Publications by authors named "Keith A Stokes"

88 Publications

Utilising a Behaviour Change Model to Improve Implementation of the Injury Prevention Exercise Programme in Schoolboy Rugby Union.

Int J Environ Res Public Health 2021 05 26;18(11). Epub 2021 May 26.

Department for Health, University of Bath, Bath BA2 7AY, UK.

The Health Action Process Approach (HAPA) is a behaviour change model showing promise in positively changing youth sport coaches' injury prevention behaviours. This study incorporated the HAPA model into coach training workshops for , an efficacious rugby injury prevention programme. Primary aims were to investigate the effect of the workshop on schoolboy rugby union coaches' (1) perceptions towards injury risk and prevention, (2) adoption and adherence. Secondary aims were to (3) assess the differences in post-season HAPA constructs between workshop attendees and non-attendees, (4) explore associations between HAPA constructs and adherence. In the pre-season, all participants ( = 76) completed a baseline survey, with 41 coaches electing to attend a workshop. Participants completed a post-season survey assessing HAPA constructs and adoption and adherence throughout the season. The workshop did not affect coach perceptions of injury risk and prevention. Attendees had significantly greater rates of adoption (95% vs. 54% χ = 17.42, < 0.01) and adherence (median = 2 sessions vs. ≤1 session per week; z = 3.45, = 0.03) than non-attendees. At post-season, attendees had significantly greater task self-efficacy (z = -3.46, < 0.05) and intention (z = -4.33, < 0.05) to use . These results support the delivery of coach workshops that utilise a behaviour change model to maximise programme implementation.
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http://dx.doi.org/10.3390/ijerph18115681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199066PMC
May 2021

Implementation of the injury prevention exercise programme in English schoolboy rugby union.

BMJ Open Sport Exerc Med 2021 4;7(2):e001018. Epub 2021 May 4.

Department for Health, University of Bath, Bath, UK.

Objectives: The implementation of the injury prevention exercise programme has not been assessed in an applied context. This study aimed to (1) describe the knowledge and perceptions of school rugby coaches and players towards injury risk, prevention and and (2) evaluate implementation in schoolboy rugby using the reach, effectiveness, adoption, implementation and maintenance framework.

Methods: Bespoke electronic surveys were administered to coaches (including support staff) and players at participating English schools (2018-2020). Most questions and statements were answered using a 7-point Likert scale. At baseline, participants detailed their awareness and perceptions of injury risk and prevention in schoolboy rugby. At postseason, participants reported use throughout the study and their perceptions towards the programme.

Results: At baseline, significant differences existed between coaches (n=106) and players (n=571) in awareness (75% and 13% respectively; χ=173.5, p<0.001). Coaches perceived rugby had a significantly greater injury risk than players, while holding more positive perceptions towards injury prevention. At postseason, coaches reported greater adoption compared with players (76% and 18% respectively; χ=41.8, p<0.001); 45% of players were unaware if they used the programme. Median session adherence was twice weekly, with a median duration of 10-15 min. This suggests was not implemented as intended, with recommendations of three 20 min sessions per week. Both groups identified common barriers to implementation, such as lack of time and inclusion of a ball.

Conclusion: Coaches are instrumental in the decision to implement . Targeting behavioural change in these individuals is likely to have the greatest impact on intervention uptake.
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http://dx.doi.org/10.1136/bmjsem-2020-001018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8098930PMC
May 2021

Unique diagnostic signatures of concussion in the saliva of male athletes: the Study of Concussion in Rugby Union through MicroRNAs (SCRUM).

Br J Sports Med 2021 Mar 23. Epub 2021 Mar 23.

University of Birmingham, Institute of Inflammation and Ageing, Birmingham, UK.

Objective: To investigate the role of salivary small non-coding RNAs (sncRNAs) in the diagnosis of sport-related concussion.

Methods: Saliva was obtained from male professional players in the top two tiers of England's elite rugby union competition across two seasons (2017-2019). Samples were collected preseason from 1028 players, and during standardised head injury assessments (HIAs) at three time points (in-game, post-game, and 36-48 hours post-game) from 156 of these. Samples were also collected from controls (102 uninjured players and 66 players sustaining a musculoskeletal injury). Diagnostic sncRNAs were identified with next generation sequencing and validated using quantitative PCR in 702 samples. A predictive logistic regression model was built on 2017-2018 data (training dataset) and prospectively validated the following season (test dataset).

Results: The HIA process confirmed concussion in 106 players (HIA+) and excluded this in 50 (HIA-). 32 sncRNAs were significantly differentially expressed across these two groups, with let-7f-5p showing the highest area under the curve (AUC) at 36-48 hours. Additionally, a combined panel of 14 sncRNAs (let-7a-5p, miR-143-3p, miR-103a-3p, miR-34b-3p, RNU6-7, RNU6-45, Snora57, snoU13.120, tRNA18Arg-CCT, U6-168, U6-428, U6-1249, Uco22cjg1,YRNA_255) could differentiate concussed subjects from all other groups, including players who were HIA- and controls, immediately after the game (AUC 0.91, 95% CI 0.81 to 1) and 36-48 hours later (AUC 0.94, 95% CI 0.86 to 1). When prospectively tested, the panel confirmed high predictive accuracy (AUC 0.96, 95% CI 0.92 to 1 post-game and AUC 0.93, 95% CI 0.86 to 1 at 36-48 hours).

