Study protocol for a prospective cohort study describing the injury characteristics in elite gymnasts in TeamGym: the Swedish TeamGym Injury Cohort - STIC.

INTRODUCTION: Gymnastics consists of several different disciplines, whereof TeamGym is one. TeamGym is a young discipline with sparse research. The aim of the study is to investigate the injury characteristics in Swedish elite gymnasts competing in TeamGym including training load and other physical and psychological factors associated with injury. METHODS AND ANALYSIS: The Swedish TeamGym Injury Cohort is a longitudinal prospective cohort study for 52 weeks that includes the junior (15-17 years) and senior (≥18 years) Swedish female and male national teams in TeamGym. A baseline questionnaire will be sent out in an online application (SmartaBase) regarding demographics, previous injuries, gymnastics-related factors, for example, time at elite level and psychosocial factors such as stress, athletic identity, coping skills, personality traits and coach-athlete relation. A weekly questionnaire will be sent out in SmartaBase every Sunday and will monitor injuries using the Oslo Sports Trauma Research Centre Overuse Questionnaire, gymnastics-related factors, for example, landing surfaces, stress, recovery and training load. A test battery for the lower extremity will be performed. Data for ankle dorsiflexion, hop tests and ankle plantarflexion strength/endurance will be collected. ETHICS AND DISSEMINATION: This project was approved by the Swedish Ethical Review Authority (2023-06653-01) and is performed according to the Declaration of Helsinki. The results will be published in peer-reviewed journals, scientific conferences and shared with the Swedish Gymnastics Federation.

Psychosocial factors associated with lower extremity re-injury risk in soccer players: Contribution of self- confidence, functional attention, and re-injury anxiety.

CONTEXT: Despite the availability of specialized assessment tools, psychological readiness is usually not considered when deciding to return to sport (RTS) after sport injury. Re-injury anxiety, self-confidence, and functional attention may be associated with sport re-injury, making it important to evaluate these factors before RTS. OBJECTIVE: This study aimed to predict lower extremity re-injury in soccer players using self- confidence, functional attention, and re-injury anxiety as predictive variables. DESIGN: Prospective cohort study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Sixty-two male soccer players, who were older than 18 years of age, suffered from lower extremity injuries, had completed the rehabilitation program, and were ready to RTS. MAIN OUTCOME MEASURES: Prior to returning to the sport, participants completed a pre-season questionnaire on their previous injuries, self-confidence, re-injury anxiety, and level of functional attention. The primary outcome measured was the risk of re-injury during the upcoming competitive season, and logistic regression was utilized to calculate odds ratios (OR) with 95% confidence intervals to determine the association between each risk factor and re- injury. RESULTS: Overall re-injury rate was 5.56 injuries per 1000 hours of play. Self-confidence scores ≤ 47 increased the risk of re-injury by 2.26 times (relative risk, 2.26; 95% CI, 1.31-3.91; OR, 5.00; 95% CI, 1.56-16.04) and each unit increase in self-confidence score reduced the risk of re-injury by 10% (OR:0.90; CI: 0.82-0.99, p=0.03). Regarding re-injury anxiety, a score >22 was associated with 2.43 times the risk of re-injury (relative risk, 2.43; 95% CI, 1.44-4.13; OR, 6.46; 95% CI, 1.93-21.69) and each unit increase in re-injury anxiety score increased the risk of injury by 45% (OR:1.45; CI: 1.13-0.87, p=0.004). CONCLUSIONS: Increased re-injury anxiety and decreased self-confidence are associated with higher odds of lower extremity re-injury in male soccer players. To reduce the risk of re-injury, athletic trainers and sport psychologists should take these psychological factors into account when evaluating the psychological readiness of soccer players with a history of lower extremity injury to RTS.

Mental health problems, sleep quality and overuse injuries in advanced Swedish rock-climbers - the CLIMB study.

OBJECTIVES: To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls. METHODS: A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire. RESULTS: A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052-0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%). CONCLUSION: The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

Protocol for a 2-year longitudinal study of eating disturbances, mental health problems and overuse injuries in rock climbers (CLIMB).

