Combining epidemiology and biomechanics in sports injury prevention research : A new approach for selecting suitable controls
- Finch, Caroline, Ullah, Shahid, McIntosh, Andrew
- Authors: Finch, Caroline , Ullah, Shahid , McIntosh, Andrew
- Date: 2011
- Type: Text , Journal article
- Relation: Sports Medicine Vol. 41, no. 1 (2011), p. 59-72
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Several important methodological issues need to be considered when designing sports injury case-control studies. Major design goals for case-control studies include the accounting for prior injury risk exposure, and optimal definitions of both cases and suitable controls are needed to ensure this. This article reviews methodological aspects of published sports injury case-control studies, particularly with regard to the selection of controls. It argues for a new approach towards selecting controls for case-control studies that draws on an interface between epidemiological and biomechanical concepts. A review was conducted to identify sport injury case-control studies published in the peer-review literature during 1985-2008. Overall, 32 articles were identified, of which the majority related to upper or lower extremity injuries. Matching considerations were used for control selection in 16 studies. Specific mention of application of biomechanical principles in the selection of appropriate controls was absent from all studies, including those purporting to evaluate the benefits of personal protective equipment to protect against impact injury. This is a problem because it could lead to biased conclusions, as cases and controls are not fully comparable in terms of similar biomechanical impact profiles relating to the injury incident, such as site of the impact on the body. The strength of the conclusions drawn from case-control studies, and the extent to which results can be generalized, is directly influenced by the definition and recruitment of cases and appropriate controls. Future studies should consider the interface between epidemiological and biomechanical concepts when choosing appropriate controls to ensure that proper adjustment of prior exposure to injury risk is made. To provide necessary guidance for the optimal selection of controls in case-control studies of interventions to prevent sports-related impact injury, this review outlines a new case-control selection strategy that reflects the importance of biomechanical considerations, which ensures that controls are selected based on the presence of the same global injury mechanism as the cases. To summarize, the general biomechanical principles that should apply to the selection of controls in future case-control studies are as follows: (i) each control must have been exposed to the same global injury mechanism as the case, (e.g. head impact, fall onto outstretched arm); and (ii) intrinsic (individual) factors (e.g. age, sex, skill level) that might modify the person's response to the relevant biomechanical loads are adjusted when either selecting the controls or are in the analysis phase. The same considerations for control selection apply to other study designs such as matched cohort studies or case-crossover studies. © 2011 Adis Data Information BV. All rights reserved.
- Authors: Finch, Caroline , Ullah, Shahid , McIntosh, Andrew
- Date: 2011
- Type: Text , Journal article
- Relation: Sports Medicine Vol. 41, no. 1 (2011), p. 59-72
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Several important methodological issues need to be considered when designing sports injury case-control studies. Major design goals for case-control studies include the accounting for prior injury risk exposure, and optimal definitions of both cases and suitable controls are needed to ensure this. This article reviews methodological aspects of published sports injury case-control studies, particularly with regard to the selection of controls. It argues for a new approach towards selecting controls for case-control studies that draws on an interface between epidemiological and biomechanical concepts. A review was conducted to identify sport injury case-control studies published in the peer-review literature during 1985-2008. Overall, 32 articles were identified, of which the majority related to upper or lower extremity injuries. Matching considerations were used for control selection in 16 studies. Specific mention of application of biomechanical principles in the selection of appropriate controls was absent from all studies, including those purporting to evaluate the benefits of personal protective equipment to protect against impact injury. This is a problem because it could lead to biased conclusions, as cases and controls are not fully comparable in terms of similar biomechanical impact profiles relating to the injury incident, such as site of the impact on the body. The strength of the conclusions drawn from case-control studies, and the extent to which results can be generalized, is directly influenced by the definition and recruitment of cases and appropriate controls. Future studies should consider the interface between epidemiological and biomechanical concepts when choosing appropriate controls to ensure that proper adjustment of prior exposure to injury risk is made. To provide necessary guidance for the optimal selection of controls in case-control studies of interventions to prevent sports-related impact injury, this review outlines a new case-control selection strategy that reflects the importance of biomechanical considerations, which ensures that controls are selected based on the presence of the same global injury mechanism as the cases. To summarize, the general biomechanical principles that should apply to the selection of controls in future case-control studies are as follows: (i) each control must have been exposed to the same global injury mechanism as the case, (e.g. head impact, fall onto outstretched arm); and (ii) intrinsic (individual) factors (e.g. age, sex, skill level) that might modify the person's response to the relevant biomechanical loads are adjusted when either selecting the controls or are in the analysis phase. The same considerations for control selection apply to other study designs such as matched cohort studies or case-crossover studies. © 2011 Adis Data Information BV. All rights reserved.
