Implementing Injury Prevention Research Articles

A CONCEPT MAPPING APPROACH TO IDENTIFY PERCEIVED FACILITATORS TO ENHANCE THE IMPLEMENTATION OF INJURY PREVENTION TRAINING IN YOUTH TEAM HANDBALL: THE I-PROTECT PROJECT

BackgroundEvidence-based injury preventive exercise programs (IPEPs) usually have limited public health impact because they are not widely implemented into regular training routines.ObjectiveTo identify facilitators that could help make IPEPs part...

Evaluating distracted driving behaviors in parents of children in suburban and rural areas of Alabama

Distracting driving is considered a dangerous epidemic in teenage drivers and adult drivers nationwide. Cell phone use, such as talking and texting is one of the most common driving distractions among adult and teenage drivers. Using the model of a previously published study from New Haven, Connecticut, we sought to investigate the driving behaviors of parents while transporting their children in Alabama. A comparison study was conducted of 150 participants from suburban (n = 86) and rural (n = 64) clinics in Alabama. Participants were recruited to complete a survey regarding their cell phone usage while driving with children. The inclusion criteria were having children younger than 18 years, a valid driver's license, and cell phone and English speaking. The survey consisted of 10 questions focusing on parental driving behaviors. Following the survey, an educational intervention was provided. A Z test proportions was used to compare the responses. Ninety percent of the suburban parents reported cell phone use while driving their children as compared with 86% of the rural parents. A significant difference was found between suburban parents and rural parents for cell phone use in speaker mode (Z = 3.35; p < 0.001; 95% confidence interval, 13-45), reading and sending texts while driving (Z = 4.1; p < 0.001; 95% CI, 19-51), and surfing the Internet (Z = 4.9; p < 0.001; 95% CI, 25-57). There was no statistical significance noted for the following: use of Bluetooth device, talking on the cell phone when parked/at red light, and texting while parked/at red light. Cell phone use among parents while transporting children is common in the state of Alabama. Parents living in suburban areas use cell phones in the speaker mode, read and send text messages, and surf the Web more often when compared with parents in rural areas. Further research on how to best implement injury prevention interventions should be done to target high-risk areas with distracted driving behaviors. Epidemiologic study, level III.

The delivery of injury prevention exercise programmes in professional youth soccer: Comparison to the FIFA 11+

Injury prevention exercise programmes for amateur soccer have gained considerable attention, but little is known about their relevance and adaptability to professional soccer settings. The first aim of this study was to evaluate the delivery and content of injury prevention exercise programmes used by professional youth soccer teams, compared to the industry standard injury prevention exercise programme for soccer, the Fédération Internationale de Football Association's FIFA 11+. The second aim was to document specific challenges to implementing injury prevention exercise programmes in this context. Prospective observational study. The participants were soccer coaches, fitness coaches and physiotherapists (n=18) from four teams in a professional youth soccer academy. Each team's chosen injury prevention exercise programmes were observed weekly across an entire soccer season (160 sessions). The delivery and content of the programmes were documented on a standardised worksheet and compared to the FIFA 11+. Specific implementation challenges were recorded. Fitness coaches were the primary deliverers of injury prevention exercise programmes, with support from physiotherapists. Multiple delivery formats and locations were employed, along with the extensive use of equipment. Across all injury prevention exercise programme sessions, a median of one FIFA 11+ exercise was performed in its original form and a further four in a modified form. Implementation challenges included poor staff communication, competing training priorities and heavy game schedules. Although the basic components of the FIFA 11+ hold relevance for professional youth male teams, the delivery and content of injury prevention exercise programmes require considerable tailoring for this context. Recognising this will inform the development of improved, context-specific injury prevention exercise programmes, along with corresponding strategies to enhance their implementation.

