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Jones B, Tooby J, Weaving D, Till K, Owen C, Begonia M, Stokes KA, Rowson S, Phillips G, Hendricks S, Falvey ÉC, Al-Dawoud M, Tierney G. Ready for impact? A validity and feasibility study of instrumented mouthguards (iMGs). Br J Sports Med 2022; 56:bjsports-2022-105523. [PMID: 35879022 DOI: 10.1136/bjsports-2022-105523] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Assess the validity and feasibility of current instrumented mouthguards (iMGs) and associated systems. METHODS Phase I; four iMG systems (Biocore-Football Research Inc (FRI), HitIQ, ORB, Prevent) were compared against dummy headform laboratory criterion standards (25, 50, 75, 100 g). Phase II; four iMG systems were evaluated for on-field validity of iMG-triggered events against video-verification to determine true-positives, false-positives and false-negatives (20±9 player matches per iMG). Phase III; four iMG systems were evaluated by 18 rugby players, for perceptions of fit, comfort and function. Phase IV; three iMG systems (Biocore-FRI, HitIQ, Prevent) were evaluated for practical feasibility (System Usability Scale (SUS)) by four practitioners. RESULTS Phase I; total concordance correlation coefficients were 0.986, 0.965, 0.525 and 0.984 for Biocore-FRI, HitIQ, ORB and Prevent. Phase II; different on-field kinematics were observed between iMGs. Positive predictive values were 0.98, 0.90, 0.53 and 0.94 for Biocore-FRI, HitIQ, ORB and Prevent. Sensitivity values were 0.51, 0.40, 0.71 and 0.75 for Biocore-FRI, HitIQ, ORB and Prevent. Phase III; player perceptions of fit, comfort and function were 77%, 6/10, 55% for Biocore-FRI, 88%, 8/10, 61% for HitIQ, 65%, 5/10, 43% for ORB and 85%, 8/10, 67% for Prevent. Phase IV; SUS (preparation-management) was 51.3-50.6/100, 71.3-78.8/100 and 83.8-80.0/100 for Biocore-FRI, HitIQ and Prevent. CONCLUSION This study shows differences between current iMG systems exist. Sporting organisations can use these findings when evaluating which iMG system is most appropriate to monitor head acceleration events in athletes, supporting player welfare initiatives related to concussion and head acceleration exposure.
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Affiliation(s)
- Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK
- England Performance Unit, Rugby Football League, Manchester, UK
- Leeds Rhinos, Leeds, UK
- Human Biology, University of Cape Town, Division of Exercise and Sports Medicine, Cape Town, South Africa
- School of Science and Technology, University of New England, Armidale, New South Wales, Australia
| | - James Tooby
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK
| | - Dan Weaving
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK
| | - Kevin Till
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK
- Leeds Rhinos, Leeds, UK
| | - Cameron Owen
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK
- England Performance Unit, Rugby Football League, Manchester, UK
| | - Mark Begonia
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK
- Rugby Football Union, Twickenham, UK
| | - Steven Rowson
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Gemma Phillips
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK
- England Performance Unit, Rugby Football League, Manchester, UK
- Hull Kingston Rovers, Hull, UK
| | - Sharief Hendricks
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK
- Human Biology, University of Cape Town, Division of Exercise and Sports Medicine, Cape Town, South Africa
| | - Éanna Cian Falvey
- World Rugby, World Rugby, Dublin, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Marwan Al-Dawoud
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK
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Tooby J, Weaving D, Al-Dawoud M, Tierney G. Quantification of Head Acceleration Events in Rugby League: An Instrumented Mouthguard and Video Analysis Pilot Study. Sensors (Basel) 2022; 22:s22020584. [PMID: 35062545 PMCID: PMC8781372 DOI: 10.3390/s22020584] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 05/31/2023]
Abstract
Instrumented mouthguards (iMG) were used to collect head acceleration events (HAE) in men's professional rugby league matches. Peak linear acceleration (PLA), peak angular acceleration (PAA) and peak change in angular velocity (ΔPAV) were collected using custom-fit iMG set with a 5 g single iMG-axis recording threshold. iMG were fitted to ten male Super League players for thirty-one player matches. Video analysis was conducted on HAE to identify the contact event; impacted player; tackle stage and head loading type. A total of 1622 video-verified HAE were recorded. Approximately three-quarters of HAE (75.7%) occurred below 10 g. Most (98.2%) HAE occurred during tackles (59.3% to tackler; 40.7% to ball carrier) and the initial collision stage of the tackle (43.9%). The initial collision stage resulted in significantly greater PAA and ΔPAV than secondary contact and play the ball tackle stages (p < 0.001). Indirect HAE accounted for 29.8% of HAE and resulted in significantly greater ΔPAV (p < 0.001) than direct HAE, but significantly lower PLA (p < 0.001). Almost all HAE were sustained in the tackle, with the majority occurring during the initial collision stage, making it an area of focus for the development of player protection strategies for both ball carriers and tacklers. League-wide and community-level implementation of iMG could enable a greater understanding of head acceleration exposure between playing positions, cohorts, and levels of play.
