Injuries in disability sports; definitions and methodologies

BACKGROUND

Fifteen percent of the world’s population live with disability, and many of these individuals choose to play sport. There are barriers to sport participation for athletes with disability and sports injury can greatly impact on daily life, which makes sports injury prevention additionally important.

OBJECTIVES

The purpose of this project is to review the definitions, methodologies and injury rates in disability sport, which should assist future identification of risk factors and development of injury prevention strategies. A specific focus lies on concussions in disability sports. A secondary aim is to highlight the most pressing issues for improvement of the quality of injury epidemiology research for disability sport.


BokSmart “Safe Six” Injury Prevention Programme

BokSmart “Safe Six” Injury Prevention Programme

Rugby union (hence ‘rugby’) is an international sport played in over 100 countries worldwide, at amateur and professional levels. Within South Africa, rugby is extremely popular with approximately 600,000 participants. The injury incidence and severity of rugby is reported to be one of the highest of all sports. This is largely explained by the high frequency of collisions between players, inherent to the sport. This high burden of injuries in rugby has required preventative measures to be implemented.

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Clinical outcome following surgical and conservative treatment of proximal hamstring avulsions

BACKGROUND

Hamstring injuries are common in the athletic population. The severity of these injuries can vary considerably: from mild injuries to a complete three tendon rupture (avulsion) with retraction of the muscles. Total avulsion of the proximal tendons, typically occurring as a result of forced hip flexion and knee extension, is less common, but can result in significant disability for patients regarding sports activity. Proximal hamstring ruptures can be treated conservatively, but are increasingly treated surgically by reattachment of the hamstring tendon to the ischial tuberosity. Present studies reporting clinical outcome following surgical treatment are of low methodological quality and very few conservatively managed cases have been published. Therefore, there is lack of consensus on optimal treatment, and indication for surgical repair. Furthermore, the outcome of conservative versus operative treatment has never been compared in the literature using the same rehabilitation protocol and outcome measures.

OBJECTIVE

The purpose of this study is to determine clinical outcome following conservative or operative treatment of acute proximal hamstring tendon avulsions during a one year follow-up.

Common elbow injuries in adult athletes are epicondylitis, impingement, ligamentous injuries and tendon ruptures

Ulnar collateral ligament reconstruction

The most affected ligament in the elbow is the ulnar collateral ligament. The UCL is often ruptured after hypervalgus or hyperextension injuries, or after a posterolateral dislocation of the elbow. Chronic UCL insufficiency is seen in overhead throwing athletes. Historically, an injury of the UCL was career ending for the professional sports player. The first description of successful UCL reconstruction was from Jobe on major baseball pitcher Tommy John. Since that publication in 1986, the anatomy, pathophysiology, (surgical) treatment and rehabilitation of UCL injuries became a very popular area of research. This is reasonable as UCL reconstruction in professional baseball players has a relatively high prevalence of 10%. Over the years, many different reconstruction techniques have been developed, all with their pros and cons. However, the optimal surgical technique for UCL reconstruction is currently still subject to debate58. It is for instance unclear whether for UCL reconstruction one implant is superior to the other. Most series are from clinics in the USA and Asia, and it is uncertain if the same results apply for European athletes.

The purpose was therefore to describe the results of a new reconstruction technique of the UCL in European athletes with a triceps fascia autograft and interference screw technique fixation.

 

Distal biceps tendon reconstruction

Rupture of the distal biceps tendon is rare in overhead throwing athletes, but more common in weightlifting, bodybuilding and contact sports. Risk factors include male gender, smoking, use of steroids and statins, and high body mass index. In athletes, surgical reconstruction is favored as nonoperative treatment fails to restore flexion and supination strength. With new insights in distal biceps tendon anatomy, also various reconstruction techniques (with new implants) were developed. In general four different reconstruction techniques are used to re-fixate the distal biceps tendon to the radial bicipital tuberosity: 1) suture anchors, 2) bone tunnels, 3) cortical buttons, and 4) interference screws. These fixation methods can be performed using a single anterior incision approach or a double incision approach. Currently, it is still unclear which fixation technique and which approach is superior over the others. A systematic review by Chavan et al in 2008 evaluated and found no significant clinical difference between the different reconstruction techniques. A biomechanical comparison showed the highest load and stiffness for cortical button reconstructions. However, the cortical button was only used in one clinical study with only 10 patients by that time. 

