Concussions in ice hockey: mixed methods study including assessment of concussions on games missed and cap hit among National Hockey League players, systematic review, and concussion protocol analysis.

OBJECTIVE: Concussions can occur at any level of ice hockey. Incidence estimates of concussions in ice hockey vary, and optimal prevention strategies and return-to-play (RTP) considerations have remained in evolution. The authors performed a mixed-methods study with the aim of elucidating the landscape of concussion in ice hockey and catalyzing initiatives to standardize preventative mechanisms and RTP considerations. METHODS: The authors performed a five-part mixed-methods study that includes: 1) an analysis of the impact of concussions on games missed and income for National Hockey League (NHL) players using a publicly available database, 2) a systematic review of the incidence of concussion in ice hockey, 3) a systematic review of preventative strategies, 4) a systematic review of RTP, and 5) a policy review of documents from major governing bodies related to concussions in sports with a focus on ice hockey. The PubMed, Embase, and Scopus databases were used for the systematic reviews and focused on any level of hockey. RESULTS: In the NHL, 689 players had 1054 concussions from the 2000-2001 to 2022-2023 seasons. A concussion led to a mean of 13.77 ± 19.23 (range 1-82) games missed during the same season. After cap hit per game data became available in 2008-2009, players missed 10,024 games due to 668 concussions (mean 15.13 ± 3.81 per concussion, range 8.81-22.60 per concussion), with a cap hit per game missed of $35,880.85 ± $25,010.48 (range $5792.68-$134,146.30). The total cap hit of all missed games was $385,960,790.00, equating to $577,635.91 per concussion and $25,724,052.70 per NHL season. On systematic review, the incidence of concussions was 0.54-1.18 per 1000 athlete-exposures. Prevention mechanisms involved education, behavioral and cognitive interventions, protective equipment, biomechanical studies, and policy/rule changes. Rules prohibiting body checking in youth players were most effective. Determination of RTP was variable. Concussion protocols from both North American governing bodies and two leagues mandated that a player suspected of having a concussion be removed from play and undergo a six-step RTP strategy. The 6th International Conference on Concussion in Sport recommended the use of mouthguards for children and adolescents and disallowing body checking for all children and most levels of adolescents. CONCLUSIONS: Concussions in ice hockey lead to substantial missed time from play. The authors strongly encourage all hockey leagues to adopt and adhere to age-appropriate rules to limit hits to the head, increase compliance in wearing protective equipment, and utilize high-quality concussion protocols.

Assessment and Conceptualization of Perceived Competence in Ice Hockey: A Scale Development and Validation Study.

Perceived competence plays a crucial role in establishing environments favorable to individual development in youth sport. As most assessment tools of perceived competence are not sport-specific, they have limited usefulness for sport practitioners and researchers. This study had two-fold aims: (i) to develop a perceived competence assessment tool specific to ice hockey; and (ii) to examine its factorial structure and internal consistency. We first developed an initial 29-item version of this ice hockey competence self-report scale, using a group of ice hockey stakeholders and sports science experts to develop the items and a pilot sample of 42 hockey players to confirm test-retest reliability. Finally, we validated the scale among a cohort of 770 adolescent ice hockey players (M age = 14.78, SD = 1.60 years). Results from exploratory factor analysis (EFA) revealed that perceived competence in ice hockey was defined by six dimensions, with rejection of seven items. Confirmatory factor analysis (CFA) suggested that the 6-factor first order model was the best fit with the conceptualization of perceived competence in ice hockey (CFI = 0.938, RMSEA = 0.044). The final, 22-item questionnaire now provides a reliable and valid measure of perceived competence in hockey for adolescent participants. It has promise for evaluating future interventions aiming to foster young athletes' perceived confidence through sport.

Force-velocity profiling in ice hockey skating: reliability and validity of a simple, low-cost field method.

