Showing papers by "Carolyn A. Emery published in 2013"
TL;DR: Different delivery methods of the FIFA 11+ to coaches influenced players’ physical performance minimally, however, high player adherence to the 11+ resulted in significant improvements in functional balance and reduced injury risk.
Abstract: Background A protective effect on injury risk in youth sports through neuromuscular warm-up training routines has consistently been demonstrated. However, there is a paucity of information regarding the quantity and quality of coach-led injury prevention programmes and its impact on the physical performance of players. Objective The aim of this cluster-randomised controlled trial was to assess whether different delivery methods of an injury prevention programme (FIFA 11+) to coaches could improve player performance, and to examine the effect of player adherence on performance and injury risk. Method During the 2011 football season (May– August), coaches of 31 tiers 1–3 level teams were introduced to the 11+ through either an unsupervised website or a coach-focused workshop with and without additional on-field supervisions. Playing exposure, adherence to the 11+, and injuries were recorded for female 13-year-old to 18-year-old players. Performance testing included the Star Excursion Balance Test (SEBT), single-leg balance, triple hop and jumping-over-a-bar tests. Results Complete preseason and postseason performance tests were available for 226 players (66.5%). Compared to the unsupervised group, singleleg balance (OR=2.8; 95% CI 1.1 to 4.6) and the anterior direction of the SEBT improved significantly in the onfield supervised group of players (OR=4.7; 95% CI 2.2 to 7.1), while 2-leg jumping performance decreased (OR=�5.1; 95% CI �9.9 to �0.2). However, significant improvements in 5 of 6 reach distances in the SEBT were found, favouring players who highly adhered to the 11+. Also, injury risk was lower for those players (injury rate ratio, IRR=0.28, 95% CI 0.10 to 0.79). Conclusions Different delivery methods of the FIFA 11+ to coaches influenced players’ physical performance minimally. However, high player adherence to the 11+ resulted in significant improvements in functional balance and reduced injury risk.
337 citations
TL;DR: Early identification of individuals at risk for OA provides an opportunity for physiotherapy management or other interventions to modify risk-related behavior.
Abstract: Study Design Systematic review with meta-analysis. Objectives To identify risk factors for osteoarthritis (OA) of the knee, hip, and ankle, including joint injury, sport, physical activity, overweight/obesity, and occupational activity, in all age groups. Background OA is a significant health problem worldwide, affecting up to 10% of men and 18% of women over 60 years of age. There has not been a comprehensive review examining modifiable physical risk factors associated with the onset of OA. This evidence is important to inform the physiotherapy management of individuals following onset of OA. Methods Twelve electronic databases were systematically reviewed. The studies selected met the following criteria: (1) original data; (2) joint injury, sport activity, physical activity, overweight/obesity, and/or occupational activity investigated as risk factors; (3) outcomes included OA (hip, knee, and/or ankle); and (4) analytic component of study design. The data extracted included study design, years of follow...
245 citations
TL;DR: The current evidence evaluating the effect of rest and treatment following SRC is sparse and low-level exercise and multimodal physiotherapy may be of benefit for those who are slow to recover.
Abstract: Objective To evaluate the evidence for rest, treatment, and rehabilitation following sport-related concussion (SRC). Data sources PubMed, CINAHL, PsychInfo, Cochrane Controlled Trials Registers, Health STAR, Sport Discus, EMBASE, Web of Science, and ProQuest. Study selection Articles were included if they met the following criteria: original research, reported SRC as a source of injury, and evaluated the effect of rest or treatment. Data extraction Study design, participants, treatment, outcome measures, and key findings. Data synthesis Three studies met the inclusion criteria for evaluating the effects of rest and twelve for treatment. Low-intensity aerobic exercise may be of benefit. Conclusions The current evidence evaluating the effect of rest and treatment following SRC is sparse. An initial period of rest may be of benefit. Low-level exercise and multimodal physiotherapy may be of benefit for those who are slow to recover. There is a strong need for high level studies evaluating the effects of rest and treatment following SRC.
197 citations
TL;DR: This is the largest and most comprehensive epidemiological report examining injuries in Paralympic athletes, finding that upper limb injuries are common and injury rates differ according to age and sport.