Conclusions: SCRUM, a large prospective observational study of non-invasive concussion biomarkers, has identified unique signatures of concussion in saliva of male athletes diagnosed with concussion.
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http://dx.doi.org/10.1136/bjsports-2020-103274DOI Listing
March 2021

Padded Headgear does not Reduce the Incidence of Match Concussions in Professional Men's Rugby Union: A Case-control Study of 417 Cases.

Int J Sports Med 2021 Sep 19;42(10):930-935. Epub 2021 Feb 19.

Medical Services, Rugby Football Union, Twickenham, United Kingdom of Great Britain and Northern Ireland.

Concussion is the most common match injury in rugby union. Some players wear padded headgear, but whether this protects against concussion is unclear. In professional male rugby union players, we examined: (i) the association between the use of headgear and match concussion injury incidence, and (ii) whether wearing headgear influenced time to return to play following concussion. Using a nested case-control within a cohort study, four seasons (2013-2017) of injury data from 1117 players at the highest level of rugby union in England were included. Cases were physician-diagnosed concussion injuries. Controls were other contact injuries (excluding all head injuries). We determined headgear use by viewing video footage. Sixteen percent of cases and controls wore headgear. Headgear use had no significant effect on concussion injury incidence (adjusted odds ratio=1.05, 95% CI: 0.71-1.56). Median number of days absent for concussion whilst wearing headgear was 8 days, compared with 7 days without headgear. Having sustained a concussion in the current or previous season increased the odds of concussion more than four-fold (odds ratio=4.55, 95% CI: 3.77-5.49). Wearing headgear was not associated with lower odds of concussions or a reduced number of days' absence following a concussion.
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http://dx.doi.org/10.1055/a-1345-9163DOI Listing
September 2021

SARS-CoV-2 transmission during rugby league matches: do players become infected after participating with SARS-CoV-2 positive players?

Br J Sports Med 2021 Jul 11;55(14):807-813. Epub 2021 Feb 11.

Rugby Football Union, Twickenham, London, UK.

Objectives: To examine the interactions between SARS-CoV-2 positive players and other players during rugby league matches and determine within-match SARS-CoV-2 transmission risk.

Methods: Four Super League matches in which SARS-CoV-2 positive players were subsequently found to have participated were analysed. Players were identified as increased-risk contacts, and player interactions and proximities were analysed by video footage and global positioning system (GPS) data. The primary outcome was new positive cases of SARS-CoV-2 within 14 days of the match in increased-risk contacts and other players participating in the matches.

Results: Out of 136 total players, there were 8 SARS-CoV-2 positive players, 28 players identified as increased-risk contacts and 100 other players in the matches. Increased-risk contacts and other players were involved in 11.4±9.0 (maximum 32) and 4.0±5.2 (maximum 23) tackles, respectively. From GPS data, increased-risk contacts and other players were within 2 m of SARS-CoV-2 positive players on 10.4±18.0 (maximum 88) and 12.5±20.7 (maximum 121) occasions, totalling 65.7±137.7 (maximum 689) and 89.5±169.4 (maximum 1003) s, respectively. Within 14 days of the match, one increased-risk contact and five players returned positive SARS-CoV-2 reverse transcriptase PCR (RT-PCR) tests, and 27 increased-risk contacts and 95 other participants returned negative SARS-CoV-2 RT-PCR tests. Positive cases were most likely traced to social interactions, car sharing and wider community transmission and not linked to in-match transmission.

Conclusion: Despite tackle involvements and close proximity interactions with SARS-CoV-2 positive players, in-match SARS-CoV-2 transmission was not confirmed. While larger datasets are needed, these findings suggest rugby presents a lower risk of viral transmission than previously predicted.
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http://dx.doi.org/10.1136/bjsports-2020-103714DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886661PMC
July 2021

Employing Standardised Methods to Compare Injury Risk Across Seven Youth Team Sports.

Int J Sports Med 2021 Jan 18. Epub 2021 Jan 18.

Department of Health, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland.

Injury surveillance systems seek to describe injury risk for a given sport, in order to inform preventative strategies. This often leads to comparisons between studies, although these inferences may be inappropriate, considering the range of methods adopted. This study aimed to describe the injury epidemiology of seven youth sports, enabling valid comparisons of injury risk. Consistent methods were employed across seven sports [male American football, basketball, soccer, rugby league, rugby union; female soccer and rugby union] at a high school in England. A 24-hour time-loss injury definition was adopted. Descriptive statistics and injury incidence (/1000 match-hours) are reported. In total, 322 injuries were sustained by 240 athletes (mean age=17.7±1.0) in 10 273 player-match hours. American football had a significantly greater injury incidence (86/1000 h; 95% CI 61-120) than all sports except female rugby union (54/1000 h; 95% CI 37-76). Concussion was the most common injury (incidence range 0.0-26.7/1000 h), while 59% of injuries occurred via player contact. This study employed standardized data collection methods, allowing valid and reliable comparisons of injury risk between youth sports. This is the first known study to provide epidemiological data for female rugby union, male basketball and American football in an English youth population, enabling the development of preventative strategies.
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http://dx.doi.org/10.1055/a-1327-3009DOI Listing
January 2021

Training Load and Injury Risk in Elite Rugby Union: The Largest Investigation to Date.

Int J Sports Med 2021 Jun 8;42(8):731-739. Epub 2020 Dec 8.

Department for Health, University of Bath, Bath, United Kingdom.

