Showing papers by "Carolyn A. Emery published in 2016"

A Systematic Review of Psychiatric, Psychological, and Behavioural Outcomes following Mild Traumatic Brain Injury in Children and Adolescents.

Abstract: BACKGROUND: Evidence regarding longer-term psychiatric, psychological, and behavioural outcomes (for example, anxiety, mood disorders, depression, and attention disorders) following mild traumatic brain injury (mTBI) in children and adolescents has not been previously synthesized. OBJECTIVE: To conduct a systematic review of the available evidence examining psychiatric, psychological, and behavioural outcomes following mTBI in children and adolescents. MATERIALS AND METHODS: Nine electronic databases were systematically searched from 1980 to August 2014. Studies selected met the following criteria: original data; study design was a randomized controlled trial, quasi-experimental design, cohort or historical cohort study, case-control study, or cross-sectional study; exposure included mTBI (including concussion); population included children and adolescents (RESULTS: Of 9472 studies identified in the initial search, 30 were included and scored. Heterogeneity in methodology and injury definition precluded meta-analyses. The median methodological quality for all 30 studies, based on the DB criteria, was 15/33 (range 6 to 19). The highest level of evidence demonstrated by all reviewed studies was level 2b based on OCEBM criteria, with the majority (28/30 studies) classified at this level. Based on the literature included in this systematic review, psychological and psychiatric problems in children with a history of mTBI were found to be more prevalent when mTBI is associated with hospitalization, when assessment occurs earlier in the recovery period (that is, resolves over time), when there are multiple previous mTBIs, in individuals with preexisting psychiatric illness, when outcomes are based on retrospective recall, and when the comparison group is noninjured healthy children (as opposed to children with injuries not involving the head). CONCLUSIONS: Overall, few rigorous prospective studies have examined psychological, behavioural, and psychiatric outcomes following mTBI. In the absence of true reports of preinjury problems and when ideally comparing mild TBI to non-TBI injured controls, there is little evidence to suggest that psychological, behavioural, and/or psychiatric problems persist beyond the acute and subacute period following an mTBI in children and adolescents.© The Author(s) 2016. Language: en

Osteoarthritis: Models for appropriate care across the disease continuum

Abstract: Osteoarthritis (OA) is a leading cause of pain and disability worldwide. Despite the existence of evidence-based treatments and guidelines, substantial gaps remain in the quality of OA management. There is underutilization of behavioral and rehabilitative strategies to prevent and treat OA as well as a lack of processes to tailor treatment selection according to patient characteristics and preferences. There are emerging efforts in multiple countries to implement models of OA care, particularly focused on improving nonsurgical management. Although these programs vary in content and setting, key lessons learned include the importance of support from all stakeholders, consistent program delivery and tools, a coherent team to run the program, and a defined plan for outcome assessment. Efforts are still needed to develop, deliver, and evaluate models of care across the spectrum of OA, from prevention through end-stage disease, in order to improve care for this highly prevalent global condition.

Policy change eliminating body checking in non-elite ice hockey leads to a threefold reduction in injury and concussion risk in 11- and 12-year-old players

Abstract: Background In ice hockey, body checking is associated with an increased risk of injury. In 2011, provincial policy change disallowed body checking in non-elite Pee Wee (ages 11–12 years) leagues. Objective To compare the risk of injury and concussion between non-elite Pee Wee ice hockey players in leagues where body checking is permitted (2011–12 Alberta, Canada) and leagues where policy change disallowed body checking (2011–12 Ontario, Canada). Method Non-elite Pee Wee players (lower 70%) from Alberta (n=590) and Ontario (n=281) and elite Pee Wee players (upper 30%) from Alberta (n=294) and Ontario (n=166) were recruited to participate in a cohort study. Baseline information, injury and exposure data was collected using validated injury surveillance. Results Based on multiple Poisson regression analyses (adjusted for clustering by team, exposure hours, year of play, history of injury/concussion, level of play, position and body checking attitude), the incidence rate ratio (IRR) associated with policy allowing body checking was 2.97 (95% CI 1.33 to 6.61) for all game injury and 2.83 (95% CI 1.09 to 7.31) for concussion. There were no differences between provinces in concussion [IRR=1.50 (95% CI 0.84 to 2.68)] or injury risk [IRR=1.22 (95% CI 0.69 to 2.16)] in elite levels of play where both provinces allowed body checking. Conclusions The rate of injury and concussion were threefold greater in non-elite Pee Wee ice hockey players in leagues where body checking was permitted. The rate of injury and concussion did not differ between provinces in elite levels, where body checking was allowed.

