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Background Little information exists on the illness and injury patterns of athletes preparing for the Olympic and Paralympic Games. Among the possible explanations for the current lack of knowledge are the methodological challenges faced in conducting prospective studies of large, heterogeneous groups of athletes, particularly when overuse injuries...

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Current methods of sports injury surveillance are limited by lack of medical validation of self-reported injuries, and/or incomplete information about injury consequences beyond time-loss from sport. The aims of this study were to 1) evaluate the feasibility of the SMS, Phone and medical Examination injury surveillance (SPEx) system 2) to evaluate...
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Aim To record overuse injuries among male junior handball players throughout a handball season. Design Prospective cohort study. Methods Ten Norwegian junior male handball teams (145 players aged 16–18 years) were followed for one 10-month season. All players were sent the Oslo Sports Trauma Research Center Overuse Injury Questionaire every secon...

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... Consenting participants were asked to partake in three rounds of online questionnaires (Survey Monkey, Sur-veyMonkey Inc., California). The questionnaires were informed by previously published work, including: the heterogeneity of injury definitions and surveillance methods used in the FJA literature [1]; the complexities of conducting surveillance with FJA [1]; the similarities of such complexities with athletes [4,21,22]; and the recommendations put forward [15,18,19] and tools developed [20,25] in the sports injury literature to address such complexities. A mix of open responses, Likert scales, and ranking responses were used. ...
... Part three consisted of seven questions regarding: onset, status, days of flying duties missed (timeloss), medical attention sought, use of symptom-relieving medications, and loss of movement. Surveillance frequency was set at weekly to minimise recall error and provide more opportunity for early identification/intervention when used as a monitoring tool and was consistent with similar validated tools [20,25]. ...
... However, consensus reached in our study indicates that other descriptors such as stiffness, reduced ROM, and tingling or numbness are also important. These align with broader terms used in other surveillance systems [20,25] and more inclusive contemporary definitions of injury and health problems [14]. The consensus that body regions beyond the spine should be included highlighted the need for broader surveillance. ...
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Background Military populations, including fast jet aircrew (FJA - aka fighter aircrew/pilots), commonly suffer from musculoskeletal complaints, which reduce performance and operational capability. Valid surveillance tools and agreed recordable injury definitions are lacking. Our objective was to develop and then evaluate the validity of a musculoskeletal complaints surveillance and monitoring tool for FJA. Methods A Delphi study with international experts sought consensus on recordable injury definitions and important content for use in a surveillance and monitoring tool for FJA. Using these results and feedback from end-users (FJA), the University of Canberra Fast Jet Aircrew Musculoskeletal Questionnaire (UC-FJAMQ) was developed. Following its use with 306 Royal Australian Air Force (RAAF) FJA over 4 × five-month reporting periods, validity of the UC-FJAMQ was evaluated via multi-level factor analysis (MFA) and compared with routine methods of injury surveillance. Results Consensus was achieved for: eight words/descriptors for defining a musculoskeletal complaint; six definitions of recordable injury; and 14 domains important for determining overall severity. The UC-FJAMQ was developed and refined. MFA identified three distinct dimensions within the 11 items used to determine severity: operational capability, symptoms, and care-seeking. MFA further highlighted that symptom severity and seeking medical attention were poor indicators of the impact musculoskeletal complaints have upon operational capability. One hundred and fifty-two episodes of time loss were identified, with the UC-FJAMQ identifying 79% of these, while routine methods identified 49%. Despite modest weekly reporting rates (61%), the UC-FJAMQ outperformed routine surveillance methods. Conclusions The UC-FJAMQ was developed to specifically address the complexities of injury surveillance with FJA, which are similar to those noted in other military and sporting populations. The results demonstrated the UC-FJAMQ to be sensitive and valid within a large group of FJA over 4 × five-month reporting periods. Adoption of consistent, sensitive, and valid surveillance methods will strengthen the FJA injury prevention literature, ultimately enhancing their health, performance, and operational capability.