In recent years, a simple method for force-velocity (F-v) profiling, based on split times, has emerged as a potential tool to examine mechanical variables underlying running sprint performance in field conditions. In this study, the reliability and concurrent validity of F-v profiling based on split times were examined when used for ice hockey skating. It was also tested how a modification of the method, in which the start instant of the sprint is estimated based on optimisation (time shift method), affects the reliability and validity of the method. Both intra- and inter-rater reliability were markedly improved when using the time shift method (approximately 50% decrease in the standard error of measurement). Moreover, the results calculated using the time shift method highly correlated (r > 0.83 for all variables) with the results calculated from a continuously tracked movement of the athlete, which was considered here as the reference method. This study shows that a modification to the previously published simple method for F-v profiling improves intra- and inter-rater reliability of the method in ice hockey skating. The time shift method tested here can be used as a reliable tool to test a player's physical performance characteristic underlying sprint performance in ice hockey skating.

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

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.

Assessment of nutrition knowledge in division I college athletes.

OBJECTIVE: Assess nutrition knowledge of Division I college athletes. PARTICIPANTS: 128 student-athletes (n = 70 female) from eight sports completed the survey in June 2018. METHODS: The survey by Calella et al (2017) was used to assess both general and sport nutrition knowledge. RESULTS: Cases with more than 20% of responses missing were excluded (n = 3). Overall average score was 57.6% ± 18.6%. Females scored significantly (p < 0.001) better than the males (66.5% ± 16.4% versus 46.2% ± 14.7%). Participants were divided into revenue (football, ice hockey, male's basketball, women's basketball; n = 63) and non-revenue sports (field hockey, golf, rowing, soccer; n = 62) to address differences in knowledge between sports with greater versus lesser nutrition resource access. Revenue sports scored significantly (p < 0.001) worse than non-revenue sports (45.7% ± 15.2% versus 69.7% ± 13.1%). CONCLUSIONS: Athletes appear to have low nutrition knowledge, putting them at risk for inappropriate dietary choices that could decrease ability to optimally perform and increase risk of injury.

Assessment of Three-Dimensional Kinematics of High- and Low-Calibre Hockey Skaters on Synthetic ice Using Wearable Sensors.

Hockey skating objective assessment can help coaches detect players' performance drop early and avoid fatigue-induced injuries. This study aimed to calculate and experimentally validate the 3D angles of lower limb joints of hockey skaters obtained by inertial measurement units and explore the effectiveness of the on-ice distinctive features measured using these wearable sensors in differentiating low- and high-calibre skaters. Twelve able-bodied individuals, six high-calibre and six low-calibre skaters, were recruited to skate forward on a synthetic ice surface. Five IMUs were placed on their dominant leg and pelvis. The 3D lower-limb joint angles were obtained by IMUs and experimentally validated against those obtained by a motion capture system with a maximum root mean square error of 5 deg. Additionally, among twelve joint angle-based distinctive features identified in other on-ice studies, only three were significantly different (p-value < 0.05) between high- and low-calibre skaters in this synthetic ice experiment. This study thus indicated that skating on synthetic ice alters the skating patterns such that the on-ice distinctive features can no longer differentiate between low- and high-calibre skating joint angles. This wearable technology has the potential to help skating coaches keep track of the players' progress by assessing the skaters' performance, wheresoever.

One-year stability of preseason Sport Concussion Assessment Tool 5 (SCAT5) values in university level collision and combative sport athletes.

