Managing the Workload in Circus Arts

PROJECT PARTNERS

• Cirque du Soleil

FUNDING

• None

BACKGROUND

Cirque du Soleil is a major circus company that was founded by a group of street performers in Baie-Saint-Paul, Canada, in 1984. From its humble beginnings, it has grown into a major entertainment attraction and now employs over 1300 artists from 55 different countries performing in 27 various shows (Soleil, 2019). Some shows are stationary and perform in the same city throughout the year while others go on travel legs and perform all over the world. A travel leg typically consists of 10 straight show weeks of performances in different cities with a two-to-three week break before the next travel leg starts. A show week runs from Monday through Sunday, where the performances are condensed into 4 days from Thursday through Sunday. Each show features from 50 to 100 artists in different positions or acts, so it is important for all of them to remain healthy and available to perform their part of the show. 

OBJECTIVES

Cirque du Soleil wants to improve their load management monitoring and injury risk management. Finding the right balance between the business needs of a circus and the health aspects of the performing artists crew leads to the following research questions:

(1) Can we relate the injury incidence to the show week within a travel leg;

(2) Is there a relationship between the injury incidence rate and the average work load by position; and

(3) Can the ACWR be used to assess the probability of injury? 

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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.

TennisReady: Development and evaluation of a tennis specific injury prevention program

PROJECT PARTNERS

• VeiligheidNL

• Royal Dutch Lawn and Tennis Association

FUNDING

• The Netherlands Organisation for Health Research and Development

BACKGROUND

Exercise-based injury prevention strategies in sports have been frequently evaluated. A meta-analysis of 36 randomized controlled trials has shown that most of these interventions are effective in reducing the number of injuries. The majority of trials have been conducted in team sports, such as basketball, volleyball, football and tackle collision ball sports.

For individual sports, the literature is limited to running athletes. Only three randomised controlled trials for exercise-based prevention in runners have been published, which all showed no significant reduction in injury rates. Given the global individual sports participation exceeds team participation, the lack of evidence-based prevention intervention is a call for action. Tennis is one of the most practised individual sports in the world. Estimates show that approximately 75 million people practice tennis worldwide. Playing tennis has proven cardiovascular health benefits, and is even associated with decreased all-cause mortality. The downside is the injury rate of up to 3.0 injuries per 1,000 hours of tennis.

These injuries have an important (economic) impact. A recent Dutch report11 showed that 43% of the injuries among tennis players were treated (para)medically, leading to an emergency room treatment cost of €3.6 million. Indirect costs due to loss of work were estimated at €8.3 million. When taking into account that approximately 800 000 people play tennis in the Netherlands, impact of tennis-related injuries can be considered significant.

OBJECTIVES

To developed, using a systematic approach guided by the KTS, a tennis-specific app-based injury prevention programme, and to evaluate its effectiveness in a randomised controlled trial.

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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MoveHealthy: Improving Health and Sustaining Participation of Youngsters in Sports

PROJECT PARTNERS

• Hanze University of Applied Sciences

• VeiligheidNL

• HEPA Europe

• European Network of Sport Education

• Lithuanian Basketball Federation

• VU Brussel

• University of Oradea

• International Council for Coaching Excellence

• Royal Dutch Football Association

FUNDING

• Erasmus+

BACKGROUND

Sport is an important aspect of social and cultural life in the European Union, and it is deeply embedded in Europe’s societies with some 300 million people regularly enjoying sport. Engaging in sport is one of the ways of being physically active and the sports movement has great influence on the level of health- enhancing physical activity of European citizens. This is why the European Commission made health- enhancing physical activity a cornerstone of its sport-related activities and policies from the very beginning. But participation in sports is not only recognized as a tool to stay healthy; it promotes social and educational values, and it has the potential to promote cohesion in societies and social inclusion.

But although the World Health Organisation identified that physical inactivity is the fourth leading risk factor for death globally and is responsible for 5-10% of deaths in the WHO European Region , and efforts to promote sport participation have been stepped up in some EU Member States, rates of physical inactivity across the EU still remain unacceptably high: the majority of citizens still does not engage in sufficient physical activity, with 60% never or seldom exercising.

