Elite Junior Australian Football Players With Impaired Wellness Are at Increased Injury Risk at High Loads.

BACKGROUND: Elite junior Australian football players experience high training loads across levels of competition and training. This, in conjunction with impaired wellness, can predispose athletes to injury. HYPOTHESIS: Elite junior Australian football players exposed to high loads with poor wellness are more likely to be at risk of injury than those with improved wellness. STUDY DESIGN: Longitudinal prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Data were collected and analyzed from 280 players across the 2014 season. Internal load was measured via session rating of perceived exertion. Player wellness was reported according to ratings of sleep quality, fatigue, soreness, stress, and mood. Week- and month-based training load measures were calculated, representing a combination of absolute and relative load variables. Principal component analysis factor loadings, based on 17 load and wellness variables, were used to calculate summed variable covariates. Injury was defined as "any injury leading to a missed training session or competitive match." Associations between covariates and injury risk (yes/no) were determined via logistic generalized estimating equations. RESULTS: A significant interaction term between load and wellness on injury was found [odds ratio (OR) 0.76; 95% CI 0.62-0.92; P < 0.01), indicating that wellness acts as a "dimmer switch" of load on injury. Further, there was evidence of moderated mediation (OR 0.71; 95% CI 0.57-0.87; P < 0.01). When wellness was low, injury risk started to increase substantially at a 1-week load of 3250 au. CONCLUSIONS: Subjective measures of training load are associated with injury risk through a nonlinear relationship. This relationship is further influenced by player wellness, which can amplify the risk of injury. There is evidence that higher stress is linked with injury and that soreness and sleep mediate any stress-injury relationship. CLINICAL RELEVANCE: Coaching efforts to manage training load and player adaptive responses, including wellness, may reduce the risk of injury, with stress, soreness, and sleep particularly relevant at this level.

A systematic review of early prognostic factors for persisting pain following acute orthopedic trauma.

BACKGROUND: Acute orthopedic trauma contributes substantially to the global burden of disease. OBJECTIVES: The present systematic review aimed to summarize the current knowledge concerning prognostic factors for the presence of persistent pain, pain severity and pain-related disability following acute orthopedic trauma involving a spectrum of pathologies to working-age adults. METHODS: The Ovid MEDLINE and EMBASE databases were searched for level II prognostic studies published between January 1996 and October 2010. Studies that were longitudinal and reported results with multivariate analyses appropriate for prognostic studies were included. Studies that addressed two specific injury types that have been the subject of previous reviews, namely, injuries to the spinal column and amputations, were excluded. RESULTS: The searches yielded 992 studies; 10 studies met the inclusion criteria and were rated for methodological quality. Seventeen factors were considered in more than one cohort. There was strong evidence supporting the association of female sex, older age, high pain intensity, preinjury anxiety or depression, and fewer years of education with persistent pain outcomes. There was moderate evidence supporting the association between postinjury depression or anxiety with persistent pain, and that injury severity was not a risk factor for ongoing pain. CONCLUSION: Many individuals experience persistent pain following acute trauma. Due to the lack of studies, the use of different constructs to measure the same factor and the methodological limitations associated with many of the studies, the present review was only able to reliably identify a limited set of factors that predicted persistent pain. Recommendations for the conduct of future methodologically rigorous studies of persistent pain are provided.

First return to work following injury: does it reflect a composite or a homogeneous outcome?

OBJECTIVE: To test whether return to work as a binary (yes/no) outcome that includes all persons who returned to work regardless of mode of return reflects a composite or a homogeneous outcome in a cohort of workers who have sustained acute orthopaedic trauma resulting in hospitalisation. METHODS: Prospective cohort study. One hundred and sixty-eight participants were recruited and followed for 6 months. The study achieved 89% follow-up. Baseline data were obtained at study recruitment and participants were further surveyed by phone at three timepoints during the study. Polytomous logistic regression was used to simultaneously examine the association between potential predictors and different modes of first return to work (RTW). A test of the equality of the ORs associated with the independent predictor variables was also undertaken. RESULTS: Of the 152 participants with full follow-up, 46 (30%) returned first to full duties, 58 (38%) returned first to modified work and 48 (32%) did not return to work during the study period. Significant determinants of the two modes of return to work were different. A test of the equality of ORs indicated that the relative ORs for the difference in the slope coefficients for five of the 10 independent factors in the two polytomous logistic regression sub-models corresponding to each mode of return to work were statistically significant. This raises the likelihood that first RTW reflects a composite rather than a homogeneous outcome. CONCLUSION: The study provides evidence that RTW may reflect a composite outcome when it includes different modes of first RTW. The identified predictive factors appear to exert different mechanisms of action depending on the mode of RTW. The findings suggest that the different modes of RTW may need to be considered independently. The results of the study have potentially important implications for research and insurance practice.

