Victor Bargoria

Meta-narrative analysis of sports injury reporting practices based on the Injury Definitions Concept Framework (IDCF): A review of consensus statements and epidemiological studies in athletics (track and field)

OBJECTIVES Consistency in routines for reporting injury has been a focus of development efforts in sports epidemiology for a long time. To gain an improved understanding of current reporting practices, we applied the Injury Definitions Concept Framework (IDCF) in a review of injury reporting in a subset of the field. DESIGN Meta-narrative review. METHODS An analysis of injury definitions reported in consensus statements for different sports and studies of injury epidemiology in athletics (track and field) published in PubMed between 1980 and 2013 was performed. Separate narratives for each of the three reporting contexts in the IDCF were constructed from the data. RESULTS Six consensus statements and 14 studies reporting on athletics injury epidemiology fulfilled the selection criteria. The narratives on sports performance, clinical examination, and athlete self-report contexts were evenly represented in the eligible studies. The sports performance and athlete self-report narratives covered both professional and community athletes as well as training and competition settings. In the clinical examination narrative, data collection by health service professionals was linked to studies of professional athletes at international championships. CONCLUSIONS From an application of the IDCF in a review of injury reporting in sports epidemiology we observed a parallel usage of reporting contexts in this field of research. The co-existence of reporting methodologies does not necessarily reflect a problematic situation, but only provided that firm precautions are taken when comparing studies performed in the different contexts.

The psychological factor ‘self-blame’ predicts overuse injury among top-level Swedish track and field athletes: a 12-month cohort study

Background Athletes’ psychological characteristics are important for understanding sports injury mechanisms. We examined the relevance of psychological factors in an integrated model of overuse injury risk in athletics/track and field. Methods Swedish track and field athletes (n=278) entering a 12-month injury surveillance in March 2009 were also invited to complete a psychological survey. Simple Cox proportional hazards models were compiled for single explanatory variables. We also tested multiple models for 3 explanatory variable groupings: an epidemiological model without psychological variables, a psychological model excluding epidemiological variables and an integrated (combined) model. Results The integrated multiple model included the maladaptive coping behaviour self-blame (p=0.007; HR 1.32; 95% CI 1.08 to 1.61), and an interaction between athlete category and injury history (p<0.001). Youth female (p=0.034; HR 0.51; 95% CI 0.27 to 0.95) and youth male (p=0.047; HR 0.49; 95% CI 0.24 to 0.99) athletes with no severe injury the previous year were at half the risk of sustaining a new injury compared with the reference group. A training load index entered the epidemiological multiple model, but not the integrated model. Conclusions The coping behaviour self-blame replaced training load in an integrated explanatory model of overuse injury risk in athletes. What seemed to be more strongly related to the likelihood of overuse injury was not the athletics load per se, but, rather, the load applied in situations when the athletes body was in need of rest.

Strategies and factors associated with preparing for competing in the heat: a cohort study at the 2015 IAAF World Athletics Championships

Purpose Assess exertional heat illness (EHI) history and preparedness in athletes competing in a World Athletics Championships under hot/humid conditions and identify the factors associated with preparedness strategies. Methods Of the 207 registered national teams invited to participate in the study, 50 (24%) accepted. The 957 athletes (49% of all 1965 registered) in these teams were invited to complete a precompetition questionnaire evaluating EHI history, heat stress prevention (heat acclimatisation, precooling and hydration) and recovery. Responses from 307 (32%) athletes were separated in field events, sprints, middle-distance and long-distance running, and decathlon/heptathlon for analysis. Results 48% of athletes had previously experienced EHI symptoms and 8.5% had been diagnosed with EHI. 15% heat acclimatised (∼20 days) before the championships. 52% had a precooling strategy, ice slurry ingestion (24%) being the most prevalent and women using it more frequently than men (p=0.005). 96% of athletes had a fluid consumption strategy, which differed between event categories (p<0.001). The most common volumes planned on being consumed were 0.5–1 L (27.2%) and ≥2 L (21.8%), water being the most frequent. 89% of athletes planned on using at least one recovery strategy. Female sex (p=0.024) and a previous EHI diagnosis increased the likelihood of using all 3 prevention strategies (p<0.001). Conclusions At a World Championships with expected hot/humid conditions, less than one-fifth of athletes heat acclimatised, half had a precooling strategy and almost all a hydration plan. Women, and especially athletes with an EHI history, were more predisposed to use a complete heat stress prevention strategy. More information regarding heat acclimatisation should be provided to protect athlete health and optimise performance at major athletics competitions in the heat.

