Reduce Injury Rates Research Articles

Adapting load limiter deployment for frontal crash diversity

Objective: Current European restraint systems may not realize their full protection potential in real-world frontal crashes because they are highly optimized for specific conditions. This research sought to quantify the potential benefit of adapting seat belt load limit thresholds to a wider range of occupant and crash characteristics.Methods: Numerical simulations using Hybrid III dummies were conducted to determine how varying load limiter thresholds could affect occupant kinematics and injury outcome in frontal impacts. Occupant–compartment models were developed with a restraint system consisting of a frontal airbag and a 3-point belt with retractor, buckle pretensioner, and load limiting at the shoulder. Load limiting threshold was varied in 5 frontal impact scenarios, covering as wide a range of real frontal crash conditions as possible. The simulated thoracic injury risks were converted into injury probability values using Abbreviated Injury Scale (AIS) 2+ age-dependent thoracic risk curves. These values were then applied to a British real-world frontal impact sample to determine the injury reduction potential of optimized load limiting, taking into account occupant seating position, impact scenario, occupant size, and occupant age and assuming that an appropriate adaptive system was fitted to all cars.Results: In low-severity impacts, a low load limit provided the best chest protection, without increasing risk to other body regions, for both the 50th and 95th percentile dummies in both front seating positions. In high-severity impacts, the low limit was not recommended because it allowed the driver dummy to move into close proximity with the vehicle interior, although there appeared to be some benefit of lower load limiting for the 50th percentile front passenger dummy, due to the increased ride down space in that seating position. Adapting the load limit showed no injury reduction potential for 5th percentile drivers. Utilizing the best load limit threshold in real-world crashes could reduce the number of occupants with AIS 2+ chest injuries from belt loading from 377 to 251 (a 33% reduction), correspondingly reducing the number of occupants with AIS 2+ chest injuries (from all sources) in the whole frontal impact population from 496 to 370. This is a reduction in injury rate from 6.4% to 4.8%.Conclusions: The concept of an adaptive load limiter shows most promise in low-speed frontal crashes where it could lower the AIS 2+ chest injury risk for most front seat occupants, except the smallest of drivers. Generally, adaptive limiters show less potential effectiveness with increased crash severities. Overall, an intelligent adjustment of load limiting threshold could result in a reduction of at least a third of front seat occupants with AIS 2+ chest injuries associated with restraining loads and an overall reduction in AIS 2+ chest injury rate in frontal crashes from 6.4% to 4.8%

A 2-yr Biomechanically Informed ACL Injury Prevention Training Intervention in Female Field Hockey Players

ABSTRACT Purpose Anterior cruciate ligament (ACL) injury prevention programs have been shown to have mixed success in reducing injury rates, raising the question whether these programs are effectively targeting biomechanical mechanisms of injury. The current study examined the efficacy of a biomechanically informed ACL injury prevention training program in reducing injury risk and injury incidence and investigated its effect on athletic performance. Participants Twenty-six elite female field hockey players participated in this study. Methods Athletes participated in a 2-yr injury prevention training program. Injury incidence (i.e., lower limb and ACL) and athletic performance (i.e., strength, speed, and aerobic power) were measured during a control season and after two intervention seasons. Biomechanical ACL injury risk factors were recorded during unplanned sidestepping at baseline and after intensive (9 wk: 4 × 20 min·wk−1) and maintenance (16 wk: 3 × 10 min·wk−1) training phases for a subset of athletes (n = 17). Results Training was effective in reducing ACL and lower limb injury incidence after the 2-yr program, where zero ACL injuries occurred after implementation (vs 0.4 per 1000 player hours in the control year). High-risk athletes reduced their peak knee valgus moments by 30% (P = 0.045) and demonstrated improvements in desirable muscle activation strategies after intensive training. The majority of benefits elicited in intensive training were retained during the maintenance phase. One-repetition max strength, beep test scores, and sprint times improved or were maintained over the 2-yr intervention period. Conclusions Biomechanically informed injury prevention training was successful in reducing both biomechanical ACL injury risk factors and ACL injury incidence while maintaining and/or improving athletic performance. It is important to consider the biomechanical mechanisms of injury when designing injury prevention programs.