Bio-psychosocial determinants of time lost from work following non life threatening acute orthopaedic trauma.

BACKGROUND: To determine factors predicting the duration of time away from work following acute orthopaedic non life threatening trauma METHODS: Prospective cohort study conducted at four hospitals in Victoria, Australia. The cohort comprised 168 patients aged 18-64 years who were working prior to the injury and sustained a range of acute unintentional orthopaedic injuries resulting in hospitalization. Baseline data was obtained by survey and medical record review. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential predictors and the duration of time away from work during the six month study. The study achieved 89% follow-up. RESULTS: Of the 168 participants recruited to the study, 68% returned to work during the six month study. Multivariate Cox proportional hazards regression analysis identified that blue collar work, negative pain attitudes with respect to work, high initial pain intensity, injury severity, older age, initial need for surgery, the presence of co-morbid health conditions at study entry and an orthopaedic injury to more than one region were associated with extended duration away from work following the injury. Participants in receipt of compensation who reported high social functioning at two weeks were 2.58 times more likely to have returned to work than similar participants reporting low social functioning. When only those who had returned to work were considered, the participant reported reason for return to work " to fill the day" was a significant predictor of earlier RTW [RR 2.41 (95% C.I 1.35-4.30)] whereas "financial security" and "because they felt able to" did not achieve significance. CONCLUSIONS: Many injury-related and psycho social factors affect the duration of time away from work following orthopaedic injury. Some of these are potentially modifiable and may be amenable to intervention. Further consideration of the reasons provided by participants for returning to work may provide important opportunities for social marketing approaches designed to alleviate the financial and social burden associated with work disability.

Absolute and Relative Load and Injury in Elite Junior Australian Football Players Over 1 Season.

PURPOSE: To investigate the association between training and match loads and injury in elite junior Australian football players over 1 competitive season. METHODS: Elite junior Australian football players (n = 290, age 17.7 [0.3] y, range 16-18 y) were recruited from the under-18 state league competition in Victoria to report load and injury information. One-week load (session rating of perceived exertion multiplied by duration) and all time-loss injuries were reported using an online sport-injury surveillance system. Absolute load measures (weekly sums) enabled the calculation of relative measures such as the acute:chronic workload ratio. Load measures were modeled against injury outcome (yes/no) using a generalized estimating equation approach, with a 1-wk lag for injury. RESULTS: Low (<300 arbitrary units [au]) and high (>4650 au) 1-wk loads were associated with significantly higher risk of injury. Furthermore, low (<100 au) and high (>850 au) session loads were associated with a higher risk of injury. High strain values (>13,000) were associated with up to a 5-fold increase in the odds of injury. There was a relatively flat-line association between the acute:chronic workload ratio and injury. CONCLUSIONS: This study is the first investigation of elite junior athletes demonstrating linear and nonlinear relationships between absolute and relative load measures and injury. Coaches should focus player loads on, or at least close to, the point at which injury risk starts to increase again (2214 au for 1-wk load and 458 au for session load) and use evidence-based strategies across the week and month to help reduce the risk of injury.

A Prospective Cohort Study of Load and Wellness (Sleep, Fatigue, Soreness, Stress, and Mood) in Elite Junior Australian Football Players.