Risk factors for musculoskeletal injury in preprofessional dancers: a systematic review

Abstract: Background Preprofessional dancers partake in rigorous training and have high injury prevalence. Attempts to identify risk factors for dance injuries have focused on a diversity of intrinsic and extrinsic factors. Objective To identify and evaluate the evidence examining risk factors for musculoskeletal injury in preprofessional ballet and modern dancers. Methods Fifteen electronic databases were systematically searched to October 2015. Studies selected met a priori inclusion criteria and investigated musculoskeletal injury risk factors in preprofessional (elite adolescent, student, young adult) ballet and modern dancers. Two reviewers independently assessed the quality and level of evidence using the Downs and Black (DB) criteria and a modified Oxford Centre of Evidence-Based Medicine 2009 model, respectively. Results Of 1364 potentially relevant studies, 47 were included and scored. Inconsistent injury definition and methodology precluded meta-analysis. The most common modifiable risk factors investigated were anthropometrics (ie, body mass index, adiposity), joint range of motion (ie, lower extremity), dance exposure (ie, years training, exposure hours) and age. The median DB score across studies was 8/33 (range 2–16). The majority of studies were classified as level 3 evidence and few considered risk factor inter-relationships. There is some level 2 evidence that previous injury and poor psychological coping skills are associated with increased injury risk. Conclusions Because of the lack of high-quality studies, consensus regarding risk factors for musculoskeletal injury in preprofessional dancers remains difficult. There is a need for injury definition consensus and high-quality prospective studies examining the multifactorial relationship between risk factors and injury in preprofessional dance.

Economic impact study: neuromuscular training reduces the burden of injuries and costs compared to standard warm-up in youth soccer

Abstract: Background There is randomised controlled trial (RCT) evidence that neuromuscular training (NMT) programmes can reduce the risk of injury in youth soccer. We evaluated the cost-effectiveness of such an NMT prevention strategy compared to a standard of practice warm-up. Methods A cost-effectiveness analysis was conducted alongside a cluster RCT. Injury incidence rates were adjusted for cluster using Poisson regression analyses. Direct healthcare costs and injury incidence proportions were adjusted for cluster using bootstrapping. The joint uncertainty surrounding the cost and injury rate and proportion differences was estimated using bootstrapping with 10 000 replicates. Results Along with a 38% reduction in injury risk (rate difference=−1.27/1000 player hours (95% CI −0.33 to −2.2)), healthcare costs were reduced by 43% in the NMT group (−$689/1000 player hours (95% CI −$1741 to $234)) compared with the control group. 90% of the bootstrapped ratios were in the south-west quadrant of the cost-effectiveness plane, showing that the NMT programme was dominant (more effective and less costly) over standard warm-up. Projecting results onto 58 100 Alberta youth soccer players, an estimated 4965 injuries and over $2.7 million in healthcare costs would be conservatively avoided in one season with implementation of a neuromuscular training prevention programme. Conclusions Implementation of an NMT prevention programme in youth soccer is effective in reducing the burden of injury and leads to considerable reduction in costs. These findings inform practice and policy supporting the implementation of NMT prevention strategies in youth soccer nationally and internationally.

A school-based injury prevention program to reduce sport injury risk and improve healthy outcomes in youth: a pilot cluster-randomized controlled trial