Effects of Pulsed ElectroMagnetic Fields on return to sports after arthroscopic debridement and microfracture of osteochondral talar defects

BACKGROUND

Osteochondral defects (OCDs) of the talus usually affect athletic patients. The primary surgical treatment consists of arthroscopic debridement and microfracture. This treatment has an 85% overall success rate and a 76% satisfactory outcome at the long term. However, it can take up to one year to obtain improvement of clinical symptoms. Various possibilities have been suggested in order to improve the recovery process after debridement and microfracture. A potential solution to obtain this goal is the application of pulsed electromagnetic fields (PEMF), which stimulates the repair process of bone and cartilage.

HYPOTHESIS

The use of PEMF after arthroscopic debridement and microfracture of an OCD of the talus leads to earlier resumption of sports, and an increased number of patients that resume sports.

DESIGN

This study is a randomized, double-blind, placebo-controlled, multicenter trial, with a one year follow-up. Sixty-eight patients will be randomized to either PEMF or placebo after arthroscopic treatment of an OCD of the talus. The primary outcomes are the number of patients that resume sports and time to resumption of sports. Functional outcomes will be assessed with questionnaires (American Orthopaedic Foot and Ankle Society ankle-hindfoot score, Foot and Ankle Outcome Score, EuroQol, and numeric rating scales for pain and satisfaction) at multiple time points up to 1 year follow-up. To assess bone repair, computed tomography (CT) scans will be obtained at 2 weeks and 1 year postoperatively.

European Fans in Training (EuroFIT); Social Innovation to improve physical activity and sedentary behaviour through elite European football clubs

FUNDING

European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no 602170.

PROJECT PARTNERS

  • University of Glasgow (UK)
  • Norwegian School of Sports Sciences (Norway)
  • Technical University of Lisbon (Portugal)
  • Radboud University, Nijmegen Medical Centre
  • KU Leuven
  • Pintail Ltd
  • PAL Technologies Limited
  • European Healthy Stadia Network CIC

PROJECT WEBSITE

www.eurofitfp7.eu

BACKGROUND

20 million fans attend top division football games each week and many more watch on TV. Our aim is to attract these men, specially targeting low-SES men who do not achieve current recommendations for physical activity, to lifestyle change through the personal connection and loyalty to the club they support using the European Fans in Training (EuroFIT) programme. EuroFIT is informed and inspired by the Scottish FFIT programme, which validated several of the key concepts that underpin this project.

This project integrates two technologies within the EuroFIT programme. The first is a novel device (SitFIT) that allows self-monitoring of objectively measured sedentary time and physical activity through real-time feedback. SitFIT will be a low-cost device with an integrated display. The second is a game-based mobile-phone app, MatchFIT, in which players form ‘teams’ to participate in an ‘alternative MatchFIT league’ which mirrors fixtures in real football leagues. These technologies will be integrated into the new lifestyle change programme, EuroFIT, to be delivered in football club grounds by club coaches. 

The project will generate research evidence on the use of social innovation for health. Social impact will include reductions in health risk, improvements in well-being and the decreased inequalities as more men, especially those in low SES groups, are attracted to lifestyle change. Research impact will utilise new understanding of the how health indicators respond to change in sedentary behaviour and physical activity and through new knowledge of long-term maintenance of lifestyle changes. Policy impact will result from the production of clear implementation strategies and involvement of policy makers and opinion leaders from the outset, supported by a targeted communication strategy.

