Does padded headgear prevent head injury in rugby union football?
- McIntosh, Andrew, McCrory, Paul, Finch, Caroline, Best, John, Chalmers, David, Wolfe, Rory
- Authors: McIntosh, Andrew , McCrory, Paul , Finch, Caroline , Best, John , Chalmers, David , Wolfe, Rory
- Date: 2009
- Type: Text , Journal article
- Relation: Medicine and Science in Sports and Exercise Vol. 41, no. 2 (2009), p. 306-313
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
- Reviewed:
- Description: BACKGROUND: Concussion is a serious problem in many contact sports, including rugby union football. The study's primary aim was to measure the efficacy of padded headgear in reducing the rates of head injury or concussion. METHODS: A cluster randomized controlled trial with three arms was conducted with rugby union football teams as the unit of randomization. Teams consisted of males participating in under 13-, 15-, 18-, and 20-yr age group competitions. The interventions were "standard" and "modified" padded headgear. Headgear wearing and injury were measured for each study team at each game over two seasons. RESULTS: Eighty-two teams participated in year 1 and 87 in year 2. A total of 1493 participants (10,040 player hours) were in the control group, 1128 participants (8170 player hours) were assigned to the standard headgear group, and 1474 participants (10,650 player hours) were assigned to the modified headgear group. The compliance rates were low in all groups, but 46% of participants wore standard headgear. An intention-to-treat analysis showed no differences in the rates of head injury or concussion between controls and headgear arms. Incidence rate ratios for standard headgear wearers referenced to controls were 0.95 and 1.02 for game and missed game injuries. Analyses of injury rates based on observed wearing patterns also showed no significant differences. Incidence rate ratios for standard headgear wearers referenced to nonwearers were 1.11 and 1.10 for game and missed game injuries. CONCLUSIONS: Padded headgear does not reduce the rate of head injury or concussion. The low compliance rates are a limitation. Although individuals may choose to wear padded headgear, the routine or mandatory use of protective headgear cannot be recommended. © 2009 by the American College of Sports Medicine.
- Description: 2003008190
Head, face and neck injury in youth rugby: Incidence and risk factors
- McIntosh, Andrew, McCrory, Paul, Finch, Caroline, Wolfe, Rory
- Authors: McIntosh, Andrew , McCrory, Paul , Finch, Caroline , Wolfe, Rory
- Date: 2010
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 44, no. 3 (2010), p. 188-193
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
- Reviewed:
- Description: OBJECTIVES: In this study, the incidence of head, neck and facial injuries in youth rugby was determined, and the associated risk factors were assessed. DESIGN: Data were extracted from a cluster randomised controlled trial of headgear with the football teams as the unit of randomisation. No effect was observed for headgear use on injury rates, and the data were pooled. SETTING: General school and club-based community competitive youth rugby in the 2002 and 2003 seasons. PARTICIPANTS: Young male rugby union football players participating in under-13, under 15, under 18 and under 21 years competitions. Eighty-two teams participated in year 1 and 87 in year 2. MAIN OUTCOME MEASURES: Injury rates for all body regions combined, head, neck and face calculated for game and missed game injuries. RESULTS: 554 head, face and neck injuries were recorded within a total of 28 902 h of rugby game exposure. Level of play and player position were related to injury risk. Younger players had the lowest rates of injury; forwards, especially the front row had the highest rate of neck injury; and inside backs had the highest rate of injuries causing the player to miss a game. Contact events, including the scrum and tackle, were the main events leading to injury. CONCLUSION: Injury prevention must focus on the tackle and scrum elements of a youth rugby game.
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.
