Publications by authors named "Carolyn Emery"

212 Publications

Injuries and Concussions in Female High School Rugby: Prevention is Worth a Try.

Clin J Sport Med 2021 Nov 10. Epub 2021 Nov 10.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; and Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland.

Objectives: To describe injury and concussion rates and mechanisms in female high school rugby players.

Design: Two-year prospective cohort study.

Setting: High school rugby.

Participants: Participants included 214 female High school rugby players (year 1) and 207 female High school players (year 2) from the Calgary Senior High School Athletics Association 2018 and 2019 rugby competition.

Intervention: None.

Main Outcome Measures: Match and training injury and concussion. Injury definition included any injury resulting in time loss, inability to complete a session, and/or requiring medical attention. Details of reported injuries were collected on injury report forms and validated by a certified athletic therapist on a validated online injury surveillance platform. Exposure hours for players were tracked using paper or virtual weekly exposure forms by team designates.

Results: A match incidence rate (IR) = 93.7 injuries/1000 match hours (95% confidence intervals (CI): 78.6-11.7) and training IR = 5.3 injuries/1000 training hours (95% CI: 4.0-6.9) were estimated. The tackle accounted for 109 (70%) match and 37 (44%) training injuries. Tackling was the most frequent mechanism of injury (IR = 37.5 injuries/1000 match hours, 95% CI: 27.5-51.8 and 1.2 injuries/1000 training hours, 95% CI: 0.7-2.4). Sixty-two match concussions (IR = 37.5 concussions/1000 match hours, 95% CI: 26.8-52.3) and 16 training concussions (IR = 1.0 concussions/1000 training hours, 95% CI: 0.7-1.4) occurred. Of 78 reported concussions, 78% for match and 56% for training were physician diagnosed. Tackling was the most frequent mechanism of concussion in matches (IR = 18.1 concussions/1000 match hours, 95% CI:11.4-28.6).

Conclusions: Injury and concussion rates in female high school rugby are high. The tackle accounted for the highest proportion of injuries. Prevention strategies (eg, tackle policy change, tackle-training programs, and neuromuscular training) should be explored to increase sport safety.
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http://dx.doi.org/10.1097/JSM.0000000000000993DOI Listing
November 2021

Association between pre-participation characteristics and risk of injury amongst pre-professional dancers.

Phys Ther Sport 2021 Nov 8;52:239-247. Epub 2021 Oct 8.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Study Design: Prospective Cohort Study.

Background: Few investigations utilize evidence-informed pre-participation evaluation, inclusive injury definitions, and prospective surveillance to identify risk factors for dance-related injuries.

Objective: To evaluate pre-participation characteristics that may be associated with greater odds of dance-related musculoskeletal complaints in pre-professional dancers.

Methods: Full-time pre-professional ballet [n = 85, 77 females, median (range) age 15-years (11-19)] and contemporary [n = 60, 58 females, 19-years (17-30)] dancers underwent pre-participation evaluation: baseline questionnaire, coping skills, body mass index, bone mineral density, ankle range-of-motion, active standing turnout, lumbopelvic control, and balance tests. Self-reported complaints (any physical problem making dance participation difficult, irrespective of medical attention or time-loss) were captured weekly via online questionnaires for one academic year. Self-reported musculoskeletal complaints were recorded weekly (yes/no). Potential risk factors were identified a-priori through systematic review. Associations between potential risk factors and musculoskeletal complaints were examined with generalized linear mixed method regression models.

Results: Response rate was 99%, with 81% of dancers reporting at least one musculoskeletal complaint. Of 1521 complaints (19% first-time, 81% ongoing), the ankle (22%), knee (21%), and foot (12%) accounted for the majority. Injury history [odds ratio (OR) 7.37 (95% CI 3.41, 15.91)] and previous week's dance hours [OR 1.02 (1.01, 1.03)] were associated with dance-related musculoskeletal complaints.

Conclusions: Prevalence of musculoskeletal complaints amongst pre-professional dancers is high and associated with injury history and training volume. Further understanding of the relationship between training load and injury is needed, with particular consideration of the dynamic and recursive nature of dance injury etiology.

Level Of Evidence: Therapy / Prevention, Aetiology / Harm, level 2b.
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http://dx.doi.org/10.1016/j.ptsp.2021.10.003DOI Listing
November 2021

Early targeted heart rate aerobic exercise for sport-related concussion.

Lancet Child Adolesc Health 2021 Nov 1;5(11):769-771. Epub 2021 Oct 1.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, AB T2N 1N4, Canada; Cardiovascular Concussion Research Laboratory, Faculty of Kinesiology, University of Calgary, AB T2N 1N4, Canada; Alberta Children's Hospital Research Institute, University of Calgary, AB T2N 1N4, Canada; Hotchkiss Brain Institute, University of Calgary, AB T2N 1N4, Canada; Libin Cardiovascular Institute, University of Calgary, AB T2N 1N4, Canada.

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http://dx.doi.org/10.1016/S2352-4642(21)00304-7DOI Listing
November 2021

Searching for the Holy Grail: A Systematic Review of Health-Related Quality of Life Measures for Active Youth.

J Orthop Sports Phys Ther 2021 Oct;51(10):478-491

Objective: To identify the most suitable existing generic and condition-specific health-related quality of life (HRQoL) patient-reported outcome measures (PROMs) for active youth with and without a musculoskeletal injury, based on measurement properties, interpretability, and feasibility.

Design: Systematic review of clinimetrics.

Literature Search: We searched MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and Scopus from inception to April 30, 2020.

Study Selection Criteria: Records with original data describing the evaluation of a PROM or PROM subscale in active youth (15-24 years old) with or without a musculoskeletal injury were included. Non-English studies and those including individuals with a cognitive, developmental, or systemic condition were excluded.

Data Synthesis: This review was conducted according to the COSMIN user manual for systematic reviews of PROMs and the PRISMA guidelines. The COSMIN user manual guided our measurement property evaluation and interpretability and feasibility description.

Results: Of 6931 potential records, 21 studies were included. Eleven generic and 7 condition-specific PROMs were identified. No PROM received a final COSMIN recommendation of "A" because all lacked sufficient content validity. The 8-item Disablement in the Physically Active scale-mental summary component Short Form (DPA-MSC SF-8), Quality of Life Survey, and Functional Arm Scale for Throwers (FAST) were the most suitable existing PROMs, given their high-quality evidence for sufficient structural validity and internal consistency.

Conclusion: No definitively robust PROM for measuring generic or condition-specific HRQoL of active youth was identified. Until one exists, we recommend the DPA-MSC SF-8, the Quality of Life Survey, or the FAST and applying mixed methods to best characterize the HRQoL of active youth. .
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http://dx.doi.org/10.2519/jospt.2021.10412DOI Listing
October 2021

The Burden and Risk Factors of Patellar and Achilles Tendinopathy in Youth Basketball: A Cohort Study.

Int J Environ Res Public Health 2021 09 8;18(18). Epub 2021 Sep 8.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada.

