Sport Injury Epidemiology

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Introduction

Injury and illness epidemiology research in sport has grown over the last couple of years. Many international governing bodies of sport and the International Olympic Committee (IOC) have systems in place to conduct surveillance studies at various sporting events. (ref) Factors that influence this growing interest include injury and illness prevention and the long-term protection of athletes' health. (ref)Not only does an injury impact the health of an athlete, it also influences their ability to train as well as their performance. Furthermore, it influences their preparation for competition and their ability to take part in competitions. This in turn may have a significant effect on their lifetime dreams and goals of success as an athlete.

The overall risk of injury can be quantified through information about the incidence, severity and nature (location and type) of sports injuries. This in turn may provide information that can aid proper injury prevention initiatives. (ref) The goal of sport injury epidemiology is thus to provide information on various determinants of sport injury incidence (ref).

Determinants of Sport Injury Incidence

  • Is there a greater risk of injury in certain sports?
  • What parts of the body are more likely to be injured?
  • What type of injuries are most likely to occur?
  • What sports are more dangerous?
  • What sports often have more severe injuries?
  • What factors influence the likelihood of an injury?
  • Can injuries be prevented?
  • Are injury prevention strategies effective?

When considering these determinants, sport injury epidemiology can be defined as: "The study of the distribution and determinants of sports injuries for the purpose of identifying and implementing measures to prevent their development." (ref)

Principles and Methods of Sport Injury Epidemiology

Study Designs

A basic understanding of study design and related terms are necessary to understand and interpret data sports injuries. The two basic types of study designs are:

  • Descriptive studies - primarily used to understand the scope of the problem and identifying trends
  • Analytical studies - to assess risk and identify risk factors

Usually the research question to be answered drives the decision as to which study design to implement.

Types of Study Designs

The table below gives a good overview of the types of study designs (adapted from ....)

Study Design Uses Population
Case Series to assess the scope of the problem injured participants
Cross-sectional determine prevalence of a problem in defined population all participants or a sample of participants in a defined area
Case-control evaluate risk factors among injured and non-injured participants injured participants and controls (non-injured)
Case-crossover to evaluate proximal risk factors among injured participants injured participants
Prospective (cohort) assess incidence of an injury

investigate cause and effect

uninjured cohort with assessment of exposure
Randomised controlled trial gold standard

assess incidence, risk factors and causality

assess prevention strategies

uninjured cohort with assessment of exposure and random assignment to treatment groups/interventions

Incidence and Prevalence

Two key concepts in sport injury epidemiology is incidence and prevalence.

Prevalence is defined as: the proportion of currently injured athletes in a sports population. For example in a sports team prevalence is the number of players unable to play or practice as a result of injury on a particular day. Note that prevalence is defined at a specific moment in time.

Incidence measures the occurrence of new injuries in a population.

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Characteristics, Incidence and Nature of Injuries

Various injury surveillance programs exist across a wide range of sports i.e. Olympics (the IOC Injury and Illness Surveillance System for Multi-sport events), FIFA World Cup Injury Surveillance System, Rugby World Cup Injury Surveillance System, IAAF Injury Surveillance System. As already emphasized these surveillance methods are crucial in the effective protection of the health of athletes (Soligard 2016). Epidemiological data is essential to contribute to better planning and provision of athlete health care. Furthermore it is important in the development of injury and illness preventative measures. (Soligard et al 2016). Some aspects included in injury surveillance systems are discussed below.

Injury Incidence

In longitudinal injury surveillance systems, injury incidences can be compared to earlier results and changes can be identified. These observed changes in injury incidence can be attributed to various factors such as:

  • changes in competition rules (Engebretsen 2013)
  • change in competition program (i.e. new sports introduced at Olympics) (Soligard 2017)
  • changes in equipment (Engbretsen Soligard
  • changes in environmental factors (E s)
  • change in venue or track design (Soligar
  • influenced by recording and reporting of injuries and illnesses by athletes and medical staff (E S)
  • the result of a natural variability of athletes' exposure to risk ( emphasizing the importance of ongoing surveillance systems to monitor trends over time) (Soligard 2017)

Severity, Location and Type of Injuries

In major sport events, even a minor injury or illness with or even without time loss can be consequential. Such injuries or illnesses have the the potential to keep an athlete from participating or have an impact on the athlete's performance. This may prevent the athlete from fulfilling their potential and achieving the goal that they worked so hard for. (E S)

The risk of concussion is of great concern in certain sports and it its diagnosis, prevention, management and return to play criteria have been studied and addressed in recent consensus statements.

Causes, Mechanisms and Onset of Injury

The causes, mechanisms and circumstances of injuries in training and competition may vary between different sports.(S) Furthermore, acute injuries are often reported, whereas the reporting of overuse injuries with a gradual or sudden onset remains unclear due to limitations in the recording of overuse injuries (E)

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References

  1. Medmastery. Incidence and Prevalence - Everything you need to know. Published on 29 July 2016. Available from https://www.youtube.com/watch?v=cTp_ONVVrh8. [last accessed 4 January 2020]