One reason for non-participation in and drop-out from sports and physical education is sports related injuries. Where especially knee and ankle injuries contribute to this problem. Therefore, the project MOVE HEALTHY: Improving Health and Sustaining Participation of Youngsters in Sports around Europe seeks to develop free-of-charge education material to effectively support sport coaches and physical educators around Europe to prevent primary lower extremity injuries of the youngsters participating in their sport trainings and PE classes.

For it, MOVE HEALTHY seeks to develop an innovative, ICT based approach with external focus visual and verbal instructions and feedback on the movement effect which is based on the implicit motor learning theory. It is intended that the consortium develops – by the process of co- creation with sport coaches and physical education (PE) teachers – functional sports exercises that can be offered and will be integrated in real world sport training and physical education sessions. With it, the project directly contributes to an improved sharing of good practices and develops innovative instruments in order to lower the risks of injuries and enhance sports participation.

OBJECTIVES

The objective is to impact on the motor behaviour of the youngsters, as well as to change the training and attitudinal behaviours of the sport coaches and PE teachers. The ultimate goal of the MOVE HEALTHY project is that the youngsters can enjoy a lifelong, healthy sport participation.

Red card for injuries in Dutch amateur football: the implementation of the 11+ program

PROJECT PARTNERS

• Royal Dutch Football Association

• VeilgheidNL

• UMC Utrecht

• Athletic Skills Model

FUNDING

• The Netherlands Organisation for Health Research and Development

BACKGROUND

In the Netherlands, football is the sport with the highest absolute number of injuries: yearly, around 850,000 injuries on average are reported by youth and adult players (especially aged 10-34 years), leading to nearly 35,000 Emergency Department visits. Therefore, the Royal Dutch Football Association (KNVB) has allied with several leading partners in injury prevention research to work towards injury prevention in Dutch football. To prevent lower extremity injuries in amateur football players, the 11+ programme was developed as a complete warm-up programme, showing an overall 39% to 48% injury reduction among youth and adult amateur players. Therefore, the logical next step for the KNVB and partners is to work towards the implementation of the 11+ programme across the Netherlands, taking into account the lessons learnt in other countries about its implementation (facilitators and barriers such as concurring with the current language/practice/structure of the coaches).

APPROACH OF THE IMPLEMENTATION
The ‘Translating Research into Injury Prevention Practice’ framework (TRIPP) stages 5 and 6 underline the importance of a pertinent implementation plan and related evaluation for the future uptake of preventive measures. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Sport Setting Matrix (SSM) framework is widely accepted and applied for the evaluation of the implementation of preventive measures.

OBJECTIVES
The overall aim is to implement the 11+ program in the Dutch amateur football (youth and adult; male and female).

(1) To explore how the 11+ program fits the current language/practice/structure of the coaches within the Dutch amateur football context;

(2) To develop a structured and evidence-based implementation plan tailored to the Dutch football context to promote the structured implementation of the 11+ program;

(3) To initiate the implementation of the 11+ program in the Dutch amateur football according to the defined implementation plan and to evaluate its implementation.

Causation vs Association: Implications for Sports Medicine Clinicians

PARTNERS

• McGill University

• Calgary University

FUNDING

• Amsterdam Movement Sciences

BACKGROUND

Although physical activity reduces disability and mortality, and improves mental health, being active also entails a risk of injury. Injury is an important reason for dropout from exercise in adults. Also among youth, sport injuries are a relevant cause for reduced physical activity levels. In total, 30-40% of all injuries lead to medical attention, producing substantial health care costs.

Injury refers to tissue damage. Biomechanically, an injury occurs when the stress applied to a tissue (load) is greater than the stress the tissue can withstand (load capacity). Common injury prevention programs are mainly focused on increasing the load capacity. Overuse-related injuries occur when the load is too high over a longer period without the appropriate recovery. Traumatic injuries may occur due to fatigue (reduced load capacity) that decreases physical control and psychological focus. Therefore, an appropriate recovery time is required between activity sessions. 

Striking a balance between activity load and injury risk is a common goal for individuals and athletes of all levels and ages. However, there is currently little high-quality evidence on the association between activity load and injury risk, as existing studies are based on (too) small samples with short follow-up of a limited number of adult elite team sports. Further, the used analytical methods are known to produce biased estimates. 

