Diagnosis of longstanding groin pain in athletes

Funding

The project is funded by Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

Team

• Hans Tol,

• Adam Weir,

• Andreas Serner,

• Zarko Vuckovic

Project Partners

Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar

Background

Diagnosing longstanding groin pain in athletes is challenging. Within the groin region, numerous anatomical structures are located in close proximity, and no gold standard exists for diagnosis. Complexity is added by numerous diagnostic terms being used to describe similar conditions. The 2015 Doha agreement meeting addressed this terminology problem by proposing a clinical classification system based on history and clinical examination findings. It is unknown if clinicians have adopted the classification system in clinical practice, and scientific support for specific clinical examination tests is limited.

Objectives

We aim to evaluate if the Doha agreement meeting classification system has been adopted by clinicians who regularly assess and treat athletes with groin pain. Secondly, we want to evaluate the inter-examiner reliability of the classification system and specific clinical examination tests that are used to classify athletes with groin pain.

1stMYMAn - Cardiac effects of first-time marathon training, running, and recovery in middle-aged men

Funding

This study is funded by the Indonesia Endowment Fund for Education (grant number 201803220412678).

Team

• Inarota Laily                          https://orcid.org/0000-0002-3744-0099

• Tom G.H. Wiggers                https://orcid.org/0000-0002-8581-8834

• Niels van Steijn                     

• Evert Verhagen                     https://orcid.org/0000-0001-9227-8234

• Adrianus J. Bakermans        https://orcid.org/0000-0001-9291-9441

• Harald Jorstad               https://orcid.org/0000-0003-3617-3256

Background

Regular participation in physical activity is associated with numerous health benefits. However, it is unclear what the upper limits of healthy physical exercise are and whether exceeding a certain amount of exercise may have detrimental effects on the cardiovascular system or general health.

Marathon running is a classic example of a popular sports activity. In the last three decades, the number of recreational marathon runners has markedly increased, with middle-aged men constituting the largest group. Importantly, this is also the age group where the atherosclerotic cardiovascular disease becomes clinically apparent.

Several phenomena that point to potentially detrimental cardiac effects of running have been reported, such as elevated biomarkers for myocardial injury (troponin T and I, NT-proBNP), and reductions in left- and right ventricular systolic and diastolic function directly after marathon completion. Most studies on cardiac effects of marathon running are cross-sectional or retrospective, do not include state-of-the-art imaging investigations such as cardiovascular magnetic resonance imaging (MRI) coupled with functional assessments and do not include recovery follow-up. Furthermore, COVID-19 in athletes is associated with myocardial abnormalities, such as inflammation and fibrosis, but no studies have reported the effects of marathon running after recovery from COVID-19.

Objectives

Our exploratory prospective cohort study in middle-aged men who train for and participate in their first marathon, including a subset of participants who recovered from COVID-19, aims to comprehensively investigate potentially detrimental cardiac changes during marathon training and participation.

The primary outcomes are cardiac morphological changes from before initiating marathon training up to 1 month after completion of the marathon: 1) 4 months before the marathon, 2) pre-marathon (2 weeks before the marathon), 3) post-marathon (<24 hours post-marathon), and 4) recovery (4 weeks after the marathon). 

Secondary outcomes include changes in other cardiac and non-cardiac parameters: 1) quantitative parameter mapping of the myocardium with MRI, 2) cardiac morphology and function with echocardiography, 3) VO2max, 4) electrocardiogram (ECG) characteristics, and 5) circulating cardiac biomarkers: high sensitivity troponin-T (hs-TnT), high sensitivity troponin-I (hs-TnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP).