Abstract: Background The characteristics and incidence of injuries at the Summer Paralympic Games have not previously been reported. A better understanding of injuries improves the medical care of athletes and informs future injury prevention strategies. Objective The objective of this prospective cohort study was to characterise the incidence and nature of injuries during the London 2012 Summer Paralympic Games. Methods Injury information was obtained from two databases. One database was populated from medical encounter forms completed by providers at the time of assessment in one of the medical stations operated by the Organising Committee. The second database was populated daily with information provided by team medical personnel who completed a comprehensive, web-based injury survey. Results The overall injury incidence rate was 12.7 injuries/1000 athlete-days. Injury rates were similar in male and female athletes. The precompetition injury rates in women were higher than those in the competition period. Higher injury rates were found in older athletes and certain sports such as football 5-a-side (22.4 injuries/1000 athlete-days). Overall, 51.5% of injuries were new onset acute traumatic injuries. The most commonly injured region (percentage of all injuries) was the shoulder (17.7%), followed by the wrist/hand (11.4%), elbow (8.8%) and knee (7.9%). Conclusions This is the largest and most comprehensive epidemiological report examining injuries in Paralympic athletes. Injury rates differ according to age and sport. Upper limb injuries are common. The knowledge gained from this study will inform future injury surveillance studies and the development of prevention strategies in Paralympic sport. The Epidemiology of Injuries at the London 2012 Paralympic Games.
156 citations
TL;DR: Proper education of coaches during an extensive preseason workshop was more effective in terms of team adherence than an unsupervised delivery of the FIFA 11+ programme to the team.
Abstract: Background Injury prevention programme delivery on adherence and injury risk, specifically involving regular supervisions with coaches and players on programme execution on field, has not been examined. Aim The objective of this cluster-randomised study was to evaluate different delivery methods of an effective injury prevention programme (FIFA 11+) on adherence and injury risk among female youth football teams. Method During the 4-month 2011 football season, coaches and 13-year-old to 18-year-old players from 31 tier 1–3 level teams were introduced to the 11+ through either an unsupervised website (‘control’) or a coachfocused workshop with (‘comprehensive’) and without (‘regular’) additional supervisions by a physiotherapist. Team and player adherence to the 11+, playing exposure, history and injuries were recorded. Results Teams in the comprehensive and regular intervention groups demonstrated adherence to the 11+ programme of 85.6% and 81.3% completion of total possible sessions, compared to 73.5% for teams in the control group. These differences were not statistically significant, after adjustment for cluster by team, age, level and injury history. Compared to players with low adherence, players with high adherence to the 11+ had a 57% lower injury risk (IRR 0.43, 95% CI 0.19 to 1.00). However, adjusting for covariates, this betweengroup difference was not statistically significant (IRR=0.44, 95% CI 0.18 to 1.06). Conclusion Following a coach workshop, coach-led delivery of the FIFA 11+ was equally successful with or without the additional field involvement of a physiotherapist. Proper education of coaches during an extensive preseason workshop was more effective in terms of team adherence than an unsupervised delivery of the 11+ programme to the team. Trial registration ISRCTN67835569.
135 citations
TL;DR: During the competition period, the IR and IP of illness and injury at the London 2012 Paralympic Games were similar and comparable to the observed rates in other elite competitions.
Abstract: Background In this study we describe (1) the implementation of a novel web-based injury and illness surveillance system (WEB-IISS) for use by a team of physicians at multisport events and (2) the incidence and characteristics of injuries and illness in athletes during the London 2012 Paralympic Games. Methods Overall, 3565 athletes from 160 of the 164 participating countries were followed daily over a 14-day period, consisting of a precompetition period (3 days), and a competition period (11 days) (49 910 athletedays). Daily injury and illness data were obtained from teams with their own medical support (78 teams, 3329 athletes) via the WEB-IISS, and without their own medical support through the London Organising Committee of the Olympic Games and Paralympic Games database (82 teams and 236 athletes). Results There were no differences between incidence rates (IR) of injury and illness, or between the precompetition and competition periods. The IR of injury during the competition period was 12.1/1000 athlete-days, with an incidence proportion (IP) of 11.6% (95% CI 11.0% to 13.3%). Upper limb injuries (35%), particularly of the shoulder (17%) were most common. The IR of illness during the competition period was 12.8/1000 athlete-days (95% CI 12.18 to 1421), with an IP of 10.2%. The IP was highest in the respiratory system (27.4%), skin (18.3%) and the gastrointestinal (14.5%) systems. Conclusions During the competition period, the IR and IP of illness and injury at the Games were similar and comparable to the observed rates in other elite competitions. In Paralympic athletes, the IP of upper limb injuries is higher than that of lower limb injuries and non-respiratory illnesses are more common.
