Challenges of translating Rasmussen’s Accimap into a usable, sustainable, and useful incident reporting system: end-user attitudes following 12-month implementation
- Authors: Goode, Natassia , Shaw, Louise , Finch, Caroline , Salmon, Paul
- Date: 2021
- Type: Text , Journal article
- Relation: Cognition, Technology and Work Vol. 23, no. 1 (2021), p. 39-49
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- Description: There have been several calls within the accident analysis literature to translate systems thinking-based theories and accident analysis methods into practical and usable tools for practitioners. This paper reports on the findings from a post-implementation evaluation of an incident reporting system underpinned Rasmussen’s (Saf Sci 27(2/3):183–213, 1997) risk-management framework and Accimap. An online survey was used to evaluate end-users’ use and attitudes towards the system after 12 months of implementation. While almost all respondents had used the incident reporting system to collect data, few had undertaken the required training. While the privacy and security of the system were evaluated favourably, significant problems were highlighted with usability, sustainability of the system, and utility of the data for organisations. Overall, the results highlight the significant resource constraints experienced by end-users during the implementation of the new incident reporting system. The challenges for translating a systems thinking-based approach into practice are discussed. © 2019, Springer-Verlag London Ltd., part of Springer Nature.
Facilitators and barriers to the implementation of iSPRINT : a sport injury prevention program in junior high schools
- Authors: Richmond, Sarah , Donaldson, Alex , Macpherson, Alison , Bridel, William , van den Berg, Carla , Finch, Caroline , Hagel, Brent , Emery, Carolyn
- Date: 2020
- Type: Text , Journal article
- Relation: Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine Vol. 30, no. 3 (2020), p. 231-238
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- Description: OBJECTIVES: Sport injury is the leading cause of hospitalization in Canadian youth and represents a high burden to the health care system. This study aims to describe the facilitators and barriers to implementation of a sport injury prevention program in junior high school physical education (known as iSPRINT), previously shown to reduce the risk of sport-related injury in youth (age, 11-15 years). METHODS: Focus group data were mapped onto constructs from the Consolidated Framework for Implementation Research (CFIR). Four schools that implemented iSPRINT participated in this study. Forty-seven key stakeholders (teachers, students, principals) participated in 9 semistructured focus groups and 4 interviews. The CFIR was used to guide the focus group discussions, data coding, and analysis using a qualitative content analysis approach. RESULTS: Of the 22 applicable CFIR constructs, 16 were identified in the transcripts. The most significant facilitators to successful implementation efforts included evidence strength and quality, adaptability, implementation climate, culture, and having a high level of compatibility facilitated successful implementation efforts. Barriers to implementation included intervention complexity, planning, and readiness for implementation. Constructs that acted as both a facilitator and a barrier, depending on the context, were self-efficacy, execution, and individual identification with the organization. CONCLUSIONS: Participants in this study reported positive attitudes about implementing iSPRINT, citing evidence strength, adaptability, and constructs related to the organizational setting that contributed to successful implementation. Potential improvements include modifying certain program components, decreasing the number of components, and reducing the equipment required.
Medical-attention injuries in community cricket : a systematic review
- Authors: McLeod, Geordie , O'Connor, Siobhan , Morgan, Damian , Kountouris, Alex , Finch, Caroline , Fortington, Lauren
- Date: 2020
- Type: Text , Journal article , Review
- Relation: BMJ Open Sport and Exercise Medicine Vol. 6, no. 1 (2020), p.