Training load monitoring has grown in recent years with the acute:chronic workload ratio (ACWR) widely used to aggregate data to inform decision-making on injury risk. Several methods have been described to calculate the ACWR and numerous methodological issues have been raised. Therefore, this study examined the relationship between the ACWR and injury in a sample of 696 players from 13 professional rugby clubs over two seasons for 1718 injuries of all types and a further analysis of 383 soft tissue injuries specifically. Of the 192 comparisons undertaken for both injury groups, 40% (all injury) and 31% (soft tissue injury) were significant. Furthermore, there appeared to be no calculation method that consistently demonstrated a relationship with injury. Some calculation methods supported previous work for a "sweet spot" in injury risk, while a substantial number of methods displayed no such relationship. This study is the largest to date to have investigated the relationship between the ACWR and injury risk and demonstrates that there appears to be no consistent association between the two. This suggests that alternative methods of training load aggregation may provide more useful information, but these should be considered in the wider context of other established risk factors.
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http://dx.doi.org/10.1055/a-1300-2703DOI Listing
June 2021

Rugby union referees' physical and physiological demands across different competitive levels.

J Sports Med Phys Fitness 2021 Jun 4;61(6):788-796. Epub 2020 Nov 4.

Department for Health, University of Bath, Bath, UK.

Background: The purpose of this study was to compare the match demands of officiating 15-a-side rugby union at different competitive levels.

Methods: Data was collected using Global Navigation Satellite Systems from 21 referees during 82 competitive rugby union matches across three different competitive levels: 1) professional; 2) semi-professional; 3) amateur.

Results: Compared with referees at the professional and semi-professional levels, referees at the amateur level covered less total distance (P=0.005). Additionally, these referees covered less distance jogging, and at low and medium intensity (all P<0.05), and had less time between repeated high-intensity efforts (P<0.001). Furthermore, compared with referees at the semi-professional and amateur levels, referees at the professional level had a higher sprint duration and covered more distance sprinting (all P<0.05), and achieved a higher maximal speed during the longest repeated high-intensity effort or "worst-case scenario" (P=0.026). The professional level referees also displayed a lower average heart rate (P<0.001), spent a higher percentage of time at <60% HRmax (P<0.001), and a lower percentage of time between 71% and 80% HRmax (P=0.004). Finally, external and internal load were strongly correlated for referees at the semi-professional level only (r=0.75, P<0.001).

Conclusions: Overall, the findings demonstrate that refereeing 15-a-side rugby union is more physically demanding at higher competitive levels, particularly in terms of high-intensity efforts. The results provide important information for practitioners involved in the physical preparation and training of rugby union referees.
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http://dx.doi.org/10.23736/S0022-4707.20.11447-6DOI Listing
June 2021

The relationships between rugby union, and health and well-being: a scoping review.

Br J Sports Med 2021 Mar 28;55(6):319-326. Epub 2020 Oct 28.

Physical Activity for Health Research Centre, The University of Edinburgh, Edinburgh, UK.

Objective: To scope the relationships between rugby union, and health and well-being.

Design: Scoping review.

Data Sources: Published and unpublished reports of any age, identified by searching electronic databases, platforms and reference lists.

Methods: A three-step search strategy identified relevant published primary, secondary studies and grey literature, which were screened using inclusion criteria. Data were extracted using a standardised tool, to form (1) a numerical analysis and (2) a thematic summary.

Results And Discussion: 6658 records were identified, and 198 studies met the inclusion criteria. All forms of rugby union can provide health-enhancing physical activity (PA). 'Non-contact' and wheelchair rugby in particular provide a wide range of physical and mental health and well-being benefits. The evidence is either mixed or unclear in relation to 'contact' rugby union and its effects on a range of physical health domains. Injury and concussion incidence rates are high for contact rugby union relative to other sports.

Conclusions: A wide range of stakeholders as well as existing and potential participants can use this information to make a more informed decision about participating in and promoting rugby union as a health-enhancing activity. Industry and policy-makers can use this review to inform policies and strategies that look to increase participation rates and use rugby union as a vehicle to contribute positively to population health. Further research understanding rugby union's contribution to PA as well as to muscle-strengthening and balance is indicated, as well as research examining more health and well-being outcomes across more diverse cohorts.
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http://dx.doi.org/10.1136/bjsports-2020-102085DOI Listing
March 2021

Trends in match injury risk in professional male rugby union: a 16-season review of 10 851 match injuries in the English Premiership (2002-2019): the Professional Rugby Injury Surveillance Project.

Br J Sports Med 2021 Jun 12;55(12):676-682. Epub 2020 Oct 12.

Department for Health, University of Bath, Bath, UK

Objectives: The Professional Rugby Injury Surveillance Project is the largest and longest running rugby union injury surveillance project globally and focuses on the highest level of rugby in England.

Methods: We examined match injuries in professional men's rugby over the period 2002/2003 to 2018/2019 and described trends in injuries over this time.

Results: Over the period 2002/2003-2018/2019, 10 851 injuries occurred in 1 24 952 hours of match play, equating to a mean of 57 injuries per club per season and one injury per team per match. The mean incidence, severity (days absence) and burden (days absence/1000 hours) of injury were 87/1000 hours (95% CI 82 to 92), 25 days (95% CI 22 to 28) and 2178 days/1000 hours (95% CI 1872 to 2484), respectively. The tackle accounted for 43% injuries with running the second most common activity during injury (12%). The most common injury location was the head/face with an incidence of 11.3/1000 hours, while the location with the highest overall burden was the knee (11.1 days/1000 hours). Long-term trends demonstrated stable injury incidence and proportion of injured players, but an increase in the mean and median severity of injuries. Concussion incidence, severity and burden increased from the 2009/2010 season onwards and from 2011 to 2019 concussion was the most common injury.