Machine learning algorithms can classify outdoor terrain types during running using accelerometry data

BackgroundRunning is a popular physical activity that benefits health; however, running surface characteristics may influence loading impact and injury risk. Machine learning algorithms could automatically identify running surface from wearable motion sensors to quantify running exposures, and perhaps loading and injury risk for a runner. Research question(1) How accurately can machine learning algorithms identify surface type from three-dimensional accelerometer sensors? (2) Does the sensor count (single or two-sensor setup) affect model accuracy? MethodsTwenty-nine healthy adults (23.3 ± 3.6 years, 1.8 ± 0.1 m, and 63.6 ± 8.5 kg) participated in this study. Participants ran on three different surfaces (concrete, synthetic, woodchip) while fit with two three-dimensional accelerometers (lower-back and right tibia). Summary features (n = 208) were extracted from the accelerometer signals. Feature-based Gradient Boosting (GB) and signal-based deep learning Convolutional Neural Network (CNN) models were developed. Models were trained on 90% of the data and tested on the remaining 10%. The process was repeated five times, with data randomly shuffled between train-test splits, to quantify model performance variability. ResultsAll models and configurations achieved greater than 90% average accuracy. The highest performing models were the two-sensor GB and tibia-sensor CNN (average accuracy of 97.0 ± 0.7 and 96.1 ± 2.6%, respectively). SignificanceMachine learning algorithms trained on running data from a single- or dual-sensor accelerometer setup can accurately distinguish between surfaces types. Automatic identification of surfaces encountered during running activities could help runners and coaches better monitor training load, improve performance, and reduce injury rates.

A Majority of Anterior Cruciate Ligament Injuries Can Be Prevented by Injury Prevention Programs: A Systematic Review of Randomized Controlled Trials and Cluster–Randomized Controlled Trials With Meta-analysis

Background: Anterior cruciate ligament (ACL) injury prevention programs (IPPs) are generally accepted as being valuable for reducing injury risk. However, significant methodological limitations of previous meta-analyses raise questions about the efficacy of these programs and the extent to which meeting current best-practice ACL IPP recommendations influences the protective effect of these programs. Purpose: To (1) estimate the protective effect of ACL IPPs while controlling for common methodological limitations of previous meta-analyses and (2) systematically categorize IPP components and factors related to IPP delivery to assess the validity of current best-practice IPP recommendations. Study Design: Systematic review with meta-analysis. Methods: A systematic search of 5 electronic scientific databases was conducted to identify studies testing the efficacy of ACL IPPs. Studies were included if (1) the intervention aimed to prevent ACL injury, (2) the incidence rate (IR) or other outcome data that made it possible to calculate the IR for both the intervention and control groups were reported, and (3) the study design was a prospective randomized controlled trial (RCT) or cluster-RCT. Results: Of the 2219 studies screened, 8 studies were included in the quantitative synthesis, and their analysis revealed a significant reduction in ACL IR when athletes received IPPs (IR ratio = 0.47; 95% CI, 0.30-0.73; P < .001). The majority of included IPPs tended to meet minimum best-practice recommendations and incorporated plyometric, strengthening, and agility exercises along with feedback on proper landing technique. However, the specific exercises included in each IPP and key factors related to IPP delivery were highly variable. Conclusion: Despite limiting the analysis to only high-quality studies and controlling for time at risk and potential clustering effects, the study showed that ACL IPPs had a significant protective effect and reduced injury rates by 53%. However, significant variability in the specific exercises and the manner of program delivery suggests that ACL IPPs may be able to be designed within an overarching best-practice framework. This may allow practitioners the flexibility to develop IPPs that meet the specific characteristics of the target population and potentially increase the likelihood that these programs will be widely adopted and implemented.

Effect of a mindfulness programme training to prevent the sport injury and improve the performance of semi-professional soccer players.