OBJECTIVES: To determine the stability of the Sport Concussion Assessment Tool (SCAT) 5 between consecutive seasons in uninjured collision and combative varsity athletes. METHODS: Thirty-six athletes (19 females) were recruited to participate (wrestling [n = 12], rugby [n = 14], and hockey [n = 10]). The SCAT5 was administration at the start of the 2017 and 2018 seasons. Median baseline demographics for 2017 were as follows: age (19 years [range: 17-24 years]), height (174 cm [range: 149-195 cm]), and weight (76 kg [range: 57-118 kg]). Outcome metrics included subcomponents of the SCAT5: symptom reporting, standardized assessment of concussion (SAC), neurological screening, and balance performance measured with the modified balance error scoring system (mBESS). Wilcoxon signed-rank tests and Cronbach's alpha (α) values were calculated to determine the stability between consecutive years for the SCAT5 variables in the same cohort of athletes. Bonferroni corrections were applied for Wilcoxon signed-rank tests, where alpha = 0.006 (0.05/9). RESULTS: Between the 2017 and 2018 seasons, no differences were noted in symptom reporting (p = 0.14), SAC (p = 0.32), neurological screening (p = 0.98), and balance performance on the mBESS (p = 0.01). The Cronbach's alpha displayed unacceptable to questionable levels of within-subject stability (range: α = 0.34-0.70) for all subcomponents, except months in reverse order (α = 0.92). CONCLUSIONS: While no statistical differences were present for all SCAT5 subcomponent metrics between 2017 and 2018 baselines, all but one displayed unacceptable to questionable stability (α ≤ 0.70) when retested one year later. Further research is needed to understand the appropriate time duration baseline SCAT5 values can reliably be utilized within longitudinal studies; as well as the normal variation of SCAT5 reporting/scoring.

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

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. Methods: 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. Results: 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)). Interpretation: Disallowing body checking in non-elite 13-14-year-old ice hockey nationally would prevent injuries and reduce public healthcare costs.

Eliminating buyer's remorse: An examination of the sunk cost fallacy in the National Hockey League draft.

The sunk cost effect describes the tendency to escalate one's commitment toward a certain endeavor, despite diminishing returns, as a consequence of irreversible resource expenditure that has already been made (Organ Behav Hum Decis Process. 1985;35:124). This effect has been observed in a number of professional sports leagues, wherein teams escalate their commitment toward players selected early in the draft, regardless of performance outcomes, due to large financial commitments invested in them (J Sports Econom. 2017;18:282; Adm Sci Q. 1995;40:474). This effect, however, has yet to be explored in the National Hockey League (NHL). The purpose of this study was to test for sunk cost effects in the NHL, by examining the relationship between draft order and playing time, while controlling for a myriad of confounding variables. Findings from our analyses provide support for the existence of this effect in the NHL, as first-round draftees were given significantly more playing time than their peers selected in the second round, regardless of injury, player relocation, penalties, or on-ice performance outcomes. We offer some plausible underlying mechanisms driving this effect. Furthermore, we suggest the observed effects have valuable implications for NHL talent development, given the importance of playing time on various aspects of expertise attainment.

Helmet Fit Assessment and Concussion Risk in Youth Ice Hockey Players: A Nested Case-Control Study.

CONTEXT: Injury surveillance has shown that concussions are the most common injury in youth ice hockey. Research examining the criteria for ensuring the correct fit of protective equipment and its potential relationship with concussion risk is very limited. OBJECTIVE: To evaluate the association between helmet fit and the odds of experiencing a concussion among youth ice hockey players. DESIGN: Nested case-control within a cohort study. SETTING: Calgary, Alberta, Canada. PATIENTS OR OTHER PARTICIPANTS: Data were collected for 72 concussed, 41 nonconcussion-injured, and 62 uninjured ice hockey players aged 11 to 18 years. MAIN OUTCOME MEASURE(S): Helmet-fit assessments were conducted across players and encompassed helmet specifications, condition, certification, and criteria measuring helmet fit. Using a validated injury-surveillance system, we identified participants as players with suspected concussions or physician-diagnosed concussions or both. One control group comprised players who sustained nonconcussion injuries, and a second control group comprised uninjured players. Helmet-fit criteria (maximum score = 16) were assessed for the concussed players and compared with each of the 2 control groups. The primary outcome was dichotomous (>1 helmet-fit criteria missing versus 0 or 1 criterion missing). Logistic and conditional logistic regression were used to investigate the effect of helmet fit on the odds of concussion. RESULTS: The primary analysis (54 pairs matched for age, sex, and level of play) suggested that inadequate helmet fit (>1 criterion missing) resulted in greater odds of sustaining a concussion when comparing concussed and uninjured players (odds ratio [OR] = 2.67 [95% CI = 1.04, 6.81], P = .040). However, a secondary unmatched analysis involving all participants indicated no significant association between helmet fit and the odds of sustaining a concussion when we compared concussed players with nonconcussion-injured players (OR = 0.98 [0.43, 2.24], P = .961) or uninjured players (OR = 1.66 [0.90, 3.05], P = .103). CONCLUSIONS: Inadequate helmet fit may affect the odds of sustaining a concussion in youth ice hockey players. Future investigators should continue to evaluate this relationship in larger samples to inform helmet-fit recommendations.

