Injuries and illnesses in Swedish Paralympic athletes—A 52‐week prospective study of incidence and risk factors

Year-round injury and illness surveillance in UK summer paralympic sport athletes: 2016-2019

OBJECTIVE

To identify the priority injuries and illnesses across UK summer Paralympic World Class Programmes (WCP).

METHODS

Four years (2016-2019) of electronic medical records from 360 athletes across 17 Paralympic WCP sports were analysed. Methods were based on the 2021 International Paralympic Committee translation of the original 2020 International Olympic Committee consensus statement for epidemiological recording and reporting. This included reporting incidence (count of injury per athlete year) and burden (time loss days per athlete year) of injuries by impairment category.

RESULTS

836 injuries and 453 illnesses were recorded during the surveillance period, accounting for 34 638 and 10 032 time-loss days, respectively. 216 (60%) athletes reported at least one injury, while 171 (47.5%) reported at least one illness. There were 0.9 injuries per athlete year, resulting in a mean injury burden of 38.1 days per athlete year. The lumbar/pelvis, shoulder and thoracic/ribs body region had the greatest incidence whereas the shoulder, lumbar/pelvis and wrist had the greatest injury burden. All impairment categories had shoulder or lumbar/pelvis as the body region with the greatest incidence, however the burden of body areas did not always reflect the incidence. Athletes reported 0.5 illnesses per athlete year, resulting in an average illness burden of 11.3 days per athlete year. The respiratory, gastrointestinal, dermatological and genitourinary organ systems had the greatest illness incidence.

CONCLUSIONS

To optimise health and performance in Paralympic sport athletes, system-wide mitigation initiatives should target priority injury problems occurring in the lumbar/pelvis, shoulder, thoracic spine/ribs and wrist. Illness types causing the greatest burden vary with impairment group, and illness mitigation initiatives should consider athlete impairment types in their design, while continuing to note the high incidence of respiratory and gastrointestinal illness across all impairments. Further research should examine associated risk factors and the influence of impairment categorisation.

Prevalence and incidence of health problems and their characteristics in Brazilian para athletes: A one-season single-center prospective pilot study

BACKGROUND

Para athletes experience high prevalence and incidence of health problems related to sport. Despite this, there are few longitudinal studies.

OBJECTIVE

To describe the characteristics, prevalence, incidence, and severity of health problems in para athletes from one of the Brazilian Paralympic Reference Centers during a sports season and to compare the prevalence of health problems between para athletics, para powerlifting, and para swimming.

METHODS

This prospective pilot study was conducted from October 2019 to March 2020. The Oslo Sports Trauma Research Center Questionnaire on Health Problems was used to record injuries and illnesses every week for 24 weeks. The characteristics, prevalence, incidence, and severity of health problems were described for each modality. The prevalence of health problems was compared among the three sport modalities.

RESULTS

Thirty-five para athletes participated. Most of the injuries occurred in the shoulder, and most illnesses caused respiratory and gastrointestinal symptoms. The average weekly prevalence and the incidence rate of health problems were 40.6% (95% CI 17.0-64.4) and 12.7 (95% CI 9.6-15.9) per 1000 athlete hours, respectively. Para powerlifting had the highest prevalence of all and substantial health problems; para swimming had the lowest prevalence of injuries; and para athletics had the lowest prevalence of illnesses.

CONCLUSIONS

This group of Brazilian para athletes showed a high prevalence and incidence of health problems throughout the season. Para athletics, para powerlifting, and para swimming each had a different prevalence of injuries and illnesses.

Team USA injury and illness incidence at the 2022 Beijing Winter Olympic and Paralympic Games

OBJECTIVE

The purpose of this study was to determine the injury and illness incidence from Team USA athletes from the 2022 Beijing Winter Olympic and Paralympic Games and assess any sex-based differences or differences between Olympic and Paralympic athletes.