Mindfulness improves psychological outcomes. We examined whether greater mindfulness scores were associated with reduced injury rates in soccer players, as well as improved performance at both the individual and team level. This was a parallel-group, pre- and post-test, randomised controlled pilot trial. Forty-five male amateur soccer players from Tehran, Iran, were randomly assigned into experimental (n=23) and control groups (n=22). Outcomes were scores on the mindfulness sport inventory, as well as injury rates and recovery as assessed by a physiotherapist using standardised criteria. Expert observers assessed the effect on individual and team performance. Data were analysed using mixed analysis of variance and, where indicated, its non-parametric alternative, the Friedman test. Significantly greater mindfulness scores in the intervention group were associated with both reduced injury and improved performance. Mindfulness training shows promise in preventing injury and improving performance. The intervention could be applied to other sports and be helpful in clinical settings given the importance of exercise in promoting psychological well-being.

Epidemiology of Foot and Ankle Injuries in NCAA Jumping Athletes in the United States from 2009-2014

Objectives: The purpose of this study was to describe the epidemiology of foot and ankle injuries in men’s and women’s NCAA basketball, women’s volleyball, and women’s gymnastics during the 2009-2010 through 2013-2014 seasons. Methods: Injury surveillance data was obtained from the NCAA Injury Surveillance Program (ISP) for the 2009-2010 through 2013-2014 seasons. Injuries were examined by mechanism, activity during injury, participation restriction time, and recurrence. Injury rates per 1000 athlete-exposures (AEs), injury rate ratios (IRRs), and risk ratios (RR) with 95% confidence intervals were calculated. Reported sex differences were calculated for men’s and women’s basketball. All 95% confidence intervals not containing 1.0 were considered statistically significant. Results: During the study period, 1136 players sustained foot and ankle injuries (483 male, 653 female) over 612,680 AEs. In total, these injuries resulted in a combined rate of 1.85/1000 athlete-exposures (AEs; 95% CI 1.75 -1.97). Ankle sprains were the most common injury overall (63.7%), with lateral ligamentous complex (LLC) injuries comprising 77.1% of all ankle sprains. The most common foot injury varied based on sport and sex. Ankle injury rates were higher in male vs female basketball players (IRR=1.33, 95% CI 1.13 -1.57), but foot injury rates did not differ. Foot injuries occurred at half the rate of ankle injuries, but were significantly more likely to be severe (time loss over 30+ days) (IRR=3.37, 95% CI 1.91-5.949). Among basketball and volleyball athletes, player contact was the most common mechanism of injury and occurred most often while engaging in team jumping activities (rebounding, shooting, blocking, spiking). Surface contact was the most common mechanism in gymnasts. Female gymnasts had higher chronic injury rates than all other sports examined (0.485/1000 AEs, 0.304-0.735, p&lt;0.002). Overall, female basketball players were 1.98 times more likely to suffer an overuse injury than male athletes (95% CI 1.14-3.45, p=0.005). Conclusion: Athletes participating in jumping sports have a higher rate of lateral ligamentous complex ankle sprains than other NCAA sports. Deterring player contact during jumping and landing by way of coaching and/or rule changes may reduce injury rates and improve player safety. The increased prevalence of chronic injuries in female collegiate athletes competing in jumping sports necessitates further investigation in order to identify opportunities to reduce injury rates through prevention and training programs. [Table: see text]

Measuring the Hip Adductor to Abductor Strength Ratio in Ice Hockey and Soccer Players: A Critically Appraised Topic.

