Evidence-based Injury Prevention Research Articles

A Qualitative Examination of a New Combined Cognitive-Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia.

Adolescents with juvenile fibromyalgia (JFM) are typically sedentary despite recommendations for physical exercise, a key component of pain management. Interventions such as cognitive-behavior therapy (CBT) are beneficial but do not improve exercise participation. The objective of this study was to obtain preliminary information about the feasibility, safety, and acceptability of a new intervention--Fibromyalgia Integrative Training for Teens (FIT Teens), which combines CBT with specialized neuromuscular exercise training modified from evidence-based injury prevention protocols. Participants were 17 adolescent females (aged 12 to 18 y) with JFM. Of these, 11 completed the 8-week (16 sessions) FIT Teens program in a small-group format with 3 to 4 patients per group. Patients provided detailed qualitative feedback via individual semistructured interviews after treatment. Interview content was coded using thematic analysis. Interventionist feedback about treatment implementation was also obtained. The intervention was found to be feasible, well tolerated, and safe for JFM patients. Barriers to enrollment (50% of those approached) included difficulties with transportation or time conflicts. Treatment completers enjoyed the group format and reported increased self-efficacy, strength, and motivation to exercise. Participants also reported decreased pain and increased energy levels. Feedback from participants and interventionists was incorporated into a final treatment manual to be used in a future trial. Results of this study provided initial support for the new FIT Teens program. An integrative strategy of combining pain coping skills via CBT enhanced with tailored exercise specifically designed to improve confidence in movement and improving activity participation holds promise in the management of JFM.

Injury prevention exercise programmes in professional youth soccer: understanding the perceptions of programme deliverers

BackgroundThere are well-known challenges to implementing injury prevention strategies in amateur soccer, but information from other soccer settings is scarce. This cross-sectional survey analysed the injury prevention perceptions of soccer...

Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older, United States, 2006–2011

IntroductionWith the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern. MethodsWe analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006–2011. We examined unintentional injury trends by 5-year age groups, sex, mechanism, body region, discharge disposition, and primary payer. For 2011, we estimated the medical costs of unintentional injury and the distribution of primary payers, plus rates by injury mechanisms and body regions injured by 5-year age groups. ResultsFrom 2006 to 2011, the age-adjusted annual rate of unintentional injury-related ED visits among persons aged ≥65years increased significantly from 7987 to 8163, per 100,000 population. In 2011, 65% of injuries were due to falls. Rates for fall-related injury ED visits increased with age and the highest rate was among those aged ≥100. Each year, about 85% of unintentional injury-related ED visits in this population were expected to be paid by Medicare. In 2011, the estimated lifetime medical cost of unintentional injury-related ED visits among those aged ≥65years was $40 billion. ConclusionIncreasing rates of ED-treated unintentional injuries, driven mainly by falls among older adults, will challenge our health care system and increase the economic burden on our society. Prevention efforts to reduce falls and resulting injuries among adults aged ≥65years have the potential to increase well-being and reduce health care spending, especially the costs covered by Medicare. Practical applicationsWith the aging of the U.S. population, unintentional injuries, and especially fall-related injuries, will present a growing challenge to our health care system as well as an increasing economic burden. To counteract this trend, we must implement effective public health strategies, such as increasing knowledge about fall risk factors and broadly disseminating evidence-based injury and fall prevention programs in both clinical and community settings.

Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial

BackgroundAdolescent female football and handball players are among the athletes with the highest risk of sustaining anterior cruciate ligament (ACL) injuries.AimThis study evaluated the effects of evidence-based lower extremity injury...

An evaluation of evidence-based paediatric injury prevention policies across Canada.