Towards the medical care and support of retired male and female professional footballers

 PROJECT PARTNERS

FIFPRO (Football Players Worldwide)

FIFA (Fédération Internationale de Football Association)

FUNDING

FIFPRO (Football Players Worldwide)

FIFA (Fédération Internationale de Football Association)

BACKGROUND

Transitioning out of professional football is not easy and during that process, players might face several challenges such as adjusting to a new life and lifestyle, being suddenly ‘like everyone else’ or missing the sport atmosphere and competition. Retired professional footballers might also face health conditions affecting various domains (e.g., musculoskeletal, psychological, cardiovascular, neurocognitive). Despite the health conditions likely to occur after retiring from professional football, support measures remain lacking. Accordingly, FIFPRO (Football Players Worldwide) and the Amsterdam University Medical Centers developed an After Career Consultation as an exit health examination to empower the sustainable health and quality of life of retired male professional footballers. A pilot-study conducted in the Netherlands revealed that retired male professional footballers were positive about the relevancy, suitability, satisfaction and added value of the After Career Consultation.

OBJECTIVES

The overall aim of this PhD research project is to work towards the medical care and support of retired male and female professional footballers. Specifically, (i) the health (e.g., mental, musculoskeletal) of retired male and female professional footballers is assessed, (ii) the After Career Consultation is implemented among male retired professional footballers, (iii) the view, experience and needs of retired male and female professional footballers and their physicians is explored, and (iv) a female-specific After Career Consultation is developed. 

What is the secret behind the successful Nordic hamstring prevention programme?

PROJECT PARTNERS

• VU Amsterdam: The Faculty of Behavioural and Human Movement Sciences

• Koninklijke Nederlandse Voetbalbond (KNVB)

FUNDING

• ZonMW ‘Sportinnovator Voucher’

BACKGROUND

Executing Nordic curls for a period of three months, reduces the amount of hamstring injuries by 50%. Although convincing evidence by a number of RCT’s, the actual mechanism behind the intervention is still unrevealed.

Is it possible that an innovative method for measuring electromyographic data, can map individual characteristics in neurophysiological recruitment of the hamstring muscles and define the secret behind the Nordic hamstring curl?’

OBJECTIVES

The objective is to describe neurophysiological characteristics while executing a Nordic hamstring curl, and the effect of a three-month Nordic hamstring injury prevention programme.

Fixable Primary and Large Secondary Osteochondral Defects of the Talus: Evidence-Based Therapy

PROJECT PARTNERS

• None

FUNDING

• Department of Orthopedic Surgery, Amsterdam UMC

• Foundation Friends of ACES

BACKGROUND

An osteochondral lesion in the ankle can occur after a trauma such as an ankle sprain or an ankle fracture. It seems that there are different types of defects from a morphological perspective when considering the defect on the CT scan or intra-operatively. Large fixable lesions can be treated with a fixation techniques, while non-fixable large lesions probably need to undergo some form of osteo(chondral) transplantation. From the present existing research it is evident that there is a scarcity of evidence on the personalized efficacy of these treatment options in an evidence-based manner.

OBJECTIVES

The objective of this thesis is therefore to work towards an evidence-based therapy for patients with osteochondral lesions of the ankle through determining the efficacy of fixation and osteochondral transplantation in an evidence-based manner so it will become evident which therapy works for which individual patient.

Treatment of Osteochondral Defects in the Ankle: Working Towards an Evidence-Based Personalized Approach

PROJECT PARTNERS

• None

FUNDING

• Department of Orthopedic Surgery, Amsterdam UMC

• Foundation Friends of ACES

BACKGROUND

Ankle sprains and fractures are highly prevalent and result in damage to the cartilage and bone in over 70% of patients. Aforementioned damage is also referred to as an osteochondral lesion (OCL). Patients suffering from an OCL of the ankle will develop osteo-arthritis over time. and during the different stages of the disease are known to suffer from impairment of the mental and physical quality of life, thereby involving a significant societal health- and economic burden. Presently there is a clear scarcity on the evidence of the treatment of these painful OCLs in the different stages of the disease, consequently as no superior treatment exists.

OBJECTIVES

The core aim of the PhD-Thesis from Dr. Jari Dahmen, within the Amsterdam Ankle Cartilage Team, is therefore to identify an evidence-based personalized treatment of OCLs in the ankle by means of cadaveric biomechanical and radiological research, a prognostic systematic review, two RCTs and an international prospective registry with a consequent development of a comprehensive web-based clinical decision support for the national and international community. 

