Carly McKay

Evaluation of how different implementation strategies of an injury prevention programme (FIFA 11+) impact team adherence and injury risk in Canadian female youth football players: a cluster-randomised trial

Background Injury prevention programme delivery on adherence and injury risk, specifically involving regular supervisions with coaches and players on programme execution on field, has not been examined. Aim The objective of this cluster-randomised study was to evaluate different delivery methods of an effective injury prevention programme (FIFA 11+) on adherence and injury risk among female youth football teams. Method During the 4-month 2011 football season, coaches and 13-year-old to 18-year-old players from 31 tier 1–3 level teams were introduced to the 11+ through either an unsupervised website (‘control’) or a coach-focused workshop with (‘comprehensive’) and without (‘regular’) additional supervisions by a physiotherapist. Team and player adherence to the 11+, playing exposure, history and injuries were recorded. Results Teams in the comprehensive and regular intervention groups demonstrated adherence to the 11+ programme of 85.6% and 81.3% completion of total possible sessions, compared to 73.5% for teams in the control group. These differences were not statistically significant, after adjustment for cluster by team, age, level and injury history. Compared to players with low adherence, players with high adherence to the 11+ had a 57% lower injury risk (IRR 0.43, 95% CI 0.19 to 1.00). However, adjusting for covariates, this between-group difference was not statistically significant (IRR=0.44, 95% CI 0.18 to 1.06). Conclusion Following a coach workshop, coach-led delivery of the FIFA 11+ was equally successful with or without the additional field involvement of a physiotherapist. Proper education of coaches during an extensive preseason workshop was more effective in terms of team adherence than an unsupervised delivery of the 11+ programme to the team. Trial registration ISRCTN67835569.

Subjective, but not Objective, Lingering Effects of Multiple Past Concussions in Adolescents

The existing literature on lingering effects from concussions in children and adolescents is limited and mixed, and there are no clear answers for patients, clinicians, researchers, or policy makers. The purpose of this study was to examine whether there are lingering effects of past concussions in adolescent athletes. Participants in this study included 643 competitive Bantam and Midget hockey players (most elite 20% by division of play) between 13 and 17 years of age (mean age=15.5, SD=1.2). Concussion history at baseline assessment was retrospectively documented using a pre-season questionnaire (PSQ), which was completed at home by parents and players in advance of baseline testing. Players with English as a second language, self-reported attention or learning disorders, a concussion within 6 months of baseline, or suspected invalid test profiles were excluded from these analyses. Demographically adjusted standard scores for the five composites/domains and raw symptom ratings from the brief Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized battery were analyzed. Adolescent athletes with one or two or more prior concussions did not have significantly worse neurocognitive functioning on ImPACT than did those with no previous concussions. There were significantly more symptoms reported in those with two or more prior concussions than in those with no or one prior concussion. Adolescents with multiple previous concussions had higher levels of baseline symptoms, but there were not group differences in neurocognitive functioning using this brief computerized battery.

The effect of coach and player injury knowledge, attitudes and beliefs on adherence to the FIFA 11+ programme in female youth soccer

Background Injury knowledge and beliefs influence uptake of prevention programmes, but the relationship between knowledge, beliefs and adherence remains unclear. Aim To describe injury knowledge and beliefs among youth female soccer coaches and players, and to identify the relationship between these factors, different delivery strategies of the FIFA 11+ programme and adherence. Methods A subcohort analysis from a cluster-randomised controlled trial of 31 female soccer teams (coaches n=29, players (ages 13–18) n=258). Preseason and postseason questionnaires were used to assess knowledge and beliefs. Teams recorded FIFA 11+ adherence during the season. Results At baseline, 62.8% (95% CI 48.4% to 77.3%) of coaches and 75.8% (95% CI 71.5% to 80.1%) of players considered ‘inadequate warm-up’ a risk factor for injury. There was no effect of delivery method (OR=1.1; 95% CI 0.8 to 1.5) or adherence (OR=1.0; 95% CI 0.9 to 1.1) on this belief. At baseline, 13.8% (95% CI 1.3% to 26.4%) of coaches believed a warm-up could prevent muscle injuries, but none believed it could prevent knee and ankle injuries. For players, 9.7% (95% CI 6.1% to 13.3%), 4.7% (95% CI 2.1% to 7.3%) and 4.7% (95% CI 2.1% to 7.3%) believed a warm-up would prevent muscle, knee and ankle injuries, respectively. Years of playing experience were negatively associated with high adherence for coaches (OR=0.93; 0.88 to 0.99) and players (OR=0.92; 0.85 to 0.98). Conclusions There were gaps in injury knowledge and beliefs, which differed for coaches and players. Beliefs did not significantly affect adherence to the FIFA 11+, suggesting additional motivational factors should be considered.

Examining attitudes toward body checking, levels of emotional empathy, and levels of aggression in body checking and non-body checking youth hockey leagues.