Use of field-based tests to identify risk factors for injury to fast bowlers in cricket
- Dennis, Rebecca, Finch, Caroline, McIntosh, Andrew, Elliott, Bruce
- Authors: Dennis, Rebecca , Finch, Caroline , McIntosh, Andrew , Elliott, Bruce
- Date: 2008
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 42, no. 6 (Jun 2008), p. 477-482
- Full Text: false
- Reviewed:
- Description: Objective: To identify risk factors for injury to cricket fast bowlers using field-based tests. Design: Prospective cohort study. Setting: High performance Australian cricket. Participants: Ninety-one male adolescent and adult fast bowlers (aged 12-33 years). Assessment of risk factors: A field-based pre-participation screening, consisting of musculoskeletal, fitness and anthropometric assessments and analysis of bowling technique was undertaken. Bowlers were prospectively monitored over the 2003-4 season and bowling workload and injuries were recorded. Logistic regression was used to identify injury risk factors. Main outcome measurement: Repetitive microtrauma injury to the trunk, back or lower limb associated with fast bowling. Results: Two variables were identified as independent predictors of injury in the multivariate logistic regression analysis. Bowlers with hip internal rotation of <= 30 degrees on the leg ipsilateral to the bowling arm were at a significantly reduced risk of injury (OR 0.20, 95% CI 0.06 to 0.73) compared with bowlers with >40 degrees of rotation. Bowlers with an ankle dorsiflexion lunge of 12.1-14.0 cm on the leg contralateral to the bowling arm were at a significantly increased risk (OR 4.03, 95% CI 1.07 to 15.21) than bowlers with a lunge of >14 cm. Bowlers with a lunge of (12 cm were also at an increased risk, but not significantly so (OR 1.38, 95% CI 0.40 to 4.84). Conclusions: Biomechanical research is needed to investigate how these two intrinsic risk factors increase injury risk so that appropriate interventions can be developed.
Mild traumatic brain injury among a cohort of rugby union players: predictors of time to injury
- Hollis, Stephanie, Stevenson, Mark, McIntosh, Andrew, Li, Ling, Heritier, Stephane, Shores, E Arthur, Collins, Michael, Finch, Caroline
- Authors: Hollis, Stephanie , Stevenson, Mark , McIntosh, Andrew , Li, Ling , Heritier, Stephane , Shores, E Arthur , Collins, Michael , Finch, Caroline
- Date: 2011
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 45, no. 12 (2011), p. 997-999
- Full Text: false
- Reviewed:
- Description: This study reports the time to sustain a mild traumatic brain injury (mTBI) among a cohort of community rugby union players. Demographic and player characteristics were collected and players followed up for between one and three playing seasons. 7% of the cohort sustained an mTBI within 10 h of game time, increasing twofold to 14% within 20 h. The mean time to first mTBI was 8 h with an SD of 6.2 (median 6.8 h; IQR: 2.9–11.7 h). Players reporting a recent history of concussion were 20% more likely to sustain an mTBI after 20 h of game time compared with those with no recent history of concussion. Players were likely to sustain an mTBI in shorter time if they trained for <3 h/week (HR=1.48, p=0.03) or had a body mass index <27 (HR=1.77, p=0.007). The findings highlight modifiable characteristics to reduce the likelihood of shortened time to mTBI.
- Hollis, Stephanie, Stevenson, Mark, McIntosh, Andrew, Shores, E Arthur, Finch, Caroline
- Authors: Hollis, Stephanie , Stevenson, Mark , McIntosh, Andrew , Shores, E Arthur , Finch, Caroline
- Date: 2012
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 46, no. 10 (2012), p. 735-740
- Full Text: false
- Reviewed:
- Description: Background: There is a risk of concussion when playing rugby union. Appropriate management of concussion includes compliance with the return-to-play regulations of the sports body for reducing the likelihood of premature return-to-play by injured players. Purpose: To describe the proportion of rugby union players who comply with the sports body's regulations on returning to play postconcussion. Study design: Prospective cohort study. Methods: 1958 community rugby union players (aged 15–48 years) in Sydney (Australia) were recruited from schoolboy, grade and suburban competitions and followed over ≥1 playing seasons. Club doctors/physiotherapists/coaches or trained injury recorders who attended the game reported players who sustained a concussion. Concussed players were followed up over a 3-month period and the dates when they returned to play (including either a game or training session) were recorded, as well as any return-to-play advice they received. Results: 187 players sustained ≥1 concussion throughout the follow-up. The median number of days before players returned to play (competition game play or training) following concussion was 3 (range 1–84). Most players (78%) did not receive return-to-play advice postconcussion, and of those who received correct advice, all failed to comply with the 3-week stand-down regulation. Conclusions: The paucity of return-to-play advice received by community rugby union players postconcussion and the high level of non-compliance with return-to-play regulations highlight the need for better dissemination and implementation of the return-to-play regulations and improved understanding of the underlying causes of why players do not adhere to return-to-play practices.
