'In a blink of an eye your life can change ' : Experiences of players sustaining a rugby-related acute spinal cord injury
- Authors: Badenhorst, Marelise , Verhagen, Evert , Lambert, Michael , van Mechelen, Willem , Brown, James
- Date: 2019
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 25, no. 4 (2019), p. 313-320
- Full Text: false
- Reviewed:
- Description: Background Though rare, rugby union carries a risk for serious injuries such as acute spinal cord injuries (ASCI), which may result in permanent disability. Various studies have investigated injury mechanisms, prevention programmes and immediate medical management of these injuries. However, relatively scant attention has been placed on the player's experience of such an injury and the importance of context. Aim The aim of this study was to explore the injury experience and its related context, as perceived by the catastrophically injured player. Methods A qualitative approach was followed to explore the immediate, postevent injury experience. Semi-structured interviews were conducted with 48 (n=48) players who had sustained a rugby-related ASCI. Results Four themes were derived from the data. Participants described the context around the injury incident, which may be valuable to help understand the mechanism of injury and potentially minimise risk. Participants also described certain contributing factors to their injury, which included descriptions of foul play and aggression, unaccustomed playing positions, pressure to perform and unpreparedness. The physical experience included signs and symptoms of ASCI that is important to recognise by first aiders, fellow teammates, coaches and referees. Lastly, participants described the emotional experience which has implications for all ASCI first responders. Significance All rugby stakeholders, including players, first responders, coaches and referees, may gain valuable information from the experiences of players who have sustained these injuries. This information is also relevant for rugby safety initiatives in shaping education and awareness interventions.
Self-regulatory skills : Are they helpful in the prevention of overuse injuries in talented tennis players?
- Authors: Van der Sluis, Alien , Brink, Michel , Pluim, Babette , Verhagen, Evert , Elferink-Gemser, Marije , Visscher, Chris
- Date: 2019
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine and Science in Sports Vol. 29, no. 7 (2019), p. 1050-1058
- Full Text: false
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- Description: Talented athletes use metacognitive skills to improve their performance. Also, it is known that these skills are important for managing one's health. The goal of this study was to identify the relationship between metacognitive skills and overuse injuries in talented tennis players. Metacognitive skills were measured in 73 talented tennis players (45 boys and 28 girls, age 11-14) at the start of the season, using the Self-Regulation of Learning Self-Report Scale. Overuse injuries were monitored for one season using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Ordinal regression indicated that moderate or low selfmonitoring skills (compared to high selfmonitoring) (OR 4.555, CI 1.096-18.927, P = 0.037) and exposure time (OR 1.380, CI 1.106-1.721, P = 0.004) were associated with more time loss overuse injuries. A second analysis showed that this was the case in girls (OR 10.757, CI 1.845-62.714, P = 0.008), but not in boys. Linear regression revealed that higher reflection scores and exposure time predicted overuse severity (F(5,58) = 2.921, P = 0.020, R2 = 0.201). Possibly, selfmonitoring can help players to prevent themselves from time loss overuse injuries. Coaches should be aware that players can differ in selfmonitoring ability and thus in the ability to prevent overuse injuries. The role of reflection needs more research.
Validity of injury self-reports by novice runners : Comparison with reports by sports medicine physicians
- Authors: Smits, Dirk-Wouter , Backx, Frank , van der Worp, Henk , van Middelkoop, Marienke , Hartgens, Fred , Verhagen, Evert , Kluitenberg, Bas , Huisstede, Bionka
- Date: 2019
- Type: Text , Journal article
- Relation: Research in Sports Medicine Vol. 27, no. 1 (2019), p. 72-87
- Full Text: false
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- Description: This study examined the criterion validity of self-reported running-related injuries (RRI) by novice runners. Fifty-eight participants (41 females; age 46 ± 11 yrs) of the “Start-to-Run” program provided self-reports on their RRIs using an online questionnaire. Subsequently, they attended injury consultations with sports medicine physicians who provided physician-reports (blinded for the self-reports) as a reference standard. Self-reports and physician-reports included information on injury location (i.e., hip/groin, upper leg, knee, lower leg, and ankle/foot) and injury type (i.e., muscle-tendon unit, joint, ligament, or bone). Sensitivity, specificity, and positive predictive values were 100% for all five injury locations. For injury type, sensitivity was low (66% for muscle-tendon unit, 50% for ligament, and 40% for bone) and lowest for joint injuries (17%). In conclusion, the validity of self-reported RRIs by novice runners is good for injury locations but not for injury types. In particular for joint injuries, the validity of novice runners’ self-reports is low. Abbreviations: RRI: Running Related Injury; SMC: Sports Medicine Centre; MTU: Muscle Tendon Unit; PPV: Positive Predictive Value.