Conclusion: The rise in overall injury severity and concussion incidence are the most significant findings from this work and demonstrate the need for continued efforts to reduce concussion risk as well as a greater understanding of changes in injury severity over time.
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http://dx.doi.org/10.1136/bjsports-2020-102529DOI Listing
June 2021

Training Load, Injury Burden, and Team Success in Professional Rugby Union: Risk Versus Reward.

J Athl Train 2020 Sep;55(9):960-966

Department for Health, University of Bath, United Kingdom.

Context: Individual and team injury burden and performance are 2 key considerations facing practitioners in the daily prescription of an athlete's training load. Whereas a considerable number of researchers have examined univariate relationships between training load and performance, training load and injury, or injury and performance, few investigators have examined all 3 concurrently.

Objective: To assess the association among training load, injury burden, and performance in professional rugby union.

Design: Descriptive epidemiology study.

Setting: The English Premiership competition.

Patients Or Other Participants: Individual injury and training load data, as well as team performance data, were captured during the 2015-2016 (n = 433 players) and 2016-2017 (n = 569 players) seasons.

Main Outcome Measure(s): Data were aggregated into team average scores for each week, including weekly (acute) load, smoothed chronic load, changes in load, injury burden, and weekly performance. Linear mixed modelling techniques were used to assess the association among measures.

Results: Injury burden was negatively associated with performance, with a high weekly burden associated with a likely harmful (P = .01) decrease in performance. Training load measures displayed only trivial associations with performance. Only the acute:chronic workload ratio measure was clearly associated with injury burden, with a possibly harmful effect (P = .02). Both squad size and player availability were associated with only trivial changes in performance.

Conclusions: Whereas no association between average training load and performance existed, associations between training load and injury burden and between injury burden and performance were clear. Further investigation using more sensitive and individualized measures of load, performance, and injury may elicit a clearer relationship and should be considered for future work.
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http://dx.doi.org/10.4085/1062-6050-0387.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534937PMC
September 2020

Evaluating the Implementation of Injury Prevention Strategies in Rugby Union and League: A Systematic Review using the RE-AIM Framework.

Int J Sports Med 2021 Feb 28;42(2):112-121. Epub 2020 Jul 28.

Department for Health, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland.

Rugby (union and league) has come under intense scrutiny due to its injury risk. Various interventions have been introduced to protect players from injury, with many deemed efficacious and advocated for use across various worldwide contexts. However, their implementation is less clear. The objective of this systematic review was to determine whether injury prevention interventions in rugby have evaluated their '', '', '', '' and '' as per the RE-AIM Multi-Dimension Item Checklist. Six electronic databases were searched in November 2019. Inclusion criteria included: English language, peer-reviewed journal article, original research, field-based rugby code, prospective intervention. Of the 4253 studies identified, 74 met the full inclusion criteria. Protective equipment, predominately mouthguards, was the intervention of interest in 44 studies. Other interventions included multimodal national injury prevention programmes, law changes and neuromuscular training programmes. 'Effectiveness' was the highest scoring RE-AIM dimension (55%), followed by 'reach' (26%). All other RE-AIM dimensions scored below 20%. Research currently focuses on determining intervention 'effectiveness'. For injury prevention strategies to have their desired impact, there must be a shift to address all determinants associated with implementation. Consideration should be given to how this can be achieved by adopting specific reporting checklists, research frameworks and study designs.
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http://dx.doi.org/10.1055/a-1212-0649DOI Listing
February 2021

Injury and Player Availability in Women's International Pathway Cricket from 2015 to 2019.

Int J Sports Med 2020 Oct 6;41(13):944-950. Epub 2020 Jul 6.

Department for Health, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland.

This prospective cohort study aimed to describe injury and illness epidemiology within women's international pathway cricket, understanding what influences player availability in this unique context where players are contracted part-time. Approximately 8.4% of players were impacted by injury or illness during the year, with an average 2.3% of players completely unavailable on any given day. Most medical complaints occurred during training (111.2 injuries/100 players per year). Of all complaints, medical illness had the highest overall incidence (45.0 complaints/100 players), followed by hand injuries (24.7 injuries/100 players). Gradual onset injuries were most common. Overall average match time-loss complaint prevalence rate was 4.1% and average match time-loss injury incidence rate was 7.0 injuries/1000 days of play. Fielding (56.4 injuries/100 players per year) was the activity resulting in the highest average overall and time-loss injury incidence rates, though 'other' activities (e. g. those occurring outside of cricket participation) collectively accounted for 78.3 injuries/100 players per year. The high incidence of medical illness relative to other complaints may be a distinct feature of the women's cricket international pathway compared to other cricket samples. The high occurrence of injuries arising from 'other' activities, likely due to part-time participation, presents an opportunity for targeted injury prevention strategies.• The first study on an international women's cricket pathway, contributes to the empirical base for specific injury risks associated with the women's cricket game, which is an emerging research area for a developing sport.• Some of the findings may be a distinct feature of the women's cricket international pathway, highlighting potential opportunities for targeted prevention strategies.• With the upcoming development of an elite domestic structure these preliminary findings will provide a good starting point for physiotherapy and medical staff working in these contexts.
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http://dx.doi.org/10.1055/a-1192-5670DOI Listing
October 2020

Ankle osteoarthritis and its association with severe ankle injuries, ankle surgeries and health-related quality of life in recently retired professional male football and rugby players: a cross-sectional observational study.

