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The Oslo Sports Trauma Research Center Questionnaire on Health Problems: a new approach to prospective monitoring of illness and injury in elite athletes

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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 and illnesses are of concern. Objective To describe a new surveillance method that is capable of recording all types of health problems and to use it to study the illness and injury patterns of Norwegian athletes preparing for the 2012 Olympic and Paralympic Games. Methods A total of 142 athletes were monitored over a 40-week period using a weekly online questionnaire on health problems. Team medical personnel were used to classify and diagnose all reported complaints. Results A total of 617 health problems were registered during the project, including 329 illnesses and 288 injuries. At any given time, 36% of athletes had health problems (95% CI 34% to 38%) and 15% of athletes (95% CI 14% to 16%) had substantial problems, defined as those leading to moderate or severe reductions in sports performance or participation, or time loss. Overuse injuries represented 49% of the total burden of health problems, measured as the cumulative severity score, compared to illness (36%) and acute injuries (13%). Conclusions The new method was sensitive and valid in documenting the pattern of acute injuries, overuse injuries and illnesses in a large, heterogeneous group of athletes preparing for the Olympic and Paralympic Games.
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The Oslo Sports T rauma R esearch C enter ques tionnaire
on health pr oblems: a new appr oach to pr ospective
monitoring of illness and injury in elite a thletes
Benjamin Clarsen,
1
Ola Rønsen,
2
Grethe Myklebust,
1
Tonje Wåle Flørenes,
1
Roald Bahr
1
Additional material is
published online only. To view
please visit the journal online
(http://dx.doi.org/10.1136/
bjsports-2012-092087).
1
Oslo Sports Trauma Research
Center, Norwegian School of
Sport Sciences, Oslo, Norway
2
The Olympic Elite Sports
Program (Olympiatoppen),
Oslo, Norway
Correspondence to
Benjamin Clarsen, Department
of Sports Medicine, Oslo Sports
Trauma Research Center,
Norwegian School of Sport
Sciences, PB 4014 Ullevål
Stadion, Oslo 0806, Norway;
ben.clarsen@nih.no
Received 13 December 2012
Revised 4 February 2013
Accepted 5 February 2013
To cite: Clarsen B,
Rønsen O, Myklebust G,
et al. Br J Sports Med
Published Online First:
[please include Day Month
Year] doi:10.1136/bjsports-
2012-092087
ABSTRACT
Backgroun d 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 and illnesses are of concern.
Objective To describe a new surveillance method that
is capable of recording all types of health problems and
to use it to study the illness and injury patterns of
Norwegian athletes preparing for the 2012 Olympic
and Paralympic Games.
Methods A total of 142 athletes were monitored over
a 40-week period using a weekly online questionnaire
on health problems. Team medical personnel were used
to classify and diagnose all reported complaints.
Results A total of 617 health problems were registered
during the project, including 329 illnesses and 288
injuries. At any given time, 36% of athletes had health
problems (95% CI 34% to 38%) and 15% of athletes
(95% CI 14% to 16%) had substantial problems,
dened as those leading to moderate or severe
reductions in sports performance or participation, or time
loss. Overuse injuries represented 49% of the total
burden of health problems, measured as the cumulative
severity score, compared to illness (36%) and acute
injuries (13%).
Conclusions The new method was sensitive and valid
in documenting the pattern of acute injuries, overuse
injuries and illnesses in a large, heterogeneous group of
athletes preparing for the Olympic and Paralympic Games.
INTRODUCTION
In recent years, the value of regular monitoring in
protecting the health of athletes has received increas-
ing recognition.
12
The International Olympic
Committee, together with several major International
Federations and National Olympic Committees, has
developed a surveillance system designed to record
injuries and illnesses in major championships,
3
and
this has been successfully implemented in several
Olympic Games, World Championships and other
major sporting tournaments.
411
Similarly, the
International Paralympic Committee has conducted
sy s tema tic injury surveillance at the 2002, 2006 and
2010 Winter P ar alympic Games.
1214
However, with
the exception of certain sports such as football,
15
there are few prospective studies of health problems
among Olympic-level athletes outside of the brief
period in which they are competing in major cham-
pionships. Little is known, therefor e, about their
patterns of illness and injury in their normal training
and preparation phases.
Among the possible explanations for this lack of
knowledge are the methodological challenges faced
when conducting longer term studies in this group
of athletes. The methods currently employed in a
majority of prospective surveillance studies are
based on those developed for recording football
injuries,
16
and while they may work well for team
sports, they are difcult to implement among
groups of individual athletes or those without a
centralised team structure.
17
Standard methods of
injury surveillance may also be poorly suited to col-
lecting information on overuse conditions, which
represent the predominant injury type in many
Olympic sports.
10 1820
We have recently discussed
these limitations in detail,
21
made general recom-
mendations for more appropriate methodology
21
and developed new tools that are better suited to
the study of overuse injuries.
22
Our rst aim in the present study was therefore
to modify our new method
22
such that it can be
used to record not only overuse injuries but also all
types of health problems in studies of large, hetero-
geneous groups of athletes. Our second aim was to
apply the method to analyse the patterns of illness
and injury in the Norwegian Olympic and
Paralympic teams during their preparations for the
2012 games in London.
METHODS
Recruitment
During the summer of 2011, the coaches of the
Norwegian national teams in all candidate sports
for the London Olympic or Paralympic Games
were asked to provide a list of athletes who had the
potential to qualify. The nal list included 143 ath-
letes, 142 of whom gave their consent to partici-
pate in the project. This included 116 Olympic
candidates (54 male and 62 female) and 26
Paralympic candidates (15 male and 11 female).