OBJECTIVES

  • Use State of the Art Theory and Evidence: To apply state-of-the-art theory and evidence on motivating and maintaining behavioral change to develop a technology-supported, culturally- and gender-sensitized lifestyle programme for men, to be delivered in top European football clubs.
  • Deliver EuroFIT in 15 Clubs: To deliver the EuroFIT programme in 15 leading football clubs across Europe and evaluate it in a pragmatic randomized controlled trial.
  • Review and Evaluate: To review and evaluate the programme in terms of experience of: a) its benefits (or harms) to participants; b) its benefits to families and wider social networks; and c) how best to refine the programme to make it most attractive to women, families and other groups.
  • Replication and Implementation: To maximize the likely implementation of EuroFIT beyond the funded project by developing detailed, validated guidelines on replication and implementation.

METHODS

This is a two arm, stratified, individually randomized, pragmatic, controlled trial with an accompanying process evaluation across 4 European countries. The trial will be conducted at 15 football clubs in Portugal, Norway, the Netherlands and England (UK). In each country, 60-80 participants will be recruited.

Using a mixed-methods, interdisciplinary approach the project will measure outcomes objectively, assess short-term cost-effectiveness and estimate long-term cost-effectiveness. We will investigate mediators of changes in health behaviours, and whether changes in lifestyle are themselves mediators of changes in clinically-measured risk factors, so that we can better understand pathways to improved physical health. We shall assess potential moderators of any effects of EuroFIT, to identify subgroups of the population for whom the programme is more or less beneficial. EuroFIT’s potential to impact on and attract other groups, particularly women and families, will be explored via qualitative research methods.


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Evaluation of the implementation effectiveness of the 'Strengthen your Ankle' app to prevent recurrent ankle sprains

Evaluation of the implementation effectiveness of the 'Strengthen your Ankle' app to prevent recurrent ankle sprains

 

Ankle sprains continue to pose a significant burden to the individual athlete, as well as society as a whole. However, despite ankle sprains being the single most common athletic injury and despite an active approach by various Dutch organizations in implementing our epidemiological knowledge on cost-effectiveness, large-scale community uptake of preventive measures, and thus actual prevention of ankle sprains, is lagging well behind. In an attempt to bridge this implementation gap VeiligheidNL looked into the possible role of new (social) media and has developed an freely available interactive App (‘Versterk je enkel’; available for iOS and Android) that contains - next to general advice on bracing and taping - the cost-effective neuromuscular program. This provides the user with, amongst others, video’s and an interactive exercise schedule. It is general belief that such interactive, online and mobile methods of information transfer are the way forward in implementation efforts. However, this has not yet been formally established for the uptake of evidence injury preventive measures, and - although user reviews are positive - the ‘Versterk je enkel’ App has not been evaluated against the ‘regular’ approach to advocate the neuromuscular program on paper and DVD.

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HealthPACT: a framework for prevention of sports injuries on the field

HealthPACT: a framework for prevention of sports injuries on the field

Regular participation in physical activity and sports increases the individual’s exposure to injury. Over the past decades the knowledge about prevention and treatment of various sports and physical activity related injuries (SPRI’s) has exponentially grown. Fortunately, based on the current available evidence it is reasonable to state that we are able to significantly cut down the risk of SPRI’s in for most participants in a wide array of sports and physical activities. However, wide-scale implementation of (cost-)effective measures under real-life conditions proves to be an ongoing challenge. 

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Improving physical activity in adolescents in deprived urban neighbourhoods

Improving physical activity in adolescents in deprived urban neighbourhoods

In general, schools have been recognized as key settings in promoting PA. Next to the home, the school is the environment where adolescents spent most of their time. Within the school, physical education lessons represents the main context in which adolescents have the opportunity to be physically active. Next to such structured and frequent PA opportunities, schools can cater irregularly for sporting days and other extracurricular activities. For the promotion of PA in the secondary school setting, interventions targeted at structural environmental changes have an important advantage over other interventions. Most PA provided by the school is on an irregular and/or non-daily basis. By altering the physical environment of a school’s grounds the adolescent is continuously exposed to PA possibilities. These changes then, of course, need to provide a continuous, appealing, challenging and socially safe PA environment. If this can be achieved all adolescents have the opportunity to be physically active each single day.

