A preliminary video analysis of concussion in the National Rugby League
- Authors: Gardner, Andrew , Iverson, Grant , Quinn, Tanya , Makdissi, Michael , Levi, Christopher , Shultz, Sandy , Wright, David , Stanwell, Peter
- Date: 2015
- Type: Text , Journal article
- Relation: Brain Injury Vol. 29, no. 10 (2015), p. 1182-1185
- Full Text: false
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- Description: Primary objective: To conduct the first video analysis of concussion in the Australian National Rugby League (NRL) and describe player and injury characteristics, situational factors and time to return to play.Research design: Descriptive, observational case series.Methods and procedures: Video analysis of 20 medically diagnosed concussions for three consenting clubs during the 2013 NRL season.Main outcome and results: Most concussions (83%) occurred during a high tackle, and all injured ball carriers were hit high. Loss of consciousness was observed in 30% of cases. Common observable signs of injury included clutching of the head, balance problems or wobbly legs and a blank or vacant state. There were no post-concussive seizures. All players with loss of consciousness were removed from play. However, only half of the total sample was removed from play and one athlete who was removed returned to play in the same match. Of the players who were removed from play, the large majority returned the following week. Illegal play accounted for 25% of all concussions.Conclusions: Video analysis may be a useful method to study the incidence, mechanism and management of concussion in sports such as Rugby League. Future studies may include larger numbers to validate this preliminary data and may also investigate other levels of play and age ranges. © 2015 Taylor and Francis Group, LLC.
Greater understanding of normal hip physical function may guide clinicians in providing targeted rehabilitation programmes
- Authors: Kemp, Joanne , Schache, Anthony , Makdissi, Michael , Sims, Kevin , Crossley, Kay
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 16, no. 4 (2013), p. 292-296
- Full Text: false
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- Description: Objectives: This study investigated tests of hip muscle strength and functional performance. The specific objectives were to: (i) establish intra- and inter-rater reliability; (ii) compare differences between dominant and non-dominant limbs; (iii) compare agonist and antagonist muscle strength ratios; (iv) compare differences between genders; and (v) examine relationships between hip muscle strength, baseline measures and functional performance. Design: Reliability study and cross-sectional analysis of hip strength and functional performance. Methods: In healthy adults aged 18-50. years, normalised hip muscle peak torque and functional performance were evaluated to: (i) establish intra-rater and inter-rater reliability; (ii) analyse differences between limbs, between antagonistic muscle groups and genders; and (iii) associations between strength and functional performance. Results: Excellent reliability (intra-rater ICC = 0.77-0.96; inter-rater ICC = 0.82-0.95) was observed. No difference existed between dominant and non-dominant limbs. Differences in strength existed between antagonistic pairs of muscles: hip abduction was greater than adduction (p < 0.001) and hip ER was greater than IR (p < 0.001). Men had greater ER strength (p = 0.006) and hop for distance (p < 0.001) than women. Strong associations were observed between measures of hip muscle strength (except hip flexion) and age, height, and functional performance. Conclusions: Deficits in hip muscle strength or functional performance may influence hip pain. In order to provide targeted rehabilitation programmes to address patient-specific impairments, and determine when individuals are ready to return to physical activity, clinicians are increasingly utilising tests of hip strength and functional performance. This study provides a battery of reliable, clinically applicable tests which can be used for these purposes. © 2012 Sports Medicine Australia.
Intention to use sport concussion guidelines among community-level coaches and sports trainers
- Authors: Newton, Joshua , White, Peta , Ewing, Michael , Makdissi, Michael , Davis, Gavin , Donaldson, Alex , Sullivan, John , Seward, Hugh , Finch, Caroline
- Date: 2013
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol.17, no.5 (2013), p.469-473
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Objectives: Sporting bodies have developed guidelines for managing community-level players with suspected concussion in response to international consensus statements on concussion in sport. The purpose of this study was to examine the factors that influence the intended use of concussion guidelines among community-level coaches and sports trainers from two popular football codes in Australia: Australian football and rugby league. Design: Cross-sectional survey. Methods: The survey, based on an extended theory of planned behaviour model, was completed by 183 Australian football coaches, 121 Australian football sports trainers, 171 rugby league coaches, and 142 rugby league sports trainers. Results: Personal norms and self-efficacy were significant predictors of intention to use concussion guidelines, although the relationship between self-efficacy and intention was stronger among Australian football coaches than rugby league coaches. Analysis of the salient beliefs that underpin self-efficacy found that coaches, irrespective of football code, felt less familiar (2 = 25.70, p < 0.001) and less experienced (2 = 31.56, p < 0.001) than sports trainers in using the concussion guidelines. At the same time, Australian football personnel, irrespective oftheir team role, feltthatthey had insufficienttime (2 = 8.04, p < 0.01) and resources (2 = 12.31, p < 0.001) to implement the concussion guidelines relative to rugby league personnel. Conclusions: Programmes aimed at increasing the intended use of sport concussion guidelines should focus on enhancing self-efficacy and leveraging personal norms. Increasing coaches’ familiarity and experience in using the concussion guidelines would also be warranted, as would finding ways to overcome the perceived time and resource constraints identified among Australian football personnel.