The Olympic sports in the study included archery
(n=1), athletics (n=22), beach volleyball (n=6),
boxing (n=2), cycling (n=12), handball (n=24),
kayak (n=7), rowing (n=13), sailing (n=8),
shooting (n=5), swimming (n=10), taekwondo
(n=3), weightlifting (n=1) and wrestling (n=2).
The Paralympic sports included archery (n=1),
athletics (n=1), boccia (n=1), cycling (n=2),
equestrian (n=4), sailing (n=4), shooting (n=7),
swimming (n=3) and table tennis (n=3). The
medical personnel that participated in classifying
and diagnosing illness and injuries included all the
Clarsen B, et al. Br J Sports Med 2013;0:18. doi:10.1136/bjsports-2012-092087 1
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doctors (n=7) and physiotherapists (n=13) who were selected
to travel with the Norwegian athletes to the Olympic or
Paralympic Games. The study was approved by the Norwegian
Data Inspectorate and reviewed by the South-Eastern Norway
Regional Committee for Research Ethics. Informed consent was
obtained from the athletes at the rst registration.
Data collection procedure
Every Sunday for the duration of the project, we used online
survey software (Questback V.9692, Questback AS, Oslo,
Norway) to send all athletes an email linking them to an internet-
based questionnaire on health problems, with an automatic
reminder email 3 days later if needed (gure 1). Each Thursday,
the project coordinator (BMC) compiled a report based on the
questionnaire responses from that week and sent it to the rele-
vant team medical staff. They were then expected to follow-up
each case and, in addition to providing normal clinical manage-
ment or advice to the athlete, to ll in a report classifying the
type and diagnosis of each health problem. These reports were
sent back to the project coordinator on a monthly basis.
The Oslo Sports Trauma Research Center (OSTRC)
questionnaire on health problems
We developed the Oslo Sports Trauma Research Center
(OSTRC) Questionnaire on Health Problems based on the
OSTRC Overuse Injury Questionnaire.
22
The four key questions
on the consequences of health problems on sports participation,
training volume and sports performance as well as the degree to
which they have experienced symptoms were modied to
capture all types of health problems including illness and acute
injuries (gure 2). If the athlete answered the minimum score
for each of these questions (full participation without problems/
no training reduction/no performance reduction/no symptoms),
the questionnaire was nished for that week. However, if the
athlete reported anything other than the minimum value for any
question, the questionnaire continued by asking them to dene
whether the problem they referred to was an illness or an injury.
In the case of an injury, they were asked to register the area
of the body in which it was located, and in the case of an
illness, they were asked to select the major symptoms they had
experienced. For all types of problems, the number of days of
complete time loss, dened as the total inability to train or
compete, was also registered. Athletes were also asked whether
or not the problem had been reported previously, whether the
problem was already being treated (and by whom) and whether
they had any further comments for their Olympic medical team.
These three questions were included for use in the weekly
reports rather than for epidemiological data collection purposes.
Finally, athletes were asked whether the problem they had been
referring to was the only health problem they had experienced
during the preceding 7 days or whether they had experienced
several problems. If they had only had one problem, the ques-
tionnaire was nished, whereas if they reported several pro-
blems, the questionnaire returned to the four key questions and
repeated itself for each subsequent problem reported. The
Figure 1 Diagram showing the procedures used to collect data on
health problems.
Figure 2 The four key questions asked at the beginning of the
weekly online Oslo Sports Trauma Research Center (OSTRC)
Questionnaire on Health Problems. If the athlete answered the
minimum value in each of the four questions, the questionnaire was
nished for that week.
2 Clarsen B, et al. Br J Sports Med 2013;0:18. doi:10.1136/bjsports-2012-092087
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questionnaire logic is summarised in gure 3, and the complete
OSTRC Questionnaire is available as an online supplement
appendix 1.
Classication and diagnosis of reported problems
Team medical personnel wer e asked to classify each problem
reported as an illness, a cute injury or o v eruse inj ury, based on their
clinical interview. In accordance with the International Olympic
Committee surve illance sy s te m,
3
health problems we r e classied as
injuries if the y wer e disorders of the musculosk eletal sy s tem or con-
cussions. They w er e classied as illnesses if they invo lv ed other
body sys tems, such as (but not limited to) the respira tory, digestiv e
and neurological sy stems, as well as non-specic/gene r alis ed, psy-
chological and social pr oblems. Injuries w er e further subca tegorised
into ov eruse and a cute injur es. Acute injuries wer e dened as thos e
whose onset could be linked to a specic injury event, whereas
ov eruse injuries were those that could not be linked to a clearly
identiable ev en t. The medical team was also asked to provide a
specic diagnosis for each event. F or illnesses, the Interna tional
Classica tion of Primary Care, V.2 (ICPC-2) was used,
23
and for
injuries the Orchard Sports Injury Classication Sys tem, V.10
(OSICS-10), w as used.
24
The rst tier of the OSICS-10 code w as
used to determine the location , and the second tier was used to
determine the type. The rst letter of the ICPC-2 code was used to
determine the body sys te m affecte d by illness.
At the conclusion of the project, the project coordinator
manually went through each athletes questionnaire responses
and cross-checked all reported health problems with the classi-
cations and diagnoses made by the medical team. All cases were
checked twice for accuracy, and in 16 cases where information
was missing or conicting, medical personnel were contacted
for clarication. In injury cases where the same diagnosis was
interspersed with periods of apparent recovery, medical person-
nel were consulted in order to classify subsequent events as
exacerbations of unresolved problems or recurrences of fully
recovered problems (reinjuries), in accordance with the deni-
tions outlined by Fuller et al.
25
Illnesses were treated in a
similar fashion, with repeated episodes of chronic conditions
treated as a single case for the purposes of analysis.