... At the end of each day, recruits completed a modified Oslo Sports Trauma Research Centre (OSTRC) Questionnaire on Health Problems, 30 in a daily diary booklet. The daily diary, consisting of repeated questionnaires for the week (7 days), commenced following week-1 consent (day 3) and continued until the final day of training in week 12 (day 80). ...
... When recruits were not present at physical training, time-loss was recorded with the reported reason "not confirmed." For self-reports, an accumulated injury score was not calculated, 30 as a modified OSTRC Questionnaire on Health Problems was used, rather the "participation" (question 1) and "severity" (questions 2 and 4) categories were analyzed. 32 All data preparation and analyses were performed with R (version 4.0.2, ...
... respectively). This discrepancy may be attributable to the increased capture of overuse injuries in daily self-reports, 21,22,30 but as only the anatomical location of problems was reported this cannot be confirmed. Considering the broad injury definition used, trauma-related injuries (e.g., acute) are also likely to have been captured by self-reports. ...
Article
Introduction The injury definitions and surveillance methods commonly used in Army basic military training (BMT) research may underestimate the extent of injury. This study therefore aims to obtain a comprehensive understanding of injuries sustained during BMT by employing recording methods to capture all physical complaints. Materials and methods Six hundred and forty-six recruits were assessed over the 12-week Australian Army BMT course. Throughout BMT injury, data were recorded via (1) physiotherapy reports following recruit consultation, (2) a member of the research team (third party) present at physical training sessions, and (3) recruit daily self-reports. Results Two hundred and thirty-five recruits had ≥1 incident injury recorded by physiotherapists, 365 recruits had ≥1 incident injury recorded by the third party, and 542 recruits reported ≥1 injury-related problems via the self-reported health questionnaire. Six hundred twenty-one, six hundred eighty-seven, and two thousand nine hundred sixty-four incident injuries were recorded from a total of 997 physiotherapy reports, 1,937 third-party reports, and 13,181 self-reported injury-related problems, respectively. The lower extremity was the most commonly injured general body region as indicated by all three recording methods. Overuse accounted for 79% and 76% of documented incident injuries from physiotherapists and the third party, respectively. Conclusions This study highlights that injury recording methods impact injury reporting during BMT. The present findings suggest that traditional injury surveillance methods, which rely on medical encounters, underestimate the injury profile during BMT. Considering accurate injury surveillance is fundamental in the sequence of injury prevention, implementing additional injury recording methods during BMT may thus improve injury surveillance and better inform training modifications and injury prevention programs.
... AMS can play an important role in elite sport, as lost training days through illness or injury are a significant issue. At any given time, 36% of elite athletes have a health problem, with 15% reporting substantial health problems weekly that may negatively impact sporting performance (Clarsen et al., 2014). ...
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Athlete monitoring systems (AMS) aid performance optimisation and support illness/injury prevention. Nonetheless, limited information exists on how AMS are employed across elite sports in the United Kingdom. This study explored how athlete monitoring (AM) data, in particular athlete self-report measures, were collected, analysed and disseminated within elite sports. Thirty elite sports practitioners representing 599 athletes responded to a survey on their AM methodologies. The majority, 83%, (n = 25) utilised an AMS, and a further 84% (n = 21) stated the collection of their AMS data was underpinned by a scientific rationale. Athlete self-report measures (ASRM) were the most commonly employed tool, with muscle soreness, sleep and energy levels amongst the most frequently collected measures. The ubiquitous use of custom single-item ASRM resulted in considerable variability in the questionnaires employed, thus potentially impacting questionnaire validity. Feedback processes were largely felt to be ineffective, with 44% (n = 11) respondents indicating that athletes did not receive sufficient feedback. Some respondents indicated that AMS data was never discussed with athletes and/or coaches. Overall, significant disparities exist in the use of athlete monitoring systems between research and elite sports practice, and the athlete, coach and practitioner experience of monitoring risks being poor if these disparities are not addressed.