Is hip range of motion and strength impaired in people with hip chondrolabral pathology?
- Authors: Kemp, Joanne , Schache, Anthony , Makdissi, Michael , Pritchard, Michael , Sims, Kevin , Crossley, Kay
- Date: 2014
- Type: Text , Journal article
- Relation: Journal of Musculoskeletal and Neuronal Interactions Vol. 14, no. 3 (2014), p.
- Full Text: false
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- Description: Objective: The aims of this study were to i) to compare physical impairments in people with chondrolabral pathology identified at hip arthroscopy 12-24 months previously to age-matched healthy people; and ii) to understand whether gendersex has any influence on impairments. Methods: 84 patients (42 female; age=36±10) 12-24 months post hip arthroscopy and 60 controls (41 female; age=36±10) were included. Measurements of active hip ROM and strength were assessed. Two-way analyses of co-variance examined the effect of gendersex and chondrolabral pathology on hip ROM and strength. Results: Patients exhibited less hip internal rotation (IR) ROM (p=0.001) and more extension (p=0.014) ROM; and less hip adduction (p<0.001), extension (p=0.001), flexion (p<0.001), ER (p=0.044) and IR (p<0.001) strength when compared to controls. For abduction strength, a significant interaction was found between the presence of chondrolabral pathology and gendersex (p=0.035). Conclusions: People with hip chondrolabral pathology have differences in hip ROM and strength when compared to controls. Rehabilitation programs should focus on addressing these specific physical impairments in order to enhance outcomes. This information may be of great value to both researchers and clinicians alike in determining interventions to improve outcomes in people with early hip OA.
- Description: C1
Is quality of life following hip arthroscopy in patients with chondrolabral pathology associated with impairments in hip strength or range of motion?
- Authors: Kemp, Joanne , Makdissi, Michael , Schache, Anthony , Finch, Caroline , Pritchard, Michael , Crossley, Kay
- Date: 2016
- Type: Text , Journal article
- Relation: Knee Surgery Sports Traumatology Arthroscopy Vol. 24, no. 12 (2016), p. 3955-3961
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- Description: If physical impairments that are associated with poorer outcomes can be identified in people with chondrolabral hip pathology, then rehabilitation programmes that target such modifiable impairments could potentially be established to improve quality of life. The aim of this study was to examine the relationship between quality-of-life PROs and physical impairment measurements in people with chondrolabral pathology post-hip arthroscopic surgery. This was a cross-sectional study where multiple stepwise linear regression analyses were conducted to determine which physical impairment measurements were most associated with poorer quality-of-life patient-reported outcomes (PROs). Eighty-four patients (42 women; all aged 36 +/- 10 years) with hip chondrolabral pathology 12- to 24-month post-hip arthroscopy were included. The Hip disability and Osteoarthritis Outcome Score Quality-of-life (HOOS-Q) subscale and International Hip Outcome Tool (IHOT-33) PROs were collected. Measurements of active hip ROM and strength were assessed. Modifiable post-surgical physical impairments were associated with PRO in patients with chondrolabral pathology. Greater hip flexion ROM was independently associated with better scores in both HOOS-Q and IHOT-33 (adjusted r (2) values ranged from 0.249 to 0.341). Greater hip adduction strength was independently associated with better HOOS-Q and IHOT-33 (adjusted r (2) 0.227-0.317). Receiver Operator Curve analyses determined that the limit value for hip flexion ROM was 100A degrees (sensitivity 92 %, specificity 75 %), and hip adduction strength was 0.86 Nm/kg (sensitivity 96 %, specificity 70 %). Hip flexion ROM and adduction strength were associated with better quality-of-life PRO scores in patients with chondrolabral pathology 12- to 24-month post-hip arthroscopy. These impairments could be targeted by clinicians designing rehabilitation programmes to this patient group.
Knowledge about sports-related concussion: is the message getting through to coaches and trainers?