Prevalence calculations
Prevalence measures were calculated for all health problems, ill-
nesses, injuries, overuse injuries and acute injuries for each week
that the project was conducted. This was performed by dividing
the number of athletes reporting any form of problem by the
number of questionnaire respondents. The prevalence of sub-
stantial problems was also calculated for each of these measures,
with substantial problems dened as those leading to moderate
or severe reductions in training volume, or moderate or severe
reductions in sports performance, or complete inability to par-
ticipate in sport (ie, problems where athletes selected option 3,
4 or 5 in either Questions 2 or 3). All prevalence measures were
also calculated for the four different subgroups of athletes:
(1) team athletes (n=30), consisting of handball and beach
volleyball players; (2) endurance athletes (n=53), consisting of
athletes from cycling, kayak, rowing, swimming as well as
the middle-distance and long-distance runners from athletics;
(3) tactical/technical athletes (n=36), consisting of athletes
participating in archery, boxing, sailing, shooting, taekwondo,
weightlifting and wrestling, as well as the sprint and eld
athletes from athletics and (4) paralympic athletes (n=26). All
prevalence measures were presented as averages, together with a
95% CI. Data from the rst week the project was conducted
were excluded from all calculations, as per our previous
recommendations.
22
Severity of health problems
Each week, a severity score was calculated for all reported
health problems based on an athletes responses to the four key
questions.
22
The severity score was plotted in order to track
the progression of each health problem, such as in the example
shown in gure 4. The cumulative severity score was then calcu-
lated for each case by summing the severity score for each week
that it was reported. The average weekly severity score was calcu-
lated by dividing the cumulative severity score by the number of
weeks the problem was reported. The total amount of complete
time loss was also calculated for each problem by summing
the weekly reported time loss. For all the above calculations,
recurrent problems were counted as the same event if they were
deemed by the medical staff to be exacerbations of an unre-
solved injury or a chronic illness.
Relative burden of illness, overuse injury and acute injury
The cumulative severity scores for all health problems were
summed, and the proportion of the total number made up by
illness, overuse injury and acute injury was determined. This
Figure 3 Diagram of questionnaire logic showing how the length of
the questionnaire varied according to the number of health problems
the athlete reported. Up to four health problems could be reported
per week.
Figure 4 Example of the severity score being used to track the
consequences of three typical health problems. The light grey area
represents a mild overuse injury (cumulative severity score: 352), the
dark grey area represents a short duration illness (91) and the area
with diagonal lines represents a severe acute injury (1005).
Clarsen B, et al. Br J Sports Med 2013;0:18. doi:10.1136/bjsports-2012-092087 3
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was performed in order to estimate the relative burden of these
different types of health problems.
Statistical analyses
In order to analyse differences in the various prevalence
measures between subgroups of athletes, Kruscal-Wallis
non-parametric analysis of variance (ANOVA) tests were
applied, using SPSS statistical software (SPSS V.18, IBM
Corporation, New York, USA).
In order to analyse differences in the duration, cumulative
severity and average weekly severity scores between different
types of health problems, as well as between diagnosed and
undiagnosed health problems, regression analyses were made.
The repeated nature of measurements was taken into account by
applying the robust option in the xtreg command in STATA stat-
istical software (STATA V.12.0, StataCorp LP, Texas, USA). The
signicance level (α) was set at 0.05 for all tests.
As the original OSTRC questionnaire was developed for
recording injury consequences,
22
it was necessary to reanalyse
the psychometric properties of the four key questions when
they were applied to illnesses. In order to do this, all question-
naires that did not report an injury (n=3384) were analysed
using SPSS software to determine internal consistency
(Cronbachs α). A factor analysis was also performed using a
principle component analysis extraction method. Additionally,
in order to assess the effects of sampling less frequently, the
primary outcome measures were recalculated using only infor-
mation from every second and fourth questionnaires.
RESULTS
Response rate to the weekly health questionnaires
The average weekly response rate to the health questionnaires
was 80% (SD 5). The rate was 84% (SD 3) among athletes that
were eventually selected for participation in London, while it
was 75% (SD 10) among those that were not selected. Figure 5
shows the response rates for each of these groups during the
course of the 40-week project. As illustrated, the response from
non-selected athletes fell during the second half of the project.
Classication of problems reported
A total of 617 health problems were reported by 132 athletes
over the course of the 40-week project, including 329 illnesses
and 288 injuries. Of these, 582 cases (94%) were followed up
by medical staff and classied with an ICPC-2 or OSICS-10
code. A majority of the 35 unclassi ed cases were brief and of
mild severity, with their average duration being shorter than that
of classied health problems (1 week (95% CI 1 to 2) vs
3 weeks (95% CI 3 to 3), p=0.03), and with their average
cumulative severity being substantially lower (51 (95% CI
34 to 67) vs 118 (95% CI 99 to 137), p<0.01).
Prevalence of health problems
The average weekly prevalence of health problems reported was
36% (95% CI 34% to 38%), with 15% of athletes reporting
substantial health problems each week (95% CI 14 to 16). As
shown in table 1, overuse injury was the most prevalent type of
health problem, and there was a variation in the prevalence of
health problems between the various subgroups of athletes.
Over the course of the 40-week project, there was a general
decline in the prevalence of illness, substantial illness, overuse
injury and substantial overuse injury (gure 6), while the preva-
lence of acute injury increased slightly over the same period.
Injury data
A total of 288 injuries were reported by 115 athletes over the
course of the study. Of these, 202 were classied as overuse
Figure 5 Response rate (%) to the weekly health questionnaires for
the whole group (solid grey area), for the athletes selected for the
Olympic and Paralympic Games (n=71, solid line) and for the athletes
not selected for participation in the games (n=71, dashed line).