Abstract: OBJECTIVE: To examine a school-based high-intensity neuromuscular training (NMT) program in reducing sport injury risk and improving fitness in youth. PARTICIPANTS: Students (ages 11-15) (n = 725) in physical education (PE) classes were randomized by school to intervention or control groups. INTERVENTION: A 12-week high-intensity NMT program (including aerobic, strength, balance, and agility components) was designed to reduce sport injury risk and improve measures of fitness. The control program was a standard of practice warm-up (including running and stretching). RESULTS: A Poisson regression model using an intent-to-treat analysis demonstrated a reduced risk of sport injury: incidence rate ratio (IRR)all injury = 0.30 (95% CI, 0.19-0.49), IRRlower extremity injury = 0.31 (95% CI, 0.19-0.51), IRRankle sprain injury = 0.27 (95% CI, 0.15-0.50), and IRRknee sprain injury = 0.36 (95% CI, 0.13-0.98). A change in waist circumference: -0.99 centimeters (95% CI, -1.84 to -0.14) and an increase in indirect measures of aerobic fitness: 1.28 mL·kg·min (95% CI, 0.66-1.90) in the intervention school compared with the control school also occurred. CONCLUSIONS: A NMT program in junior high school PE class was efficacious in reducing sport-related injury and improving measures of adiposity and fitness in the intervention group. Language: en

The impact of concussion on cardiac autonomic function: A systematic review

Abstract: Primary objective: To evaluate the evidence regarding the effect of concussion on cardiac autonomic function (CAF).Inclusion criteria: Original research; available in English; included participants with concussion or mild traumatic brain injury (mTBI) and a comparison group; included measures of heart rate (HR) and/or heart rate variability (HRV) as outcomes. Studies of humans (greater than 6 years old) and animals were included.Critical appraisal tools: The Downs and Black (DB) criteria and Structured Effectiveness Quality Evaluation Scale (SEQES).Results: Nine full-length articles and four abstracts were identified. There is conflicting evidence regarding CAF at rest following concussion. There is evidence of elevated HR and reduced HRV with low-intensity, steady-state exercise up to 10 days following concussion. There was no significant difference in HRV during isometric handgrip testing or HR while performing cognitive tasks following concussion. The validity of current literature is limited b...

Risk of Injuries in Paralympic Track and Field Differs by Impairment and Event Discipline: A Prospective Cohort Study at the London 2012 Paralympic Games

Abstract: Background:The incidence rates (IRs) and factors associated with injuries in the sport of Paralympic athletics (track and field) have not been comprehensively and prospectively studied.Purpose:To determine injury IRs, characteristics of injuries, and associated factors in the sport of athletics at the London 2012 Paralympic Games.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 977 athletes competing in the sport of athletics were followed over a total 10-day competition period of the Paralympic Games. Daily injury data were obtained via 2 databases: (1) a custom-built, web-based injury and illness surveillance system (WEB-IISS), maintained by team medical personnel; and (2) the organizing committee database, maintained by medical providers in the medical stations operated by the London Organising Committee of the Olympic and Paralympic Games. Athlete impairment and event discipline were obtained via the International Paralympic Committee athlete database. IRs (injuries per 1000 athlete-...

The Epidemiology of Injuries in Football at the London 2012 Paralympic Games

Abstract: Background The epidemiology of injury in Paralympic football has received little attention. A study of all sports at the London 2012 Paralympic Games identified football 5-a-side as the sport with the highest injury rate, meriting further detailed analysis, which may facilitate the development of strategies to prevent injuries. Objective To examine the injury rates and risk factors associated with injury in Paralympic football. Design Secondary analysis of a prospective cohort study of injuries to football 5-a-side and football 7-a-side athletes. Setting London 2012 Paralympic Games. Participants Participants included 70 football 5-a-side athletes and 96 football 7-a-side athletes. Athletes from all but one country chose to participate in this study. Methods The Paralympic Injury and Illness Surveillance System was used to track injuries during the Games, with data entered by medical staff. Main Outcome Measurements Injury incidence rate (IR) and injury incidence proportion (IP). Results The overall IR for football 5-a-side was 22.4 injuries/1000 athlete-days (95% confidence interval [CI], 14.1-33.8) with an IP of 31.4 injuries per 100 athletes (95% CI, 20.9-43.6). In 5-a-side competition, 62.5% of injuries were associated with foul play. The overall IR for football 7-a-side was 10.4 injuries/1000 athlete-days (95% CI, 5.4-15.5), with an IP of 14.6 injuries per 100 athletes (95% CI, 7.5-21.6). The most commonly injured body region in both sports was the lower extremity. Conclusions To our knowledge, this study is the first to examine IR and risk factors associated with injury in Paralympic football. Future studies are needed to determine mechanisms of injury and independent risk factors for injury, thus informing prevention strategies.

