How do sports injury epidemiological outcomes vary depending on athletes' response rates to a weekly online questionnaire? An analysis of 39-week follow-up from 391 athletics (track and field) athletes

OBJECTIVE

To explore how sports injury epidemiological outcomes (i.e., prevalence, average prevalence, incidence, burden, and time to first injury) vary depending on the response rates to a weekly online self-reported questionnaire for athletes.

METHODS

Weekly information on athletics injuries and exposure from 391 athletics (track and field) athletes was prospectively collected over 39 weeks (control group of the PREVATHLE randomized controlled trial) using an online self-reported questionnaire. The data were used to calculate sports injury epidemiological outcomes (i.e., prevalence, average prevalence, incidence, burden, and time to first injury) for sub-groups with different minimum individual athletes' response rates (i.e., from at least 100%, at least 97%, at least 95%, … to at least 0% response rate). We then calculated the relative variation between each sub-group and the sub-group with a 100% response rate as a reference. A substantial variation was considered when the relative variation was greater than one SD or 95% CI of the respective epidemiological outcome calculated in the sub-group with a 100% response rate.

RESULTS

Of 15 249 expected weekly questionnaires, 7209 were completed and returned, resulting in an overall response rate of 47.3%. The individual athletes' response rates ranged from 0% (n = 51) to 100% (n = 100). The prevalence, average weekly prevalence, and time to first injury only varied substantially for the sub-groups below a 5%, 10% and 18% minimum individual response rate, respectively. The incidence and injury burden showed substantial variations for all sub-groups with a response rate below 100%.

CONCLUSIONS

Epidemiological outcomes varied depending on the minimum individual athletes' response rate, with injury prevalence, average weekly prevalence, and time to first injury varying less than injury incidence and injury burden. This highlights the need to take into account the individual response rate when calculating epidemiological outcomes, and determining the optimal study-specific cut-offs of the minimum individual response rate needed.

Perceptions and beliefs on sports injury prediction as an injury risk reduction strategy: An online survey on elite athletics (track and field) athletes, coaches, and health professionals

OBJECTIVES

To explore perceptions and beliefs of elite athletics (track and field) athletes, coaches, and health professionals, towards the use of injury prediction as an injury risk reduction strategy.

DESIGN

Cross-sectional study.

METHOD

During the 2022 European Athletics Championships in Munich, registered athletes, coaches, and health professionals were asked to complete an online questionnaire on their perceptions and beliefs of injury prediction use as an injury risk reduction strategy. The perceived level of interest, intent to use, help, potential stress (psychological impact) and dissemination were assessed by a score from 0 to 100.

RESULTS

We collected 54 responses from 17 countries. Elite athletics stakeholders expressed a perceived level of interest, intent to use, and help of injury prediction of (mean ± SD) 85 ± 16, 84 ± 16, and 85 ± 15, respectively. The perceived level of potential stress was 41 ± 33 (range from 0 to 100), with an important inter-individual variability in each elite athletics stakeholder's category.

CONCLUSIONS

This was the first study investigating the perceptions and beliefs of elite athletics stakeholders regarding the use of injury prediction as an injury risk reduction strategy. Regardless of the stakeholders, there was a high perceived level of interest, intent to use and help reported in this potential strategy.

Understanding the first injury in athletics and its effect on dropout from sport: an online survey on 544 high-level youth and junior athletics (track and field) athletes

Objective

To describe the first injury and to investigate whether it plays a role in altering athletics' sustainable practice.

Methods

We conducted a cross-sectional study using an exploratory survey on the first injury and its consequences on athletics practice. In 2021, we asked all high-level athletes licensed with the French Federation of Athletics (FFA) under 18 years, under 20 years and under 23 years categories between 2007 and 2021.

Results

Out of 6560 emails sent by FFA, 544 athletes responded, and 93.6% (n=510) reported experiencing at least one injury during their career. The first injury occurred at a mean age of 17.5±3.3 years after 6.1±4.1 years of athletics practice. The main locations of the first injury were the posterior thigh (28.9%), the ankle (16.5%) and the knee (12.6%), and the principal reported injury types were muscle (37.7%), tendon (17.5%) and ligament (15.5%). More than a third of injured athletes (36.7%) reported experiencing ongoing symptoms or sequelae after their first injury, and about half (48.5%) experienced recurrences. About 20% had stopped athletics at the time of the survey, with injury problems the primary cause of athletes dropping out (46.2%), including the first injury (9.4%).

Conclusions

Injuries played an important role in altering sustainable athletics practice, with injury accounting for about 50% of all reported dropouts and the first injury accounting for about 10% of all reported causes. Our results provide evidence to target the prevention of the first injury, which could be considered the origin of the 'vicious circle' of injuries.

Epidemiology of injuries in elite Women's Artistic Gymnastics: a retrospective analysis of six seasons

Background

Women's Artistic Gymnastics (WAG) is a sport well known for requiring a heavy and difficult training load from a younger age to reach a high level of performance. This also is associated with an injury risk. Epidemiological studies are thus needed to improve injury prevention strategies.

Objective

We aimed to determine the injury epidemiology in French high-level WAG.

Methods

We conducted a retrospective analysis of injury data collected prospectively over six seasons from the 2014-2015 season to the 2019-2020 season among French high-level Women's Artistic Gymnasts from the France Gymnastics National Centre of Saint-Etienne. We performed descriptive analyses, including the calculation of the 1-year injury prevalence.