Effectiveness of a nationwide intervention to increase helmet use in Dutch skiers and snowboarders : An observational cohort study
- Authors: Vriend, Ingrid , Hesselink, Arlette , Kemler, Ellen , Gouttebarge, Vincent , van Mechelen, Willem , Verhagen, Evert
- Date: 2018
- Type: Text , Journal article
- Relation: Injury Prevention Vol. 24, no. 3 (2018), p. 205-212
- Full Text: false
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- Description: Objective Helmet use in Dutch recreational skiers and snowboarders (DRSS) remains low. This study evaluated the effects of exposure to a nationwide intervention on relevant determinants of helmet use and helmet use in DRSS. Methods The intervention mapping protocol was used to develop an in-season intervention programme targeted at adult DRSS. A prospective single-cohort study was conducted to evaluate the impact of intervention exposure on determinants of helmet use (ie, knowledge about head injury risk and preventive measures, risk perception, attitudes to head injury risk and helmet use and intention to helmet use) and self-reported helmet use. A random sample of 363 DRSS from an existing panel participated in this study. Data were collected using online questionnaires before and immediately after the 2010/2011 intervention season. In a separate sample of 363 DRSS, intervention reach was assessed after the 2010/2011 season. Results Overall, no significant associations were found between intervention exposure and the determinants of helmet use. However, subgroup analyses revealed intervention effects on risk perception and knowledge in specific subpopulations. Intervention exposure had a significant, positive effect on helmet use in DRSS (β=0.23; 95% CI 0.017 to 0.44). Subgroup analyses revealed that this effect was found in: (1) skiers, (2) female DRSS, (3) young skiers and (4) intermediate skiers. Overall, intervention reach was 28.1%, with differences found between skiers and snowboarders. Conclusions Exposure to a nationwide intervention programme was associated with increased selfreported helmet use in DRSS. Differences were found in intervention effectiveness and reach between subpopulations. These differences must be taken into account when developing and evaluating future interventions.
No association between rate of torque development and onset of muscle activity with increased risk of hamstring injury in elite football
- Authors: van Dyk, Nicol , Bahr, Roald , Burnett, Angus , Verhagen, Evert , Von Tiggelen, D. , Witvrouw, Erik
- Date: 2018
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine and Science in Sports Vol. 28, no. 10 (2018), p. 2153-2163
- Full Text: false
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- Description: Hamstring injuries remain a significant burden in sports that involve high-speed running. In elite male football, hamstring injury has repeatedly been identified as the most common non-contact injury, representing 12% of all injuries. As the incidence remains high, investigations are aimed at better understanding how to improve prevention efforts. Intrinsic risk factors such as strength have been investigated extensively in a cohort of professional football players; however, other intrinsic measures of neuromuscular function have not been studied in this cohort. This study aims to investigate the association between timing of hamstring muscle activity onset and the rate of torque development during the early phase of isokinetic strength testing with risk of hamstring injury in professional football players in a prospective cohort study. All teams (n = 18) eligible to compete in the premier football league in Qatar underwent a comprehensive strength assessment during their annual periodic health evaluation at Aspetar Orthopaedic and Sports Medicine Hospital in Doha, Qatar. Variables included rate of torque development and timing of muscle activity onset. A total of 367 unique players (60.6% of all QSL players) competed for 514 player seasons (103 players competed both seasons) and sustained 65 hamstring injuries. There was no difference in the onset of muscle activity between the biceps femoris and medial hamstrings comparing the injured to uninjured players. For both onset of muscle activity and rate of torque development, there were no significant differences between any of the variables (P >.05), with small effect sizes detected across all the different variables (d < 0.3). Rate of torque development and onset of muscle activity were not associated with a risk of future hamstring injury. The use of these measures as part of a periodic health evaluation to identify risk of hamstring injury is unsupported.