Predictors of FIFA 11+ Implementation Intention in Female Adolescent Soccer: An Application of the Health Action Process Approach (HAPA) Model

Abstract: The Federation Internationale de Football (FIFA) 11+ warm-up program is efficacious at preventing lower limb injury in youth soccer; however, there has been poor adoption of the program in the community. The purpose of this study was to determine the utility of the Health Action Process Approach (HAPA) behavior change model in predicting intention to use the FIFA 11+ in a sample of 12 youth soccer teams (coaches n = 10; 12–16 year old female players n = 200). A bespoke cross-sectional questionnaire measured pre-season risk perceptions, outcome expectancies, task self-efficacy, facilitators, barriers, and FIFA 11+ implementation intention. Most coaches (90.0%) and players (80.0%) expected the program to reduce injury risk but reported limited intention to use it. Player data demonstrated an acceptable fit to the hypothesized model (standardized root mean square residual (SRMR) = 0.08; root mean square of error of approximation (RMSEA) = 0.06 (0.047–0.080); comparative fit index (CFI) = 0.93; Tucker Lewis index (TLI) = 0.91) Task self-efficacy (β = 0.53, p ≤ 0.01) and outcome expectancies (β = 0.13 p ≤ 0.05) were positively associated with intention, but risk perceptions were not (β = −0.02). The findings suggest that the HAPA model is appropriate for use in this context, and highlight the need to target task self-efficacy and outcome expectancies in FIFA 11+ implementation strategies.

The epidemiology of injuries in powerlifting at the London 2012 Paralympic Games: an analysis of 1411 athlete-days

Abstract: Sport injury epidemiology has received increased recognition as a field of sport medicine research that can improve the health and safety of athletes. Injuries among Paralympic powerlifters have not previously been systematically studied. The purpose of this prospective cohort study was to characterize injuries among Paralympic powerlifters. Athletes competing in the sport of powerlifting were followed over the 7-day competition period of the 2012 London Paralympic Games. The main outcome measurements were injury incidence rate (IR; number of injuries per 1000 athlete-days) and injury incidence proportion (IP; injuries per 100 athletes). A total of 38 injuries among 163 powerlifters were documented. The overall IR was 33.3 injuries/1000 athlete-days (95% CI 24.0-42.6) and the overall IP was 23.3 injuries per 100 athletes (95% CI 16.8-29.8). The majority of injuries were chronic overuse injuries (61%). The most commonly injured anatomical region was the shoulder/clavicle (32% of all injuries), followed by the chest (13%) and elbow (13%). The information obtained in this study opens the door for future study into the mechanisms and details of injuries into powerlifters with physical impairments.

Pain, function, and strength outcomes for males and females with patellofemoral pain who participate in either a hip/core- or knee-based rehabilitation program.

Abstract: Background Hip exercise has been recommended for females with patellofemoral pain (PFP). It is unknown if males with PFP will benefit from a similar treatment strategy. Hypotheses/purpose The purpose of this study was to compare improvements in pain, function, and strength between males and females with PFP who participated in either a hip/core or knee rehabilitation program. The directional hypothesis was that females would respond more favorably to the hip/core rehabilitation program and males to the knee program. Study design Randomized-controlled clinical trial. Methods Patients were randomly assigned to a six-week hip/core or knee rehabilitation program. Visual analog scale (VAS), Anterior Knee Pain Scale (AKPS), and hip and knee isometric strength were collected before and after subjects completed the rehabilitation program. Data were analyzed using an intention-to-treat basis. Separate mixed-model analyses of variance (ANOVA) with repeated measures were used to determine changes in VAS and AKPS and strength changes for subjects classified as treatment responders (successful outcome) and non-responders (unsuccessful outcome). Results Regardless of sex or rehabilitation group, VAS (F1,181=206.5; p 0.05) strength changes. Conclusion On average, males and females with PFP benefitted from either a hip/core or knee rehabilitation program. Subjects with successful outcomes likely had hip and knee weakness that responded well to the intervention. These males and females had similar and meaningful improvements in hip extensor and knee extensor strength. Only males had relevant changes in hip external rotator strength. Clinicians should consider a subgroup of males who may benefit from hip extensor and external rotator exercise and females who may benefit from hip extensor exercise. Level of evidence 2b.

