Journal of Science and Medicine in Sport 18 (2015) 651–655

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Journal of Science and Medicine in Sport journal homepage: www.elsevier.com/locate/jsams

Original research

Injuries in community-level Australian football: Results from a club-based injury surveillance system Christina L. Ekegren a,∗ , Belinda J. Gabbe a , Alex Donaldson b , Jill Cook c , David Lloyd d , Caroline F. Finch b a

Department of Epidemiology and Preventive Medicine, Monash University, Alfred Centre, Australia Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Australia c Department of Physiotherapy, School of Primary Health Care, Monash University, Australia d Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Australia b

a r t i c l e

i n f o

Article history: Received 5 August 2014 Received in revised form 8 October 2014 Accepted 14 November 2014 Available online 21 November 2014 Keywords: Sports Epidemiology Database Sports Injury Tracker Sports trainers

a b s t r a c t Objectives: Far fewer injury surveillance systems exist within community sport than elite sport. As a result, most epidemiological data on sports injuries have limited relevance to community-level sporting populations. There is potential for data from community club-based injury surveillance systems to provide a better understanding of community sports injuries. This study aimed to describe the incidence and profile of community-level Australian football injuries reported using a club-based injury surveillance system. Design: Prospective, epidemiological study. Methods: Sports trainers from five community-level Australian football leagues recorded injury data during two football seasons using the club-based system. An online surveillance tool developed by Sports Medicine Australia (‘Sports Injury Tracker’) was used for data collection. The injury incidence, profile and match injury rate were reported. Results: Injury data for 1205 players were recorded in season one and for 823 players in season two. There was significant variability in injury incidence across clubs. However, aggregated data were consistent across football seasons, with an average of 0.7 injuries per player per season and 38–39 match injuries per 1000 h match exposure. A large proportion of injuries occurred during matches, involved the lower limb and resulted from contact. Conclusions: Data from the club-based system provided a profile of injuries consistent with previous studies in community-level Australian football. Moreover, injury incidence was consistent with other studies using similar personnel to record data. However, injury incidence was lower than that reported in studies using player self-report or healthcare professionals and may be an underestimate of true values. © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

1. Introduction Increasing participation in organised sport is a key public health priority for many developed nations.1 While there are clear benefits to sports participation, such as improved health,2 there is also a risk of injury and there is evidence that the healthcare burden of sports injury is increasing. In British Columbia, Canada, there was a 28% increase in the frequency of children presenting to hospital for sports injuries from 1992 to 2005.3 In Victoria, Australia, there was a 47% increase between 2004 and 2010 in the frequency of hospital-

∗ Corresponding author. E-mail address: [email protected] (C.L. Ekegren).

treated sports injury in adults and children combined.4 Thus, sports injuries are a growing public health issue and efforts must be made to prevent them. Successful injury prevention strategies are reliant on epidemiological injury data to inform their development.5 Data on who is being injured, what types of injuries are occurring and what is causing them are needed in order to design sports-specific injury prevention strategies.6 Furthermore, injury data need to be collected continuously over time to monitor trends and evaluate the success of injury prevention strategies.7 In sports injury research, ‘ongoing and systematic collection’7 of injury data or ‘injury surveillance’ is rare8 and sport-specific surveillance systems exist mainly in professional and elite sports rather than at the community

http://dx.doi.org/10.1016/j.jsams.2014.11.390 1440-2440/© 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

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C.L. Ekegren et al. / Journal of Science and Medicine in Sport 18 (2015) 651–655

level.9–11 As a result, it has been difficult to develop effective injury prevention strategies for community sport settings. There is potential for injury surveillance systems based within community sports clubs and operated by club-based personnel to provide an ongoing source of injury data. An opportunity to implement such a system in a large sample of community sports clubs arose within the conduct of a research project in community-level Australian football clubs (the ‘National Guidance for Australian Football Partnerships and Safety’ (NoGAPS) project).12 The aim of the current study was to describe the incidence and profile of community-level Australian football injuries reported using the club-based injury surveillance system. Results were compared for consistency with previous studies in community-level Australian football in order to establish whether community-club based surveillance systems can provide a plausible dataset for use in informing preventive strategies in community sport settings.

