Christina L. Ekegren

Injuries in pre-professional ballet dancers: Incidence, characteristics and consequences

OBJECTIVES Compared to other athletic activities, research on injury incidence and risk factors in dance is limited. There is also a need for more research evaluating the impact of intense training on elite adolescent athletes. The aim of this study was to evaluate the rates and risk of injuries, the hours of dance exposure and the characteristics and consequences of injuries among elite pre-professional ballet students. DESIGN Prospective epidemiological study. METHODS 266 (112 male) full-time students aged 15-19 years from three elite pre-professional ballet schools were followed prospectively over one school year. Injury rate was reported per 1000 h of dance and 1000 dance exposures (DEs). Injury details collected included type and anatomical location of injury. RESULTS The clinical incidence of injury was 1.42 injuries per dancer and the risk of injury was 76% over the one-year period. The rate of injury was 1.38/1000 h of dance and 1.87/1000 DEs. Joints were the most commonly injured structures and the ankle was the most commonly injured body area. Overuse injuries were more common than traumatic injuries. Bony injuries (e.g. stress fractures), and injuries to the knee were associated with the greatest time loss per injury. Injury risk and rate increased as students progressed through their three years of training. CONCLUSIONS In comparison with other adolescent athletic populations, participants in this study had a similar injury rate but a higher risk of injury. This may be attributable to the high level of training exposure in pre-professional ballet students.

Implementing injury surveillance systems alongside injury prevention programs: evaluation of an online surveillance system in a community setting

BackgroundPrevious research aimed at improving injury surveillance standards has focused mainly on issues of data quality rather than upon the implementation of surveillance systems. There are numerous settings where injury surveillance is not mandatory and having a better understanding of the barriers to conducting injury surveillance would lead to improved implementation strategies. One such setting is community sport, where a lack of available epidemiological data has impaired efforts to reduce injury. This study aimed to i) evaluate use of an injury surveillance system following delivery of an implementation strategy; and ii) investigate factors influencing the implementation of the system in community sports clubs.MethodsA total of 78 clubs were targeted for implementation of an online injury surveillance system (approximately 4000 athletes) in five community Australian football leagues concurrently enrolled in a pragmatic trial of an injury prevention program called FootyFirst. System implementation was evaluated quantitatively, using the RE-AIM framework, and qualitatively, via semi-structured interviews with targeted-users.ResultsAcross the 78 clubs, there was 69% reach, 44% adoption, 23% implementation and 9% maintenance. Reach and adoption were highest in those leagues receiving concurrent support for the delivery of FootyFirst. Targeted-users identified several barriers and facilitators to implementation including personal (e.g. belief in the importance of injury surveillance), socio-contextual (e.g. understaffing and athlete underreporting) and systems factors (e.g. the time taken to upload injury data into the online system).ConclusionsThe injury surveillance system was implemented and maintained by a small proportion of clubs. Outcomes were best in those leagues receiving concurrent support for the delivery of FootyFirst, suggesting that engagement with personnel at all levels can enhance uptake of surveillance systems. Interview findings suggest that increased uptake could also be achieved by educating club personnel on the importance of recording injuries, developing clearer injury surveillance guidelines, increasing club staffing and better remunerating those who conduct surveillance, as well as offering flexible surveillance systems in a range of accessible formats. By increasing the usage of surveillance systems, data will better represent the target population and increase our understanding of the injury problem, and how to prevent it, in specific settings.