... Traumatic stress disorder is seen as a severe psychological disorder, and research has indicated that athletes have a much higher possibility of suffering from stress disorders than the general population [3]. This is due to the frequency of experiencing physical injuries in sports [4]. The most common symptoms of sports injury-related stress disorder include attention distraction and uncontrolled body movements in specific scenarios [5], which become an obstacle preventing the athletes from returning to competitive sports. ...
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Background For professional athletes, sports injury has been considered one of the most influential factors determining their athletic careers' duration and quality. High-intensity training and competitiveness of the sports competition are perhaps critical causes of sports-related stress. This article reviews the relevant research on sports injuries and stressor-related disorders. Further, it explores the following three issues in depth: (1) Do physical injuries caused by competitive sports lead to acute or posttraumatic stress disorder for athletes? What are the abnormal stress responses? (2) What diagnoses are currently available for sports injury related traumatic stress disorder? (3) What kinds of psychological rehabilitation are available for trauma-related symptoms in sports injury? How efficient are they in alleviating these symptoms? Methods The study searched electronic databases, including PubMed, MEDLINE, CINAHL, etc. And reference lists of included papers were also screened. Two researchers selected the literature strictly according to the inclusion criteria and sorted them out. Based on the proved conclusions, the study established a new framework to manage traumatic stress disorders after the injury occurred. Results 16 articles were included in the study. (Q1: N = 10; Q2: N = 3; Q3: N = 3 ) The findings of this review suggested that athletes who suffer from sports injuries are more likely to experience abnormal physiological or psychological stress responses, which may become a massive challenge for athletes to continue their sports careers at a competitive level. However, there is a minimal understanding of addressing sports injury-related traumatic stress disorder from a biological perspective. Thus, it is challenging to build a scientific basis for diagnosis, screening, and treatment. In addition, the current diagnostic tool for athletes stress disorder still heavily relies on subjective measurement, and the treatment plan is not different from that of the general population. Conclusions It highlighted that sports-related stress disorder could be the greatest challenge to return to competition for injured athletes. The present study indicated the importance of systematically identifying the symptoms of sports-related stress disorder and improving the current diagnosis and treatment system.
... The variables related to health problems of participants were collected through the Brazilian version of the Oslo Sports Trauma Research Center questionnaire on health problems (OSTRC-BR), developed by Clarsen, Rønsen, Myklebust, Flørenes, and Bahr (2014) and translated and validated to Brazilian Portuguese by Pimenta, Hespanhol, and Lopes (2021). This questionnaire was developed to be an online tool to monitor the athlete's injury and illness complaints that may affect their performance, considering the previous week. ...
... It provides information on the relative impact of health problems on the athlete, as it takes into account the degree of consequences and the duration of the problem. In addition, the average weekly severity score was calculated by dividing the cumulative severity score by the number of weeks that the health problem was reported (Clarsen et al., 2014). These two variables were collected throughout the sport season. ...
Article
Objectives To evaluate sleep characteristics and investigate the relationship of sleep with injuries and illnesses in Paralympic athletes. Design Cross-sectional. Setting Sports Training Center. Participants 20 Paralympic athletes of athletics, swimming, and powerlifting. Outcomes Injury and illnesses were recorded during the sports season through the Oslo Sports Trauma Research Center questionnaire (OSTRC-BR). Sleep-wake pattern was monitored for 2 weeks using actigraphy. Chronotype, sleep quality, sleep behavior, and sleep complaints were cross-sectionally collected. Results Poor sleep quality and poor sleep behavior were highly prevalent. The mean total sleep time was 6.57 ± 49.91. Duration of naps (r= −0.46; p=0.04) was associated with occurrence of health problems; frequency of insomnia (r= 0.51; p= 0.02), Pittsburgh Sleep Quality Index score (r= 0.45; p=0.04), and frequency of awakenings at night (r= 0.58; p= 0.01) were associated with severity of health problems; frequency of movements during sleep was associated with OSTRC-BR cumulative score (r= 0.58; p=0.00); and frequency of nightmares was associated with OSTRC mean score. Conclusions Paralympic athletes tend to report poor sleep quality, have poor sleep behavior and sleep less than the recommended. Insomnia symptoms, awakenings at night, movements during sleep and poor sleep quality were associated with the occurrence and/or severity of health problems.