2. Methods Five community-level Australian football leagues from Victoria, Australia were included in the study. The leagues were selected based on their involvement in the larger NoGAPS project.12 In choosing the leagues, the NoGAPS research team considered a range of factors, including having a mix of metropolitan and rural settings, large enough leagues with a range of competition levels (i.e. skill-based divisions) and a similar level of professionalism across leagues (e.g. the level of operational support).12 All 78 football clubs within each of the five leagues were included in the study. Data collection took place over the 2012 and 2013 football seasons. Before the start of the 2012 season, the chief executive officer (CEO) from each league agreed to their league’s involvement in the study. A nominated sports trainer from each affiliated club was then invited to an information session about the study. Although attempts were made to contact and invite all nominated sports trainers to these sessions, only 54 of the 78 clubs’ sports trainers could be contacted (37 in 2012 and an additional 17 in 2013). The remaining sports trainers were unable to be contacted mainly because clubs did not have their contact details. During the information sessions, the sports trainers were taught how to use the online surveillance tool employed in this research (‘Sports Injury Tracker’).13 They were also informed about the importance of injury surveillance for the prevention of sports injuries. Attendees were provided with manuals about Sports Injury Tracker and information about how to set up their online accounts. These accounts were password protected so that only the sports trainer could access the full injury record. After attending information sessions, 35 of the 54 sports trainers agreed to be involved in the study and returned to their clubs to recruit players on the researchers’ behalf. Players were eligible for inclusion if they were men aged 18 years or over and planned to play football for their club for the entire football season. All players were provided with information about the study and given the opportunity to ask questions before providing informed consent via an opt-out method. They were assured their data would not be identifiable. Only one individual chose to opt-out and his injuries were not recorded. This same process was repeated at the start of the second season (in 2013) to capture any new players and/or trainers. Ethics approval was obtained from the Monash University Human Research Ethics Committee. Data collection commenced in the first week of each football season (March) and finished after the last match prior to finals (September). Players were asked to report ‘any football-related injury occurring during football training sessions or matches’ (including overuse and traumatic injuries) to the designated sports trainer at their club. This broad definition of injury was used to

provide an opportunity to evaluate the feasibility of recording different types of injuries. To record injuries in Sports Injury Tracker, users progress through six pages completing a range of data fields by selecting from a list of response options or providing free-text responses where appropriate. A paper-based version of Sports Injury Tracker was also available to sports trainers, allowing manual recording and transfer to the online tool at a later date (see Supplementary Figure 1). After each round of matches, trainers who had not entered injury data into the system were sent a short message service (SMS) reminder to do so. Supplementary material related to this article can be found, in the online version, at doi:10.1016/j.jsams.2014.11.390. At the end of the season, de-identified injury data from Sports Injury Tracker were analysed using Stata® 12 (StataCorp 2011, College Station, TX, USA). Match injury rates were calculated per 1000 h of matches and the clinical incidence of injury as the number of injuries per player per season.14 Match exposure was estimated from the number of matches per team per season, average game length (100 min) and usual team size (18 players on the field at any point in time).15 Training exposure was not recorded and therefore, training injury rates and overall injury rates were not calculated. Player numbers were retrieved from league websites that provided the full list of active players per season per club. Frequencies and percentages of injury events (i.e. isolated incidents) were reported using a range of criteria. These were: type of activity at time of injury (match/training), type of injury (new/reinjury/exacerbation), mechanism of injury (e.g. contact/non-contact/etc.), immediate action taken (returned to activity/did not return), place of referral (e.g. physiotherapist/hospital/etc.) and severity (e.g. mild/moderate/severe). Mild injuries were classified as leading to 1–7 days of modified activity, moderate leading to 8–21 days of modified activity and severe injuries leading to >21 days of modified activity. Frequencies and percentages of injuries were reported according to: body region injured (e.g. shoulder/thigh/etc.), specific body part (e.g. acromioclavicular (AC) joint/hamstring muscles/etc.), nature of injury (e.g. sprain/strain/etc.) and specific injury diagnosis (e.g. AC joint sprain/hamstring strain/etc.). Response categories for each injury variable were based on the Australian Sports Injury Data Dictionary.16