Clinical Scenario: Ice hockey and soccer are both dynamic sports that involve continuous, unpredictable play. These athletes consistently demonstrate higher rates of groin strains compared with other contact sports. Measuring the hip adductor/abductor ratio has the potential to expose at-risk players, reduce injury rates, and preserve groin health in players with chronic strains. Focused Clinical Question: What is the clinical utility of measuring the hip adductor/abductor ratio for preseason and in-season ice hockey and soccer players? Summary of Key Findings: Three studies, all of which were prospective cohort designs, were included. One study involved assessing preseason strength and flexibility as a risk factor for adductor strains in professional ice hockey players. Another study performed with the same professional hockey team used preseason hip adductor/abductor strength ratios to screen for those players who would benefit from a strengthening intervention aimed at reducing the incidence of adductor strains. The final study, which was performed in elite U17 soccer players, assessed the effectiveness of monthly in-season strength monitoring as a guide to trigger in-season interventions to decrease injury incidence. Clinical Bottom Line: Measuring the hip adductor/abductor strength ratio in hockey and soccer players can be a beneficial preseason and in-season tool to predict future groin strain risk and screen for athletes who might benefit from a strengthening intervention. Strength of Recommendation: Level 3 evidence exists to support monitoring the hip adductor/abductor strength ratio to assess and reduce the risk of adductor strains in ice hockey and soccer players.

Summer Adaptive Sports Technology, Equipment, and Injuries.

As adaptive sports grow in popularity, it is increasingly important to understand the injuries for which their athletes are at risk. This population is challenging to study given its small size and diversity of its participants; accordingly, research is mostly low quality because of limited sample sizes and study durations. Summer adaptive sports account for 22 of 28 Paralympic sports, with the most frequently studied being wheelchair basketball, rugby, tennis, athletics, swimming, and soccer. Injuries vary by sport because of differences in contact level, limbs utilized, and athlete impairments. Equipment changes and technological advances, especially within wheelchair and amputee sports, have increased the level of competition and reduced injury rates. Fortunately, the majority of injuries across adaptive sports are minor and do not result in significant time off from sport. Still, even minor injuries can negatively impact these athletes' mobility and activities of daily living compared to the nondisabled population.

The effectiveness of traditional tools and computer-aided technologies for health and safety training in the construction sector: A systematic review

For workers, the exposure to on-site hazards can result in fatalities and serious injuries. To improve safety outcomes, different approaches have been implemented for health and safety training in the construction sector, such as traditional tools and computer-aided technologies (e.g., serious games, computer-generated simulations, virtual reality, augmented reality, and mixed reality). However, the effectiveness of these approaches has been barely explored. In order to bridge this gap, a systematic review of existing studies was conducted. Unlike previous review studies in this field that focused on uncovering the technology characters and challenges, this study mainly evaluated the effectiveness of training using traditional tools and computer-aided technologies on the well-being of individuals. Measures of the effectiveness included knowledge acquisition, unsafe behaviour alteration, and injury rate reduction. Results indicated that: 1. the effectiveness of traditional tools is sufficiently supported by statistical evidence; and 2. the use of computer-aided technologies has evidence to support its effectiveness, but more solid evidence is required to support this statement. The systematic review also revealed that the overall performance of computer-aided technologies is superior in several technical aspects compared to traditional tools, namely, representing the actual workplace situations, providing text-free interfaces, and having better user engagement.