METHODS

Team USA Olympic (n=231, 48.5% female) and Team USA Paralympic (n=63, 22.2% female) athletes had medical encounters documented during the Games. Injuries and illnesses were defined according to the 2020 International Olympic Committee Consensus Statement and reviewed for accuracy by a physician. Incidence rates were calculated per 1000 athlete-days and further analysed by sex, sport, anatomical location, type of illness, injury event and injury mechanism, with incident rate ratios (IRRs) used for group comparisons.

RESULTS

There were no differences in illness (Olympic illness, IRR=0.99 (95% CI 0.48 to 2.07), p=0.998; Paralympic illness, IRR=1.43 (95% CI 0.41 to 4.97), p=0.572) or injury rates (Olympic injury, IRR=0.63 (95% CI 0.39 to 1.03), p=0.062; Paralympic injury, IRR=1.01 (95% CI 0.43 to 2.35), p=0.988) between male and female (reference group) athletes. However, Olympic athletes had significantly lower illness (IRR=0.41 (95% CI 0.22 to 0.76), p=0.003) and injury (IRR=0.56 (95% CI 0.37 to 0.87), p=0.009) risks compared with Paralympic athletes.

CONCLUSION

No significant sex-related differences in injury or illness were detected in Team USA Olympic or Paralympic participating in the 2022 Beijing Winter Games. However, Paralympic athletes exhibited higher rates of injury and illness compared with their Olympic counterparts. This study highlights delegation-specific epidemiological data which may facilitate more focused approaches for injury and illness prevention.

Mental health, sleep, and pain in elite Para athletes and the association with injury and illness-A prospective study

INTRODUCTION

The interest in the health of Para athletes continues to increase. Still, there are few studies that have evaluated health parameters beyond injury and illness in this athlete population.

OBJECTIVE

To assess (1) the weekly proportion of elite Para athletes reporting anxiety/depression, low sleep levels (≤7 hours), and pain over 52 weeks; (2) and to explore whether these health parameters are associated with the risk for a sports injury or illness.

DESIGN

A 52-week prospective study, part of the Sports-related Injury and Illness in Paralympic Sport Study (SRIIPSS).

SETTING

A total of 107 Swedish elite Para athletes with physical, visual, and intellectual impairment participated.

MAIN OUTCOME MEASURES

Data on self-reported anxiety/depression, sleep levels, pain, and injuries/illnesses were collected weekly. Comparisons of these parameters preceding an injury/illness were made using Friedman's analysis of variance (ANOVA).

RESULTS

The proportion of athletes reporting weekly anxiety/depression was 34.1%; 60.9% of athletes reported sleeping ≤7 hours and 49.9% reported pain. In exploratory analyses, there were no significant differences between weeks before an injury for any of the variables. There were significant differences in levels of sleep over the weeks, where sleep levels were significantly higher (>10 hours) 4 weeks prior to an illness (p = .016).

CONCLUSION

This cohort of elite Para athletes reported relatively high levels of anxiety/depression, low sleep levels, and pain, which is a concern. High sleep levels and the risk for illness might be an indication of overtraining, which commonly leads to persistent fatigue and an increased susceptibility to infections. Monitoring of the health of elite Para athletes is recommended to be able to improve performance and health in this population.

Current Technologies and Practices to Assess External Training Load in Paralympic Sport: A Systematic Review

CONTEXT

Knowing the methods to assess the external load in Paralympic sports can help multidisciplinary teams rely on scientific evidence to better prescribe and monitor the athlete's development, improving sports performance and reducing the risk of injury/illness of Paralympic athletes.

OBJECTIVES

This review aimed to systematically explore the current practices of quantifying the external load in Paralympic sports and provide an overview of the methods and techniques used.

EVIDENCE ACQUISITION

A search in PubMed, Web of Science, Scopus, and EBSCO was carried out until November 2022. The measures of interest were objective methods for quantifying the external load of training or competition. The inclusion criteria for the studies were as follows: (1) peer-reviewed article; (2) the population were Paralympic athletes; (3) evaluated during training or competition; (4) reported at least one external load measure; and (5) published in English, Portuguese, or Spanish.