OBJECTIVES

The goal is to establish sports injury risk profile charts. These charts will visualize the individual risk of sport participants based on their multifactorial risk profile. The outcomes will support sports and clinical practice in managing activity load and recovery to prevent injury. This aim will be achieved through three objectives:

(1) Combining existing large-scale prospective data sets on injury risk factors, activity load, and injury outcomes;

(2) Establishing a multifactorial injury risk model out of this combined data set, using state-of-the-art analytical approaches; and

(3) Translating the outcomes into clinically usable risk profiles.

Evaluating the Impact of the IOC Sports Medicine Statements on Olympic Athlete Health and Wellbeing

PROJECT PARTNERS

• Edith Cowan University, Australia

• University of Pretoria, South Africa

FUNDING

• International Olympic Committee

BACKGROUND

Over recent years, the International Olympic Committee (IOC) Sports Medical and Scientific Commission has strongly supported the development and dissemination of sports medicine consensus statements, produced in conjunction with peak sports medicine organizations and published across leading scientific journals. The statements cover a wide range of issues from use of platelet rich plasma to concussion management to youth athletic development. Since 2004, 24 consensus statements have been published, all of which were developed to provide consistent, evidence-based guidance for the promotion of athlete health and wellbeing across the IOC community. 

The number of consensus statements continues to grow. However, to date, the dissemination (where the documents have been used, by whom and how) and implementation (how are the documents used and what are the outcomes) of these statements has not been evaluated. This means that it is not known if there has been uptake of the consensus statements or if the goal of the documents has been achieved: to improve athlete health and wellbeing. 

Before continuing to invest, financially and academically, in the preparation of future statements, evidence for their usefulness and effectiveness is required. 

OBJECTIVES

The aim of this project is to formally evaluate the impact of the medical consensus statements, through three related phases. 

(1) Document analysis – summarizing the content and citations of the statements (no ethical approval for this phase is required) 

(2) Interviews with stakeholders in Australia and South Africa to understand if and how they have used the statements and/or what barriers they have faced in use of the statements 

(3) Survey of international sports federations and national olympic committee. The survey will be based on the issues identified in phase 2, to identify the scope of statement use (or non-use) worldwide. 

My Running Health: A qualitative analysis on the perceptions, beliefs and behaviors in regard to injury, injury risk and injury prevention practices across different levels of runners.

PROJECT PARTNERS

• None

FUNDING

• None

BACKGROUND

Running injuries are prevalent and lead to loss of participation and medical care for participants. With the growing number of participants, the absolute numbers of injuries are also increasing, but the increase in participation rates are not in line with the increase in injury rates. Dutch figures show that the novice runners have a relatively higher number of injuries than experienced runners. This higher risk of injury is also seen in the international literature. A few - but not substantiated - explanations have been given. As a result, injury prevention remains sub-optimal for this growing group of athletes.

Recent research from our group has shown that the definition of an injury depends on the context of the individual. This means that the perceived risk factors and preventive strategies are inherently different between levels of experience. This means that athletes from different sports and experience levels view their injuries differently and deal with injuries in a different way.

Perhaps the same applies to runners, where starting runners, due to a lack of experience and a different motivation, view injuries differently than experienced runners. If this is the case then we are not dealing with a difference in injury risk, but with a difference in perception and experience. This would require an inherently different preventive approach between running target groups.

OBJECTIVES

Exploring and describing the context and vision regarding injuries and the prevention of injuries among recreational runners of various levels. We will have a specific focus on:

(1) Vision and perception of what a running injury is;

(2) Perceived risk factors and mechanisms of a running injury; and

(3) Preventive measures implemented and the motivation with regard to the implementation of preventive measures.

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.

The ACTIVE trial: (cost-)effectiveness of a transmural integrated care program for knee arthroplasty patients in the working population

PROJECT PARTNERS

· Amphia Hospital, Breda, The Netherlands.