118 citations
TL;DR: Evidence of structural changes in the integrity of white matter in adolescent athletes after sports-related concussion is provided, and the association between changes in white-matter integrity and a clinical measure of concussion is examined.
105 citations
TL;DR: Adolescent athletes with one or two or more prior concussions did not have significantly worse neurocognitive functioning on ImPACT than did those with no previous concussions, and there were not group differences in neuroc cognitive functioning using this brief computerized battery.
Abstract: The existing literature on lingering effects from concussions in children and adolescents is limited and mixed, and there are no clear answers for patients, clinicians, researchers, or policy makers. The purpose of this study was to examine whether there are lingering effects of past concussions in adolescent athletes. Participants in this study included 643 competitive Bantam and Midget hockey players (most elite 20% by division of play) between 13 and 17 years of age (mean age=15.5, SD=1.2). Concussion history at baseline assessment was retrospectively documented using a pre-season questionnaire (PSQ), which was completed at home by parents and players in advance of baseline testing. Players with English as a second language, self-reported attention or learning disorders, a concussion within 6 months of baseline, or suspected invalid test profiles were excluded from these analyses. Demographically adjusted standard scores for the five composites/domains and raw symptom ratings from the brief Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) computerized battery were analyzed. Adolescent athletes with one or two or more prior concussions did not have significantly worse neurocognitive functioning on ImPACT than did those with no previous concussions. There were significantly more symptoms reported in those with two or more prior concussions than in those with no or one prior concussion. Adolescents with multiple previous concussions had higher levels of baseline symptoms, but there were not group differences in neurocognitive functioning using this brief computerized battery.
78 citations
TL;DR: Illness is common in Paralympic athletes and the main factor associated with higher IR of illness was the type of sport (athletics), while age and gender were not independent predictors of illness.
Abstract: Background The incidence and factors associated with illness in Paralympic athletes have not been documented. Aim To determine the factors associated with illness in athletes participating in the London 2012 Paralympic Games. Methods A cohort of 3565 athletes from 160 of the 164 participating countries in the London 2012 Paralympic Games were followed over a 14-day period (precompetition period=3 days, competition period=11 days; 49 910 athlete-days). Daily illness data were obtained from (1) teams with their own medical support who completed a daily illness log (78 teams, 3329 athletes) on a novel web-based system and (2) teams without their own medical support through the local organising committee database (82 teams, 236 athletes). Illness information from all athletes included age, gender, type of sport and the main system affected. Main outcome measurement Incidence rate (IR) of illness (illness per 1000 athlete-days) and factors associated with IR (time period, gender, age and sport). Results The IR of illness was 13.2 (95% CI 12.2 to 14.2). The highest IR of illness was in the respiratory system, followed by the skin, digestive, nervous and genitourinary systems. The IR in the precompetition period was similar to that in the competition period, but the IR was significantly higher in athletics compared with other sports. Age and gender were not independent predictors of illness. Conclusions Illness is common in Paralympic athletes and the main factor associated with higher IR of illness was the type of sport (athletics).
65 citations
TL;DR: Male youth athletes reporting headache and neck pain at baseline were at an increased risk of concussion during the season and the risk associated with dizziness and any 2 of dizziness, neck pain, or headaches depended on age group and body checking.