BMJ Open 2020 06 21;10(6):e036775. Epub 2020 Jun 21.

Orthopaedic Surgery, Amsterdam UMC - Locatie AMC, Amsterdam, North Holland, The Netherlands.

Objectives: To determine (1) the prevalence of ankle osteoarthritis (OA) among former professional football and rugby players, (2) assess the association between ankle injuries or ankle surgeries with ankle OA, and (3) compare the mental and physical quality of life (QoL) between former professional football and rugby players with and without OA.

Methods: We conducted a questionnaire-based observational study with a cross-sectional design. Former professional football and rugby players were recruited by the Football Players Worldwide and the International Rugby Players. Information concerning ankle OA, sustained ankle injuries and ankle surgeries was gathered (medical record or most recent medical professional). Health-related QoL was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) physical and mental health scores.

Results: Overall, 553 former professional football (n=401) and rugby (n=152) players were enrolled in the study (response rate of 56%). Ankle OA prevalence among former professional football and rugby players was 9.2% and 4.6%, respectively. Football players were more likely to suffer from ankle OA following every ankle injury and/or surgery. Football and rugby players with ankle OA had similar PROMIS physical and mental health scores to the norm for the general population.

Conclusion: Former professional football and rugby players had higher ankle OA prevalence than the general population (3.4%). Football players are more likely to suffer from ankle OA following every ankle injury and/or surgery. No clinically relevant difference was seen for physical or mental health-related QoL among football and rugby players. Preventive measures for ankle injuries are recommended.
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http://dx.doi.org/10.1136/bmjopen-2020-036775DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310999PMC
June 2020

The epidemiology of kicking injuries in professional Rugby Union: A 15-season prospective study.

Scand J Med Sci Sports 2020 Sep 18;30(9):1739-1747. Epub 2020 Jun 18.

Applied Sports, Technology, Exercise and Medicine Research Centre, Swansea University, Swansea, UK.

Purpose: While kicking in Rugby Union can be influential to match outcome, the epidemiology of kicking injuries remains unknown. This study therefore aimed to investigate the epidemiology of injuries attributed to kicking in professional rugby, including playing position-specific effects and differences in kicking volumes and kick types.

Methods: Fifteen seasons of injury surveillance data and two seasons of match kicking characteristics from professional rugby players were analyzed. Incidence, propensity, and severity of kicking-related injuries were calculated together with the locations and types of these injuries. Position-related differences in match kicking types and volumes were also established.

Results: Seventy-seven match and 55 training acute-onset kicking injuries were identified. The match kicking injury incidence for backs was 1.4/1000 player-match-hours. Across all playing positions, the propensity for match kicking injury was 0.57 injuries/1000 kicks. Fly-halves sustained the greatest proportion of match kicking injuries (47%) and performed the greatest proportion of match kicks (46%); an average propensity for match kicking injury (0.58/1000 kicks). Scrum-halves executed 27% of match-related kicks but had a very low propensity for match kicking injury (0.17/1000 kicks). All other positional groups executed a small proportion of match-related kicks but a high propensity for match kicking injury. Ninety-two percent of match kicking injuries occurred in the pelvis or lower limb, with the majority sustained by the kicking limb. 21% of all match kicking injuries were associated with the rectus femoris muscle.

Conclusion: Match kicking profiles and kicking injuries sustained are position-dependent, which provides valuable insight for developing player-specific conditioning and rehabilitation protocols.
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http://dx.doi.org/10.1111/sms.13737DOI Listing
September 2020

Returning to Play after Prolonged Training Restrictions in Professional Collision Sports.

Int J Sports Med 2020 Oct 29;41(13):895-911. Epub 2020 May 29.

Department for Health, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland.

The COVID-19 pandemic in 2020 has resulted in widespread training disruption in many sports. Some athletes have access to facilities and equipment, while others have limited or no access, severely limiting their training practices. A primary concern is that the maintenance of key physical qualities (e. g. strength, power, high-speed running ability, acceleration, deceleration and change of direction), game-specific contact skills (e. g. tackling) and decision-making ability, are challenged, impacting performance and injury risk on resumption of training and competition. In extended periods of reduced training, without targeted intervention, changes in body composition and function can be profound. However, there are strategies that can dramatically mitigate potential losses, including resistance training to failure with lighter loads, plyometric training, exposure to high-speed running to ensure appropriate hamstring conditioning, and nutritional intervention. Athletes may require psychological support given the challenges associated with isolation and a change in regular training routine. While training restrictions may result in a decrease in some physical and psychological qualities, athletes can return in a positive state following an enforced period of rest and recovery. On return to training, the focus should be on progression of all aspects of training, taking into account the status of individual athletes.
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http://dx.doi.org/10.1055/a-1180-3692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7799169PMC
October 2020

Serious sports-related injury in England and Wales from 2012-2017: a study protocol.

Inj Epidemiol 2020 Apr 27;7(1):14. Epub 2020 Apr 27.

Department for Health, University of Bath, Bath, UK.