Preventing recurrent ankle sprains : Is the use of an App more cost-effective than a printed Booklet? Results of a RCT
- Authors: van Reijen, Miriam , Vriend, Ingrid , van Mechelen, Willem , Verhagen, Evert
- Date: 2018
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine & Science in Sports Vol. 28, no. 2 (2018), p. 641-648
- Full Text: false
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- Description: Recurrent ankle sprains can be reduced by following a neuromuscular training (NMT) program via a printed Booklet or a mobile application. Regarding the high incidence of ankle sprains, cost-effectiveness regarding implementation can have a large effect on total societal costs. In this economic analysis, we evaluated whether the method of implementing a proven effective NMT program using an App or a Booklet resulted in differences in injury incidence rates leading to costs and hence to differences in cost-effectiveness. In total, 220 athletes with a previous ankle sprain were recruited for this randomized controlled trial with a follow-up of 12 months. Half of the athletes used the freely available “Strengthen your ankle” App and the other half received a printed Booklet. After the 8-week program, athletes were questioned monthly on their recurrent injuries. Primary outcome measures were incidence density of ankle injury and incremental cost-effectiveness ratio (ICER). During follow-up, 31 athletes suffered from a recurrent ankle sprain that led to costs resulting in a hazard ratio of 1.13 (95% CI: 0.56-2.27). The incremental cost-effectiveness ratio of the App group in comparison with the Booklet group was €361.52. The CE plane shows that there was neither a difference in effects nor in costs between both intervention methods. This study showed that the method of implementing the NMT program using an App or a Booklet led to similar cost-effectiveness ratios and the same occurrence of recurrent injuries leading to costs. Both the App and the Booklet can be used to prevent recurrent ankle injuries, showing no differences in (cost-) effectiveness at 12-month follow-up.
Trends in time-loss injuries during the 2011-2016 South African rugby youth weeks
- Authors: Sewry, Nicola , Verhagen, Evert , Lamvert, Michael , van Mechelen, Willem , Marsh, J. , Readhead, Clint , Viljoen, Wayne , Brown, James
- Date: 2018
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine & Science in Sports Vol. 28, no. 9 (2018), p. 2066-2073
- Full Text: false
- Reviewed:
- Description: Youth rugby is a popular sport in South Africa (SA) with a high injury incidence. The annual SA Rugby Youth Week tournaments attract the top age-group players in the country providing a sample of players for reliable injury surveillance. The aim of the study was to analyze the changes in time-loss injury rates at the SA Rugby Youth Week tournaments between 2011 and 2016, differences between age-groups, and to investigate associated injury risk factors. All confirmed time-loss injuries at the 4 age-group tournaments (under-13, under-16, and 2 under-18) from 2011 to 2016 were recorded. Injury incidence densities (IID) for years, tournaments, and injury risk factors were calculated and Poisson regression analyses were performed to determine differences. Time-loss injuries (n = 494) were reported over 24 240 exposure hours, with an overall IID of 20.4 (18.6-22.2) injuries per 1000 player hours. The year 2013 had a significantly lower IID compared to 2011. Injury risk decreased with increasing age; under-13 and under-16 had significantly higher IID compared to under-18 Craven Week. Tackling was the phase of play at highest risk, with an IID of 7.4 (6.3-8.5) injuries per 1000 player hours. Central/peripheral nervous system (CNS/PNS) and, therefore, the head/neck were the most commonly occurring injuries/location injured. In conclusion, within the SA Rugby tournament structure, the older players had a decreased rate of injury. The tackle event was still the phase of play with the highest injury incidence regardless of age. This increase in incidence is largely due to an increase in CNS/PNS injuries.
A 12-month prospective cohort study of symptoms of common mental disorders among European professional footballers
- Authors: Gouttebarge, Vincent , Aoki, Haruhito , Verhagen, Evert , Kerkhoffs, Gino
- Date: 2017
- Type: Text , Journal article
- Relation: Clinical Journal of Sport Medicine Vol. 27, no. 5 (2017), p. 487-492
- Full Text: false
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- Description: Objective: To determine the 12-month incidence and comorbidity of symptoms of common mental disorders (CMD) among European professional footballers and to explore the association of potential stressors with the health conditions under study among those European professional footballers. Design: Observational prospective cohort study with a follow-up period of 12 months. Participants: Male professional footballers from 5 European countries (n = 384 at baseline). Assessment of Risk Factors: Adverse life events, conflicts with trainer/coach, and career dissatisfaction were explored by using validated questionnaires. Main Outcome Measures: Symptoms of distress, anxiety/depression, sleep disturbance, and adverse alcohol use were assessed using validated questionnaires. Results: A total of 384 players (mean age of 27 years old; mean career duration of 8 years) were enrolled, of which 262 completed the follow-up period. The incidence of symptoms of CMD were 12% for distress, 37% for anxiety/depression, 19% for sleep disturbance, and 14% for adverse alcohol use. Over the follow-up period of 12 months, approximately 13% of the participants reported 2 symptoms, 5% three symptoms, and 3% four symptoms. Professional footballers reporting recent adverse life events, a conflict with trainer/coach, or career dissatisfaction were more likely to report symptoms of CMD, but statistically significant associations were not found. Conclusions: The 12-month incidence of symptoms of CMD among European professional footballers ranged from 12% for symptoms of distress to 37% for symptoms of anxiety/depression. A professional football team typically drawn from a squad of 25 players can expect symptoms of CMD to occur among at least 3 players in one season.