· St. Anna, Geldrop, The Netherlands

· Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

· Maastricht UMC, Maastricht, The Netherlands

· Alrijne Ziekenhuis, Leiderdorp, The Netherlands

· Flevoziekenhuis, Almere, The Netherlands

· Kliniek ViaSana, Mill, The Netherlands

· Bergman Clinics, Naarden, The Netherlands

· Maxima Medisch Centrum, Eindhoven, The Netherlands

FUNDING

· The study was funded by ZonMw Efficiency

BACKGROUND

Knee osteoarthritis is the most prevalent joint disease in the Netherlands with 571,600 patients in 2016 suffering from it. This burden is particularly high for those undergoing knee arthroplasty (KA). Due to the ageing population and the obesity epidemic, it is expected that there will be about 57,900 knee arthroplasties in the Netherlands in 2030. Half of these patients are expected to be in the working population. Currently, the care as usual post-surgery is not aimed at (work) participation, and three out of ten Dutch knee arthroplasty patients do not return to work (RTW). Additionally, only 50% of the patients accomplish RTW within three months. This is accompanied by a significant impact on patients’ quality of life as periods of being off work not only lead to a high risk of work disability, but also contribute to poor general and mental health of the patient and increasing health care and work productivity loss costs for society. Hence, improving perioperative care for KA patients, with a primary focus on societal participation, could contribute to more (cost) effective care.

OBJECTIVES

The aim of the study is to assess the (cost-)effectiveness of a new transmural integrated care program for KA patients aiming to increase (societal) participation post-surgery. In this transmural integrated care intervention, we will combine identified effective elements (e.g. referral to a case-manager, rehabilitation with personalized goals and eHealth) aiming to increase (work and sport) participation and thereby quality of life of KA patients. In a multi-center randomized controlled trial, we will examine whether this integrated care program will be (cost) effective as compared to the care as usual on resumption of (working) activities and improving quality of life in knee arthroplasty patients. The results from this study will provide health care providers and policy makers with guidance to improve arthroplasty patients’ care and future implementation of this integrated care program in Dutch orthopaedic practices and hospitals.

Imaging of physeal stress in the upper extremity: (ab)normal redefined

PROJECT PARTNERS

None

FUNDING

None

BACKGROUND

An increasing number of young athletes are encouraged to specialize in a single sport at a young age. Especially elite-athletes are involved in intensive training schedules, exposing the musculoskeletal system to excessive repetitive stress. The most vulnerable structure in the musculoskeletal system of young athletes is the cartilaginous growth plate. As a result, injuries of this growth plate are prevalent.

Although the exact effect of growth plate injuries is uncertain, some studies have linked physeal injuries to long term effects as growth disturbances. Accurate assessment of the growth plate is therefore important to prevent long-term side effects or injuries, and ensure long-term healthy sport participation. However, extensive loading of the musculoskeletal system can result in a changing appearance of the musculoskeletal system on diagnostic images, even in healthy athletes. As these appearance changes can reflect adaptations of the athlete’s body, these changes should not be interpreted as pathology in order to prevent unnecessary sport cessation.

Many studies have focused on the appearance of the injured upper extremity; however, the appearance of the healthy athlete’s wrist, elbow and shoulder is less well established.

OBJECTIVES

The aim of the study is to develop an imaging based strategy for the early detection and accurate evaluation of the presence and severity of injuries of the growth plates in the upper extremity. In order to achieve this, new methods that can be valuable in the diagnostic workup of physeal injuries are tested in elite gymnasts that are involved in extensive wrist-loading. This analysis is done by evaluating MR images of the wrist both morphologically and quantitatively.

Reducing the re-injury rate and enhancing return to play after acute hamstring injurie

PROJECT PARTNERS

· Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar

FUNDING

· This PhD project is internally funded by Aspetar.

BACKGROUND

Injuries in professional football (UEFA Champions League, UCL) are estimated to cost up to €20 million per season or up to €20.000 a day. Hamstring injuries are the most common muscle injury in professional football and despite preventative efforts, the injury rate is increasing with 2.3% per year. In the Australian Football League (AFL), 27% of all hamstring injuries are re-injuries. Re-injuries are thought to have longer recovery period and thus pose an even greater (financial) burden on teams. A previous hamstring injury is also the primary risk factor for a future hamstring injury.

Increasingly, research is focused on either preventing hamstring (re-)injuries or returning the athlete with a hamstring injury to sport as fast and safe as possible. Currently there is only an expert-opinion based consensus on the return to sport criteria and decision-making process, but it lacks validation.

