Last week in Australia was National Science Week, a nation-wide celebration of science and technology via three key pathways.
Pathway one is to inspire the general public to be involved in science – creating new knowledge – through engaging activities such as Citizen Science. This year’s Citizen Scientists are identifying Australian wildlife that are featured in photos captured via automatic cameras, and anyone with internet access can participate whether they have a university qualification or not. This fantastic activity means that science is indeed inclusive, when many times it can feel like science is a members-only club.
The second pathway is through showcasing the contributions of scientists to the world of knowledge through the Australian Institute of Policy and Science Tall Poppy Awards. As the joint-Queensland 2015 winner of this award, I was delighted to attend the 2016 award evening on Wednesday and was pleased to learn about innovative projects across a breadth of disciplines, such as infecting coeliacs with hookworms, the sexual attractiveness of facial hair, and optimising agricultural irrigation to name a few. Next month I will be one of the inaugural Flying Scientists, bringing science to rural regions in which exposure to science can be limited.
The third pathway relates to a flurry of activities to inspire the next generation to be scientists – both today and in their future education and career paths. Recognising the importance of encouraging girls in particular to become – and stay – engaged in scientific pursuits, I was delighted to host the first University of the Sunshine Coast Growing Tall Poppies program in my research unit here at the University of the Sunshine Coast earlier this year.
Adolescent Risk Research Unit team members Jeanne, Jamie, and Natalie, mentoring Sasha, Isabella, Mikayala, and Sian.
The four Grade 10 students learnt about career paths through and in science, and conducted their own research project under the guidance of members of my team, before making a presentation of their research activities and the key findings before the senior school assembly on Wednesday morning. This presentation was very well-received by the students and teachers in attendance, further breaking silos such as ‘academics’, ‘schools’, and ‘science’ which can pervade.
Bridie and the 4 GTP stars after their school assembly presentation.
If we are to continue to effectively prevent injury, we need to make science accessible to everyone, and to the next generation especially.
I have invited Dr Johna Register-Mihalik (follow her on Twitter @johnamihalik), an assistant professor in the Department of Exercise and Sport Science at The University of North Carolina at Chapel Hill, to share her thoughts on concussion prevention with us. Dr Register-Mihalik serves as a research scientist at the Injury Prevention Research Centre at UNC-CH. She is on the Brain Injury Association of North Carolina Board and USA Baseball’s Medical and Safety Advisory Committee, and is also an active member of the National Athletic Trainers’ Association (NATA) and the American College of Sports Medicine (ACSM), amongst others.
[JRM] Few injuries receive the attention and the discussion that concussion does, especially those occurring in sports such as football, in both the mainstream and medical communities. Concussion is a complex injury that is the result of forces transmitted through the brain, resulting in a complex neurometabolic cascade leading to a wide array of signs and symptoms. The more we learn about concussion, as well as exposure to head impacts, the more we realize that we don’t know. It is an injury, that – perhaps because it is the brain that is affected – most in the sporting community are hyper aware of, regardless of level of participation.
However, due to this increasing attention and focus, one of the most common discussions and recommendations is to change the “culture” to improve safety concerning concussion and head trauma. However, when we say “change the culture”, what are we actually trying to change? Certainly, we can think of key things we want to see changed universally, such as: recognizing as many injuries as possible, student-athletes disclosing these injuries if they haven’t been identified (when possible), individuals and organizations consistently adhering to no same day return to play, no student-athlete returning to play without clearance from a medical professional with the training to make the decision, and perhaps more general, a sporting environment that encourages safe practices, not playing through injury, and creates a positive environment for players, coaches, fans, and families alike. I am sure we could continue to add to this list of things we want to change or see as a consistent part of sport. However, most factors or behaviors around the culture of sport are complex and multifaceted.