PURPOSE: To investigate associations between load (training and competition) and wellness in elite junior Australian Football players across 1 competitive season. METHODS: A prospective cohort study was conducted during the 2014 playing season in 562 players from 9 teams. Players recorded their training and match intensities according to the session-rating-of-perceived-exertion (sRPE) method. Based on sRPE player loads, a number of load variables were quantified, including cumulative load and the change in load across different periods of time (including the acute-to-chronic load ratio). Wellness was quantified using a wellness index including sleep, fatigue, soreness, stress, and mood on a Likert scale from 1 to 5. RESULTS: Players spent an average of 85 (21) min in each match and 65 (31) min per training session. Average match loads were 637 (232) arbitrary units, and average training loads were 352 (233) arbitrary units. Over the 24 wk of the 2014 season, overall wellness had a significant linear negative association with 1-wk load (B = -0.152; 95% confidence interval, -0.261 to -0.043; P = .006) and an inverse U-curve relationship with session load (B = -0.078; 95% confidence interval, 0.143 to 0.014; P = .018). Mood, stress, and soreness were all found to have associations with load. CONCLUSIONS: This study demonstrates that load (within a session and across the week) is important in managing the wellness of elite junior Australian Football players. Quantifying loads and wellness at this level will help optimize player management and has the potential to reduce the risk of adverse events such as injury.

The incidence, prevalence, severity, mechanism and body region of injury in elite junior Australian football players: A prospective cohort study over one season.

OBJECTIVES: To describe the incidence, prevalence, severity, mechanism and body region of injuries in elite junior Australian football (AF) players over one competitive season in order to help inform injury prevention interventions. DESIGN: Prospective cohort, data collected during the 2014 playing season. METHODS: Player and staff-reported injuries sustained by 562 players from an under-18 state league were entered into an online sports injury surveillance system. An injury was recorded if it led to a missed training session or match. Injury incidence was calculated as the number of injuries per 1000h of training and competition. Injury severity was defined by the number of days players missed training or competition. Injury mechanism was identified as either contact, non-contact or overuse. RESULTS: There were 1192 football-related injuries sustained during the season; the majority (n=1041, 87.3%) were new, occurred during competition (n=954, 86%) and led to 4-7 missed days in severity (n=429, 46%). Injury incidence was 37.2 injuries per 1000h of exposure. Over half of injuries were contact in mechanism (n=355, 51%). Most injuries were to the lower limb (n=720, 60%), with the thigh representing the highest proportion of these. CONCLUSIONS: This study provides key information as to the aetiology of injury in this level of competition and provides a stronger foundation from which injury prevention studies could be carried out. Future research is well-placed to develop an understanding of the injury risk factors in the elite junior cohort, whilst also reducing injury risk once players transition to the AFL.

U.S. consumer crash test results and injury risk in police-reported crashes.

Consumer crash test programs provide comparative information on the crashworthiness of new vehicles which, in turn, should predict the performance of the same vehicles in real-world crashes. However, the detail and quality of available information from tests and real-world crashes differ widely, so identifying meaningful relationships between crash test results and real-world crashworthiness can be difficult. Despite these data limitations, studies in the late 1980s and mid-1990s reported positive correlations between dummy injury measures from the U.S. New Car Assessment Program (USNCAP) and real-world fatality rates. More recent analyses of results from Australian crash tests and real-world crashes also have found positive correlations. This article considers relationships between recent U.S. frontal crash test results from the Insurance Institute for Highway Safety (IIHS) and USNCAP, and real-world crash injury risk estimates computed from police-reported crash data from three U.S. states. The frontal crash test results include dummy injury measures by body region from both IIHS offset tests and USNCAP full-width barrier tests plus measures of structural performance from the IIHS offset tests. Individually, results from the full-width and offset tests were not significantly correlated with the real-world injury risk estimates. Stronger relationships were found when a combination of overall ratings from the full-frontal and offset tests was used. However, the current results find only weak correlations between both full-front and offset frontal crash test performance and the real-world injury risk estimates. These weak relationships likely reflect the lack of detail and fundamental difference in injury information in police crash reports compared to that used in deriving crashworthiness ratings from the crash tests.

Characteristics of the road and surrounding environment in metropolitan shopping strips: association with the frequency and severity of single-vehicle crashes.