Results

43 gymnasts were included in this study, representing 111 gymnast-seasons. A total of 285 injuries were collected over the study period, that was, an average of 2.6 injuries per gymnast per season. On average, 91.4% of gymnasts had at least one injury per season. The estimated injury incidence rate was 1.8 injuries per 1000 hours of gymnastics practice. The knee was the most affected joint (16%), followed by the elbow (12%) and the ankle (12%). The most frequent injury type was physis pathologies (16%) and bone injuries (15%). Eighty-eight per cent of injuries required a modification of the gymnastics practice.

Conclusions

The results of this study allowed a description of the epidemiology of injuries in this population of young and elite gymnasts. This very high injury prevalence supports the need to improve injury risk reduction strategies in WAG.

Relationship between a daily injury risk estimation feedback (I-REF) based on machine learning techniques and actual injury risk in athletics (track and field): protocol for a prospective cohort study over an athletics season

INTRODUCTION

Two-thirds of athletes (65%) have at least one injury complaint leading to participation restriction (ICPR) in athletics (track and field) during one season. The emerging practice of medicine and public health supported by electronic processes and communication in sports medicine represents an opportunity for developing new injury risk reduction strategies. Modelling and predicting the risk of injury in real-time through artificial intelligence using machine learning techniques might represent an innovative injury risk reduction strategy. Thus, the primary aim of this study will be to analyse the relationship between the level of Injury Risk Estimation Feedback (I-REF) use (average score of athletes' self-declared level of I-REF consideration for their athletics activity) and the ICPR burden during an athletics season.

METHOD AND ANALYSIS

We will conduct a prospective cohort study, called Injury Prediction with Artificial Intelligence (IPredict-AI), over one 38-week athletics season (from September 2022 to July 2023) involving competitive athletics athletes licensed with the French Federation of Athletics. All athletes will be asked to complete daily questionnaires on their athletics activity, their psychological state, their sleep, the level of I-REF use and any ICPR. I-REF will present a daily estimation of the ICPR risk ranging from 0% (no risk for injury) to 100% (maximal risk for injury) for the following day. All athletes will be free to see I-REF and to adapt their athletics activity according to I-REF. The primary outcome will be the ICPR burden over the follow-up (over an athletics season), defined as the number of days lost from training and/or competition due to ICPR per 1000 hours of athletics activity. The relationship between ICPR burden and the level of I-REF use will be explored by using linear regression models.

ETHICS AND DISSEMINATION

This prospective cohort study was reviewed and approved by the Saint-Etienne University Hospital Ethical Committee (Institutional Review Board: IORG0007394, IRBN1062022/CHUSTE). Results of the study will be disseminated in peer-reviewed journals and in international scientific congresses, as well as to the included participants.

Relationships Between Performance and Injury Occurrence in Athletics (Track and Field): A Pilot Study on 8 National-Level Athletes From Sprints, Jumps and Combined Events Followed During at Least Five Consecutive Seasons

Background

Performance success or failure in athletics (Track and Field) and the capacity to succeed are driven at the adult level, like in other sports, by many factors, injury being one of them. More information regarding the potential relationships between performance and injuries in athletics is needed.

Objective

To analyse the potential association between performance and occurrence of injuries in national-level athletics athletes from sprints, jumps and combined events through several seasons.

Methods

We performed a retrospective analysis of performance and injury data collected prospectively in 8 national-level athletics athletes followed during at least five consecutive seasons from 2009 to 2019. For each athlete, injuries data [total injuries (injuries) and time-loss injuries (TLI)] were collected by the same sports medicine physician throughout the study period using a medical attention injury definition. Performances during official competitions were collected on the French Federation of Athletics website, and included (i) any participation in national championships, (ii) any participation in an international competition (i.e., being national team member for an international competition), (iii) any podium at the national championships, (iv) any podium at an international competition, and (v) performance metrics normalised to the world record (WR) of the respective athletics speciality (%WR). For each athlete, we performed a descriptive analysis of the performances and injuries. We also performed four binomial logistic regressions with (1) national championships participation (yes/no) or (2) international competition participation (yes/no) as dependent variables, and injuries (yes/no) or TLI (yes/no) as independent variables, adjusted for individual athlete and number of seasons, and in models on participation in international competitions, was also adjusted for national championship participation (yes/no), with Odd Ratios (OR) with 95% confidence intervals (95%CI).

Results

Among the 8 national-level athletics athletes included in the present study, cumulated 155 injuries, including 52 TLI (33.5%). There was an average of 2.7 ± 1.7 injuries and 0.9 ± 0.6 TLI per athlete per season over the study period. The occurrence of injuries was significantly associated with higher odds of national championships participation (OR = 4.85 [95% CI 3.10 to 3050.5], p = 0.021). The occurrence of TLI was significantly associated with higher odds of national championships participation (OR = 133.6 [95% CI 4.92 to 14251.5], p = 0.013). The occurrence of injuries or TLI were associated with insignificantly lower odds of international championships participation.

Conclusions

Our present pilot study confirms that injuries are part of an athletes' life. The occurrence of at least one injury was associated with higher odds of participation in a national championship, whereas the absence of at least one injury was associated with higher odds of participation in an international championship. We hypothesised that the length of the season can play a role in the risk of injury occurrence, but if the athlete wants to reach his/her highest level, decreasing the risk of injuries seems to be of importance. Despite the caution that should be taken in the interpretation of our results, our present study confirms the interest and relevance of injury risk reduction approach in athletics.