For one, many aspects of the culture of sport that are at their core good, may progress to risky decisions down the road. Let’s take the concept of persistence and not quitting. While at the core those are good things, these may be the constructs that then drive playing through injuries, especially those like concussions that we cannot always see. While no studies have directly addressed these relationships, data does highlight not wanting to let teammates or coaches down and not wanting to be pulled from play as primary reasons for not disclosing a concussion (McCrea, 2004, Register-Mihalik, 2013; Kerr, 2016). In addition, there is data to show that even some of the efforts that we direct to improve the culture, may have a negative effect (Kroshus et al, 2015) . This body of work highlights the importance of careful thoughtful messaging and imagery giving in our educational sessions, videos, and programs.
The type of change we talk about around concussion and head trauma is multifaceted. As such, the work to truly improve outcomes, improve behaviors, and create a “safe” environment (both social and physical) must also be multifaceted and affect multiple levels of the socio-ecological framework. It is also work that should be thoughtful, not sensationalized, and rooted in evidence – which can all be difficult things in the face of such heightened attention around a topic, where many have opinions. The work to truly insightful change will continue to require an interdiscplinary and community-based approach to not only develop the interventions and tools for change, but to see them be both successfully implemented and sustainable. I for one am excited about this work ahead and look forward to working with others to continue to see change happen for the better.
The Translating Research into Injury Prevention Practice (TRIPP) framework, developed by Caroline Finch a decade ago, built on van Mechelen and colleagues’ ‘sequence of prevention’ for sports injuries. TRIPP highlighted the fact that only research that can, and will, be adopted by sports participants, their coaches and sporting bodies will prevent sports injuries. Stage 5 of TRIPP (‘Describe intervention context to inform implementation strategies) introduced the (then) novel idea of focusing research attention on understanding how the outcomes of efficacy research (TRIPP Stage 4) could be translated into interventions (policies, programmes, environmental or technical modifications) that could be actually implemented in the real-world context. This included developing an understanding of the best way to target and market evidence-based interventions to sport bodies and their participants.
However, implementing injury prevention programmes in the real-world is challenging and there is precious little information available in the scientific literature about how to transition from having an evidence-based intervention to getting that intervention widely, properly and sustainably implemented. As a consequence, most research remains in the early stages of these models/frameworks (i.e. describing the extent of the problem and identify causes or mechanisms of injury) which limits the potential for injuries to be prevented.
In a soon to be completed study investigating the factors that influence the translation of evidence-based injury prevention interventions into practice in community sport, I (as the project manager) found myself in the situation where my colleagues and I had:
What we then needed was an implementation plan for FootyFirst. The burning question was how can we ensure that the programme we had developed will be used and maintained for as long as it is needed by community-level Australian Football coaches and players?
Luckily for me, I had recently attended a short training course facilitated by Guy Parcel (then Dean Emeritus of the University Texas School of Public Health (Austin) on Intervention Mapping (IM). IM is a framework for health promotion intervention development underpinned by the notion that the impact of a health promotion (or injury prevention) programme is a function of the programme (its efficacy) and its implementation (whether people actually use it properly for sustained periods of time). IM is a six-step tool for planning and developing health promotion programmes. Like other programme planning frameworks, it starts with needs assessment and ends in evaluation. However, unlike other frameworks, it includes a step (Step 5) specifically focused on planning programme adoption, implementation and sustainability. IM Step 5 comprises seven tasks that are operationalised through six core processes (see Figure 1) and can be used independent of the other IM steps.
The thing I found particularly useful about IM Step 5 was that it helped me to focus my attention on answering some key questions during the FootyFirst implementation planning process including:
Who will decide to use FootyFirst and who will deliver it to the players?
How can we involve the delivers (coaches) and participants (players) in developing the implementation plan for FootyFirst?
What do community-AF coaches actually need to do to adopt and implement FootyFirst?
What is likely to influence whether coaches adopt and implement FootyFirst?
What needs to change for coaches to adopt and implement FootyFirst?
What strategies could be used to help, support or encourage coaches to achieve the identified changes?
Why do we think a particular implementation strategy is likely to work – what is the evidence or theoretical underpinnings for the selected strategy?
based on a partnership between health promotion, implementation science, and injury prevention researchers, and community sports administrators and coaches;
informed by behaviour change theory, implementation science frameworks and published evidence about effective implementation strategies for safety programmes in community sport; and
supplemented with in-depth knowledge of the implementation context and input from the programme end-users.