Is risk-taking in talented junior tennis players related to overuse injuries?
- Authors: Van der Sluis, Alien , Brink, Michel , Pluim, Babette , Verhagen, Evert , Elferink-Gemser, Marije , Visscher, Chris
- Date: 2017
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine & Science in Sports Vol. 27, no. 11 (2017), p. 1347-1355
- Full Text: false
- Reviewed:
- Description: Overuse injuries are a serious problem in junior tennis. Gaining insight in age-specific risk factors can contribute to prevention. The developmental cognitive processes that take place during adolescence make talented players more inclined to take risks. This may be even more pronounced in the high performance culture in which they move. Therefore, this study focuses on the relationship between risk-taking and overuse injuries in talented tennis players. Seventy-three talented tennis players (45 boys and 28 girls, age 11-14years) were monitored for 32weeks, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Risk-taking was measured at the start of the season with the Iowa Gambling Task. Linear regression analyses were executed to predict (a) overuse injuries, (b) time loss overuse injuries and (c) overuse severity, by risk-taking, exposure time, and injury history. In boys, risk-taking contributed significantly to time loss overuse injuries [F(1,39) = 7.764, P = 0.008, R-2 = 0.15] and to overuse severity [F(1,39) = 5.683, P = 0.022, with an R-2 of 0.13] In girls, time loss overuse injuries [F(1,23) = 6.889, P = 0.018, R-2 = 0.20] and overuse severity [F(1,23) = 7.287, P = 0.013, R-2 = 0.24] were predicted by exposure time. Coaches and trainers should be aware that talented male tennis players who are inclined to take risks, are more likely to maintain risky behavioral patterns related to overuse injuries.
A one-season prospective study of injuries and illness in elite junior tennis
- Authors: Pluim, Babette , Loeffen, F. , Clarsen, Ben , Bahr, Roald , Verhagen, Evert
- Date: 2016
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine and Science in Sports Vol. 26, no. 5 (2016), p. 564-571
- Full Text: false
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- Description: The objective of this study was to estimate the incidence and prevalence of injury and illness among elite junior tennis players. A cohort of 73 players (11-14 years) in the 2012-2013 Dutch national high-performance program was followed for 32 weeks; all participants completed the study. The OSTRC Questionnaire on Health Problems was used to record self-reported injuries and illnesses and to record training and match exposure. Main outcome measures were average prevalence of overuse injury and illness and incidence density of acute injury. On average, players practiced 9.1h/week (SD 0.6; range 2.3-12.0) and had 2.2h of match play (SD 0.6; range 2.3-12.0). During the course of the study, 67 players reported a total of 187 health problems. The average weekly prevalence of all health problems was 21.3% (95% CI: 19.2-22.9), of which 12.1% (95% CI: 10.9-13.3) constituted overuse injuries and 5.8% (95% CI: 4.6-6.9) illnesses. The incidence of acute injuries was 1.2/1000h of tennis play (95% CI: 0.7-1.7). The high occurrence of overuse injuries among elite junior tennis players suggests that an early focus on preventative measures is warranted, with a particular focus on the monitoring and management of workload. © 2016 John Wiley & Sons A/S.