Table 1 Average weekly prevalence (percentage of athletes affected) of all health problems and substantial problems reported, as well as the
prevalence of the subcategories illness, injury, overuse injury and acute injury in the whole group and each of the four subgroups of athletes
Team Endurance Tactical/technical Paralympic Total cohort
n=30 n=53 n=36 n=26 n=142
Health problems reported
All 45 (4248)**
,
***
,
**** 30 (2732)*
,
*** 25 (2128)*
,
** 29 (2633)* 36 (3438)
Illness 6 (58)**
,
***
,
**** 16 (1318)*
,
*** 10 (912)*
,
**
,
**** 16 (1419)*
,
*** 13 (1214)
Injury 42 (3945)**
,
***
,
**** 17 (1619)* 18 (1422)* 19 (1721)* 25 (2427)
Overuse injury 31 (2933)**
,
***
,
**** 15 (1317)* 16 (1318)* 13 (1214)*
,
** 20 (1821)
Acute injury 10 (812)**
,
***
,
**** 2 (12)* 3 (24)* 2 (13)* 4 (35)
Substantial problems
All 16 (1417)*** 14 (1316)*** 11 (913)*
,
**
,
**** 16 (1419)*** 15 (1416)
Illness 2 (13)**
,
***
,
**** 8 (610)* 6 (58)* 8 (610)* 6 (67)
Injury 14 (1316)**
,
***
,
**** 7 (67)* 5 (47)*
,
**
,
**** 11 (912)*
,
**
,
*** 9 (910)
Overuse injury 9 (811)**
,
*** 6 (56)* 4 (35)*
,
**
,
**** 10 (811)**
,
*** 7 (68)
Acute injury 5 (46)**
,
***
,
**** 1 (01)* 2 (12)* 1 (02)* 2 (23)
p<0.05 vs *team group, **endurance group, ***tactical/technical group, ****paralympic group.
All data are mean values with 95% CI in parenthesis. Substantial problem: causing moderate/severe reductions in training volume or sports performance, or complete inability to
participate in training or competition.
4 Clarsen B, et al. Br J Sports Med 2013;0:18. doi:10.1136/bjsports-2012-092087
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injuries, 60 as acute injuries and 26 were unclassied. The
average duration, average weekly severity score and average
cumulative injury score for acute and overuse injuries are shown
in table 2. As shown in the table, there were no signicant dif-
ferences between the average duration, average weekly severity
score or average cumulative severity score between overuse and
acute injuries, although overuse injuries tended to last longer
(p=0.055).
Of the 288 injuries reported, 122 were substantial problems,
including 86 overuse injuries and 27 acute injuries (9 were
unclassied; average duration: 1.3 weeks, SD 0.5).
The location of acute and overuse injuries and their severity
measured by time loss are shown in table 3. The most common
overuse injury types were unspecied pain (29% of cases),
muscle injury (25%), tendon injury (16%) and synovitis/
impingement/bursitis (15%), while the most common types of
acute injury were joint sprains (48%), muscle injury (15%) and
bruising/haematoma (12%).
Illness data
A total of 329 illnesses were reported by 106 athletes over the
course of the study, and 97% of cases were classied with an
ICPC-2 code. Of the 329 illnesses reported, 198 represented
substantial problems. The average weekly prevalence of illness
and of substantial illness for the whole group and for each sub-
group of athletes is shown in table 1. As shown in table 2, ill-
nesses had a higher average weekly severity score than injuries.
However, as their average duration was shorter, their average
cumulative severity score was signicantly lower. The most com-
monly affected systems were the respiratory system (68% of
cases) and the digestive system (16%).
Relative burden of illness, overuse injury and acute injury
When the cumulative severity score of all health problems was
summed, overuse injuries represented 49% of the total number,
illnesses represented 36% and acute injuries represented 13%.
The remaining 2% consisted of unclassied injuries.
Psychometric questionnaire properties
The questionnaire had high internal consistency when all
questionnaires were analysed, as well as for non-injury cases
(Cronbachs α of 0.96 and 0.97, respectively). This was
not improved by removing items in either case (table 4). The
factor weighting was relatively even for all four questions in
both cases.
Effects of different sampling frequencies on outcome
measures
Sampling less frequently led to fewer cases being identied and
a reduction in the average cumulative severity score and dur-
ation. However, the average prevalence and average weekly
severity measures were not affected (table 5).
DISCUSSION
This paper describes a new approach to monitor athletes
health, and presents the rst prospective data on the illness and
injury patterns of Olympic and Paralympic athletes preparing for
the games. The main ndings were that, at any given time, 36%
of athletes had some form of health problem, and 15% had a
substantial illness or injury. The new method was able to show
that overuse injuries represented the greatest burden on the
group, owing to the large number of cases and the relatively long
duration of consequences they had on the athletes participation
and performance. In contrast, illnesses were of signicantly
shorter duration and there were far fewer cases of acute injury.
The methods used in this study represent a modication of
those we developed for recording overuse injuries in predened
anatomical areas,
22
such that they can be used to monitor all
types of health complaints. Although the previous approach is
more appropriate for the study of specic problems, such as
shoulder problems, the current approach is better suited to
general surveillance studies, particularly when the cohort is het-
erogeneous and a wide variety of complaints is expected. In
both approaches, the methods differ considerably from those
typically used in prospective surveillance studies as health pro-
blems are reported directly by athletes through regular online
questionnaires, rather than via team medical staff. We have pre-
viously discussed the benets and limitations of this approach in
detail
21 22
; therefore, this discussion will focus primarily on the
modications made in the current study.