- Authors: White, Peta , Newton, Joshua , Makdissi, Michael , Sullivan, John , Davis, Gavin , McCrory, Paul , Donaldson, Alex , Ewing, Michael , Finch, Caroline
- Date: 2014
- Type: Text , Journal article
- Relation: British Journal of Sports Medicine Vol. 48, no. 2 (2014), p. 119-124
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Aim: The need for accurate diagnosis and appropriate return-to-play decisions following a concussion in sports has prompted the dissemination of guidelines to assist managing this condition. This study aimed to assess whether key messages within these guidelines are reflected in the knowledge of coaches and sports trainers involved in community sport. Methods: An online knowledge survey was widely promoted across Australia in May–August 2012 targeting community Australian Football (AF) and Rugby League (RL) coaches and sports trainers. 260 AF coaches, 161 AF sports trainers, 267 RL coaches and 228 RL sports trainers completed the survey. Knowledge scores were constructed from Likert scales and compared across football codes and respondent groups. Results: General concussion knowledge did not differ across codes but sports trainers had higher levels than did coaches. There were no significant differences in either concussion symptoms or concussion management knowledge across codes or team roles. Over 90% of respondents correctly identified five of the eight key signs or symptoms of concussion. Fewer than 50% recognised the increased risk of another concussion following an initial concussion. Most incorrectly believed or were uncertain that scans typically show damage to the brain after a concussion occurs. Fewer than 25% recognised, and >40% were uncertain that younger players typically take longer to recover from concussion than adults. Conclusions: The key messages from published concussion management guidelines have not reached community sports coaches and sports trainers. This needs to be redressed to maximise the safety of all of those involved in community sport.
Patients with chondrolabral pathology have bilateral functional impairments 12 to 24 months after unilateral hip arthroscopy : A cross-sectional study
- Authors: Kemp, Joanne , Risberg, May , Schache, Anthony , Makdissi, Michael , Pritchard, Michael , Crossley, Kay
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Orthopaedic & Sports Physical Therapy Vol. 46, no. 11 (2016), p. 947-956
- Full Text: false
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- Description: STUDY DESIGN: Cross-sectional study. BACKGROUND: Functional task performance in patients with chondrolabral pathology following hip arthroscopy is unknown. OBJECTIVES: To investigate in people with chondrolabral pathology following hip arthroscopy (1) the bilateral differences in functional task performance compared to controls, (2) the association of hip muscle strength with functional task performance, and (3) the association of functional task performance scores with good outcome, as measured by International Hip Outcome Tool score. METHODS: Seventy-one patients who had unilateral hip arthroscopy for hip pain and 60 controls were recruited. Patient-reported outcomes included the 4 subscales of the International Hip Outcome Tool. Hip muscle strength measures included abduction, adduction, extension, flexion, external rotation, and internal rotation. Functional tasks assessed included the single hop test, the side bridge test, and the single-leg rise test. For aim 1, analyses of covariance tests were used. For aim 2, stepwise multiple linear regression analyses were used. For aim 3, receiver operating characteristic curve analyses were used. RESULTS: Compared to controls, the chondrolabral pathology group had significantly worse performance on both legs for each of the functional tasks (P<.001). Greater hip abduction strength was moderately associated with better performance on functional tasks in the chondrolabral pathology group (adjusted R' range, 0.197-0.407; P<.001). Cutoff values associated with good outcome were 0.37 (hop distance/height) for the single hop, 16 repetitions for the single-leg rise, and 34 seconds for the side bridge test. CONCLUSION: Patients with hip chondrolabral pathology had reduced functional task performance bilaterally 12 to 24 months after unilateral hip arthroscopy when compared to controls.
Translating Guidelines for the Diagnosis and Management of Sports-Related Concussion Into Practice
- Authors: Donaldson, Alex , Newton, Joshua , McCrory, Paul , White, Peta , Davis, Gavin , Makdissi, Michael , Finch, Caroline
- Type: Text , Journal article
- Relation: American Journal of Lifestyle Medicine, Volume 10, Issue 2, (2016) p.120-135
- Relation: http://purl.org/au-research/grants/nhmrc/565900
- Full Text: false
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- Description: Sports injuries are a significant clinical and public health concern. There is a growing call to improve the translation of available evidence-based and expert-informed sports injury prevention interventions into sustained use in practice by physicians and others (eg, athletic trainers, coaches, and parents) who care for injured athletes. This article provides a brief overview of the current sport injury prevention implementation literature before focusing specifically on the translation of guidelines (including consensus and position statements) developed to assist physicians and others diagnose and manage athletes with sport-related concussion and the associated return-to-play decisions. The outcomes of more than 20 published studies indicate that physician, athletic trainer, coach, parent, and athlete knowledge, use of, and compliance with sport-related concussion guidelines are limited. More concerted, coordinated, and theory-informed efforts are required to facilitate the widespread dissemination, translation, and implementation of such guidelines. An example is provided of how implementation drivers could be used to inform the development of a comprehensive, multilevel implementation strategy targeting the individual, organizational, and system-level changes necessary to support the translation of available sport-related concussion guidelines in both the clinical and sports settings.
