Description:
Objectives: The use of microsensor technologies to conduct research and implement interventions in sports and exercise medicine has increased recently. The objective of this paper was to determine the validity and reliability of the ViPerform as a measure of load compared to vertical ground reaction force (GRF) as measured by force plates. Design: Absolute reliability assessment, with concurrent validity. Methods: 10 professional triathletes ran 10 trials over force plates with the ViPerform mounted on the mid portion of the medial tibia. Calculated vertical ground reaction force data from the ViPerform was matched to the same stride on the force plate. Bland–Altman (BA) plot of comparative measure of agreement was used to assess the relationship between the calculated load from the accelerometer and the force plates. Reliability was calculated by intra-class correlation coefficients (ICC) with 95% confidence intervals. Results: BA plot indicates minimal agreement between the measures derived from the force plate and ViPerform, with variation at an individual participant plot level. Reliability was excellent (ICC = 0.877; 95% CI = 0.825–0.917) in calculating the same vertical GRF in a repeated trial. Standard error of measure (SEM) equalled 99.83 units (95% CI = 82.10–119.09), which, in turn, gave a minimum detectable change (MDC) value of 276.72 units (95% CI = 227.32–330.07). Conclusions: The ViPerform does not calculate absolute values of vertical GRF similar to those measured by a force plate. It does provide a valid and reliable calculation of an athlete’s lower limb load at constant velocity.
Description:
Objectives: Physiotherapists promote physical activity as part of their practice. This study reviewed the behaviour change techniques physiotherapists use when promoting physical activity in experimental and observational studies. Design: Systematic review of experimental and observational studies. Methods: Twelve databases were searched using terms related to physiotherapy and physical activity. We included experimental studies evaluating the efficacy of physiotherapist-led physical activity interventions delivered to adults in clinic-based private practice and outpatient settings to individuals with, or at risk of, non-communicable diseases. Observational studies reporting the techniques physiotherapists use when promoting physical activity were also included. The behaviour change techniques used in all studies were identified using the Behaviour Change Technique Taxonomy. The behaviour change techniques appearing in efficacious and inefficacious experimental interventions were compared using a narrative approach. Results: Twelve studies (nine experimental and three observational) were retained from the initial search yield of 4141. Risk of bias ranged from low to high. Physiotherapists used seven behaviour change techniques in the observational studies, compared to 30 behaviour change techniques in the experimental studies. Social support (unspecified) was the most frequently identified behaviour change technique across both settings. Efficacious experimental interventions used more behaviour change techniques (n = 29) and functioned in more ways (n = 6) than did inefficacious experimental interventions (behaviour change techniques = 10 and functions = 1). Conclusions: Physiotherapists use a small number of behaviour change techniques. Less behaviour change techniques were identified in observational studies compared to experimental studies, suggesting physiotherapists use less BCTs clinically than experimentally.
Description:
Objectives: To assess the utility and functionality of the X-Patch® as a measurement tool to study head impact exposure in Australian Football. Accuracy, precision, reliability and validity were examined. Designs: Laboratory tests and prospective observational study. Methods: Laboratory tests on X-Patch® were undertaken using an instrumented Hybrid III head and neck and linear impactor. Differences between X-Patch® and reference data were analysed. Australian Football players wore the X-Patch® devices and games were video-recorded. Video recordings were analysed qualitatively for head impact events and these were correlated with X-Patch® head acceleration events. Wearability of the X-Patch® was assessed using the Comfort Rating Scale for Wearable Computers. Results: Laboratory head impacts, performed at multiple impact sites and velocities, identified significant correlations between headform-measured and device-measured kinematic parameters (p < 0.05 for all). On average, the X-Patch®-recorded peak linear acceleration (PLA) was 17% greater than the reference PLA, 28% less for peak rotational acceleration (PRA) and 101% greater for the Head Injury Criterion (HIC). For video analysis, 118 head acceleration events (HAE) were included with PLA ≥30 g across 53 players. Video recordings of X-Patch®-measured HAEs (PLA ≥30 g) determined that 31.4% were direct head impacts, 9.3% were indirect impacts, 44.1% were unknown or unclear and 15.3% were neither direct nor indirect head impacts. The X-Patch® system was deemed wearable by 95–100% of respondents. Conclusions: This study reinforces evidence that use of the current X-Patch® devices should be limited to research only and in conjunction with video analysis.