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- Description: Objectives The aim was to identify and describe outcomes from original published studies that present the number, nature, mechanism and severity of medically treated injuries sustained in community-level cricket. Design Systematic review. Methods Nine databases were systematically searched to December 2019 using terms "cricket
"It Doesn't Make Sense for Us Not to Have One" - Understanding reasons why community sports organizations chose to participate in a funded automated external defibrillator program
- Authors: Fortington, Lauren , Bekker, Sheree , Morgan, Damian , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: Clinical Journal of Sport Medicine Vol. 29, no. 4 (2019), p. 324-328
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- Description: Objective: Implementation of automated external defibrillators (AEDs) in community sports settings is an important component of emergency medical planning. This study aimed to understand motivations for why sports organizations participated in a government-funded program that provided AEDs and associated first-aid training. Design: Face-to-face interviews. Setting: Community sports organizations in Victoria, Australia. Participants: Representatives from 14 organizations who participated in a government-funded AED program. Main Outcome Measures: Motivations to participate in the AED program were explored using a qualitative descriptive approach. Results: Two overarching themes emerged: awareness of the program and decision to apply. Awareness was gained indirectly through grant advertising in newsletters/emails/web sites and directly through their sporting associations. For most organizations, there was no decision process per se, rather, the opportunity to apply was the key determinant for participating in the program. A duty of care also emerged as a key driving factor, with recognition of AEDs as a valuable asset to communities broadly, not just the participants' immediate sports setting. Reflecting on participation in the program, these participants identified that it was important to increase awareness about AED ownership and use. The program benefits were clearly summed up as being best prepared for a worst-case scenario. Discussion: This study provides new understanding of why community sports organizations apply for an AED and training. The strongest reason was simply the opportunity to acquire this at no cost. Therefore, for wider implementation of AEDs, additional funding opportunities, targeted awareness of these opportunities, and continued promotion of AED importance are recommended.
A 2-year prospective study of injury epidemiology in elite Australian rugby sevens : Exploration of incidence rates, severity, injury type, and subsequent injury in men and women
- Authors: Toohey, Liam , Drew, Michael , Finch, Caroline , Cook, Jill , Fortington, Lauren
- Date: 2019
- Type: Text , Journal article
- Relation: American Journal of Sports Medicine Vol. 47, no. 6 (2019), p. 1302-1311
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- Description: Background: Injuries are common in rugby sevens, but studies to date have been limited to short, noncontinuous periods and reporting of match injuries only. Purpose: To report the injury incidence rate (IIR), severity, and burden of injuries sustained by men and women in the Australian rugby sevens program and to provide the first longitudinal investigation of subsequent injury occurrence in rugby sevens looking beyond tournament injuries only. Study Design: Descriptive epidemiology study. Methods: Ninety international rugby sevens players (55 men and 35 women) were prospectively followed over 2 consecutive seasons (2015-2016 and 2016-2017). All medical attention injuries were reported irrespective of time loss. Individual exposure in terms of minutes, distance, and high-speed distance was captured for each player for matches and on-field training, with the use of global positioning system devices. The IIR and injury burden (IIR × days lost to injury) were calculated per 1000 player-hours, and descriptive analyses were performed. Results: Seventy-three players (81.1%) sustained 365 injuries at an IIR of 43.2 per 1000 player-hours (95% CI, 43.0-43.3). As compared with male players, female players experienced a lower IIR (incidence rate ratio, 0.91; 95% CI, 0.90-0.91). Female players also sustained a higher proportion of injuries to the trunk region (relative risk, 1.75; 95% CI, 1.28-2.40) but a lower number to the head/neck region (relative risk, 0.58; 95% CI, 0.37-0.93; P =.011). The majority (80.7%) of subsequent injuries were of a different site and nature than previous injuries. A trend toward a reduced number of days, participation time, distance, and high-speed distance completed before the next injury was observed after successive injury occurrence. Conclusion: Female players have a lower IIR than male players, with variation of injury profiles observed between sexes. With a surveillance period of 2 years, subsequent injuries account for the majority of injuries sustained in rugby sevens, and they are typically different from previous types of sustained injuries. After each successive injury, the risk profile for future injury occurrence appears to be altered, which warrants further investigation to inform injury prevention strategies in rugby sevens.