BackgroundPolicies to reduce injury among Canadians can be controversial and there is variability in the enactment of injury prevention laws across the country. In general, laws are most effective when they are based on good research evidence, supported by widespread public awareness and education, and maintained by consistent enforcement strategies. The purpose of this study was to document and compare key informants’ perceptions of the quality, awareness, and enforcement of three evidence-based paediatric injury prevention policies (bicycle helmet legislation, child booster seat legislation, graduated driver licensing) among Canadian provinces and territories.MethodsWe identified best practices related to each policy, then developed an online survey to ascertain the extent to which each jurisdiction’s policy aligned with best practices, whether experts believed that the public was aware of the policy and whether it was enforced. The survey was distributed using a snowball sampling strategy to key informants across Canada.ResultsThirty-eight key informants responded to the bicycle helmet survey, with 73 and 35 key informants for the booster seat and graduated driver licensing surveys, respectively. Respondent’s perceptions of the policies varied substantially. Key informants indicated that residents are not always aware of legislation, and legislation is not consistently enforced. These results suggest that child health policy is not always guided by evidence.ConclusionsThere was variation between evidence and the policies related to paediatric injury prevention among Canadian provinces and territories. Experts generally rate their policies more highly when they align with evidence and best practice. There is room for improvement and harmonization of injury prevention policies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1986-9) contains supplementary material, which is available to authorized users.

Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey

BackgroundThe Nordic hamstring (NH) exercise programme was introduced in 2001 and has been shown to reduce the risk of acute hamstring injuries in football by at least 50%. Despite this,...

ABCs of Evidence-based Anterior Cruciate Ligament Injury Prevention Strategies in Female Athletes.

Anterior cruciate ligament (ACL) injury is a major concern in physically active females. Although ACL reconstruction techniques have seen significant advances in recent years, risk associated with re-injury and future osteoarthritis remains a major concern. Thus, prevention of ACL injury is a logical step to protect and preserve healthy knee joints in young athletes. The current report aims to summarize a list of evidence-based prevention strategies to reduce ACL injury in female athletes. A list of six critical principles, which come from documented, large scale clinical trial studies and further analyses, were presented with ABC format including age, biomechanics, compliance, dosage, exercise, and feedback. Also, a grade for evidence and implications of future research is noted. Finally, in the conclusion section, importance of collaborative efforts from healthcare practitioners, researchers, and personnel associated with athletics is addressed.

Focused deterrence and the prevention of violent gun injuries: practice, theoretical principles, and scientific evidence.

Focused deterrence strategies are a relatively new addition to a growing portfolio of evidence-based violent gun injury prevention practices available to policy makers and practitioners. These strategies seek to change offender behavior by understanding the underlying violence-producing dynamics and conditions that sustain recurring violent gun injury problems and by implementing a blended strategy of law enforcement, community mobilization, and social service actions. Consistent with documented public health practice, the focused deterrence approach identifies underlying risk factors and causes of recurring violent gun injury problems, develops tailored responses to these underlying conditions, and measures the impact of implemented interventions. This article reviews the practice, theoretical principles, and evaluation evidence on focused deterrence strategies. Although more rigorous randomized studies are needed, the available empirical evidence suggests that these strategies generate noteworthy gun violence reduction impacts and should be part of a broader portfolio of violence prevention strategies available to policy makers and practitioners.

Translating Guidelines for the Diagnosis and Management of Sports-Related Concussion Into Practice.

Sports injuries are a significant clinical and public health concern. There is a growing call to improve the translation of available evidence-based and expert-informed sports injury prevention interventions into sustained use in practice by physicians and others (eg, athletic trainers, coaches, and parents) who care for injured athletes. This article provides a brief overview of the current sport injury prevention implementation literature before focusing specifically on the translation of guidelines (including consensus and position statements) developed to assist physicians and others diagnose and manage athletes with sport-related concussion and the associated return-to-play decisions. The outcomes of more than 20 published studies indicate that physician, athletic trainer, coach, parent, and athlete knowledge, use of, and compliance with sport-related concussion guidelines are limited. More concerted, coordinated, and theory-informed efforts are required to facilitate the widespread dissemination, translation, and implementation of such guidelines. An example is provided of how implementation drivers could be used to inform the development of a comprehensive, multilevel implementation strategy targeting the individual, organizational, and system-level changes necessary to support the translation of available sport-related concussion guidelines in both the clinical and sports settings.