Reliability of the Sport Concussion Assessment Tool 5 baseline testing: A 2-week test-retest study.

OBJECTIVES: To examine short-term test-retest reliability of the Sport Concussion Assessment Tool 5 (SCAT5). DESIGN: Longitudinal study. METHODS: Sixty-two professional male ice hockey players (mean age=22.5, SD=3.2) completed a preseason baseline test twice over a two-week interval. Half of the players were tested by the same assessor on both testing sessions. Spearman's correlations (rs) were used to determine linear agreements, and Wilcoxon signed rank tests (sig r) were used to determine mean differences, between testing sessions. RESULTS: Symptoms had high test-retest reliability (Score: rs=0.85, p<0.001, sig r p<0.001; Severity: rs=0.84, p<0.001, sig r p<0.001). The reliability coefficients for the SAC (rs=0.58, p<0.001, sig r: p=0.412), and mBESS (rs=0.40, p=0.001, sig r: p=0.607) were considerably lower than symptoms. More than half (52%) of the athletes reported at least one baseline symptom (Md=1, M=2.2, SD=3.3). The most commonly reported symptoms were fatigue or low energy and neck pain. The broad ranges of SAC total scores (range=28-45, Md=35, M=35.4, SD=4.2) and SAC test-retest change scores (range -7 to +11) were mostly due to variability on the memory performance, tested using 10-item word lists. The number of mBESS single leg stance errors (Md=1, Md 3.2, SD=4.0) was greater than Tandem stance errors (Md=0, Md=2.0, SD=3.6). CONCLUSIONS: The two-week test-retest reliability of the SCAT5 baseline scores varied from moderate to high. However, there was considerable individual variability on the SAC and mBESS scores and most players have notable short-term fluctuation on performance even if uninjured. Recommendations for interpreting change on the SCAT5 are provided.

Assessment of On-Ice Oxygen Cost of Skating Performance in Elite Youth Ice Hockey Players.

ABSTRACT: Allisse, M, Bui, HT, Desjardins, P, Léger, L, Comtois, AS, and Leone, M. Assessment of on-ice oxygen cost of skating performance in elite youth ice hockey players. J Strength Cond Res 35(12): 3466-3473, 2021-The purpose of this study was to evaluate the robustness of equations to predict the oxygen requirement during different skating circumstances commonly found in ice hockey game situations (skating forward, backward, with and without controlling a puck, during cornering and stops and starts). Twenty-four male elite ice hockey players from 3 categories (pee-wee, bantam, and midget) participated in this study. Anthropometric measurements were taken, and 4 different on-ice high-intensity and short-duration tests were performed. Execution time, heart rate, oxygen uptake, skating strides, and a skating efficiency index were measured for each test. A regression equation was calculated for each of the 4 tests providing an estimation of oxygen cost. Correlation coefficients ranged from 0.91 to 0.93, and SEE was between 4.5 and 8.4%, indicating that the precision of the regression algorithms was excellent. The results also suggest that execution time alone, which is the traditional manner to measure skating performance, is a bad estimator of oxygen uptake requirement for this kind of effort (average common variance <11%). Furthermore, age proved to be a determining factor with younger players showing an overall lower level of skating efficiency compared with older players. In addition, the introduction of a skating index also helps to better determine which factor of performance needs to be improved. Using simple and easy-to-measure variables, coaches will be able to obtain information that will allow them to intervene more precisely on the training parameters that will optimize the individual on-ice performance of their players.

