Christine Provvidenza

Spinal injuries in Canadian ice hockey: documentation of injuries sustained from 1943-1999.

OBJECTIVES Study objectives were: (a) to examine the causes and incidence of major spinal cord injuries sustained by ice hockey players; and (b) to add recently reported Canadian cases to the Canadian Ice Hockey Spinal Injury Registry to determine the effectiveness of prevention efforts. METHODS The study was a review of questionnaires returned retrospectively by physicians and other sources reporting ice hockey related spinal injuries in Canada. Physicians reported on the mechanism of injury, vertebral level of injury, presence of neurologic deficit, type of event, and type of fracture. RESULTS Between 1943 and 1999, 271 major spinal injuries were reported in Canadian ice hockey players, of which 49.0% occurred to players 16-20 years of age. Ontario has had a disproportionately large number of injuries compared to some provinces, especially Quebec. Of the spinal cord injuries, 65.8% resulted from colliding with the boards, and 36.6% were due to players being pushed or checked from behind. The recent survey shows that there has been a decline in the number of major spinal cord injuries in Canadian ice hockey, especially those causing paralysis due to checking or pushing from behind. CONCLUSIONS Impact of the head with the boards after being checked or pushed from behind was the most common mechanism of spinal cord injury. Injury prevention programs are becoming effective in reducing the overall number of injuries, especially those due to checking from behind. Greater awareness of the occurrence and mechanisms of injury through educational programs and rules changes by organized hockey have reduced the annual incidence of catastrophic spinal injuries in Canadian ice hockey.

Spinal injuries in Canadian ice hockey: an update to 2005.

Objective:Measure incidence of spinal injuries in Canadian ice hockey for the 6-year period 2000-2005 and examine trends from 1943 to 2005. Design:Data about spinal injuries with and without spinal cord injury in ice hockey have been collected by ThinkFirsts Canadian Ice Hockey Spinal Injuries Registry since 1981 through questionnaires from practitioners, ice hockey organizations, and media reports. Setting:All provinces and territories of Canada. Participants:All Canadian ice hockey players. Assessment of Risk Factors:Age, gender, level of play, location, and mechanism of injury. Main Outcome Measures:Incidence and nature of injuries. Results:Forty cases occurred in 2000-2005, representing a decline in annual injuries and bringing the total registry cases to 311 during 1943-2005. Five (12.5%) of these 40 cases were severe, which includes all complete and incomplete spinal cord injuries, and is a decline from the previous 23.5% in this category. In the 311 cases, men comprised 97.7%, the median age was 18 years, 82.8% of the injuries were cervical, and 90.3% occurred in games in organized leagues. The most common mechanism of injury was impact with the boards (64.8%), and the most common cause was check/push from behind at 35.0%, which has declined. The major provincial differences in injury rates persist, with the highest in Ontario, British Columbia, New Brunswick, and Prince Edward Island and the lowest in Quebec and Newfoundland. Conclusions:There has been a recent decline in spinal injuries in Canadian ice hockey that may be related to improved education about injury prevention and/or specific rules against checking/pushing from behind.

Concussion in hockey: compliance with return to play advice and follow-up status.

OBJECTIVES To determine the compliance rate among hockey players with concussion or other head injuries who were advised by a physician about return to play. To assess compliance of hockey players with return to play advice and to assess the incidence of long-term post-concussion symptoms. METHODS A retrospective chart review, telephone questionnaire and follow-up analysis of income, level of education and professional aspirations. The study examined 40 hockey players with concussion or other head injury treated at a neurosurgical ambulatory clinic, who had initial visits between 1995 and 2003, and had been seen at least two years prior to completing the questionnaire. RESULTS There was a 58% (23 of 40) participation rate in the study. Fifteen (65%) of the 23 participants were advised to never return to play, and 5 (33%) were non-compliant and returned to play. Four (80%) of the five noncompliant players continued to suffer from post concussion symptoms. Overall, 15 (65%) of the 23 players participating in the study continued to suffer post concussion symptoms at least two years after the clinic visit. CONCLUSIONS Five (33%) of 15 hockey players advised to never return to play were non-compliant and returned to play, and four continued to suffer from post concussion symptoms two or more years later. After repeated concussions, 65% of hockey players had long-term sequelae that prevented return to play and produced long-term post-concussion symptoms.