INFLUENCE OF A PRE-SEASON COACHES’ EDUCATION WORKSHOP STRATEGY ON ATHLETE INJURY RISK ASSESSMENT

Background: Evidence-based preventive training programs (PTPs) used as a pre-participation warm-up for sport have been shown to reduce injury risk in youth athletes; however, injury risk improvements depend on PTP dosage and fidelity, where increased levels of PTP compliance facilitate and sustain greater reductions in injury risk. While coaches represent the best option to facilitate PTPs long term, it is unknown how to best train coaches to ensure effective PTP implementation behavior. In other areas of health behavior research, education strategies tailored specifically to an individual’s needs and interests increase the likelihood of adopting a given behavior. To encourage youth sport coaches to implement PTPs, it may be beneficial to tailor workshops. One way to gauge the impact of an education strategy is to look at end-user outcomes. Therefore, the purpose of this study was to evaluate changes in athlete injury risk, as measured by the Landing Error Scoring System (LESS), between adolescent basketball and soccer athletes whose coach attended a General pre-season education workshop on PTP implementation compared to a Tailored pre-season education workshop. Methods: A cluster randomized control trial was utilized. Youth soccer and basketball organizations were contacted to participate in a pre-season coaches’ education workshop on PTP implementation. Organizations were randomized into either a General or Tailored workshop. All participating coaches within a given organization attended the same workshop. General workshops contained standardized content including: youth sport injury epidemiology, injury rate and risk reduction benefits of PTPs, and hands-on instruction on how to implement a PTP. Coaches in Tailored workshops completed pre-workshop surveys. The pre-workshop survey contained Likert-style questions on knowledge of and experience with implementing PTPs. Researchers used the results to prioritize and inform content emphasis within the Tailored workshop. For example, if an organization had a high frequency of coaches who reported that they were particularly interested in the sport performance benefits of PTPs, the research team would devote increased time to discussing that particular component. Both the General and Tailored workshop were approximately 1-hour in length but varied in the amount of time spent on different topic areas. Athletes completed a PRE and POST season baseline assessment of injury risk. The injury risk assessment included three trials of a jump-landing task that was evaluated using the Landing Error Scoring System (LESS). The LESS is a valid and reliable clinical movement assessment used to identify high-risk movement patterns during a jump-landing task. LESS scores are based on observable errors, where a higher score indicates a greater number of movement errors and an increased risk of sustaining a lower extremity injury. To complete the task, participants jumped off a 30-cm high box to a distance half of their height and immediately rebounded straight in the air for maximum vertical height. A single, reliable rater graded all trials for PRE and POST. All three trials were averaged together for one composite LESS score at each time point. A mixed model analysis of variance (ANOVA) was used to evaluate differences in composite LESS score over time (PRE, POST) between educational workshops (General, Tailored). All data were analyzed using SPSS Version 21.0 with an a priori alpha level of p&lt;0.05. Results: Seventy-seven athletes on 9 teams across 6 different organizations (Coaches’ Workshops: General=5 teams from 4 organizations; Tailored=4 teams from 2 organizations) completed both PRE and POST testing sessions. There were no significant differences between workshop (General, Tailored) and LESS scores at POST (P&gt;0.05). Regardless of workshop LESS scores improved over time ((Mean±SD [95%CI]) Generalized PRE: 5.46±0.10 [4.84, 6.08], Generalized POST: 4.62±0.10 [4.00, 5.25], Tailored PRE: 5.99±0.09[5.40, 6.59], Tailored POST: 5.66±0.09[5.06, 6.25])(P=0.03). Conclusions: Regardless of coaches’ educational workshop strategy, athletes improved movement technique from PRE to POST across a single sport season. These findings suggest that any level of exposure to PTP-related content could have beneficial downstream effects for the end user, or in this case reduced injury risk for youth athletes. Future studies should look to evaluate the content of pre-season coach education workshops in conjunction with tracking fidelity of program delivery in order to optimize efforts to disseminate and implement PTPs for youth sport coaches. [Figure: see text]

Application of a Preventive Training Program Implementation Framework to Youth Soccer and Basketball Organizations.

Preventive training programs (PTPs) can reduce injury rates and improve neuromuscular control and sport performance. However, PTPs must be implemented correctly and consistently over time for athletes to benefit. Coaches represent the best long-term option for implementing PTPs. Youth athletes are at the optimal age for developing good habits before maturation. Although frameworks have been proposed to guide implementation efforts, little is known regarding the feasibility and real-world context of PTP implementation at the youth sport level. To evaluate the application of the 7-Step framework for promoting implementation of a preseason PTP workshop. Descriptive epidemiology study. Youth soccer and basketball organizations. Organizations with at least 1 team of athletes aged 8 to 14 years were invited to participate in a free preseason coaches' education workshop on PTP implementation. The 7-Step framework was used to guide PTP education and implementation for each organization. Personnel at organizations that agreed to participate attended a single preseason workshop for coaches. Research staff were available as a resource throughout the season but did not actively implement or monitor the PTPs. Retrospective evaluation of each organization's completion of steps 1 through 5 of the 7-Step framework. A total of 62 youth soccer (n = 40) and basketball (n = 22) organizations were invited to participate. Twelve organizations completed steps 1 through 4 and steps 5a through 5d. The highest drop-off rate occurred during step 1, "Establishing Administrative Support." No organization completed all components of steps 1 through 5. To better understand how to successfully promote PTP adoption, we must identify the implementation steps that may present the most challenges. Because the highest drop-off rate was seen during the initial step, establishing administrative support and strengthening initial engagement are necessary to improve PTP implementation.