Updating the Skating Multistage Aerobic Test and Correction for V[Combining Dot Above]O2max Prediction Using a New Skating Economy Index in Elite Youth Ice Hockey Players.

Allisse, M, Bui, HT, Léger, L, Comtois, A-S, and Leone, M. Updating the skating multistage aerobic test and correction for V[Combining Dot Above]O2max prediction using a new skating economy index in elite youth ice hockey players. J Strength Cond Res 34(11): 3182-3189, 2020-A number of field tests, including the skating multistage aerobic test (SMAT), have been developed to predict V[Combining Dot Above]O2max in ice hockey players. The SMAT, like most field tests, assumes that participants who reach a given stage have the same oxygen uptake, which is not usually true. Thus, the objectives of this research are to update the V[Combining Dot Above]O2 values during the SMAT using a portable breath-by-breath metabolic analyzer and to propose a simple index of skating economy to improve the prediction of oxygen uptake. Twenty-six elite hockey players (age 15.8 ± 1.3 years) participated in this study. The oxygen uptake was assessed using a portable metabolic analyzer (K4b) during an on-ice maximal shuttle skate test. To develop an index of skating economy called the skating stride index (SSI), the number of skating strides was compiled for each stage of the test. The SMAT enabled the prediction of the V[Combining Dot Above]O2max (ml·kg·min) from the maximal velocity (m·s) and the SSI (skating strides·kg) using the following regression equation: V[Combining Dot Above]O2max = (14.94 × maximal velocity) + (3.68 × SSI) - 24.98 (r = 0.95, SEE = 1.92). This research allowed for the update of the oxygen uptake values of the SMAT and proposed a simple measure of skating efficiency for a more accurate evaluation of V[Combining Dot Above]O2max in elite youth hockey players. By comparing the highest and lowest observed SSI scores in our sample, it was noted that the V[Combining Dot Above]O2 values can vary by up to 5 ml·kg·min. Our results suggest that skating economy should be included in the prediction of V[Combining Dot Above]O2max to improve prediction accuracy.

Sports Medicine Staffing Patterns and Incidence of Injury in Collegiate Men's Ice Hockey.

CONTEXT: The relative availability of clinicians as well as the types and training of health care providers have been associated with morbidity and mortality in non-athletic health care settings. Whether staffing variations are associated with injury incidence in collegiate athletes is unknown. OBJECTIVE: To evaluate whether the institutional ratio of athletes to athletic trainers (patient load) or the ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers or both is associated with the incidence of injuries sustained by male ice hockey athletes at the school. DESIGN: Descriptive epidemiology study. SETTING: National Collegiate Athletic Association (NCAA) men's ice hockey teams. PATIENTS OR OTHER PARTICIPANTS: Collegiate men's ice hockey athletes. MAIN OUTCOME MEASURE(S): The NCAA Injury Surveillance Program collected data from collegiate men's ice hockey athletes. Staffing patterns were obtained through telephone interviews. Injury counts, injury rates per 1000 athlete-exposures, and injury rate ratios with 95% confidence intervals were calculated and compared between the following groups: (1) schools with high (versus low) patient load and (2) schools with high (versus low) ratio of staff to nonstaff (graduate assistant and certified intern) athletic trainers. RESULTS: Both the patient load and relative number of staff athletic trainers were associated with variations in the incidences and types of diagnosed injuries in male ice hockey players. Specifically, fewer injuries were diagnosed by clinicians at institutions with high patient loads. The rates of injury overall and non-time-loss injuries were lower in the high patient-load group. Time-loss injury rates, severe injury rates, concussion rates, and overall rates of injury during competition were greater in the group with a higher proportion of staff athletic trainers, whereas non-time-loss injury rates were lower. CONCLUSIONS: In this study of collegiate men's ice hockey players, athlete health outcomes were directly related to the number and types of clinicians available. Future researchers should evaluate whether this finding extends beyond men's ice hockey.