Description:
Background: Tendon pathology on imaging has been associated with an increased risk of developing symptoms. This evidence is based on classifying the tendon as normal or pathological. It is unclear whether the extent of tendon pathology is associated with the development or severity of symptoms. Objectives: To investigate whether the presence and extent of tendon pathology on ultrasound tissue characterisation (UTC), or a previous history of symptoms, were associated with the development of symptoms over a football season. Methods: 179 male Australian football players underwent UTC imaging of their Achilles and/or patellar tendon at the start of the pre-season. Players completed monthly OSTRC overuse questionnaires to quantify the presence and severity of Achilles and/or patellar tendon symptoms. Risk factor analysis was performed to identify associations between imaging and the development of symptoms. Results: A pathological Achilles tendon increased the risk of developing symptoms (RR = 3.2, 95%CI 1.7–5.9). Conversely, a pathological patellar tendon was not significantly associated with the development of symptoms (RR = 1.8, 95%CI 0.9–3.7). Quantification of tendon structure using UTC did not enhance the ability to identify athletes who developed symptoms. Previous history of symptoms was the strongest predictor for the development of symptoms (Achilles RR = 3.0 95%CI 1.8–4.8; patellar RR = 3.7 95%CI 2.2–6.1). Conclusion: Tendon pathology was associated with the development of self-reported symptoms; however previous history of symptoms was a stronger risk factor. The extent of disorganisation quantified by UTC should not be used as a marker for the presence or severity of current and future symptoms.
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.
Description:
Objectives To examine different timeframes for calculating acute to chronic workload ratio (ACWR) and whether this variable is associated with intrinsic injury risk in elite Australian football players. Design Prospective cohort study. Methods Internal (session rating of perceived exertion: sRPE) and external (GPS distance and sprint distance) workload and injury data were collected from 70 players from one AFL club over 4 seasons. Various acute (1–2 weeks) and chronic (3–8 weeks) timeframes were used to calculate ACWRs: these and chronic load categories were then analysed to determine the injury risk in the subsequent month. Poisson regression with robust errors within a generalised estimating equation were utilised to determine incidence rate ratios (IRR). Results Altering acute and/or chronic timeframes did not improve the ability to detect high injury risk conditions above the commonly used 1:4 week ACWR. Twenty-seven ACWR/chronic load combinations were found to be “high risk conditions” (IRR > 1, p < 0.05) for injury within 7 days. Most (93%) of these conditions occurred when chronic load was low or very low and ACWR was either low (<0.6) or high (>1.5). Once a high injury risk condition was entered, the elevated risk persisted for up to 28 days. Conclusions Injury risk was greatest when chronic load was low and ACWR was either low or high. This heightened risk remained for up to 4 weeks. There was no improvement in the ability to identify high injury risk situations by altering acute or chronic time periods from 1:4 weeks.
How much is enough in rehabilitation? High running workloads following lower limb muscle injury delay return to play but protect against subsequent injury
Description:
Objectives: Examine the influence of rehabilitation training loads on return to play (RTP) time and subsequent injury in elite Australian footballers. Design: Prospective cohort study. Methods: Internal (sessional rating of perceived exertion: sRPE) and external (distance, sprint distance) workload and lower limb non-contact muscle injury data was collected from 58 players over 5 seasons. Rehabilitation periods were analysed for running workloads and time spent in 3 rehabilitation stages (1: off-legs training, 2: non-football running, 3: group football training) was calculated. Multi-level survival analyses with random effects accounting for player and season were performed. Hazard ratios (HR) and 95% confidence intervals (CI) for each variable were produced for RTP time and time to subsequent injury. Results: Of 85 lower limb muscle injuries, 70 were rehabilitated to RTP, with 30 cases of subsequent injury recorded (recurrence rate = 11.8%, new site injury rate = 31.4%). Completion of high rehabilitation workloads delayed RTP (distance: >49,775 m [reference: 34,613–49,775 m]: HR 0.12, 95%CI 0.04–0.36, sRPE: >1266 AU [reference: 852–1266 AU]: HR 0.09, 95%CI 0.03–0.32). Return to running within 4 days increased subsequent injury risk (3–4 days [reference: 5–6 days]: HR 25.88, 95%CI 2.06–324.4). Attaining moderate-high sprint distance (427–710 m) was protective against subsequent injury (154–426 m: [reference: 427–710 m]: HR 37.41, 95%CI 2.70–518.64). Conclusions: Training load monitoring can inform player rehabilitation programs. Higher rehabilitation training loads delayed RTP; however, moderate-high sprint running loads can protect against subsequent injury. Shared-decision making regarding RTP should include accumulated training loads and consider the trade-off between expedited RTP and lower subsequent injury risk.
