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Towards systematic prevention of athletics injuries: Use of clinical epidemiology for evidence-based injury prevention
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of this thesis were to outline the design protocol for a prospective clinical epidemiological study of injuries among athletics athletes; study the 1-year prevalence, the point prevalence and incidence of injuries in total cohorts of Swedish elite adult and talented youth athletics athletes; pinpoint the risk indicators and factors for different injury types/patterns in athletics.

In paper I, an argument-based method to investigate complex design problems was used to structure the collection and analysis of data. A requirement analysis showed that a central requirement of an injury surveillance protocol for elite athletics should allow for detailed epidemiological analyses of overuse injuries, requiring self-reported data from athletes. The resulting study protocol was centred on a web-based weekly athlete e-diary enabling continuous collection of individual-level data on exposure and injuries.

In paper II, the prevalence of injuries was examined and 278 athletes (87%) of the enrolled study population submitted their assessments via the web survey. The overall 1-year retrospective injury prevalence was 42.8% (95% CI 36.9–49.0%). The point prevalence of ongoing injury was 35.4% (95% CI 29.7–41.4%). The 1-year injury prevalence showed a tendency to vary with regard to gender and age (p = 0.11). The diagnostic group that displayed the highest 1-year prevalence (20.9%, 95% CI 16.2–22.2%) and point prevalence (23.2%, 95% CI 18.4–28.7%) of injury was inflammation and pain with gradual onset.

In paper III, during the 52-week period, 292 athletes (91% of the study population) submitted weekly reports reporting a cumulative injury incidence of 3.57 injuries per 1000 hours of exposure to athletics. Most injuries (73%) were reported from training. There was a statistically significant difference with regard to gender and age in the proportion of athletes who avoided injury (P=0.043). Differences between event groups could not be statistically demonstrated (P=0.937). Ninety-six percent of the reported injuries were nontraumatic (associated with overuse). About every second injury (51%) was severe, causing a period of absence from normal training exceeding 3 weeks. Seventy-seven percent of the injuries occurred in lower extremities.

In paper IV, 199 (68%) athletes reported an injury during the study year. The median time to first injury was 101 days (95% confidence interval (CI) 75–127). Univariate log-rank tests revealed risk differences with regard to athlete category (p = 0.046), serious injury (>3 weeks time loss) during the previous season (p = 0.039) and training load rank index (TLRI) (p = 0.019). Athletes in the third and fourth TLRI quartile had almost a twofold increased risk of injury compared to the first quartile. Youth male athletes with a previous serious injury had more than a fourfold increased risk of injury compared with youth females with no previous injury.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. , 71 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1308
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-81400ISBN: 978-91-7519-901-6 (print)OAI: oai:DiVA.org:liu-81400DiVA: diva2:552231
Public defence
2012-10-09, Torben Grut salen, Stockholms Stadion, Lidingövägen, Stockholm, 13:00 (English)
Opponent
Supervisors
Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2015-06-05Bibliographically approved
List of papers
1. Design of a protocol for large-scale epidemiological studies in individual sports: the Swedish Athletics injury study
Open this publication in new window or tab >>Design of a protocol for large-scale epidemiological studies in individual sports: the Swedish Athletics injury study
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2010 (English)In: BRITISH JOURNAL OF SPORTS MEDICINE, ISSN 0306-3674, Vol. 44, no 15, 1106-1111 p.Article in journal (Refereed) Published
Abstract [en]

Background Epidemiological studies have mainly been performed on team sports. The authors set out to develop a protocol for large-scale epidemiological studies of injuries among elite athletics athletes. Methods An argument-based method for investigation of complex design problems was used to structure the collection and analysis of data. Specification of the protocol was preceded by an examination of requirements on injury surveillance in individual sports and iterated drafting of protocol specifications, and followed by formative evaluations. Results The requirements analysis shows that the central demand on the protocol is to allow for detailed epidemiological analyses of overuse injuries, which subsequently requires regular collection of self-reported data from athletes. The resulting study protocol is centred on a web-based weekly athlete e-diary enabling continual collection of individual-level data on exposure and injuries. To be able to interpret the self-reported data on injury events, collection of a wide range of personal baseline data from the athlete, including a psychological profile, is included in the protocol. Conclusions The resulting protocol can be employed in intervention programmes that can prevent suffering among both adult elite and youth talent athletes who have made considerable life investments in their sport.