An educational video to promote multi-factorial approaches for fall and injury prevention in long-term care facilities.

BackgroundOlder adults living in long term care (LTC) settings are vulnerable to fall-related injuries. There is a need to develop and implement evidence-based approaches to address fall injury prevention in LTC. Knowledge translation (KT) interventions to support the uptake of evidence-based approaches to fall injury prevention in LTC need to be responsive to the learning needs of LTC staff and use mediums, such as videos, that are accessible and easy-to-use. This article describes the development of two unique educational videos to promote fall injury prevention in long-term care (LTC) settings. These videos are unique from other fall prevention videos in that they include video footage of real life falls captured in the LTC setting.MethodsTwo educational videos were developed (2012–2013) to support the uptake of findings from a study exploring the causes of falls based on video footage captured in LTC facilities. The videos were developed by: (1) conducting learning needs assessment in LTC settings via six focus groups (2) liaising with LTC settings to identify learning priorities through unstructured conversations; and (3) aligning the content with principles of adult learning theory.ResultsThe videos included footage of falls, interviews with older adults and fall injury prevention experts. The videos present evidence-based fall injury prevention recommendations aligned to the needs of LTC staff and: (1) highlight recommendations deemed by LTC staff as most urgent (learner-centered learning); (2) highlight negative impacts of falls on older adults (encourage meaning-making); and, (3) prompt LTC staff to reflect on fall injury prevention practices (encourage critical reflection).ConclusionsEducational videos are an important tool available to researchers seeking to translate evidence-based recommendations into LTC settings. Additional research is needed to determine their impact on practice.

PRIORITIZING CONCUSSION PREVENTION IN YOUTH ICE HOCKEY: AN ASSESSMENT OF ENGLISH-LANGUAGE CANADIAN NEWSPAPERS AS A VEHICLE FOR EVIDENCE-BASED KNOWLEDGE TRANSLATION

BackgroundThe extent to which evidence-based injury prevention knowledge is conveyed to the public can have considerable impact on the implementation of injury prevention practice and policy change, which requires significant...

Preventing child unintentional injury deaths: prioritising the response to the New Zealand Child and Adolescent Injury Report Card

To develop recommendations for child unintentional injury prevention by comparing New Zealand's child unintentional injury mortality and injury prevention policies with those of European countries. Unintentional child injury death rates based on external cause of injury were calculated and ranked. NZ's score for each of the 12 domains (based on external causes of injury) from the New Zealand Child and Adolescent Report Card was compared to European scoring. Policy priorities are identified by domains where mortality makes up a high proportion of overall child unintentional injury mortality (high burden of injury) and where report card score for that domain is low in comparison to other countries (under-utilisation of effective interventions). Death as a motor vehicle occupant accounts for 49% of all child unintentional injury deaths, followed by pedestrian (10%) and drowning deaths (8%). The overall score for the 12 policy domains of the NZ Report Card ranks NZ as 15(th) among the 25 European countries. There are important policy and legislative actions which NZ has not implemented. A number of evidence-based injury prevention policy and legislative actions are available that could target areas of greatest childhood injury mortality in NZ. A set of injury prevention policy and legislation priorities are presented which, if implemented, would result in a significant reduction in the injury mortality and morbidity rates of NZ children.