 Another focus of the research team is to investigate the rare but impactful OCLs of the distal tibia, led by MD/PhD student Quinten Rikken. These lesions prove difficult to treat and lack evidence, thus warranting further research. The aim is to strengthen the evidence-based personalized-treatment of these lesions by providing insights in clinical, radiological, and sport outcomes of these patients as well as to explore novel treatment techniques and applications. 

 The goal of the research carried out by the Amsterdam Ankle Cartilage team is to provide answers to important clinical questions so that in the near future the treating physician and the patient with the OCL together can collectively decide what the best treatment option would be in order to facilitate an active and pain-free life.

Proximal Hamstring Avulsions: Towards an Individualized Treatment Algorithm

PROJECT PARTNERS

• Amager-Hvidovre Hospital, IOC Research Center, Copenhagen, Denmark

• University college hospital, IOC Research Center, London, United Kingdom

• Aspetar Orthopedic and Sports Medicine Hospital, IOC Research Center, Doha, Qatar

FUNDING

• None

BACKGROUND

Full-thickness hamstring tendon injuries have a large impact on sports participation and activities of daily living. These injuries have the ability to end a professional sports career. Full-thickness hamstring tendon injuries are relatively rare. There is a lack of evidence to advise if and when operative or non-operative treatment is indicated. These and other pressing clinical questions remain unanswered to today’s date.

OBJECTIVES

With our prospective study we gather clinical and imaging data on full-thickness hamstring tendon injuries on international base. Due to the international research collaboration we create a large database, which will provide us the ability to study different aspects of these injuries. By mapping these different aspects, we expect to be able to create an evidence-based individualized treatment algorithm for full-thickness hamstring tendon injuries in the future.

Novel Perspectives on Aetiology and Treatment of Osteochondral Lesions of the Talus

PROJECT PARTNERS

• None

FUNDING

• Department of Orthopedic Surgery, Amsterdam UMC

• Foundation Friends of ACES

BACKGROUND

Osteochondral defects (OCD) can occur after ankle sprains and ankle fractures. Due to the high impact of the tibial plafond on the talus, a cartilage crack could cause this defects. Last years, a lot of surgical treatment strategies are developed. After the surgical procedure, a certain period of rehabilitation is needed. This rehabilitation period could play a prominent role in the end result of the treatment. To this date, evidence based guidelines are not available for this specific injury.

Despite the developing treatment strategies, it’s seen that patients will suffer from end-stage osteo-arthritis in the long term, which brought up the hypothesis that osteochondral lesions may be a sign of early osteo-arthritis in the ankle joint.

OBJECTIVES

This PhD will focus on these two gaps in the literature. The first part will focus on the current used rehabilitation guidelines. An international survey and a review of the literature will be conducted, and an evidence based protocol will be developed.

The second part of this PhD will focus on the etiology of OCDs. More specific, signs of early osteoarthritis of the ankle will be studied in patients who have an OCD of their talus.

Recurrence risk in shoulder instability

PROJECT PARTNERS

• OLVG, Amsterdam, the Netherlands

• Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, the Netherlands

• Faculty of Behavioural and Movement Sciences, VU, Amsterdam, the Netherlands

FUNDING

• AMC MD/PhD Scholarship: The AMC Medical School and Graduate School for Medical Sciences offer a grand to outstanding and scientifically promising students to participate in the MD-PhD program. The program combines the medical Master’s degree program with PhD research.