Place, publisher, year, edition, pages
BMJ Publishing, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-64580 (URN)10.1136/bjsm.2009.067678 (DOI)000285420500007 ()
Available from: 2011-01-28 Created: 2011-01-28 Last updated: 2014-01-21Bibliographically approved
2. Prevalence of Musculoskeletal Injuries in Swedish Elite Track and Field Athletes
Open this publication in new window or tab >>Prevalence of Musculoskeletal Injuries in Swedish Elite Track and Field Athletes
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2012 (English)In: American Journal of Sports Medicine, ISSN 0363-5465, E-ISSN 1552-3365, Vol. 40, no 1, 163-169 p.Article in journal (Refereed) Published
Abstract [en]

Background: Little is known of injury patterns in track and field (athletics). Injury prevalence has been proposed as the most appropriate measure of the injury rate in sports where athletes are at risk for overuse problems. less thanbrgreater than less thanbrgreater thanPurpose: To ascertain 1-year retrospective and current prevalence of injury in elite track and field athletes to help plan injury prevention programs for this sport. less thanbrgreater than less thanbrgreater thanStudy Design: Descriptive epidemiology study. less thanbrgreater than less thanbrgreater thanMethods: Two hundred seventy-eight youth (16 years old) and adult athletes from an eligible study population of 321 athletes were included. less thanbrgreater than less thanbrgreater thanResults: The 1-year retrospective injury prevalence was 42.8% (95% confidence interval [CI], 36.9%-49.0%); the point prevalence was 35.4% (95% CI, 29.7%-41.4%). The diagnosis group displaying the highest injury prevalence was inflammation and pain in the gradual onset category (1-year prevalence, 20.9%; 95% CI, 16.2%-26.2%; and point prevalence, 23.2%; 95% CI, 18.4%-28.7%). A strong tendency for higher 1-year prevalence of 16.5% (95% CI, 12.2%-21.4%) than point prevalence of 8.5% (95% CI, 5.5%-12.5%) was recorded for sudden onset injuries in the diagnosis group sprain, strain, and rupture. The body region showing the highest injury prevalence was the knee and lower leg with 15.0% (95% CI, 11.0%-19.8%) 1-year prevalence and 13.7% (95% CI, 9.8%-18.3%) point prevalence, followed by the Achilles tendon, ankle, and foot/toe with 11.7% (95% CI, 8.2%-16.1%) 1-year prevalence and 11.4% (95% CI, 7.9%-15.8%) point prevalence. less thanbrgreater than less thanbrgreater thanConclusion: The injury prevalence is high among Swedish elite track and field athletes. Most of the injuries affect the lower extremities and are associated with a gradual onset. Although it is associated with a potential recall bias, the 1-year retrospective prevalence measure captured more sudden onset injuries than the point prevalence measure. Future prospective studies in track and field are needed to identify groups of athletes at increased risk.