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Life after the game: quantitative and qualitative analyses of long-term effects of injuries in Rugby Union players

Life after the game: quantitative and qualitative analyses of long-term effects of injuries in Rugby Union players

Recent evaluations of the BokSmart programme indicate the programme is achieving some of it’s goals – the most important of which is the prevention of catastrophic injuries, there are some areas where the programme is less successful. These shortfalls could be ascribed, in part, to the enormous socioeconomic diversity that still exists in South Africa. Furthermore, some injury risk factors, specific to South Africa, have been identified during the evaluation of the BokSmart programme, particularly in youth populations. The South African Rugby Union has requested for on-going assistance from the existing ESSM/VUmc relationship to further improve the programme and to help ameliorate injury risk factors specific to the players of South Africa. Therefore, this research project aims to develop intervention strategies to reduce identified barriers and injury risk factors to a minimum.

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Running for health: the net health effect of running

Running for health: the net health effect of running

The objectives of this project are: (1) to summarise the evidence about the health benefits of running on biomedical health-indicators; (2) to summarise the evidence about the prevalence and incidence of the main running injuries; (3) to investigate the prevalence, nature and economical burden of running injuries in two different populations (trail and novice runners); and (4) to use the Knowledge Transfer Scheme (KTS) as a way to develop a strategy to implement in practice the current knowledge on running injury prevention.

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Sports Injury Prevention in Practice

Sports Injury Prevention in Practice

In the Netherlands, interventions have been developed and implemented to increase the uptake and correct use of efficacious preventive measures by community-level (amateur) athletes, with the overall goal to prevent sports injuries. These interventions include both primary and secondary sports injury prevention with the focus on individual athletes, trainers/coaches, sport clubs, and referees, within various field-based sport settings. Process and effect evaluations of these interventions provide insight into what works in real-world sport settings. The overall aim of the project is to gain insight into the effectiveness of various intervention strategies to promote the large-scale implementation of effective preventive interventions in real-world sports settings and optimize future implementation efforts.

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Stand Up For Health; Understanding sedentary behaviors & working towards healthy solutions

PROJECT PARTNERS

  • The Netherlands Twin Register

FUNDING

This project is funded through the ReVanche Program of the Emgo+ Institute for Health and Care Research

BACKGROUND

Changing sedentary behavior patterns in modern societies is increasingly deemed to be a public health priority and understanding the determinants of sedentary behavior is of utmost importance to this end. Much research has focused on potential environmental determinants such as socioeconomic status or the built environment. However, even under identical circumstances, some individuals are more predisposed towards a sedentary lifestyle than others. These individual differences must be due to factors that reside within the person, more specifically due to their genetic material. Twin- and family studies lend themselves to investigate the contribution of genes and the environment to a trait. In addition, they allow for a test of the association between two traits while controlling for genetic and shared environmental factors.

OBJECTIVES

This project has three main objectives, namely (1) to determine the contribution of genetic and environmental factors to subjectively and objectively assessed sedentary behavior, (2) to identify genetic variants that are related to sedentary behavior, and (3) to assess the relationship between sedentary behavior and cardio-metabolic health.

DESIGN

The STAND UP FOR HEALTH project uses survey data, DNA data and data on biomarkers for cardio-metabolic health of the Netherlands Twin Register. In addition, accelerometer data are being collected in a large number of twins and their siblings as part of the project.

To address objective 1, genetic twin models will be fitted on survey data and accelerometer data. These models allow the decomposition of variance into variance that is (1) due to genes, (2) due to the part of the environment that two twins of a pair share, or (3) due to the part of the environment that they do not share. Objective 2 will be addressed by means of an association study between sedentary behavior and genetic DNA markers. Finally, the association between sedentary behavior and biomarkers in the blood will be examined while controlling for genetic background and shared environmental effects.


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The effect of schoolzones on children's physical activity

FUNDING

The project is funded by the Sport programme of the Netherlands Organisation for Health Research and Development (ZonMw).