Epidemiology of Knee Injuries in Indian Kabaddi Players

Background: Detailed injury epidemiology is an unmatched tool for reducing injury risks associated with any sport. Very little epidemiologic data exists regarding injuries sustained by kabaddi players. Objectives: To study knee injuries in kabaddi players. Patients and Methods: This is a cross-sectional, observational study. Seventy six kabaddi players (both professionals and amateurs) presenting with sports-related knee injuries were identified from previous records; data was analysed for demographic features, injury mechanism, injury scenario, duration of injury before presentation, injury pattern, management, return to sport and time lost in sport due to the knee injury. Results: The mean duration prior to presentation was 14.4 months. Majority of the injuries (88.16%) occurred during competitive games. The most common injury noted was ACL tear (89.47%), followed by meniscus tears which were noted in 68.42% of the players. Forty four players (57.89%) retired from the sport as a consequence of the knee injury. Time lost in sport in those who returned to kabaddi was an average of 16.6 months; signifying the high morbidity due to knee injuries in kabaddi players. Return to sport was significantly more (P = 0.04) in those treated surgically than in those treated conservatively; but was not affected by mechanism of injury, injury scenario, injury pattern, duration of injury at presentation or level of competition of the athlete. Conclusions: Epidemiologic studies in kabaddi are the need of the hour to assess the burden of this predominantly rural sport and to implement injury prevention programs. Our study emphasises the morbidity of knee injuries in kabaddi players of India and the exacting toll it takes on their careers.

Pressure injury prevention strategies in acute medical inpatients: an observational study

Background: Pressure injuries are a patient safety issue. Despite the suite of prevention strategies, sustained reductions in pressure injury prevalence rates have not been achieved. Generally, nurses are usually responsible for assessing patients’ pressure injury risk, and then implementing appropriate prevention strategies. The study aim was to describe five planned and implemented pressure injury prevention strategies (risk assessment, management plan, support surface, repositioning, and education), and determine if a relationship existed between the planning and implementation of support surfaces and regular repositioning. Method: An observational study collecting data using chart audits and semi-structured observations. Data were analysed using descriptive and inferential statistics. This study was set in four medical units across two Australian metropolitan hospitals. The sample comprised adult medical inpatients with reduced mobility. A subsample of participants assessed at pressure injury risk on admission was drawn from this sample. Participants were aged ≥18 years, had a hospital length of stay of ≥3 days prior to recruitment, provided an informed consent, and had reduced mobility. Results: There was suboptimal planning and implementation of pressure injury prevention strategies for the sample and subsample. There was a significant relationship between planned and implemented support surfaces at both hospitals; however, no relationship existed between the planned and implemented of regular repositioning at either site. Conclusion: The planning and implementation of pressure injury strategies is haphazard. Patients received support surfaces; however, gaps exist in pressure injury risk assessment, management planning, regular repositioning, and patient education.

Association of Socio-economic Status with Injuries in Children Andadolescents:the CASPIAN-IV Study

Background:Childhood and adolescence injuries are still frequently occuring in developing countries. This study aims to assess the association of socio-economic status (SES) with injuriesin Iranian children and adolescents. Materials and Methods: This multicentricsurvey was part of a national surveillance program, which was conducted in 2011-2012 amongst 14,880 students aged6-18 years. Participants were randomly selected from urban and rural areas of 30 provinces in Iran. Socio- economic status (SES) of participants was categorized to “low”, “middle” ,and “high” by using principle component analysis method by considering parental job and education as well as family assets. Prevalence, types and places of injuries were based on the questionnaire of the World Health Organization- Global School-based student Health Survey (WHO-GSHS).Multivariate modelwas used for comparison of variables between SES groups. Results: Overall, 13486 out of 14880 invited students (response rate: 90.6%) participated in this study.Their mean (SD) age was12.47 (3.36) years.Boys and urban residents constituted the majority of participants (50.8% and 75.6%, respectively). Compared with low SES group, odds of sport injury was higher in students with middle (OR=1.44; 95%CI: 0.92-2.26) and highSES (OR=1.96; 95%CI: 1.27-3.01). Compared to participants withlow SES,odds of home injuries was significantly lower in high SES group (OR=0.78; 95%CI: 0.64-0.95). Conclusion: This study revealedconsiderable differences in injuries of children and adolescents according to their SES, with higher prevalence of home injuries in low SES families and higher prevalence of sport injuries in middle and high SES levels. When implementing injury prevention programs, such differences should be taken into account.

The evolution of multiagency partnerships for safety over the course of research engagement: experiences from the NoGAPS project

ObjectiveImplementation of effective population-level injury prevention interventions requires broad multiagency partnerships. Different stakeholders address this from varying perspectives, and potential conflicts in priorities need to be addressed for such partnerships...

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...