Background: Physical activity is an important component of healthy lifestyles, with a central role in morbidity prevention. However, sporting and physical activity also involve an inherent injury risk. Some sports and activities have a higher injury risk, and may involve more severe injuries. Furthermore, injuries of a severe nature have substantial individual and societal consequences, including the burden of assessment, treatment, and potential on-going care costs. There are limited data on severe sports injury risk in England and Wales, and no national data describing risk across sports. The aims of this study are to identify the cases and incidence of: i) paediatric and ii) adult severe sports injury from 2012 to 2017; and to describe injury incidence in individual sports.

Methods: This study is an analysis of prospectively collected sport-related injuries, treated from January 2012 to December 2017. Incidents involving a severe injury (in-patient trauma care) in England and Wales, will be identified from the Trauma Audit Research Network registry. Data for patients who were: transfers or direct hospital admissions, with inpatient stays of ≥3 days, admissions to High Dependency areas, or in-hospital mortality after admission; and whose injury mechanism was sport, or incident description included one of 62 sporting activities, will be extracted. Data will be categorised by sport, and sports participation data will be derived from Sport England participation surveys. Descriptive statistics will be estimated for all demographic, incident, treatment and sport fields, and crude serious annual injury incidence proportions estimated. Poisson confidence intervals will be estimated for each sport and used to describe injury risk (incidence) across sporting activities.

Discussion: This study will be the first to describe the number of, and trends in severe sport-related injuries in England and Wales. These data are useful to monitor the number and burden of severe sports injury, and inform injury prevention efforts. The monitoring and mitigation of sports injury risk is essential for individuals, health services and policy, and to encourage physically active lifestyles and safer participation for adults and children.
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http://dx.doi.org/10.1186/s40621-020-00243-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184700PMC
April 2020

International Olympic Committee Consensus Statement: Methods for Recording and Reporting of Epidemiological Data on Injury and Illness in Sports 2020 (Including the STROBE Extension for Sports Injury and Illness Surveillance (STROBE-SIIS)).

Orthop J Sports Med 2020 Feb 18;8(2):2325967120902908. Epub 2020 Feb 18.

Background: Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport- or setting-specific consensus statements on sports injury (and, eventually, illnesses) epidemiology to date.

Objective: To further strengthen consistency in data collection, injury definitions, and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension.

Study Design: Consensus statement of the International Olympic Committee (IOC).

Methods: The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups, and a 3-day consensus meeting in October 2019.

Results: This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems, severity of health problems, capturing and reporting athlete exposure, expressing risk, burden of health problems, study population characteristics, and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS).

Conclusion: The IOC encourages ongoing in- and out-of-competition surveillance programs and studies to describe injury and illness trends and patterns, understand their causes, and develop measures to protect the health of the athlete. The implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
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http://dx.doi.org/10.1177/2325967120902908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029549PMC
February 2020

Consensus on a video analysis framework of descriptors and definitions by the Rugby Union Video Analysis Consensus group.

Br J Sports Med 2020 May 20;54(10):566-572. Epub 2020 Feb 20.

Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.

Using an expert consensus-based approach, a rugby union Video Analysis Consensus (RUVAC) group was formed to develop a framework for video analysis research in rugby union. The aim of the framework is to improve the consistency of video analysis work in rugby union and help enhance the overall quality of future research in the sport. To reach consensus, a systematic review and Delphi method study design was used. After a systematic search of the literature, 17 articles were used to develop the final framework that described and defined key actions and events in rugby union (rugby). Thereafter, a group of researchers and practitioners with experience and expertise in rugby video analysis formed the RUVAC group. Each member of the group examined the framework of descriptors and definitions and rated their level of agreement on a 5-point agreement Likert scale (1: ; 2: ; 3: ; 4: ; 5). The mean rating of agreement on the five-point scale (1: ; 5: ) was 4.6 (4.3-4.9), 4.6 (4.4-4.9), 4.7 (4.5-4.9), 4.8 (4.6-5.0) and 4.8 (4.6-5.0) for the tackle, ruck, scrum, line-out and maul, respectively. The RUVAC group recommends using this consensus as the starting framework when conducting rugby video analysis research. Which variables to use (if not all) depends on the objectives of the study. Furthermore, the intention of this consensus is to help integrate video data with other data (eg, injury surveillance).
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http://dx.doi.org/10.1136/bjsports-2019-101293DOI Listing
May 2020

International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)).

Br J Sports Med 2020 Apr 18;54(7):372-389. Epub 2020 Feb 18.

Aspetar Sports Medicine and Orthopedic Hospital, Doha, Qatar.

Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems; severity of health problems; capturing and reporting athlete exposure; expressing risk; burden of health problems; study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension-the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
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http://dx.doi.org/10.1136/bjsports-2019-101969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146946PMC
April 2020

Does reducing the height of the tackle through law change in elite men's rugby union (The Championship, England) reduce the incidence of concussion? A controlled study in 126 games.

Br J Sports Med 2021 Feb 19;55(4):220-225. Epub 2019 Dec 19.

Rugby Football Union, Twickenham, London, UK.

Objectives: Most concussions in rugby union occur during tackles. We investigated whether legislation to lower maximum tackle height would change tackle behaviour, and reduce concussion incidence rate.

Methods: In an observational evaluation using a prospective cohort design, 12 elite men's teams played in two competitions during the 2018/2019 season. The Championship (90 games) retained standard Laws of Rugby for the tackle; the Championship Cup (36 games) used revised laws-the maximum tackle height was lowered from the line of the shoulders on the ball carrier to the line of the armpits. Videos of tackles were analysed for ball carrier and tackler behaviour. Injury data were collected using standardised methods.

