Risk Factor For Subsequent Injury Research Articles

Plantar fasciitis injury status influences foot mechanics during running

BackgroundThe biomechanical factors related to plantar fasciitis are not well understood. A history of injury is considered a risk factor for subsequent injury, but it is unknown if differences in mechanics exist before, during, and after injury. This study compared gait mechanics among individuals with plantar fasciitis, resolved plantar fasciitis, and uninjured controls. MethodsThirty male and female runners were divided into three groups: 1) plantar fasciitis (n = 10, age 43 ± 11 years); 2) resolved plantar fasciitis (n = 10, age 43 ± 13 years); and 3) control (n = 10, age 38 ± 11 years). Participants ran at preferred velocity and 3.3 m/s while kinematics and kinetics were collected. Variables of interest include vertical loading rate, foot, ankle, knee, and hip kinematics, arch height index, arch rigidity index, and arch drop. Group differences were analyzed at each velocity using one-way analysis of variance. FindingsThe plantar fasciitis group exhibited less forefoot extension (P = 0.02), more midfoot inversion (P < 0.01), and more midfoot extension (P < 0.01) than the resolved plantar fasciitis group. Foot mechanics in controls did not differ. Sagittal knee range of motion was greater in the plantar fasciitis group than resolved or control (P = 0.01). No other variables were significantly different among groups. InterpretationThe plantar fasciitis group exhibited dynamic foot mechanics which suggest a lower, more flexible arch compared to the resolved group, although static measures of foot structure and ankle motion did not differ. The differences between these groups indicate that the motion of the forefoot and midfoot during gait are important to consider for plantar fasciitis.

Can Achilles and patellar tendon structures predict musculoskeletal injuries in combat soldiers?

Aiming to investigate whether Achilles tendon (AT) structure and patellar tendon (PT) structure are risk factors for musculoskeletal injuries in combat soldiers, 168 participants were recruited from an infantry commander's course. The AT and PT were examined pre-course using UTC to capture the structure of four echo-type fibers (I-IV). All injuries were assessed by military physicians pre-course and throughout the 14-week course. Soldiers who were injured during the course had a significantly higher pre-course prevalence of AT and PT echo-type III and echo-type IV compared to soldiers that were not injured during the course. Variables that were found to be associated with injured/non-injured participants were echo-type III+IV of the PT (OR=1.44, 95% CI=1.24-1.68) and echo-type III of the AT (OR=1.69, 95% CI=1.35-2.12). ROC analyses showed that the best model, exhibiting both high sensitivity and low specificity, was that participants with PT echo-type III+IV>10% or AT echo-type III>8.5% had the highest risk of being injured during the course. In conclusions, the tendon structure at the beginning of high-intensity activity or physical training program might be a risk factor for subsequent injury during the course. Soldiers and high-level athletes should be aware of the cutoff points for fiber types in tendon structure that might put them at high risk for future injury. At-risk soldiers/athletes should be provided with an intervention program before they start their training program, with the aim of improving the tendon structure and preventing subsequent injury.

Session Availability as a Result of Prior Injury Impacts the Risk of Subsequent Non-contact Lower Limb Injury in Elite Male Australian Footballers.

Prior injury is a commonly identified risk factor for subsequent injury. However, a binary approach to classifying prior injury (i.e., yes/no) is commonly implemented and may constrain scientific findings, as it is possible that variations in the amount of time lost due to an injury will impact subsequent injury risk to differing degrees. Accordingly, this study investigated whether session availability, a surrogate marker of prior injury, influenced the risk of subsequent non-contact lower limb injury in Australian footballers. Data were collected from 62 male elite Australian footballers throughout the 2015, 2016, and 2017 Australian Football League seasons. Each athlete’s participation status (i.e., full or missed/modified) and any injuries that occurred during training sessions/matches were recorded. As the focus of the current study was prior injury, any training sessions/matches that were missed due to reasons other than an injury (e.g., load management, illness and personal reasons) were removed from the data prior to all analyses. For every Monday during the in-season periods, session availability (%) in the prior 7, 14, 21, 28, 35, 42, 49, 56, 63, 70, 77, and 84 days was determined as the number of training sessions/matches fully completed (injury free) relative to the number of training sessions/matches possible in each window. Each variable was modeled using logistic regression to determine its impact on subsequent injury risk. Throughout the study period, 173 non-contact lower limb injuries that resulted in at least one missed/modified training session or match during the in-season periods occurred. Greater availability in the prior 7 days increased injury probabilities by up to 4.4%. The impact of session availability on subsequent injury risk diminished with expanding windows (i.e., availability in the prior 14 days through to the prior 84 days). Lesser availability in the prior 84 days increased injury probabilities by up to 14.1%, only when coupled with greater availability in the prior 7 days. Session availability may provide an informative marker of the impact of prior injury on subsequent injury risk and can be used by coaches and clinicians to guide the progression of training, particularly for athletes that are returning from long periods of injury.