EVIDENCE SYNTHESIS

Of the 1961 articles found, 22 were included because they met the criteria, and 8 methods were identified to quantify the external load in training or competition in 8 Paralympic sports. The methods varied according to the characteristics of the Paralympic sports. To date, the devices used included an internal radiofrequency-based tracking system (wheelchair rugby) a miniaturized data logger (wheelchair tennis, basketball, and rugby); a linear position transducer (powerlifting and wheelchair basketball); a camera (swimming, goalball, and wheelchair rugby); a global positioning system (wheelchair tennis); heart rate monitors that assess external load variables in set (paracycling and swimming) and an electronic timer (swimming).

CONCLUSIONS

Different objective methods were identified to assess the external load in Paralympic sports. However, few studies showed the validity and reliability of these methods. Further studies are needed to compare different methods of external load quantification in other Paralympic sports.

Incidence and burden of injury at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days

OBJECTIVE

To describe the epidemiology of injuries at the Tokyo 2020 Paralympic Games, including injuries sustained in the new sports of badminton and taekwondo.

METHODS

Injury data were obtained daily via the established web-based injury and illness surveillance system (WEB-IISS; 81 countries, 3836 athletes) and local organising committee medical facilities (81 countries, 567 athletes). Univariate unadjusted incidences (injuries per 1000 athlete days with 95% CIs), injury proportion (IP, %) and injury burden (days lost per 1000 athlete days) are reported.

RESULTS

A total of 4403 athletes (1853 women, 2550 men) from 162 countries were monitored prospectively during the 3-day pre-competition and 12-day competition periods (66 045 athlete days). 386 injuries were reported in 352 athletes (IP=8.0%) with an incidence of 5.8 per 1000 athlete days (95% CI 5.3 to 6.5). Football 5-a-side (17.2), taekwondo (16.0), judo (11.6) and badminton (9.6) had the highest incidence. There was a higher incidence of injuries in the pre-competition period than in the competition period (7.5 vs 5.4; p=0.0053). Acute (sudden onset) injuries and injuries to the shoulder (0.7) and hand/fingers (0.6) were most common. Injury burden was 10.9 (8.6-13.8), with 35% of injuries resulting in time loss from training and competition.

CONCLUSION

Compared with previous Paralympic Games, there was a reduction in injury incidence but higher injury burden at the Tokyo 2020 Paralympic Games. The new sports of taekwondo and badminton had a high injury incidence, with the highest injury burden in taekwondo, compared with other sports. These findings provide epidemiological data to inform injury prevention measures for high-risk sports.

Monitoring mental distress in Para athletes in preparation, during and after the Beijing Paralympic Games 2022: A 22 week prospective mixed-method study

It is common in elite sport to monitor athletes' training load, injuries and illnesses, but mental distress is rarely included. An improved understanding of the epidemiology of mental distress among elite Para athletes and how their coaches perceive such monitoring would allow us to better develop and implement preventive measures. The purpose of this study was therefore to (1) prospectively describe elite Para athletes' mental distress, before, during and after the Beijing Paralympic Games (Paralympics Games 22 = PG22); and to (2) gain a better understanding of if and potentially how awareness of athletes' mental distress changed, through weekly monitoring, and influenced how coachers perceive athletes' mental distress and if they accounted for this before, during and after PG22. A mixed-method study design was used, in which prospective mental distress (depression and anxiety) data were collected weekly from 13 [Swedish] elite Para athletes in preparation, during and after PG22. Data were screened and evaluated weekly by a physiotherapist and a sports psychologist, and coaches also received weekly reports. A focus-group interview with the coaches were conducted post Paralympics to address coaches' awareness about mental distress and athlete health monitoring in Parasport. For data analyses, descriptive statistics was used for the quantitative data and a content analysis was conducted for the qualitative data. The results reveled the following proportion of datapoints indicating symptoms of anxiety and depression: before PG22 (15.8 and 19.1%); during PG22 (47.6 and 38.2%); and after PG22 (0 and 11.8%). The qualitative results indicated that coaches perceived athlete health monitoring as helpful for increasing their awareness of mental distress, and as a useful tool to initiate support for their athletes as well as improving their coaching. In summary, this cohort of elite Para athletes reported a high proportion of mental distress during the Winter Paralympic Games in Beijing. The results also show that it is important and feasible to monitor Para athletes' mental distress to detect and manage early symptoms of mental distress.