Health and economic burden of running-related injuries in runners training for an event : A prospective cohort study
- Authors: Hespanhol Junior, Luiz , van Mechelen, Willem , Postuma, Eva , Verhagen, Evert
- Date: 2016
- Type: Text , Journal article
- Relation: Scandinavian Journal of Medicine and Science in Sports Vol. 26, no. 9 (2016), p. 1091-1099
- Full Text: false
- Reviewed:
- Description: Prospective running-related injury (RRI) data from runners training for an event are scarce, especially with regard to RRI-associated costs. Therefore, the aim of this study was to investigate the prevalence and economic burden of RRIs in runners participating in an organized training program preparing them for an event. This was a prospective cohort study with 18 weeks of follow-up. Individuals aged 18 or older and registered to participate in an organized running program were eligible. Follow-up surveys were sent every 2 weeks to collect data about running exposure, RRIs, and costs. Of the 161 potential participants, 53 (32.9%) were included in this study. A total of 32 participants reported 41 RRIs. The mean prevalence during follow-up was 30.8% [95% confidence interval (CI) 25.6–36.0%]. Overuse was the main mechanism of RRI (85.4%, n = 35). An RRI was estimated to have an economic burden of €57.97 (95% CI €26.17–94.00) due to healthcare utilization (direct costs) and €115.75 (95% CI €10.37–253.73) due to absenteeism from paid work (indirect costs). These results indicate that the health and economic burden of RRIs may be considered significant for public health. Therefore, prevention programs are needed for runners participating in organized training programs. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Interventions preventing ankle sprains; previous injury and high-risk sport participation as predictors of compliance
- Authors: Janssen, Kasper , Van Der Zwaard, Babette , Finch, Caroline , van Mechelen, Willem , Verhagen, Evert
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 19, no. 6 (Jun 2016), p. 465-469
- Full Text: false
- Reviewed:
- Description: Objectives: To describe the association between participants' person-related potential predictor variables and cumulative compliance with interventions for preventing ankle sprains: neuromuscular training, wearing an ankle brace, and a combined training and bracing. Design: Secondary analysis of compliance data from a randomized controlled trial (RCT) comparing measures preventing ankle ligament injuries. Methods: Ordinal regression with a backward selection method was used to obtain a descriptive statistical model linking participants' person-related potential predictor variables with the monthly cumulative compliance measurements for three interventions preventing ankle ligament injuries. Results: Having had a previous ankle injury was significantly associated with a higher compliance with all of the preventive measures trialed. Overall compliance with bracing and the combined intervention was significantly lower than the compliance with NM training. Per group analysis found that participating in a high-risk sport, like soccer, basketball, and volleyball, was significantly associated with a higher compliance with bracing, or a combined bracing and NM training. In contrast, participating in a high-risk sport was significantly associated with a lower per group compliance with NM training. Conclusions: Future studies should include at least registration of previous ankle sprains, sport participation (high- or low-risk), experience in NM training, and hours of sport exposure as possible predictors of compliance with interventions preventing ankle sprains. Practitioners should take into account these variables when prescribing preventive neuromuscular training or bracing. (C) 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
Short-term absenteeism and health care utilization due to lower extremity injuries among novice runners : A prospective cohort study
- Authors: Smits, Dirk-Wouter , Huisstede, Bionka , Verhagen, Evert , van der Worp, Henk , Kluitenberg, Bas , van Middelkoop, Marienke , Hartgens, Fred , Backx, Frank
- Date: 2016
- Type: Text , Journal article
- Relation: Clinical Journal of Sport Medicine Vol. 26, no. 6 (2016), p. 502-509
- Full Text: false
- Reviewed:
- Description: Objective: To describe absenteeism and health care utilization (HCU) within 6 weeks after occurrence of running-related injuries (RRIs) among novice runners and to explore differences relating to injury and personal characteristics. Participants: One thousand six hundred ninety-six novice runners (18-65 years) participating in a 6-week running program ("Start-to-Run"). Main Outcome Measures: Injury characteristics were assessed by weekly training logs and personal characteristics by a baseline questionnaire. Data on absenteeism and HCU were collected using questionnaires at 2 and 6 weeks after the RRI occurred. Results: A total of 185 novice runners (11%) reported an RRI during the 6-week program. Of these injured novice runners, 78% reported absence from sports, whereas only 4% reported absence from work. Fifty-one percent of the injured novice runners visited a health care professional, mostly physical therapists (PTs) rather than physicians. Absenteeism was more common among women than men and was also more common with acute RRIs than gradual-onset RRIs. As regards HCU, both the variety of professionals visited and the number of PT visits were higher among runners with muscle-tendon injuries in the ankle/foot region than among those with other RRIs. Conclusions: Among novice runners sustaining an RRI during a 6-week running program, over three quarters reported short-term absence from sports, whereas absence from work was very limited, and over half used professional health care. Both absence and HCU are associated with injury characteristics.