Results: In the lowered tackle height setting, there was a significantly lower proportion of tackles; (1) in which ball carriers (rate ratio (RR) 0.83, 95% CI 0.79 to 0.86) and tacklers (RR 0.80, 95% CI 0.76 to 0.84) were upright, (2) in which the tackler's initial contact was to the ball carrier's head or neck (RR 0.70, 95% CI 0.58 to 0.84) and (3) in which initial contact was above the line of the ball carrier's armpit (RR 0.84, 95% CI 0.80 to 0.88). Concussion incidence rate did not differ between conditions (RR 1.31, 95% CI 0.85 to 2.01). Unexpectedly, compared with the standard tackle height setting, tacklers in the lowered tackle height setting were themselves concussed at a higher rate as measured by; (1) incidence (RR 1.90, 95% CI 1.05 to 3.45) and (2) concussions per 1000 tackles (2.09, 95% CI 1.15 to 3.80).

Conclusions: Legislating to lower the height of the tackle meant that tacklers made contact with the ball carrier's head and neck 30% less often. This did not influence concussion incidence rates. Tacklers in the lowered tackle height setting suffered more concussions than did tacklers in the standard tackle height setting.
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http://dx.doi.org/10.1136/bjsports-2019-101557DOI Listing
February 2021

Patterns of training volume and injury risk in elite rugby union: An analysis of 1.5 million hours of training exposure over eleven seasons.

J Sports Sci 2020 Feb 22;38(3):238-247. Epub 2019 Nov 22.

Department for Health, University of Bath, Bath, UK.

Rugby union is a popular team sport that demands high levels of physical fitness and skill. The study aim was to examine trends in training volume and its impact on injury incidence, severity and burden over an 11-season period in English professional rugby. Data were recorded from 2007/08 through 2017/18, capturing 1,501,606 h of training exposure and 3,782 training injuries. Players completed, on average, 6 h 48 minutes of weekly training (95% CI: 6 h 30 mins to 7 h 6 mins): this value remained stable over the 11 seasons. The mean incidence of training-related injuries was 2.6/1000 player-hours (95% CI: 2.4 to 2.8) with a mean severity rising from 17 days in 2007/08 to 37 days in 2017/18 (Change/season = 1.773, 0.01). Rate of change in severity was dependent on training type, with conditioning (non-gym-based) responsible for the greatest increase (2.4 days/injury/season). As a result of increasing severity, injury burden rose from 51 days absence/1000 player-hours in 2007/08 to 106 days' absence/1000 player-hours in 2017/18. Despite the low incidence of injury in training compared to match-play, training accounted for 34% of all injuries. Future assessments of training intensity may lead to a greater understanding of the rise in injury severity.
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http://dx.doi.org/10.1080/02640414.2019.1692415DOI Listing
February 2020

Exercise Snacking to Improve Muscle Function in Healthy Older Adults: A Pilot Study.

J Aging Res 2019 3;2019:7516939. Epub 2019 Oct 3.

Department for Health, University of Bath, Bath BA2 7AY, UK.

Loss of muscle mass and strength are seemingly accepted as part of the ageing process, despite ultimately leading to the loss of independence. Resistance exercise is considered to be primary defence against loss of muscle function in older age, but it typically requires access to exercise equipment often in a gym environment. This pilot study aimed at examining the effect of a 28-day, unsupervised home-based exercise intervention on indices of leg strength and muscle size in healthy older adults. Twenty participants were randomly assigned to either maintain their habitual physical activity levels (Control; =10; age, 74 (5) years; body mass, 26.3 (3.5) kg/m) or undertake "exercise snacks" twice daily (ES; =10; age, 70 (4) years; body mass, 25.0 (3.4) kg/m). Both groups consumed 150 g of yogurt at their breakfast meal for the duration of the intervention. Sixty-second sit-to-stand score improved by 31% in ES, with no change in Control ( < 0.01). Large effect sizes were observed for the difference in change scores between the groups for interpolated maximum leg pressing power (6% increase in ES) and thigh muscle cross-sectional area (2% increase in ES). The present pilot data suggest that exercise snacking might be a promising strategy to improve leg muscle function and size in older adults and that further investigation into zero-cost exercise strategies that allow high frequency of training is warranted.
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http://dx.doi.org/10.1155/2019/7516939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794984PMC
October 2019

The relationships between rugby union and health: a scoping review protocol.

BMJ Open Sport Exerc Med 2019 24;5(1):e000593. Epub 2019 Aug 24.

Rugby Football Union, Twickenham, UK.

Introduction: Rugby union is played by over eight million people across the world and is considered a form of moderate-to-vigorous physical activity. Consequently, playing rugby may confer health benefits; however, to date, the principal focus of research has been on associated injuries and potential detrimental long-term health sequelae. This protocol outlines the methods behind studying any potential associations between rugby union and both physical and mental health.

Methods And Analysis: Best practice methodological frameworks (Arksey and O'Malley, Levac and the Joanna Briggs Institute) and previously published scoping review protocols in sport informs the methodology of this protocol. This protocol enables us to map the key concepts and evidence available, summarise and share existing research findings, and identify research gaps in the current literature. A three-step search strategy will identify reviews, original research, and published and grey literature. An initial search will identify suitable search terms, followed by a search using keyword and index terms. Two reviewers will independently screen identified studies for final inclusion.