BACKGROUND

With 4000 new anterior shoulder dislocations annually in the Netherlands, it is the most dislocated joint. The trauma occurs mainly in young individuals and up to 60% of patients later experience a dislocation again (re-dislocation), which has a negative impact on quality of life. Determining risk of a re-dislocation is a difficult task, as there are a lot of factors that contribute to the stability of the shoulder. For example, glenoid bone loss, a Hill-Sachs lesion, neuromusculair control and muscle strength are factors that play an important role in stabilizing the shoulder. Currently, glenoid bone loss is used as a parameter to predict recurrence risk. However, this is not the only factor that determines this risk and how do you measure something that is not there? Advances in technology create the opportunity to analyze (dynamic) 3D-models of humerus and scapula. By analyzing the interaction between these bony structures, this project looks for parameters that can predict recurrence risk more accurately by taking more of the factors that determine stability into account.

OBJECTIVES

The main objective of this project is to improve our ability to estimate risk of a re-dislocation. This goal is achieved through multiple objectives:

1.     Identify and critically evaluate currently available methods and risk factors that are used to determine re-dislocation risk

2.     Determine if new factors can be identified through 3D analysis of the bony structures' interactions.

3.     Determine which patient-reported and clinical outcomes should be used in shoulder instability research. These outcomes will facilitate standardized research and setting up a prospective cohort.

Further Information

More can be found at http://www.shoulderelbowcenter.com/

Outcome of acute ankle ligament injuries with stable syndesmosis involvement in athletes

PROJECT PARTNERS

• Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar

FUNDING

• The study is funded by Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

BACKGROUND

Acute ankle sprains are one of the most common injuries in sports. Historically, ankle sprains were considered to primarily affect the lateral ankle ligaments. With increased understanding of the injury mechanism, we now know that other structures might be affected concomitantly (e.g. syndesmosis; cartilage). While many studies have investigated the diagnosis and outcome of acute lateral ligament injuries, few studies have evaluated the outcome of these concomitant injuries.

OBJECTIVES

The aim of the study is to evaluate the outcome of acute ligamentous ankle injuries in athletes. First, the diagnostic value of various diagnostic strategies for ligamentous ankle injuries will be evaluated. Using MR imaging as the reference standard, physical examination, clinical tests and (dynamic-) ultrasound in the diagnosis of ligamentous ankle injuries will be investigated. 

To determine the outcome of acute ligamentous ankle injuries, time to return to play and functional outcome questionnaires will be administered 6 weeks, 6 months and 12 months after the injury.

Impact of Continuing Medical Education on Clinical Practice in a Multidisciplinary Sports Medicine Hospital

PROJECT PARTNERS

• Aspetar orthopaedic and sports medicine hospital

FUNDING

• None

 BACKGROUND

In recent years, continuing medical education has gained significant attention in Qatar due to the implementation of the mandatory CME/CPD participation policy by the Qatar Council for Healthcare Practitioners (QCHP). Since the implementation, Aspetar has delivered various types of CME/CPD activities including conferences, symposia, workshops, journal clubs and lecture series. There is increasing focus to measure the impact of CME programs to determine their effectiveness on clinical performance and healthcare outcomes as some evidence has shown that CME activities lack such an effect. 

OBJECTIVES

The aim of the study is to determine the impact of a locally - accredited interprofessional lecture series on clinical practice among healthcare practitioners in a specialized orthopaedic and sports medicine hospital. Impact on clinical practice will be initially assessed through the Implementation and evaluation of the Aspetar Tuesday Lecture Series.

METHODS

Data is initially collected using an anonymous online questionnaire in which healthcare practitioners will provide information on demographics and assess their feedback relevant to the overall learning objectives of the lecture series including impact on clinical care, contribution to evidence-based medicine, and interprofessional education. Furthermore, healthcare practitioners will report on perceived barriers and facilitators in changing clinical practice and suggest topics to address perceived practice gaps. 

Self-report questionnaires remains a valuable tool to assess outcomes of CPD activities, but are known to be subject to limitations. Consequently, in addition we ask if healthcare practitioners are willing to participate in focus groups interviews; in which we will examine group perceptions towards the Tuesday Lecture Series and discuss strategies for improvement. 