Prevention of Unintentional Injuries: A Global Role for Pediatricians

In spite of many proven ways to prevent childhood injuries, the relative prevalence of unintentional injury continues to plague the health and well-being of children worldwide. No population groups are spared, with children living in all social and economic circumstances at risk. Dr Hollwarth describes the extent of this injury pandemic. He also cites practical approaches for pediatricians to help advocate for evidence-based injury prevention policies and more consistent inclusion of anticipatory guidance in their daily practice. The simple truth is that children are much more susceptible to unintentional injuries than adults and the societal costs are unacceptably high. This column serves as a call to arms for pediatricians everywhere to work on combating this growing public health challenge. —Jay E. Berkelhamer, MD, FAAP Editor, Global Health Monthly Feature Primary care pediatricians serve as physicians for the entire family because they accompany children from infancy through adolescence, and quite often into adulthood. The pediatrician may be primarily consulted in cases of diseases, but his or her advice with regard to vaccination, healthy nutrition, and a safe environment is usually appreciated by families. Thus, pediatricians can play a significant role in injury prevention, too. Why is injury prevention important? Unintentional injuries constitute a global public health problem and are the leading cause of death in children and adolescents between the ages 5 and 18 years. More than 800 000 children younger than 18 die every year as a result of unintentional injuries.1 In the United States, this is the leading cause of death among children aged 18 and younger, claiming more than 12 000 lives annually.2 For each child who dies as a result of injury, another 553 children are treated at emergency departments, a further 11.2 children need to … Address correspondence to Michael E. Hollwarth, Univ. Prof. Dr., Department of Paediatric and Adolescent Surgery, Medical University, Auenbruggerplatz 34, A-8036 Graz, Austria. E-mail: michael.hoellwarth{at}medunigraz.at

Epidemiology of Injury Among Handlers and Dogs Competing in the Sport of Agility

Little is known about the epidemiology of dog sport-related injuries. This study examines injuries among handlers and dogs in the sport of dog agility. A cross-sectional pilot study captured data on demographics, exposures, and injury for a sample of agility handlers and dogs. Logistic regressions predicted odds of injury. Survey of 217 handlers and 431 dogs identified 31 handler injuries (1.55 training injuries per 1000 hours, 2.14 competition injuries per 1000 runs) and 38 dog injuries (1.74 training injuries per 1000 hours, 1.72 competition injuries per 1000 runs). Handlers most commonly injured knees (48.4%) and lower trunk (29.0%). Most common diagnoses were strains (51.6%) and sprains (32.3%). Obese handlers had increased odds of injury compared with normal weight handlers (OR = 5.5, P < .001). Dogs most commonly injured front paws (23.7%) and shoulders (15.8%). Most common diagnoses were strains (44.7%) and cut/scrapes (21.1%). Injury was positively associated with dog's age (P < .05). Handlers more commonly reported positive physical, emotional, and social motivations for participation than competitive. Despite many health benefits, dog agility poses a risk of injury to both handlers and dogs. Future research on specific mechanisms of injury should drive evidence-based injury prevention strategies.

Epidemiology of injuries to wildland firefighters

IntroductionWildland fires have significant ecologic and economic impact in the United States. Despite the number of firefighters involved in controlling them, little is known about the injuries that they sustain. We hypothesized that the mechanism of injury would predict injury characteristics and severity of fire-related injuries. MethodsWe examined firefighter injuries reported to the US Department of the Interior from the years 2003 to 2007. Associations between the injury mechanism and the injury diagnosis and body part were assessed. A logistic regression model was used to evaluate the odds of disabling injury associated with mechanism of injury after controlling for demographic and temporal variables. ResultsA total of 1301 nonfatal injuries to wildland firefighters were reported during the 5-year period. Mechanism of injury was significantly associated with the type of injury and injured body part (P ≤ .001). The most common injury mechanism was slips/trips/falls followed by equipment/tools/machinery. Injuries from poisoning or environmental exposure were less likely to lead to severe injury than slips, trips, or falls (odds ratio, 0.45; 95% confidence interval, 0.21-0.95). Compared with injuries in the early and peak season, those in the late season had more than twice the odds of being severe (odds ratio, 2.24; 95% confidence interval, 1.23-4.10). DiscussionThis study contributes important knowledge for implementing evidence-based injury prevention programs, for planning emergency medical responses on fire incidents and for provoking further inquiry into occupational risk factors affecting this high-risk occupational group.

Bridging the gap between research evidence and real-world implementation: the nogaps project

BackgroundThere is an increasing momentum to develop, widely implement and evaluate evidence-based injury prevention programmes in sport. However, navigating the literature to evaluate the evidence, and bridging the gap between...