Controlled ecological evaluation of an implemented exercise-training programme to prevent lower limb injuries in sport : Population-level trends in hospital-treated injuries
- Authors: Finch, Caroline , Gray, Shannon , Akram, Muhammad , Donaldson, Alex , Lloyd, David , Cook, Jill
- Date: 2019
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 53, no. 8 (2019), p. 487-492
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- Description: Objective Exercise-training programmes have reduced lower limb injuries in trials, but their population-level effectiveness has not been reported in implementation trials. This study aimed to demonstrate that routinely collected hospital data can be used to evaluate population-level programme effectiveness. Method A controlled ecological design was used to evaluate the effect of FootyFirst, an exercise-training programme, on the number of hospital-treated lower limb injuries sustained by males aged 16-50 years while participating in community-level Australian Football. FootyFirst was implemented with a € support' (FootyFirst+S) or a € without support' (FootyFirst+NS) in different geographic regions of Victoria, Australia: 22 clubs in region 1: FootyFirst+S in 2012/2013; 25 clubs in region 2: FootyFirst+NS in 2012/2013; 31 clubs region 3: control in 2012, FootyFirst+S in 2013. Interrupted time-series analysis compared injury counts across regions and against trends in the rest of Victoria. Results After 1 year of FootyFirst+S, there was a non-statistically significant decline in the number of lower limb injuries in region 1 (2012) and region 3 (2013); this was not maintained after 2 years in region 1. Compared with before FootyFirst in 2006-2011, injury count changes at the end of 2013 were: region 1: 20.0% reduction (after 2 years support); region 2: 21.5% increase (after 2 years without support); region 3: 21.8% increase (after first year no programme, second year programme with support); rest of Victoria: 12.6% increase. Conclusion Ecological analyses using routinely collected hospital data show promise as the basis of population-level programme evaluation. The implementation and sustainability of sports injury prevention programmes at the population-level remains challenging.
Epidemiology of hospital-treated cricket injuries sustained by women from 2002-2003 to 2013-2014 in Victoria, Australia
- Authors: Perera, Nirmala , Kemp, Joanne , Joseph, Corey , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 11 (Nov 2019), p. 1213-1218
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- Description: Objectives: To present the first comprehensive epidemiological profile of hospital-treated injuries sustained by female cricketers from 2002-2003 to 2013-2014 in Victoria, Australia. Design: Analysis of routinely collected hospital data (detailed case-series). Methods: A retrospective analysis of hospital-treatment data associated with cricket injuries sustained by women between 1 July 2002 and 30 June 2014, inclusive were extracted from databases held by the Victorian Injury Surveillance Unit in Australia. Results: Over the 12-year period, 668 cases were treated in Victoria. Of these, 547 were emergency department (ED)-presentations. There were 121 hospital-admissions, of which, the length of stay was <2 days for 78.5% cases. All cases were treated and released, and no fatalities were reported. The 10-14 year age group most frequently presented to ED (19.9%) and were most commonly admitted to hospital (16.5% of the total admissions). Fractures were the most common cause of hospital-admissions (47.1%) but only accounted for 17.2% of the ED-presentations. Dislocations, sprains and strains, were the most common (36.4%) cause of ED-presentations. The head was the most commonly injured anatomical location (27.8% of ED-presentations and 28.1% of hospital-admissions), followed by the wrist and hand (27.8% ED-presentations and 17.4% hospital-admissions). Conclusions: These findings provide the first overview of the nature of injuries requiring hospital attendance in female cricketers, and a foundation to inform the development of targeted injury prevention programs for female cricketers. (C) 2019 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
Estimating the international burden of sport-related death : A review of data sources
- Authors: Kucera, Kristen , Fortington, Lauren , Wolff, Catherine , Marshall, Stephen , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 25, no. 2 (2018), p.83-89
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- Description: Introduction Despite detailed recommendations for sports injury data capture provided since the mid-1990s, international data collection efforts for sport-related death remains limited in scope. The purpose of this paper was to review the data sources available for studying sport-related death and describe their key features, coverage, accessibility and strengths and limitations. Methods The outcomes of interest for this review was death occurring as a result of participation in organised sport-related activity. Data sources used to enumerate death in sport were identified, drawing from the authors’ knowledge/experience and review of key references from international organisations. The general purpose, case identification, structure, strengths and limitations of each source in relation to collection of data for sport-related death were summarised, drawing on examples from the international published literature to illustrate this application. Results Seven types of resources were identified for capturing deaths in sport. Data sources varied considerably in their ability to identify: participant status, sport relatedness of the death, types of sport-related deaths they capture, level of detail provided about the circumstances and medical care received. The most detailed sources were those that were dedicated to sports surveillance. Sport relatedness and type of sport may not be reliably captured by systems not dedicated to sports injury surveillance. Only one source permitted international comparisons and was limited to one sport (soccer). Conclusion Data on sport-related death are currently collected across a wide variety of data sources. This review highlights the need for robust, comprehensive approaches with standardised methodologies enabling linkage between sources and international comparisons.
