method showed 100% overlap with the uncoupled RA and EWMA method.

CONCLUSIONS

The difference in change in training load measured by weekly training load and ACWR methods was high. To validate an appropriate measure of change in training load in runners, future research on the association between training loads and RRI risk is needed.

Sex-specific analysis of hiking accidents in the Austrian Alps: a follow-up from 2015 to 2021

Background

Hiking is one of the most popular leisure sport activities practiced in the Alps during the summer season, but bears the risk of mountain emergencies, accidents, and fatalities. This paper provides an updated analysis of hiking accidents for the years 2015 to 2021 in the Austrian Alps, thereby outlining fatal and non-fatal accident characteristics.

Methods

For this retrospective analysis, mountain hiking accidents documented by the Austrian Alpine Police during a 7-year period were screened for potential exclusion criteria. The final sample size consisted of 7368 accidents and 7552 victims. The outcome measures were mainly specified by sex, age, injury degree, injury location, pathophysiological characteristics, and cause of injury.

Results

The overall annual number of accidents showed a continuous increase from 428 in 2015 to 544 in 2021. In total, 7.1% of the total victims died during the 7-year period, with male hikers being significantly more affected than female hikers (m: 80.8%, f: 19.2%; p ≤ 0.001). The sex specific distribution for non-fatal hiking accidents was 55.9% in women and 44.1% in men. Male victims showed significantly more frequent cardiovascular events (m: 78.5%, f: 21.5%), multiple injuries (m: 60.2%, f: 39.8%), and wounds/blood loss (m: 57.4%, f: 42.6%) than female victims, whereas women showed more fractures (m: 31.5%, f: 68.5%) than men (p ≤ 0.001). Additionally, men were more likely to injure their abdomen/chest (3.7%), head (14.1%), and multiple body parts (26.5%), whereas women were more likely to injure their ankle or foot (42.3%). Finally, men were more likely to have an accident during the ascent (24.1%), whereas women during the descent (69.0%) (p ≤ 0.001).

Conclusion

This paper provides the latest data and a deeper insight into sex-specific characteristics of mountain hiking accidents in the Austrian Alps.

Perspectives and Experiences of Dance-Related Injuries: A Qualitative Survey of Adolescent Pre-Professional Ballet Dancers in Australia

Objective: To explore perspectives and experiences of adolescent ballet dancers in Australia in relation to dance-related injuries and their impact, injury risk factors, prevention, and treatment. Design: Adolescent ballet dancers aged from 12 to 19 years in Australia were invited to participate in an online qualitative survey. Methods: Responses to open-ended questions were analyzed thematically using grounded theory while quantitative information was summarized with descriptive statistics and triangulated with qualitative data. Results: Nineteen adolescent dancers reported experiencing pain and multiple injuries but hiding or ignoring injuries due to fear. Dancers recognized the significant physical and psycho-social impact of dance-related injuries on themselves and others. Several risks and injury prevention strategies were identified by dancers. Dancers perceived that treatments were not always informed or effective. Conclusion: Findings suggest that adolescent ballet dancers experience multiple dance-related injuries but require support to disclose injuries, participate in injury prevention, and access treatment. Health professionals may improve quality of care by increasing their understanding of ballet and providing specific management advice. Dance teachers may benefit from further education to support their students. Clinical trials are required to confirm or negate the validity of proposed injury risks and the effectiveness of injury prevention strategies and treatments.

The Development and Evaluation of Netball-Specific High-Intensity Interval Training Sessions: The Netball-HIIT Study

This two-phase study involved the design, development, and evaluation of netball-specific high-intensity interval training sessions (Netball-HIIT) for use with netballers of varied ages and abilities. In Phase 1 (2020), a systematic analysis of netball GPS data from 30 netball players and gameplay video footage (10 h) was conducted, followed by the design and testing of five 8 min Netball-HIIT sessions involving 100 netball players (age 21 ± 8.44 years; Australia). In Phase 2 (2021), the feasibility and preliminary efficacy of delivering one Netball-HIIT session each week for five weeks was assessed using a two-armed, dose-matched, randomized, controlled feasibility study with netball players (born in 2010) (Netball HIIT n = 15; Netball Knee Program: NKP n = 15). Cardiorespiratory and muscular fitness was assessed at baseline and 6 weeks. Data were analyzed using linear mixed models and Cohen's d effect sizes. Netball-HIIT sessions were highly rated by players, and higher average (139 bpm) and peak heart rates (156 bpm) were detected amongst Netball-HIIT participants (KNP = 127 bpm and 152 bpm). We observed a large effect for cardiorespiratory fitness (+2.4 laps, d = 0.89), and a small to medium effect for muscular fitness (push-ups +1.2, d = 0.49; standing jump +0.8 cm, d = 0.36) in favor of Netball-HIIT, suggesting that coach-led Netball-HIIT may provide a time-efficient and effective training component for use in netball.