One of the principal modications was to restructure OSTRC
questionnaire: The four key questions were made more general
Table 2 Average duration, weekly severity score and cumulative
severity score of illnesses, overuse injuries and acute injuries
Illness Overuse injury Acute injury
n=329 n=202 n=60
Duration (weeks) 2 (22) 5 (46)* 3 (24)*
Average weekly severity score 45 (4247) 32 (2934)* 35 (3040)
Cumulative severity score 78 (6987) 169 (125214)* 153 (66240)*
*Significantly different to illness (p<0.03).
Data are mean values with the 95% CI in parenthesis.
Figure 6 Prevalence of illness, overuse injury and acute injury over
the 40-week study. Light grey area: all complaints (linear regression
line=long dashes), dark grey area: substantial problems (linear
regression line=short dashes).
Clarsen B, et al. Br J Sports Med 2013;0:18. doi:10.1136/bjsports-2012-092087 5
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(referring to any health problem or complaint rather than a spe-
cic anatomical area) and logical functions were used to register
multiple problems. These changes were made to allow for the
registration of all types of problems and to minimise the time
burden of completing the questionnaire. However, in our
experience, one of the limitations of trying to capture all pro-
blems is that fewer are identied than when specic questioning
is used.
19
To combat this, we structured the questionnaire such
that all athletes had to complete the four key questions regard-
less of whether or not they had any health problems to report.
This prompted the athlete to consider the question have you
had any health problems in several different ways.
A second modication was the use of team medical staff to
classify and diagnose each health problem reported by athletes,
allowing for the prospective collection of exact diagnoses, as
well as a comprehensive subclassication of each case. As this
method records all physical complaints, a considerable propor-
tion of minor and transient cases are likely to be non-specicor
difcult to diagnose. This was the case in the current study,
where the most common type of overuse injury was unspecied
pain, representing 29% of all cases. Nevertheless, monitoring
the prevalence of specic injury types, such as tendinopathy or
stress fractures, becomes possible using this approach. In add-
ition, the system of weekly feedback reports to team medical
staff established to facilitate data collection (gure 1) also served
as a practical tool to optimise medical coverage for the teams.
This was important, as the athletes involved spent most of the
preparatory period with their club, relying upon local/external
medical support. The weekly reporting enhanced the Olympic
medical teams awareness of health problems among their ath-
letes, and in many cases this led to earlier and more comprehen-
sive intervention. This is one potential explanation for the
reduction in the prevalence of overuse and illness problems
throughout the course of this study. However, it must be taken
into consideration that by improving athletes medical coverage,
the system inherently affects its own data.
A third modication is that, in addition to the average weekly
severity score, an additional measure of severity, the cumulative
severity score, was calculated for each health problem. This pro-
vides information on the relative impact each case has on the
athlete, as it takes into account the degree of consequences and
the duration of the problem. Summing cumulative severity
scores also enables an estimation of the total burden of different
types of problems, or within different groups of athletes. One
important nding in the current study was that overuse injuries
placed a much greater burden on the athletes than illnesses and
acute injuries (49%, 36% and 13%, respectively, of the summed
cumulative severity score), in contrast to what is typically found
using standard surveillance methods.
79152629
For acute injuries, we consider standard surveillance methods
to be a satisfactory alternative to the new method, as it was
Table 3 Location and degree of time loss for acute and overuse injuries
Location
Acute injuries Overuse injuries
Slight Minimal Mild Moderate Severe
Total
Slight Minimal Mild Moderate Severe
Total(0 days) (13 days) (47 days) (828 days) (>28 days) (0 days) (13 days) (47 days) (828 days) (>28 days)
Head 1 2 1 –– 4 –––
Neck 1 –– 15221 10
Shoulder 11 1 322 3 1 430
Upper arm –– 1 ––1 2
Elbow 1 1 –– 23 1 1 16
Forearm –– 3 1 –– 4
Wrist and hand 10 6 1 17 3 2 1 –– 6
Chest –– 11 –– 2
Trunk and abdomen –– 11–– 2
Thoracic spine 1 –– 16 2 1 9
Lumbar spine –– 1 114643 27
Pelvis and buttock –– 31 2 –– 6
Hip and groin 2 2 –– 47 ––1 8
Thigh 1 5 1 2 910 3 1 ––
14
Knee 2 1 1
4199332 36
Lower leg 1 1 23231 9
Ankle 6 4 1 1 12 8 5 1 –– 14
Foot –– 5712 15
Disabled –– 2 –– 2
Total 25 21 6 6 2 60 113 47 22 13 7 202
Table 4 Interitem and itemtotal correlations and effects of
removing items on internal consistency
Interitem correlation matrix
Itemtotal
correlation
Cronbachs
α if item
deleted
Question
1
Question
2
Question
3
All questionnaires (n=4470)
Question 1 0.92 0.94
Question 2 0.87 0.90 0.94
Question 3 0.89 0.88 0.92 0.94
Question 4 0.85 0.80 0.84 0.87 0.95
Non-injury cases (n=3384)
Question 1 0.94 0.95
Question 2 0.91 0.91 0.96
Question 3 0.90 0.91 0.94 0.95
Question 4 0.87 0.82 0.88 0.88 0.96
6 Clarsen B, et al. Br J Sports Med 2013;0:18. doi:10.1136/bjsports-2012-092087
Original article
group.bmj.com on February 27, 2013 - Published by bjsm.bmj.comDownloaded from
arguably for this purpose that they were developed.
16 21
However, data collected by medical staff may not always be
complete and accurate,
30 31
and systematic bias may be intro-
duced when broad denitions are used.
32
As the methods used
in this study do not rely on medical staff as the means of deter-
mining the occurrence of a case, a major source of systematic
bias is eliminated. Therefore, the novel methodology may be a
preferable alternative, particularly as recording all complaints is
desirable in many instances.