Implementing automated external defibrillators into community sports clubs/facilities : A cross-sectional survey of community club member preparedness for medical emergencies
- Authors: Fortington, Lauren , West, Liam , Morgan, Damian , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: BMJ Open Sport and Exercise Medicine Vol. 5, no. 1 (2019), p. 1-8
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- Description: Objective There is a growing focus on ensuring the availability of automated external defibrillators (AED) in sport settings to assist in preventing sudden cardiac death. For the AED to be most effective, understanding how best to integrate it with wider risk management and emergency action plans (EAP) is needed. The aim of this survey was to identify sports club/facility member knowledge of AED use and club EAPs, 6 months following participation in a government-funded AED provision and cardiopulmonary resuscitation training programme. Methods Cross-sectional survey of community sports clubs and facilities in Victoria, Australia. Included participants were members of sports club/facilities that had been provided with an AED and basic first aid training as part of a government programme to increase access to, and awareness of, AEDs. A descriptive analysis of availability of EAPs and AEDs, together with practical scenarios on AED use and maintenance, is presented. Results From 191 respondents, more than half (56%) had no previous training in AED use. Knowledge on availability of an EAP at the club/facility was varied: 53% said yes and knew where it was located, while 41% did not have, or did not know if they had, an EAP. Responses to clinical scenarios for use of AED were mostly accurate, with the exception of being unsure how to respond when 'participant falls to the ground and is making shaking movements.' Conclusions While there were positive outcomes from this programme, such as half of the respondents being newly trained in emergency first aid response, further improvements are required to assist members with embedding their AED into their club/facility EAP and practices.
Match injuries in Sri Lankan junior cricket : A prospective, longitudinal study
- Authors: Gamage, Prasanna , Fortington, Lauren , Kountouris, Alex , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 6 (2019), p. 647-652
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- Description: Objectives: Understanding the nature of injuries in cricket is key to mitigate injury risks and prioritise preventive measures. This study aimed to identify the incidence and nature of match injuries among Sri Lankan junior cricketers. Design: Longitudinal follow-up study with prospective in-season data collection. Methods: A national survey of schoolboy, division-1 cricket teams in under-15 and under-17 age groups. Using a paper-based questionnaire, distributed to school-teams at the start of the 2016 cricket season, respondents recorded any injuries, including the site, type and mechanism. Match injury incidence rates (match-IIR) (injuries/100 match-player-days) were calculated overall, by position and for match time loss (MTL) and non-MTL injuries. Results: From 59 school-teams, 573 players responded, with 404 players reporting 744 injuries in 648 matches. The match-IIR was 28.0 injuries/100 match-player-days (95% CI = 26.0–30.2). The highest match-IIR was reported among fielders (46.0% of all injuries sustained; match-IIR = 12.9) compared with batters (25.4%; match-IIR = 7.1) and bowlers (20.3%; match-IIR = 5.7). Abrasions and bruises to the knee or elbow were the most common injuries among fielders, with the majority being non-MTL injuries. Conclusions: Almost half (46.0%) of all injuries were to fielders, and more research into their severity and mechanisms is needed to identify the need for, and design of, preventive measures. Batters sustained a relatively large number of facial-organ injuries from being struck by the ball, presenting a need to evaluate the use and appropriateness of helmets by Sri Lankan junior cricketers. Similar to other junior cricket studies, the most common injuries among bowlers were strains and sprains, mainly affecting the lower limbs and lower back. © 2018
Risk perceptions for exertional heat illnesses in junior cricket in Sri Lanka
- Authors: Gamage, Prasanna , Fortington, Lauren , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: BMJ Open Sport and Exercise Medicine Vol. 5, no. 1 (2019), p. 1-7
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- Description: Objectives Exertional heat illnesses (EHI) can occur when sport is played in hot and humid environments, such as those common across Asia. Measures to reduce the risk of EHI are important; however, causal data on EHI occurrence are limited and challenging to capture. To gain an initial understanding of EHI risks, we aimed to assess the risk perceptions of EHI of youth cricketers. Methods A descriptive cross-sectional survey, comprised of 14 questions on EHI risks, was conducted with 365 Sri Lankan junior male cricketers (age=12.9±0.9 years) who typically play in hot and humid conditions. Results For climate related risks, relative humidity was perceived as having a low risk of EHI compared with ambient temperature. The EHI risk associated with wearing protective gear, as commonly used in cricket, was perceived as low. Most junior cricketers perceived a low level of risk associated with recommended preventive measures such as body cooling and heat-acclimatisation. Conclusion This is the first study to explore EHI risk perceptions in any sporting context. Young players may not be mindful of all risks. Therefore, leadership and initiative from competition organisers and parents is required to promote countermeasures.