This study aimed at evaluating the burden and risk factors of patellar and Achilles tendinopathy among youth basketball players. Patellar and Achilles tendinopathy were prospectively monitored in 515 eligible male and female youth basketball players (11-18 years) through a competitive season. Overall, the season prevalence of patellar tendinopathy was 19.0% (95% CI: 15.7-22.7%), 23.2% (95% CI: 18.6-28.2%) in males and 12.5% (95% CI: 8.3-17.9%) in females. The season prevalence of Achilles tendinopathy was 4.3% (95% CI: 2.7-6.4%), 4.1% (95% CI: 2.2-7.0%) in males and 4.5% (95% CI: 2.1-8.4%) in females. Median proportion of symptoms duration was 83% of average total weeks of basketball exposure for patellar tendinopathy and 75% for Achilles tendinopathy. Median time to patellar tendinopathy onset was 8 weeks for male players and 6 weeks for female players. Higher odds of patellar tendinopathy risk were seen in males (OR: 2.23, 95% CI: 1.10-4.69) and players with previous anterior knee pain had significantly elevated odds (OR: 8.5, 95% CI: 4.58-16.89). The burden and risk of patellar tendinopathy is high among competitive youth basketball players. Risk factors include sex and previous anterior knee pain. These findings provide directions for practice and future research.
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http://dx.doi.org/10.3390/ijerph18189480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470990PMC
September 2021

Sport participation and injury rates in high school students: A Canadian survey of 2029 adolescents.

J Safety Res 2021 09 14;78:314-321. Epub 2021 Jul 14.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada.

Introduction: The objective of this study is to examine sport and recreational (S&R) activity participation and injury rates (IR) in high school students (ages 14-19).

Methods: High school students (N = 24 schools, n = 2,029; 958 male, 1,048 female, 23 identified 'other' or missing; ages 14-19) in Alberta completed a web-based survey during class (October 2018-March 2019). Students identified their top three sports for participation in the past year. Primary outcome measures included IR for (a) any S&R-related injury, (b) most serious S&R-related injury resulting in medical attention, and (c) most serious injury resulting in restriction from S&R for at least one day.

Results: In total, 1763/2029 (86.89%) respondents [861/958 (89.87%) male, 886/1048 (84.54%) female, 16/23 (69.57%) identifying as 'other' or missing] participated in an S&R activity in the past year. Top sports for male participation were basketball (33.08%; 95% CI 27.67-39.00), ice hockey (20.46%; 95% CI 14.87-27.47), and soccer (19.42%; 95% CI 15.67-23.80). Top sports for female participation were dance (22.52%; 95% CI 17.98-27.82), basketball (18.32%; 95% CI 14.32-23.14), and badminton (17.84%; 95% CI 13.35-23.43). Of the 1,971 students completing the S&R injury question, 889 reported at least one injury during the past year [(IR = 45.10 injuries/100 students/year (95% CI 39.72-50.61)]. The medical attention IR was 29.09 injuries/100 students/year (95% CI 24.49-34.17) and time loss IR was 36.00 injuries/100 students/year (95% CI 30.47-41.93).

Conclusions: High school student S&R IRs are high with 29% of adolescents reporting at least one medical attention injury within the past year. Injury prevention strategies targeting youth are necessary. Practical Application: Participation in S&R activities has multiple physical, psychological, and health benefits for adolescents, but some S&R activities also have greater risks of injury. This study informs the next sports to target for implementation of optimal prospective surveillance and injury prevention strategies among high school aged students.
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http://dx.doi.org/10.1016/j.jsr.2021.06.008DOI Listing
September 2021

Health-Related Outcomes 3-15 Years Following Ankle Sprain Injury in Youth Sport: What Does the Future Hold?

Foot Ankle Int 2021 Aug 5:10711007211033543. Epub 2021 Aug 5.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Background: This study examined the association between youth sport-related ankle sprain injury and health-related outcomes, 3-15 years postinjury.

Methods: A historical cohort study in which uninjured controls were cluster-matched with injured cases. The primary outcome was self-reported Foot and Ankle Outcome Score (FAOS). Secondary outcomes included measures of adiposity, validated questionnaires for physical activity, athletic identity, fear of pain, and tests of strength, balance, and function.

Results: We recruited 86 participants (median age of 23 years; 77% female); 50 with a time-loss ankle sprain, median of 8 years postinjury, and 36 uninjured controls cluster-matched by sex and sport. Based on mixed effects multivariable regression models, previously injured participants demonstrated poorer outcomes than controls on all 5 FAOS subscales regardless of sex and time since injury, with the largest differences observed in symptoms (-20.9, 99% CI: -29.5 to -12.3) and ankle-related quality of life (-25.3, 99% CI: -34.7 to -15.9) subscales. Injured participants also had poorer unipedal dynamic balance (-1.9, 99% CI: 3.5 to -0.2) and greater fear of pain (7.2, 99% CI: 0.9-13.4) compared with controls. No statistically significant differences were found for other secondary outcomes.

Conclusion: At 3-15 years following time-loss ankle sprain injury in youth sport, previously injured participants had more pain and symptoms, poorer self-reported function, ankle-related quality of life, reduced sport participation, balance, and greater fear of pain than controls. This underlines the need to promote the primary prevention of ankle sprains and secondary prevention of potential health consequences, including posttraumatic osteoarthritis.

Level Of Evidence: Level III, historical cohort study.
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http://dx.doi.org/10.1177/10711007211033543DOI Listing
August 2021

Prevalence and pain distribution of anterior knee pain in college basketball players.

J Athl Train 2021 Jul 30. Epub 2021 Jul 30.

1La Trobe Sport and Exercise Medicine Research Centre; College of Science, Health and Engineering; La Trobe University; Australia.

Context: Causes of anterior knee pain (AKP) in jumping athletes include patellofemoral pain and patellar tendinopathy. Differential diagnosis of AKP is challenging, with variation in clinical presentations. No previous research has used pain location to describe AKP in basketball athletes.

Objectives: To describe the prevalence and pain distribution of AKP in college basketball. To report the prevalence of focal inferior pole pain using two outcome measures.

Design: Cross-sectional study Setting: University and college basketball facilities in Alberta, Canada.

Patients Or Other Participants: 242 collegiate basketball athletes Main Outcome Measure(s): The single leg decline squat test (SLDS) was used to capture pain location using pain mapping (dichotomised into focal/diffuse) and pain severity (numerical rating scale). The Oslo Sports Trauma Research Centre Knee questionnaire (OSTRC-Knee) and adapted version for patellar tendinopathy (OSTRC-P) were used to report the prevalence of anterior knee pain (AKP) and patellar tendinopathy respectively. Focal inferior pole pain during the SLDS was used to classify patellar tendinopathy.