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Affiliation(s)
- James Tooby
- School of Biomedical Sciences, University of Leeds, Leeds LS2 9JT, UK
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds LS1 3HE, UK; (D.W.); (G.T.)
| | - Dan Weaving
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds LS1 3HE, UK; (D.W.); (G.T.)
- Leeds Rhinos Rugby League Club, Leeds LS5 3BW, UK;
| | | | - Gregory Tierney
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds LS1 3HE, UK; (D.W.); (G.T.)
- Sport and Exercise Sciences Research Institute, School of Sport, Faculty of Life and Health Sciences, Ulster University, Belfast BT15 1ED, UK
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Tierney G, Weaving D, Tooby J, Al-Dawoud M, Hendricks S, Phillips G, Stokes KA, Till K, Jones B. Quantifying head acceleration exposure via instrumented mouthguards (iMG): a validity and feasibility study protocol to inform iMG suitability for the TaCKLE project. BMJ Open Sport Exerc Med 2021; 7:e001125. [PMID: 34603742 PMCID: PMC8438841 DOI: 10.1136/bmjsem-2021-001125] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/04/2022] Open
Abstract
Instrumented mouthguards (iMGs) have the potential to quantify head acceleration exposures in sport. The Rugby Football League is looking to deploy iMGs to quantify head acceleration exposures as part of the Tackle and Contact Kinematics, Loads and Exposure (TaCKLE) project. iMGs and associated software platforms are novel, thus limited validation studies exist. The aim of this paper is to describe the methods that will determine the validity (ie, laboratory validation of kinematic measures and on-field validity) and feasibility (ie, player comfort and wearability and practitioner considerations) of available iMGs for quantifying head acceleration events in rugby league. Phase 1 will determine the reliability and validity of iMG kinematic measures (peak linear acceleration, peak rotational velocity, peak rotational acceleration), based on laboratory criterion standards. Players will have three-dimensional dental scans and be provided with available iMGs for phase 2 and phase 3. Phase 2 will determine the on-field validity of iMGs (ie, identifying true positive head acceleration events during a match). Phase 3 will evaluate player perceptions of fit (too loose, too tight, bulky, small/thin, held mouth open, held teeth apart, pain in jaw muscles, uneven bite), comfort (on lips, gum, tongue, teeth) and function (speech, swallowing, dry mouth). Phase 4 will evaluate the practical feasibility of iMGs, as determined by practitioners using the system usability scale (preparing iMG system and managing iMG data). The outcome will provide a systematic and robust assessment of a range of iMGs, which will help inform the suitability of each iMG system for the TaCKLE project.