The behaviour change techniques used by Australian physiotherapists to promote non-treatment physical activity to patients with musculoskeletal conditions
- Authors: Kunstler, Breanne , Cook, Jill , Kemp, Joanne , O'Halloran, Paul , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 1 (2019), p. 2-10
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- Description: Objectives: To determine: (i) the behaviour change techniques used by a sample of Australian physiotherapists to promote non-treatment physical activity; and (ii) whether those behaviour change techniques are different to the techniques used to encourage adherence to rehabilitation exercises. Design: Cross-sectional survey. Method: An online self-report survey was advertised to private practice and outpatient physiotherapists treating patients with musculoskeletal conditions. The use of 50 behaviour change techniques were measured using five-point Likert-type scale questions. Results: Four-hundred and eighty-six physiotherapists responded to the survey, with 216 surveys fully completed. Most respondents (85.1%) promoted non-treatment physical activity often or all of the time. Respondents frequently used 29 behaviour change techniques to promote non-treatment physical activity or encourage adherence to rehabilitation exercises. A similar number of behaviour change techniques was frequently used to encourage adherence to rehabilitation exercises (n = 28) and promote non-treatment physical activity (n = 26). Half of the behaviour change techniques included in the survey were frequently used for both promoting non-treatment physical activity and encouraging adherence to rehabilitation exercises (n = 25). Graded tasks was the most, and punishment was the least, frequently reported technique used to promote non-treatment physical activity and encourage adherence to rehabilitation exercises. Conclusions: Respondents reported using similar behaviour change techniques to promote non-treatment physical activity and encourage adherence to rehabilitation exercises. The variability in behaviour change technique use suggests the behaviour the physiotherapist is promoting influences their behaviour change technique choice. Including the frequently-used behaviour change techniques in non-treatment physical activity promotion interventions might improve their efficacy. © 2018 Sports Medicine Australia
The incidence, prevalence, nature, severity and mechanisms of injury in elite female cricketers : A prospective cohort study
- Authors: Perera, Nirmala , Kountouris, Alex , Kemp, Joanne , Joseph, Corey , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 9 (2019), p. 1014-1020
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- Description: Objectives: Incidence, prevalence, nature, severity and mechanisms of injury in elite female cricketers over two seasons from March 2014 to March 2016, inclusive. Design: Prospective cohort study. Methods: Injury data collected via Cricket Australia's Athlete Management System on all elite female players over two seasons were analysed. Profiles of the nature, anatomical location and mechanism of injuries were presented according to dominant player position. Injury incidence rates were calculated based on match playing hours. Results: There were 600 medical-attention injuries; with 77.7% players reporting ≥1 injury. There were 79.5% acute injuries compared to gradual onset injuries. Of the all medical-attention injuries, 20.2% led to time-loss; 34.7% were match-time-loss injuries. Match injury incidence was 424.7 injuries/10,000 h for all injuries and 79.3 injuries/10,000 h for time-loss injuries. Of all the injuries, 31.8% were muscle injuries and 16.0% joint sprains. Wrist and hand (19.8%), lumbar spine (16.5%) and knee (14.9%) injuries were the most common time-loss injuries. Six players sustained lumber spine bone stress injury that resulted in the most days missed due to injury (average 110.5 days/injury). Conclusions: There is a need to focus on specific injuries in female cricket, including thigh, wrist/hand and knee injuries because of their frequency, and lumbar spine injuries because of their severity.