Results: Of the 242 players (138 women, 104 men), 146 (60%) reported pain with the SLDS [unilateral n=64, (26%); bilateral n=82 (34%)]. 101 (43%) reported knee pain using the OSTRC-Knee. Pain mapping captured variability in pain location. Diffuse pain was more prevalent [left 70%; right 72%] than focal pain [left 30%; right 28%]. There was low prevalence of patellar tendinopathy with either outcome measure; OSTRC-P [n=21, 8.7%] and inferior pole pain during the SLDS [n=25, 10.3%] Conclusions: Diffuse AKP was common in Canadian basketball players, however pain mapped to the inferior pole of the patella was not. Few players reported tendinopathy using the OSTRC-P, suggesting that patellar tendinopathy was not a primary knee pain presentation in this jumping cohort. Pain location rather than presence or severity of pain alone may better describe the clinical presentations of AKP in jumping athletes.
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http://dx.doi.org/10.4085/1062-6050-0604.20DOI Listing
July 2021

Reality Check 2: The Cost-Effectiveness of Policy Disallowing Body Checking in Non-Elite 13- to 14-Year-Old Ice Hockey Players.

Int J Environ Res Public Health 2021 06 11;18(12). Epub 2021 Jun 11.

Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada.

Sport-related injuries are the leading cause of injury in youth and are costly to the healthcare system. When body checking is disallowed in non-elite levels of Bantam (ages 13-14 years) ice hockey, the injury rate is reduced, but the impact on costs is unknown. This study compared rates of game injuries and costs among non-elite Bantam ice hockey leagues that disallow body checking to those that did not. : An economic evaluation was conducted alongside a prospective cohort study comparing 608 players from leagues where body checking was allowed in games (Calgary/Edmonton 2014-2015, Edmonton 2015-2016) with 396 players from leagues where it was not allowed in games (Vancouver, Kelowna 2014-2015, Calgary in 2015-2016). The effectiveness measure was rate of game injuries per 1000 player-hours. Costs were estimated based on associated healthcare use within the publicly funded healthcare system as well as privately paid healthcare costs. Probabilistic sensitivity analysis was conducted using bootstrapping. Disallowing body checking reduced the rate of injuries by 4.32 per 1000 player-hours (95% CI -6.92, -1.56) and reduced public and total healthcare system costs by $1556 (95% CI -$2478, -$559) and $1577 (95% CI -$2629, -$500) per 1000 player-hours, respectively. These finding were robust in over 99% of iterations in sensitivity analyses in the public healthcare and the total healthcare system perspectives. There was no statistically significant difference in privately paid healthcare costs (-$65 per 1000 player-hours (95% CI -$220, $99)). Disallowing body checking in non-elite 13-14-year-old ice hockey nationally would prevent injuries and reduce public healthcare costs.
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http://dx.doi.org/10.3390/ijerph18126322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296129PMC
June 2021

What Does the Future Hold? Health-Related Quality of Life 3-12 Years Following a Youth Sport-Related Knee Injury.

Int J Environ Res Public Health 2021 06 26;18(13). Epub 2021 Jun 26.

Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada.

Knee trauma can lead to poor health-related quality of life (HRQoL) and osteoarthritis. We aimed to assess HRQoL 3-12 years following youth sport-related knee injury considering HRQoL and osteoarthritis determinants. Generic (EQ-5D-5L index, EQ-VAS) and condition-specific (Knee injury and Osteoarthritis Outcome Score quality of life subscale, KOOS QOL) HRQoL were assessed in 124 individuals 3-12 years following youth sport-related knee injury and 129 uninjured controls of similar age, sex, and sport. Linear regression examined differences in HRQoL outcomes by injury group. Multivariable linear regression explored the influence of sex, time-since-injury, injury type, body mass index, knee muscle strength, Intermittent and Constant Osteoarthritis Pain (ICOAP) score, and Godin Leisure-Time Exercise Questionnaire (GLTEQ) moderate-to-strenuous physical activity. Participant median (range) age was 23 years (14-29) and 55% were female. Injury history was associated with poorer KOOS QOL (-8.41; 95%CI -10.76, -6.06) but not EQ-5D-5L (-0.0074; -0.0238, 0.0089) or EQ-VAS (-3.82; -8.77, 1.14). Injury history (-5.14; -6.90, -3.38), worse ICOAP score (-0.40; -0.45, -0.36), and anterior cruciate ligament tear (-1.41; -2.77, -0.06) contributed to poorer KOOS QOL. Worse ICOAP score contributed to poorer EQ-5D-5L (-0.0024; -0.0034, -0.0015) and higher GLTEQ moderate-to-strenuous physical activity to better EQ-VAS (0.10; 0.03, 0.17). Knee trauma is associated with poorer condition-specific but not generic HRQoL 3-12 years post-injury.
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http://dx.doi.org/10.3390/ijerph18136877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8295930PMC
June 2021

Using a Prism Paradigm to Identify Sensorimotor Impairment in Youth Following Concussion.

J Head Trauma Rehabil 2021 Jun 15. Epub 2021 Jun 15.

Faculty of Kinesiology (Drs Little, Schneider, and Emery), Department of Clinical Neurosciences (Dr Dukelow), and Cumming School of Medicine (Drs Dukelow and Emery), University of Calgary, Calgary, Alberta, Canada.

Objective: The study assesses the intrarater reliability and utility of a prism paradigm to identify sensorimotor impairment following sports-related concussion in youth, (recent and history of concussion) compared with youth with no concussion.

Setting: University of Calgary.

Participants: Three groups of 40 ice hockey players ranging in age from 11 to 17 years were included: (1) no concussion; (2) recent concussion, mean number of days since last concussion 5 (95% CI, 4-6); and (3) history of concussion, mean number of days since last concussion 631 (95% CI, 505-730).

Design: Cross-sectional study.

Main Measures: The vestibulo-ocular reflex is a fundamental reflex of the central nervous system that stabilizes the position of the eyes during head movement and adapts when sensory input is altered (the bend of the light on the retina by prism glasses). The prism adaptation measure was the number of throws taken to adapt to wearing prism glasses while throwing balls at a central target.

Results: The intraclass correlation coefficient (0.73; 95% CI, 0.55-0.84) and the Bland-Altman 95% levels of agreement (lower limit -18.5; 95% CI, -22.4 to -14.6); and upper limit 16.6; 95% CI, 12.7-20.5) reflected good intrarater reliability. Prism adaptation measures were significantly different across groups (F2,119 = 51.9, P < .001, r = 0.52, power of 90%), with the mean number of throws for youth (aged 11-17 years) in each group as follows: 10 (95% CI, 8-12) no concussion history; 25 (95% CI, 23-27) recent concussion (1-11 days); and 17 (95% CI, 15-20) history of concussion (90-1560 days).

Conclusion: Use of a prism paradigm as a clinical measurement tool has the potential to alter concussion management in youth. The prism paradigm is objective, is readily translatable to the clinical arena, has minimal associated costs, and is easily administered, reliable, and portable.
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http://dx.doi.org/10.1097/HTR.0000000000000690DOI Listing
June 2021

Canadian High School Rugby Coaches Readiness for an Injury Prevention Strategy Implementation: Evaluating a Train-the-Coach Workshop.