Do children and adolescent ice hockey players with and without a history of concussion differ in robotic testing of sensory, motor and cognitive function?

Abstract: KINARM end point robotic testing on a range of tasks evaluating sensory, motor and cognitive function in children/adolescents with no neurologic impairment has been shown to be reliable. The objective of this study was to determine whether differences in baseline performance on multiple robotic tasks could be identified between pediatric/adolescent ice hockey players (age range 10–14) with and without a history of concussion. Three hundred and eighty-five pediatric/adolescent ice hockey players (ages 10–14) completed robotic testing (94 with and 292 without a history of concussion). Five robotic tasks characterized sensorimotor and/or cognitive performance with assessment of reaching, position sense, bimanual motor function, visuospatial skills, attention and decision-making. Seventy-six performance parameters are reported across all tasks. There were no significant differences in performance demonstrated between children with a history of concussion [median number of days since last concussion: 480 (range 8–3330)] and those without across all five tasks. Performance by the children with no history of concussion was used to identify parameter reference ranges that spanned 95 % of the group. All 76 parameter means from the concussion group fell within the normative reference ranges. There are no differences in sensorimotor and/or cognitive performance across multiple parameters using KINARM end point robotic testing in children/adolescents with or without a history of concussion.

Association between Body Composition and Sport Injury in Canadian Adolescents.

Abstract: Purpose: To examine the association between overweight or obesity and sport injury in a population-based sample of Canadian adolescents. Methods: Cross-sectional analyses were performed using the Canadian Community Health Survey (2009-2010), a nationally representative sample (n=12,407) of adolescents aged 12-19 years. Body composition was quantified using BMI, grouping participants into healthy weight, overweight, or obese. The outcome of interest was acute or repetitive strain injury sustained during sport in the previous year. We examined the relationship between sport injury and overweight or obesity compared with healthy weight using multivariate logistic regression, controlling for sex, ethnicity, physical activity, and socio-economic status. We also examined the interaction between physical activity and body composition in a secondary analysis with a subset of active adolescents. Results: No significant relationship was found between being overweight and sport injury (odds ratio [OR]=1.04, 95% CI: 0.92, 1.17); however, a protective effect was seen between obesity and sport injury (OR=0.67, 95% CI: 0.53, 0.84). Secondary analysis revealed that overweight youths with the highest activity level (quartile 4) did have increased odds of sport injury (OR=1.38, 95% CI: 1.04, 1.83), yet obese youths with a moderate activity level (quartile 2) were protected compared with healthy-weight youths (OR=0.46, 95% CI: 0.24, 0.91). Conclusions: Further examination of active adolescents is warranted. Studies should consider sport-specific differences and comprehensive measurement of exposure to sport.

Injury Prevention in Youth Sport

Abstract: Youth have very high participation and injury rates in sport; in fact sport is the leading cause of injury in adolescents. Sport injury reduces future participation in physical activity which adversely affects future health. In addition, sport injury may lead to overweight/obesity, post-traumatic osteoarthritis, or post-concussion syndrome. It is impossible to eliminate all injury in youth sport; however, injury prevention strategies can reduce the number and seriousness of injuries in many sports. The chapter provides an evidence-based review on what is known about intrinsic and extrinsic injury prevention strategies which have been evaluated in child and adolescent sport. Adolescence (ages 12–19) was the age of focus for the vast majority of research papers evaluating injury prevention strategies. Injury prevention strategies are highlighted and gaps in the literature in injury prevention in child and adolescent sport are summarized. There is an increasing body of rigorous scientific evidence to inform best practice and policy in injury prevention in youth sport. While there is evidence for the effectiveness of neuromuscular training strategies in the reduction of injury in numerous team sports, there is also evidence to support the lack of program uptake and ongoing maintenance of such programs. There is evidence to support the use of protective equipment (e.g., helmets, wrist guards) in youth sport, yet despite this there is also evidence to support less than optimal uptake of equipment strategies. A focus on implementation is critical if there is going to be a shift in knowledge, behavior change, and sustainability of evidence-informed injury prevention practice and policy. Recommendations to contribute to effective and sustainable injury prevention in youth sport have been summarized.