Description:
Objectives: Examine the influence of rehabilitation training loads on return to play (RTP) time and subsequent injury in elite Australian footballers. Design: Prospective cohort study. Methods: Internal (sessional rating of perceived exertion: sRPE) and external (distance, sprint distance) workload and lower limb non-contact muscle injury data was collected from 58 players over 5 seasons. Rehabilitation periods were analysed for running workloads and time spent in 3 rehabilitation stages (1: off-legs training, 2: non-football running, 3: group football training) was calculated. Multi-level survival analyses with random effects accounting for player and season were performed. Hazard ratios (HR) and 95% confidence intervals (CI) for each variable were produced for RTP time and time to subsequent injury. Results: Of 85 lower limb muscle injuries, 70 were rehabilitated to RTP, with 30 cases of subsequent injury recorded (recurrence rate = 11.8%, new site injury rate = 31.4%). Completion of high rehabilitation workloads delayed RTP (distance: >49,775 m [reference: 34,613–49,775 m]: HR 0.12, 95%CI 0.04–0.36, sRPE: >1266 AU [reference: 852–1266 AU]: HR 0.09, 95%CI 0.03–0.32). Return to running within 4 days increased subsequent injury risk (3–4 days [reference: 5–6 days]: HR 25.88, 95%CI 2.06–324.4). Attaining moderate-high sprint distance (427–710 m) was protective against subsequent injury (154–426 m: [reference: 427–710 m]: HR 37.41, 95%CI 2.70–518.64). Conclusions: Training load monitoring can inform player rehabilitation programs. Higher rehabilitation training loads delayed RTP; however, moderate-high sprint running loads can protect against subsequent injury. Shared-decision making regarding RTP should include accumulated training loads and consider the trade-off between expedited RTP and lower subsequent injury risk.
Description:
Objectives Forearm injuries are common and debilitating to elite rowers. Chronic exertional compartment syndrome, intersection syndrome and proximal radial bone stress injuries have been documented in this population. This paper explores the imaging findings related to these conditions in asymptomatic elite rowers. Design Observational study. Methods 19 asymptomatic senior elite and under-23 rowers currently competing at National level or above underwent ultrasound (US), Magnetic Resonance Imaging (MRI) and muscle functional MRI evaluation of their forearms. A comprehensive evaluation sheet identifying characteristics of bone stress, intersection syndrome and chronic exertional compartment syndrome was utilised based on a literature search and review by senior clinicians working with this population. Results Peritendinous fluid of Extensor Carpi Radialis Longus (n=10, 53%) or Extensor Carpi Radialis Brevis (n=6, 32%) was a common finding on US. MRI had a higher rate of identification than US. Extensor Digitorum (Coeff=−1.76, 95%CI −3.04 to −0.49), Flexor Carpi Radialis (Coeff=−2.86, 95%CI −5.35 to −0.38) and Flexor Carpi Ulnaris (Coeff=−3.31, 95%CI −5.30 to −1.32), Pronator Teres (Coeff=−3.94, 95%CI −6.89 to −0.99), and Supinator (Coeff=−168, 95%CI −3.28 to −0.02) showed statistically significant changes immediately post-exercise. Mild proximal radial marrow hyperintensity was present (n=15, 78.9%) with three participants (15.8%) also having mild periosteal oedema of the radius. Conclusions Imaging findings commonly seen in symptomatic populations are observed in elite, asymptomatic rowers. Care should be taken when diagnosing bone stress injuries, intersection syndrome and compartment syndrome on imaging findings alone. Data presented can be utilised as a normative dataset for future case studies.