Front Sports Act Living 2021 31;3:672603. Epub 2021 May 31.

Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada.

Canadian rugby coach injury prevention beliefs and attitudes have not been studied, yet are key to informing injury prevention strategy implementation. Despite neuromuscular training (NMT) warm-up success in reducing injury, adoption of these programs is variable. Therefore, objectives of this study included (1) describing Canadian youth rugby coach injury prevention beliefs and attitudes and current warm-up practices and (2) evaluating intention to use a rugby-specific NMT warm-up. High school rugby coaches completed a questionnaire before and after a rugby-specific NMT warm-up workshop. The pre-workshop questionnaire captured demographics, current warm-up practice, and NMT warm-up knowledge and use. Both questionnaires captured injury prevention beliefs, attitudes and behavioral intention. Forty-eight coaches participated in the workshops. Pre-workshop, 27% of coaches were aware of NMT warm-ups. Coaches primarily included aerobic and stretching components, while balance components were not common in their warm-ups over the past year. Additionally, 92% of coaches agreed to some extent they would "complete a rugby-specific warm-up program prior to every game and training session this season." Post-workshop, 86% of coaches agreed to some extent that they would use the program in every rugby session. No differences were observed between pre- and post-workshop intention to implement the warm-up ( = 0.10). This is the first study to examine current Canadian youth rugby coach warm-up practices and intention to use NMT warm-ups. Canadian rugby coach intention to use a rugby-specific NMT warm-up is high, providing ample opportunity to investigate the efficacy of a NMT warm-up in youth rugby.
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http://dx.doi.org/10.3389/fspor.2021.672603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200819PMC
May 2021

Secondary consequences of juvenile idiopathic arthritis in children and adolescents with knee involvement: physical activity, adiposity, fitness, and functional performance.

Rheumatol Int 2021 Jun 16. Epub 2021 Jun 16.

Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.

Objective: Secondary consequences of juvenile idiopathic arthritis (JIA) may impact long-term health outcomes. This study examined differences in physical activity, cardiorespiratory fitness, adiposity, and functional performance in children and adolescents with JIA compared to their typically developing (TD) peers.

Methods: Participants with JIA (n = 32; 10-20 years old) and their TD peers (n = 35) volunteered for assessments of: daily moderate-to-vigorous physical activity (MVPA, body-worn accelerometer); peak oxygen consumption (VO, incremental bike test); fat mass index (FMI, dual-energy X-ray absorptiometry); and triple-single-leg-hop (TSLH) distance. Statistical analyses were performed in R using four linear mixed-effect models with Bonferroni adjustment (⍺ = 0.0125). Fixed effects were group, sex, and age. Participant clusters based on sex and age (within 1.5 years) were considered as random effects.

Results: Participants with JIA displayed lower mean daily MVPA than their TD peers [p = 0.006; β (98.75% CI); -21.2 (-40.4 to -2.9) min]. VO [p = 0.019; -1.4 (-2.5 to -0.2) ml/kg/min] decreased with age. Females tended to have lower V [p = 0.045; -6.4 (-13.0 to 0.4) ml/kg/min] and greater adiposity [p = 0.071; 1.4 (-0.1 to 3.0) kg/m] than males.

Conclusion: The findings support the need for strategies to promote MVPA participation in children and adolescents with JIA. Sex and age should be considered in research on the consequences of JIA.
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http://dx.doi.org/10.1007/s00296-021-04920-5DOI Listing
June 2021

More Than Just Adolescence: Differences in Fatigue Between Youth With Cerebral Palsy and Typically Developing Peers.

Ann Rehabil Med 2021 Jun 14;45(3):197-203. Epub 2021 Jun 14.

Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Objective: To quantify differences in fatigue and disordered sleep between adolescents with cerebral palsy (CP) and their typically developing peers. A secondary aim was to investigate the association between fatigue and disordered sleep in adolescents with CP.

Methods: A convenience sample of 36 youth with CP aged 10-18 years was matched for age and sex with 36 typically developing peers. The Fatigue Impact and Severity Self-Assessment (FISSA), the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue profile, and the Sleep Disturbance Scale for Children (SDSC) were collected.

Results: Higher fatigue was reported in participants with CP than in their typically developing peers based on the FISSA total score (mean paired difference=19.06; 99% confidence interval [CI], 6.06-32.1), the FISSA impact subscale (mean paired difference=11.19; 99% CI, 3.96-18.4), and the FISSA Management and Activity Modification subscale (mean paired difference=7.86; 99% CI, 1.1-14.6). There were no differences between groups in the PROMIS fatigue profile (mean paired difference=1.63; 99% CI, -1.57-4.83) or the SDSC total score (mean paired difference=2.71; 99% CI, -2.93-8.35).

Conclusion: Youth with CP experienced significantly more fatigue than their peers as assessed by a comprehensive measure that considered both general and diagnosis-specific concerns. Sleep did not differ between youth with CP and their typically developing peers. These findings underscore the need to consider the clinical management of fatigue across the lifespan of individuals with CP to prevent the associated deterioration of functional abilities.
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http://dx.doi.org/10.5535/arm.20250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8273725PMC
June 2021

An Economic Evaluation of Disallowing Body Checking in 11- to 12-Year-Old Ice Hockey Leagues.

Sports Health 2021 Jun 6:19417381211021551. Epub 2021 Jun 6.

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Background: After a national policy change in 2013 disallowing body checking in Pee Wee ice hockey games, the rate of injury was reduced by 50% in Alberta. However, the effect on associated health care costs has not been examined previously.

Hypothesis: A national policy removing body checking in Pee Wee (ages 11-12 years) ice hockey games will reduce injury rates, as well as costs.

Study Design: Cost-effectiveness analysis alongside cohort study.

Level Of Evidence: Level 3.

Methods: A cost-effectiveness analysis was conducted alongside a cohort study comparing rates of game injuries in Pee Wee hockey games in Alberta in a season when body checking was allowed (2011-2012) with a season when it was disallowed after a national policy change (2013-2014). The effectiveness measure was the rate of game injuries per 1000 player-hours. Costs were estimated based on associated health care use from both the publicly funded health care system and privately paid health care cost perspectives. Probabilistic sensitivity analysis was conducted using bootstrapping.

Results: Disallowing body checking significantly reduced the rate of game injuries (-2.21; 95% CI [-3.12, -1.31] injuries per 1000 player-hours). We found no statistically significant difference in public health care system (-$83; 95% CI [-$386, $220]) or private health care costs (-$70; 95% CI [-$198, $57]) per 1000 player-hours. The probability that the policy of disallowing body checking was dominant (with both fewer injuries and lower costs) from the perspective of the public health care system and privately paid health care was 78% and 92%, respectively.

Conclusion: Given the significant reduction in injuries, combined with lower public health care system and private costs in the large majority of iterations in the probabilistic sensitivity analysis, our findings support the policy change disallowing body checking in ice hockey in 11- and 12-year-old ice hockey leagues.
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http://dx.doi.org/10.1177/19417381211021551DOI Listing
June 2021

Factors Associated With Clinical Recovery After Concussion in Youth Ice Hockey Players.