The impact of injury definition on injury surveillance in novice runners
- Authors: Kluitenberg, Bas , van Middelkoop, Marienke , Verhagen, Evert , Hartgens, Fred , Huisstede, Bionka , Diercks, Ron , van der Worp, Henk
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 19, no. 6 (Jun 2016), p. 470-475
- Full Text: false
- Reviewed:
- Description: Objectives: Despite several consensus statements, different injury definitions are used in the literature. This study aimed to identify the impact of different injury definitions on the nature and incidence of complaints captured during a short-term running program for novice runners. Methods: 1696 participants completed weekly diaries on running exposure and musculoskeletal complaints during a 6-week running program. These data were used to compare six different injury definitions (presence of running-related pain, training-reduction, time-loss of.one day or one week). Injuries were registered under these different definitions. Consequently incidence and the nature of complaints were compared between definitions. Results: The different injury definitions resulted in incidences that varied between 7.5% and 58.0%, or 18.7 and 239.6 injuries per 1000 h of running. The median duration of injury complaints was 4-7 days for injuries registered under a 'day definition', while complaints registered under a 'week definition' lasted 20-22 days. For running-related pain injuries the median of the maximum amount of pain was 3.0. In training-reduction and time-loss injuries these median values were scored between 5.0 and 7.0. No significant differences in anatomical locations between injuries that were registered under a 'day definition' or a 'week definition' were found. Injuries registered under a time-loss definition were located relatively more often at the knee, while complaints at the pelvis/sacrum/buttock were captured more often under a running-related pain definition. Conclusions: Injury definitions largely impact injury incidence. Location of injury is also affected by choice of injury definition. This stressed the need for standardized injury registration methods. (C) 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved. Groningen, Netherlands.
The NLstart2run study : Economic burden of running-related injuries in novice runners participating in a novice running program
- Authors: Hespanhol Junior, Luiz , Huisstede, Bionka , Smits, Dirk-Wouter , Kluitenberg, Bas , van der Worp, Henk , van Middelkoop, Marienke , Hartgens, Fred , Verhagen, Evert
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 19, no. 10 (2016), p. 800-804
- Full Text: false
- Reviewed:
- Description: Objectives: To investigate the economic burden of running-related injuries (RRI) occurred during the 6-week 'Start-to-Run' program of the Dutch Athletics Federation in 2013. Methods: This was a monetary cost analysis using the data prospectively gathered alongside the RRI registration in the NLstart2run study. RRI data were collected weekly. Cost diaries were applied two and six weeks after the RRI registration to collect data regarding healthcare utilisation (direct costs) and absenteeism from paid and unpaid work (indirect costs). RRI was defined as running-related pain that hampered running ability for three consecutive training sessions. Results: From the 1696 participants included in the analysis, 185 reported a total of 272 RRIs. A total of 26.1% of the cost data (71 RRIs reported by 50 participants) were missing. Therefore, a multiple imputation procedure was performed. The economic burden (direct plus indirect costs) of RRIs was estimated at (sic)83.22 (95% CI(sic)50.42-(sic)116.02) per RRI, and (sic)13.35 (95% CI(sic)7.07-(sic)19.63) per participant. The direct cost per RRI was (sic)56.93 (95% CI (sic)42.05-(sic)71.81) and the indirect cost per RRI was (sic)26.29(95% CI (sic)0.00-(sic)54.79). The indirect cost was higher for sudden onset RRIs than for gradual onset RRIs, with a mean difference of (sic)33.92 (95% CI (sic)17.96-(sic)49.87). Conclusions: Direct costs of RRIs were 2-fold higher than the indirect costs, and sudden onset RRIs presented higher costs than gradual onset RRIs. The results of this study are important to provide information to public health agencies and policymakers about the economic burden of RRIs in novice runners. (C) 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
The NLstart2run study : Training-related factors associated with running-related injuries in novice runners
- Authors: Kluitenberg, Bas , van der Worp, Henk , Huisstede, Bionka , Hartgens, Fred , Diercks, Ron , Verhagen, Evert , van Middelkoop, Marienke
- Date: 2016
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 19, no. 8 (2016), p. 642-646
- Full Text: false
- Reviewed:
- Description: Objectives: The incidence of running-related injuries is high. Some risk factors for injury were identified in novice runners, however, not much is known about the effect of training factors on injury risk. Therefore, the purpose of this study was to examine the associations between training factors and running-related injuries in novice runners, taking the time varying nature of these training-related factors into account. Design: Prospective cohort study. Methods: 1696 participants completed weekly diaries on running exposure and injuries during a 6-week running program for novice runners. Total running volume (min), frequency and mean intensity (Rate of Perceived Exertion) were calculated for the seven days prior to each training session. The association of these time-varying variables with injury was determined in an extended Cox regression analysis. Results: The results of the multivariable analysis showed that running with a higher intensity in the previous week was associated with a higher injury risk. Running frequency was not significantly associated with injury, however a trend towards running three times per week being more hazardous than two times could be observed. Finally, lower running volume was associated with a higher risk of sustaining an injury. Conclusions: These results suggest that running more than 60 min at a lower intensity is least injurious. This finding is contrary to our expectations and is presumably the result of other factors. Therefore, the findings should not be used plainly as a guideline for novices. More research is needed to establish the person-specific training patterns that are associated with injury. © 2015 Sports Medicine Australia.