SUB-PROJECTS

1.     Implementation and evaluation of an accredited lecture series in a sports medicine hospital: a retrospective cohort study;

2.     What makes an impactful presentation? An analysis of the lectures presented during the 2018/2019 Aspetar Tuesday Lecture Series; and

3.     Value of Tuesday Lectures, Journal Clubs to improve clinical outcomes.

Bringing Research To Real Life: Development, Implementation, and Evaluation of a Context-Specific Longitudinal Injury Monitoring System for the Maltese National Football Team - A Mixed-Method Study

FUNDING

• Malta Sports Scholarship Scheme

PROJECT PARTNERS

• Malta Football Association

• Cardiff University

BACKGROUND

National team sporting events are popular and exciting for spectators, however, they entail a risk of injury for the National team players. In order to mitigate the risk and prevent injuries, sporting organisational bodies have carried out injury surveillance under the guidance of the respective consensus statements to understand injury patterns during such tournaments. Yet, it has been reported that injury data obtained from these short events only provide a ‘snapshot’ of information with regards to the injury burden, thus emphasising the need for a long-term, continuous injury monitoring system for national team players. Therefore, this study will aim to bridge the gap in knowledge through the design of a prospective longitudinal injury monitoring system framework that aims to monitor injuries of national team players both while with their clubs and with the National team. However, designing and implementing an injury monitoring system as guided by sport-respective consensus statements will not translate effectively in non-elite settings –such as in Maltese football setting- due to different and various contextual determinants revolving around injury perceptions and injury reporting methods. Hence, there is a need to understand the role of contextual determinants in order to develop and implement a longitudinal injury monitoring system that best fit the context of the Maltese National team football players

Objectives of the project:

1.     Develop a longitudinal injury monitoring system tailored for Maltese National team football players

2.     Understand Injury Problem

3.     Evaluate the Injury monitoring system as a practical tool

This development of the injury monitoring system will be based on findings from the initial qualitative study, which will shed light on the perceptions of injuries and the current practices and barriers in injury reporting. The injury monitoring system will be implemented with the U-21 National Maltese Football Team and the Senior Female Maltese Football Team for 2 consecutive seasons. The monitoring system will be used both as a practical tool to monitor injuries throughout the study period and as a research tool to understand the injury problem. Thereafter, the injury monitoring system will be evaluated using the RE-AIM framework, triangulated with qualitative findings on the acceptability and utility of the system.

Long-term and Sports Outcomes of Osteochondral defects of the Ankle

PROJECT PARTNERS

• None

FUNDING

• Department of Orthopedic Surgery Amsterdam UMC

• Foundation Friends of Aces

BACKGROUND

An osteochondral defect (OCD) of the ankle can significantly impact the life of the athletic patient. Surgical intervention is a common tool to relieve pain, improve function and have patients return to sports. To date, consensus for surgical interventions for a range of morphological OCDs is slim and new techniques are being pioneered at a constant rate. However, for existing proven treatments long-term outcomes, as well as outcomes from its application in the distal tibia are lacking. These findings could question our understanding of the sustainability and long-term implications of the treatments for the often younger and active patients who sustain an OCD.

OBJECTIVES

To determine long-term treatment outcomes for established treatments and identify possible characteristics leading to osteo-arthritis after an ankle OCD. Another objective is to asses sport outcomes following ankle OCD treatment.

QRSMed: Qualitative Research in Sports Medicine

PROJECT PARTNERS

• University of Tubingen

• University of Bath

• University of Zurich

• Aspetar

• Linkoping University

FUNDING

• None

BACKGROUND

Over the past decades research within the field of sports medicine has yielded a large amount of evidence of the prevention and treatment of athletic injuries. Despite the availability of high quality evidence, compliance to interventions that protect athletes’ health is low. Consequently, evidence-based programs are not achieving their optimal effect in real-life athletic situations. Implementation and knowledge translation are the contemporary incantations to resolve this apparent gap between science and practice. This has provided us novel research questions and challenges that follow on efficacious outcomes. Most of these questions are not answered through quantifiable outcomes measures as they revolve around user behaviors. If we want to know why athletes and coaches behave as they do, and what barriers there may be to changing their behavior, qualitative research can be used to give athletes and coaches a voice.