Pediatric Overuse Sports Injury and Injury Prevention

Participation in sports by the pediatric population has grown vastly over the years. Overuse injuries in the pediatric population signify a significant health care interest. Some reports and clinical observations designate 50% of all pediatric sport-related injuries as overuse or repetitive trauma. Furthermore, it is ventured that more than half of these injuries may be preventable with straightforward strategies. Nurse practitioners are well positioned to identify these injuries and implement injury prevention in their practices.

The repositioning of hospitalized patients with reduced mobility: a prospective study.

AimTo determine the frequency of patient repositioning across three consecutive nursing shifts (day, evening and night) and to identify predictors of repositioning frequency.BackgroundPatient repositioning is a frequently implemented pressure injury prevention strategy. Yet, little is known about how often it should be implemented, or the frequency of movement among hospitalized patients with reduced mobility.DesignAn observational prospective study.MethodsChart audits were used to gather clinical and demographic data. Semi‐structured observations were conducted every 30 minutes for a continuous 24‐hour period. Observational data included the patient's body position, the frequency of repositioning, assistance require to reposition and the use of support surfaces.ResultsPatients were repositioned frequently during the day and evening and least at night time. Elevation of the head of the bed (1–45°) was the most frequently adopted position. The independent predictors of repositioning frequency were age and gender, with older patients and males repositioned less frequently.

Recreational Snow-Sports Injury Risk Factors and Countermeasures: A Meta-Analysis Review and Haddon Matrix Evaluation.

Snow sports (alpine skiing/snowboarding) would benefit from easily implemented and cost-effective injury prevention countermeasures that are effective in reducing injury rate and severity. For snow sports, to identify risk factors and to quantify evidence for effectiveness of injury prevention countermeasures. Searches of electronic literature databases to February 2014 identified 98 articles focused on snow sports that met the inclusion criteria and were subsequently reviewed. Pooled odds ratios (ORs) with 90% confidence intervals (CIs) and inferences (percentage likelihood of benefit/harm) were calculated using data from 55 studies using a spreadsheet for combining independent groups with a weighting factor based on quality rating scores for effects. More experienced skiers and snowboarders are more likely to sustain an injury as a result of jumps, while beginners sustain injuries primarily as a result of falls. Key risk factors that countermeasure interventions should focus on include, beginner skiers (OR 2.72; 90% CI 2.15-3.44, 99% most likely harmful), beginner snowboarders (OR 2.66; 90% CI 2.08-3.40, 99% harmful), skiers/snowboarders who rent snow equipment (OR 2.58; 90% CI 1.98-3.37, 99% harmful) and poor visibility due to inclement weather (OR 2.69; 90% CI 1.43-5.07, 97% harmful). Effective countermeasures include helmets for skiers/snowboarders to prevent head injuries (OR 0.58; 90% CI 0.51-0.66, 99% most likely beneficial), and wrist guards for snowboarders to prevent wrist injuries (OR 0.33; 90% CI 0.23-0.47, 99% beneficial). The review identified key risk factors for snow-sport injuries and evaluated the evidence for the effectiveness of existing injury prevention countermeasures in recreational (general public use of slopes, not racing) snow sports using a Haddon's matrix conceptual framework for injury causation (host/snow-sport participant, agent/mechanism and environment/community). Best evidence for the effectiveness of injury prevention countermeasures in recreational snow sports was for the use of helmets and wrist guards and to address low visibility issues via weather reports and signage.

Risk factors for groin injury in sport: an updated systematic review

BackgroundThe identification of risk factors for groin injury in sport is important to develop and implement injury prevention strategies.ObjectiveTo identify and evaluate the evidence examining risk factors for groin injury...

Parental perceptions of barriers and facilitators to preventing child unintentional injuries within the home: a qualitative study.