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Affiliation(s)
- Gregory Tierney
- Sport and Exercise Science Research Institute, Ulster University, Belfast, UK.,Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK
| | - Daniel Weaving
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK.,Leeds Rhinos Rugby League Club, Leeds, UK
| | - James Tooby
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK
| | - Marwan Al-Dawoud
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK.,Leeds Rhinos Rugby League Club, Leeds, UK
| | - Sharief Hendricks
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK.,Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Rondebosch, South Africa
| | - Gemma Phillips
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK.,England Performance Unit, Rugby Football League, Leeds, UK
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK.,Rugby Football Union, Twickenham, UK
| | - Kevin Till
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK.,Leeds Rhinos Rugby League Club, Leeds, UK
| | - Ben Jones
- Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK.,Leeds Rhinos Rugby League Club, Leeds, UK.,Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Rondebosch, South Africa.,England Performance Unit, Rugby Football League, Leeds, UK.,School of Science and Technology, University of New England, Armidale, NSW, Australia
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Ravindra A, Cuff A, Bernstein IA, Al-Dawoud M. Musculoskeletal risk stratification tool to inform a discussion about face-to-face assessment during the COVID-19 pandemic. BMJ Open Sport Exerc Med 2020; 6:e000916. [PMID: 33033623 PMCID: PMC7534730 DOI: 10.1136/bmjsem-2020-000916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2020] [Indexed: 11/04/2022] Open
Abstract
The COVID-19 pandemic and lockdown caused clinicians in the UK to switch to delivering musculoskeletal care using telephone or video consultations. NHS England (an executive non-departmental public body of the Department of Health and Social Care, England) recommended prioritisation of more urgent conditions, including those people whose condition has deteriorated and those waiting the longest as part of a phased return to pre-COVID-19 service provision. Clinicians will need to assess an individual's risk factors for complications from COVID-19 alongside their clinical priority to inform a shared decision-making discussion about appropriate face-to-face care delivery. This paper outlines a risk stratification tool that informs that discussion and aims to reduce the subjectivity in the risk assessment between clinicians.
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Affiliation(s)
- Andrea Ravindra
- NHS Musculoskeletal Services, Connect Health Ltd, Newcastle upon Tyne, UK
| | - Andrew Cuff
- NHS Musculoskeletal Services, Connect Health Ltd, Newcastle upon Tyne, UK
| | - Ian A Bernstein
- NHS Musculoskeletal Services, Connect Health Ltd, Newcastle upon Tyne, UK
- Medical Directorate, Central London Community Healthcare NHS Trust, London, UK
| | - Marwan Al-Dawoud
- NHS Musculoskeletal Services, Connect Health Ltd, Newcastle upon Tyne, UK
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Khan A, Al-Dawoud M, Salaman R, Al-Khaffaf H. Management of Endurance Athletes with Flow Limitation in the Iliac Arteries: A Case Series. EJVES Short Rep 2018; 40:7-11. [PMID: 30101198 PMCID: PMC6083816 DOI: 10.1016/j.ejvssr.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022] Open
Abstract
Introduction Vascular surgeons increasingly encounter flow limitation of iliac arteries (FLIA) in endurance athletes. An experience of managing this condition is reported. Report This is a retrospective cohort analysis of prospectively collected data at a single vascular centre. Between 2001 and 2017, 12 athletes with exercise induced pain underwent investigation and assessment. Patients with significant radiological findings (iliac kinking ± stenosis demonstrated on duplex ultrasound or catheter angiography) and dynamic flow changes (marked reduction in ankle brachial pressure indices following exertion, or increase in the common iliac artery peak systolic velocity during hip flexion on duplex) underwent surgery after trialling conservative management; the majority were open iliac shortening procedures. Patients with radiological findings, but no dynamic flow changes were managed conservatively. All patients were followed up. Discussion There were 10 men and two women with a median age of 40 years. Nine patients had iliac kinking (five in isolation, four associated with stenosis), two had stenosis, and one had no iliac disease. Eight patients had severe symptoms (absolute loss of power on maximal exertion) demonstrated dynamic post-exertional flow changes. Seven patients successfully underwent surgery, returning to their sport at similar intensity. One procedure was abandoned owing to severe adhesions from a prior procedure. This patient subsequently changed sport. Three patients with mild symptoms (two had reduction in power at maximal intensity, one was an incidental finding) and who demonstrated no clinical signs of FLIA continued their sport at a lower intensity. Kinking of the iliac arteries in athletes can occur with or without of iliac stenosis. Patients with the most severe iliac symptoms demonstrate dynamic post-exertional flow limitation and may benefit from surgery following a period of conservative management. Patients who have milder symptoms and no dynamic exercise flow limitations can be managed conservatively.
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Affiliation(s)
- Assad Khan
- Department of Vascular Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Marwan Al-Dawoud
- Department of Vascular Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Robert Salaman
- Department of Vascular Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Haytham Al-Khaffaf
- Department of Vascular Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Teaching Hospital, Blackburn, UK
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