Examining Measures of Weight as Risk Factors for Sport-Related Injury in Adolescents

Abstract: Objectives. To examine body mass index (BMI) and waist circumference (WC) as risk factors for sport injury in adolescents. Design. A secondary analysis of prospectively collected data from a pilot cluster randomized controlled trial. Methods. Adolescents (n = 1,040) at the ages of 11-15 years from two Calgary junior high schools were included. BMI (kg/m(2)) and WC (cm) were measured from direct measures at baseline assessment. Categories (overweight/obese) were created using validated international (BMI) and national (WC) cut-off points. A Poisson regression analysis controlling for relevant covariates (sex, previous injury, sport participation, intervention group, and aerobic fitness level) estimated the risk of sport injury [incidence rate ratios (IRR) with 95% confidence intervals (CI)]. Results. There was an increased risk of time loss injury (IRR = 2.82, 95% CI: 1.01-8.04) and knee injury (IRR = 2.07, 95% CI: 1.00-6.94) in adolescents that were overweight/obese; however, increases in injury risk for all injury and lower extremity injury were not statistically significant. Estimates suggested a greater risk of time loss injury [IRR = 1.63 (95% CI: 0.93-2.47)] in adolescents with high measures of WC. Conclusions. There is an increased risk of time loss injury and knee injury in overweight/obese adolescents. Sport injury prevention training programs should include strategies that target all known risk factors for injury.

The Incidence and Types of Physical Contact Associated with Body Checking Regulation Experience in 13-14 Year Old Ice Hockey Players.

Abstract: Background: Ice hockey has one of the highest sport participation and injury rates in youth in Canada. Body checking (BC) is the predominant mechanism of injury in leagues in which it is permitted. The objectives of this study were to determine whether the incidence and types of physical contact differ for Bantam players (aged 13–14 years) who were exposed to BC at Pee Wee level (aged 11–12 years) in Calgary, Alberta versus Bantam players who were not exposed to BC at Pee Wee level in Quebec City, Quebec. All teams were exposed to BC at bantam level; Methods: A cohort study was conducted in Quebec City and Calgary. Sixteen games for Calgary and 15 for Quebec City were randomly selected and analysed with a validated observation system to quantify five intensities of physical contact and to observe different types of physical contact such as slashing and holding; Results: A total of 5610 incidences of physical contact with the trunk and 3429 other types of physical contact were observed. Very light intensity trunk contact was more frequent in Calgary (adjusted incidence RR (ARR): 1.71; 95% CI: 1.28–2.29). Holding (ARR: 1.04; 95% CI: 1.02–1.07) and slashing (ARR: 1.38; 95% CI: 1.07–1.77) were more frequent in Calgary; Conclusion: Results suggest that players’ physical contacts differ between Bantam leagues in which BC was permitted at Pee Wee level and leagues in which it was not permitted until Bantam level.

750 The effect of body checking policy change on contact mechanisms in 11–12 year old ice hockey players

Abstract: Background Hockey Canada’s evidence-based body checking (BC) policy change (2013) was informed by evidence that policy allowing BC in Pee Wee (11–12 year old) ice hockey players resulted in a >3-fold increased risk of injury and concussion compared with leagues where BC was not allowed. Objective To compare the frequency of type and intensity of physical contacts (PC) and head contact in elite (upper 30%) Pee Wee ice hockey games in leagues not allowing BC (2013–2014) compared with leagues allowing BC (2007–2008) using video analysis. Methods Ten elite games pre-policy change (2007–2008) and 11 elite games post-policy change (2013–2014) were video recorded and analysed using a validated methodology to compare the frequency of type (trunk and other types of PC with limb/head/stick) and intensity (trunk contacts – level 1–5 intensity) of PC and head contact. Incidence rate ratios (IRR) were estimated using Poisson regression controlling for clustering by game) to compare PC before and after the BC policy change. Results A total of 4409 trunk PCs and 2623 other PCs were observed. The total number of trunk PCs (IRR = 0.97, 95% CI: 0.83–1.14) and other contacts (IRR = 0.87, 95% CI: 0.59–1.29) did not change post-policy change. High intensity contacts (levels 4 and 5) were less frequent post-policy change (IRR 4 = 0.13, 95% CI: 0.09–0.19 and IRR 5 = 0.13, 95% CI: 0.07–0.26) and low intensity contacts (level 2) increased (IRR 2 = 1.47, 95% CI: 1.21–1.79). Limb PCs decreased in 2013–14 (IRR = 0.48, 95% CI; 0.33–0.71) and there was no difference for head contacts (IRR = 0.81, 95% CI; 0.51–1.30). Conclusions There were no significant differences in total number of PC by study year. However, the incidence of high intensity (level 4–5) PCs decreased post -policy change. There was no significant difference in direct head contact or total number of other contacts. This will inform the development and evaluation of injury prevention and skill training strategies in youth ice hockey.