Preparticipation predictors for championship injury and illness: cohort study at the Beijing 2015 International Association of Athletics Federations World Championships

Objectives To determine preparticipation predictors of injury and illness at a major Athletics championship. Methods A cohort study design was used. Before the 2015 International Association of Athletics Federations World Championships in Athletics, all 207 registered national teams were approached about partaking in a study of preparticipation health; 50 teams accepted. The athletes (n=957) in the participating teams were invited to complete a preparticipation health questionnaire (PHQ). New injuries and illnesses that occurred at the championships were prospectively recorded. Logistic regression analyses were performed with simple and multiple models using any in-championship injury and in-championship illness as outcomes. Results The PHQ was completed by 307 (32.1%) of the invited athletes; 116 athletes (38.3%) reported an injury symptom during the month before the championships, while 40 athletes (13%) reported an illness symptom. 20 (6.5%) of the participating athletes sustained a health problem during the championships. Endurance athletes were almost 10-fold more likely to sustain an in-championship illness than speed/power athletes (OR, 9.88; 95% CI 1.20 to 81.31; p=0.033). Participants reporting a preparticipation gradual-onset injury symptom were three times more likely (OR, 3.09; 95% CI 1.08 to 8.79; p=0.035) and those reporting an illness symptom causing anxiety were fivefold more likely (OR, 5.56; 95% CI 1.34 to 23.15; p=0.018) to sustain an in-championship injury. Summary and conclusions Analyses of preparticipation predictors of injury and illness at a major Athletics championship suggest that endurance athletes require particular clinical attention. Preparticipation symptoms causing anxiety are interesting predictors for in-championship health problems.

Perception of health problems among competitive runners: a qualitative study of cognitive appraisals and behavioral responses

Background: Approximately 2 of every 3 competitive runners sustain at least 1 health problem each season. Most of these problems are nontraumatic injuries with gradual onset. The main known risk indicator for sustaining a new running-related injury episode is a history of a previous injury, suggesting that behavioral habits are part of the causal mechanisms. Purpose: Identification of elements associated with purposeful interpretations of body perceptions and balanced behavioral responses may supply vital information for prevention of health problems in runners. This study set out to explore competitive runners’ cognitive appraisals of perceived symptoms on injury and illness and how these appraisals are transformed into behavior. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study population consisted of Swedish middle- and long-distance runners from the national top 15 list. Qualitative research methods were used to categorize interview data and perform a thematic analysis. The categories resulting from the analysis were used to construct an explanatory model. Results: Saturation of the thematic classification required that data from 8 male and 6 female runners (age range, 20-36 years) were collected. Symptoms interpreted to be caused by illness or injury with a sudden onset were found to lead to immediate action and changes to training and competition programs (activity pacing). In contrast, perceptions interpreted to be due to injuries with gradual onset led to varied behavioral reactions. These behavioral responses were planned with regard to short-term consequences and were characterized by indifference and neglect of long-term implications, consistent with an overactivity behavioral pattern. The latter pattern was consistent with a psychological adaptation to stimuli that is presented progressively to the athlete. Conclusion: Competitive runners appraise whether a health problem requires immediate withdrawal from training based on whether the problem is interpreted as an illness and/or has a sudden onset. The ensuing behaviors follow 2 distinct patterns that can be termed “activity pacing” and “overactivity.”

Lifetime history of sexual and physical abuse among competitive athletics (track and field) athletes: cross sectional study of associations with sports and non-sports injury

Objective To examine associations between lifetime sexual and physical abuse, and the likelihood of injury within and outside sport in athletes involved in competitive athletics. Methods A cross sectional study was performed among the top 10 Swedish athletics athletes using 1 year prevalence of sports and non-sports injuries as the primary outcome measure. Associations with sociodemographic characteristics, lifetime abuse history and training load were investigated. Data were analysed using simple and multiple logistic regression models. Results 11% of 197 participating athletes reported lifetime sexual abuse; there was a higher proportion of women (16.2%) than men (4.3%) (P=0.005). 18% reported lifetime physical abuse; there was a higher proportion of men (22.8%) than women (14.3%) (P=0.050). For women, lifetime sexual abuse was associated with an increased likelihood of a non-sports injury (OR 8.78, CI 2.76 to 27.93; P<0.001). Among men, increased likelihood of a non-sports injury was associated with more frequent use of alcoholic beverages (OR 6.47, CI 1.49 to 28.07; P=0.013), while commencing athletics training at >13 years of age was associated with a lower likelihood of non-sports injury (OR 0.09, CI 0.01 to 0.81; P=0.032). Lifetime physical abuse was associated with a higher likelihood of sports injury in women (OR 12.37, CI 1.52 to 100.37; P=0.019). Among men, athletes with each parents with ≤12 years formal education had a lower likelihood of sustaining an injury during their sports practice (OR 0.37, CI 0.14 to 0.96; P=0.040). Conclusions Lifetime sexual and physical abuse were associated with an increased likelihood of injury among female athletes. Emotional factors should be included in the comprehension of injuries sustained by athletes.