The self-reported factors that influence Australian physiotherapists’ choice to promote non-treatment physical activity to patients with musculoskeletal conditions
- Authors: Kunstler, Breanne , Cook, Jill , Kemp, Joanne , O'Halloran, Paul , Finch, Caroline
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 3 (2019), p. 275-280
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- Description: Objectives: To determine the factors that influence physiotherapists’ choice to promote non-treatment physical activity to patients with musculoskeletal conditions. Design: Cross sectional survey. Methods: A national, online self report survey was targeted at Australian registered physiotherapists primarily treating patients with musculoskeletal conditions in private practice and outpatient settings. Likert scale questions were used to measure the factors influencing non-treatment physical activity promotion by physiotherapists. Results: Two hundred and sixteen full responses were received. Most (56.6%) respondents irregularly promoted non-treatment physical activity, whereas 43.4% always promoted non-treatment physical activity. Promotion of non-treatment physical activity was bivariately associated with respondents’ own physical activity level (x2[2] = 7.670, p = 0.022) and exercise science education (x2[1] = 4.613, p = 0.032). Multivariable analysis identified that Knowledge (knowing how to promote non-treatment physical activity) (OR = 1.60, 95%CI 1.026–2.502), Goals (other patient problems are more important) (OR = 0.62, 95%CI 0.424–0.897) and Innovation (compatibility of non-treatment physical activity promotion with the clinical environment) (OR = 1.75, 95%CI 1.027–2.985) were significantly and independently associated with non-treatment physical activity promotion. Conclusions: The majority of surveyed Australian physiotherapists irregularly promoted non-treatment physical activity. Lack of knowledge of how to promote non-treatment physical activity, prioritising other patient problems before non-treatment physical activity promotion and using promotion methods that are not compatible with current practice might reduce non-treatment physical activity promotion frequency by physiotherapists.
Time-to-event analysis for sports injury research part 1 : Time-varying exposures
- Authors: Nielsen, Rasmus , Bertelsen, Michael , Ramskov, Daniel , Møller, Merete , Hulme, Adam , Theisen, Daniel , Finch, Caroline , Fortington, Lauren , Mansournia, Mohammad , Parner, Erik
- Date: 2019
- Type: Text , Journal article , Review
- Relation: British Journal of Sports Medicine Vol. 53, no. 1 (2019), p. 61-68
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- Description: Background: 'How much change in training load is too much before injury is sustained, among different athletes?' is a key question in sports medicine and sports science. To address this question the investigator/practitioner must analyse exposure variables that change over time, such as change in training load. Very few studies have included time-varying exposures (eg, training load) and time-varying effect-measure modifiers (eg, previous injury, biomechanics, sleep/stress) when studying sports injury aetiology. Aim: To discuss advanced statistical methods suitable for the complex analysis of time-varying exposures such as changes in training load and injury-related outcomes. Content: Time-varying exposures and time-varying effect-measure modifiers can be used in time-to-event models to investigate sport injury aetiology. We address four key-questions (i) Does time-to-event modelling allow change in training load to be included as a time-varying exposure for sport injury development? (ii) Why is time-to-event analysis superior to other analytical concepts when analysing training-load related data that changes status over time? (iii) How can researchers include change in training load in a time-to-event analysis? and, (iv) Are researchers able to include other time-varying variables into time-to-event analyses? We emphasise that cleaning datasets, setting up the data, performing analyses with time-varying variables and interpreting the results is time-consuming, and requires dedication. It may need you to ask for assistance from methodological peers as the analytical approaches presented this paper require specialist knowledge and well-honed statistical skills. Conclusion: To increase knowledge about the association between changes in training load and injury, we encourage sports injury researchers to collaborate with statisticians and/or methodological epidemiologists to carefully consider applying time-to-event models to prospective sports injury data. This will ensure appropriate interpretation of time-to-event data. © 2019 Author(s).