Mapping Research Trends of Adapted Sport from 2001 to 2020: A Bibliometric Analysis

OBJECTIVES

To identify the research landscape in terms of keywords, annual outputs, journals, countries, and institutions and explore the hot topics and prospects regarding adapted sport research.

MATERIALS AND METHODS

Publications designated as "article" on adapted sport retrieved from the Web of Science Core Collection. VOSviewer 1.6.11, Citespace, and Bibliometrix in R Studio were applied for the bibliometric analyses.

RESULTS

A total of 1887 articles were identified. Over the past two decades, athletic performance, sociology/psychology, and rehabilitation were extensively investigated. Basketball, soccer, and swimming were the three most focused adapted sports. Researchers showed a growing interest in submitting their studies to sport science, rehabilitation, and sociological journals. Adapted sport research was more common in developed countries and regions. The UK contributed most publications accounting for about 20% of the total publications.

CONCLUSIONS

With the growth of publications concerning adapted sport, the bibliometric analysis presented an overview of collaboration, trends, and hotspots in the field.

Safe and Healthy Para sport project (SHAPE): a study protocol of a complex intervention within Para sport

Elite Para athletes report a high incidence of sports injuries, illnesses and other health issues. Despite this, there are few prevention programmes in Para sport, and many of the existing prevention programmes are not adapted to Para athletes. To improve the success of preventive measures, it has been suggested that sports safety work should facilitate health promotion, including athlete health education. Therefore, the overarching aim of this project is to evaluate an accessible health promotion web platform as part of a complex intervention that aims to improve knowledge of athlete health in Para sport. In this protocol, the development, future implementation and evaluation of the intervention are described. To inform the implementation and use of such interventions, it is recommended to involve end users in the development and implementation process. Therefore, a participatory design process, including athletes and the sports organisation, was used to develop an accessible health promotion web platform. To evaluate this complex intervention, a process evaluation combining quantitative evaluation assessing causal pathways with qualitative methods assessing multifaceted pathways will be used. The primary outcomes are injury/illness incidence, athlete health parameters, health literacy and user behaviour. A cohort of elite Para athletes (n=150) from Sweden and South Africa will be invited to participate. This project will be the first that aims to improve athlete health in Para sport through pragmatic and accessible health promotion. It is a boundary-crossing project that will be conducted in a real-world sport setting, including athletes with different socioeconomic backgrounds.

Tokyo 2020: A Sociodemographic and Psychosocial Characterization of the Portuguese Paralympic Team

The importance of practicing sports and its impact on the quality of life of people with disabilities is fundamental. Characterizing subjective well-being, resilience, and social influence in the practice of adapted sports, namely in those who participate in elite sport in Portugal, is truly important to support a set of initiatives to promote higher levels of practice. Thus, this study describes the Portuguese delegation at the Tokyo 2020 Paralympic Games through sociodemographic and psychosocial (positive and negative affect, life satisfaction, resilience, and social support) variables. The study involved 31 of the 33 athletes of the Portuguese Paralympic team aged between 15 and 58 years (34.45 ± 11.7 years), with 21 men and 10 women. Individual-level sociodemographic data gave us a clear insight into the reality of adapted sport in Portugal. The high values of life satisfaction, high positive affect and low negative affect, as well as high levels of resilience and social support seem to be important variables for these athletes. The data from the present study highlighted the importance of understanding the characteristics of Paralympic athletes, in order to better understand the reality of Paralympic sport in Portugal.

Injuries in Judo Athletes With Disabilities: Prevalence, Magnitude, and Sport-Related Mechanisms

CONTEXT

The participation of judo athletes with disabilities in competitions has increased over the years as well as the burden of sports-related injuries and illnesses in this population. However, there is limited knowledge about sports-related injuries in judo athletes with different disabilities.

OBJECTIVE

To investigate the prevalence of injuries in judo athletes with disabilities, considering the different impairment groups, magnitude of injury (ie, mechanism, nature, and severity of injury), and specific body parts.