Abstract: OBJECTIVE:: The objective of this study was to determine the risk of concussion in youth male hockey players with preseason reports of neck pain, headaches, and/or dizziness. DESIGN:: Secondary data analysis of pooled data from 2 prospective cohort studies. SETTING:: Ice hockey rinks in Alberta and Quebec, Canada. PARTICIPANTS:: A total of 3832 male ice hockey players aged 11 to 14 years (280 teams) participated. ASSESSMENT OF RISK FACTORS:: Participants recorded baseline preseason symptoms of dizziness, neck pain, and headaches on the Sport Concussion Assessment Tool. Incidence rate ratios (IRR) were estimated using Poisson regression, adjusted for cluster by team, hours of exposure, and other covariates. MAIN OUTCOME MEASURES:: Concussions that occurred during the season were recorded using a validated prospective injury surveillance system. RESULTS:: Preseason reports of neck pain and headache were risk factors for concussion (IRR = 1.67; 95% confidence interval [CI], 1.15-2.41 and IRR = 1.47; 95% CI, 1.01-2.13). Dizziness was a risk factor for concussion in the Pee Wee nonbody checking cohort (IRR = 3.11; 95% CI, 1.33-7.26). A combination of any 2 symptoms was a risk factor in the Pee Wee nonbody checking cohort (IRR = 3.65; 95% CI, 1.20-11.05) and the Bantam cohort (IRR = 2.40; 95% CI, 1.15-4.97). CONCLUSIONS:: Male youth athletes reporting headache and neck pain at baseline were at an increased risk of concussion during the season. The risk associated with dizziness and any 2 of dizziness, neck pain, or headaches depended on age group and body checking. CLINICAL RELEVANCE:: Baseline testing may be of benefit to identify individuals with symptoms of dizziness, neck pain, and headaches who may be at a higher risk of concussion during the season. Language: en
56 citations
TL;DR: The risk of sustaining a sport injury in obese adolescents was greater compared to those of healthy weight and there is also a greater risk with increasing hours of play, in Caucasian adolescents, and those that play at a higher sporting level.
TL;DR: The standardized clinical tests exhibited moderate to substantial reliability in patients with axial neck pain referred for diagnostic facet joint blocks, and the incorporation of these tests into a clinical prediction model to screen patients before referral for diagnostic facets joint blocks is justified.
TL;DR: There is an urgent need for knowledge translation of prevention strategies to decrease both incidence and long‐term consequences of knee injuries in female adolescent soccer players.
Abstract: This study sought to determine if knowledge regarding the risk for knee injuries and the potential for their prevention is being translated to female adolescent soccer players (13-18 years), their parents, and coaches. Eligible participants in the 2007 indoor soccer season were surveyed to determine their knowledge of the risk for and the potential to prevent knee injuries, and their knowledge of effective prevention strategies, if they felt that injury prevention was possible. Team selection was stratified to be representative of both competitive and recreational level play and age group distributions within the selected soccer association. Of the study subjects, 773/1396 (55.4%) responded to the survey: 408 (53%) players, 292 (38%) parents, and 73 (9%) coaches. Most respondents (538 [71%]) were aware of the risk for knee injury. Coaches and parents were more likely than players to view knee injuries as preventable; however, appropriate prevention strategies were often not identified. Four hundred eighty-four (63.8%) respondents reported that they had never received information on knee injuries. Substantial knowledge gaps regarding knee injury prevention and effective preventative strategies were identified. Given the predominance of knee injuries in female adolescent soccer players, there is an urgent need for knowledge translation of prevention strategies to decrease both incidence and long-term consequences of knee injuries. Language: en
TL;DR: The TT should not be used as a screening measure for HABD strength in populations demonstrating strength greater than 30%BW but should be reserved for use with populations with marked HabD weakness.
Abstract: Objective: To investigate the validity of the Trendelenburg test (TT) using an ultrasound-guided nerve block (UNB) of the superior gluteal nerve and determine whether the reduction in hip abductor muscle (HABD) strength would result in the theorized mechanical compensatory strategies measured during the TT. Design: Quasi-experimental. Setting: Hospital. Participants: Convenience sample of 9 healthy men. Only participants with no current or previous injury to the lumbar spine, pelvis, or lower extremities, and no previous surgeries were included. Interventions: Ultrasound-guided nerve block. Main Outcome Measures: Hip abductor muscle strength (percent body weight [%BW]), contralateral pelvic drop (cPD), change in contralateral pelvic drop (Delta cPD), ipsilateral hip adduction, and ipsilateral trunk sway (TRUNK) measured in degrees. Results: The median age and weight of the participants were 31 years (interquartile range [IQR], 22-32 years) and 73 kg (IQR, 67-81 kg), respectively. An average 52% reduction of HABD strength (z = 2.36, P = 0.02) resulted after the UNB. No differences were found in cPD or Delta cPD (z = 0.01, P = 0.99, z = 20.67, P = 0.49, respectively). Individual changes in biomechanics showed no consistency between participants and nonsystematic changes across the group. One participant demonstrated the mechanical compensations described by Trendelenburg. Conclusions: The TT should not be used as a screening measure for HABD strength in populations demonstrating strength greater than 30% BW but should be reserved for use with populations with marked HABD weakness. Clinical Relevance: This study presents data regarding a critical level of HABD strength required to support the pelvis during the TT.