Neuropsychological Assessment of Professional Ice Hockey Players: A Cross-Cultural Examination of Baseline Data Across Language Groups.

OBJECTIVE: Neuropsychological testing in sports has become routine across all levels of play. The National Hockey League (NHL) has conducted baseline neuropsychological assessment of all players since 1997. This study seeks to examine baseline differences among linguistically and culturally diverse groups within the NHL and to present comprehensive normative data for these groups. METHOD: Baseline data were obtained from 3,145 professional hockey players' baseline symptom reporting, neuropsychological test performance on a battery of traditional "paper and pencil" measures, and self-reported concussion history. In addition, 604 baseline post-injury paper and pencil evaluations were conducted the season following a concussion and 4,780 computerized baseline ImPACT administrations were obtained following the introduction of computerized testing. RESULTS: Normative data for paper and pencil tests and ImPACT are presented for the major language groups within the league: English, French, Swedish, Russian, Czech, Finnish, and German (ImPACT only). It was found that symptom reporting, the number of concussions sustained, and neuropsychological test results vary significantly based on a players' language of origin. This variability was also present when players were tested in their language of origin. CONCLUSIONS: This study provides insight into the significant baseline differences that exist among NHL players regarding symptoms, concussion history, and cognitive functioning. The findings are discussed with respect to the evaluation and management of NHL players who sustain concussion and more generally in the context of neuropsychological assessment in cross-cultural settings, including the importance of examining neuropsychological functioning using culturally specific norms.

Participating in a new group and the identification processes: The quest for a positive social identity.

Immigrants experience identity shifts; they can identify with the new cultural group and, sometimes, identify less with their group of origin. Previous research suggests that participation in the new cultural group predicts these two identity shifts. However, these studies have exclusively used correlational methodologies. Furthermore, previous research ignored that when a group is negatively valued, individuals may not identify with it, even after participating in it, to preserve a positive social identity. This article tests with an experimental methodology whether participation recreated the identity shifts previously identified (greater identification with the new group and lower identification with the group of origin when perceiving dissimilarity). Furthermore, it tested how a group's value impacted these identity shifts following participation. Immigrants in Quebec (N = 184) either participated in Quebec's culture (watched hockey) or did not (watched basketball). Quebec's value was manipulated by changing whether Quebec won, tied, or lost the game. Compared to watching basketball, watching Quebec's team win or tie showed the hypothesized identity shifts, illustrating the importance of the new group's value when participating.

A Comparison of Self-Reported Unmet Healthcare Needs among Adaptive and Able-Bodied Athletes.