33
It should be noted that data col-
lected using the new method can also be presented according to
consensus guidelines,
16
as demonstrated in table 3.
Although illnesses are increasingly being included in surveil-
lance studies,
6810112634
there is a wide variation in the way
in which they are recorded and reported. Similar to injuries,
issues are likely to arise when recording illnesses using standard
prospective methods, particularly as athletes with mild or
chronic conditions are likely to continue to participate in sport.
The methods used in this study may therefore be a good option
when these problems are of interest. Although OSTRC
Questionnaire was rst developed for the study of injuries, our
analyses of its psychometric properties suggest that it may also
be appropriate to monitor illness consequences.
It must be acknowledged that the success of this method of data
collection is entirely dependent on a good response from athletes,
as well as a thorough follow-up from team medical staff to record
diagnoses. In the current study, the average response rate of 80%
was high, as was the percentage of cases successfully diagnosed
(94%). However, this was a study of highly motivated elite athletes
in a well-organised Olympic team structure, and it is not yet
known how these methods will function in other settings.
Finally, as in our previous paper, we performed data simula-
tions of the effects of administering questionnaires every second
and fourth week, rather than weekly. The results indicate that,
in future epidemiological studies using this method, it is possible
to sample less frequently as the primary outcome measures,
average prevalence and severity are unchanged. However, the
data simulations highlight the fact that cumulative severity
scores are not comparable between studies unless the studies are
of the same duration and use the same sampling frequency.
Also, as fewer problems are identied and the frequency of
reporting to the medical team is reduced, administering ques-
tionnaires less frequently would comprise this methods value as
a practical health monitoring tool.
CONCLUSION
This paper presents a new approach to recording all types of
health problems in sport, showing that the method is sensitive
and valid in documenting the pattern of acute injuries, overuse
injuries and illnesses in a large, heterogeneous group of athletes
during a 40-week preparatory period before the Olympic and
Paralympic Games. Overuse injuries represented a much greater
burden (49%) on the athletes than illnesses (36%) and acute
injuries (13%), in contrast to what is typically found using
standard surveillance methods.
What are the new ndings?
A new approach to monitor athletes health using regular
online questionnaires enables valid and reliable registration
of all types of problems, including illness, overuse injury and
acute injury.
At any given time, more than one in three athletes
preparing for the Olympic or Paralympic Games had health
problems.
Overuse injuries represented the greatest burden on athletes
health, in comparison to acute injuries and illnesses.
How might it impact on clinical practice in the near
future?
This paper may lead to a change in the methods used in
surveillance studies of athletes, particularly when overuse
injuries and illnesses are of interest.
Acknowledgements The authors would like to acknowledge Olympiatoppens
support of this project. We would also like to thank the athletes, physicians and
physiotherapists involved in the project for their assistance in data collection. The
Oslo Sports Trauma Research Center has been established at the Norwegian School
of Sport Sciences through generous grants from the Royal Norwegian Ministry of
Culture, the South-Eastern Norway Regional Health Authority, the International
Olympic Committee, the Norwegian Olympic Committee & Confederation of Sport,
and Norsk Tipping AS.
Table 5 Variations in outcome measures with different sampling frequencies
Sample Sample every Sample every
Weekly 2 weeks 4 weeks
Number of completed questionnaires 4469 2244 1124
Number of health problems identified 617 428 294
Illnesses 329 216 132
Injuries 288 212 162
Number of substantial problems 320 220 131
Illnesses 198 129 71
Injuries 122 91 60
Average prevalence (all health problems) 36 (3438) 36 (3438) 37 (3440)
Average prevalence (substantial) 15 (1416) 16 (1417) 16 (1417)
Average weekly severity score 40 (3842) 40 (3842) 38 (3541)
Average cumulative severity score 114 (96132) 83 (7195) 60 (5169)
Average duration of problems (weeks) 3 (33) 2 (22) 2 (12)
Clarsen B, et al. Br J Sports Med 2013;0:18. doi:10.1136/bjsports-2012-092087 7
Original article
group.bmj.com on February 27, 2013 - Published by bjsm.bmj.comDownloaded from
Contributors All authors were involved in planning the project, data collection
and preparing the manuscript. BMC was responsible for co-ordination of the data
collection and for data analysis. BMC is responsible for the overall content as the
guarantor.
Competing interests None.
Ethics approval Norwegian Data Inspectorate and South-Eastern Norway Regional
Committee for Research Ethics.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Unpublished data are available upon request.
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doi: 10.1136/bjsports-2012-092087
published online February 21, 2013Br J Sports Med
Benjamin Clarsen, Ola Rønsen, Grethe Myklebust, et al.
illness and injury in elite athletes
approach to prospective monitoring of
questionnaire on health problems: a new
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... 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). ...
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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.
... 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). ...
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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.
... 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. ...
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... 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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... 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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... 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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... 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.
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Introduction Most epidemiological studies in the field of military medicine have been based on data from medical records and registries. The aims of this study were to test a self-reporting injury surveillance system commonly used in sports medicine in a military setting, and to describe the injury pattern among Norwegian army conscripts during a period of military training. Method A total of 296 conscripts in His Majesty the King’s Guard were asked to report all injuries each week for 12 weeks, using a modification of the Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H2). We recorded all injuries irrespective of their need for medical attention or consequences for military participation. In addition, we retrieved data on injuries recorded by military physicians in the medical record from the Norwegian Armed Forces Health Register. Results The mean weekly response rate was 74%. A total of 357 injuries were recorded, of which 82% were only captured through the OSTRC-H2 and 3% only in the medical records. The average weekly prevalence of injury was 28% (95% CI: 25% to 31%), and 10% (95% CI: 8% to 12%) experienced injuries with a substantial negative impact on training and performance. The greatest injury burden was caused by lower limb injuries, with knee and foot injuries as the predominant injury locations. Conclusion The OSTRC-H2 is suitable for use in a military setting and records substantially more injuries than the standard medical record. The prevalence of injuries among conscripts is high and comparable with many elite sports.