WHAT PRE-PARTICIPATION HEALTH COMPLAINTS AND ATHLETE CHARACTERISTICS PREDICT INJURY AND ILLNESS AT MAJOR ATHLETICS CHAMPIONSHIPS? COHORT STUDY AT THE BEIJING 2015 IAAF WORLD CHAMPIONSHIPS

Background During the month before world championships in individual sports, about one-third of athletes are disturbed by injury complaints. Athletics athletes reporting a pre-championship gradual-onset injury complaint are known to be at increased risk to sustain an injury at the upcoming competitions. Predictors for in-championship illness and the predictive value of anxiety associated with pre-participation injury and illness complaints have not been investigated. Objective To determine pre-participation predictors of injury and illness at a major Athletics championship. Design Prospective cohort study. Setting The 2015 IAAF World Championships in Athletics. Participants 307 (32.1%) of 957 athletes in 50 national teams that accepted to participate. Assessment of Risk Factors Sex, age, home continent, event category and pre-participation health complaints with qualifiers (injury or illness complaint, onset type (injury complaints only), reduction in participation, severity estimated by duration of time loss, associated anxiety, expected performance impact, etc.). Main Outcome Measurements In-championship injury and in-championship illness. Results 116 athletes (38.3%) of the participating athletes reported an injury complaint during the month before the championships, while 40 athletes (13%) reported an illness complaint. Twenty athletes (6.5%) sustained an injury or illness during the championships. Endurance athletes were almost tenfold more likely to sustain an in-championship illness than speed/power athletes (OR, 9.88; 95% CI, 1.20–81.31; P=0.033). Participants reporting a pre-participation gradual-onset injury complaint were three times more likely (OR, 3.09; 95% CI, 1.08–8.79; P=0.035) and those reporting an illness complaint causing anxiety were fivefold more likely (OR, 5.56; 95% CI, 1.34–23.15; P=0.018) to sustain an in-championship injury. Conclusions Endurance athletes require particular clinical attention at major Athletics championships. Pre-participation complaints causing anxiety are interesting predictors for in-championship health problems. Diagnostic criteria for different types of exertion-related illness and the clinical and educational services provided to athletes preparing for championships in individual sports warrant further study.

PSYCHOLOGICAL MEDIATORS BETWEEN PAIN AND SELF-REPORTED HEALTH IN ELITE ATHLETIC ATHLETES: A CROSS-SECTIONAL STUDY TO INFORM OVERUSE INJURY PREVENTION

Background Understanding how sensations of pain affect health status appraisal among athletics athletes is of importance for prevention of overuse injuries. Identification of psychological mediators of the association opens for new intervention possibilities. Objective To examine psychological mediators of the association between pain and self-reported health in elite athletics athletes. Design Cross-sectional study using e-epidemiological survey methods. Setting Swedish male and female youth and adult elite athletics athletes. Participants Athletics athletes ranked in the national top-10 were invited (n=301). 226 (75%) athletes returned complete data. Risk factor assessment Pain measured on a 3-graded scale; the psychological mediators perceived motivational climate (measured by the PMCSQ), coping behavior (Brief Cope), body consciousness and hyperactivity (BCS-ADHD), and commitment to exercise (CES). Main outcome easurements Self-reported health (EuroQol-5D). Results 85 (38%) athletes reported experiencing pain at the time of the study. The level of pain was associated with the self-reported health (P<.001); the strength of the association did not differ between men and women (P=.720). A multi-component model of psychological elements mediating the association between pain and self-rated health included body competence (Mediation Effect (ME) −1.053 (90% CI −2.025 – −0.082), private body consciousness (ME –0.744 (90% CI –1.478 – −0.010), and a perceived motivational climate endorsing mastery (ME –0.623 (90% CI –1.229 – −0.017). No influence from gender or age on the mediating effects could be statistically confirmed. Conclusions Awareness of internal sensations (private body consciousness), an affirmative evaluation of own body functions (body competence), and a perceived endorsement of athletic development (mastery) augmented the influence of pain on self-reported health among elite athletic athletes. This paradoxical observation warrants further investigation in prospective studies on associations between pain, perceived health, athlete and coach behaviors, and overuse injury in elite athletics athletes.