... Due to the larger number of athletes and more complicated logistics, the XC ski coaches chose not to prioritize measurements of [U] in their team. All athletes also registered their injuries and/or illnesses weekly during, and after the first week following the training camp using the Oslo Sports Trauma Research Center questionnaire on health problems (Clarsen et al., 2014). ...
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Objective: To monitor the daily variations and time course of changes in selected variables during a 17–21-day altitude training camp at 1,800 m in a group of elite cross-country skiers (9 women, 12 men) and biathletes (7 women, 4 men). Methods: Among other variables, resting peripheral oxygen saturation (SpO2rest), resting heart rate (HRrest) and urine specific gravity (USG) were monitored daily at altitude, while illness symptoms were monitored weekly. Before and after the camp, body composition (i.e., lean and fat mass) and body mass were assessed in all athletes, while roller-skiing speed at a blood lactate concentration of 4 mmol·L−1 (Speed@4mmol) was assessed in the biathletes only. Results: Neither SpO2rest, HRrest nor USG changed systematically during the camp (p > 0.05), although some daily time points differed from day one for the latter two variables (p < 0.05). In addition, body composition and body mass were unchanged from before to after the camp (p > 0.05). Eleven out of 15 illness episodes were reported within 4 days of the outbound or homebound flight. The five biathletes who remained free of illness increased their Speed@4mmol by ~ 4% from before to after the camp (p = 0.031). Conclusions: The present results show that measures typically recommended to monitor acclimatization and responses to altitude in athletes (e.g., SpO2rest and HRrest) did not change systematically over time. Further research is needed to explore the utility of these and other measures in elite endurance athletes at altitudes typical of competition environments
... Based on the conceptual framework introduced, a survey instrument was designed through an iterative process by adopting questions from existing validated questionnaires (Clarsen et al., 2014;Hendricks et al., 2015;Kines et al., 2011) and designing a series of original questions, involving a team of experts from the following disciplines: Sports Management; Occupational Safety and Health; and Public Health. The key themes in the survey include demographic information, health outlook, tackle behavior, awareness of risk acceptance, consideration for other players, and reasons for risk-taking. ...
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Introduction: Considerable media attention has recently focused on an increased number of professional athletes that experience forced retirement due to severe injuries. Despite the highly completive, physical nature and tolerance of risk in contact sports, no Occupational Safety and Health (OSH) awareness-related measurement instrument exists in professional sports. As part of a wider project, this study aimed to develop a survey instrument to evaluate risk and safety awareness in sports, taking elite rugby (union) as an example. Methods: Based on the identified conceptual framework incorporating theories from the OSH discipline, the survey has been updated for three rounds according to the feedback from a multidisciplinary team of experts before the pilot test. The pilot test data (n=46, response rate 76.7%) were imported to SPSS for analysis and validation. The survey's key themes included health outlook, tackle behavior, awareness of risk acceptance, reasons for risk-taking, and safety consideration for other players. Results: Overall, the survey has a high internal consistency (Cronbach's α= 0.742). Some sections of the survey require a further factor analysis, such as awareness of risk acceptance during the competition (Kaiser-Meyer-Olkin Measure of Sampling Adequacy-KMO <0.767, p<0.001) and reasons for risk-taking (KMO<0.604, p=0.003). Some sections require a larger sample size for further validation, such as safety consideration for other players (KMO<0.481, p<0.001). Conclusion: This is the first survey that evaluates players' safety and risk awareness in rugby drawing upon OSH concepts. Such a survey has the potential to improve athletes' health and wellbeing by customized educational intervention, which could point the way forward for its application in a wider range of sport settings internationally.