Intraoperative Neurophysiological Monitoring of the Phrenic Nerve: Utility and Descriptions of the Technique

In surgical procedures of the supraclavicular and lateral cervical regions, as well as in cardiac and mediastinal surgeries, diaphragm function can be compromised by the risk of injury to the phrenic nerve and/or the C4 root. There are few publications that treat the intraoperative stimulation of these nerve structures to evaluate their functionality and, to our knowledge, until now it has not been hypothesized about whether it is possible to reduce the injury rates, which reach 26% in some cardiac surgery studies.We describe the technique used for the neurophysiological monitoring of the phrenic nerve. Also, its usefulness and advantages over other techniques are discussed.We conclude that, with the increasing incorporation in recent years of intraoperative neurophysiological monitoring, its application to the phrenic nerve is possible in procedures with a risk of injury and, thus, the reduction of iatrogenic injury rates may be feasible.

Musculoskeletal Injuries Are Commonly Reported Among Gastroenterology Trainees: Results of a National Survey.

Endoscopy-related musculoskeletal injuries are increasingly recognized among gastroenterologists. While injury rates and risk factors have been studied among practicing gastroenterologists, little is known about rates among trainees during fellowship. This study analyzes the prevalence of endoscopy-related overuse injuries and risk factors for injuries among a national sample of gastroenterology (GI) fellows. We also surveyed GI fellowship program directors and fellows about perceptions of overuse injuries during GI training. We distributed a 29-item electronic survey to GI fellows at accredited programs in the USA in April 2016. Survey items included demographic information, questions pertaining to injuries, and level of agreement on the importance of ergonomics training in GI fellowship. Additionally, we distributed a 7-item electronic survey to fellowship program directors evaluating perception of overuse injuries and prevention during fellowship training. Fisher's exact test determined factors associated with sustaining an injury. An estimated 1509 fellows received the survey. Eleven percent (n = 165) of gastroenterology fellows completed the survey. Twenty percent reported having a musculoskeletal injury. Female gender was the only factor associated with a higher rate of reported injury (p < 0.01). The most common injuries reported were thumb and other hand-related pain (n = 28 [64%]). Musculoskeletal injuries may affect up to 20% of GI fellows. Female fellows more frequently report injuries and may be at particularly high risk which has not been found in previously reported surveys of practicing gastroenterologists. Standardized curricula on ergonomic considerations and injury prevention are needed to enhance GI fellowship training and reduce injury rates.

Monitorización neurofisiológica intraoperatoria del nervio frénico: utilidad y descripción de la técnica

In surgical procedures of the supraclavicular and lateral cervical regions, as well as in cardiac and mediastinal surgeries, diaphragm function can be compromised by the risk of injury to the phrenic nerve and/or the C4 root. There are few publications that treat the intraoperative stimulation of these nerve structures to evaluate their functionality and, to our knowledge, until now it has not been hypothesized about whether it is possible to reduce the injury rates, which reach 26% in some cardiac surgery studies.We describe the technique used for the neurophysiological monitoring of the phrenic nerve. Also, its usefulness and advantages over other techniques are discussed.We conclude that, with the increasing incorporation in recent years of intraoperative neurophysiological monitoring, its application to the phrenic nerve is possible in procedures with a risk of injury and, thus, the reduction of iatrogenic injury rates may be feasible.

General versus sports-specific injury prevention programs in athletes: A systematic review on the effect on injury rates.