This in turn enabled us to develop an implementation plan specifically designed to bridge the gap between research (top-down) and community (bottom-up) driven programme implementation processes.
Our experience demonstrates the critical importance of researchers, practitioners and community end-users collaborating early in the implementation planning process underpinned by a mutual respect for the knowledge, skills and experience that these different groups bring to the implementation planning process.
Dr Soomro kindly agreed to answer a few questions for the blog!
Q1. Tell us about Cricket Predict; what is it and how did you come up with the concept?
I’ve been interested in prediction for a long time now. Today, we use technology and science to predict everything from the weather to cardiovascular risk. This carries into Sport as well: If you have a look at NFL, previous injury is used extensively in determining injury risk; Rugby players are similarly triaged using GPS data and the number of tackles per game. My aim was to develop a similar system for Cricket.
Cricket predict is a mobile app that harnesses technology in the surveillance of injuries, measures risk factors for injury and ultimately, aims to predict (and prevent!) injury. By tracking risk factors for injury in real-time, medical and coaching staff can receive alerts when an individual player’s risk profile is high – and interventions can be implemented. Further, whenever a player is injured, there is an electronic injury form which can be filled out through the app that goes onto a central online database, helping with identification of injuries.
Q2. Cricket predict utilises a number of different risk factors to help predict injury, what is the evidence for using these risk factors specifically? The risk factors that are used in Cricket Predict are all validated in the literature. They include:
I. Cricket workload, such as number of balls bowled
II. Non-cricket workload e.g. Strength and conditioning sessions, cross-training
III. Psychological status – measured by a modified Profile of Mood States (POMS) questionnaire, usually 76 items but modified to 10 items to be cricket-specific and “player-friendly”.
IV. Sleep, a measure of fatigue and documented risk factor for injury, measured by an accelerometer and analysed by Activ Graph.
V. Previous injury profile
VI. Pre-season strength parameters, including Internal Rotation to External Rotation ratio (predicts injury in Throwing Athletes), Hamstring to Quadriceps ratio (predicts hamstring injury)
Cricket Predict’s algorithm incorporates all of these risk factors and displays to the user a graphical representation of the player’s injury risk. However, exactly how predictive these risk factors are in cricket players is yet to be studied and my research group is running a prospective validation study to do just that. Q3. What are the implications of the findings of this study for readers?
There are 2 main implications of this research:
One of the biggest implications of my research is the integration of technology into Sports Medicine, which I see as the way forward. Its one of the reasons I developed this mobile app. Developing an electronic injury surveillance system makes data collection very easy, and numerous studies have demonstrated that electronic injury surveillance systems are superior to paper-based systems. Additionally, with the advent of wearable technology, large amounts of quantitative data can be incorporated.
Secondly, if the algorithm in Cricket Predict is validated, this research will revolutionise the way that Sportspeople play the game. Based on what we prove and validate, the coaches are going to change their coaching techniques, they will be able to select the best players for their teams, and develop policies for junior players as well.
Q4. Has this type of research been undertaken in other sports?
There is a recent article by Tim Gabbett which studied an injury prediction model in Australian Rugby League in which he was able to predict approximately 50-80% of soft-tissue non contact injuries over the course of 2 seasons. In the course of a tournament, an injury to a key player can change the balance of a team. Even if an algorithm can predict 10-20% of injuries, for an elite team that is very significant.
Q5. This research is heavily reliant on Technology, where do you see Technology and Medicine, or Technology and Injury Prevention going forward? A lot of data that we get these days is subjective data from players, and I think the best way to quantify data and validate data is to get data electronically from the use of sensors. Sensor-based technology and imaging technology is going to go very far in terms of performance analysis and the usage of physical characteristics of players. I see the usage of wearable technology being really big in sports. What I mean by this is the use of accelerometers or gyroscopes to look at movement patterns, similar sensors to look at medical data such as the amount of perspiration, and the amount of stress hormones such as Cortisol that can be measured in saliva and also in sweat. We can also look at blood sugar levels, heart rate, oxygen saturations – all of these things can be measured using wearable technology which can send wireless information to the medical and coaching staff. One of the most important things coaches can get out of this is the amount of fatigue of their players. If we can use technology to quantify this fatigue, that is going to revolutionise sport.