INTRODUCTION: Rock climbing is a rapidly growing sport in which performance may be affected by participant's weight and leanness, and there may be pressure on athletes with respect to their eating behaviour and body weight. However, there is sparse research performed on climbers, constituting a knowledge gap which the present study aims to fill. The primary outcomes of the study are to examine disordered eating and overuse injuries in rock climbers. Secondary variables are body image, indicators of relative energy deficiency, mental health problems, compulsive training, perfectionism, sleep quality and bone density. METHOD AND ANALYSIS: This prospective longitudinal study aims to recruit Swedish competitive rock climbers (>13 years) via the Swedish Climbing Federation. A non-athlete control group will be recruited via social media (n=equal of the climbing group). Data will be collected using streamlined validated web-based questionnaires with three follow-ups over 2 years. Inclusion criteria for rock climbers will be a minimum advanced level according to International Rock-Climbing Research Association. The non-athlete control group is matched for age and gender. Exclusion criteria are having competed at an elite level in any sport as well as training more often than twice per week. Statistical analyses will include multinominal logistic regression, multivariate analysis of variance (MANOVA) and structural equation modelling (SEM). We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up. ETHICS AND DISSEMINATION: The Rock-Climbers' Longitudinal attitudes towards Injuries, Mental health and Body image study, CLIMB, was approved by the Swedish ethics authority (2021-05557-01). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications. TRIAL REGISTRATION NUMBER: NCT05587270.

Youth athletes at Swedish sports high schools with an athletics specialism emphasise environmental support for injury risk management: a focus group study.

In this study, we examined knowledge and understanding of sport-related injuries among youth athletics (track and field) athletes and assessed their needs in managing any health problems. Qualitative data were collected via 12 focus groups with youth athletes (16-19 years) studying at Swedish sports high schools with an athletics specialism. All focus group discussions were audiorecorded and transcribed before being analysed using a thematic analysis approach. Four researchers independently reviewed the transcripts, generated codes and developed themes. Three overarching themes related to the athletes' knowledge and understanding of sport-related injury were developed: (1) awareness of injuries, (2) perception of injuries, and (3) factors contributing to injuries. The youth athletes were typically uncertain about how to acknowledge a sport-related injury. They expressed that knowledge about injuries was obtained in part by reflecting on the lived experiences of their peers. It was also demonstrated that there appears to be a 'culture of acceptance' regarding injury occurrence. In contrast, causes of injuries were viewed as dependent on multiple factors (eg, lack of context-specific knowledge about training practices). Regarding athletes' needs in managing injuries, an additional three themes were developed: (1) creating functioning elite sports environments, (2) application of knowledge and (3) fostering athletes. An apparent lack of structure and organisation related to the school environment was identified as an important issue to review to create opportunities for sustainable athletic development. The study identified areas that can be improved in Swedish sports high schools with an athletic specialism and could be applied in other youth sports contexts. The results of this study guide school stakeholders, alongside the sport governing bodies who have the mandate to influence activities in youth sports contexts, whereby special attention should be directed towards improving the social environment for youth athletes.

Lifestyle characteristics in adolescent female football players: data from the Karolinska football Injury Cohort.

BACKGROUND: Normative values of lifestyle characteristics in adolescent female football players may be used by clinicians and coaches to take actions because the potential important for well-being, performance on the pitch, and risk of injury. The aim was to report descriptive characteristics of lifestyle factors in adolescent female football players and potential changes over 1 year. METHODS: We included 419 adolescent competitive female football players from 12 clubs and 27 teams (age 14 ± 1 years, range 12-17 years) and 286 were followed over 1 year. The players completed an extensive questionnaire regarding demographics, football-related factors, and lifestyle factors including tobacco consumption, alcohol use, medicine intake, eating and sleeping habits, well-being, stress, coping, and passion. Baseline data are presented for the total cohort and separately for 4 age groups (12, 13, 14, and 15-17 years). RESULTS: 12% skipped breakfast, 8% skipped lunch and 11% used protein supplements several days per week. 16% slept less than 8 h/night, 8% had impaired sleep with daytime consequences, and 22% stated that they were tired in daily activities several days per week. 32% experienced stress some or most days/week and 24% were classified as having psychological distress. Medicine intake (23% vs. 34%), skipping breakfast or lunch several days per week (10% vs. 47% and 20 vs. 33%), tiredness (20% vs. 27%), stress (26% vs. 40%), and psychological distress (27% vs. 37%) increased significantly (P = 0.031 to < 0.001) at the 1-year follow-up. CONCLUSION: Many adolescent female football players skip breakfast and lunch, have insufficient sleep, experience stress and are classified as having psychological distress. These factors increased over 1 year.