TL;DR: It is concluded that CHirPP in Calgary provides a representative profile of injuries compared to regional health administrative data and supports the use of CHIRPP for establishing injury prevention priorities.
Abstract: The objective of this study was to assess the representativeness of sport and recreational injury data from Canadian Hospital Injury Reporting and Prevention Programme (CHIRPP) in Calgary. Internal representativeness was assessed by comparing CHIRPP and regional health administrative data (ambulatory care classification system-ACCS) at Alberta Children's Hospital (ACH). External representativeness was assessed by comparing CHIRPP with ACCS at all hospitals. Comparisons were performed using descriptive statistics for top injury-producing sports and sports that produced severe injuries. Stratified distributions of injury-producing sports by gender, age group and severity of injury in CHIRPP and ACCS were compared. The proportion of all injuries in Calgary captured by CHIRPP was 64.8% (99%CI: 64.02-65.54%) (16,977/26,206). CHIRPP captured more cases of top injury-producing sports than ACCS at ACH. Rankings of top injury-producing sports in CHIRPP and ACCS at ACH were remarkably consistent (ρ = 0.92, p < 0.0001). Rankings of top injury-producing sports in CHIRPP and ACCS at all hospitals were almost identical (ρ = 0.98, p < 0.0001). Stratified distributions of top injury-producing sports by gender, age group and the severity of injury showed strong consistency between CHIRPP and ACCS. It is concluded that CHIRPP in Calgary provides a representative profile of injuries compared to regional health administrative data. This project supports the use of CHIRPP for establishing injury prevention priorities.
TL;DR: Snowboarders were significantly more likely to sustain head/neck or trunk injuries than upper extremity injuries on aerial features and the accuracy of ski patrol injury assessments compared with physician diagnoses was examined.
Abstract: OBJECTIVE:: To determine injured body regions and injury type resulting from snowboarding on aerial and nonaerial terrain park features and the accuracy of ski patrol assessments compared with physician diagnoses. DESIGN:: Case series study. SETTING:: An Alberta terrain park during the 2008-2009 and 2009-2010 seasons. PATIENTS:: There were 333 snowboarders injured on features (379 injuries). ASSESSMENT OF RISK FACTORS:: Aerial or nonaerial terrain park feature used at injury, injured body region, injury type, and additional risk factors were recorded from ski patrol Accident Report Forms, emergency department medical records, and telephone interviews. MEASURES:: Odds of injury to body regions and injury types on aerial versus nonaerial features were calculated using multinomial logistic regression. Accuracy of ski patrol injury assessments was examined through sensitivity, specificity, and kappa (κ) statistics. RESULTS:: The wrist was the most commonly injured body region (20%), and fracture was the most common injury type (36%). Compared with the upper extremity, the odds of head/neck [odds ratio (OR), 2.58; 95% confidence interval (CI), 1.37-4.85] and trunk (OR, 3.65; 95% CI, 1.68-7.95) injuries were significantly greater on aerial features. There was no significant association between aerial versus nonaerial feature and injury type. The accuracy of ski patrol injury assessment was higher for injured body region (κ = 0.65; 95% CI, 0.54-0.75) than for injury type (κ = 0.29; 95% CI, 0.22-0.37). CONCLUSIONS:: Snowboarders were significantly more likely to sustain head/neck or trunk injuries than upper extremity injuries on aerial features. Investigators should acknowledge potential misclassification when using ski patrol injury assessments. Language: en
TL;DR: The transition process continues but has occurred slower than expected due to: 1) limited scheduling availability for physicians; 2) patients scheduled outside the correct timeframe; 3) limited compliance by patients non-compliant in attending; and 4) limited enforcement by physicians and nursing staff.
Abstract: Results or Clinical Course: The baseline showed a daily average of 18.2 patient requests with 58% for Schedule II, 23% for Schedule III, and 5% for both Schedule II and III medications. During this time frame there were 7 physicians rotating in clinic (4.0 FTE of coverage). There was a daily average of 14.15 follow-up visits during baseline. The following two months showed declines in average daily patient medication requests (M1⁄416.4, M1⁄414.25, respectively) and slight increases in daily average follow-up visits (M1⁄415.55 and M1⁄415.75). Conclusions: The transition process continues but has occurred slower than expected due to: 1) limited scheduling availability for physicians; 2) patients scheduled outside the correct timeframe; 3) limited compliance by patients non-compliant in attending; and 4) limited enforcement by physicians and nursing staff.