Injury Risk In Athletes With And Without A History Of Lower Extremity Injury

Previous injury has been shown to be a risk factor for subsequent injury. Female basketball athletes are at greatest risk for injury during puberty, generally ages 10–17, and are 3.5 times more likely to injure an anterior cruciate ligament than their male counterparts. Landing technique has been shown to identify lower extremity (LE) injury risk in youth athletes. PURPOSE: To compare injury risk of female youth basketball athletes with and without history of LE injury. METHODS: Sixty-five female basketball athletes volunteered to participate in a single test session during which they completed a questionnaire regarding injury history and performed a jump-landing task videotaped from the front and side. Previous LE injury history was defined as any self-reported injury to the foot, ankle, lower leg, knee, thigh or hip. A single rater blinded to injury history graded all videos using the Landing Error Scoring System (LESS). Separate independent t-tests compared athletes with and without LE injury history, with knee injury history and no LE injury history, and with ankle injury history and no LE injury history (α=0.05). RESULTS: Forty athletes reported history of LE injury (13±1 yr, 165.7±9.8 cm, 57.4±13.9 kg), of which 20 reported history of knee injury (14±2 yr, 167.5±8.8 cm, 61.8±15.7 kg) and 24 reported history of ankle injury (14±2 yr, 167.6±10.0 cm, 60.6±15.7 kg). Twenty-five athletes reported no history of LE injury (12±2 yr, 161.3±9.9 cm, 52.6±12.5 kg). No significant differences in LESS score were observed between athletes with (5.2±1.8 errors) and without (5.3±2.2 errors) history of LE injury (p>0.05, mean difference= 0.12±0.5 errors, 95%CI [−0.9, 1.1]) No significant differences in LESS score were found between athletes with history of knee injury and with no history of LE injury (p>0.05, mean difference= −0.124±0.7 errors, 95%CI [−1.4, 1.2]) as well as athletes with history of ankle injury and no history of LE injury (p>0.05, mean difference= 0.5±0.6 errors, 95%CI [−0.7, 1.6]). CONCLUSION: History of LE, knee or ankle injury did not increase injury risk compared to athletes with no LE injury history. Our results do not support previous findings that prior LE injury increases risk of subsequent injury. Further research is needed to evaluate the impact of LE injury history on injury risk in at-risk populations.

History of Shoulder Instability and Subsequent Injury During Four Years of Follow-up

Little is known about the risk factors for glenohumeral joint instability. We hypothesized that a prior history of instability would be a significant risk factor for subsequent injury. We conducted a prospective cohort study over a four-year period within a high-risk group of young athletes to address the research hypothesis. Subjects were freshmen entering the U.S. Military Academy in June of 2006. Part of the baseline assessment included documenting a prior history of glenohumeral instability on entry into the study. All subjects were followed for subsequent glenohumeral joint instability events until graduation in May of 2010. The primary outcome of interest in this study was time to glenohumeral instability event during the follow-up period. We examined injury outcomes, looking for any instability, anterior instability, and posterior instability events. Cox proportional-hazards regression models were used to analyze the data. Among the 714 subjects, eight shoulders were excluded from the analyses due to prior surgical stabilization, leaving 1420 shoulders, of which 126 had a self-reported prior history of instability. There were forty-six (thirty-nine anterior and seven posterior) acute instability events documented in the cohort during the follow-up period. Subjects with a prior history of instability were over five times (p < 0.001) more likely to sustain an acute (anterior or posterior) instability event during the follow-up period. Subjects with a history of instability were also 5.6 times (p < 0.001) more likely to experience a subsequent anterior instability event and 4.6 times (p = 0.068) more likely to experience a posterior instability event during follow-up. Similar results were observed in multivariable models after controlling for the influence of demographic and baseline physical examination findings. Despite meeting the rigorous physical induction standards for military service, subjects with a prior history of glenohumeral joint instability were approximately five times more likely to experience a subsequent instability event, regardless of direction, within this high-risk athletic population.

Past Injury as a Risk Factor: An Illustrative Example Where Appearances Are Deceiving

Previous injury is believed to be a causal risk factor for subsequent injury. Using empirical data on circus artists (n = 1,281 artists) between 2004 and 2008 in Montreal, Canada, as a motivating example, the authors use patient vector plots to demonstrate that a bias away from the null must always occur in the typical analyses cited as evidence (i.e., survival analysis, Poisson regression), except in the improbable context where all subjects have the same inherent risk independent of previous injury. In addition, using simulated data, the authors demonstrate that a simple method that conditions on the individual will approximate conclusions from more complex analytical methods. By using the typical analysis of the authors' empirical data, Kaplan-Meier curves and Cox regression suggested increasing injury rates for both the second and third injuries compared with the first injury. However, conditional analyses using a matched population (i.e., time to first, second, and third injuries among artists with 3 or more injuries) showed that injury rates were unchanged for both the second and third injuries compared with the first injury. These results suggest that previous injury should not be evaluated as a causal risk factor unless one conditions on the individual in some way.