3. Results Nineteen of the 54 clubs instructed on the use of Sports Injury Tracker fully implemented the system. Full details of the degree of implementation across all clubs have been published previously.17 In the first season, injury data were recorded by 15 clubs (n = 1205 players) and in the second by 11 clubs (n = 823 players). Only seven clubs recorded data over both seasons. Complete match exposure data were obtained for all participating clubs. The number of players per club ranged from 45 to 117 and the mean age of injured players was 24 years (SD 4, range 18–41). For a full summary of the range of variables from each of the 19 clubs see Supplementary Table 1. Supplementary material related to this article can be found, in the online version, at doi:10.1016/j.jsams.2014.11.390. The number of injuries per club per season ranged from 10 to 193 (Supplementary Table 1). There were 788 injuries in the first season (clinical incidence = 0.7 injuries per player per season; range 0.2–2.7) and 564 injuries (clinical incidence = 0.7 injuries per player per season; range 0.2–2.8) in the second season. There were 725 match-related injuries reported in the first season and 498 in the second. In the first season, the total match injury rate was 39/1000 h of match exposure (range: 19–148 across clubs) (Fig. 1). In the sec-

C.L. Ekegren et al. / Journal of Science and Medicine in Sport 18 (2015) 651–655

653

200

Match injury rate per 1000 match hours (95% CI)

180

Season 1 Season 2

160 140 120 100 80 60 40 20 0

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

Club Fig. 1. Match injury rates per 1000 match hours (with 95% CI) per club (1–19) for seasons 1 and 2.

ond season, the total match injury rate was 38/1000 h of match exposure (range: 8–161 across clubs). For each injury event (i.e. incident) there were up to three discrete injuries reported (e.g. a fractured cheekbone, a bruised eye and a concussion). This meant there were more injuries (n = 1352) than injury events (n = 1282) reported. The majority (93%) of the 1282 injury events occurred during matches (Table 1). Of all injury events, 82% resulted in new injuries and 17% led to a recurrence or an exacerbation of a previous injury. There were roughly even numbers of contact (50%) and non-contact injury events (47%). Approximately half of all injury events (54%) resulted in the player being unable to return to activity on the same day. Of all injury events, 39% resulted in referral to a physiotherapist while 38% did not result in a referral of any sort. In terms of severity, over half of all injuries (52%) were considered mild, while 17% were severe. Readers are referred to Supplementary Table 2 for a full breakdown of injury events and injuries. Supplementary material related to this article can be found, in the online version, at doi:10.1016/j.jsams.2014.11.390. Table 2 presents the profile of 1352 injuries reported over the two seasons in terms of the five most frequent responses for each variable. The thigh was the most commonly injured body region (17% of all injuries), followed by the knee (12%) and ankle (10%). Across all body regions, ‘soft tissues’ were the body part most frequently injured (22% of all injuries). This category included mainly peripheral joint structures such as ligaments and capsules. Bruises and contusions were the most commonly reported nature of injury (22% of all injuries) followed by muscle strains (22%) and joint sprains (19%). The most frequent specific diagnosis was hamstring strains (8% of all injuries) and they were mainly due to overexertion (72% of all hamstring strains).

Table 1 Profile of reported isolated injury events (n = 1282) over two football seasons. Variable

Classification

n

% total

Activity

Match Training Other Total

1172 83 6 1261a

93 7 0.5 100

Type of injury

New injury Recurrent or exacerbated/aggravated injury Other Total

1045 221

82 17

4 1270a

0.3 100

644 606 27 5 1282

50 47 2 0.4 100

Mechanism of injury

Contactb Non-contactc Other Unsure Total

Immediate response

Immediate return to activity today Did not return to activity today Total

586

46

17 1271a

54 100

Referral

No referral Physiotherapist Medical practitioner Hospital Ambulance transport Other Total

486 490 166 79 22 23 1266a

38 39 13 6 2 2 100

Severity

No time loss Mild (1–7 days modified) Moderate (8–21 days modified) Severe (>21 days modified) Total

64 574 286 185 1106a

6 52 26 17 100

a

Where total

Injuries in community-level Australian football: Results from a club-based injury surveillance system.

Far fewer injury surveillance systems exist within community sport than elite sport. As a result, most epidemiological data on sports injuries have li...
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