Priorities for investment in injury prevention in community Australian football
- Finch, Caroline, Gabbe, Belinda, White, Peta, Lloyd, David, Twomey, Dara, Donaldson, Alex, Elliott, Bruce, Cook, Jill
- Authors: Finch, Caroline , Gabbe, Belinda , White, Peta , Lloyd, David , Twomey, Dara , Donaldson, Alex , Elliott, Bruce , Cook, Jill
- Date: 2013
- Type: Text , Journal article
- Relation: Clinical journal of sport medicine Vol. 23, no. 6 (November 2013 2013), p. 430-438
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/565907
- Full Text:
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- Description: Objective:High-quality sport-specific information about the nature, type, cause, and frequency of injuries is needed to set injury prevention priorities. This article describes the type, nature, and mechanism of injuries in community Australian Football (community AF) players, as collected through field-based monitoring of injury in teams of players.Data Sources:Compilation of published prospectively collected injury data from 3 studies in junior community AF (1202 injuries in 1950+ players) and 3 studies in adult community AF (1765 injuries in 2265 players). This was supplemented with previously unpublished data from the most recent adult community AF injury cohort study conducted in 2007 to 2008. Injuries were ranked according to most common body regions, nature of injury, and mechanism.Main Results:In all players, lower limb injuries were the most frequent injury in community AF and were generally muscle strains, joint sprains, and superficial injuries. These injuries most commonly resulted from incidental contact with other players, or from overexertion. Upper limb injuries were less common but included fractures, strains, and sprains that were generally caused by incidental contact between players and the result of players falling to the ground.Conclusions:Lower limb injuries are common in community AF and could have an adverse impact on sustained participation in the game. Based on what is known about their mechanisms, it is likely that a high proportion of lower limb injuries could be prevented and they should therefore be a priority for injury prevention in community AF.
- Authors: Finch, Caroline , Gabbe, Belinda , White, Peta , Lloyd, David , Twomey, Dara , Donaldson, Alex , Elliott, Bruce , Cook, Jill
- Date: 2013
- Type: Text , Journal article
- Relation: Clinical journal of sport medicine Vol. 23, no. 6 (November 2013 2013), p. 430-438
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/565907
- Full Text:
- Reviewed:
- Description: Objective:High-quality sport-specific information about the nature, type, cause, and frequency of injuries is needed to set injury prevention priorities. This article describes the type, nature, and mechanism of injuries in community Australian Football (community AF) players, as collected through field-based monitoring of injury in teams of players.Data Sources:Compilation of published prospectively collected injury data from 3 studies in junior community AF (1202 injuries in 1950+ players) and 3 studies in adult community AF (1765 injuries in 2265 players). This was supplemented with previously unpublished data from the most recent adult community AF injury cohort study conducted in 2007 to 2008. Injuries were ranked according to most common body regions, nature of injury, and mechanism.Main Results:In all players, lower limb injuries were the most frequent injury in community AF and were generally muscle strains, joint sprains, and superficial injuries. These injuries most commonly resulted from incidental contact with other players, or from overexertion. Upper limb injuries were less common but included fractures, strains, and sprains that were generally caused by incidental contact between players and the result of players falling to the ground.Conclusions:Lower limb injuries are common in community AF and could have an adverse impact on sustained participation in the game. Based on what is known about their mechanisms, it is likely that a high proportion of lower limb injuries could be prevented and they should therefore be a priority for injury prevention in community AF.
Injury surveillance in community sport : Can we obtain valid data from sports trainers?