If you’d like to keep this conversation going, or be involved with Cricket Predict in the future, please get in touch with Dr Najeeb Soomro via email email@example.com or Twitter @CricDoctor. Specifically, if you are a cricket club, sports scientist or health professional interested in doing injury surveillance or helping to validate the app, Dr Soomro is happy to share the app with you! Let us know what you think @BMJ_IP too!
David Bui is a final year medical student at the University of New South Wales and outgoing President of the University of New South Wales Sports Medicine Society. He has an interest in Orthopaedics, Sports Medicine and Injury – in all forms! @David_Bui_
I spent last week travelling in Adjumani district (located in Northern Uganda) as part of an exercise in improving the quality of immunization data through support supervision and mentor-ship. This required us as a team to visit as many of the health facilities in the district as possible. Due to the limited sources of our country, we had to make do with one of the hospital ambulances as a means of transport. In between ferrying us from one health facility to another, the driver would get calls to go pick up emergency cases that required urgent transportation to hospital.
The interior of the ambulance, lacking paramedic supplies for first aid.
This highlights a major need to prioritize the development of prehospital trauma care if we are to address the issue of injuries. In addition, while the presence of an ambulance will reduce the travel time to hospital and thus increase the chance of survival, the ambulances themselves should be equipped with materials to offer some basic first aid during the course of transportation. They key policy and clinical practice questions we should ask ourselves should include; how equipped are the ambulances?; what should be the minimum standards a vehicle should attain before it is designated as an ambulance?
One of the authors on this paper, Dr James Brown, kindly agreed to answer a few questions on this work for this blog post. James is a Post-Doctoral Fellow for BokSmart and the Chris Burger Petro Jackson Players’ Fund at the Division of Exercise Science and Sports Medicine, University of Cape Town.
1) Tell us about BokSmart. What is it and why is it important?
BokSmart is a nationwide injury prevention program for rugby in South Africa. It is based on the successful New Zealand program, RugbySmart, and is a joint initiative of the national rugby federation of South Africa – the South African Rugby Union (SARU) – and the Chris Burger Petro Jackson Players’ Fund. Mainly through extensive coach and referee education, the program attempts to reduce all injuries, but specifically catastrophic (permanently disabling) injuries in players. Preventing injuries is particularly important in rugby as it is a collision sport with a higher risk of injury than most other sports and because it is particularly popular in South Africa with an estimated 400-500,000 players.
2) I know that you are active on Twitter (follow James @jamesbrown06), so what is the main message of this research in 140 characters or less?
Injury-preventing behaviours of rugby players have improved since the launch of the @BokSmart nationwide injury prevention program in South Africa in 2008
3) What are the implications of the findings of this study for readers of Injury Prevention?
The success of any intervention is reliant, in part, on the intervention’s ability to influence the behaviour of the intervention target. Thus, it was important to the BokSmart implementers to assess if there was a change in player injury-preventing behaviour. While we could not exclude other potential influences on these players’ behaviour in this ecological study, it is a positive sign that most of the behaviours improved in this five year period, particularly the behaviours that were targeted by the intervention’s implementers.
4) This research focuses on player behaviour, why is this an important component of an injury prevention programme?
Besides what is mentioned above, this study was also an important comparison to New Zealand’s evaluation of RugbySmart, as BokSmart used a very similar questionnaire to assess their players’ behaviours.
Starting the RugbyScientists.com website was an attempt to deliver some of the plethora of useful, practical scientific research that exists in rugby to the end-user. A colleague, Dr Sharief Hendricks, and I were involved in rugby at both a research and practical level as coaches/players a couple of years ago. We both had experiences a number of coaches, parents and players who asked us questions that had already been answered in the form of scientific publications. From research that Dr Hendricks had conducted, it was obvious that it would be unlikely that coaches would read any scientific publication, so we hoped this might bridge that gap.
