Considerations for the Interpretation of Epidemiological Studies of Injuries in Team Sports: Illustrative Examples

Hammond, Lucy; Lilley, Jeanette M.; Pope, Grahame D; Ribbans, William J

doi:10.1097/jsm.0b013e318201a7ab

Cited by 16 publications

(19 citation statements)

References 14 publications

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“…There has also been considerable attention given to consensus statements for sports injury surveillance, with the vast majority considering recurrent injury as one type of subsequent injury 13–16. Most of these follow the suggestions of Fuller et al ,7 though a new conceptualisation of overuse injury has been proposed by Bahr,8 and a refined definition of subsequent injury was given more recently by Hamilton et al 4 Reported definitions of subsequent injury have been both sport-specific and context-specific and whether or not the person has fully or partially recovered (or continues to play injured) from a previous injury has been considered to varying degrees 4 7 10…”

Section: Defining Subsequent Injury Risk In Relation To Recovery Frommentioning

confidence: 90%

“…Correctly categorising subsequent injuries (multiple, recurrent, exacerbation or new) is important because if correct definitions are not used, there is the potential for either under-reporting or overestimation of a new injury incidence and/or injury recurrences 10. While correct classification requires considerable clinical expertise, there is also value in combining this with more objective statistical criteria.…”

Section: Introductionmentioning

confidence: 99%

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Categorising sports injuries in epidemiological studies: the subsequent injury categorisation (SIC) model to address multiple, recurrent and exacerbation of injuries

2013

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ObjectiveSports injuries are often recurrent and there is wide recognition that a subsequent injury (of either the same or a different type) can be strongly influenced by a previous injury. Correctly categorising subsequent injuries (multiple, recurrent, exacerbation or new) requires substantial clinical expertise, but there is also considerable value in combining this expertise with more objective statistical criteria. This paper presents a new model, the subsequent injury categorisation (SIC) model, for categorising subsequent sports injuries that takes into account the need to include both acute and overuse injuries and ten different dependency structures between injury types.MethodsThe suitability of the SIC model was demonstrated with date ordered sports injury data from a large injury database from community Australian football players over one playing season. A subsequent injury was defined to have occurred in the subset of players with two or more reported injuries.Results282 players sustained 469 subsequent injuries of which 15.6% were coded to categories representing injuries that were directly related to previous index injuries. This demonstrates that players can sustain a number of injuries over one playing season. Many of these will be unrelated to previous injuries but subsequent injuries that are related to previous injury occurrences are not uncommon.ConclusionThe handling of subsequent sports injuries is a substantial challenge for the sports medicine field—both in terms of injury treatment and in epidemiological research to quantify them. Application of the SIC model allows for multiple different injury types and relationships within players, as well as different index injuries.

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Section: Defining Subsequent Injury Risk In Relation To Recovery Frommentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Categorising sports injuries in epidemiological studies: the subsequent injury categorisation (SIC) model to address multiple, recurrent and exacerbation of injuries

2013

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“…In the sports injury literature to date, recurrent injuries have been considered from a clinical management and return-to-play (or time away from sport to recover from injury) perspective 1–3 15 53 54. Sports injury surveillance guidelines and several conceptual papers describe the complex issues associated with properly classifying injuries as recurrent, re-injury, exacerbations or overuse 4 55–58.…”

Section: Discussionmentioning

confidence: 99%

Statistical modelling for recurrent events: an application to sports injuries

2012

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BackgroundInjuries are often recurrent, with subsequent injuries influenced by previous occurrences and hence correlation between events needs to be taken into account when analysing such data.ObjectiveThis paper compares five different survival models (Cox proportional hazards (CoxPH) model and the following generalisations to recurrent event data: Andersen-Gill (A-G), frailty, Wei-Lin-Weissfeld total time (WLW-TT) marginal, Prentice-Williams-Peterson gap time (PWP-GT) conditional models) for the analysis of recurrent injury data.MethodsEmpirical evaluation and comparison of different models were performed using model selection criteria and goodness-of-fit statistics. Simulation studies assessed the size and power of each model fit.ResultsThe modelling approach is demonstrated through direct application to Australian National Rugby League recurrent injury data collected over the 2008 playing season. Of the 35 players analysed, 14 (40%) players had more than 1 injury and 47 contact injuries were sustained over 29 matches. The CoxPH model provided the poorest fit to the recurrent sports injury data. The fit was improved with the A-G and frailty models, compared to WLW-TT and PWP-GT models.ConclusionsDespite little difference in model fit between the A-G and frailty models, in the interest of fewer statistical assumptions it is recommended that, where relevant, future studies involving modelling of recurrent sports injury data use the frailty model in preference to the CoxPH model or its other generalisations. The paper provides a rationale for future statistical modelling approaches for recurrent sports injury.

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“…No studies have discussed the impact of the congested playing calendar in professional football on the decision-making of injured athletes. The practice of looking for 'windows of opportunity', convenient times within which players can schedule corrective surgery to avoid missing time during the competitive season has previously been discussed (Hammond et al 2011). The examination of the forthcoming schedule by injured players could also be viewed as seeking 'windows of opportunity', however the outlook is condensed into the next week or two, rather than a period of months to the end of the season.…”

Section: Importance Of Decline In Performancementioning

confidence: 99%

“…Club staff and team mates have been shown to apply pressure on athletes to play when injured, with players being deliberately inconvenienced by medical teams to deter Table 1. Summary of assumptions pertaining to contributing factors to playing with injuries in professional football (Roderick et al 2000, Roderick 2006, Hammond et al 2011.…”

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confidence: 99%

‘We’ve just learnt to put up with it’: an exploration of attitudes and decision-making surrounding playing with injury in English professional football

Hammond¹,

Lilley²,

Pope³

et al. 2013

Qualitative Research in Sport, Exercise and Health

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A number of psychological and sociocultural factors have been suggested to influence athletes' willingness to play despite being injured. Investigation of this phenomenon is undertaken optimally at the time when athletes are injured; however, many studies have relied upon retrospective recall of feelings in individuals following recovery. This study aimed, through semi-structured existential-phenomenological interviews, to explore decision-making and attitudes surrounding playing with injury in professional footballers that were currently injured but continuing to play in matches in the English football leagues. Using deductive qualitative content analysis, cultural, situational and personal moderators that have been theorised to influence playing with injury in professional football were tested. The sample comprised nine professional footballers from three different playing leagues that were identified as playing whilst injured by team physiotherapists. There was a high level of agreement in the findings of this study with previous research. Personal and cultural moderators were stable across participants, and included conforming to the athlete role and operating in a culture where pain has been normalised. Situational factors, however, were unstable and were influenced by playing league, with constraints in squad size being an important influence for lower league players. These professional footballers sought windows of opportunity for treatment and recovery both within the season and at the end of the season. It appeared that a decline in performance, rather than the presence of pain, is used as a critical marker for injury. More research is needed to explore differences in presenteeism practices at different playing levels using larger number of participants.

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Considerations for the Interpretation of Epidemiological Studies of Injuries in Team Sports: Illustrative Examples

Cited by 16 publications

References 14 publications

Categorising sports injuries in epidemiological studies: the subsequent injury categorisation (SIC) model to address multiple, recurrent and exacerbation of injuries

Categorising sports injuries in epidemiological studies: the subsequent injury categorisation (SIC) model to address multiple, recurrent and exacerbation of injuries

Statistical modelling for recurrent events: an application to sports injuries

‘We’ve just learnt to put up with it’: an exploration of attitudes and decision-making surrounding playing with injury in English professional football

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