- Ekegren, Christina, Gabbe, Belinda, Finch, Caroline
- Authors: Ekegren, Christina , Gabbe, Belinda , Finch, Caroline
- Date: 2015
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine and Science in Sports Vol. 25, no. 3 (2015), p. 315-322
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
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- Description: A lack of available injury data on community sports participants has hampered the development of informed preventive strategies for the broad-base of sports participation. In community sports settings, sports trainers or first-aiders are well-placed to carry out injury surveillance, but few studies have evaluated their ability to do so. The aim of this study was to investigate the reporting rate and completeness of sports trainers' injury records and agreement between sports trainers' and players' reports of injury in community Australian football. Throughout the football season, one sports trainer from each of four clubs recorded players' injuries. To validate these data, we collected self-reported injury data from players via short message service (SMS). In total, 210 discrete injuries were recorded for 139 players, 21% by sports trainers only, 59% by players via SMS only, and 21% by both. Completeness of injury records ranged from 95% to 100%. Agreement between sports trainers and players ranged from K=0.32 (95% confidence interval: 0.27, 0.37) for date of return to football to K=1.00 for activity when injured. Injury data collected by sports trainers may be of adequate quality for providing an understanding of the profile of injuries. However, data are likely to underestimate injury rates and should be interpreted with caution. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
- Authors: Ekegren, Christina , Gabbe, Belinda , Finch, Caroline
- Date: 2015
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine and Science in Sports Vol. 25, no. 3 (2015), p. 315-322
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
- Full Text:
- Reviewed:
- Description: A lack of available injury data on community sports participants has hampered the development of informed preventive strategies for the broad-base of sports participation. In community sports settings, sports trainers or first-aiders are well-placed to carry out injury surveillance, but few studies have evaluated their ability to do so. The aim of this study was to investigate the reporting rate and completeness of sports trainers' injury records and agreement between sports trainers' and players' reports of injury in community Australian football. Throughout the football season, one sports trainer from each of four clubs recorded players' injuries. To validate these data, we collected self-reported injury data from players via short message service (SMS). In total, 210 discrete injuries were recorded for 139 players, 21% by sports trainers only, 59% by players via SMS only, and 21% by both. Completeness of injury records ranged from 95% to 100%. Agreement between sports trainers and players ranged from K=0.32 (95% confidence interval: 0.27, 0.37) for date of return to football to K=1.00 for activity when injured. Injury data collected by sports trainers may be of adequate quality for providing an understanding of the profile of injuries. However, data are likely to underestimate injury rates and should be interpreted with caution. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Sport injuries sustained by athletes with disability : A systematic review
- Weiler, Richard, van Mechelen, Willem, Fuller, Colin, Verhagen, Evert
- Authors: Weiler, Richard , van Mechelen, Willem , Fuller, Colin , Verhagen, Evert
- Date: 2016
- Type: Text , Journal article , Review
- Relation: Sports Medicine Vol. 46, no. 8 (2016), p. 1141-1153
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- Description: Background Fifteen percent of the world's population live with disability, and many of these individuals choose to play sport. There are barriers to sport participation for athletes with disability and sports injury can greatly impact on daily life, which makes sports injury prevention additionally important. Objective The purpose of this review is to systematically review the definitions, methodologies and injury rates in disability sport, which should assist future identification of risk factors and development of injury prevention strategies. A secondary aim is to highlight the most pressing issues for improvement of the quality of injury epidemiology research for disability sport. Methods A search of NICE, AMED, British Nursing Index, CINAHL, EMBASE and Medline was conducted to identify all publications up to 16 June 2015. Of 489 potentially relevant articles and reference searching, a total of 15 studies were included. Wide study sample heterogeneity prevented data pooling and meta-analysis. Results Results demonstrated an evolving field of epidemiology, but with wide differences in sports injury definition and with studies focused on short competitions. Background data were generally sparse; there was minimal exposure analysis, and no analysis of injury severity, all of which made comparison of injury risk and injury severity difficult. Conclusion There is an urgent need for consensus on sports injury definition and methodology in disability sports. The quality of studies is variable, with inconsistent sports injury definitions, methodologies and injury rates, which prevents comparison, conclusions and development of injury prevention strategies. The authors highlight the most pressing issues for improvement of the quality in injury epidemiology research for disability sport.
- Authors: Weiler, Richard , van Mechelen, Willem , Fuller, Colin , Verhagen, Evert
- Date: 2016
- Type: Text , Journal article , Review
- Relation: Sports Medicine Vol. 46, no. 8 (2016), p. 1141-1153
- Full Text:
- Reviewed:
- Description: Background Fifteen percent of the world's population live with disability, and many of these individuals choose to play sport. There are barriers to sport participation for athletes with disability and sports injury can greatly impact on daily life, which makes sports injury prevention additionally important. Objective The purpose of this review is to systematically review the definitions, methodologies and injury rates in disability sport, which should assist future identification of risk factors and development of injury prevention strategies. A secondary aim is to highlight the most pressing issues for improvement of the quality of injury epidemiology research for disability sport. Methods A search of NICE, AMED, British Nursing Index, CINAHL, EMBASE and Medline was conducted to identify all publications up to 16 June 2015. Of 489 potentially relevant articles and reference searching, a total of 15 studies were included. Wide study sample heterogeneity prevented data pooling and meta-analysis. Results Results demonstrated an evolving field of epidemiology, but with wide differences in sports injury definition and with studies focused on short competitions. Background data were generally sparse; there was minimal exposure analysis, and no analysis of injury severity, all of which made comparison of injury risk and injury severity difficult. Conclusion There is an urgent need for consensus on sports injury definition and methodology in disability sports. The quality of studies is variable, with inconsistent sports injury definitions, methodologies and injury rates, which prevents comparison, conclusions and development of injury prevention strategies. The authors highlight the most pressing issues for improvement of the quality in injury epidemiology research for disability sport.