TL;DR: Evidence of microstructural changes in the integrity of the white matter in adolescent athletes following a sport related concussion is provided, which may indicate persistent structural change in the adolescent brain after injury.
Abstract: Concussion is among the least understood neurologic injuries. The impact of concussion on the adolescent brain remains largely unknown. This study sought to establish short-term changes in white-matter integrity after sports-related concussion in adolescents, and examine the association between changes in white-matter integrity and a clinical measure of concussion. Twelve adolescents, aged 14-17 years with a sports-related concussion within 2 months, and 10 age-matched adolescents with no history of concussion were evaluated with the Sports Concussion Assessment Tool 2 and diffusion tensor imaging. Two measures compared the two groups: fractional anisotropy and mean diffusivity. Whole-brain fractional anisotropy values significantly increased (F(1,40) ¼ 6.29, P ¼ 0.010), and mean diffusivity values decreased (F(1,40) ¼ 4.75, P ¼ 0.036), in concussed athletes compared with control participants. Total scores on the Sports Concussion Assessment Tool 2 were associated with whole-brain fractional anisotropy. Mean diffusivity values with lower scores were associated with higher fractional anisotropy (R 2 ¼ 0.25, P ¼ 0.017) and lower mean diffusivity (R 2 ¼ 0.20,
TL;DR: Athletic identity was implicated as an injury risk factor in this population of elite youth ice hockey players and return to play before medical clearance was not a risk factor, but the point estimate warrants additional investigation.
Abstract: OBJECTIVE:: To determine the risk of injury associated with athletic identity, attitudes toward body checking, competitive state anxiety, and reinjury fear in elite youth ice hockey. Also, to determine if there is an elevated risk of subsequent injury associated with return to play before medical clearance. DESIGN:: Cohort study. SETTING:: Hockey arenas, Calgary, Alberta. PARTICIPANTS:: A total of 316 male participants from 18 elite (A, AA, AAA) Bantam (age, 13-14 years) and Midget (age, 15-17 years) teams. ASSESSMENT OF RISK FACTORS:: At season commencement and postinjury, participants completed the Athletic Identity Measurement Scale, Competitive State Anxiety Inventory-2R, Body Checking Questionnaire, and fear of reinjury questions. MAIN OUTCOME MEASURES:: Hockey injury resulting in medical attention, the inability to complete a hockey session, and/or missing a subsequent hockey session. RESULTS:: Players scoring below the 25th percentile in athletic identity were at increased risk of a first injury [incidence rate ratios (IRR): 1.53, 95% confidence interval (CI): 1.05-2.22], but scoring above the 25th percentile was associated with subsequent injury (IRR = 2.28, 95% CI: 1.01-6.04). There was no increase in risk associated with return to play before clearance (IRR: 1.58; 95% CI: 0.30-5.42). CONCLUSIONS:: Athletic identity was implicated as an injury risk factor in this population. Return to play before medical clearance was not a risk factor in this study, but the point estimate warrants additional investigation. Language: en
TL;DR: Schneider et al. as discussed by the authors used a randomized controlled trial to determine if a combination of cervical and vestibular physiotherapy is an effective treatment for individuals with persistent symptoms following a sport related concussion.
Abstract: Objective The objective of this study was to determine if a combination of cervical and vestibular physiotherapy is an effective treatment for individuals with persistent symptoms following a sport related concussion (SRC). Design Randomised Controlled Trial. Subjects Thirty-one participants (12–30 years) who attended the University of Calgary Sport Medicine Centre for a SRC and had persistent symptoms of dizziness, neck pain and/or headaches. Intervention Participants were randomly allocated to a treatment group (ie, multimodal physiotherapy including vestibular rehabilitation, manual therapy, neuromotor and sensorimotor retraining exercises) or a control group (ie, rest followed by gradual exertion). Participants in both groups were seen by the study treating physiotherapist once weekly for 8 weeks or until the time of medical clearance. A sport medicine physician who was blinded to treatment group determined time to medical clearance. Outcome Measurements The primary outcome of interest was medical clearance to return to sport. Results One of 14 subjects (7.1%) in the control group and 11 of 15 subjects (73.3%) in the treatment group were medically cleared to return to sport at 8 weeks. The participants in the treatment group were 10.27 (95% CI 1.51 to 69.55) times more likely to be medically cleared to return to sport in 8 weeks than the participants in the control group (p Conclusions Participants who received multimodal physiotherapy treatment were more likely to achieve medical clearance before 8 weeks when compared with rest in individuals with persistent symptoms following an SRC. Acknowledgements The Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. This study was funded by an Investigator Driven Small Grant from the Alberta Centre for Child, Family and Community Research. Kathryn Schneider is supported by a studentship through Alberta Innovates Health Solutions (AIHS) and Carolyn Emery by AIHS and Alberta Children9s Hospital Research Institute.