Injury reporting via SMS text messaging in community sport

Background The use of text messaging or short message service (SMS) for injury reporting is a recent innovation in sport and has not yet been trialled at the community level. Considering the lack of personnel and resources in community sport, SMS may represent a viable option for ongoing injury surveillance. The aim of this study was to evaluate the feasibility of injury self-reporting via SMS in community Australian football. Methods A total of 4 clubs were randomly selected from a possible 22 mens community Australian football clubs. Consenting players received an SMS after each football round game asking whether they had been injured in the preceding week. Outcome variables included the number of SMS-reported injuries, players’ response rates and response time. Poisson regression was used to evaluate any change in response rate over the season and the association between response rate and the number of reported injuries. Results The sample of 139 football players reported 167 injuries via SMS over the course of the season. The total response rate ranged from 90% to 98%. Of those participants who replied on the same day, 47% replied within 5 min. The number of reported injuries decreased as the season progressed but this was not significantly associated with a change in the response rate. Conclusions The number of injuries reported via SMS was consistent with previous studies in community Australian football. Injury reporting via SMS yielded a high response rate and fast response time and should be considered a viable injury reporting method for community sports settings.

The Effect of a Novel Movement Strategy in Decreasing ACL Risk Factors in Female Adolescent Soccer Players

Abstract Celebrini, RG, Eng, JJ, Miller, WC, Ekegren, CL, Johnston, JD, and MacIntyre, DL. The effect of a novel movement strategy in decreasing ACL risk factors in female adolescent soccer players. J Strength Cond Res 26(12): 3406–3417, 2012—There is a need to investigate the effect of specific movement strategies in reducing biomechanical risk factors for anterior cruciate ligament injury in young female athletes. The purpose of this study was (a) to determine the feasibility of implementing a novel movement strategy (Core-PAC) into a team warm-up before soccer training based on subject compliance and integration of the Core-PAC into the warm-up and (b) to determine whether the Core-PAC would improve peak knee flexion angles and peak abduction moments at the knee during a side cut (SC) and an unanticipated side cut (USC) before kicking a soccer ball, and a side hop (SH) task after immediate instruction and after a 4-week training program. A convenience sample of ten 14- to 16-year-old female soccer players were instructed in the Core-PAC immediately after baseline testing and during a training program consisting of a 20-minute warm-up, 2 times per week. The Core-PAC was understood and accepted by the subjects and incorporated into their warm-up activities with good compliance. After the immediate instruction, there were significant increases in peak knee flexion angles of a mean 6.4° during the SC (p = 0.001), 3.5° during the USC (p = 0.007), and 5.8° during the SH (p < 0.001) tasks. Peak knee abduction moments decreased by a mean of 0.25 N·m·kg−1 during the SC (p < 0.03), 0.17 N·m·kg−1 during the USC (p = 0.05), and 0.27 N·m·kg−1 during the SH (p = 0.04) tasks. After the 4-week training program, some individuals showed improvement. The results of this study suggest that the Core-PAC may be 1 method of modifying high-risk movements for ACL injury such as side cutting and single-leg landing.

Association between perception of fault for the crash and function, return to work and health status 1 year after road traffic injury: a registry-based cohort study

Objectives To establish the association between the patients perception of fault for the crash and 12-month outcomes after non-fatal road traffic injury. Setting Two adult major trauma centres, one regional trauma centre and one metropolitan trauma centre in Victoria, Australia. Participants 2605 adult, orthopaedic trauma patients covered by the states no-fault third party insurer for road traffic injury, injured between September 2010 and February 2014. Outcome measures EQ-5D-3L, return to work and functional recovery (Glasgow Outcome Scale—Extended score of upper good recovery) at 12 months postinjury. Results After adjusting for key confounders, the adjusted relative risk (ARR) of a functional recovery (0.57, 95% CI 0.46 to 0.69) and return to work (0.92, 95% CI 0.86 to 0.99) were lower for the not at fault compared to the at fault group. The ARR of reporting problems on EQ-5D items was 1.20–1.35 times higher in the not at fault group. Conclusions Patients who were not at fault, or denied being at fault despite a police report of fault, experienced poorer outcomes than the at fault group. Attributing fault to others was associated with poorer outcomes. Interventions to improve coping, or to resolve negative feelings from the crash, could facilitate better outcomes in the future.