Use of rule changes to reduce injury in the Australian Football League
- Authors: Orchard, John , McCrory, Paul , Makdissi, Michael , Seward, Hugh , Finch, Caroline
- Date: 2014
- Type: Text , Journal article
- Relation: Orotpedica e Traumatologica Vol. 65, no. 6 (December 2014), p. 355-364
- Relation: http://purl.org/au-research/grants/nhmrc/1058737
- Full Text: false
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- Description: AIM: Injuries are common in all professional football codes (including soccer, rugby league and union, American football, Gaelic Football and Australian football). The aim of the present study was to assess the potential effect that rule changes can have on injuries in professional football. METHODS: The Australian Football League (AFL) conducts an annual audit of injuries and makes regular rule changes on a semi-annual basis. An injury was defined as “any physical or medical condition that causes a player to miss a match in the regular season or finals” with ongoing records kept and publicly released over the decade 2004-2013. RESULTS: Over the ten years from 2004-2013, the AFL Commission made 26 rule changes, of which eight were considered to have potential impact on injury rates. The 2005 centre circle rule has significantly reduced rates of posterior cruciate ligament (PCL) injury in ruckmen. The rates of head and neck injuries dropped after initial rule changes, but rates of concussion and other head and neck injuries have increased since 2011, since a rule change that players could not re-enter the game after suffering concussion. Rates of hamstring and groin injuries have significantly fallen since the substitute rule was instituted in 2011, but rates of other lower limb injuries have risen over the same time period. CONCLUSION: Rule changes have, in some instances, had a beneficial effect on the rates of specific injuries over the last decade. However, the overall injury incidence in the AFL has not fallen, possibly because of a concurrent background increase in the speed of player movement across the decade. The AFL is in a fortunate position of being able to easily institute rule changes as it is the peak body of the sport which does not have to consider international competitions. The well established annual injury survey is able to monitor the effects of any rule changes on injury rates in a timely manner.
Use of video to facilitate sideline concussion diagnosis and management decision-making
- Authors: Davis, Gavin , Makdissi, Michael
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 19, no. 11 (2016), p. 898-902
- Full Text: false
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- Description: Objectives: Video analysis can provide critical information to improve diagnostic accuracy and speed of clinical decision-making in potential cases of concussion. The objective of this study was to validate a hierarchical flowchart for the assessment of video signs of concussion, and to determine whether its implementation could improve the process of game day video assessment. Methods: All impacts and collisions potentially resulting in a concussion were identified during 2012 and 2013 Australian Football League (AFL) seasons. Consensus definitions were developed for clinical signs associated with concussion. A hierarchical flowchart was developed based on the reliability and validity of the video signs of concussion. Ninety videos were assessed, with 45 incidents of clinically confirmed concussion, and 45 cases where no concussion was sustained. Each video was examined using the hierarchical flowchart, and a single response was given for each video based on the highest-ranking element in the flowchart. Results: No protective action, impact seizure, motor incoordination or blank/vacant look were the highest ranked video signs in almost half of the clinically confirmed concussions, but in only 8.8% of non-concussed individuals. The presence of facial injury, clutching at the head and slow to get up were the highest ranked sign in 77.7% of non-concussed individuals. Conclusions: This study suggests that the implementation of a flowchart model could improve timely assessment of concussion, and it identifies the video signs that should trigger automatic removal from play. (C) 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
Using video analysis for concussion surveillance in Australian football
- Authors: Makdissi, Michael , Davis, Gavin
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 19, no. 12 (2016), p. 958-963
- Full Text: false
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- Description: Objectives: The objectives of the study were to assess the relationship between various player and game factors and risk of concussion; and to assess the reliability of video analysis for mechanistic assessment of concussion in Australian football. Methods: All impacts and collisions resulting in concussion were identified during the 2011 Australian Football League season. An extensive list of factors for assessment was created based upon previous analysis of concussion in Australian Football League and expert opinions. The authors independently reviewed the video clips and correlation for each factor was examined. Results: A total of 82 concussions were reported in 194 games (rate: 8.7 concussions per 1000 match hours; 95% confidence interval: 6.9-10.5). Player demographics and game variables such as venue, timing of the game (day, night or twilight), quarter, travel status (home or interstate) or score margin did not demonstrate a significant relationship with risk of concussion; although a higher percentage of concussions occurred in the first 5 min of game time of the quarter (36.6%), when compared to the last 5 min (20.7%). Variables with good inter-rater agreement included position on the ground, circumstances of the injury and cause of the impact. The remainder of the variables assessed had fair-poor inter-rater agreement. Common problems included insufficient or poor quality video and interpretation issues related to the definitions used. Conclusions: Clear definitions and good quality video from multiple camera angles are required to improve the utility of video analysis for concussion surveillance in Australian football. (C) 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.