Description:
Objectives: Physiotherapists promote physical activity as part of their practice. This study reviewed the behaviour change techniques physiotherapists use when promoting physical activity in experimental and observational studies. Design: Systematic review of experimental and observational studies. Methods: Twelve databases were searched using terms related to physiotherapy and physical activity. We included experimental studies evaluating the efficacy of physiotherapist-led physical activity interventions delivered to adults in clinic-based private practice and outpatient settings to individuals with, or at risk of, non-communicable diseases. Observational studies reporting the techniques physiotherapists use when promoting physical activity were also included. The behaviour change techniques used in all studies were identified using the Behaviour Change Technique Taxonomy. The behaviour change techniques appearing in efficacious and inefficacious experimental interventions were compared using a narrative approach. Results: Twelve studies (nine experimental and three observational) were retained from the initial search yield of 4141. Risk of bias ranged from low to high. Physiotherapists used seven behaviour change techniques in the observational studies, compared to 30 behaviour change techniques in the experimental studies. Social support (unspecified) was the most frequently identified behaviour change technique across both settings. Efficacious experimental interventions used more behaviour change techniques (n = 29) and functioned in more ways (n = 6) than did inefficacious experimental interventions (behaviour change techniques = 10 and functions = 1). Conclusions: Physiotherapists use a small number of behaviour change techniques. Less behaviour change techniques were identified in observational studies compared to experimental studies, suggesting physiotherapists use less BCTs clinically than experimentally.
Implementation of concussion guidelines in community Australian Football and Rugby League - The experiences and challenges faced by coaches and sports trainers
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.
Description:
Objectives: Due to the complex systems nature of injuries, the responsibility for injury risk management cannot lie solely within a single domain of professional practice. Interdisciplinary collaboration between technical/tactical coaches, strength and conditioning coaches, team doctors, physical therapists and sport scientists is likely to have a meaningful impact on injury risk. This study describes the application and efficacy of a multidisciplinary approach to reducing team injury risk in professional rugby union. Design: Observational longitudinal cohort study. Methods: Epidemiological injury data was collected from a professional rugby union team for 5 consecutive seasons. Following each season, these data informed multidisciplinary intervention strategies to reduce injury risk. The effectiveness of these strategies was iteratively assessed to inform future interventions. Specific examples of intervention strategies are provided. Results: Overall team injury burden displayed a likely beneficial decrease (−8%; injury rate ratio (IRR) 0.9, 95%CI 0.9–1.0) from 2012 to 2016. This was achieved through a most likely beneficial improvement in non-contact injury burden (−39%; IRR 0.6, 95%CI 0.6–0.7). Contact injury burden was increased, but to a lesser extent (+18%; IRR 1.2, 95%CI 1.1–1.3, most likely harmful) during the same period. Conclusions: The range of skills required to effectively manage complex injury phenomena in professional collision sport crosses disciplinary boundaries. The evidence presented here points to the effectiveness of a multidisciplinary approach to reducing injury risk. This model will likely be applicable across a range of team and individual sports.
Description:
Objectives: Due to the complex systems nature of injuries, the responsibility for injury risk management cannot lie solely within a single domain of professional practice. Interdisciplinary collaboration between technical/tactical coaches, strength and conditioning coaches, team doctors, physical therapists and sport scientists is likely to have a meaningful impact on injury risk. This study describes the application and efficacy of a multidisciplinary approach to reducing team injury risk in professional rugby union. Design: Observational longitudinal cohort study. Methods: Epidemiological injury data was collected from a professional rugby union team for 5 consecutive seasons. Following each season, these data informed multidisciplinary intervention strategies to reduce injury risk. The effectiveness of these strategies was iteratively assessed to inform future interventions. Specific examples of intervention strategies are provided. Results: Overall team injury burden displayed a likely beneficial decrease (−8%; injury rate ratio (IRR) 0.9, 95%CI 0.9–1.0) from 2012 to 2016. This was achieved through a most likely beneficial improvement in non-contact injury burden (−39%; IRR 0.6, 95%CI 0.6–0.7). Contact injury burden was increased, but to a lesser extent (+18%; IRR 1.2, 95%CI 1.1–1.3, most likely harmful) during the same period. Conclusions: The range of skills required to effectively manage complex injury phenomena in professional collision sport crosses disciplinary boundaries. The evidence presented here points to the effectiveness of a multidisciplinary approach to reducing injury risk. This model will likely be applicable across a range of team and individual sports.