OBJECTIVES

Within the QRSMed initiative we aim to bring together sports medicine researchers with an expertise in qualitative research. The goal is to develop and implement qualitative research methods within sports medicine research.

Leadership in Sports Medicine & Performance: Taking the lead towards healthy performance

PROJECT PARTNERS

• None

FUNDING

• None

OBJECTIVES

Sports has evolved rapidly over the past decades. With an increased economic value, a surge of professionalization has taken place across various levels of play and across a multitude of sports. In contemporary sports athletes have become high-value assets in a business that is driven by athletic performance. This development also affects the role of the sports medical professional. Where not too long ago we serviced athletes, nowadays we lead a multidisciplinary team that is mandated to protect the athletes’ health and full availability. We are dubbed from being the doctor to be the Director of Performance. In essence our roles have shifted from being a service provider to a health manager who steers a multidisciplinary team of specialists. The question is whether we really have the necessary skills to lead a ‘team’ like this effectively?

Over the years most research on leadership in sports has focused on the coach and manager and their roles and impact on performance. In contrast, little has been done in regard to effective leadership Sports Medicine roles. Some evidence exists though, e.g. from professional football, where it was shown that coaching style and team communication are linked to team injury risk and player availability. Other insights stem from recent qualitative research that described from athlete interviews that the entire staff needs to be engaged in athlete health protection and needs to effectively communicate with athletes about symptoms and injuries. Also, it was shown in artistic environments that most of the potential for targeting injury risk factors lies outside the realm of sports medical care and sits in other departments within an organization. In light of such evidence, it would only flow logically to assume that those who know how to communicate effectively and unlock the potential of their multidisciplinary teams will do a better job in having the athletes ready and in full health to perform. 

OBJECTIVES

This project aims to – through a qualitative study – explore the narrative of individuals with a leadership role in Sports Medicine and Sports Performance. Specifically this project aims to unravel the skills required to be an effective in Sports Medicine and Sports Performance, and develop a framework towards effective leadership in our field.

Athletes’ voices: a qualitative research study on injury, injury prevention and implementation of preventive measures in professional female football

PROJECT PARTNERS

• Federação Portuguesa de Futebol

FUNDING

• None

BACKGROUND

Professional football involves a high degree of athletic ability with extreme physical demands placed on players. Through this, playersare exposed to a high risk of injury. The prevention of injuries in sports in general and football in particular, has been researched over the past decades. This had led to a wide array of efficacious preventive measures for various injuries. However, real-world implementation and effective use of this evidence lags behind. 

Focused and effective injury prevention starts with a description of the injury problem. To understand the injury problem, however, in the first step of the sequence of prevention a broader research focus is needed. Looking not only at the isolated injury, but also at the underlying behavioral factors, taking into account the athlete and his / her context. Based on this reasoning, the players’ context should be explored to better understand the injury problem of players’ who perform in a professional environment.

OBJECTIVES

This project aims to – through a qualitative study – explore the narrative of professional female footballers and stakeholders (i.e. coaching, medical staff, strength & conditioning coaches) in regard to injury, injury prevention and implementation of preventive measures in professional female football.

Shared decision-making knowledge and attitudes of healthcare practitioners in sports medicine

PROJECT PARTNERS

· Aspetar Orthopedic and Sports Medicine Hospital

FUNDING

None

BACKGROUND

Shared-decision making (SDM) has become the golden standard in making heath care decisions. It is defined as a process in which both clinician and patient bring their own expertise to reach an informed and personalized decision. The clinician is the expert on risks and benefits of options, the patient the expert on his or her personal preferences and values. Reconciling these two is the essence of shared decision making.

There is abundant research on shared-decision making in various specific and more general populations. But little is known about shared-decision making in sports medicine.