IntroductionAnnually, 2 million sports-related injuries are reported in Germany of which athletes contribute to a large proportion. Multiple sport injury prevention programs designed to decrease acute and overuse injuries in athletes have been proven effective. Yet, the programs’ components, general or sports-specific, that led to these positive effects are uncertain. Despite not knowing about the superiority of sports-specific injury prevention programs, coaches and athletes alike prefer more specialized rather than generalized exercise programs. Therefore, this systematic review aimed to present the available evidence on how general and sports-specific prevention programs affect injury rates in athletes.MethodsPubMed and Web of Science were electronically searched throughout April 2018. The inclusion criteria were publication dates Jan 2006–Dec 2017, athletes (11–45 years), exercise-based injury prevention programs and injury incidence. The methodological quality was assessed with the Cochrane Collaboration assessment tools.ResultsOf the initial 6619 findings, 15 studies met the inclusion criteria. In addition, 13 studies were added from reference lists and external sources making a total of 28 studies. Of which, one used sports-specific, seven general and 20 mixed prevention strategies. Twenty-four studies revealed reduced injury rates. Of the four ineffective programs, one was general and three mixed.ConclusionThe general and mixed programs positively affect injury rates. Sports-specific programs are uninvestigated and despite wide discussion regarding the definition, no consensus was reached. Defining such terminology and investigating the true effectiveness of such IPPs is a potential avenue for future research.

Risky Ride or Carefree Drive? An Analysis of Virginia’s Moped Safety and Registration Law on Operator Collision and Injury Outcomes

The U.S. State of Virginia enacted a two-phased moped operator law, SB 1038, in 2013 that was intended to reduce collisions and injuries by requiring basic safety equipment, possession of identification (ID), and obtaining vehicle registration. This study evaluates the law’s effect on moped collisions, injuries, and fatalities through a two-part evaluation framework of the pre- and post-policy implementation periods. These components include a series tool, the interrupted time series analysis (ITSA), and a logistic regression of individual-level crash characteristics. The research design controls for gasoline prices, socioeconomic status, roadway conditions, population, seasonality, alcohol consumption, age, and gender, among other factors. Findings from ITSA demonstrate that the implementation of a helmet and ID requirements for moped operator reduced collision rates in the months following that requirement, however no such effect was found for reductions in serious injury and fatality rates, or frequencies following that stage and the vehicle registration requirement (referred to as Phase II). The logistic regression analysis of individual moped collision outcomes similarly found no support for Phase II’s role in reducing the risk of serious injury and fatal outcomes. As a public safety policy, SB 1038 was partially effective through its reduction of moped collisions, though the mechanism for achieving this is unclear. Potential explanations include the policy’s role in reducing the pool of risk-taking individuals through disincentivizing moped use, and mainstreaming safer moped operation. The study’s results indicate that states without moped operator requirements could experience reduced moped collisions from adoption of similar legislation.

A systematic review of injuries in gymnastics

ABSTRACTObjectives: To identify all studies of gymnastics injuries and assess injury rates, types, locations, and causes.Methods: Seven electronic and two grey literature databases were searched. Two reviewers independently assessed titles/abstracts, abstracted data, and calculated average rates weighted by study size.Results: One study (n = 963) of three Olympic games (2008,2012,2016) provided injury rates for females of 86.4/1000gymnasts and males 79.9. For 29 databases one study of males (n = 64) provided a rate of 8.8 injuries/1000hours/AE (AE = athletic-exposure) and three of females varied rates (8.5, 9.4, and 91). Three studies for males (n = 153) provided a weighted average rate of 1.4 injuries/1000hours/training, and for females six studies (n = 476) 1.5 injuries. Four studies of males (n = 286) provided a weighted average of 678 injuries/1000gymnasts per year and eight studies of females (n = 1,764) a rate of 306. Of 19 surveys, eight provided rates for females (n = 1,463) of 596 injuries/gymnast per year and two for males (n = 40) a rate of 1,036. In the Olympics injuries were preponderately lower limb (63%) then trunk (23%) and upper limb (14%); injury type was sprains (35%) followed by tendinopathy/arthritis/impingements (17%), contusions (10%), and fractures (7%). Five database studies provided injury location data for 274 males: averages weighted by study size were upper extremity 42.8%, lower extremity 33.6%, torso/spine 11.8%, and head/neck 4.9% and 12 studies with 843 females provided average rates for lower extremity 51%, upper extremity 30.8%, torso/spine 13% and head/neck 0.8%. Official gymnastics organizations’ websites provide no readily available data about injury rates or methods of prevention.Conclusions: Studies need to collect comprehensive data for injury rates by training/competitions, gender, age, injury location/type/cause. Studies could assess whether trainers and physiotherapists monitoring gymnasts closely for injury risk would reduce injuries. Studies including randomized controlled trials (RCTs) of interventions in training, videotaping and performance feedback to reduce injury rates would be helpful.