A prospective cohort study on symptoms of common mental disorders among Dutch elite athletes
- Gouttebarge, Vincent, Jonkers, Ruud, Moen, Maarten, Verhagen, Evert, Wylleman, Paul, Kerkhoffs, Gino
- Authors: Gouttebarge, Vincent , Jonkers, Ruud , Moen, Maarten , Verhagen, Evert , Wylleman, Paul , Kerkhoffs, Gino
- Date: 2017
- Type: Text , Journal article
- Relation: Physician and Sportsmedicine Vol. 45, no. 4 (2017), p. 426-432
- Full Text:
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- Description: Objective: Scientific knowledge about symptoms of common mental disorders in elite sports is scarce. Consequently, the objectives of the study were to (i) establish the 12-month incidence of symptoms of common mental disorders (CMD; distress, anxiety/depression, sleep disturbance, adverse alcohol use, eating disorders) among Dutch elite athletes and (ii) explore their potential association with several stressors (being injured, recent life events, career dissatisfaction).Methods: A prospective cohort study with a 12-month follow-up period was conducted. The study used validated questionnaires to assess symptoms of common mental disorders (thus not clinically diagnosed) as well as several stressors; an electronic questionnaire was set up and repeatedly distributed.Results: A total of 203 elite athletes gave their written informed consent to participate in the study, from which 143 completed the 12-month follow-up period (follow-up rate of 70%). Incidence of symptoms of CMD ranged from 6% for adverse alcohol use to 57% for symptoms of anxiety/depression. Over the follow-up period, around 17% of the participants reported two simultaneous symptoms of CMD, and around 19% reported three simultaneous symptoms of CMD. Inferences between some stressors and symptoms of CMD were found but none of the associations were statistically significant.Conclusions: Substantial 12-month incidence rates of symptoms of CMD (self-reported and not clinically diagnosed) were found among Dutch elite athletes (especially for anxiety/depression), appearing similar to the ones found among athletes from other sports disciplines and the Dutch general population. Also, inferences between some stressors and symptoms of CMD were found but none of the associations were statistically significant. Supportive and preventive measures directed towards symptoms of CMD should be developed to improve awareness and psychological resilience of athletes, which would likely improve their performance and quality-of-life.
- Authors: Gouttebarge, Vincent , Jonkers, Ruud , Moen, Maarten , Verhagen, Evert , Wylleman, Paul , Kerkhoffs, Gino
- Date: 2017
- Type: Text , Journal article
- Relation: Physician and Sportsmedicine Vol. 45, no. 4 (2017), p. 426-432
- Full Text:
- Reviewed:
- Description: Objective: Scientific knowledge about symptoms of common mental disorders in elite sports is scarce. Consequently, the objectives of the study were to (i) establish the 12-month incidence of symptoms of common mental disorders (CMD; distress, anxiety/depression, sleep disturbance, adverse alcohol use, eating disorders) among Dutch elite athletes and (ii) explore their potential association with several stressors (being injured, recent life events, career dissatisfaction).Methods: A prospective cohort study with a 12-month follow-up period was conducted. The study used validated questionnaires to assess symptoms of common mental disorders (thus not clinically diagnosed) as well as several stressors; an electronic questionnaire was set up and repeatedly distributed.Results: A total of 203 elite athletes gave their written informed consent to participate in the study, from which 143 completed the 12-month follow-up period (follow-up rate of 70%). Incidence of symptoms of CMD ranged from 6% for adverse alcohol use to 57% for symptoms of anxiety/depression. Over the follow-up period, around 17% of the participants reported two simultaneous symptoms of CMD, and around 19% reported three simultaneous symptoms of CMD. Inferences between some stressors and symptoms of CMD were found but none of the associations were statistically significant.Conclusions: Substantial 12-month incidence rates of symptoms of CMD (self-reported and not clinically diagnosed) were found among Dutch elite athletes (especially for anxiety/depression), appearing similar to the ones found among athletes from other sports disciplines and the Dutch general population. Also, inferences between some stressors and symptoms of CMD were found but none of the associations were statistically significant. Supportive and preventive measures directed towards symptoms of CMD should be developed to improve awareness and psychological resilience of athletes, which would likely improve their performance and quality-of-life.
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