Time-to-event analysis for sports injury research part 2 : Time-varying outcomes
- Authors: Nielsen, Rasmus , Bertelsen, Michael , Ramskov, Daniel , Møller, Merete , Hulme, Adam , Theisen, Daniel , Finch, Caroline , Fortington, Lauren , Mansournia, Mohammad , Parner, Erik
- Date: 2019
- Type: Text , Journal article , Review
- Relation: British Journal of Sports Medicine Vol. 53, no. 1 (2019), p. 70-78
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- Description: Background: Time-to-event modelling is underutilised in sports injury research. Still, sports injury researchers have been encouraged to consider time-to-event analyses as a powerful alternative to other statistical methods. Therefore, it is important to shed light on statistical approaches suitable for analysing training load related key-questions within the sports injury domain. Content: In the present article, we illuminate: (i) the possibilities of including time-varying outcomes in time-to-event analyses, (ii) how to deal with a situation where different types of sports injuries are included in the analyses (ie, competing risks), and (iii) how to deal with the situation where multiple subsequent injuries occur in the same athlete. Conclusion: Time-to-event analyses can handle time-varying outcomes, competing risk and multiple subsequent injuries. Although powerful, time-to-event has important requirements: researchers are encouraged to carefully consider prior to any data collection that five injuries per exposure state or transition is needed to avoid conducting statistical analyses on time-to-event data leading to biased results. This requirement becomes particularly difficult to accommodate when a stratified analysis is required as the number of variables increases exponentially for each additional strata included. In future sports injury research, we need stratified analyses if the target of our research is to respond to the question: 'how much change in training load is too much before injury is sustained, among athletes with different characteristics?' Responding to this question using multiple time-varying exposures (and outcomes) requires millions of injuries. This should not be a barrier for future research, but collaborations across borders to collecting the amount of data needed seems to be an important step forward.
"...like you're pushing the snowball back up hill"-the experiences of Australian physiotherapists promoting non-treatment physical activity : A qualitative study
- Authors: Kunstler, Breanne , O'Halloran, Paul , Cook, Jill , Kemp, Joanne , Finch, Caroline
- Date: 2018
- Type: Text , Journal article
- Relation: Aims Medical Science Vol. 5, no. 3 (2018), p. 224-237
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- Description: Participating in physical activity is important for maintaining general health. When physiotherapists promote physical activity for the purposes of maintaining or improving a patient’s general health, they are promoting non-treatment physical activity. Physiotherapists have a responsibility to promote non-treatment physical activity to their patients while also providing the patient with treatment for their presenting complaint. This qualitative study explored the experiences of Australian physiotherapists promoting non-treatment physical activity to patients with musculoskeletal conditions. Ten Australian physiotherapists treating patients with musculoskeletal conditions in private practice and outpatient settings were recruited using a social media campaign and snowballing. All interviewees received one $AU20 gift card for participating. Sixty-minute semi-structured interviews were conducted and were transcribed verbatim. Interpretative phenomenological analysis was used to design the interview guide and analyse data. Transcripts were used to identify emergent and superordinate themes. Most interviewees were female, aged between 25–34 years, physically active and reported promoting NTPA. The superordinate themes that emerged from the transcripts included: Internal and external influences on NTPA promotion, approach taken by the physiotherapist towards NTPA promotion, challenges experienced when promoting NTPA, and skills and training. In conclusion, physiotherapists reported they were well-placed to promote NTPA, but they face many challenges. The perceived inability to motivate patients to become physically active and the need to prioritise patient expectations of hands-on therapy made NTPA promotion difficult. Workplace specific factors, such as having an open-plan clinic environment and having other staff who promote NTPA, were perceived to make NTPA promotion easier. Using effective marketing strategies that portray the physiotherapy clinic as a physically active environment might see patients expect NTPA promotion, making NTPA promotion easier for Australian physiotherapists in the future.