Medical-attention injuries in community Australian football: a review of 30 years of surveillance data from treatment sources

Objective:In recent reports, Australian football has outranked other team sports in the frequency of hospitalizations and emergency department (ED) presentations. Understanding the profile of these and other “medical-attention” injuries is vital for developing preventive strategies that can reduce health costs. The objective of this review was to describe the frequency and profile of Australian football injuries presenting for medical attention. Data Sources:A systematic search was carried out to identify peer-reviewed articles and reports presenting original data about Australian football injuries from treatment sources (hospitals, EDs, and health-care clinics). Data extracted included injury frequency and rate, body region, and nature and mechanism of injury. Main Results:Following literature search and review, 12 publications were included. In most studies, Australian football contributed the greatest number of injuries out of any sport or recreation activity. Hospitals and EDs reported a higher proportion of upper limb than lower limb injuries, whereas the opposite was true for sports medicine clinics. In hospitals, fractures and dislocations were most prevalent out of all injuries. In EDs and clinics, sprains/strains were most common in adults and superficial injuries were predominant in children. Most injuries resulted from contact with other players or falling. Conclusions:The upper limb was the most commonly injured body region for Australian football presentations to hospitals and EDs. Strategies to prevent upper limb injuries could reduce associated public health costs. However, to understand the full extent of the injury problem in football, treatment source surveillance systems should be supplemented with other datasets, including community club-based collections.

Effect of a novel movement strategy in decreasing ACL risk factors in female adolescent soccer players: a randomized controlled trial.

Objective:To determine the effect of a novel movement strategy incorporated within a soccer warm-up on biomechanical risk factors for anterior cruciate ligament injury during 3 sport-specific movement tasks. Design:Single-blind, randomized controlled clinical trial. Setting:Laboratory setting. Participants:Twenty top-tier female teenage soccer players. Interventions:Subjects were randomized to the Core Position and Control movement strategy (Core-PAC) warm-up or standard warm-up, which took place before their regular soccer practice over a 6-week period. The Core-PAC focuses on getting the centre of mass closer to the plant foot or base of support. Main Outcome Measures:Peak knee flexion angle and abduction moments during a side-hop (SH), side-cut, and unanticipated side-cut task after the 6 weeks with (intervention group only) and without a reminder to use the Core-PAC strategy. Results:The Core-PAC group increased peak flexion angles during the SH task [mean difference = 6.2 degrees; 95% confidence interval (CI), 1.9-10.5 degrees; effect size = 1.01; P = 0.034] after the 6-week warm-up program without a reminder. In addition, the Core-PAC group demonstrated increased knee flexion angles for the side-cut (mean difference = 8.5 degrees; 95% CI, 4.8-12.2 degrees; ES = 2.02; P = 0.001) and SH (mean difference = 10.0 degrees; 95% CI, 5.7-14.3 degrees; ES = 1.66; P = 0.001) task after a reminder. No changes in abduction moments were found. Conclusions:The results of this study suggest that the Core-PAC may be one method of modifying high-risk soccer-specific movements and can be implemented within a practical, team-based soccer warm-up. The results should be interpreted with caution because of the small sample size.

Quality of care for patients with a fracture of the hip in major trauma centres: a national observational study

AIMS In this study, we aimed to determine whether designation as a major trauma centre (MTC) affects the quality of care for patients with a fracture of the hip. PATIENTS AND METHODS All patients in the United Kingdom National Hip Fracture Database, between April 2010 and December 2013, were included. The indicators of quality that were recorded included the time to arrival on an orthopaedic ward, to review by a geriatrician, and to operation. The clinical outcomes were the development of a pressure sore, discharge home, length of stay, in-hospital mortality, and re-operation within 30 days. RESULTS There were 289 466 patients, 49 350 (17%) of whom were treated in hospitals that are now MTCs. Using multivariable logistic and generalised linear regression models, there were no significant differences in any of the indicators of the quality of care or clinical outcomes between MTCs, hospitals awaiting MTC designation and non-MTC hospitals. CONCLUSION These findings suggest that the regionalisation of major trauma in England did not improve or compromise the overall care of elderly patients with a fracture of the hip. TAKE HOME MESSAGE There is no evidence that reconfiguring major trauma services in England disrupted the treatment of older adults with a fracture of the hip.