Orthop J Sports Med 2021 May 5;9(5):23259671211013370. Epub 2021 May 5.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Background: The identification of factors associated with clinical recovery in youth after sports-related concussion could improve prognostication regarding return to play (RTP).

Purpose: To assess factors associated with clinical recovery after concussion in youth ice hockey players.

Study Design: Cohort study; Level of evidence, 2.

Methods: Participants were part of a larger longitudinal cohort study (the Safe to Play study; N = 3353). Included were 376 ice hockey players (age range, 11-17 years) from teams in Calgary and Edmonton, Canada, with 425 physician-diagnosed ice hockey-related concussions over 5 seasons (2013-2018). Any player with a suspected concussion was referred to a sports medicine physician for diagnosis, and a Sport Concussion Assessment Tool (SCAT) form was completed. Time to clinical recovery was based on time between concussion and physician clearance to RTP. Two accelerated failure time models were used to estimate days to RTP clearance: model 1 considered symptom severity according to the SCAT3/SCAT5 symptom evaluation score (range, 0-132 points), and model 2 considered responses to individual symptom evaluation items (eg, headache, neck pain, dizziness) of none/mild (0-2 points) versus moderate/severe (3-6 points). Other covariates were time to physician first visit (≤7 and >7 days), age group (11-12, 13-14, and 15-17 years), sex, league type (body checking and no body checking), tandem stance (modified Balance Error Scoring System result ≥4 errors out of 10), and number of previous concussions (0, 1, 2, and ≥3).

Results: The complete case analysis (including players without missing covariates) included 329 players (366 diagnosed concussions). The median time to clinical recovery was 18 days. In model 1, longer time to first physician visit (>7 days) (time ratio [TR], 1.637 [95% confidence interval (CI), 1.331-1.996]) and greater symptom severity (TR, 1.016 [95% CI, 1.012-1.020]) were significant predictors of longer clinical recovery. In model 2, longer time to first physician visit (TR, 1.698 [95% CI, 1.399-2.062]), headache (moderate/severe) (TR, 1.319 [95% CI, 1.110-1.568]), and poorer tandem stance (TR, 1.249 [95% CI, 1.052-1.484]) were significant predictors of longer clinical recovery.

Conclusion: Medical clearance to RTP was longer for players with >7 days to physician assessment, poorer tandem stance, greater symptom severity, and moderate/severe headache at first visit.
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http://dx.doi.org/10.1177/23259671211013370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114271PMC
May 2021

Body checking in non-elite adolescent ice hockey leagues: it is never too late for policy change aiming to protect the health of adolescents.

Br J Sports Med 2021 May 20. Epub 2021 May 20.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Objectives: The objective of this study is to evaluate the effect of policy change disallowing body checking in adolescent ice hockey leagues (ages 15-17) on reducing rates of injury and concussion.

Methods: This is a prospective cohort study. Players 15-17 years-old were recruited from teams in non-elite divisions of play (lower 40%-70% by division of play depending on year and city of play in leagues where policy permits or prohibit body checking in Alberta and British Columbia, Canada (2015-18). A validated injury surveillance methodology supported baseline, exposure-hours and injury data collection. Any player with a suspected concussion was referred to a study physician. Primary outcomes include game-related injuries, game-related injuries (>7 days time loss), game-related concussions and game-related concussions (>10 days time loss).

Results: 44 teams (453 player-seasons) from non-body checking and 52 teams (674 player-seasons) from body checking leagues participated. In body checking leagues there were 213 injuries (69 concussions) and in non-body checking leagues 40 injuries (18 concussions) during games. Based on multiple multilevel mixed-effects Poisson regression analyses, policy prohibiting body checking was associated with a lower rate of injury (incidence rate ratio (IRR): 0.38 (95% CI 0.24 to 0.6)) and concussion (IRR: 0.49; 95% CI 0.26 to 0.89). This translates to an absolute rate reduction of 7.82 injuries/1000 game-hours (95% CI 2.74 to 12.9) and the prevention of 7326 injuries (95% CI 2570 to 12083) in Canada annually.

Conclusions: The rate of injury was 62% lower (concussion 51% lower) in leagues not permitting body checking in non-elite 15-17 years old leagues highlighting the potential public health impact of policy prohibiting body checking in older adolescent ice hockey players.
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http://dx.doi.org/10.1136/bjsports-2020-103757DOI Listing
May 2021

Evaluating Methods for Imputing Missing Data from Longitudinal Monitoring of Athlete Workload.

J Sports Sci Med 2021 06 5;20(2):188-196. Epub 2021 Mar 5.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada.

Missing data can influence calculations of accumulated athlete workload. The objectives were to identify the best single imputation methods and examine workload trends using multiple imputation. External (jumps per hour) and internal (rating of perceived exertion; RPE) workload were recorded for 93 (45 females, 48 males) high school basketball players throughout a season. Recorded data were simulated as missing and imputed using ten imputation methods based on the context of the individual, team and session. Both single imputation and machine learning methods were used to impute the simulated missing data. The difference between the imputed data and the actual workload values was computed as root mean squared error (RMSE). A generalized estimating equation determined the effect of imputation method on RMSE. Multiple imputation of the original dataset, with all known and actual missing workload data, was used to examine trends in longitudinal workload data. Following multiple imputation, a Pearson correlation evaluated the longitudinal association between jump count and sRPE over the season. A single imputation method based on the specific context of the session for which data are missing (team mean) was only outperformed by methods that combine information about the session and the individual (machine learning models). There was a significant and strong association between jump count and sRPE in the original data and imputed datasets using multiple imputation. The amount and nature of the missing data should be considered when choosing a method for single imputation of workload data in youth basketball. Multiple imputation using several predictor variables in a regression model can be used for analyses where workload is accumulated across an entire season.
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http://dx.doi.org/10.52082/jssm.2021.188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057705PMC
June 2021

Magnitude, Frequency, and Accumulation: Workload Among Injured and Uninjured Youth Basketball Players.

Front Sports Act Living 2021 6;3:607205. Epub 2021 Apr 6.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.