Normative values and changes in range of motion, strength, and functional performance over 1 year in adolescent female football players: Data from 418 players in the Karolinska football Injury Cohort study.

OBJECTIVE: To study normative values of range of motion (ROM), strength, and functional performance and investigate changes over 1 year in adolescent female football players. DESIGN: Cross-sectional. PARTICIPANTS: 418 adolescent female football players aged 12-17 years. MAIN OUTCOME MEASURES: The physical characteristic assessments included (1) ROM assessment of the trunk, hips, and ankles; (2) strength measures (maximal isometric and eccentric strength for the trunk, hips, and knees, and strength endurance for the neck, back, trunk and calves), and (3) functional performance (the one-leg long box jump test and the square hop test). RESULTS: Older players were stronger, but not when normalized to body weight. Only small differences in ROM regarding age were found. ROM increased over 1 year in most measurements with the largest change in hip external rotation, which increased by 6-7° (Cohen's d = 0.83-0.87). Hip (d = 0.28-1.07) and knee (d = 0.38-0.53) muscle strength and the square hop test (d = 0.71-0.99) improved over 1 year. CONCLUSIONS: Normative values for ROM and strength assessments of neck, back, trunk, hips, knees, calves and ankles are presented for adolescent female football players. Generally, fluctuations in ROM were small with little clinical meaning, whereas strength improved over 1 year.

Athletic Identity and Shoulder Overuse Injury in Competitive Adolescent Tennis Players: The Smash Cohort Study.

Objectives: Our primary aim was to determine if athletic identity is prospectively associated with shoulder overuse injuries. Secondly, we aimed to determine if athletic identity is prospectively associated with playing through pain and to describe how athletic identity relates to sex, age, playing level, weekly training load, and match volume. Methods: A cohort of 269 adolescent tennis players were followed over a period of 52 weeks. Cox regression was used to estimate the hazard rate ratio (HRR) of first-time shoulder overuse injury associated with every 10-unit increase on the Athletic Identity Measurement Scale (AIMS). Results: The adjusted HRR of shoulder overuse injury was 0.89 (95% CI: 0.36-2.20) and the odds ratio of playing through pain was 2.41 (95% CI: 0.74-8.96) for every 10 unit increase on AIMS. The level of athletic identity was higher among players at the national level than among players at the regional level and was weakly correlated to weekly hours of tennis matches, tennis training, and fitness training. Conclusions: Our results indicate that higher levels of athletic identity may be associated with a lower incidence of shoulder overuse injuries, and potentially with playing through pain, although these results are inconclusive due to wide confidence intervals.

Cocreating injury prevention training for youth team handball: bridging theory and practice.

Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The 'Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)' uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants' contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.

Study protocol for a prospective cohort study identifying risk factors for sport injury in adolescent female football players: the Karolinska football Injury Cohort (KIC).

INTRODUCTION: Football is a popular sport among young females worldwide, but studies concerning injuries in female players are scarce compared with male players. The aim of this study is to identify risk factors for injury in adolescent female football players. METHODS AND ANALYSIS: The Karolinska football Injury Cohort (KIC) is an ongoing longitudinal study that will include approximately 400 female football academy players 12-19 years old in Sweden. A detailed questionnaire regarding demographics, health status, lifestyle, stress, socioeconomic factors, psychosocial factors and various football-related factors are completed at baseline and after 1 year. Clinical tests measuring strength, mobility, neuromuscular control of the lower extremity, trunk and neck are carried out at baseline. Players are followed prospectively with weekly emails regarding exposure to football and other physical activity, health issues (such as stress, recovery, etc), pain, performance and injuries via the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O). Players who report a substantial injury in the OSTRC-O, that is, not being able to participate in football activities, or have reduced their training volume performance to a moderate or major degree, are contacted for full injury documentation. In addition to player data, academy coaches also complete a baseline questionnaire regarding coach experience and education. ETHICS AND DISSEMINATION: The study was approved by the Regional Ethical Review Authority at Karolinska Institutet, Stockholm, Sweden (2016/1251-31/4). All participating players and their legal guardians give their written informed consent. The study will be reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology. The results will be published in peer-reviewed academic journals and disseminated to the Swedish football movement through stakeholders and media.

Profiles of psychosocial factors: Can they be used to predict injury risk?