OBJECTIVES: Modeling crash risk in urban areas is more complicated than in rural areas due to the complexity of the environment and the difficulty obtaining data to fully characterize the road and surrounding environment. Knowledge of factors that impact crash risk and severity in urban areas can be used for countermeasure development and the design of risk assessment tools for practitioners. This research aimed to identify the characteristics of the road and roadside, surrounding environment, and sociodemographic factors associated with single-vehicle crash (SVC) frequency and severity in complex urban environments, namely, strip shopping center road segments. METHODS: A comprehensive evidence-based list of data required for measuring the influence of the road, roadside, and other factors on crash risk was developed. The data included a broader range of factors than those traditionally considered in accident prediction models. One hundred and forty-two strip shopping segments located on arterial roads in metropolitan Melbourne, Australia, were identified. Police-reported casualty data were used to determine how many SVC occurred on the segments between 2005 and 2009. Data describing segment characteristics were collected from a diverse range of sources; for example, administrative government databases (traffic volume, speed limit, pavement condition, sociodemographic data, liquor licensing), detailed maps, on-line image sources, and digital images of arterial roads collected for the Victorian state road authority. Regression models for count data were used to identify factors associated with SVC frequency. Logistic regression was used to determine factors associated with serious and fatal outcomes. RESULTS: One hundred and seventy SVC occurred on the 142 selected road segments during the 5-year study period. A range of factors including traffic exposure, road cross section (curves, presence of median), road type, requirement for sharing the road with other vehicle types (trams and bicycles), roadside poles, and local amenities were associated with SVC frequency. A different set of risk factors was associated with the odds of a crash leading to a severe outcome: segment length, road cross section (curves, carriageway width), pavement condition, local amenities and vehicle, and driver factors. The presence of curves was the only factor associated with both SVC frequency and severity. CONCLUSIONS: A range of risk factors were associated with SVC frequency and severity in complex urban areas (metropolitan shopping strips), including traditionally studied characteristics such as traffic density and road design but also less commonly studied characteristics such as local amenities. Future behavioral research is needed to further investigate how and why these factors change the risk and severity of crashes before effective countermeasures can be developed.

How important is vehicle safety for older consumers in the vehicle purchase process?

OBJECTIVE: This study aimed to investigate the importance of vehicle safety to older consumers in the vehicle purchase process. METHODS: Older (n = 102), middle-aged (n = 791), and younger (n = 109) participants throughout the eastern Australian states of Victoria, New South Wales, and Queensland who had recently purchased a new or used vehicle completed an online questionnaire about their vehicle purchase process. RESULTS: When asked to list the 3 most important considerations in the vehicle purchase process (in an open-ended format), older consumers were mostly likely to list price as their most important consideration (43%). Similarly, when presented with a list of vehicle factors (such as price, design, Australasian New Car Assessment Program [ANCAP] rating), older consumers were most likely to identify price as the most important vehicle factor (36%). When presented with a list of vehicle features (such as automatic transmission, braking, air bags), older consumers in the current study were most likely to identify an antilock braking system (41%) as the most important vehicle feature, and 50 percent of older consumers identified a safety-related vehicle feature as the highest priority vehicle feature (50%). When asked to list up to 3 factors that make a vehicle safe, older consumers in the current study were most likely to list braking systems (35%), air bags (22%), and the driver's behavior or skill (11%). When asked about the influence of safety in the new vehicle purchase process, one third of older consumers reported that all new vehicles are safe (33%) and almost half of the older consumers rated their vehicle as safer than average (49%). A logistic regression model was developed to predict the profile of older consumers more likely to assign a higher priority to safety features in the vehicle purchasing process. The model predicted that the importance of safety-related features was influenced by several variables, including older consumers' beliefs that they could protect themselves and their family from a crash, their traffic infringement history, and whether they had children. CONCLUSIONS: These findings are consistent with previous research that suggests that, though older consumers highlight the importance of safety features (i.e., seat belts, air bags, braking), they often downplay the role of safety in their vehicle purchasing process and are more likely to equate vehicle safety with the presence of specific vehicle safety features or technologies rather than the vehicle's crash safety/test results or crashworthiness. The findings from this study provide a foundation to support further research in this area that can be used by policy makers, manufacturers, and other stakeholders to better target the promotion and publicity of vehicle safety features to particular consumer groups (such as older consumers). Better targeted campaigns may help to emphasize the value of safety features and their role in reducing the risk of injury/death. If older consumers are better informed of the benefits of safety features when purchasing a vehicle, a further reduction in injuries and deaths related to motor vehicle crashes may be realized.

Rating the overall secondary safety of vehicles from real world crash data: the Australian and New Zealand Total Secondary Safety Index.

Various systems for rating secondary safety of particular makes and models of vehicles have been developed internationally. These measures generally evaluate crashworthiness (the ability of the vehicle to protect its own occupants in the event of a crash) separately from aggressivity (the harm a vehicle is liable to impose on other road users into which it crashes). This paper describes an approach using Australian and New Zealand data that combines these two facets of secondary safety into one 'Total Secondary Safety Index' estimated from real world crash outcomes. The Index estimates the risk of death or serious injury to all key road users in crashes involving light passenger vehicles across the full range of crash types. This paper describes the rationale and method for producing this Index, together with some estimates for common Australian and New Zealand makes and models of light passenger vehicles.