... All participants prospectively reported their injuries using the Oslo Sports and Trauma Research Centre (OSTRC)-questionnaire on health problems with 2-week measurement intervals (Clarsen et al., 2014). For data collection and database management, the electronic data capture tool REDCap ® was used. ...
... A traumatic injury was defined as any physical complaint with a clearly identifiable inciting event; for overuse injuries, such an event was absent. Additionally, injuries were subcategorised as being substantial when leading to moderate to severe reduction in training volume or sports performance or to complete inability to participate (i.e., option 3, 4, and 5 in either question 2 or 3 of the OSTRC questionnaire), as defined by Clarsen et al. (2014). ...
... Level of significance based on unpaired sample t tests and backed up by biascorrected accelerated (BCa) bootstrapping with 10,000 samples: p < 0.05. Substantial health problems were defined in accordance withClarsen et al. (2014). ...
Article
Studies comparing children and adolescents from different periods have shown that physical activity and fitness decreased in the last decades, which might have important adverse health consequences such as body fat gain and poor metabolic health. The purpose of the current article is to present the benefits of high-intensity multimodal training (HIMT), such as CrossFit, to young people, with a critical discussion about its potential benefits and concerns. During HIMT, exercise professionals might have an opportunity to promote positive changes in physical function and body composition in children and adolescents, as well as to promote improvements in mental health and psychosocial aspects. Moreover, this might serve as an opportunity to educate them about the benefits of a healthy lifestyle and overcome the perceived barriers for being physically active. In technical terms, the characteristics of HIMT, such as, the simultaneous development of many physical capacities and diversity of movement skills and exercise modalities might be particularly interesting for training young people. Many concerns like an increased risk of injury and insufficient recovery might be easily addressed and not become a relevant problem for this group.
... All participants prospectively reported their injuries using the Oslo Sports and Trauma Research Centre (OSTRC)-questionnaire on health problems with 2-week measurement intervals (Clarsen et al., 2014). For data collection and database management, the electronic data capture tool REDCap ® was used. ...
... A traumatic injury was defined as any physical complaint with a clearly identifiable inciting event; for overuse injuries, such an event was absent. Additionally, injuries were subcategorised as being substantial when leading to moderate to severe reduction in training volume or sports performance or to complete inability to participate (i.e., option 3, 4, and 5 in either question 2 or 3 of the OSTRC questionnaire), as defined by Clarsen et al. (2014). ...
... Level of significance based on unpaired sample t tests and backed up by biascorrected accelerated (BCa) bootstrapping with 10,000 samples: p < 0.05. Substantial health problems were defined in accordance withClarsen et al. (2014). ...