The creation of risk profiles using the model of stress and athletic injury (J Appl Sport Psychol. 1998;10(1):5) represents a proposed shift from the reductionism paradigm to the complex sport approach in an attempt to formulate prevention strategies to combat the increasing number of injuries being reported in sporting populations. As a result, the primary purpose of this study was to: (a) identify different risk profiles based on psychosocial factors associated with the Williams and Andersen's model of stress and athletic injury model; and (b) examine potential differences in the frequency of injuries across these risk profiles. A prospective research design was utilized with a sample of 117 competitive soccer players (81 males and 36 females) from Sweden and the United States of America. Data was collected at two time points over the course of three months. At time 1 (beginning of the season) - a demographic information sheet, the Life Event Survey for Collegiate Athletes (LESCA), Sport Competitive Anxiety Test (SCAT), and Brief Cope were administered. At time two (T2), three months after the initial data collection, participants' traumatic injuries were recorded. Latent profile analysis (LPA) showed that 3 profiles solution showed best fit to data. Players in profile 1 and 2 reported fewer injuries compared to players in profile 3. However, whereas individuals in profile 1 had a lower predictive risk of sustaining an injury when compared to those in profile 3, both profiles had similar anxiety levels and use of coping strategies with differing stress levels. These findings suggest that the interaction between different proposed risk factors might influence injury risk.

Psychosocial Risk Factors for Overuse Injuries in Competitive Athletes: A Mixed-Studies Systematic Review.

BACKGROUND: While the psychosocial risk factors for traumatic injuries have been comprehensively investigated, less is known about psychosocial factors predisposing athletes to overuse injuries. OBJECTIVE: The aim of this review was to systematically identify studies and synthesise data that examined psychosocial risk factors for overuse injuries in athletes. DESIGN: Systematic review. DATA SOURCES: MEDLINE, Web of Science and PsycINFO databases, supplemented by hand searching of journals and reference lists. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Quantitative and qualitative studies involving competitive athletes, published prior to July 2021, and reporting the relationship between psychosocial variables and overuse injury as an outcome were reviewed. This was limited to academic peer-reviewed journals in Swedish, English, German, Spanish and French. An assessment of the risk of bias was performed using modified versions of the RoBANS and SBU Quality Assessment Scale for Qualitative Studies. RESULTS: Nine quantitative and five qualitative studies evaluating 1061 athletes and 27 psychosocial factors were included for review. Intra-personal factors, inter-personal factors and sociocultural factors were found to be related to the risk of overuse injury when synthesised and reported according to a narrative synthesis approach. Importantly, these psychosocial factors, and the potential mechanisms describing how they might contribute to overuse injury development, appeared to be different compared with those already known for traumatic injuries. CONCLUSIONS: There is preliminary evidence that overuse injuries are likely to partially result from complex interactions between psychosocial factors. Coaches and supporting staff are encouraged to acknowledge the similarities and differences between traumatic and overuse injury aetiology.

The Role of the Results of Functional Tests and Psychological Factors on Prediction of Injuries in Adolescent Female Football Players.

Football is a popular sport among adolescent females. Given the rate of injuries in female footballers, identifying factors that can predict injuries are important. These injuries are often caused by complex reasons. The aim of this study was to investigate if the combination of demographic (age, number of training and match play hours/week), psychosocial (perceived stress, adaptive coping strategies) and physiological factors (functional performance) can predict a traumatic injury in adolescent female footballers. A cohort consisting of 419 female football players aged 13-16 years was established. Baseline questionnaires covered potential risk factors for sport injuries, and measurements included football-related functional performance tests. Data were collected prospectively with a weekly online questionnaire for 52 weeks covering, e.g., injuries, training, and match play hours/week. A total of 62% of the players reported at least one traumatic injury during the 52 weeks. The coping strategy "positive reframing" had the strongest association with the risk of traumatic injuries. The combination of more frequent use of the coping strategy, positive reframing, and high levels of physical performance capacity may prevent a traumatic injury in adolescent female footballers. Coaches are encouraged to adopt both physiological and psychological factors when preventing injuries in young female footballers.

Risk factors for, and prevention of, shoulder injuries in overhead sports: a systematic review with best-evidence synthesis.