The effects of health status, distress, alcohol and medicinal drug use on subsequent motor vehicle injuries

Objective The purpose of this study was to examine the effects of health factors and substance use on subsequent motor vehicle collision (MVC) injuries of three different age groups, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994–2002. Methods Path analysis technique was used to determine the relations between MVC injury and four risk factors: binge drinking; health status; distress; and medication use. The three demographic variables, age at ‘baseline’, sex, and immigration status were added into the model as control variables. Three age groups were examined: young = 12–29.9; middle-aged = 30–59.9 and old = 60–85 years of age. The total sample size was 16,093. Results A lower percentage of males, older persons, immigrants, and non-binge drinkers reported a subsequent MVC injury, as did respondents reporting better health and lower distress scores. Medication use was associated with higher subsequent MVC injuries. Path analysis found that among younger individuals, the variable binge drinking, was the only significant risk factor associated with subsequent injuries. In contrast, among middle-aged individuals, the variable medication use, was the only statistically significant risk factor for subsequent injuries. No variables were significant risk factors of injuries for older individuals. Conclusions Various demographic and risk factors were found to influence injuries among a nationally representative sample of Canadians. Reported binge drinking among young individuals and medication use among middle-aged individuals were found to be risk factors for subsequent MVC injury. These findings support the need for continued focus on alcohol, drugs and traffic safety.

Factors associated with risk for subsequent injuries after traumatic spinal cord injury

Krause JS. Factors associated with risk for subsequent injuries after traumatic spinal cord injury. Arch Phys Med Rehabil 2004;85:1503–8. Objectives To identify the annual incidence and risk factors for subsequent injury among subjects with preexisting spinal cord injury (SCI) Design Cross-sectional, mailed survey. Setting A specialty hospital in the southeastern United States. Participants Subjects (N=1328) with SCI participated in this study (response rate, 72%), each of whom met the following inclusion criteria: (1) traumatic SCI with residual impairment American Spinal Injury Association (ASIA) grades A through D, (2) nonsurgical onset, (3) age 18 years or older at the time of the study, and (4) a minimum of 12 months post-SCI. Interventions Not applicable. Main outcome measures A general health assessment survey was used that required participants to report the number of injuries that were severe enough to require treatment in a clinic, emergency department, or hospital in the past year, as well as whether any injury resulted in hospitalization. Risk measures included the Behavioral Risk Factor Surveillance System, CAGE, Zuckerman-Kuhlman Personality Questionnaire, Multidimensional Health Locus of Control scale, and prescription medication usage. Results Nineteen percent of participants reported at least 1 injury within the past year, with an annual incidence of .33 when considering those with multiple injuries. Twenty-seven percent of those with at least 1 injury reported 1 or more injury-related hospitalizations in the past year. Being younger; having an ASIA grade D injury; higher sensation-seeking scores; heavy drinking; and prescription medication use for pain, spasticity, depression, and sleep were associated with a greater likelihood of subsequent injuries. Conclusions Subsequent injuries impact nearly 20% of people with SCI annually; yet, this problem has received little attention in the literature. Further study is needed to identify the costs, severity, and circumstances surrounding injury to design prevention programs that target risk behaviors.

Evaluating risk of re-injury among 1214 Army Airborne soldiers using a stratified survival model

Background: Many factors interact to influence an injured individual’s risk of sustaining a second injury. However, the quantitative assessment of subsequent injury risk has been limited, primarily due to methodologic constraints. The purpose of this study is to present analytical methodology not previously employed in injury epidemiology to identify risk factors for subsequent injury. Methods: Data were collected from a retrospective cohort of 1214 U.S. Army Airborne soldiers. Lower extremity and low-back musculoskeletal injuries were identified from outpatient medical records. The Prentice, Williams, and Peterson (PWP) model, stratified by injury event, was used to identify risk factors for initial and subsequent injuries. A Cox proportional hazards model to the time of last injury was used to determine the magnitude of the increased risk associated with having a previous injury history. Results: Risk factors for initial injuries were similar to those seen in other epidemiologic studies of military populations. However, this study found that race/ethnicity, physical fitness, medical provider training, and initial injury types (traumatic versus other) were associated with subsequent injury risk. Additionally, the observed risk of injury was seven times greater among previously injured individuals. Conclusions: In this population, the risk factors for injury differed by event (initial or subsequent injury), and prior injury history was a risk factor for subsequent injury. The associations between demographic characteristics, the nature of the initial injury, and risk of subsequent injury suggest that changes in the evaluation and medical management of injured individuals may decrease the risk of subsequent injury.