Dissemination: When publishing the scoping review, we will map key concepts and evidence both numerically and thematically, as well as identify key research priorities for further studies. The review will subsequently be disseminated to stakeholder groups, practitioners and policymakers through a variety of peer-reviewed and non-peer-reviewed publications, conferences and via multimedia platforms.
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http://dx.doi.org/10.1136/bmjsem-2019-000593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733317PMC
August 2019

Physical Demands of Refereeing Rugby Sevens Matches at Different Competitive Levels.

J Strength Cond Res 2019 Jul 1. Epub 2019 Jul 1.

Department for Health, University of Bath, Bath, United Kingdom.

Sant'Anna, RT, Roberts, SP, Moore, LJ, and Stokes, KA. Physical demands of refereeing rugby sevens matches at different competitive levels. J Strength Cond Res XX(X): 000-000, 2019-The aim of this study was to compare the physical demands of officiating across different competitive levels in rugby sevens. An observational design was used involving 27 referees (26 men and 1 woman, age: 27 ± 6 years, body mass [mean ± SD]: 78.5 ± 9.3 kg, and height: 179 ± 5 cm). Global Navigation Satellite Systems data were collected across a total of 114 matches during 5 separate rugby sevens tournaments played in England-between May and July 2018-categorized into 4 competitive levels: (a) international, (b) professional, (c) semiprofessional, and (d) amateur. Compared with referees officiating at the international, professional, and semiprofessional levels, referees officiating at the amateur level covered less total (p < 0.001) and relative distance (p < 0.001). In addition, these referees covered more distance walking and jogging (p < 0.001). Amateur referees also completed fewer sprints (p = 0.006), repeated high-intensity efforts (RHIEs) per game (p < 0.001), and spent longer between RHIEs (p = 0.015). Finally, for the amateur referees, the duration of the longest repeated high-intensity bout (i.e., worst case scenario) was lower (p < 0.001), with less distance covered (p < 0.001) and fewer high-intensity accelerations (p < 0.001). Refereeing rugby sevens is therefore more physically demanding at higher competitive levels, particularly in terms of high-intensity efforts. The results provide vital information for practitioners involved in the physical preparation of rugby sevens referees.
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http://dx.doi.org/10.1519/JSC.0000000000003246DOI Listing
July 2019

Athlete Monitoring in Rugby Union: Is Heterogeneity in Data Capture Holding Us Back?

Sports (Basel) 2019 Apr 27;7(5). Epub 2019 Apr 27.

Department for Health, University of Bath, Bath BA2 7AY, UK.

In an effort to combat growing demands on players, athlete monitoring has become a central component of professional sport. Despite the introduction of new technologies for athlete monitoring, little is understood about the practices employed in professional rugby clubs. A questionnaire was circulated amongst conditioning staff across the 12 Premiership rugby clubs to capture the methods used, relative importance, perceived effectiveness and barriers to the use of multiple different athlete monitoring measurements. Previous injury, Global Positioning System (GPS) metrics, collision counts and age were deemed the most important risk factors for managing future injury risk. A wide range of GPS metrics are collected across clubs with high-speed running (12/12 clubs), distance in speed zones (12/12 clubs) and total distance (11/12 clubs) the most commonly used. Of the metrics collected, high-speed running was deemed the most important for managing future injury risk (5/12 clubs); however, there was considerable variation between clubs as to the exact definition of high-speed running, with both absolute and relative measures utilised. While the use of such monitoring tools is undertaken to improve athlete welfare by minimising injury risk, this study demonstrates the significant heterogeneity of systems and methods used by clubs for GPS capture. This study therefore questions whether more needs to be done to align practices within the sport to improve athlete welfare.
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http://dx.doi.org/10.3390/sports7050098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571870PMC
April 2019

The prevalence of hand and wrist osteoarthritis in elite former cricket and rugby union players.

J Sci Med Sport 2019 Aug 16;22(8):871-875. Epub 2019 Mar 16.

Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, UK.

Objectives: This study aimed to determine the prevalence of hand and wrist osteoarthritis in former elite cricket and rugby union players, by sport and playing position, and to define the prevalence of severe hand injury, and its association with hand osteoarthritis.

Design: Cross-sectional.

Methods: Data from cross-sectional studies of former elite male cricket and rugby players were used to determine the prevalence of hand pain, physician-diagnosed osteoarthritis, and previous severe injury. Multivariable logistic regression was used to determine the association of previous injury with pain and osteoarthritis.

Results: Data from 200 cricketers and 229 rugby players were available. Complete case analysis resulted in 127 cricketers and 140 rugby players. Hand pain was more prevalent amongst cricketers (19.7%) than rugby players (10.0%). The prevalence did not differ between cricket and rugby players for hand osteoarthritis (2.4% and 3.6%), wrist osteoarthritis (1.6% and 2.1%), or previous severe hand injury (36.2% and 31.4%). No significant association between previous hand injury and pain or osteoarthritis was identified in either sport.

Conclusions: Former elite cricketers reported more hand pain than rugby players. No significant association was found between self-reported severe injury and hand osteoarthritis in either cohort, potentially indicating that risk factors aside from injury may be more prominent in the development of hand osteoarthritis.
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http://dx.doi.org/10.1016/j.jsams.2019.03.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593259PMC
August 2019
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