BackgroundChildhood unintentional injury represents an important global health problem. Most of these injuries occur at home, and many are preventable. The main aim of this study was to identify key facilitators and barriers for parents in keeping their children safe from unintentional injury within their homes. A further aim was to develop an understanding of parents’ perceptions of what might help them to implement injury prevention activities.MethodsSemi-structured interviews were conducted with sixty-four parents with a child aged less than five years at parent’s homes. Interview data was transcribed verbatim, and thematic analysis was undertaken. This was a Multi-centre qualitative study conducted in four study centres in England (Nottingham, Bristol, Norwich and Newcastle).ResultsBarriers to injury prevention included parents’ not anticipating injury risks nor the consequences of some risk-taking behaviours, a perception that some injuries were an inevitable part of child development, interrupted supervision due to distractions, maternal fatigue and the presence of older siblings, difficulties in adapting homes, unreliability and cost of safety equipment and provision of safety information later than needed in relation to child age and development. Facilitators for injury prevention included parental supervision and teaching children about injury risks. This included parents’ allowing children to learn about injury risks through controlled risk taking, using “safety rules” and supervising children to ensure that safety rules were adhered to. Adapting the home by installing safety equipment or removing hazards were also key facilitators. Some parents felt that learning about injury events through other parents’ experiences may help parents anticipate injury risks.ConclusionsThere are a range of barriers to, and facilitators for parents undertaking injury prevention that would be addressable during the design of home safety interventions. Addressing these in future studies may increase the effectiveness of interventions.

Patterns of youth injury: a comparison across the northern territories and other parts of Canada

BackgroundInjury is the leading cause of death for young people in Canada. For those living in the northern territories (Yukon, Nunavut, and the Northwest Territories), injury represents an even greater problem, with higher rates of injury for people of all ages in northern areas compared with the rest of Canada; however, no such comparative studies have focussed specifically on non-fatal injury in youth.ObjectiveTo profile and examine injuries and their potential causes among youth in the northern territories as compared with other parts of Canada.DesignCross-sectional data from the 2009/2010 Health Behaviour in School-aged Children survey (youth aged 11–15 years) were examined for the Canadian northern territories and the provinces (n=26,078). Individual survey records were linked to community-level data to profile injuries and then study possible determinants via multilevel regression modelling.ResultsThe prevalence of injury reported by youth was similar in northern populations and other parts of Canada. There were some minimal differences by injury type: northern youth experienced a greater percentage of neighbourhood (p<0.001) and fighting (p=0.02) injuries; youth in the Canadian provinces had a greater proportion of sport-related injuries (p=0.01). Among northern youth, female sex (RR=0.87, 95% CI 0.81–0.94), average (RR=0.88, 95% CI 0.80–0.97) or above-average affluence (RR=0.84, 95% CI 0.76–0.91), not being drunk in the past 12 months (RR=0.77, 95% CI 0.69–0.85), not riding an all-terrain vehicle (RR=0.81, 95% CI 0.68–0.97) and not having permanent road access (RR=0.89, 95% CI 0.80–0.98) were protective against injury; sport participation increased risk (RR=1.45, 95% CI 1.33–1.59).ConclusionsPatterns of injury were similar across youth from the North and other parts of Canada. Given previous research, this was unexpected. When implementing injury prevention initiatives, individual and community-level risk factors are essential to understand; however, specific positive safety assets that might exist in different community contexts must also be considered.

Symposium Title: Just because they say they want to doesn’t mean they do: The challenges of implementing injury prevention initiatives in community sport

Symposium Title: Just because they say they want to doesn’t mean they do: The challenges of implementing injury prevention initiatives in community sport

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.

A-35 Free Communication/Poster - Amino Acid Intake, Exercise and Protein Metabolism

PURPOSE: There is a well-known female bias in anterior cruciate ligament (ACL) injury risk. This is in part due to differences in neuromuscular characteristics, which emerge during maturation and are associated with a corresponding spike in the incidence of ACL injury. This may arise from the divergence between males and females in lean body mass development, resulting in a lack of a “neuromuscular spurt” in females to accompany the growth spurt. A school-centered strength-based intervention during this critical period may help prevent the development of high injury risk neuromuscular characteristics. The purpose of this study is to compare the lower extremity biomechanics of peri-pubescent females during a jump-landing task before and after a strength training program. METHODS: Maximum voluntary isometric contraction (MVIC) of the knee extensors, knee flexors, hip extensors, and hip abductors as well as Landing Error Scoring System (LESS) data were collected for healthy female middle school students (Grades 6-8, N=25, Ht 1.62±0.07m, Wt 47.7±7.6kg, Age 13.6±1.0yrs). MVIC values were normalized to height/weight. Time points of collection were before and after a five-month strength training protocol administered through a gym class that targeted the listed muscle groups. Dependent samples t-tests were used for comparisons across time (alpha = 0.05). Backwards stepwise linear regression was performed to examine the relationship between MVIC and LESS change scores. RESULTS: MVIC values (Nm/kg) increased significantly for hip extension (3.85±1.14 vs 4.69±1.76, p<0.01), hip abduction (4.12±1.05 vs 5.21±2.40, p<0.01), knee extension (4.61±0.79 vs 5.38±1.79, p<0.05), and knee flexion (3.03±0.70 vs 3.64±1.21, p<0.01) while LESS grades significantly decreased (6.03±0.99 vs 5.19±1.49, p<0.001). Hip extension and knee extension change score explained 94% of the variance (p<0.001) in LESS change score. CONCLUSIONS: A school-based strength training program focused on the hip and knee musculature significantly improved both lower extremity strength and jump landing biomechanics and may hold significant promise as an easily implemented widespread injury prevention protocol. Further investigation using larger sample sizes, control groups, and both genders is warranted.