Assessing Biomechanical and Clinical Outcomes of an Elbow Orthosis Intervention in Youth Baseball: Preliminary Results

Proper orthosis design may help youth baseball players develop safer pitching mechanics to prevent elbow injuries. This study evaluated the impact of a custom elbow orthosis on pitching biomechanics and adverse events. Ten 11-12-year-old players (mean age 11.5 years) from a regional league team were recruited. The inclusion criteria were at least two years of baseball experience. Six players were randomly assigned to the orthosis group, with four in the control group. Anthropometric data and baseline characteristics were recorded. A video analysis assessed elbow flexion angle during pitching at baseline and at 2 months. The frequency of orthosis wear was also tracked. Adverse events during twice-weekly practices were documented. Post-study surveys evaluated orthosis comfort, stability, and safety perceptions. In the orthosis group (n = 6), four participants showed improved elbow flexion angle, and two of the six participants showed almost no change. The overall median difference was 23.5°. In the control group (n = 4), three participants showed improvement, with a median improvement of 5.5°. Twelve adverse events, including pain, were reported by players not wearing orthoses, whereas no events occurred with orthosis use. Individual players in the control group or who did not wear the orthosis correctly experienced multiple episodes of pain from pitching over the study period. This preliminary study indicates a custom elbow orthosis can optimize pitching biomechanics and prevent adverse events in youth baseball players over the course of two months.

Prioritization of Injury Prevention and Management Programs and Research and Development (R&D) Projects: Survey Using the Delphi Technique and Analytic Hierarchy Process

We prioritized injury prevention and management programs, and research and development (R&D) projects using the Delphi method and analytic hierarchy process (AHP) for national plan. We summarized 21 programs and 31 R&D projects based on opinions collected in the opinion survey and brainstorming. Expert panel evaluated program and project relevance in the two Delphi rounds to make consensus. Total scores were calculated by adding criterion weights calculated through the AHP multiplied by the average of scores for each program and project. The top three programs were "Integrated Management System for Injury Data," "Comprehensive Injury Surveillance System," and "Transport System Improvement Program for Major Trauma." The top three R&D projects were researches on "Identification of Vulnerable Workers Injuries to Strengthen Protections," "Data Integration on Injury and Disability," and "Using Public Health Big Data to Identify Injury Status and Risk Factors." Experts highly rated the programs to improve injury surveillance system.

Effects of Hypopressive Exercise on Dynamic Neuromuscular Control in Female Roller-Skaters

The effects of hypopressive exercise (HE) on dynamic balance have never been studied. We aimed to study the effects of a HE program on dynamic balance, posterior chain kinematics and expiratory peak flow on female competitive roller skaters over a 6-week training period. Twenty competitive female roller-skaters (13-22 years of age, SD 2.25) performed a 30-minute HE session once weekly before the regular roller-skating practice for 6 weeks. The HE program consisted of breathing and postural awareness exercises in addition to 5 basic HE poses performed three times each. Dynamic neuromuscular control was assessed with the Y-Balance Test (YBT), posterior back chain kinematics with the sit and reach test and peak expiratory flow rate with a digital spirometer. Paired t-test revealed significant differences between the measurement periods for all YBT leg directions and composite score (p ≤ 0.01). Significant differences were also revealed between baseline and after the intervention for the sit and reach test (p ≤ 0.01) and peak expiratory flow (p = 0.01). No differences in forced expiratory volume in the first second were found (p = 0.04). These preliminary findings suggest that a 6-week HE program could be a feasible neuromuscular option for training dynamic balance, posterior back chain kinematics and peak expiratory flow in female roller-skaters.

Older People's Descriptions of Their Engagement in Fall Prevention

Evidence-based strategies to decrease fall rates are well established. However, little is understood about how older people engage in fall prevention strategies. Motivational Interviewing (MI) sessions aimed to facilitate individuals' engagement in fall prevention can be analyzed to learn what it means for older people to engage in fall prevention. Thus, the purpose of this study was to explore how older people describe their engagement in fall prevention. Participants in our parent project, MI for Fall Prevention (MI-FP), who received MI sessions were purposively selected for maximum variation in age, sex, fall risks, and MI specialist assigned. The first (of 8) MI sessions from 16 participants were recorded, transcribed, and analyzed using qualitative content analysis. Three researchers first deductively analyzed fall prevention strategies that participants described using an evidence-based fall prevention guideline as a reference. Then, we inductively analyzed the characteristics of these strategies and how participants engaged in them. Finally, we used the Capability, Opportunity, Motivation, Behavior (COM-B) model to organize our results about factors influencing engagement. We found (1) older adults engage in unique combinations of fall prevention strategies and (2) decisions about engagement in fall prevention strategies were influenced by multiple factors that were personal (e.g., who I am, capability, motivation, and opportunities). This study highlighted how fall prevention can be a life-long lifestyle decision for older people. Understanding older people's perspectives about engaging in fall prevention is essential to develop interventions to promote evidence-based fall prevention strategies in real-world settings.