James and I would be happy to keep this conversation going either on the comments of this blog, or over on Twitter. Feel free to contact him directly via these Rugby Science contact details.
Previous research has already shown that area-wide traffic calming has the potential to prevent road traffic deaths and injuries. There are a number of area-wide traffic calming mechanisms to choose from as a way of promoting road safety, such as the creation of one way streets, changes at junctions, or speed humps, traffic lights, road signage, road surface treatment to make roads slip-proof, to mention but a few. With the road sector continuing to exist as the ultimately one of the most important modes of transportation worldwide, this is partly why road traffic deaths and injuries continue to rise. The beauty about this all is that the causes of road traffic crashes/accidents are known to us and they (crashes/accidents) are easily preventable if we all elect to strictly adhere to road safety mechanisms and interventions to reduce the carnage on our roads.
Sports-related concussion is currently, arguably, the most heated topic in sports injury prevention. Sensationalist media headlines and stories about the toll of concussive hits, particularly in contact sports, are all-too-common. Recently, during the FIFA Women’s World Cup, we saw this head-knock between Alexandra Popp and Morgan Brian, which once again called into question protocols around the handling of suspected concussion in sports settings.
Concussion is known to be an important issue, and its prevention is of utmost importance for the health and safety of all those who play sport. A recent study monitored the number of people treated in hospital for sport-related concussion over a period of nine years in Victoria, Australia. It showed that more people are being hospitalised for sports-related concussion than in the past, but we don’t know why. We think that better healthcare, more people knowing about concussion and the importance of being monitored for symptoms, as well as changes in the way that sport is played could all have contributed to the increase.
Any athlete with a suspected concussion should be removed from play, medically assessed, monitored for deterioration (i.e., should not be left alone) and should not drive a motor vehicle until cleared to do so by a medical professional. No athlete diagnosed with concussion should be returned to sports participation on the day of injury.
Yet, as is shown in the media and on our sports fields, more often than not this advice is not followed. It is true that general knowledge about concussion symptoms is good (and most people now understand that you do not need to be knocked ‘out cold’ to experience concussion), but knowledge about concussion management in sport settings is lagging.
short-term improvements in knowledge, attitudes and behaviours; however, the long-term benefits of concussion education programmes were less clear
It has been found that coaches and sports trainers tasked with concussion management do not yet know how to fully use concussion guidelines, even if they are aware of them being available. They need more education and hands-on practical experience. Asking a player if they want to play on after a head-knock is about as useful as a chocolate teapot. Whilst it may appear a common sense question at first, we just do not know enough about how potentially concussive head-knocks affect individuals, and as such cannot rely on the athlete with potential concussion to make such a call. It is vitally important that concussion management is addressed by sports governing bodies, put into operation by clubs, and handled correctly and ethically by team doctors, coaches, and sports trainers – for the ultimate welfare of athletes.
Research into the management of sports-related concussion can, and should, do more to effect change. Guidelines are necessary but insufficient. Conceiving injury prevention interventions differently by recognising the unique and nuanced challenges of sports culture – such as the win-at-all-costs attitude, and the celebration of hero-athletes returning to play – within complex sports settings is vital.
*Thanks Reidar Lystad for suggesting the chocolate teapot metaphor on twitter last night.
As an injury prevention researcher, I am often dismayed at the way in which injuries, risk, and injury prevention efforts are portrayed in the media. I clearly recall being disgusted as an idealistic teenager, having read a newspaper article regarding the untimely death of a peer who had been killed during a police chase. The police involved were vilified, and the article waxed lyrical about how the teen was a pillar of the community, which was a very different representation of reality. Since this time I have taken most media with a grain of salt, preferring to investigate myself, and to make up my own mind, rather than blithely accepting everything that is said, written and printed. I realise this is not the case for everyone, however, and the media has an amazing capacity to influence public opinion, which is highly relevant for injury prevention efforts in particular.