BACKGROUND: Studies have revealed a higher incidence of injury and illness among elite adaptive athletes when compared to able-bodied athletes in competition. However, individuals with disabilities report poorer access to health care. OBJECTIVE: The purpose of this study is to identify differences in healthcare access, satisfaction, and unmet needs between recreational adaptive and able-bodied athletes in all sports and within a single sport (hockey). DESIGN: Cross-sectional, survey-based study. SETTING: Recreation sports programs in Boston, MA and Chicago, IL. PARTICIPANTS: Adult, recreational, competitive adaptive, and able-bodied athletes. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): The Short-Form Patient Satisfaction Questionnaire (PSQ-18) for healthcare access and satisfaction; percentage of athletes reporting unmet sports-related healthcare needs in the prior year. RESULTS: Sixty adaptive athletes (78% male, age 35.7 ± 12.4 years) and 65 able-bodied athletes (40% male, age 34.9 ± 11.9 years) participated. Mean access and satisfaction scores were not significantly different between groups in all sports (P = .53 and P = .19, respectively) or hockey (P = .28 and P = .55, respectively). Unmet needs were more commonly reported among adaptive athletes (18.3% all sports, 20.0% hockey) as compared to able-bodied athletes (9.2% all sports, 4.0% hockey). This reached statistical significance in the hockey group (P = .03), but not all sports (P = .12). CONCLUSIONS: No differences were seen between groups in healthcare access or satisfaction scores. Adaptive athletes of the same sport reported a higher rate of unmet sports-related healthcare needs but with few doctor's visits in the preceding year, suggesting discrepancies in expectations and healthcare-seeking behavior. LEVEL OF EVIDENCE: III.

Prevalence of Spondylolysis in Symptomatic Adolescent Athletes: An Assessment of Sport Risk in Nonelite Athletes.

OBJECTIVE: To assess the risk of spondylolysis by sport in nonelite adolescent athletes with low back pain (LBP). DESIGN: Retrospective case series. SETTING: Hospital-based sports medicine clinic. PATIENTS: The medical charts of 1025 adolescent athletes with LBP (age 15 ± 1.8 years) were examined; 308 (30%) were diagnosed with a spondylolysis. ASSESSMENT OF RISK: Risk of spondylolysis was assessed in 11 sports for males and 14 sports for females. MAIN OUTCOME MEASURE: Relative risk of diagnosis of spondylolysis injury. RESULTS: The risk of spondylolysis differed by sex with baseball (54%), soccer (48%), and hockey (44%) having the highest prevalence in males and gymnastics (34%), marching band (31%), and softball (30%) for female athletes. Baseball was the only sport to demonstrate a significant increased risk of spondylolysis. CONCLUSIONS: The sports with the greatest risk of spondylolysis in adolescent athletes in this study were not consistent with published literature. Clinicians should be cautious generalizing high-risk sports to their practice, as geographic region and level of the athlete may significantly influence the incidence of spondylolysis in the population they are treating.

Using Microtechnology to Quantify Torso Angle During Match-Play in Field Hockey.

Warman, GE, Cole, MH, Johnston, RD, Chalkley, D, and Pepping, GJ. Using microtechnology to quantify torso angle during match-play in field hockey. J Strength Cond Res 33(10): 2648-2654, 2019-Field hockey is played in a dynamic environment placing specific postural demands on athletes. Little research has been devoted to understanding the nature of a player's torso postures in field hockey match-play and its relationship with the perceptuomotor demands of the sport. We used commercially available microtechnology worn by 16 athletes during a 6-match national tournament to quantify torso flexion/extension angles. Orientation was derived using the inertial and magnetic sensors housed within global positioning system devices, assessing torso angle in the sagittal plane from 91 individual match files. The main independent variable was playing position, whereas the dependent variable was torso flexion/extension, presented as a percentage of playing time spent in 15 × 10° torso postural bands ranging from ≥40° extension to ≥90° flexion. It was shown that athletes spent 89.26% of their playing time in various torso postures, ranging from 20 to 90° of flexion. Defenders spent more time than midfielders (p = 0.004, effect size [ES] = 0.43) and strikers (p = 0.004; ES = 0.44) in the posture band of 10-20° torso flexion, whereas midfielders spent more time between 20 and 30° of torso flexion (p = 0.05; ES = 0.32) than strikers. Conversely, strikers spent more time between 30 and 40° of flexion than defenders (p < 0.001; ES = 0.74). These results reflect the sport-specific and role-specific torso angles adopted by field hockey athletes during match-play. Coaching staff can use these data to gain insight into the postural demands of their sport and inform the preparation of athletes for the perception-action demands of competition.