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Background: Current methods for injury registration in sports injury epidemiology studies may substantially underestimate the true burden of overuse injuries due to a reliance on time-loss injury definitions. Objective: To develop and validate a new method for the registration of overuse injuries in sports. Methods: A new method, including a new overuse injury questionnaire, was developed and validated in a 13-week prospective study of injuries among 313 athletes from five different sports, cross-country skiing, floorball, handball, road cycling and volleyball. All athletes completed a questionnaire by email each week to register problems in the knee, lower back and shoulder. Standard injury registration methods were also used to record all time-loss injuries that occurred during the study period. Results: The new method recorded 419 overuse problems in the knee, lower back and shoulder during the 3-month-study period. Of these, 142 were classified as substantial overuse problems, defined as those leading to moderate or severe reductions in sports performance or participation, or time loss. Each week, an average of 39% of athletes reported having overuse problems and 13% reported having substantial problems. In contrast, standard methods of injury registration registered only 40 overuse injuries located in the same anatomical areas, the majority of which were of minimal or mild severity. Conclusion: Standard injury surveillance methods only capture a small percentage of the overuse problems affecting the athletes, largely because few problems led to time loss from training or competition. The new method captured a more complete and nuanced picture of the burden of overuse injuries in this cohort.
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Protection of the athletes' health is a clearly articulated objective of the International Olympic Committee. Longitudinal surveillance of injuries and illnesses can provide valuable data that may identify high-risk sports and disciplines. This is a foundation for introducing tailored preventive measures. During the XXIX Summer and XXI Winter Games, comprehensive injury and illness recording through the medical staff of the participating National Olympic Committees and the sports medicine clinics revealed that between 7% and 11% of all athletes incurred an injury or suffered from at least one occurrence of illness during the Games. The incidence of injuries and illnesses varied substantially between sports. In the future, risk factor and injury mechanism analyses in high-risk Olympic sports are essential to better direct injury-prevention strategies. Concomitantly, periodic health evaluations of athletes will be instrumental to optimise health protection.
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To determine the incidence and characteristics of newly incurred injuries and illnesses during international Athletics Championships, by improving the medical surveillance coverage, in order to determine future prevention strategies. Prospective recording of newly occurred injuries and illnesses. 13th International Association of Athletics Federations World Championships in Athletics 2011 in Daegu, Korea. National team and Local Organising Committee physicians; and 1851 registered athletes. Incidence and characteristics of newly incurred injuries and illnesses. 82% of athletes were covered by medical teams participating with a response rate of 94%. A total of 249 injuries were reported, representing an incidence of 134.5 injuries per 1000 registered athletes, and 119 (48%) resulted in time loss from sport. A total of 185 injuries affected the lower limb (74%). Hamstring strain was the main diagnosis and 67% resulted in absence from sport. Overuse (n=148; 59%) was the predominant cause. A total of 126 illnesses were reported, signifying an incidence of 68.1 per 1000 registered athletes. Upper respiratory tract infection was the most common reported diagnosis (18%), followed by exercise-induced dehydration (12%), and gastroenteritis/diarrhoea (10%). The highest incidences of injuries were found in combined events and middle and long-distance events, and of illness in race walking events. During elite Athletics World Championships, 135 injuries, 60 time-loss injuries and 68 illnesses per 1000 registered athletes were reported. Higher risks of injuries were found in combined events and long-distance runs. Preventive interventions should focus on overuse injuries and hamstring strains, decreasing the risk of transmission of infectious diseases, appropriate event scheduling and heat acclimatisation.
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Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries, making interstudy comparisons difficult. Therefore an Injury Consensus Group was established under the auspices of Fédération Internationale de Football Association Medical Assessment and Research Centre. A nominal group consensus model approach was used. A working document on definitions, methodology, and implementation was discussed by the group. Iterative draft statements were prepared and circulated to members of the group for comment before the final consensus statement was produced. Definitions of injury, recurrent injury, severity, and training and match exposures in football together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players’ baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented.
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This study aimed to record and analyse incidence and characteristics of injuries and illnesses incurred during the Indoor Athletics Championships. During the 2011 European Indoor Athletics Championships in Paris, incidence and characteristics of new injuries and illnesses were recorded prospectively by physicians and physiotherapists from national teams and local organizing committee in 631 registered athletes. Around 70% of athletes were covered by the medical teams (response rate: 84%). Thirty injuries, including eight time-loss injuries, were reported, representing an incidence of 47.5 injuries and 29.4 time-loss injuries per 1000 registered athletes. Injury and time-loss injury risk were highest in heptathlon and hurdles. Three-quarters of injuries affected the lower extremity. Thigh strain was the most common diagnosis (n = 7; 23%). Noncontact trauma (n = 9; 30%) was the predominant cause. A total of 18 illnesses were reported. Incidence of illnesses was 28.5 per 1000 registered athletes, with 17% resulting in time lost from sport. Upper respiratory tract infection was the most common diagnosis (n = 8; 44%) followed by upper respiratory tract allergy (n = 3; 17%) and gastroenteritis (n = 3; 17%). Injury and illness incidence and severity were lower during the 2011 European Indoor Athletics Championships than during outdoor championships, probably due to the shorter duration, the fewer number of events, and shorter sprint distances.