Overuse injuries are common in basketball. Wearable technology enables the workload to be monitored in sport settings. However, workload-injury models lack a biological basis both in the metrics recorded and how workload is accumulated. We introduce a new metric for monitoring workload: weighted jump height, where each jump height is weighted to represent the expected effect of the jump magnitude on damage to the tendon. The objectives of this study were to use principal components analysis to identify distinct modes of variation in all workload metrics accumulated over 1, 2, 3, and 4 weeks and to examine differences among the modes of variation in workload metrics between participants before the injury and uninjured participants. Forty-nine youth basketball players participated in their typical basketball practices and games, and lower extremity injuries were classified as patellar or Achilles tendinopathy, other overuse, or acute. An inertial measurement unit recorded the number and height of all jumps, and session rating of perceived exertion was recorded. The previous 1-, 2-, 3-, and 4-week workloads of jump count, jump height, weighted jump height, and session rating of perceived exertion were summed for each participant-week. Principal components analysis explained the variance in the accumulated workload variables. Using the retained principal components, the difference between the workload of injured participants in the week before the injury and the mean workload of uninjured participants was described for patellar or Achilles tendinopathy, overuse lower extremity injury, and any lower extremity injury. Participants with patellar or Achilles tendinopathy and overuse lower extremity injuries had a low workload magnitude for all variables in the 1, 2, 3, and 4 weeks before injury compared with the weeks before no injury. Participants with overuse lower extremity injuries and any lower extremity injury had a high previous 1-week workload for all variables along with a low previous 3- and 4-week jump count, jump height, and weighted jump height before injury compared with the weeks before no injury. Weighted jump height represents the cumulative damage experienced by tissues due to repetitive loads. Injured youth basketball athletes had a low previous 3- and 4-week workloads coupled with a high previous 1-week workload.
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http://dx.doi.org/10.3389/fspor.2021.607205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056300PMC
April 2021

Para sport translation of the IOC consensus on recording and reporting of data for injury and illness in sport.

Br J Sports Med 2021 Oct 14;55(19):1068-1076. Epub 2021 Apr 14.

Amsterdam Collaboration on Health & Safety in Sports (ACHSS), AMC/VUmc IOC Research Center of Excellence, Amsterdam, The Netherlands.

In 2020, the IOC proposed a universal methodology for the recording and reporting of data for injury and illness in sport. Para sport is played by individuals with impairment, and they have a unique set of considerations not captured by these recommendations. Therefore, the aim of this addendum to IOC consensus statement was to guide the Para sport researcher through the complexities and nuances that should be taken into consideration when collecting, registering, reporting and interpreting data regarding Para athlete health. To develop this translation, experts in the field of Para sports medicine and epidemiology conducted a formal consensus development process, which began in March 2020 with the formation of a consensus group that worked over eight phases, incorporating three virtual consensus meetings to finalise the translation. This translation is consistent with the IOC consensus statement, yet provides more detailed Para athlete specific definitions and recommendations on study population, specifically, diagnostic and eligible impairment categorisation and recording of adaptive equipment, and defining and classifying health problems in the context of Para sport. Additionally, recommendations and Para athlete specific examples are described with regards to injury mechanism, mode of onset, injury and illness classification, duration, capturing and reporting exposure and risk. Finally, methods and considerations are provided to cater to the varied needs of athletes with impairment with respect to data collection tools. This harmonisation will allow the science to develop and facilitate a more accurate understanding of injury and illness patterns for tailoring evidence-informed prevention programmes and enabling better planning of medical services for Para sport events.
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http://dx.doi.org/10.1136/bjsports-2020-103464DOI Listing
October 2021

Effect of Anterior Cruciate Ligament Rupture on Physical Activity, Sports Participation, Patient-Reported Health Outcomes, and Physical Function in Young Female Athletes.

Am J Sports Med 2021 05 8;49(6):1460-1469. Epub 2021 Apr 8.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada.

Background: Return to sports (RTS) is frequently considered an indicator of successful recovery after anterior cruciate ligament reconstruction (ACLR). However, despite the well-recognized health benefits of physical activity (PA), little is known about objectively measured PA in the 1 to 2 years after ACLR. Given that young female athletes have a high prevalence of ACLR and lower RTS rates as compared with their male counterparts, an in-depth examination of PA in this subgroup is warranted.

Hypothesis: We hypothesized that female youth and young adults who have had ACLR in the previous 1 to 2 years would have less moderate or vigorous PA (MVPA) compared with healthy matched controls. We also hypothesized that the ACLR group would report lower levels of sports participation, patient-reported health outcomes, and physical function.

Study Design: Cohort study; Level of evidence, 3.

Methods: Participants included 51 female athletes with primary unilateral ACLR for a sports-related injury in the previous 1 to 2 years and 51 age- and sports-matched controls. Outcomes included objectively measured PA (GT3X accelerometers), previous and current sports participation and RTS, body mass index, Knee injury and Osteoarthritis Outcome Score (KOOS), triple single-leg hop, and one-leg rise. Mean within-pair differences with 95% CIs were used to assess differences between groups across all outcomes. Multivariable linear regression (clustered by pair) was used to examine whether the ACLR group had less MVPA than did the age- and sports-matched control group, adjusting for total wear time, age, time since injury, and body mass index.

Results: Median age was 17.8 years (range, 14.6-22.6 years). There was no significant difference between groups in MVPA. However, the injury group had fewer mean minutes per day of vigorous PA (-1.22; 95% CI, -2.40 to -0.04), poorer KOOS values on all subscales, and shorter triple single-leg hop distance. In the injury group, 28 (55%) returned to sports, including 14 (27.5%) who returned at preinjury performance level. Across both groups, over one-third changed their most important sport, shifting toward an individual-based sport.

Conclusion: At 1 to 2 years after ACLR, female athletes demonstrated no differences in combined MVPA and only a very small reduction in vigorous PA, yet they had higher levels of self-reported knee pain and symptoms, reduced knee function in sports, lower quality of life, and poorer objective knee function compared with matched controls.
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http://dx.doi.org/10.1177/03635465211002530DOI Listing
May 2021

The Impact of COVID-19 on High School Student-Athlete Experiences with Physical Activity, Mental Health, and Social Connection.

Int J Environ Res Public Health 2021 03 29;18(7). Epub 2021 Mar 29.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada.

COVID-19 restrictions led to reduced levels of physical activity, increased screen usage, and declines in mental health in youth; however, in-depth understandings of the experiences of high school student-athletes have yet to be explored. To describe the experiences of the COVID-19 pandemic on student-athletes' physical activity, social connection, and mental health, 20 high school student-athletes living in Calgary, Alberta participated in semi-structured interviews, designed using phenomenography. Participants reported variations in physical activity, social connections, and mental health which were influenced by stay-at-home restrictions and weather. Access to resources, changes to routines, online classes, and social support all influenced engagement in physical activity. School and sports provided opportunities for in-person social connections, impacted by the onset of the pandemic. Participants reported their mental health was influenced by social connections, online classes, and physical activity. Findings from this study will inform the development of resources for high school student-athletes amidst COVID-19.
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http://dx.doi.org/10.3390/ijerph18073515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036482PMC
March 2021

Adiposity as a Risk Factor for Sport Injury in Youth: A Systematic Review.

Clin J Sport Med 2021 Mar 24. Epub 2021 Mar 24.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada; Health Promotion, Chronic Disease, and Injury Prevention, Public Health Ontario, Toronto, ON, Canada; Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, VIC, Australia; and Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Objective: To determine whether high or low adiposity is associated with youth sport-related injury.

Data Sources: Ten electronic databases were searched to identify prospective studies examining the association between adiposity [body mass index (BMI) or body fat] and a future time-loss or medical attention sport-related musculoskeletal injury or concussion in youth aged 20 years and younger. Two independent raters assessed the quality (Downs and Black criteria) and risk of bias (Joanna Briggs Institute Critical Appraisal Tool). Random-effects meta-analyses were used to calculate pooled odds ratio [95% confidence interval (CI)] of injury.