Associations between helmet use and brain injuries amongst injured pedal- and motor-cyclists: A case series analysis of trauma centre presentations
- McIntosh, Andrew, Curtis, Kate, Rankin, Tiffany, Cox, Marie, Pang, Toh Yen, McCrory, Paul, Finch, Caroline
- Authors: McIntosh, Andrew , Curtis, Kate , Rankin, Tiffany , Cox, Marie , Pang, Toh Yen , McCrory, Paul , Finch, Caroline
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of the Australasian College of Road Safety Vol. 24, no. 2 (April 2013), p. 11-20
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Abstract: A retrospective case-series study of pedal- and motorcyclists presenting to a major metropolitan trauma centre over an 18 month period was undertaken. The injury data were coded according to a number of outcome variables, including intracranial injury of AIS severity >/= 2. Helmet use was coded. After stratification by rider type, data were analysed to examine the relationships between helmet use and injury using logistic regression. A total of 220 injured motorcycle riders and 137 injured pedal cyclists met the study's inclusion criteria, with 195 motorcycle riders and passengers (88.6%) and 87 pedal cyclists (63.5%) wearing helmets. Helmets were associated with a significant reduction (p<0.05) in the likelihood of head and intracranial injury in both rider groups. Associated with helmet use was a reduction in intracranial injury likelihood of 66% for both helmeted motorcycle riders and pedal cyclists. The study is further evidence of the benefits offered by helmets.
- Authors: McIntosh, Andrew , Curtis, Kate , Rankin, Tiffany , Cox, Marie , Pang, Toh Yen , McCrory, Paul , Finch, Caroline
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of the Australasian College of Road Safety Vol. 24, no. 2 (April 2013), p. 11-20
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text:
- Reviewed:
- Description: Abstract: A retrospective case-series study of pedal- and motorcyclists presenting to a major metropolitan trauma centre over an 18 month period was undertaken. The injury data were coded according to a number of outcome variables, including intracranial injury of AIS severity >/= 2. Helmet use was coded. After stratification by rider type, data were analysed to examine the relationships between helmet use and injury using logistic regression. A total of 220 injured motorcycle riders and 137 injured pedal cyclists met the study's inclusion criteria, with 195 motorcycle riders and passengers (88.6%) and 87 pedal cyclists (63.5%) wearing helmets. Helmets were associated with a significant reduction (p<0.05) in the likelihood of head and intracranial injury in both rider groups. Associated with helmet use was a reduction in intracranial injury likelihood of 66% for both helmeted motorcycle riders and pedal cyclists. The study is further evidence of the benefits offered by helmets.
Collecting health and exposure data in Australian olympic combat sports : Feasibility study utilizing an electronic system
- Bromley, Sally, Drew, Michael, Talpey, Scott, McIntosh, Andrew, Finch, Caroline
- Authors: Bromley, Sally , Drew, Michael , Talpey, Scott , McIntosh, Andrew , Finch, Caroline
- Date: 2018
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 20, no. 10 (2018), p. 1-11
- Full Text:
- Reviewed:
- Description: Background: Electronic methods are increasingly being used to manage health-related data among sporting populations. Collection of such data permits the analysis of injury and illness trends, improves early detection of injuries and illnesses, collectively referred to as health problems, and provides evidence to inform prevention strategies. The Athlete Management System (AMS) has been employed across a range of sports to monitor health. Australian combat athletes train across the country without dedicated national medical or sports science teams to monitor and advocate for their health. Employing a Web-based system, such as the AMS, May provide an avenue to increase the visibility of health problems experienced by combat athletes and deliver key information to stakeholders detailing where prevention programs May be targeted. Objective: The objectives of this paper are to (1) report on the feasibility of utilizing the AMS to collect longitudinal injury and illness data of combat sports athletes and (2) describe the type, location, severity, and recurrence of injuries and illnesses that the cohort of athletes experience across a 12-week period. Methods: We invited 26 elite and developing athletes from 4 Olympic combat sports (boxing, judo, taekwondo, and wrestling) to participate in this study. Engagement with the AMS was measured, and collected health problems (injuries or illnesses) were coded using the Orchard Sports Injury