DESIGN

Cross-sectional study (level of evidence, 3).

SETTING

Brazilian Judo athletes with disabilities.

PATIENTS

Fifty-one judo athletes with disabilities (15 men and 36 women) participated in this study.

MAIN OUTCOME MEASURES

Data were obtained from an adapted injury report form. The prevalence of injuries was assessed, considering type of impairment, body parts, mechanisms, and severity as well as differences between male and female athletes, with the significance level set at P < .05.

RESULTS

The results demonstrated a high prevalence of injuries in female athletes with visual impairment (n = 11, 73.3%) and male athletes with amputations (n = 14, 38.8%). A high prevalence was found in the national group, especially for male athletes (n = 29, 80.5%). Among athletes who had injuries, 69.4% (n = 12) of male and 80.0% (n = 25) of female athletes' injuries occurred due to direct contact with other athletes, and 72.2% (n = 26) of male and 86.6% (n = 13) of female athletes' injuries were in the training environment. The magnitude of injuries ranged from moderate to severe for male and female athletes. The knee (n = 25, 49.0%) and shoulder (n = 12, 23.5%) were the body parts most affected by injuries in both male and female athletes.

CONCLUSION

A large percentage of judo athletes with disabilities reported experiencing an injury during the previous 2 years; percentages were greater in athletes with visual and physical impairment. Moreover, most injuries occurred in the knee or shoulder, during training, and in direct contact with other athletes and were of severe magnitude.

Patterns of Athlete Medication Use at the 2018 PyeongChang Paralympic Games: A Descriptive Cohort Study

OBJECTIVE

Medication use among elite athletes has received growing attention over the past decades. However, only limited studies have focused on para athletes, and trends in medication use among this cohort remain unclear. The aims of this study were (1) to describe the pattern of medication use in elite Paralympic athletes, with a particular focus on analgesics, (2) to analyze whether medications declared by athletes were included in the 2018 World Anti-Doping Agency's prohibited list and monitoring program, (3) to report on a variety of novel supplements, and (4) to review whether athlete analgesic needs will be met by the new Olympic & Paralympic Model Formulary.

DESIGN

This is a retrospective, descriptive cohort study.

RESULTS

Of all athletes who underwent doping control, 21% declared the use of an analgesic medication. Athletes with limb deficiency and para snowboarders declared the most analgesic medications in their respective categories. It was determined that 84% of the athletes' analgesic medication needs were provided from the new Olympic & Paralympic Model Formulary.

CONCLUSIONS

Analgesic use among athletes who participated at the 2018 PyeongChang Winter Paralympics was high. Para snowboarders and athletes with limb deficiency declared the most analgesics. The new Olympic & Paralympic Model Formulary adequately addressed the medication needs of the athletes attending the 2018 games.

Preparing for snow-sport events at the Paralympic Games in Beijing in 2022: recommendations and remaining questions

During the 2022 Winter Paralympic Games in Beijing, the Para snow-sport events will be held at high altitudes and in possibly cold conditions while also requiring adjustment to several time zones. Furthermore, the ongoing COVID-19 pandemic may lead to suboptimal preparations. Another concern is the high rate of injuries that have been reported in the Para alpine and snowboard events. In addition to these challenges, Para athletes various impairments may affect both sports-specific demands and athlete health. However, the group of Para snow-sport athletes is an understudied population. Accordingly, this perspective paper summarises current knowledge to consider when preparing for the Paralympic Games in Beijing and point out important unanswered questions. We here focus specifically on how sport-specific demands and impairment-related considerations are influenced by altitude acclimatisation, cold conditions, travel fatigue and jetlag, complications due to the COVID-19 pandemic, and injury prevention and sports safety considerations. As Para athletes with spinal cord injury, limb deficiency, cerebral palsy and visual impairment account for the majority of the Para snow-sport athletes, the focus is mainly on these impairment groups. In brief, we highlight the extra caution required to ensure athlete health, performance and sports safety among Para athletes participating in the snow-sport events in the 2022 Beijing Paralympic Games. Although there is an urgent need for more high-quality research focusing on Para winter athletes, we hope these non-consensus recommendations will help prepare for the 2022 Beijing Paralympic Winter Games.