Main Results: Of 11 424 potentially relevant records, 38 articles were included with 17 eligible for meta-analyses. In qualitative synthesis, no clear association was identified between adiposity and any sport injury; however, 16/22 studies identified high adiposity as a significant risk factor for lower-extremity injury. Meta-analyses revealed higher BMI in youth with any sport-related injury and lower BMI in youth who developed a bone stress injury (BSI) compared with noninjured controls. The pooled OR (95% CI) examining the association of BMI and injury risk (excluding bone injury) was 1.18 (95% CI: 1.03-1.34). A major source of bias in included articles was inconsistent adjustment for age, sex, and physical activity participation.

Conclusions: Level 2b evidence suggests that high BMI is associated with greater risk of youth sport injury, particularly lower-extremity injury and excluding BSI or fracture. Although pooled mean differences were low, anthropometric risk of injury seems to be dependent on type and site of injury in youth sport.
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http://dx.doi.org/10.1097/JSM.0000000000000927DOI Listing
March 2021

Associations of inter-segmental coordination and treadmill walking economy in youth with cerebral palsy.

J Biomech 2021 05 20;120:110391. Epub 2021 Mar 20.

Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

This study investigated associations of thigh-shank coordination deficit severity and metabolic demands of walking in youth with cerebral palsy (CP) and their typically developing (TD) peers. Youth (ages 8-18 years) with hemiplegic and diplegic CP [Gross Motor Classification System (GMFCS) I-III] and their age (within 12 months) and sex-matched peers performed a modified six-minute-walk-test on a treadmill. Kinematics (Motion Analysis, USA, 240 Hz) and mass-specific gross metabolic rate (GMR; COSMED, Italy) were analyzed for minute two of treadmill walking. Thigh-shank coordination was determined using continuous relative phase (CRP) analysis. GMR was normalized using participant specific Froude numbers (i.e. GMR). Maximum and minimum CRP deficit angles (CRP,CRP) were analysed in SPSS (IBM, USA) using paired samples t-tests with Bonferroni correction (p = 0.0125). Associations of knee extension angle deficit (KED) and coordination outcomes with GMR (log) were assessed using multiple linear regression. Twenty-eight matched pairs were included, demonstrating significantly larger CRP for youth with CP [GMFCS I mean pair difference (98.75%CI) 8.2 (-0.1,16.5), P = 0.013; GMFCS II/III 26.1 (2.3,50.0), P = 0.008]. Joint kinematics and coordination outcomes were significantly associated with GMR (P < 0.001), primarily due to CRP (P < 0.001), leading to a 1.7 (95%CI; 1.1, 2.4)% increase in GMR for every degree increase in CRP. These findings indicate an association of thigh-shank coordination deficit severity and increasing metabolic demands of walking in youth with CP. CRP may be a clinically useful predictor of metabolic demands of walking in CP. Future work will evaluate the sensitivity of CRP to coordination and walking economy changes with surgical and non-surgical management.
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http://dx.doi.org/10.1016/j.jbiomech.2021.110391DOI Listing
May 2021

Incidence of Head Contacts, Penalties, and Player Contact Behaviors in Youth Ice Hockey: Evaluating the "Zero Tolerance for Head Contact" Policy Change.

Orthop J Sports Med 2021 Mar 5;9(3):2325967121992375. Epub 2021 Mar 5.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Background: To reduce the risk of concussion in youth ice hockey, Hockey Canada implemented a national "zero tolerance for head contact" (HC) policy in 2011. A previous cohort study revealed higher concussion rates after this implementation in players aged 11 to 14 years. However, it is unknown whether the elevated risk was due to higher HC rates or factors such as increased concussion awareness and reporting.

Purpose: To compare the rates of primary and secondary HCs and HC policy enforcement in elite U15 ice hockey leagues (players <15 years) before (2008-2009) and after (2013-2014) the zero-tolerance policy change.

Study Design: Cohort study; Level of evidence, 3.

Methods: A total of 32 elite U15 games before (n = 16; 510 players) and after (n = 16; 486 players) HC policy implementation were video recorded. Videos were analyzed with validated criteria for identifying HC types (primary/direct contact by players [HC1], secondary/indirect contact via boards, glass, or ice surface [HC2]) and other player-to-player contact behavior. Referee-assessed penalties were cross-referenced with the official Hockey Canada casebook, and penalty types were displayed using proportions. Univariate Poisson regression (adjusted for cluster by team game, offset by game length [minutes]) was used to estimate HC incidence rates (IRs) and incidence rate ratios (IRRs) between cohorts.

Results: A total of 506 HCs were analyzed, 261 before HC policy implementation (IR, 16.6/100 team minutes) and 245 after implementation (IR, 15.5/100 team minutes). The HC1 rate (IRR, 1.05; 95% CI, 0.86-1.28) and HC2 rate (IRR, 0.74; 95% CI, 0.50-1.11) did not significantly differ before versus after implementation. Only 12.0% and 13.6% of HC1s were penalized pre- and postimplementation, respectively. Before implementation, HC1s were commonly penalized as roughing or elbowing penalties (59%), while after implementation, HC1s were penalized with the HC penalty (76%), and only 8% as roughing or elbowing.

Conclusion: Despite implementation of the "zero tolerance for HC" policy, there was no difference in the rate of HC1s and HC2s or the proportion of HC1 penalized from before to after implementation. This research is instrumental in informing Hockey Canada's future referee training and rule enforcement modifications.
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http://dx.doi.org/10.1177/2325967121992375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7940749PMC
March 2021

On the bright side of PhD life: the perspectives of physiotherapist clinician-scientists.

Br J Sports Med 2021 Jun 15;55(12):654-655. Epub 2021 Mar 15.

Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada

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http://dx.doi.org/10.1136/bjsports-2021-104124DOI Listing
June 2021

Warm-Ups and Coaches' Perceptions: Searching for Clues to Improve Injury Prevention in Youth Basketball.

Front Sports Act Living 2021 11;3:619291. Epub 2021 Feb 11.

Sport Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada.