Injury risk during different physical activity behaviours in children: A Systematic review with bias assessment
- Authors: Nauta, Joske , Martin-Diener, Eva , Martin, Brian , van Mechelen, Willem , Verhagen, Evert
- Date: 2015
- Type: Text , Journal article
- Relation: Sports Medicine Vol. 45, no. 3 (2015), p. 327-336
- Full Text: false
- Reviewed:
- Description: Results: Eight studies were included. The risk of bias assessment resulted in two studies with a score that was higher than 75 %; risk bias of those two studies was considered low. The medically treated, injury incidence rate was reported to be between 0.15 and 0.27 injuries per 1,000 h of physical activity. The absolute number of injuries related to unorganised leisure time physical activity was higher than the absolute number of injuries reported in organised sports. The respective injury incidence rate expressed per 1,000 h exposure was, however, generally lower during unorganised leisure time than during organised sports. Reported injury incidence rates related to active commuting were comparable to those for unorganised leisure time physical activity. Conflicting injury incidence rates were reported for physical education. Subgroup analysis suggested that girls and children with low habitual levels of physical activity are at increased injury risk. A limitation of the review is that no standard bias assessment was available for this specific context.Conclusions: Children are at an inherent injury risk while participating in physical activities. Most injury prevention efforts have focussed on the sports setting, but our results suggest that many children sustain an injury during unorganised leisure time physical activities.Introduction: The current focus on a physically active lifestyle in children puts children at increased physical activity-related injury risk.Objective: To summarise, in a systematic review, the evidence for the injury risk of several physical activity behaviours in 6- to 12-year-old children.Methods: An electronic search was performed in three databases (Embase, PubMed and SPORTDiscus). Inclusion criteria were: age 6–12 years; report on injuries related to overall physical activity, active commuting, unorganised leisure time physical activity, physical education and/or organised sports; incidence rates expressed as injuries per hours of physical activity; and published after January 1st 2000. Risk of bias was assessed for all studies included. © 2014, Springer International Publishing Switzerland.
Exercise-Based Injury Prevention in Child and Adolescent Sport: A Systematic Review and Meta-Analysis
- Authors: Rossler, Roland , Donath, Lars , Verhagen, Evert , Junge, Astrid , Schweizer, Thomas , Faude, Oliver
- Date: 2014
- Type: Text , Journal article
- Relation: Sports Medicine Vol. 44, no. 12 (2014), p. 1733-1748
- Full Text: false
- Reviewed:
- Description: Background: The promotion of sport and physical activity (PA) for children is widely recommended to support a healthy lifestyle, but being engaged in sport bears the risk of sustaining injuries. Injuries, in turn, can lead to a reduction in current and future involvement in PA and, therefore, may negatively affect future health as well as quality of life. Thus, sports injury prevention is of particular importance in youth. Objective: The aim of this systematic review was to quantify the effectiveness of exercise-based injury prevention programs in child and adolescent sport in general, and with respect to different characteristics of the target group, injury prevention program, and outcome variables. Data Sources: An Internet-based literature search was conducted in six databases (CINAHL, Cochrane, EMBASE, ISI Web of Science, PubMed, SPORTDiscus) using the following search terms with Boolean conjunction: (sport injur* OR athletic injur* OR sport accident*) AND (prevent* OR prophylaxis OR avoidance) AND (child* OR adolescent OR youth). Study Selection: Randomized controlled trials and controlled intervention studies in organized sport, published in English in a peer-reviewed journal, analyzing the effects of an exercise-based injury prevention program in athletes younger than 19 years of age. Data Extraction: Two reviewers evaluated eligibility and methodological quality. Main outcome extracted was the rate ratio (RR). Statistical analyses were conducted using the inverse-variance random effects model. Results: Twenty-one trials, conducted on a total of 27,561 athletes (median age 16.7 years [range 10.7-17.8]), were included. The overall RR was 0.54 (95% CI 0.45-0.67) [p < 0.001]. Girls profited more from injury prevention than boys (p = 0.05). Both prevention programs with a focus on specific injuries (RR 0.48 [95% CI 0.37-0.63]) and those aiming at all injuries (RR 0.62 [95% CI 0.48-0.81]) showed significant reduction effects. Pre-season and in-season interventions were similarly beneficial (p = 0.93). Studies on programs that include jumping/plyometric exercises showed a significant better (p = 0.002) injury preventive effect (RR 0.45 [95 % CI 0.35-0.57], Z = 6.35, p < 0.001) than studies without such exercises (RR 0.74 [95% CI 0.61-0.90], Z = 3.03, p = 0.002). Conclusions: The results provide good evidence and clearly demonstrate beneficial effects of exercise-based injury prevention programs in youth sports as they can result in statistically significant and practically relevant injury reduction. In particular, multimodal programs including jumping/plyometric exercises can be recommended. However, there is a considerable lack of data for children (under 14 years of age) and for individual sports in general. Future research should include these groups and focus on the effect of specific exercises and compliance.