PROJECT PARTNERS

  • TNO
  • the Amsterdam Public Health Service
  • Jantje Beton Foundation
  • the Netherlands Institute for Sport and Physical Activity (NISB)
  • Royal HaskoningDHV
  • the City Region of Amsterdam
  • The Hague University of Applied Sciences

BACKGROUND

When children are involved in physical activity from an early age, this has a positive effect on their health later in life. This, in turn, will reduce future healthcare costs. That is why there is a great need for effective measures that stimulate children to be physically active. The built environment, and especially the school environment, can play a major role in promoting youth’s physical activity levels. The school environment provides the opportunity to reach children with diverse backgrounds within a setting in which children spend a large proportion of their time. Research has shown that a safer environment with sufficient crossing points and play areas has a positive effect on the amount of sports and exercise that children engage in.

SCHOOLZONES

In recent years, local Dutch governments have started to promote the traffic safety in the vicinity of primary school buildings, designating these area as a so-called ‘schoolzone’. Schoolzones increase traffic safety in the primary school area through infrastructural changes. These changes may include measures such as sidewalk improvements, traffic calming, pedestrian or bicycle crossings, bicycle facilities and traffic signs. Besides these infrastructural changes, education of the parents and enforcement of new regulations are an important part of the schoolzone. If, in addition to increasing traffic safety, these school zones have a positive influence on the amount sports and physical activity in youth, this can be an added incentive for local authorities to invest in them. TNO and the VU University Medical Center (VUmc) are conducting research to establish whether school zones are also encouraging children to be physically active.

STUDY METHODS

The School Zones project runs for three years (2013-2016) andcompares  schools that acquire schoolzones with those that do not. In total, 10 primary schools in the Netherlands will take part in the study. Physical activity and location of 400 children in stage 6 and 7 (9-11 years old) will be monitored using accelerometers and GPS. In addition to this objective measurement of physical activity, changes in the school environment will be assessed using questionnaires and observations. The cost-effectiveness of various measures will also be studied. This will provide insight into the factors that determine the success or failure of school zones to stimulate physical activity.


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The Health & Safety of the Elite Swimmer

The Health & Safety of the Elite Swimmer

While aquatic sports have relatively low incidence of acute injuries there are health risks for the elite aquatic athlete. This project focuses on the health and safety of the elite swimmer in addition to the role of the International Federation in safeguarding the health and well-being of its athletes. In this study, various aspects of elite aquatic athlete health will be investigated to identify the prevalence of acute injuries and illnesses.

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The trAPP-study: Treatment of acute ankle sprains in general practice

PROJECT PARTNERS

•  ErasmusMC

FUNDING

This project is funded by a grant of The Netherlands Organisation for Health Research and Development (ZonMw)(project number 80-83910-98-13003) and the Dutch Arthritis Foundation. 

BACKGROUND

Ankle sprains are one of the most frequent injuries of the musculoskeletal system, with yearly around 680.000 new sprains in the Netherlands. Of these, about 130.000 people will visit the general practitioner (GP) each year. In addition, patients have an increased risk of a recurrent ankle sprain and about a third report at least one re-sprain. No optimal treatment strategy has proven to be effective in general practice. However, promising results were achieved by a recent preventive trial conducted among athletes in the Netherlands. An unsupervised neuromuscular training program was effective in the prevention of re-sprains. When this intervention also appears to be effective in general practice and could reduce the number of re-sprains, direct treatment tools will be available for the GP for acute ankle sprains

OBJECTIVES

The aim of this project is to examine the (cost)-effectiveness of an unsupervised e-health supported neuromuscular training program in combination with usual care in general practice compared to usual care alone in patients with acute ankle sprains in general practice.

DESIGN

This study is a multi-center, open-label randomized controlled trial, with a one-year follow-up. Patients with an acute lateral ankle sprain, aged between 14 and 65 years and visiting the GP within three weeks of injury are eligible for inclusion. Patients will be randomized in two study groups. The intervention group will receive, in addition to usual care, a standardized eight-week neuromuscular training program guided by an App. The control group will receive usual care in general practice alone. The primary outcome of this study is the total number of ankle sprain recurrences reported during one year follow-up. Secondary outcomes are subjective recovery after one year follow-up, pain at rest and during activity, function, return to sport, cost-effectiveness and compliance of the intervention. Measurements will take place monthly for the study period of 12 months after baseline measurement


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