Twelve-month mortality and functional outcomes in hip fracture patients under 65 years of age

INTRODUCTION There has been a recent call for improved functional outcome reporting in younger hip fracture patients. Younger hip fracture patients represent a different population with different functional goals to their older counterparts. Therefore, previous research on mortality and functional outcomes in hip fracture patients may not be generalisable to the younger population. The aims of this study were to report 12-month survival and functional outcomes in hip fracture patients aged <65 years and predictors of functional outcome. METHODS Hip fracture patients aged <65years (range 17-64) registered by the Victorian Orthopaedic Trauma Outcomes Registry over four years were included and their 12-month survival and functional outcomes (Extended Glasgow Outcome Scale) reported. Ordered multivariable logistic regression was used to identify predictors of higher function. RESULTS There were 507 patients enrolled in the study and of the 447 patients (88%) with 12-month outcomes, 24 (5%) had died. The majority of patients had no comorbidities or pre-injury disability and were injured via road trauma or low falls. 40% of patients sustained additional injuries to their hip fracture. 23% of patients had fully recovered at 12 months and 39% reported ongoing moderate disability. After adjusting for all key variables, odds of better function 12-months post-fracture were reduced for patients with co-morbidities, previous disability or additional injuries, those receiving compensation or injured via low falls. CONCLUSIONS While 12-month survival rates were satisfactory in hip fracture patients aged under 65 years, their functional outcomes were poor, with less than one quarter having fully recovered 12 months following injury. This study provides new information about which patients may have difficulty returning to their pre-injury level of function. These patients may require additional or more intensive post-discharge care in order to fulfil their functional goals and continue to contribute productively to society.

Twelve-month work–related outcomes following hip fracture in patients under 65 years of age

INTRODUCTION Recent research has highlighted the need for improved outcome reporting in younger hip fracture patients. For this population, return to work (RTW) is a particularly important measure against which to evaluate treatment outcomes. However, to date, only two small studies have reported RTW outcomes in young hip fracture patients and neither investigated factors predictive of RTW. The aims of this study were to report return to work (RTW) status and predictors of RTW 12 months after hip fracture in patients <65 years. METHODS Two hundred and ninety-one adults aged <65 years, admitted with hip fractures between July 2009 and June 2013 and registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) were included in this prospective cohort study. Twelve-month return to work status was collected through structured telephone interviews conducted by trained interviewers. Multivariate logistic regression was used to identify demographic and injury variables that were important predictors of 12-month work status. RESULTS Sixty-five per-cent of patients had returned to work 12 months after hip fracture (62% of whom had an isolated hip fracture and 38% of whom had additional injuries). Relative to patients aged 16-24 years, odds of RTW was reduced by 78%-89% for each 10-year increase in age (p=0.02). Relative to patients employed as managers/administrators/professionals, odds of RTW were 68% to 95% lower for all other workers (p<0.001). For those reporting a pre-injury disability, odds of RTW were 79% lower compared to those without disability (p=0.004) and 69% lower for patients with multiple injuries compared to isolated hip fracture patients (p=0.002). Finally, patients compensated by a work or transport insurer had a 67% lower odds of RTW relative to patients who were not compensated (p=0.02). CONCLUSIONS Approximately one third of patients <65years had not returned to work 12 months after hip fracture. Patients who are older, have multiple injuries or pre-existing disabilities or who work in more physical occupations may need more assistance to RTW following hip fracture. The compensation system should be examined to determine why compensated patients may be at risk of poor RTW outcomes.