Can the reduction of pediatric injury rates be sustained using a community-based approach?

Injuries are the leading cause of morbidity and mortality in US residents aged 1 to 44 years. Community-based interventions are effective in reducing injuries. Using this approach, investigators significantly reduced injuries in Avondale, Ohio, between 1999 and 2004 compared with three control communities (42 vs. 15%, respectively). The objective of this study was to determine if injury reduction was sustained through the 5 years after initial implementation of injury prevention (IP) efforts in Avondale compared with the same three control communities. Injury prevention interventions implemented in Avondale, Ohio, during previous study years were sustained. Two new playgrounds were built, but no other new interventions were introduced. Control communities had no programs introduced by the team during the study period. Data were obtained from the Hamilton County Injury Surveillance System from 2005 to 2009 for deaths, hospitalizations, and emergency department visits due to injury for children 0 to 19 years old. Data from the study community were compared with those of the same three control communities as in our previous work, with similar demographics and socioeconomic characteristics, as well as with data obtained previously from 1999 to 2004. Census data based on annual estimates were used to calculate injury rates. The injury rate in Avondale decreased from 17,073 to 11,284 injuries per 100,000 children per year during the 11-year period (33.9% reduction). The injury rate in the control communities decreased from 14,436 to 12,381 injuries per 100,000 children per year in the same period (14.2% reduction). The difference in the injury rate decrease between the intervention and control communities was statistically significant, p < 0.001. From 2005 to 2009, the lower injury rate was sustained in Avondale, p = 0.58. Community-based strategies to prevent injuries to children in high-risk communities can be successful in reducing overall injury rates. These efforts can result in sustained injury reduction over time despite no new interventions being introduced.

The Evaluation of a Fall Management Program in a Nursing Home Population

This study evaluates a nursing home Fall Management program to see if residents' mobility increased and injurious falls decreased. Administrative health care use and fall occurrence report data were analyzed from 2 rural health regions in Manitoba, Canada, from June 1, 2003 to March 31, 2008. A quasiexperimental, pre-post, comparison group design was used to compare rates of three outcomes, falls, injurious falls, and falls resulting in hospitalization, by RHA (program vs nonprogram nursing homes) and period (preprogram vs postprogram). Data collectors entered occurrence report information into spreadsheets. This was supplemented with administrative health care use data. The program appears to have benefitted residents-falls trended upward, injurious falls remained stable, and hospitalized falls decreased significantly (0.036-0.021 per person-year [ppy]; p = .043). Compared with nonprogram residents in the postperiod, both groups had the same fall rate, but program residents had significantly fewer injurious falls (0.596-0.746 ppy; p = .02) and hospitalized falls (0.02-0.041 ppy; p = .023). These results are among a small body of literature showing that Fall Management was associated with improved outcomes in program nursing homes from pre- to postperiod and compared with nonprogram nursing homes. This research provides some support for the benefits of being proactive and implementing injury prevention strategies universally and pre-emptively before a resident falls, helping to minimize injuries while keeping residents mobile and active. Larger scale research is needed to identify the true effectiveness of the Fall Management program and generalizability of results.

Exposure-adjusted incidence rates and severity of competition injuries in Australian amateur taekwondo athletes: a 2-year prospective study

Background/aimThe main purposes of this study were to determine the injury incidence and severity in Australian amateur taekwondo athletes, and to investigate potential risk factors for injury in competition taekwondo.MethodsData...