Illness and injury among Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles: prevailing high illness burden on the road from 2012 to 2020

OBJECTIVE

To describe the illness and injury pattern of Norwegian Para athletes over five consecutive Paralympic Summer and Winter Games cycles and to identify which health problems should be targeted in risk management plans with respect to impairment types.

METHODS

We monitored athletes from 12 to 18 months prior to each Game using a weekly online questionnaire (Oslo Sports Trauma Research Center-H2 (OSTRC-H2)). We asked them to report all health problems they had experienced in the preceding 7 days, irrespective of their consequences on their sports participation or performance and whether they had sought medical attention.

RESULTS

Between 2011 and 2020, 94 candidate athletes were included in this monitoring programme and prepared to represent Norway; of these, 66 (71%) were finally selected for multiple Paralympic Games. The overall response rate to the weekly questionnaires was 87%. At any given time during the five observation cycles, 37% of the athletes (95% CI 36% to 38%) reported having at least one health problem. Athletes with neurological impairments (n=51) lost 10 days per year due to respiratory problems (95% CI 9 to 11) compared with 9 days (8-10) among those with musculoskeletal impairments (n=37). Gastrointestinal problems caused a time loss of on average 4 days per year in athletes with neurological impairments versus 1 day in athletes with musculoskeletal impairments (mean difference 2.7 days, 2.1-3.3). Musculoskeletal injuries generated a high burden for both athlete groups, in particular, to the elbow, shoulder and lumbosacral regions.

CONCLUSION

At any given time, nearly two out of five elite Norwegian Para athletes reported at least one health problem. Respiratory tract and other infections; gastrointestinal problems, injuries to the shoulder, elbow and lumbosacral regions represented the greatest health burden. Our findings can help guide the allocation of clinical resources, which should include a broad network of medical specialists, together with dieticians and physiotherapists, to meet the health challenges in Para athletes.

Incidence of sports-related concussion in elite para athletes - a 52-week prospective study

Objective: To assess the 52-week incidence proportion and incidence rate of sports-related concussion (SRC) among elite Para athletes, and to analyze the injury mechanisms.Method: In total, 70 male and 37 female Swedish elite Para athletes (median age 29 years) with vision, physical and intellectual impairment, weekly self-reported sports-related injuries including concussion in an eHealth application adapted to Para athletes. Descriptive statistics were used to assess the incidence rate and incidence proportion. Chi-square statistics were used to analyze differences in the proportion of SRC.Results: A total of 13 SRC were reported: three athletes each sustained two SRC. The incidence proportion was 9.3% (95% CI 4.8-16.7), and the incidence rate 0.5 SRC/1000 hours (95% CI 0.3-0.9) of sports exposure. Athletes with vision impairment and female athletes reported a significantly higher proportion of SRC. A majority of the injuries (n = 9; 69%) occurred during sport-specific training. The injury mechanisms were collision with object (n = 7; 54%), collision with person (n = 4; 31%), and poor playing field conditions (n = 2; 16%).Conclusion: The incidence of concussion among elite Paralympic athletes is comparable to sports for able-bodied athletes. Athletes with vision impairment and female athletes reported a significantly higher incidence of SRC, and collisions were the most common injury mechanism. These results can form the basis for future preventive research studies.

Methods, challenges and benefits of a health monitoring programme for Norwegian Olympic and Paralympic athletes: the road from London 2012 to Tokyo 2020

OBJECTIVE

To describe the implementation of a health monitoring programme for Norwegian Paralympic and Olympic candidates over five consecutive Olympic and Paralympic Games cycles (London 2012, Sochi 2014, Rio de Janeiro 2016, PyeongChang 2018 and Tokyo 2020).

METHODS

Athletes were monitored for 12-18 months preparing for the games using a weekly online questionnaire (OSTRC-H2) with follow-up by physicians and physiotherapists, who provided clinical care and classified reported problems.