Chronic Pain Assessment Tools for Cerebral Palsy: A Systematic Review.

BACKGROUND AND OBJECTIVE: Chronic pain in children with cerebral palsy (CP) is underrecognized, leading to detriments in their physical, social, and mental well-being. Our objective was to identify, describe, and critique pediatric chronic pain assessment tools and make recommendations for clinical use for children with CP. Secondly, develop an evidence-informed toolbox to support clinicians in the assessment of chronic pain in children with disabilities. METHODS: Ovid Medline, Cumulative Index to Nursing and Allied Health Literature, and Embase databases were systematically searched by using key terms “chronic pain” and “clinical assessment tool” between January 2012 and July 2014. Tools from multiple pediatric health conditions were explored contingent on inclusion criteria: (1) children 1 to 18 years; (2) assessment focus on chronic pain; (3) psychometric properties reported; (4) written in English between 1980 and 2014. Pediatric chronic pain assessment tools were extracted and corresponding validation articles were sought for review. Detailed tool descriptions were composed and each tool underwent a formal critique of psychometric properties and clinical utility. RESULTS: Of the retrieved 2652 articles, 250 articles met eligibility, from which 52 chronic pain assessment tools were retrieved. A consensus among interprofessional working group members determined 7 chronic pain interference tools to be of importance. Not all tools have been validated with children with CP nor is there 1 tool to meet the needs of all children experiencing chronic pain. CONCLUSIONS: This study has systematically reviewed and recommended, through expert consensus, valid and reliable chronic pain interference assessment tools for children with disabilities.

Screening and assessment of chronic pain among children with cerebral palsy: a process evaluation of a pain toolbox

Abstract Purpose: Though high numbers of children with cerebral palsy experience chronic pain, it remains under-recognized. This paper describes an evaluation of implementation supports and adoption of the Chronic Pain Assessment Toolbox for Children with Disabilities (the Toolbox) to enhance pain screening and assessment practices within a pediatric rehabilitation and complex continuing care hospital. Methods: A multicomponent knowledge translation strategy facilitated Toolbox adoption, inclusive of a clinical practice guideline, cerebral palsy practice points and assessment tools. Across the hospital, seven ambulatory care clinics with cerebral palsy caseloads participated in a staggered roll-out (Group 1: exclusive CP caseloads, March–December; Group 2: mixed diagnostic caseloads, August–December). Evaluation measures included client electronic medical record audit, document review and healthcare provider survey and interviews. Results: A significant change in documentation of pain screening and assessment practice from pre-Toolbox (<2%) to post-Toolbox adoption (53%) was found. Uptake in Group 2 clinics lagged behind Group 1. Opportunities to use the Toolbox consistently (based on diagnostic caseload) and frequently (based on client appointments) were noted among contextual factors identified. Overall, the Toolbox was positively received and clinically useful. Conclusion: Findings affirm that the Toolbox, in conjunction with the application of integrated knowledge translation principles and an established knowledge translation framework, has potential to be a useful resource to enrich and standardize chronic pain screening and assessment practices among children with cerebral palsy. Implications for Rehabilitation It is important to engage healthcare providers in the conceptualization, development, implementation and evaluation of a knowledge-to-action best practice product. The Chronic Pain Toolbox for Children with Disabilities provides rehabilitation staff with guidance on pain screening and assessment best practice and offers a range of validated tools that can be incorporated in ambulatory clinic settings to meet varied client needs. Considering unique clinical contexts (i.e., opportunities for use, provider engagement, staffing absences/turnover) is required to optimize and sustain chronic pain screening and assessment practices in rehabilitation outpatient settings.

Update and Overview of Spinal Injuries in Canadian Ice Hockey, 1943 to 2011: The Continuing Need for Injury Prevention and Education.