Article
Background: Postural balance represents a fundamental movement skill for the successful performance of everyday and sport-related activities. There is ample evidence on the effectiveness of balance training on balance performance in athletic and non-athletic population. However, less is known on potential transfer effects of other training types, such as plyometric jump training (PJT) on measures of balance. Given that PJT is a highly dynamic exercise mode with various forms of jump-landing tasks, high levels of postural control are needed to successfully perform PJT exercises. Accordingly, PJT has the potential to not only improve measures of muscle strength and power but also balance. Objective: To systematically review and synthetize evidence from randomized and non-randomized controlled trials regarding the effects of PJT on measures of balance in apparently healthy participants. Methods: Systematic literature searches were performed in the electronic databases PubMed, Web of Science, and SCOPUS. A PICOS approach was applied to define inclusion criteria, (i) apparently healthy participants, with no restrictions on their fitness level, sex, or age, (ii) a PJT program, (iii) active controls (any sport-related activity) or specific active controls (a specific exercise type such as balance training), (iv) assessment of dynamic, static balance pre- and post-PJT, (v) randomized controlled trials and controlled trials. The methodological quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. This meta-analysis was computed using the inverse variance random-effects model. The significance level was set at p < 0.05. Results: The initial search retrieved 8,251 plus 23 records identified through other sources. Forty-two articles met our inclusion criteria for qualitative and 38 for quantitative analysis (1,806 participants [990 males, 816 females], age range 9–63 years). PJT interventions lasted between 4 and 36 weeks. The median PEDro score was 6 and no study had low methodological quality (�3). The analysis revealed significant small effects of PJT on overall (dynamic and static) balance (ES = 0.46; 95% CI = 0.32–0.61; p < 0.001), dynamic (e.g., Y-balance test) balance (ES = 0.50; 95% CI = 0.30–0.71; p < 0.001), and static (e.g., flamingo balance test) balance (ES = 0.49; 95% CI = 0.31–0.67; p<0.001). The moderator analyses revealed that sex and/or age did not moderate balance performance outcomes. When PJT was compared to specific active controls (i.e., participants undergoing balance training, whole body vibration training, resistance training), both PJT and alternative training methods showed similar effects on overall (dynamic and static) balance (p = 0.534). Specifically, when PJT was compared to balance training, both training types showed similar effects on overall (dynamic and static) balance (p = 0.514). Conclusion: Compared to active controls, PJT showed small effects on overall balance, dynamic and static balance. Additionally, PJT produced similar balance improvements compared to other training types (i.e., balance training). Although PJT is widely used in athletic and recreational sport settings to improve athletes’ physical fitness (e.g., jumping; sprinting), our systematic review with meta-analysis is novel in as much as it indicates that PJT also improves balance performance. The observed PJT-related balance enhancements were irrespective of sex and participants’ age. Therefore, PJT appears to be an adequate training regime to improve balance in both, athletic and recreational settings.
... The prevalence of health problems was calculated each week by dividing the number of athletes that reported any health problem by the number of questionnaire respondents (Clarsen et al. 2014). We also calculated weekly prevalence of the following sub-categories: substantial health problems, all injuries, substantial injuries, all illnesses, and substantial illnesses, as well as for sub-groups: male, female, on-field referees and assistant referees. ...
... We expressed the incidence of each type of health problem as the number of cases per referee per season (49 weeks), and the number of cases per 1000 hours of officiating. Severity of injuries were described by categorizing each case based on time-loss as slight (0 days), mild (1-7 days), moderate (8-28 days), or severe (>28 days) (Clarsen et al. 2014). The injury burden was expressed as time loss days per referee per year and visualised in a risk matrix, showing the cross product of incidence and severity . ...
Article
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Background: Top-level football referees take decisions during strenuous physical activity, and often under great mental pressure. Despite their central role in a football match, little is known about referees' health problems, particularly in female referees. Aim: To investigate the prevalence and burden of health problems in female and male top-level referees. Study design: Prospective cohort study. Method: Fifty-five Norwegian male and female top-level referees reported health problems (injuries and illnesses) in pre-season and during the 2020 competitive season, using the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). Results: We recorded data for 49 weeks with a compliance of 98%. On average, 34% (95% CI 31-36%) of referees reported at least one health problem each week, and 20% (95% CI 19-22%) reported substantial health problems. Female referees reported more health problems than male referees, and on-field referees reported more health problems than assistant referees. Gradual-onset injuries were most prevalent and caused the greatest absence from training and matches, whereas illnesses represented only a small portion to the overall burden of health problems. The injury incidence was three injuries per athlete-year (95% CI 2.5-3.5) and 11 injuries per 1000 match hours (95% CI 7-18). The illness incidence was 1.4 illnesses per athlete-year (95% CI 1.1-1.8). Injuries to the lower legs and feet represented the highest burden of health problems. Conclusion: Top-level referees, especially females, reported a high prevalence of health problems. Gradual-onset injuries to the lower leg and foot represented the highest injury burden.