OBJECTIVES

Due to the limited evidence in the return to sports period and due to the need to promote a faster and safer return to sport after an acute hamstring (re-)injury, this research project aims to:

1. To enhance return to sport and reduce re-injury rate after an acute hamstring injury.

2. To provide validation for the expert-based consensus in the return to sports decision making process.

Visual stimuli and motor performance in athletes with anterior cruciate ligament reconstruction

PROJECT PARTNERS

· University of Paderborn

FUNDING

· None

BACKGROUND

Rehabilitation progression and return to play decisions after anterior cruciate ligament reconstruction are based on measures within the psychomotor domain.

Strength, flexibility and speed are the ground motor skills, which are commonly assessed by clinicians. New sensor technology allows quantifying movement quality and balance in a more easy way.

Investigators studying neuroplasticity after ACL reconstruction (ACLR) have suggested a possible visual-motor control alteration after injury that remains unresolved after conventional therapy. Recently, patients who were 3 years after ACLR demonstrated altered knee range of motion wearing stroboscopic glasses during a drop landing task. It is unknown whether these alterations are also present in the first year after ACLR. Whether or not motor output is affected by the amount of visual input is also questioned.

In the light of the return to sports (RTS) continuum decision making process, it would be of interest if the outcomes of commonly used hop tests will reveal differences in conditions with and without wearing stroboscopic glasses. It is known that patients after ACLR have altered kinematics, however based on recent findings it is hypothesized that a more pronounced effect will occur if patients perform a balance task and hop test with stroboscopic vision (SV).

OBJECTIVES

The purpose of this observatory study is to determine the effect of SV on a set of performance test outcomes in patients with a history of ACLR. The patients will be performing a hop test in normal visual conditions as well as during SV in a counterbalanced order.

Patients will be recruited from an outpatient sports physical therapy clinic in Utrecht, the Netherlands. Patients are routinely tested at 6, 9 and 12 months after ACLR and will perform several tests in 2 conditions 1) normal full visual condition 2) stroboscopic vision (SV). In order to assure that patients have no visual impairments prior to measurements, a validated visual test using the Bioptor will be carried out. Measurements include:

1. Single leg hop test for distance. First maximal hop distance for the injured leg will be determined. In order to standardize conditions for this study, 50% of the maximal hop distance will be used for both legs. 3 hop tests will be performed per side.

2. Maximal single leg hop for distance (best of 3). Absolute (per side) and relative limb symmetry index (LSI) outcomes will be studied.

3. Maximal triple hop for distance (best of 3). Absolute and relative LSI will be studied.

4. Side hop. Patients will perform a maximum number of hops over 2 lines, 40 cm apart.

5. Balance task. This will be assessed in two conditions during a 30 sec static balance task on a pressure plate (RSScan).

Outcome measures on the hop tests:

1. Distance jumped

2. Absolute and relative LSI

3. Number of hops for side hop

4. Hip and knee kinematics using IMU’s

Outcome measure on the balance task:

1. Center of Pressure

2. Balance error scoring system (BESS)

The Basketball and Muscle Injury (BAMI) study: Game changing innovative sports research

PROJECT PARTNERS

None

FUNDING

· The study was funded by ‘NBA & GE Orthopedics and Sports Medicine Collaboration’

BACKGROUND

The current literature on muscle injuries in basketball is limited and there are no clinical studies in elite female basketball. To help advance the field, innovative new techniques can be utilized. Current standard MRI techniques do not allow visualization of individual muscle fiber architecture. Consequently, the quantification of both muscle pathology and muscle architecture is only indirectly estimated by measuring the extent of edema (suggesting minor injury) and hematoma (suggesting fiber disruption) with suboptimal reproducibility and unknown validity.

OBJECTIVES

The main objectives are:

1. Evaluate and monitor the injury and recovery mechanisms of the hamstrings muscles

2. Evaluate efficacy of injury prevention programs for the hamstrings and calf muscles

3. Evaluate the risk of re-injury

Using an innovative Diffuse Tensor (DT) MRI imaging technique, which allows accurate evaluation of the muscle fibers.