My post today was prompted by the publication of a paper in Accident Analysis and Prevention by Brubacher, Desapriya, Chan, Ranatunga, Harjee, Erdelyi, Asbridge, Purssel, and Pike. Brubacher and colleagues noted that British Colombia introduced new road safety laws focused on impaired driving, speeding and distracted driving in 2010, and examined the focus of the injury-related media during the period May 2010 to December 2012. From an injury prevention perspective, clearly these laws are designed to keep British Colombians safe – not just drivers, but others with whom they share the road such as pedestrians. Pleasingly 51% of reports which mentioned the new laws were supportive, but disappointingly 11% of reports were against the changes: in real terms this means that every tenth article during this time was NOT supportive of these injury prevention efforts.
To maximise our capacity as injury prevention researchers, policy-makers and practitioners, I believe it is vital to work with media as much as possible, clearly and consistently emphasising benefits rather than giving extensive airtime to perceived downsides such as being ‘unfair’ (downsides of which personally I struggle greatly to relate – I think being injured or killed by a distracted, impaired, and/or drunk driver is unfair).
Blog 3: So today I wanted to share some more background on our blogging team. As an applied social psychologist, I find this information very interesting indeed!
What excites you about being part of the Injury Prevention social media editorial team?
Sheree Bekker: The invaluable conversation that has sprung up around scholarly work through the collaborative power of social media and blogs inspires me to no end. I tend to find more relevant scholarly content through Twitter than through traditional platforms, and Injury Prevention has played a big part in that. As researchers, I believe that we should own our voice on social media, and constructively add value to this conversation.
David Bui: Through my studies in medical school I have seen the costs of injuries to society and individuals worldwide. This is a great opportunity to harness the underutilised power of Social Media in health promotion and Injury Prevention, across multiple disciplines and multiple borders.
Angy El-Khatib: Being a part of the Injury Prevention social media editorial team is a great opportunity personally and collectively. By being a part of the social media editorial team, I am able to stay up to date on various topics within the realm of Injury Prevention while acquiring different perspectives from individuals from different backgrounds, disciplines, and locations. I’m also excited to be able to potentially increase readership and engage readers to create a conversation around the latest Injury Prevention research and ideas.
Klara Johansson: I am very interested to explore ways to share and disseminate knowledge and research results, outside the “old-school”, regular channels. I look forward to learning from my new co-editors, who all seem to be great communicators.
Joseph Magoola: The opportunity to work and collaborate with a variety of scholars on the injury prevention platform is nothing short of exciting. It also excites and inspires me to have an opportunity to represent Africa since low and medium income countries bear the brunt of the injury burden.
Julian Santaella-Tenorio: It is really exciting to be part of this team and to have a space to communicate and express ideas on ways to improve injury prevention, and to discuss about new studies and topics relevant to this field. I am very motivated to learn more and continue growing as a researcher as I walk through this experience.
What are you passionate about?
Sheree Bekker: Intersectional issues drive my life’s work, and my aim is that my research is, and always will be, an extension of that.
David Bui: Passionate about bringing people and ideas together.
Angy El-Khatib: I am passionate about translating scientific evidence and research into public health action. My goal is to improve the health and wellbeing of myself as well as my community. Outside of my work, I am passionate about health, fitness, and wellness.
Klara Johansson: Open discussions and innovative research in collaborative teams with high scientific ambition + high levels of tolerance and kindness; I also enjoy making difficult subjects understandable to students and the general population. Passions on my free time: nature, gardening, books, movies, writing fiction, playing music (clarinet, harmonium, piano, accordion).
Joseph Magoola: Writing on my social media accounts (facebook, twitter and my blog) as a way of reaching out to the masses. I am also interested travelling a lot, especially by road and as such, ensuring road safety is part and parcel of my aims to contribute towards reducing the carnage of our roads.
Julian Santaella-Tenorio: I am passionate about things that can make people have a better, healthier and happier life. I am inspired by ideas challenging previous knowledge, creative thinking finding answers from different angles, and the power of multidisciplinary groups. That is why I am passionate about public health research.
I hope you are looking forward to hearing from our bloggers, starting next month!