Regular use of neuromuscular training (NMT) warm-up programs improves performance and prevents injuries. However, low level of adoption of these programs remains a problem. Understanding the current warm-ups in youth basketball and coaches' perceptions on injury prevention can guide the design of superior implementation strategies. This study describes warm-ups in youth basketball and coaches' injury prevention-related knowledge, attitudes, beliefs, and information sources. Youth basketball coaches ( = 50) completed a preseason questionnaire. The questionnaire covered warm-up length, use of aerobic/agility/balance/strength/other exercises in the warm-up, injury-related knowledge, attitudes, beliefs, and sources of information. Typical warm-up duration was ≤ 10 min (48.0% of coaches, 95% CI: ±13.8%). All coaches included aerobic exercises in their warm-up. Agility, strength, and balance exercises were utilized by 80.0% (95% CI: ±11.7%), 70.7% (95% CI: ±13.6%), and 26.8% (95% CI: ±13.6%) of coaches, respectively. Most coaches agreed to some extent that basketball injuries are preventable (94%) and that participating in a NMT warm-up program would reduce player's risk of injury (92%). Other coaches were identified as the most common source of information on warm-ups and injury prevention. Coaches use parts of effective NMT warm-up programs, but balance exercises are not well adopted. Considering the level of evidence supporting the importance of balance exercises in injury prevention, it is crucial to improve the implementation of NMT warm-up programs in youth basketball, for example, through educational courses. As fellow coaches were identified as the most important source of information, coaches' role in knowledge translation should be emphasized.
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http://dx.doi.org/10.3389/fspor.2021.619291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904865PMC
February 2021

Knee Injury and Osteoarthritis Outcome Score (KOOS) Responder Criteria and Minimal Detectable Change 3-12 Years Following a Youth Sport-Related Knee Injury.

J Clin Med 2021 Feb 1;10(3). Epub 2021 Feb 1.

Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada.

The applicability of thresholds that constitute an acceptable score or meaningful change on the Knee injury and Osteoarthritis Outcome Score (KOOS) in cohorts ≥ 5 years following knee injury is not well understood. The primary objective of this study was to evaluate the association between intra-articular knee injury type and two different KOOS pain thresholds (patient acceptable symptom state (PASS) and Englund symptomatic knee criteria) in the Alberta Youth Prevention of Osteoarthritis (PrE-OA) cohort, which includes participants 3-12 years following a youth sport-related knee injury and uninjured controls with similar age, sex and sport characteristics. Analyses accounted for sex, time since injury and the interaction between time since injury and injury type. Secondary objectives were to report proportions meeting thresholds for KOOS outcomes and minimal detectable change (MDC) from published test-retest reliability data, over a 1-4-year follow-up. Two hundred and fifty-three (253) participants (124 injured, 129 controls) were included in analyses, of which 153 (77 injured, 76 controls) had follow-up data. Similar odds were observed for presence of pain (below PASS threshold) in participants with anterior cruciate ligament (ACL)/meniscus injury (odds ratio (OR) 4.2 (97.5% confidence interval (CI): 1.8, 9.9)) and other knee injuries (OR 4.9 (97.5% CI: 1.2, 21.0)), while there were higher odds for presence of Englund "symptomatic knee" criteria in participants with ACL/meniscus injury (OR 13.6 (97.5% CI: 2.9, 63.4)) than other knee injuries (OR 7.3 (97.5% CI: 0.8, 63.7)) compared to controls. After a median 23.4 (8 to 42) month follow-up, 35% of previously injured participants had at least one KOOS sub-scale score that worsened by more than the MDC published threshold. Despite limited research, this study shows that individuals with youth sport knee injuries other than ACL or meniscus injury may also experience significant pain and symptoms 3-12 years following injury. Replication and further follow-up are needed to identify a possible clinical trajectory towards osteoarthritis.
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http://dx.doi.org/10.3390/jcm10030522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867131PMC
February 2021

Preliminary study of the stability of dexamethasone when added to commercial veterinary ear cleaners over a 90 day period.

Vet Dermatol 2021 Apr 2;32(2):168-e39. Epub 2021 Feb 2.

Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California Davis, One Shields Avenue, Davis, CA, 95616, USA.

Background: Topical corticosteroids are commonly used in the management of allergic otitis externa to diminish inflammation. A common strategy is to make compounded solutions of dexamethasone in ear cleaner.

Hypothesis/objectives: The objective of this study was to determine the stability of dexamethasone when added to four commercial ear cleaners (ec): designated ecA, ecB, ecC and ecD.

Methods And Materials: Two concentrations (0.1 and 0.25 mg/mL) of dexamethasone were formulated for each cleaner solution from a 2 mg/mL solution and stored in the original manufacturers' bottles at two temperatures: room (22 ˚C) and refrigerated (4 ˚C). Samples were evaluated in triplicate, using liquid chromatography-tandem mass spectrometry at 10 time points over 90 days. The mean and standard deviation were calculated for each time point.

Results: A solution was considered stable if the dexamethasone value remained >90% of the target concentration. All dexamethasone solution values were stable to 90 days, except two solutions for ecA; the 0.25 mg/mL dexamethasone concentration was only stable to 14 (4 ˚C) and 21 days (22 ˚C).

Conclusions And Clinical Importance: These results provide preliminary evidence in support of pharmaceutical stability data for dexamethasone when included in the above compounded solutions at the noted concentrations and temperatures.
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http://dx.doi.org/10.1111/vde.12924DOI Listing
April 2021

A Standardized Buffalo Concussion Treadmill Test Following Sport-Related Concussion in Youth: Do ActiGraph Algorithms Matter?

J Athl Train 2021 Jan 22. Epub 2021 Jan 22.

1Sport Injury Prevention Research Center, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.

Context: Current recovery guidelines following sport-related concussion (SRC) include 24-48 hours of rest followed by gradual return-to-activity with heart rate (HR) maintained below symptom threshold. Additionally, the monitoring of physical activity (PA) post-SRC using ActiGraph accelerometers can provide further objective insight on amounts of activity associated with recovery trajectories. Cut-point algorithms for these devices allow minute-by-minute PA to be classified into intensity domains; however, studies have shown different algorithms employed on the same healthy participant dataset can produce varying classifications.

Objective: To identify the most physiologically appropriate cut-point algorithm (Evenson or Romanzini) to analyze ActiGraph data in concussed youth with comparisons to HR response on the Buffalo Concussion Treadmill Test (BCTT).

Design: Prospective cohort study.

Setting: Sport-concussion clinic within a university setting.

Patients Or Other Participants: Eleven high-school students (5 male, 6 female; median [range] age =16 years [15-17], height = 177.8 cm [157.5-198.1], weight = 67 kg [52-98], body mass index = 22 kg/m2 [17-31]) involved in high-risk sport who sustained a physician diagnosed SRC.

Main Outcome Measure(s): Evenson and Romanzini algorithm PA intensity domains via ActiGraph data and HR during the BCTT.

Results: There were differences in moderate (P = .001) and vigorous (P = .002) intensities between algorithms, but no difference in light (P = .548). Evenson classified most of the time as moderate intensity (57.03% [0.00-94.12%]), whereas Romanzini classified virtually all PA as vigorous (88.25% [2.94-97.06%]). PA based on HR (stages 1-7: 20-39% HR reserve (HRR), stages 8-13: 40-59% HRR, stages 14 and above: 60-85% HRR) indicated the BCTT primarily involves light-to-moderate intensity, and therefore is better represented by the Evenson algorithm.

Conclusions: The Evenson algorithm better characterizes the HR response during a standardized exercise test in concussed individuals and therefore should be used to analyze ActiGraph PA data in a concussed paediatric population.
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http://dx.doi.org/10.4085/527-20DOI Listing
January 2021
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