FURTHER INFORMATION

For further information and current updates on the project, please refer to our website (only in Dutch): www.hamstringonderzoek.nl

PRIMA Study: Platelet-Rich plasma Injection Management for Ankle osteoarthritis

PROJECT PARTNERS

· Flevoziekenhuis – Orthopaedic surgery, Almere, The Netherlands

· OLVG – Sports Medicine, Amsterdam, The Netherlands

· Spaarne gasthuis – Orthopaedic surgery, Hoofddorp, The Netherlands

· Erasmus Medical Center – Sports Medicine, Rotterdam, The Netherlands

· The Bergman Clinics – Sports Medicine, Naarden, The Netherlands

FUNDING

· The study was funded by the Dutch Arthritis Foundation

BACKGROUND

Platelet-rich plasma (PRP) is a potentially efficacious treatment for ankle osteoarthritis (OA), but its use has not been examined in high-quality studies. Systematic reviews show that PRP injections significantly decrease pain and improve function in patients with knee OA. Ankle OA is more common than hip or knee OA in the young active population; with a prevalence of 3.4%. PRP injections in ankle OA are shown to be safe and improve quality of life over time, but no randomized controlled trial has been conducted.

OBJECTIVES

Our randomized controlled trial will evaluate the efficacy of PRP injections for symptom reduction and functional improvement, compared with placebo, in the treatment of ankle (talocrural) OA, using standardized questionnaires and physical examination.

FURTHER INFORMATION

For further information and current updates on the project we refer you to the published protocol of the study or the website of the Dutch Arthritis Foundation.

ACTION Trial: The goal attainment scaling for knee arthroplasty in younger patients

PROJECT PARTNERS

· This project is a single center study performed at the Amphia hospital, Breda, The Netherlands

FUNDING

· The study was funded by Foundation NuthsOhra (grant number 1403-026).  

BACKGROUND

Knee arthroplasty (KA) has proven to be a reliable treatment to relieve pain, improve function and enhance health-related quality of life in patients suffering from knee osteoarthritis (OA). Following the increasing prevalence of knee OA, the demand for KA is expected to rise worldwide, especially in patients 55 – 65 years of age. These patients often wish to return to work and to participate in knee-demanding leisure time activities. Despite the aforementioned benefits of KA, up to 20% of patients remain dissatisfied after surgery.

Unmet expectations are the primary cause for dissatisfaction after KA, and rehabilitation likely plays a crucial role in establishing and obtaining reasonable goals. Since younger KA patients have a wide variety of activity goals and expectations, a ‘one-size-fits-all’ rehabilitation approach likely does not suffice. A possible instrument to tailor the rehabilitation to patients’ personal goals is Goal Attainment Scaling (GAS). Theoretically, GAS could prove to be a useful instrument to establish realistic goals, increase goal attainment and thus improve satisfaction in younger KA patients.

OBJECTIVES

We will investigate the effect of GAS-based rehabilitation on satisfaction in younger, active KA patients. We hypothesize that a GAS-based, personalized, goal-directed rehabilitation leads to higher satisfaction scores for postoperative performance of activities, compared to usual-care rehabilitation after KA.

FURTHER INFORMATION

Witjes S, Hoorntje A, Kuijer PP, Koenraadt KL, Blankevoort L, Kerkhoffs GM, van Geenen RC. Does Goal Attainment Scaling improve satisfaction regarding performance of activities of younger knee arthroplasty patients? Study protocol of the randomized controlled ACTION trial. BMC Musculoskelet Disord. 2016 Mar 2;17:113. doi: 10.1186/s12891-016-0965-3. PMID: 26936270

Hoorntje A, Witjes S, Kuijer PPFM, Bussmann JBJ, Horemans HLD, Kerkhoffs GMMJ, van Geenen RCI, Koenraadt KLM. Does Activity-Based Rehabilitation With Goal Attainment Scaling Increase Physical Activity Among Younger Knee Arthroplasty Patients? Results From the Randomized Controlled ACTION Trial. J Arthroplasty. 2019 Oct 23. pii: S0883-5403(19)31005-8. doi: 10.1016/j.arth.2019.10.028. [Epub ahead of print]. PMID:31740103

Witjes S, Hoorntje A, Kuijer PP, Koenraadt KL, Blankevoort L, Kerkhoffs GM, van Geenen RC. Goal Setting and Achievement in Individualized Rehabilitation of Younger Total and Unicondylar Knee Arthroplasty Patients: A Cohort Study. Arch Phys Med Rehabil. 2019 Aug;100(8):1434-1441. doi: 10.1016/j.apmr.2018.11.019. Epub 2018 Dec 22. PMID: 30582918