Epidemiology w1

Why do people play sport? (elite v recreational reasons)

For fun, improvement of skills, challenge, keep fit. Elite = career, glory, represent country. Recreational = for fun, social life, health benefits

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What do most sport injuries impair?

musculoskeletal system, including limbs, joints, bones, muscles, tendons, ligaments, cartilages

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How do bone fractures differ from soft tissue injuries in terms of prevelance?

Bone fractures are usually more severe but fewer in number, soft tissue injuries account for the majority of sport injuries (80%+)

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Define 'Sport Injury'

Any physical complaint sustained by practising or competing in a sport, that causes: 1) A reduction in future training/competition ('time loss injury') or 2) an athlete to seek medical attention ('medical attention injury')

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Why is sport medicing so important nowadays?

1) Increase in involvement in sport, 2) Increase demand of medical services to sportsmen and women

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Name some consequences of sport injuries

Pain, loss of playing time, loss of earnings/working time, medical expenditure, joint instaibility, limited mobility, disability, psychological problems, death

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Define Epidemiology

The study of diseases in relation to populations

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What is epidemiology in regards to sport medicine?

The study of injuries, acute or chronic, in relation to the sporting populations. e.g. what is the incidence of ankle sprain injury in football?

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Why is epidemiology in sport important?

1) Provides info to establish the extent of the sport injury problem. 2) Provides descriptive info for identifying the prevalence in different sites, incident rate of injury types, severity of injuries, and sports with mojority of injuries

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Incidence definition:

The number of instances of illness commening (new cases), or of persons becoming ill, during a given period in a specified population (Usually measures with set no. of people and time period)

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Prevelance definition:

Gives a figure for a factor at a single point of time ('prevalence proportion')

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What is 'incidence' in regards to sport medicine?

The indication of the number of new sports injuring during a particular period divided by the total number of sportspersons at the start of the period (e.g. population at risk), during a particular period (e.g. 1 year)

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How can you make the 'incidence' number more accurate?

Divide by the number of events, days or hours a person has competed/trained (e.g. 10/1000 person-match or person-hours)

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Example of incidence in rugby:

In rugby, the incidence of ankle sprains is 4.20 per 1000 person-hour, or 233.40 per 1000 person-year

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Example of Prevelance in rugby:

In rugby, the prevalence of injuries among all body sites is 11.6% (head 13.7%, thigh 12.7%, knee 9.7%, leg 8.4% etc). The prevalence of ankle sprains among all ankle injuries is 74.9% (fractures and others 25.1%)

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What are the variables of assessing injury incidence?

1) the definition of sport injury, 2) the way the incidence is expressed, 3) The method used to count injuries, 4) the method to establish the population at risk, 5) the representativeness of the sample

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What is a retrospective study?

Research starts now and includes the past 10 years (for example)

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What are the cons of a retrospective epidemiology?

Error from recall bias, estimation of exposure hours (not exact), startard to diagnose the injury and this the number of episodes (was the diagnosis formal by a doctor or by self?)

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What is a prospective study?

Research starts now and continues for a duration of time into the future

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What are the pro's and con's of a prospective epidemiology?

Pro's = can accurately estimate the exposure time, diagnose the injury and thus count the number of episodes, etc. Cons= People may drop out, lose interest, may lose contact with participants

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Epidemiology of sport injuries : Study 1

A 1 year audit report in regional emergency department serving 1 million people in hong-kong reported most attendance were related to domestic (35.5%), industrial (28.0%), traffic (12.5%) and sport (12.0%)

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Epidemiology of sport injuries: Study 2

Sports injuries may have accounted for the greatest number of all injuries, as less that 1/6 people would attend an emergency ward

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Epidemiology of sport injuries: Study 3

A 10-year study in Switzerland showed that 39.8% of all athletic injuries are on the knee, with anterior cruciate ligament (ACL) injury the majority (20.3%). It's 7 times more likely in athletes than non-athletes, mainly soccer and skiing.

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Epidemiology of sport injuries: Study 4

Ankle sprain is the single most common injury in sports, despite that knee injuries dominate as the most common injried body sites

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Epidemiology of sport injuries: Study 5

DUring the 2012 Olympics, 11% of athletes suffered an injury in training or competition during the 17-day period

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'Sequence of Injury Prevention' Model

....

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What is no.1 of the 'Sequence of Injury Prevention' Model

WHAT? 1) Establishing the extent of the injury problem: incidence and severity, using epidemiology studies.

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What is no.2 of the 'Sequence of Injury Prevention' Model

WHO + WHY + HOW? 2) identify risk factors, establish the aetiology and mechanisms of sports injuries

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What is no.3 of the 'Sequence of Injury Prevention' Model

IDEA TO PREVENT? 3) Introducing a preventative measure to tackle to problem

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What is no.4 of the 'Sequence of Injury Prevention' Model

TEST IT! 4) Assessing its effectiveness by repeating step 1 -> repeat epidemiology study

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Give examples of preventative measures?