Results from research on shared-decision making in other populations cannot be immediately translated to the sports medicine population. The circumstances under which athlete health care decisions are made is significantly different. Athletes are often part of a multidisciplinary team, consisting not only of medically trained professionals such as a physician and physiotherapist but also of non-medical professionals such as a coach and trainer. My research will focus on how to implement shared-decision making in sports medicine.

OBJECTIVES

This first project aims to assess the knowledge of and attitude towards shared decision making of sports medicine healthcare practitioners. This will be the first step in researching the implementation of shared decision-making in sports medicine.

TIPAS: Tailored Injury Prevention in Adapted Sports

PROJECT PARTNERS

• Reade Rehabilitation Center

• Oslo Sports Trauma Research Center

• Inholland University of Applied Sciences

• VU Amsterdam

• DeSportartsengroep

• Leiden University

• Royal Dutch Lawn and Tennis Assocation

• Dutch Triathlon Association

• Royal Dutch Hockey Association

• Royal Dutch Soccer Association

FUNDING

• The Netherlands Organisation for Health Research and Development

BACKGROUND

Sports participation and a physically active lifestyle have been advocated for its health and social benefits and increased quality of life, both in able-bodied individuals and those with physical disabilities. Although sports participation lags behind in the latter group, it has increased over the past years.
Sports injuries do pose problems for all athletes and impact society, but often go hand-in-hand with additional problems in individuals with a disability as injuries can impose upon an already restricted lifestyle. With the relevance of studies on injury surveillance and epidemiology for preventive efforts widely acknowledged, there is a limited number of these studies in disability sports.

Injury prevention is relevant to enable long-time sports participation and continuation of activities of daily living. This may be even more important for athletes with a physical disability. The variability in disabilities, and their relationship with each individual athlete’s ability to participate in sports and injury risk, highlights the need for tailored preventive approaches. Such individual approaches are upcoming, enabled by current technologies for the prospective and continuous online monitoring of health and performance related measures in individuals.

Our previous research has shown the ability to automatically provide online preventive advice to individual able-bodied runners tailored to their reported health status (monitored over time using the OSTRC-questionnaire on health problems), and the effectiveness of this systematic approach to increase prevention adherence and prevent injuries. This approach is applicable to disabled athletes and fits the challenges prevention faces in these athletes. Given the specific injury risk and health problems in athletes with a disability, this approach needs first to be adapted to make it valid and feasible for this specific population.

OBJECTIVES

This study will:

(1) adapt the systematic preventive approach to disability sports;

(2) implement and evaluate the online tailored approach aimed to increase preventive behaviours and reduce acute and overuse injuries in disability sports; and

(3) evaluate end-users’ perspectives on the intervention.

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A qualitative research study on injury, injury prevention and implementation of preventive measures in Olympic Athletes

PROJECT PARTNERS

• The Australian Centre for Research into Injury in Sport and its Prevention (Edith Cowan University and La Trobe University Sport and Exercise Medicine Research Centre, Australia)

• Sport Injury Prevention Research Centre (University of Calgary, Canada)

• Institute of Sports Medicine & Sports Orthopedic Research Center-Copenhagen (SORC-C) (Copenhagen University Hospital, Denmark)

• French-speaking Research Network for Athlete Health Protection & Performance (French Institute of Sport; University and University Hospital of Liège; Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science; National Sport Institute of Quebec; Geneva University Hospitals)

• Yonsei Institute of Sports Science and Exercise Medicine (Yonsei University, Wonju Severance Christian Hospital, Korean Sports and Olympic, Sol Hospital, Korea National Sport University, Republic of Korea)

• Aspetar Orthopaedic and Sports Medicine Hospital (Qatar)

• Sport, Exercise Medicine and Lifestyle Institute (University of Pretoria, University of Stellenbosch, South African Medical Research Council, South Africa)

• London’s Institute for Sports, Exercise and Health and National Centre for Sports Exercise and Medicine (United Kingdom)

• United States Coalition for the Prevention of Illness and Injury in Sport (United States Olympic Committee, Steadman Philippon Research Institute, The University of Utah, USA)