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Data on the injury and illness risk among young elite athletes are of utmost importance, because injuries and illnesses can counter the beneficial effects of sports participation at a young age, if children or adolescents are unable to continue to participate because of residual effects of injury or chronic illness. To analyse the frequencies and characteristics of injuries and illnesses during the 2012 Innsbruck Winter Youth Olympic Games (IYOG). We employed the International Olympic Committee (IOC) injury surveillance system for multisport events, which was updated for the Winter Olympic Games in Vancouver 2010. All National Olympic Committees (NOCs) were asked to report the daily occurrence (or non-occurrence) of newly sustained injuries and illnesses on a standardised reporting form. In addition, information on athletes treated for injuries and illnesses by the Local Organizing Committee medical services was retrieved from the medical centre at the Youth Olympic Village and from the University hospital in Innsbruck. Among the 1021 registered athletes (45% women, 55% men) from 69 NOCs, a total of 111 injuries and 86 illnesses, during the IYOG, were reported, resulting in an incidence of 108.7 injuries and 84.2 illnesses per 1000 registered athletes, respectively. Injury frequency was highest in skiing in the halfpipe (44%) and snowboarding (halfpipe and slope style: 35%), followed by ski cross (17%), ice hockey (15%), alpine skiing (14%) and figure skating (12%), taking into account the respective number of participating athletes. Knee, pelvis, head, lower back and shoulders were the most common injury locations. About 60% of injuries occurred in competition and about 40% in training, respectively. In total, 32% of the injuries resulted in an absence from training or competition. With regard to illnesses, 11% of women and 6% of men suffered from an illness (RR=1.84 (95% CI 1.21 to 2.78), p=0.003). The respiratory system was affected most often (61%). Eleven per cent of the athletes suffered from an injury and 9% from illnesses, during the IYOG. The presented data constitute the basis for future analyses of injury mechanisms and associated risk factors in Olympic Winter sports, which, in turn, will be essential to develop and implement effective preventive strategies for young elite winter-sport athletes.
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Objective: To examine the incidence of illness and highlight gender differences in tennis players competing in a major professional tennis tournament over a 16-year period between 1994 and 2009. Design: Descriptive epidemiology study of illness trends in professional tennis players. Setting: Archival data from the US Open Tennis Championships. Participants: Participants in the US Open Tennis Championships main draw from 1994 to 2009. Main outcome measures: Illness data collected at the US Open Tennis Championships between 1994 and 2009 were classified using guidelines presented in a sport-specific consensus statement. Each case was categorized according to the medical system effected and impact on play availability during the tournament. Illness rates were determined based on the exposure of an athlete to a match event and were calculated as the ratio of illness cases per 1000 match exposures (ME). Results: The average number of illness cases over the 16-year period analyzed was 58.19 ± 12.02 per year (36.74 per 1000 ME) requiring assistance by the medical staff. Statistical analyses showed a significant fluctuation in illness cases related to the dermatological (DERM), gastrointestinal, renal/urogenital/gynecological, neurological, ophthalmic and otorhinolaryngological (ENT), and infectious medical systems (P < 0.05). The ENT and DERM conditions were the most commonly reported types of illness for both men and women. Conclusions: Numerous medical systems are susceptible to illness in tennis players. Sport-specific factors may influence susceptibility to common illnesses experienced by professional tennis players.
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The aim of this study was to monitor injury incidence and pattern in Norwegian male professional football over six consecutive seasons and compare the risk of injury between the preseason and competitive season. All time loss injuries were recorded by the medical staff of each club. In total, 2365 injuries were recorded. The incidence of acute injuries was 15.9/1000 match hours [95% confidence interval (CI): 14.9-16.8], 1.9/1000 training hours (95% CI: 1.7-2.0), and 1.4 (95% CI: 1.3-1.5) overuse injuries/1000 h. A linear regression model found an annual increase of 1.06 acute match injuries/1000 h (95% CI: 0.40-1.73), corresponding to a total increase of 49% during the 6-year study period. When accounting for interteam variation and clustering effects using a general estimating equation model, the increase in injury incidence was 0.92 (95% CI: -0.11-1.95, P = 0.083). No difference in the risk of acute match injuries (rate ratio (RR): 0.86, 95% CI: 0.73-1.01), acute training injuries (RR: 1.16, 95% CI: 0.99-1.36), or overuse injuries (RR: 1.04, 95% CI: 0.89-1.21) was observed between the preseason and competitive season. In conclusion, the overall risk of acute match injuries in Norwegian male professional football increased by 49% during the study period, although this increase was not fully consistent across teams. We detected no change in the risk of training and overuse injuries or any difference between the preseason and competitive season.
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Methodological differences in epidemiologic studies have led to significant discrepancies in injury incidences reported. The aim of this study was to evaluate text messaging as a new method for injury registration in elite female football players and to compare this method with routine medical staff registration. Twelve teams comprising 228 players prospectively recorded injuries and exposure through one competitive football season. Players reported individually by answering three text messages once a week. A designated member of the medical staff conducted concurrent registrations of injuries and exposure. Injuries and exposure were compared between medical staff registrations from nine teams and their 159 affiliated players. During the football season, a total of 232 time-loss injuries were recorded. Of these, 62% were captured through individual registration only, 10% by the medical staff only, and 28% were reported through both methods. The incidence of training injuries was 3.7 per 1000 player hours when calculated from individual registration vs 2.2 from medical staff registration [rate ratio (RR): 1.7, 1.2-2.4]. For match injuries, the corresponding incidences were 18.6 vs 5.4 (RR: 3.4, 2.4-4.9), respectively. There was moderate agreement for severity classifications in injury cases reported by both methods (kappa correlation coefficient: 0.48, confidence interval: 0.30-0.66).