Injury Prevention Strategies for Adolescent Cricket Pace Bowlers

Adolescent cricket pace bowlers are prone to non-contact shoulder, low back and lower-limb injuries. Exercise-based injury prevention programmes (IPPs) are effective for reducing non-contact injuries in athletes; however, a specific programme for adolescent pace bowlers has not been published. This paper therefore seeks to provide a rationale for the development of an exercise-based IPP specific for adolescent pace bowlers. It also outlines design principles and provides an example exercise programme that can be implemented at the community level. In addition, the paper addresses other injury prevention techniques concerned with the prescription of appropriate bowling loads and the modification of poor bowling biomechanics. Performing an exercise-based IPP before cricket training could reduce injury rates in adolescent pace bowlers. Eccentric strengthening exercises can be employed to target injuries to the posterior shoulder muscles, hip adductors and hamstring muscles. The risk of low back, knee and ankle injury could also be reduced with the inclusion of dynamic neuromuscular control exercises and trunk extensor endurance exercises. Other prevention strategies that need to be considered include the modification of poor bowling biomechanics, such as shoulder counter-rotation and lateral trunk flexion. Coaches and players should also aim to quantify bowling load accurately and coaches should use this information to prescribe appropriate individualised bowling loads. Specifically, players would benefit from avoiding both long periods of low load and acute periods when load is excessively high. Future evidence is needed to determine the effectiveness of the example programme outlined in this paper. It would also be beneficial to investigate whether the modification of bowling biomechanics is achievable at the non-elite level and if bowling load can be accurately measured and manipulated within a community-level population.

All-terrain vehicle serious injuries and death in children and youth: A national survey of Canadian paediatricians.

All-Terrain Vehicles (ATVs) are a leading cause of serious injury in children and youth. Certain Canadian regions have implemented legislation to promote safety, including age restrictions, mandatory training and helmet use. Jurisdictions with more stringent ATV safety legislation have been shown to have reduced injury rates in the short term. To estimate the burden of ATV-related serious injury and death in Canada and to identify Canadian physicians' knowledge of ATV-related legislation, safety and health promotion practices. A one-time survey was distributed to practicing paediatricians and paediatric subspecialists participating in the Canadian Paediatric Surveillance Program (CPSP) in October 2016. Of 2793 physicians contacted, 904 responded (32.4%). There were 181 reported cases of serious and/or fatal ATV-related injuries, including 6 deaths. Children aged 10 to 14 represented the most number of cases (n=82, 45.3%), followed by 15 to 19 (n=48, 26.5%) and 5 to 9 (n=40, 22.1%). Most cases occurred in July/August (48.3%) and May/June (25.2%), were in males (n=133, 78.2%), and occurred during recreational activity (n=139, 83.2%) or organized racing (n=6, 3.6%). In 99 cases (58.9%), the child was the driver of the ATV. Only two-thirds of respondents (67.5%) knew that ATVs should not carry passengers while under half (42.2%) never discussed ATV safety with their patients. ATV-related injuries and deaths in Canadian children remain a serious public health problem. Education of health care practitioners, including paediatricians, is needed to promote safety. Despite efforts to reduce ATV-related injuries, there remains a significant number of serious injuries and/deaths related to their use.

The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial

BackgroundGroin injuries represent a considerable problem in male football. Previous groin-specific prevention programmes have not shown a significant reduction in groin injury rates. An exercise programme using the Copenhagen Adduction...