TL;DR: Computerized DVA (85 degrees/second) and CFE were lower in players with a previous history of concussion and the effect of past concussion history on tasks of divided attention depended on age group and sex.
Abstract: Background Concussion is a commonly encountered injury. Evaluation of clinical tests at baseline will provide insight on clinical alterations that may persist following concussion. Objective The objective of this study was to evaluate differences in baseline measures of cervical flexor endurance (CFE), walking while talking test (WWTT) and computerized dynamic visual acuity (cDVA) in elite youth ice hockey players who do and do not report a previous history of concussion. Design Cross-sectional study. Setting Sport Medicine Clinic (Alberta, Canada). Participants Bantam (12–14 years) and Midget (15–17 years) ice hockey players (n=550). Risk factor assessment Participants completed a baseline questionnaire, including a question regarding previous history of concussion (yes/no). Main outcome measurements Participants completed clinical tests of CFE, WWTT and cDVA at baseline. Results Multivariate linear regression, adjusted for cluster, age group and sex was used to estimate mean differences in clinical measurement scores by concussion history (yes/no). Individuals reporting a previous history of concussion were able to hold a test of CFE for a geometric mean time of 0.88 (95% CI; 0.81–0.97) seconds less than those who did not report a previous history of concussion (P=.009). The time to complete WWTT complex compared to self-selected walking speed was a mean of 2.85 (1.09–4,62) seconds slower in midget females with a previous history of concussion. Players reporting a previous concussion had significantly lower cDVA score at 85 degrees/second [cDVA left =−0.036 logMAR (95%CI: −0.056, −0.016)]. Conclusion Computerized DVA (85 degrees/second) and CFE were lower in players with a previous history of concussion. The effect of past concussion history on tasks of divided attention depended on age group and sex. These findings allow a further understanding of clinical alterations that may persist following a concussion and identify an area to target in a future clinical trial for prevention.
07 Nov 2013
TL;DR: The IIP (28.3%) and medical attention IP (10.6%) was lower than previously reported in adolescents (ages 12–18), suggesting less severe injuries in younger children, and will inform the development of future targeted interventions within specific sports as well as within school-based curriculums to prevent sport injury in children.
TL;DR: There is a greater risk of concussion in elite ice hockey players 15–17 years old with a previous history of concussion, and Baseline TSS and SCAT2 Total Score in the lowest 25%ile are also predictive of concussion.
Abstract: Objective To examine the risk of concussion amongst elite youth male and female ice hockey players. Design Prospective cohort study. Setting Community ice rinks and sport medicine clinics. Participants 764 Bantam (12–14 years) and Midget (15–17 years) ice hockey players. Assessment of Risk Factors: 743 players completed baseline SCAT2 testing (2011/2012 season). Age group, sex, previous concussion history, Total Symptoms Score (TSS), Balance Error Score (BES), Standardised Assessment of Concussion (SAC) Score and SCAT2 Total Score at baseline were evaluated as potential risk factors. Higher scores indicate greater impairment or symptoms. Main Outcome Measurements Players with a suspected concussion were assessed by a team therapist and referred to a sport medicine physician. Results Multivariate Poisson Regression analyses, adjusted for cluster by team, were used to estimate concussion risk ratios (RR). The RR for Bantam players with previous concussion history was 1.15 (95% CI 0.69 to 1.90) and for Midget players with previous concussion history was 2.83 (95% CI 1.69 to 4.72) compared to players in the same age group with no previous concussion history. The RR for players with baseline TSS and SCAT2 Total Score in the lowest 25%ile were 1.54 (95% CI 1.07 to 2.20) and 1.40 (95% CI 1.03 to 1.90), respectively, compared to those in the upper 75%ile. Sex, BES and SAC score were not predictive of concussion. Conclusions There is a greater risk of concussion in elite ice hockey players 15–17 years old with a previous history of concussion. Baseline TSS and SCAT2 Total Score in the lowest 25%ile are also predictive of concussion. Acknowledgements The University of Calgary Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. We also acknowledge the support of Alberta Innovates Health Solutions, the Alberta Children9s Hospital Institute for Child and Maternal Health (Alberta Children9s Hospital Foundation) and Talisman Energy for their generous support.