Introduce rules to ensure safetly in a sports game, e.g. no high tackles in rugby and a red card if it happends. Equipment = ensure safety and prevent injury, e.g. helmets

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Name the first 4 descriptive epidemiology of sports injury

1) How many (incidence, prevelance), 2) Who (age, sex, playing position), 3) Nature of injury (acute - traumatic or chronic - overuse), 4) What type (fracture, strain, sprain etc),

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Name the second 4 descriptive epidemiology of sports injury

5) Where (anatomical location, tissue injured), 6) Severity (time loss, medical cost, economic cost), 7) situation (training or competition), 8) process (inciting mechanisms = contact/non-contact, sprinting, turning, cutting, landing etc

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Define and give examples of an acute (traumatic) injury

Sudden trauma caused by an impact or excessive loading. Moment of injury easily identified. e.g. Sprain of joint/ligament, strain of muscle/tendon, contusion, dislocation, fracture, laceration, concussion.

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Define and give examples of chronic (overuse) injury

Caused by repetitive movements and activities. Usually difficult to identify the onset of the problem. E.g. back pain, stress fracture, shin splints (medial tibial stress syndrome)

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Give an example of an injury that could be acute or chronic?

Fracture = usually acute with breaking of bone upon impact, but stress fracture can be an overuse injury

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What are the 3 classifications for 'severity of injury' and their durations?

1) Minor/mild = 0-7 days, 2) Moderate = 8-21 days, 3) Severe = 21 days or more or permanent damage

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Describe the spectrum of regeneration potential of musculoskeletal tissues

HIGH -> Bone, muscle, tendon, (MIDDLE of spectrum), Ligament, Meniscus, Cartilage (LOW)

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What is the cost of injury (of sprained ankles)?

In UK, 1-1.5 million visits to a+e. 5,600 incidence per day. Medical cost for 1 injury ranges from £940-1314. Total cost between £1-2 billion annually. Re-injury counts for 49% of these visits. Important for sport medicine to reduce number!!

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What is a systematic review?

Summary of injury incidence and prevalence on specific sport, injury, population etc

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What is a meta-analysis?

Breakdown of comparison = contrains a comparison study of previous studies and previous data.

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What is a risk factor? And what are the 2 sub-categories?

A risk factor increases the risk of an individual obtaining the injury. 1) Intrinsic factors (within the body = anatomy, psysiology, biomechanis, sex, age, etc). 2) Extrinsic (outside body = surface, environment, equipment, opponents, contact injury)

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Define and give examples of Aetiology:

The inciding event. E.g. landing on opponent's foot (sprained ankle), knee-in toe-out landing (knee sprain).

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Define and give examples of Mechanism:

The process of the injury. e.g. excessive ROM and.or excessive forces > acute injuries. Repetative movement and/or forces above the adaptive/healing capacity of tissues (chronic injury)

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Draw and describe how risk factors can effect causes

Lowering the unknown factor reduces the risk factor and the risk of injury. The risk factor is the cause of injury. E.g. Cigarette consumption -> carcinogenic chemical conc -> lung cancer. (Reduce 1 = reduces 2 and 3!)

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Draw and describe how risk factors don't effect causes

Lowering the risk factor does not reduce the risk of injury. The risk factor is not a cause of injury and instead is another result of the unknown factor. E.g. Cigarette consumption -> teeth stain and lung cancer (cleaning your teeth wont effect LC)

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Describe the relationship between intrinsic risk factors and external risk factors

Internal = capacity (human), externam = stress (environment). Interaction between the two is important! If capacity increases (improved fitness etc), proneness to injury decreases. Prevention could be reducing stress (mouthguards, strapping etc)

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Give examples of intrinsic risk factors (within the body)

Physical defect, physical fitnes (strength, speed, skill, flexibility), previous injury, psychological factors (personality, Locus of control, self-concept), Physical build (height, weight, joint stability, body fat), age, sex

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Give examples of extrinsic risk factors (outside the body)

Sport-related factors (type, exposure, opponents), venue (floor, lights), equipment (tools, protection, shoes etc), weather (temp, wind, rain), trainer (conduct of match, rules, referee's application of rules)

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How do you work out relative risk (RR)?

Work out the risk of sample A and risk of sample B (effected divided by total). RR = Risk of sample A divided by Risk of sample B

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How do you work out odd ratio (OR)?

Odds for sample A and Odds for sample B (effected divided by not effected). Odds Ratio = Odds for sample A divided by Odds for sample B

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Draw the model for injury causation

Predisposed athlete (internal risk factors) --> (exposure to external risk factors) --> susceptible athlete --> (inciting event) --> INJURY

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Facts of risk factors to running injuries

Females were at lower risk than male, previous injury increases risk, female only RF = older age, previous activity, surface, weekly distance (30-39miles). Male only RF = previous injury, less than 2 years running experience, run 20-29 miles weekly

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Facts of risk factors to football injuries = F-MARC study

264 players Czech republic, 81.2% injured, with 29.2% having severe injury. 18.0% no injury. 2 or more risk factors presented = increased change of injury. (e.g. body fat, smoking, more than 6 previous injuries, age starting football etc)

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Define 'Mechanism'

The process of how one is injured. Can be macro (e.g. tackled from behind, hit on head with ball), or micro (hyperextension of knee, excessive inversion of ankle etc)

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Define 'DIagnosis'

The outcome after the mechanism. Should be diagnosed by medical professional. E.g. Muscle strain, tendon/ligament rupture, dislocations, bone fractures, etc

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How are mechanism and diagnosis different? (Ankle sprain example)

Mechanism = spraining motion: inversion, eversion, plantarflexion etc. Diagnosis = ligamnetous sprain/tear (ATFL, PTFL etc), Tendon rupture (achilles tendon) or fracture (tibia, fibula)

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Epidemiology w1

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