Objectives:To determine if attitudes associated with body checking, emotional empathy, and aggression differ between players in body checking and non-body checking hockey leagues and to determine the influence of these attitudes on injury rates. Design:Prospective cohort. Setting:Participants were randomly recruited by team from the Calgary Minor Hockey Association at the beginning of the 2006-2007 season. Participants:There were 283 participants from Pee Wee (aged 11-12 years), Bantam (aged 13-14 years), and Midget (aged 15-16 years) teams. Of 13 teams from the body checking league, 138 players participated, and of 24 teams in the non-body checking league, 145 players participated. Assessment of Risk Factors:Participants completed 4 self-report questionnaires: (1) Medical Questionnaire, (2) Body Checking Questionnaire, (3) Empathy Index for Children and Adolescents, and (4) Buss-Perry Aggression Questionnaire. Main Outcome Measures:Participants were followed through the season for injury reports. The injury definition included any hockey injury resulting in medical attention, the inability to complete a hockey session, and/or missing a subsequent hockey session. Results:Body checking players reported more positive attitudes toward body checking (35.59; 95% confidence interval [CI]: 34.52-36.65) than non-body checking players (22.43; 95% CI, 21.38-23.49; t = −17.34; P < 0.00005). There was no significant difference in the empathy scores between cohorts (t = 1.51, P = 0.13). The mean aggression score for the body checking players (76.22; 95% CI, 73.18-79.25) was significantly higher than the mean for the non-body checking players (70.57; 95% CI, 67.35-73.80; t = −2.52; P = 0.013). Conclusions:Body checking seems to influence attitudes toward body checking and aggression, but attitudes toward body checking, empathy, and aggression did not influence injury rates.

The epidemiology of professional ice hockey injuries: a prospective report of six NHL seasons

Background There is a paucity of literature examining injury and illness rates in mens professional ice hockey. This study aimed to determine injury and illness rates in the NHL over six seasons, and identify predictors of injury-related time loss in this population. Methods This study involved an inclusive cohort of hockey players from all NHL teams competing in the 2006–2007 through 2011–2012 seasons. A standardised electronic injury surveillance system was used to report injury and illness events. The primary outcome was regular season and postseason time-loss injury/illness. The secondary outcome was man-games lost from the competition. Results On the basis of the estimated athlete exposures (AEs), the overall regular season incidence density was 15.6 injuries/1000 AEs and 0.7 illnesses/1000 AEs. Based on recorded time on ice, the injury rates were roughly threefold higher at 49.4 injuries/1000 player game-hours and 2.4 illnesses/1000 player game-hours. There was a reduction in injury rates over the 6-year period, with the greatest reduction between the 2007–2008 and 2008–2009 seasons. Multivariate predictors of time loss greater than 10 days were being a goalie (OR=1.68, 95% CI 1.18 to 2.38), being injured in a road game (OR=1.43, 95% CI 1.25 to 1.63) and the mechanism of injury being a body check (OR=2.21, 95% CI 1.86 to 2.62). Conclusions There was an overall reduction in the time-loss injury and illness rates over six seasons. Being a goaltender, being injured on the road and being injured by a body check were the risk factors for time loss greater than five ‘man games’.

Absence of differences between male and female adolescents with prior sport concussion.

Objective:Sex differences following concussion are poorly understood. The purpose of this study was to examine whether male and female adolescent athletes with prior concussions differ regarding neurocognitive function and symptom reporting. Setting:Community-based hockey teams. Participants:Participants included 615 elite hockey players 13 to 17 years old (mean = 15.5, 95% confidence interval [CI] = 15.4-15.6). There were 517 males and 98 females. Players with English as a second language, attention or learning problems, a concussion within 6 months of baseline, or suspected invalid test profiles were excluded from these analyses. Design:Cross-sectional. Main Measure:Domain scores and symptom ratings from the ImPACT computerized battery. Results:There were no significant neurocognitive differences between males and females with (F5,227 = 1.40, P = .227) or without (F5,376 = 1.33, P = 0.252) a prior history of concussion. Male and female athletes with a history of concussion reported higher raw symptom scores than those without a prior concussion; however, sex differences disappear when symptom scores are adjusted for known sex differences in controls (total score, F2,230 = 0.77, P = .46; Cohen d = 0.01 or domain scores (F4,227 = 1.52, P = .197; Cohen d = 0.07-0.18). Conclusions:Although those with prior concussions report more symptoms (but do not differ on neurocognition), this study does not support sex differences with cognition or symptoms in adolescent athletes with prior concussions.

Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial

Background Injury risk in youth rugby has received much attention, highlighting the importance of establishing evidence-based injury reduction strategies. Aim To determine the efficacy of a movement control exercise programme in reducing injuries in youth rugby players and to investigate the effect of programme dose on injury measures. Methods In a cluster-randomised controlled trial, 40 independent schools (118 teams, 3188 players aged 14–18 years) were allocated to receive either the intervention or a reference programme, both of which were to be delivered by school coaches. The intervention comprised balance training, whole-body resistance training, plyometric training, and controlled rehearsal of landing and cutting manoeuvres. Time-loss (>24 hours) injuries arising from school rugby matches were recorded by coaches and medical staff. Results 441 time-loss match injuries (intervention, 233; control, 208) were reported across 15 938 match exposure-hours (intervention, 9083; control, 6855). Intention-to-treat results indicated unclear effects of trial arm on overall match injury incidence (rate ratio (RR)=0.85, 90% confidence limits 0.61 to 1.17), although clear reductions were evident in the intervention arm for concussion incidence (RR=0.71, 0.48 to 1.05). When trial arm comparisons were limited to teams who had completed three or more weekly programme sessions on average, clear reductions in overall match injury incidence (RR=0.28, 0.14 to 0.51) and concussion incidence (RR=0.41, 0.17 to 0.99) were noted in the intervention group. Conclusion A preventive movement control exercise programme can reduce match injury outcomes, including concussion, in schoolboy rugby players when compared with a standardised control exercise programme, although to realise the greatest effects players should complete the programme at least three times per week.

Risk factors for injury in sport climbing and bouldering: a systematic review of the literature

Background Rock climbing is an increasingly popular sport worldwide, as a recreational activity and a competitive sport. Several disciplines including sport climbing and bouldering have developed, each employing specific movements and techniques, leading to specific injuries. Objective To examine risk factors and prevention measures for injury in sport climbing and bouldering, and to assess the methodological quality of existing studies. Methods 12 electronic databases and several other sources were searched systematically using predetermined inclusion and exclusion criteria. Eligible articles were peer-reviewed, based on primary research using original data; outcome measures included injury, morbidity or mortality in rock climbing, and included one or more potential risk factor or injury prevention strategy. Two independent reviewers assessed the methodology of research in each study using the Downs and Black Quality Index. The data extracted is summarised, and appraisals of the articles are presented with respect to the quality of evidence presented. Results 19 studies met the inclusion criteria, and introduced 35 possible risk factors or injury prevention measures in climbing. Age, increasing years of climbing experience, highest climbing grade achieved (skill level), high climbing intensity score (CIS) and participating in lead climbing are potential risk factors. Results regarding injury prevention measures remain inconclusive. Discussion This field is relatively new and, as such, the data are not as robust as for more established sports with a larger research foundation. The key need is establishing modifiable risk factors using prospective studies and high quality methodology, such that injury prevention strategies can be developed. The CIS may be a useful measure in this field of research.

‘Compliance’ versus ‘adherence’ in sport injury prevention: why definition matters

For sport injury prevention efforts to be successful, athletes must adopt and continue to use preventive measures.1 To this end, researchers have conceptualised intervention uptake as both a modifying factor in efficacy trials,2 and as an outcome in effectiveness and implementation studies.3 While this has advanced our understanding of effective intervention designs, dose–response relationships, and barriers to programme use, the definition of ‘uptake’ has been inconsistent. Researchers often use ‘compliance’ and ‘adherence’ interchangeably, overlooking important differences in these constructs.4 We propose that efficacy trials require ‘compliance’, but effectiveness studies do not; instead, these should measure and interpret ‘adherence’ in real-life contexts. This distinction is an important first step for developing a framework to guide appropriate selection of outcome measures, measurement tools and analysis strategies to answer specific research questions. ‘Compliance’ refers to the act of an individual conforming to professional recommendations with regard to prescribed dosage, timing and frequency of an intervention.5 This requires the measurement of behaviour relative to a fixed standard, …

Incidence, mechanism and risk factors for injury in youth rock climbers

Background Rock-climbing participation has grown globally in recent years, and the sport was officially recognised by the International Olympic Committee in 2010. The epidemiology of climbing injuries in adults has been examined, but few studies have investigated injury in youth climbers. Objective To examine the incidence, mechanisms and risk factors for injury in recreational and elite sport climbers and boulderers aged 11–19 years. Study design Cross-sectional. Methods Youth (n=116) were recruited from climbing facilities across Alberta, Canada. Participants completed an anonymous questionnaire from October 2012 to March 2013. Climbing injury incidence proportions and incidence rates (IR) were calculated. ORs with corresponding 95% CIs were estimated for possible risk factors. Results The injury IR was 4.44 injuries/1000 climbing hours (95% CI 3.74 to 5.23). Sprains (27%) and strains (26%) were the predominant injury types, and repetitive overuse was the primary mechanism of injury (42%). Hands and fingers were the most commonly injured locations (21%). Exploratory analyses showed three risk factors for injury: older age (15–19 vs 11–14 years; OR=11.30, 95% CI 2.33 to 54.85), injury in a sport other than climbing (OR=6.46, 95% CI 1.62 to 25.68) and preventive taping (OR=5.09, 95% CI 1.44 to 18.02). Conclusions Injury risk is high in youth climbers. Findings are consistent with the reported rates, types and mechanisms in adults. Modifiable risk factors warrant further investigation to inform the development of injury prevention strategies, targeting high-risk climbers including adolescents and those with previous injury.