TL;DR: There was a 3-fold increased risk of concussion in non-elite Pee Wee ice hockey players in leagues where BC is permitted compared to a cohort whereBC is no longer permitted, which has important implications for further BC policy change to reduce the public health burden of injury and concussion in youth ice hockey.
Abstract: Objective The objective of this study was to determine if the risk of concussion differed for non-elite Pee Wee ice hockey players (ages 11–12) in leagues where Body Checking (BC) is permitted (Alberta, Canada) versus leagues where policy no longer permits BC (Ontario, Canada). Design Cohort study. Setting Community ice rinks and sport medicine clinics during the 2011/12 season. Participants Forty-four teams from Alberta (n=658) and 32 from Ontario (n=258) participated. Players were from non-elite Pee Wee teams (lower 70% of divisions of play). Assessment of Risk Factors Non-elite Pee Wee ice hockey leagues where BC is permitted (Alberta) compared to leagues where policy no longer permits BC (Ontario). Main Outcome Measurements Players with a suspected concussion were identified by a team therapist or safety designate and referred to a sport medicine physician. Results There were 83 concussions (Incidence Proportion (IP)=12.61 (95% CI; 10.17 to 15.4)) in Alberta and 11 concussions (IP=4.26 (95% CI; 2.15 to 7.5)) in Ontario. The Concussion Risk Ratio was 2.96 (95% CI; 1.6 to 5.46). Overall, 76% of players identified with a concussion were assessed by a physician. Conclusions There was a 3-fold increased risk of concussion in non-elite Pee Wee ice hockey players in leagues where BC is permitted compared to a cohort where BC is no longer permitted. These findings have important implications for further BC policy change to reduce the public health burden of injury and concussion in youth ice hockey. Acknowledgements The University of Calgary Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. We also acknowledge the support of Max Bell Foundation, Alberta Innovates Health Solutions and the Alberta Children9s Hospital Institute for Child and Maternal Health (Alberta Children9s Hospital Foundation).
TL;DR: Age and sex influence preseason ImPACT scores, although concussion history does not appear to have an effect, although previous concussion was not predictive of ImPact scores in the poorest quartile on any subscale.
Abstract: Objective To examine the effect of age, sex, and concussion history on preseason scores from the ImPACT computer-based neurocognitive test battery in elite 12–17-year-old ice hockey players. Design Cross-sectional. Setting Participants were recruited from the most elite divisions (AA, AAA) of youth ice hockey leagues in Calgary and Edmonton, Alberta, Canada. Participants 714 Bantam (ages 12–14) (47 female, 161 male) and Midget (ages 15–17) (67 female, 439 male) hockey players. Assessment of Risk Factors Players completed a preseason ImPACT test before the 2011–2012 season. Outcome Measures Outcomes were composite scores 75th percentile for visual motor speed, reaction time, and total symptoms. Results Using multivariate Poisson regression, adjusted for cluster by team, those aged 16–17 years were less likely to score 75th percentile in reaction time (IRR=0.79; 95% CI 0.69 to 0.91), but were more likely to score >75th percentile in visual motor speed (IRR=1.27; 95% CI 1.17 to 1.37) and total symptoms (IRR=1.14; 95% CI 1.04 to 1.25). Males were less likely to score 75th percentile in visual motor speed (IRR=1.20; 95% CI 1.05 to 1.38) and total symptoms (IRR=1.21; 95% CI 1.02 to 1.44). Previous concussion was not predictive of ImPACT scores in the poorest quartile on any subscale. Conclusions Age and sex influence preseason ImPACT scores, although concussion history does not appear to have an effect. Acknowledgements The Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. We acknowledge the funding from the McCarthy Tetrault Award, Alberta Innovates Health Solutions, and the Alberta Children9s Hospital Research Institute for Child and Maternal Health. Competing interests Author B Brooks declares research grant support from CNS Vital Signs (neurocognitive test battery publisher) and PAR, Inc (test publisher).
TL;DR: This response to Stuart McGill's commentary on the issues surrounding the usefulness of reliable clinical tests in the management of patients with spinal pain conditions will address the points raised in the commentary and provide a rationale for the use of reliable Tests in the development of clinical decision guides.