Towards systematic prevention of athletics injuries: Use of clinical epidemiology for evidence-based injury prevention

................................................................................................................. 1 LIST OF PAPERS ........................................................................................................ 3 ABBREVIATIONS...................................................................................................... 4 INTRODUCTION ...................................................................................................... 5 Background ........................................................................................................... 6 Athletics............................................................................................................ 6 What is known about injuries in athletics? ................................................. 7 Prevention of sports-related injuries.......................................................... 12 AIMS OF THE STUDY ............................................................................................ 15 SUBJECTS AND METHODS................................................................................. 17 Design of the studies......................................................................................... 17 Development of the study protocol (paper I) ............................................... 17 Data collection ............................................................................................... 18 Design of the study protocol ....................................................................... 18 Evaluation of the study protocol ................................................................ 18 Pilot study ...................................................................................................... 19 Injury surveillance (papers II–IV) .................................................................. 20 Overview of research design....................................................................... 20 Subjects ........................................................................................................... 20 Recruitment ................................................................................................... 21 Data collection .................................................................................................... 21 Injury definitions........................................................................................... 22 Data collection instruments (papers II, III, IV)............................................ 23 Baseline form (papers II, III, IV) ................................................................. 23 Electronic weekly athlete diary (papers III, IV)........................................ 23 Injury report form (papers III, IV) .............................................................. 24 Injury closure form (papers III, IV) ............................................................ 24 Categorization and classification of injuries (papers II, III, IV) .............. 25 Injury severity .................................................................................................... 26 Statistical methods............................................................................................. 27 Ethics .................................................................................................................... 28 RESULTS .................................................................................................................... 29 Requirements for injury surveillance in athletics (paper I) ...................... 29 Definition of athletics injury........................................................................ 29 Individual-level data collection .................................................................. 30 Study population (papers II, III IV)............................................................. 31 Prevalence of injuries (paper II) ..................................................................... 31 Injury prevalence .......................................................................................... 31 Incidence of injuries (papers III, IV).............................................................. 32 Incidence of injured athletes ....................................................................... 32 Injury mechanism/circumstances of injuries ........................................... 33 Injury locations, types and rates ................................................................. 34 Injury severity ............................................................................................... 34 Risk factors and risk indicators................................................................... 37 GENERAL DISCUSSION ....................................................................................... 39 Generalizability of findings ............................................................................ 39 Study population and representativeness................................................. 39 Data collection ............................................................................................... 41 Injury definition and categorization.............................................................. 41 Injury definitions........................................................................................... 41 Categorization of injuries ............................................................................ 43 Extent of the problem........................................................................................ 44 Prevalence ...................................................................................................... 44 Incidence ........................................................................................................ 45 Reported injury types................................................................................... 46 Factors associated with risk for injury........................................................... 46 Consequences of injury .................................................................................... 48 Previous and subsequent injuries............................................................... 48 Injury severity ............................................................................................... 50 FUTURE PERSPECTIVES....................................................................................... 51 CONCLUSIONS ....................................................................................................... 53 SUMMARY IN SWEDISH...................................................................................... 55 ACKNOWLEDGEMENTS...................................................................................... 57 REFERENCES ............................................................................................................ 61 APPENDIX 1 .............................................................................................................. 71