FUNDING

• None

BACKGROUND

It has been argued that, for better and more effective ‘real-world’ injury prevention and athlete health protection, a broader research focus is needed – moving from the isolated problem and the underlying factors, towards the athlete as a whole. As such, there is a need to take into account the demands, wishes, needs, possibilities, and motivations of the athlete and other stakeholders. For this purpose, a large-scale qualitative study was initiated in the Netherlands to explore the narrative of athletes, and their respective coaches and medical staff (stakeholders), in regard to injury and illness definitions, perceived causal factors, and preventive practices. This study has elicited varying definitions of injury, the breadth of perceived risk factors, and – most importantly – the complex system around the elite athletes.

Although vital for future directions in intervention translation, these results and insights remain restricted to a specific local non-Olympic context. Given the fact that across countries support and development by Olympic programs differs (i.e. budget, sports culture, support, talent development, etc.) these initial local findings beg the question how differences between national Olympic programs affect athlete and stakeholder perceptions, and to what extent evidence and interventions require tailoring across countries and international Olympic settings. For this reason, we now extend the Dutch study to an international setting, including Olympic athletes, coaches and medical staff from the United Kingdom, South Africa, Canada, South Korea, Australia, France / Belgium, Qatar, and Denmark.

OBJECTIVES

The goal of the proposed project is to explore the narrative of Olympic athletes, coaches, and health care providers in relation to their perceptions of injury and illness prevention. Based on this narrative, this project aims to explore and understand the practicalities of sports related injury and illness prevention based on beliefs, attitudes and knowledge from key stakeholders in different countries:

Specific research questions to be answered across elite athletic cultures are:

(1) How do Olympic athletes and stakeholders define injury and illness, and are there differences in definitions between stakeholders?

(2) Which factors and mechanisms are related to risk of injury and illness from the Olympic athletes’ and stakeholders’ perspective?

(3) How do Olympic athletes and stakeholders deal with health problems and their prevention in everyday practice?

(4) Which contextual factors influence actual preventive behavior, and do these factors differ between Olympic programs, sports and stakeholders?

Patellofemoral Pain: opening the black box

PROJECT PARTNERS

· Physiotherapy YsveldFysio, Berg en Dal, The Netherlands

· Physiotherapy Utrecht Oost, Utrecht, The Netherlands

FUNDING

None

BACKGROUND

Patellofemoral pain (PFP) is a challenging condition from both the athlete’s and clinician’s perspective. Multimodal treatment regimes are advised but the results are far from optimal which is reflected by the 50% positive outcomes of this type of intervention.

The majority of PFP research focuses on the results of exercise regimes whether or not combined with foot support (insoles). The exercise regimes target lower limb alignment and strength production from the greater kinetic chain. The role of soft tissue flexibility in PFP was only assessed in a small number of studies. New insights in lower limb function and multi-segmental tissue flexibility showed that flexibility of a musculo-tendinous structure is related to positions of other adjacent body segments and thereby can negatively affect patellofemoral joint kinematics.

The pathogenesis of PFP is still unknown. Increased innervation (vessels and nerves) of peripatellar tissue and increased intra-osseous pressure in the patella were previously reported. A homeostasis theory was proposed but this is still not adopted as the pain mechanism for this condition.

OBJECTIVES

In the first part of this PhD we investigate soft tissue flexibility in the kinetic chain in patients with PFP and healthy controls and how this may relate to pain-free knee function. As weight bearing knee flexion is provocative in this condition we developed a test incorporating this construct, which can then be used in the clinical evaluation of PFP patients. We studied the reliability and validity of this test.

In the second part of this PhD project, we investigate changes in arterial blood flow of the patellar bone.

The results of these studies likely assist in developing more targeted treatment regimes for PFP in order to increase the overall treatment effect in this common musculo-skeletal condition.

FURTHER INFORMATION

Publications of this project thus far:

The decline step-down test measuring the maximum pain-free flexion angle: A reliable and valid performance test in patients with patellofemoral pain.