Place, publisher, year, edition, pages
SAGE Publications (UK and US), 2012
Keyword
injury prevalence, track and field, overuse injuries, epidemiological methods
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-74643 (URN)10.1177/0363546511425467 (DOI)000298857200021 ()
Note

Funding Agencies|Swedish Centre for Research in Sports||Swedish Athletic Association, JK JK Biostatistics||Ren Idrott (Clean Sports in Sweden)||

Available from: 2012-02-03 Created: 2012-02-03 Last updated: 2017-12-08Bibliographically approved
3. Injury patterns in Swedish elite athletics – part 1: annual incidence and injury types
Open this publication in new window or tab >>Injury patterns in Swedish elite athletics – part 1: annual incidence and injury types
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2013 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 47, no 15Article in journal (Refereed) Published
Abstract [en]

Objective To estimate the incidence, type and severity of musculoskeletal injuries in youth and adult elite athletics athletes and to explore risk factors for sustaining injuries. Design Prospective cohort study conducted during a 52-week period. Setting Male and female youth and adult athletics athletes ranked in the top 10 in Sweden (n=292). Results 199 (68%) athletes reported an injury during the study season. Ninety-six per cent of the reported injuries were non-traumatic (associated with overuse). Most injuries (51%) were severe, causing a period of absence from normal training exceeding 3 weeks. Log-rank tests revealed risk differences with regard to athlete category (p=0.046), recent previous injury (>3 weeks time-loss; p=0.039) and training load rank index (TLRI; p=0.019). Cox proportional hazards regression analyses showed that athletes in the third (HR 1.79; 95% CI 1.54 to 2.78) and fourth TLRI quartiles (HR 1.79; 95% CI 1.16 to 2.74) had almost a twofold increased risk of injury compared with their peers in the first quartile and interaction effects between athlete category and previous injury; youth male athletes with a previous serious injury had more than a fourfold increased risk of injury (HR=4.39; 95% CI 2.20 to 8.77) compared with youth females with no previous injury. Conclusions The injury incidence among both youth and adult elite athletics athletes is high. A training load index combing hours and intensity and a history of severe injury the previous year were predictors for injury. Further studies on measures to quantify training content and protocols for safe return to athletics are warranted.

Place, publisher, year, edition, pages
BMJ PUBLISHING GROUP, 2013
Keyword
Sports injury epidemiology, track and field, injury incidence, overuse injuries, subsequent injuries
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81397 (URN)10.1136/bjsports-2012-091651 (DOI)000324415300004 ()
Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2017-12-07Bibliographically approved
4. Injury patterns in Swedish elite athletics – part 2: risk indicators
Open this publication in new window or tab >>Injury patterns in Swedish elite athletics – part 2: risk indicators
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2012 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: To examine the risk indicators associated with sustaining musculoskeletal injuries in youth and adult elite athletics athletes competing at national and international levels.

Design: Prospective cohort study conducted during a 52-week period starting in March 2009. A web-based athlete electronic diary was administrated every week by email to athletes for self-reporting of data on training, competition and injuries.

Setting: Male and female youth and adult athletics athletes ranked in the top 10 in Sweden (n=292).

Results: One-hundred ninety-nine (68%) athletes reported an injury during the study season. The median time to first injury was 101 days (95% confidence interval (CI) 75–127). Univariate log-rank tests revealed risk differences with regard to athlete category (P=0.046), serious injury (>3 weeks time loss) during the previous season (P=0.039) and training load rank index (TLRI) (P=0.019). Multivariate Cox proportional hazards regression analyses showed that athletes in the third (hazard ratio (HR) 1.79; 95% CI 1.54–2.78) and fourth TLRI quartile (HR 1.79; 95% CI 1.16–2.74) had almost a twofold increased risk of injury compared with their peers in the first quartile and interaction effects between athlete category and previous injury; youth male athletes with a previous serious injury had more than a fourfold increased risk of injury (HR=4.39; 95% CI 2.20–8.77) compared with youth females with no previous injury.

Conclusions: A training load index combing hours and intensity and a history of severe injury the previous year are predictors for injury risk among elite athletic athletes. Future studies on measures to quantify training content and protocols for safe return to athletics are warranted.

Keyword
sports injury epidemiology, track and field, injury incidence, previous injury, training load, prevention
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81398 (URN)
Available from: 2012-09-13 Created: 2012-09-13 Last updated: 2013-09-05Bibliographically approved

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