RESULTS

Between 2011 and 2020, 533 Olympic and 95 Paralympic athletes were included in the monitoring programme, with an overall response of 79% to the weekly questionnaire and a total observation period of 30 826 athlete weeks. During this time, 3770 health problems were reported, with a diagnosis rate of 97%. The average prevalence of health problems at any given time was 32% among Olympic athletes and 37% among Paralympic athletes. Acute traumatic injuries represented the greatest burden for Olympic team sport athletes, and illnesses represented the greatest burden for Olympic endurance and Paralympic athletes. On average, Olympic athletes lost 27 days and Paralympic athletes lost 33 days of training per year due to health problems.

CONCLUSION

Conducting long-term health monitoring of Olympic and Paralympic athletes is challenging, particularly because athletes travel frequently and often relate to many medical providers. This programme has been implemented and improved within Team Norway for five Olympic and Paralympic cycles and during this time we believe it has helped protect our athletes' health.

Para sport translation of the IOC consensus on recording and reporting of data for injury and illness in sport

In 2020, the IOC proposed a universal methodology for the recording and reporting of data for injury and illness in sport. Para sport is played by individuals with impairment, and they have a unique set of considerations not captured by these recommendations. Therefore, the aim of this addendum to IOC consensus statement was to guide the Para sport researcher through the complexities and nuances that should be taken into consideration when collecting, registering, reporting and interpreting data regarding Para athlete health. To develop this translation, experts in the field of Para sports medicine and epidemiology conducted a formal consensus development process, which began in March 2020 with the formation of a consensus group that worked over eight phases, incorporating three virtual consensus meetings to finalise the translation. This translation is consistent with the IOC consensus statement, yet provides more detailed Para athlete specific definitions and recommendations on study population, specifically, diagnostic and eligible impairment categorisation and recording of adaptive equipment, and defining and classifying health problems in the context of Para sport. Additionally, recommendations and Para athlete specific examples are described with regards to injury mechanism, mode of onset, injury and illness classification, duration, capturing and reporting exposure and risk. Finally, methods and considerations are provided to cater to the varied needs of athletes with impairment with respect to data collection tools. This harmonisation will allow the science to develop and facilitate a more accurate understanding of injury and illness patterns for tailoring evidence-informed prevention programmes and enabling better planning of medical services for Para sport events.

Prevalence and incidence of injuries in para athletes: a systematic review with meta-analysis and GRADE recommendations

OBJECTIVE

To investigate prevalence, incidence and profile of musculoskeletal injuries in para athletes.

DESIGN

Systematic review.

DATA SOURCES

Searches were conducted in MEDLINE, EMBASE, AMED, SPORTSDiscus, CINAHL and hand searching.

ELIGIBILITY CRITERIA

Studies were considered if they reported prevalence or incidence of musculoskeletal injuries in para athletes. Study selection, data extraction and analysis followed the protocol. Meta-analyses were conducted to estimate the prevalence and incidence rate among studies and subgroup analyses investigated whether methodological quality and sample size of the studies influenced on the estimated injury prevalence and incidence. The Grading of Recommendations Assessment, Development and Evaluation system determined the strength of evidence.

RESULTS

Forty-two studies were included. The prevalence of musculoskeletal injuries was 40.8% (95% CI 32.5% to 49.8%). Because of imprecision, indirectness and inconsistency, the strength of evidence was very low quality. The incidence of musculoskeletal injuries was 14.3 injuries per 1000 athlete-days (95% CI 11.9 to 16.8). The strength of evidence was low quality because of imprecision and indirectness. The subgroup analyses revealed that the sample size influenced on estimated injury prevalence and methodological quality influenced on estimated incidence. Injuries were more prevalent in the shoulder, for non-ambulant para athletes, and in the lower limbs, for ambulant para athletes.

SUMMARY/CONCLUSION

Para athletes show high prevalence and incidence of musculoskeletal injuries. Current very low-quality and low-quality evidence suggests that future high-quality studies with systematic data collection, larger sample size and specificities of para athletes are likely to change estimates of injury prevalence and incidence in para athletes.

PROSPERO REGISTRATION NUMBER

CRD42020147982.