158 Prevention of ankle sprain injuries in youth soccer and basketball

Abstract: Background Sport participation is the leading cause of injury in youth and ankle sprain is the most common sport injury. This study evaluates the effectiveness of neuromuscular training (NMT) in reducing the risk of ankle sprains in youth soccer and basketball players. The secondary objective includes evaluation of sex, age, sport and previous lower extremity (LE) injury as independent risk factors for ankle sprain. Methods A secondary data analysis of three cohort studies and two randomised controlled trials conducted in one season of play in youth soccer and basketball players (ages 11–18) in Alberta, Canada (2005–2011) was completed. The definition of ankle sprain and injury surveillance methodology was consistent in all studies. Multivariable Poisson regression analysis (controlling for clustering by team) was used to estimate incidence rate ratios (IRR) with 95% confidence intervals (CI), considering confounding and effect modification (e.g., sex, age, sport, previous injury). Results There were 188 ankle sprains in 171 players in 2,265 study participants. Multivariable analysis suggests that NMT was protective for ankle sprain injury [IRR = 0.69 (95% CI: 0.45–1.05)] based on the point estimate. Sex, age, sport and previous injury did not modify this effect. Independent risk factors for ankle sprain injury included previous LE injury history [(IRR = 1.77 (95% CI: 1.34–2.35)] and participation in basketball vs. soccer [(IRR = 1.98 (95% CI: 1.30–3.01)]. The risk of ankle sprain injury did not differ by sex [IRR = 1.01 (95% CI: 0.53–1.92)]. Conclusions Exposure to a NMT program is protective for ankle sprain injury in youth soccer and basketball players. Independent risk factors for ankle sprain in youth sport include basketball participation (vs. soccer) and previous LE injury. Future research should focus on optimising NMT programs for the prevention of ankle sprain injuries and maximising player-adherence to NMT programs in youth soccer and basketball.

915 Evaluating the implementation of a sport injury prevention program in a school setting

Abstract: Background Sport injuries are a significant burden, and while there are studies demonstrating the effectiveness of injury prevention programs, there is less guidance on how they are adopted and implemented successfully. The aim of this project was to conduct a process and formative evaluation of an injury prevention program implemented in a school setting. Methods This study proposes two frameworks [RE-AIM and the Consolidated Framework for Implementation Research (CFIR)] to evaluate the implementation of a neuromuscular training program (iSPRINT) to reduce sport injury and improve health-related measures in a junior high school population. The five dimensions of the RE-AIM and CIFR frameworks will be used. Results A total of 245/320 students were willing to participate in the program (68% reach). There was a lower risk of injury in intervention schools (n = 2) compared to controls (n = 2) [RR = 0.52 (95% CI: 0.33–0.81)]. 76% of students and 83% of teachers reported positive attitudes towards the program, 60% of students reported they believed the program could reduce the risk of injury, and 74% reported the program could improve fitness. 14% of the schools approached agreed to participate in the program (adoption). For students, the most frequently reported reason for participating was the belief that the program would reduce injury and increase fitness. Factors related to successful implementation of the program in schools included clear explanation and demonstration of the program, and barriers included difficulty in executing certain program components. Finally, 88% of teachers reported interest in maintaining the program. Ongoing formative evaluation will be collected via focus groups using CFIR constructs (2015–2016). Conclusions Teachers were able and keen to continue to use the iSPRINT program. We will provide further discussion on the dimensions of REAIM, and report the specific constructs that facilitated and impeded implementation of the iSPRINT program.