A systematic review of early prognostic factors for return to work following acute orthopaedic trauma.

INTRODUCTION: Acute orthopaedic trauma is a major contributor to the global burden of disease. This study aims to synthesise and summarise current knowledge concerning prognostic factors for return to work and duration of work disability following acute orthopaedic trauma. METHODS: A systematic review of prognostic studies was performed. The Medline, Embase, PsychINFO, CINAHL and AMED electronic databases were searched for studies between 1985 and May 2009. Included studies were longitudinal, reported results with multivariate statistical analyses appropriate to prognostic studies, comprised persons employed at the time of the injury, included prognostic factors measured proximal to the injury and focused on upper and lower extremity injuries. RESULTS: Searches yielded 980 studies of which 15 met the inclusion criteria and were rated for methodological quality. Analysis focused on the 14 factors considered in more than one study. There was limited evidence for the role of any factor as a predictor of return to work. There is strong evidence for level of education and blue collar work and moderate evidence for self-efficacy, injury severity and compensation as prognostic factors for the duration of work disability. Significant methodological issues were encountered in the course of the review that limited interpretation of the evidence and the conclusions that could be drawn from the findings. CONCLUSION: People who have sustained acute orthopaedic trauma regardless of severity experience difficulties in returning to work. Due to the lack of factors considered in more than one cohort, the results of this review are inconclusive. The review highlights the need for more prospective studies that are methodologically rigorous, have larger sample sizes and considers a comprehensive range of factors.

Determinants of return to work following non life threatening acute orthopaedic trauma: a prospective cohort study.

OBJECTIVE: To determine factors associated with return to work following acute non-life-threatening orthopaedic trauma. DESIGN: Prospective cohort study. PARTICIPANTS: One hundred and sixty-eight participants were recruited and followed for 6 months. The study achieved 89% participant follow-up. METHODS: Baseline data were obtained by survey and medical record review. Participants were further surveyed at 2 weeks, 3 and 6 months post-injury. Logistic regression was used to examine the association between potential predictors and first return to work by these 3 time-points. RESULTS: Sixty-eight percent of participants returned to work within 6 months. Those who sustained isolated upper extremity injuries were more likely to return to work early. Significant positive determinants of return to work included a strong belief in recovery, the presence of an isolated injury, education to university level and self-employment. Determinants associated with non-return to work included the receipt of compensation, older age, pain attitudes and blue-collar work. The primary reason given for return to work was financial security. CONCLUSION: Demographic, injury, occupation and psychosocial factors were significant predictors of return to work. The relative importance of factors at different time-points suggests that return to work is a multifactorial process that involves the complex interaction of many factors in a time-dependent manner.

Bio-psychosocial determinants of persistent pain 6 months after non-life-threatening acute orthopaedic trauma.

UNLABELLED: The study quantifies the association between a range of bio-psychosocial factors and the presence of persistent pain, pain severity and pain interfering with normal work activities in a cohort of 168 patients with a range of non-life-threatening orthopaedic injuries. Participants were recruited following presentation to 1 of 4 Victoria hospitals for treatment for their injury and followed until 6 months postinjury. Multivariate analysis was employed to determine factors associated with pain outcomes, 6 months postinjury. The prevalence of pain was common; 54% of participants reported the presence of persistent pain at 6 months, with the majority (87%) reporting that pain interfered to an extent with their normal work activities. High initial pain, external attributions of responsibility for the injury, and psychological distress were found to be significant independent predictors of the presence of all 3 outcomes. In addition, poor recovery expectations was found to be a significant predictor of pain-related work disability and being injured at work a significant predictor of pain severity. Many of these factors are potentially modifiable and should alert the clinician about the need for interventions in order to prevent the development of pain chronicity. PERSPECTIVE: This study has quantified determinants of pain, 6 months after non-life-threatening acute orthopaedic trauma. Psychosocial factors strongly predicted persistent pain, pain-related work disability, and pain severity. These findings may assist clinicians to determine the need for, and likely effectiveness of, individual pain-management approaches in this population.