Classification System (version 10.1) and International Classification of Primary Care (version 2). Results: Despite >160 contacts, athlete engagement with online tools was poor, with only 13% compliance across the 12-week period. No taekwondo or wrestling athletes were compliant. Despite low overall engagement, a large number of injuries or illness were recorded across 11 athletes who entered data—22 unique injuries, 8 unique illnesses, 30 recurrent injuries, and 2 recurrent illnesses. The most frequent injuries were to the knee in boxing (n=41) and thigh in judo (n=9). In this cohort, judo players experienced more severe, but less frequent, injuries than boxers, yet judo players sustained more illnesses than boxers. In 97.0% (126/130) of cases, athletes in this cohort continued to train irrespective of their health problems. Conclusions: Among athletes who reported injuries, many reported multiple conditions, indicating a need for health monitoring in Australian combat sports. A number of factors May have influenced engagement with the AMS, including access to the internet, the design of the system, coach views on the system, previous experiences with the system, and the existing culture within Australian combat sports. To increase engagement, there May be a requirement for sports staff to provide relevant feedback on data entered into the system. Until the Barriers are addressed, it is not feasible to implement the system in its current form across a larger cohort of combat athletes.
- Authors: Bromley, Sally , Drew, Michael , Talpey, Scott , McIntosh, Andrew , Finch, Caroline
- Date: 2018
- Type: Text , Journal article
- Relation: Journal of Medical Internet Research Vol. 20, no. 10 (2018), p. 1-11
- Full Text:
- Reviewed:
- Description: Background: Electronic methods are increasingly being used to manage health-related data among sporting populations. Collection of such data permits the analysis of injury and illness trends, improves early detection of injuries and illnesses, collectively referred to as health problems, and provides evidence to inform prevention strategies. The Athlete Management System (AMS) has been employed across a range of sports to monitor health. Australian combat athletes train across the country without dedicated national medical or sports science teams to monitor and advocate for their health. Employing a Web-based system, such as the AMS, May provide an avenue to increase the visibility of health problems experienced by combat athletes and deliver key information to stakeholders detailing where prevention programs May be targeted. Objective: The objectives of this paper are to (1) report on the feasibility of utilizing the AMS to collect longitudinal injury and illness data of combat sports athletes and (2) describe the type, location, severity, and recurrence of injuries and illnesses that the cohort of athletes experience across a 12-week period. Methods: We invited 26 elite and developing athletes from 4 Olympic combat sports (boxing, judo, taekwondo, and wrestling) to participate in this study. Engagement with the AMS was measured, and collected health problems (injuries or illnesses) were coded using the Orchard Sports Injury Classification System (version 10.1) and International Classification of Primary Care (version 2). Results: Despite >160 contacts, athlete engagement with online tools was poor, with only 13% compliance across the 12-week period. No taekwondo or wrestling athletes were compliant. Despite low overall engagement, a large number of injuries or illness were recorded across 11 athletes who entered data—22 unique injuries, 8 unique illnesses, 30 recurrent injuries, and 2 recurrent illnesses. The most frequent injuries were to the knee in boxing (n=41) and thigh in judo (n=9). In this cohort, judo players experienced more severe, but less frequent, injuries than boxers, yet judo players sustained more illnesses than boxers. In 97.0% (126/130) of cases, athletes in this cohort continued to train irrespective of their health problems. Conclusions: Among athletes who reported injuries, many reported multiple conditions, indicating a need for health monitoring in Australian combat sports. A number of factors May have influenced engagement with the AMS, including access to the internet, the design of the system, coach views on the system, previous experiences with the system, and the existing culture within Australian combat sports. To increase engagement, there May be a requirement for sports staff to provide relevant feedback on data entered into the system. Until the Barriers are addressed, it is not feasible to implement the system in its current form across a larger cohort of combat athletes.
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