Adaptation, translation and reliability of the Australian 'Juniors Enjoying Cricket Safely' injury risk perception questionnaire for Sri Lanka
- Authors: Gamage, Prasanna , Fortington, Lauren , Finch, Caroline
- Date: 2018
- Type: Text , Journal article
- Relation: BMJ Open Sport and Exercise Medicine Vol. 4, no. 1 (2018), p. 1-9
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- Description: Objectives Cricket is a very popular sport in Sri Lanka. In this setting there has been limited research; specifically, there is little knowledge of cricket injuries. To support future research possibilities, the aim of this study was to cross-culturally adapt, translate and test the reliability of an Australian-developed questionnaire for the Sri Lankan context. Methods The Australian 'Juniors Enjoying Cricket Safely' (JECS-Aus) injury risk perception questionnaire was cross-culturally adapted to suit the Sri Lankan context and subsequently translated into the two main languages (Sinhala and Tamil) based on standard forward-back translation. The translated questionnaires were examined for content validity by two language schoolteachers. The questionnaires were completed twice, 2 weeks apart, by two groups of school cricketers (males) aged 11-15 years (Sinhala (n=24), Tamil (n=30)) to assess reliability. Test-retest scores were evaluated for agreement. Where responses were <100% agreement, Cohen's kappa (κ) statistics were calculated. Questions with moderate-to-poor test-retest reliability (κ <0.6) were reconsidered for modification. Results Both the Sinhala and Tamil questionnaires had 100% agreement for questions on demographic data, and 88%-100% agreement for questions on participation in cricket and injury history. Of the injury risk perception questions, 72% (Sinhala) and 90% (Tamil) questions showed a substantial (κ =0.61-0.8) and almost perfect (κ =0.81-1.0) test-retest agreement. Conclusion The adapted and translated JECS-SL questionnaire demonstrated strong reliability. This is the first study to adapt the JECS-Aus questionnaire for use in a different population, providing an outcome measure for assessing injury risk perceptions in Sri Lankan junior cricketers.
An updated subsequent injury categorisation model (SIC-2.0) : Data-driven categorisation of subsequent injuries in sport
- Authors: Toohey, Liam , Drew, Michael , Fortington, Lauren , Finch, Caroline , Cook, Jill
- Date: 2018
- Type: Text , Journal article
- Relation: Sports Medicine Vol. 48, no. 9 (2018), p. 2199-2210
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- Description: Background: Accounting for subsequent injuries is critical for sports injury epidemiology. The subsequent injury categorisation (SIC-1.0) model was developed to create a framework for accurate categorisation of subsequent injuries but its operationalisation has been challenging. Objectives: The objective of this study was to update the subsequent injury categorisation (SIC-1.0 to SIC-2.0) model to improve its utility and application to sports injury datasets, and to test its applicability to a sports injury dataset. Methods: The SIC-1.0 model was expanded to include two levels of categorisation describing how previous injuries relate to subsequent events. A data-driven classification level was established containing eight discrete injury categories identifiable without clinical input. A sequential classification level that sub-categorised the data-driven categories according to their level of clinical relatedness has 16 distinct subsequent injury types. Manual and automated SIC-2.0 model categorisation were applied to a prospective injury dataset collected for elite rugby sevens players over a 2-year period. Absolute agreement between the two coding methods was assessed. Results: An automated script for automatic data-driven categorisation and a flowchart for manual coding were developed for the SIC-2.0 model. The SIC-2.0 model was applied to 246 injuries sustained by 55 players (median four injuries, range 1–12), 46 (83.6%) of whom experienced more than one injury. The majority of subsequent injuries (78.7%) were sustained to a different site and were of a different nature. Absolute agreement between the manual coding and automated statistical script category allocation was 100%. Conclusions: The updated SIC-2.0 model provides a simple flowchart and automated electronic script to allow both an accurate and efficient method of categorising subsequent injury data in sport.
Collecting health and exposure data in Australian olympic combat sports : Feasibility study utilizing an electronic system
- 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
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- 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.