Objective:To identify spinal injuries in Canadian ice hockey from 2006 to 2011 and to discuss data from 1943 to 2011 and impact of injury prevention programs. Design:Data about spinal injuries with and without spinal cord injury in ice hockey have been collected by ThinkFirsts (now Parachute Canada) Canadian Ice Hockey Spinal Injuries Registry since 1981 through questionnaires from practitioners, ice hockey organizations, and media. Setting:All Canadian provinces and territories. Participants:All registered Canadian ice hockey players. Assessment of Risk Factors:Age, gender, level of play, location, mechanism of injury. Main Outcome Measures:Incidence, incidence rate, prevalence, and nature (morbidity) of the injuries. Results:Between 2006 and 2011, 44 cases occurred, 4 (9.1%) of which were severe. The incidence in the recent years continues to be lower than the peak years. From 1943 to 2011, 355 cases have been documented, primarily males (97.7%) and cervical spine injuries (78.9%), resulting from impact with the boards (64.2%). Check or push from behind (36.0%) was still the most common cause of injury, although slightly lower during 2006 to 2011. From 1943 to 2011, Prince Edward Island, New Brunswick, and British Columbia/Yukon had the highest injury rates. Ontario and Quebec continued to show markedly different injury rates, with Ontario more than twice that of Quebec. Conclusions:Current data for 2006 to 2011 indicate that spinal injuries in ice hockey continue to occur, although still at lower rates than the peak years 1982 to 1995. It is imperative to continue educating players and team officials about spinal injury prevention and to reinforce the rules against checking or pushing from behind to reduce the incidence of these serious injuries.

Education in action: evaluating kids concussion infographics

Objective To assess the impact of infographics on enhancing concussion knowledge and their effectiveness as a knowledge translation (KT) strategy. Design Prospective, post-survey design to assess a KT strategy. Setting Community and hospital based education events. Participants Individuals across various stakeholder groups were invited to provide feedback on six infographics. Data (N=106) was collected from youth (52%) and adults (48%), representing five stakeholder groups: athletes, students, teachers, healthcare trainees and healthcare professionals. Intervention Six infographics were created to provide salient information about concussion for a multi-stakeholder audience. Outcome measures A survey was designed to gather information about the value and utility of the infographics as a KT strategy and to determine additional knowledge needs. Main results Ninety percent of participants identified that the infographics met their knowledge needs, and 84% of participants indicated that the infographics gave them new knowledge related to sleep, myths and facts, and signs and symptoms. Participants indicated that they intend to use the infographics to build knowledge (91%), educate others (52%), and cope with concussion (26%). Feedback provided about the infographic format was positive, and suggestions for future topics were offered. Conclusions Infographics are a potentially effective KT strategy that meets knowledge needs and appeals to many different audiences. Participants identified that they want to learn more about areas including concussion recovery and management. Data collection is ongoing and continues to inform the value of infographics as a KT strategy. This study is part of a broader education initiative to optimise paediatric concussion knowledge. Competing interests None.

Knowledge, attitudes and practices in paediatricpediatric concussion: informing research, education and clinical care

Objective To assess knowledge, attitudes, and practices surrounding research, education and clinical care in paediatric concussion at One Voice: the 1st International Symposium on Paediatric Concussion. Design Quantitative, cross sectional, one-group survey design. Setting One Voice: the 1st International Symposium on Paediatric Concussion. Participants Sixty-two international paediatric concussion leaders representing a multi-stakeholder group. Intervention None. Outcome measures A survey was designed to assess self-reported knowledge, attitudes, and practices surrounding paediatric concussion research, education, and clinical care. Main results Participants identified knowledge gaps as an issue across different groups including athletes and coaches. Attitude towards concussion in the sport culture was recognised as a barrier to common issues such as under reporting and playing while symptomatic. Stakeholders also identified that healthcare professionals do not have adequate training to diagnose and manage paediatric concussion, and highlighted the need for additional knowledge and streamlined education to enhance clinical practices. Conclusions Knowledge, attitude and practice gaps in paediatric concussion exist across various stakeholder groups, leading to inconsistencies in concussion care and a lack of concussion recognition and reporting. Survey results align with outcomes identified in the literature. One Voice stakeholders underscored the value of education in enhancing knowledge, and its role in shifting attitude and optimising practices in paediatric concussion: identification, management and prevention. These outcomes will inform research, education and clinical initiatives to best meet the needs of the paediatric concussion community. Competing interests None.