The scope, focus and quality of international sports injury prevention research

 

In the (almost) two decades that I have been working in injury research, I have witnessed increasing attention to sports injury prevention and the conduct of many new studies into this important issue. The area has moved from being almost exclusively focussed on only describing the injury problem through case series reports to a hive of activity keen to demonstrate the preventive potential of evidence-informed interventions. This is reflected in the large numbers of journals publishing sports injury prevention research and the supporting of the World Conference on the Prevention of Injury and Illness in Sport by the IOC.[1]

The March 2012 46(3) issue of the British Journal of Sports Medicine includes several papers which neatly show how the field has progressed, particularly since the 1980’s and into the first decade of the twenty first century. Two papers are based on a systematic review of over 2525 articles, with one paper focusing on applied biomechanics and physiology outcomes research and the other on clinical science research. A third compares the quality of abstracts across a conference series.

McBain et al identified 144 studies that reported modification of intermediate risk factors for injury that were either biomechanical or physiological in nature. The authors found that, since the 1980’s, the number of randomised controlled trials (RCTs) has increased by 650%, and other study designs such as crossover designs, have declined in use. Interestingly, much of the earlier research was focussed on protective equipment and there has been a more recent trend towards the publication of studies relating to training factors. Given their known preponderance in sport and amenability to training interventions, it is not surprising that the focus of 92% of all published studies has been on lower extremity injuries. Most emphasis has been given to contact sports (58% of the total), with equal attention among the remainder being given to collision and non-contact sports.

In terms specific clinical interventions to reduce injury risk, the second paper by McBain et al also shows that the number of these studies has also increased over recent years, particularly for RCTs, cohort studies and pre-post evaluation studies. Once again, the focus has been on protective equipment (42% of all studies) or training interventions (32%) with priority given to acute injuries on collision and contact sports.

Unfortunately, these two McBain et al. reviews did not undertake a quality assessment of the published studies and just because more RCTs were reported, this may not necessarily mean that the quality of the evidence has improved. In the same issue of the BJSM, Yoon and Knobloch provide an interesting quality assessment of abstracts submitted for presentation at the World Congress of Sports Injury Prevention. The information presented in each published abstract was assessed against either the CONSORT [2] or the STROBE [3] criteria and significant improvements in quality scores over time were demonstrated.

Collectively, these three papers show the progression of the sports injury prevention research field towards the conduct of studies with higher level evidence for intervention efficacy and effectiveness, but there is still much work to be done. Publication of more studies directly guided by the reporting criteria, such as those of the CONSORT and STROBE statements, will continue to improve the quality of research in this field.

The concentration of most research effort on two major countermeasure types (training programs for improving the physical conditioning of athletes and the use of protective equipment) has meant that most of the prevention research has focussed on lower level strategies within Haddon’s hierarchy of control.[4] With the increasing recognition of the ecological settings in which sports injuries occur,[5] and the need to engage the full sports delivery and participation sector in safety program implementation, additional studies will be needed to address a more comprehensive range of preventive measures and to explore how to optimise their uptake and sustained adoption. [6, 7] Such research will need to include more studies to understand the policy and practice interfaces with researcher. It will also require a shift from the traditional sports science/sports medicine approaches alone to a broader mix of methods that embrace behavioural science, health promotion and sociological perspectives.

Additional References
1. Steffen K, Soligard T, Engebretsen L. The IOC’s endeavour to protect the health of the athlete continues. Br J Sports Med. 2011;45:551-2.
2. Hopewell S, Clarke M, Moher D, et al. CONSORT for reporting randomized controlled trials in journal and conference abstracts: explanation and elaboration. 2008;5:e20.
3. von Elm E, Altman DG, Egger M, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. 2007;335:806-8.
4. Haddon WJ. Energy damage and the 10 countermeasure strategies. J Trauma. 1973;13:321-31.
5. Finch CF, Donaldson A. A sports setting matrix for understanding the implementation context for community sport. Br J Sports Med. 2010;44:973-8.
6. Finch C. A new framework for research leading to sports injury prevention. J Sci Med Sport. 2006;9:3-9.
7. Finch C. No longer lost in translation – the art and science of sports injury prevention implementation research. Br J Sports Med. 2011;45:1253-7.

 

Caroline Finch is an injury prevention researcher from the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Monash Injury Research Centre, Monash University, Australia. She specialises in implementation and dissemination science applications for sports injury prevention. She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and a member of the Editorial Board of Injury Prevention; both journals are published by the BMJ Group. Caroline can be followed on Twitter @CarolineFinch

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