The impact of adherence on sports injury prevention effect estimates in randomised controlled trials : Looking beyond the CONSORT statement
- Authors: Verhagen, Evert , Huuperans, Maarten , Finch, Caroline , van Mechelen, Willem
- Date: 2011
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 14, no. 4 (July 2011 2011), p. 287-292
- Relation: http://purl.org/au-research/grants/nhmrc/565900
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- Description: Objective: To investigate estimated outcome effects of a sports injury prevention intervention when analysed by means of a per protocol (PP) analysis approach. Design: Randomised controlled trial (RCT) involving 522 athletes who sustained a lateral ankle sprain allocated to either an intervention (received a preventive programme in addition to usual care) or control group who were followed prospectively for one year. Methods: Secondary analysis of data relating to registered ankle sprain recurrences, exposure and adherence to the allocated intervention using a PP analysis approach. Results: Twenty-three percent of the RCT intervention group indicated to have fully adhered with the neuromuscular training programme. A per protocol analysis only considering fully adherent athletes and control athletes, showed a Hazard Ratio of 0.18 (95% CI: 0.07-0.43). Significantly fewer recurrent ankle sprains were found in the fully adherent group compared to the group that was not adherent (relative risk = 0.63; 95% CI: 0.43-0.99). Conclusions: A PP analysis on fully adherent athletes versus control group athletes showed that the established intervention effect was over threefold higher compared to an earlier intention-to-treat based analysis approach. This shows that outcomes of intervention studies are heavily biased by adherence to the allocated intervention.
Seasonal time-loss match injury rates and burden in South African under-16 rugby teams
- Authors: Sewry, Nicola , Verhagen, Evert , Lambert, Mike , van Mechelen, Willem , Readhead, Clint , Viljoen, Wayne , Brown, James
- Date: 2019
- Type: Text , Journal article
- Relation: Journal of Science and Medicine in Sport Vol. 22, no. 1 (2019), p. 54-58
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- Reviewed:
- Description: Objectives: Youth rugby union is a popular sport with a high injury incidence density (IID) and burden. This high risk has called for further research into the factors affecting the injuries in youth rugby. The aim of the study was to analyse time-loss IID and burden in multiple schoolboy rugby teams over a season and the potential factors associated with injury. Design: Prospective cohort Methods: All time-loss injuries were recorded from three schools for the whole season. Overall IID and injury burden were calculated, as well as for injury event, type, location and the match quarter in which they occurred and Poisson regression analyses were performed to determine differences. Results: IID was 28.8 (18.9–38.6) injuries per 1000 player hours over the season, with an injury burden of 379.2 (343.6–414.9) days lost per 1000 player hours. The ball-carrier had a significantly higher IID (11.3 (5.2–17.5) per 1000 player hours) compared to other events, and the joint (non-bone)/ligament injuries were the most common (IID of 12.2 (5.8–18.6) per 1000 player hours) and severe type of injury (burden of 172.6 (148.5–196.6) days lost per 1000 player hours). Conclusions: The IID was similar to previous youth rugby studies, however the injury burden was much lower. The South African youth cohort showed similar factors associated with injury for inciting event (the tackle) and injury type (joint (non-bone)/ligament) and location (lower limb) as seen in other studies in both youth and senior players.