Using social media to get our child injury prevention messages out there

BackgroundSafekids New Zealand uses our national series of ‘Safekids Campaign’ Workshops, our www.safekids.org.nz website, media releases/work with media, print advertising, resources and quarterly newsletter Safekids News to disseminate our unintentional...

Reach of a kiosk-based pediatric injury prevention program

While controlled trials are important for determining the efficacy of public health programs, implementation studies are critical to guide the translation of efficacious programs to general practice. To implement an evidence-based injury prevention program and examine program use and completion rates in two implementation phases, Safe N' Sound, an evidence-based program, was implemented in five pediatric clinics. Data on program use were collected from program files and patient census data. Program use averaged 12.1% of eligible patients during implementation and 9.5% during the continuation phase. Program completion averaged 9.7% and 6.5%, respectively. Findings from this study can inform the dissemination of evidence-based public health programs, particularly in practice-based clinical settings.

Quantifying homicide trends in Australia: a methodological caution

Reducing the incidence of assault-related deaths remains an ongoing interest for injury prevention practitioners. In Australia, and elsewhere, an area of particular attention has been quantifying the incidence of firearm homicide (and tracking potential method substitution) following legislative change. In Australia, the majority of epidemiological studies in this field rely on Australian Bureau of Statistics (ABS) data. However, it has recently been noted by the Australian Institute of Criminology (AIC) that the ABS have been ‘undercounting’ firearm homicides since the year 2004. Specifically “…coding procedures used since 2004 (related to an increase in the number of open coroners cases) have resulted in an under-counting of firearm deaths due to assault (i.e. firearm homicide)”.1ABS data do not take into account coroners cases that were ‘open’ at the time of annual ABS data collation. The ABS under-counting issue has previously been flagged in relation to suicide.2-4Recent cross-checks of ABS suicide data against other sources (for example, the National Coronial Information System)2,3suggest that the actual number of suicides from the early 2000s onwards may be in the order of between 200 and 400 deaths per year higher than ABS data indicate. It has been suggested that at least part of the apparent decline in suicide rates since the mid 1990s may in fact be due to under-counting, rather than representing a ‘real’ decline.2 Discrepancies between actual and recorded numbers of deaths have clear implications for the development of robust, evidence-based injury prevention policy. It is concerning, therefore, that the under-counting issue for suicides also appears to apply to homicide data. This implies that the annual number of firearm and non-firearm homicides may be higher than thought. Given the relatively low number of homicides each year in Australia, a small number of ‘uncounted’ deaths could have substantial impacts on observed homicide rates. This in turn could impact on research findings and the evidence base used to inform policy development. While under-counting is unlikely to seriously affect studies of firearm and non-firearm homicide that use pre-2005 data,5it has potential to significantly alter studies that include data from 2004 onwards. It is recommended that the under-counting issue be investigated as a matter of priority, with ABS data revised as appropriate. In the interim, we suggest extreme caution when examining data on deaths due to assault from 2004 onwards.

The safety attitudes of people who use multi-purpose recreation facilities as a physical activity setting

Multi-purpose recreation facilities (MPRFs) are a popular setting for physical activity and it is therefore important that they are safe for all patrons. However, the attitudes of MPRF users towards safety are a potential barrier to the success of injury prevention programmes implemented within MPRFs. This article reports a survey of the safety attitudes of over 700 users of four indoor MPRFs. Factor analysis of 12 five-point Likert scale statements showed that the attitudes clustered around three major dimensions – the importance of safety, the benefits of safety and the perceptions of injury risk. Together, these three dimensions accounted for 49% of the variability in the attitudes. More than 85% of respondents agreed/strongly agreed that: safety was an important aspect of physical activity participation; being injured affected enjoyment of physical activity; people should adopt appropriate safety measures for all physical activity; and individuals were responsible for their own safety. The MPRF users, particularly women and older people, were generally safety conscious, believed in adopting safety measures, and were willing to take responsibility for their own safety. Facility managers can be confident that if they provide evidence-based injury prevention interventions in these settings, then users will respond appropriately and adopt the promoted behaviours.