OBJECTIVE: To assess the evidence for risk factors and prevention measures for shoulder injuries in overhead sports. DESIGN: Systematic review with best-evidence synthesis. DATA SOURCES: Medline (Ovid), PubMed (complementary search), Embase (Elsevier), Cochrane (Wiley), SPORTDiscus (Ebsco) and Web of Science Core Collection (Thomson Reuters), from 1 January 1990 to 15 May 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials, cohort studies and case-control studies on risk factors or prevention measures for shoulder injuries in overhead sports. The eligible studies were quality assessed using the Scottish Intercollegiate Guidelines Network criteria. RESULTS: Of 4778 studies identified, 38 were eligible for quality review and 17 met the quality criteria to be included in the evidence synthesis. One additional quality study presented a shoulder injury prevention programme. Most studies focused on baseball, lacrosse or volleyball (n=13). The risk factors examined included participation level (competition vs training) (n=10), sex (n=4), biomechanics (n=2) and external workload (n=2). The evidence for all risk factors was limited or conflicting. The effect of the prevention programme within the subgroup of uninjured players at baseline was modest and possibly lacked statistical power. CONCLUSIONS: All investigated potential risk factors for shoulder injury in overhead sports had limited evidence, and most were non-modifiable (eg, sex). There is also limited evidence for the effect of shoulder injury prevention measures in overhead sports. PROSPERO TRIAL REGISTRATION NUMBER: CRD42015026850.

Negative psychological responses of injury and rehabilitation adherence effects on return to play in competitive athletes: a systematic review and meta-analysis.

Previous research offers evidence that psychological factors influence an injured athlete during the rehabilitation process. Our first objective was to conduct a systematic review and meta-analysis of the results from all published studies that examined the relationships among negative affective responses after sport injuries, rehabilitation adherence, and return to play (RTP). The second objective was to use a meta-analytic path analysis to investigate whether an indirect effect existed between negative affective responses and RTP through rehabilitation adherence. This literature review resulted in seven studies providing 14 effect sizes. The results from the meta-analysis showed that negative affective responses had a negative effect on successful RTP, whereas rehabilitation adherence had a positive effect on RTP. The results from the meta-analytic path analysis showed a weak and nonsignificant indirect effect of negative affective responses on RTP via rehabilitation adherence. These results underline the importance of providing supportive environments for injured athletes to increase the chances of successful RTP via a decrease in negative affective responses and increase in rehabilitation adherence.

Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention.

BACKGROUND: Several studies have suggested that psychosocial variables can increase the risk of becoming injured during sport participation. OBJECTIVES: The main objectives of these meta-analyses were to examine (i) the effect sizes of relationships between the psychosocial variables (suggested as injury predictors in the model of stress and athletic injury) and injury rates, and (ii) the effects of psychological interventions aimed at reducing injury occurrence (prevention). METHODS: Electronic databases as well as specific sport and exercise psychology journals were searched. The literature review resulted in 48 published studies containing 161 effect sizes for injury prediction and seven effect sizes for injury prevention. RESULTS: The results showed that stress responses (r = 0.27, 80 % CI [0.20, 0.33]) and history of stressors (r = 0.13, 80 % CI [0.11, 0.15]) had the strongest associations with injury rates. Also, the results from the path analysis showed that the stress response mediated the relationship between history of stressors and injury rates. For injury prevention studies, all studies included (N = 7) showed decreased injury rates in the treatment groups compared to control groups. CONCLUSION: The results support the model's suggestion that psychosocial variables, as well as psychologically, based interventions, can influence injury risk among athletes.

Injury Profile in Swedish Elite Floorball.

BACKGROUND: Floorball is an indoor team sport with growing popularity worldwide characterized by rapid accelerations, decelerations, and cutting and pivoting movements. While injuries are common, there are few high-quality epidemiological investigations of floorball injuries. Therefore, the aim of this study was to determine the incidence and severity of injuries in male and female elite-level floorball players in Sweden. HYPOTHESIS: The incidence of injuries has not decreased; female players are more vulnerable to injury than male players. STUDY DESIGN: Prospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Twelve floorball teams (6 male, 6 female) in the Swedish premiere leagues were followed for 1 year (preseason, game season, and the entire year). The team medical staff reported injury incidence, location, type (traumatic or overuse), and severity. Differences between male and female players were analyzed using the Mann-Whitney U test. RESULTS: The injury incidence was greater in female players during preseason (22.9 vs 7.4, P = 0.01), game season (39.5 vs 28.3, P = 0.002), as well as the whole year combined (33.9 vs 20.8, P = 0.02). The thigh was the most common injury location in male players and the ankle in female players. Overuse injuries were more common among men and were primarily back problems. Traumatic injuries were more common in women-mainly knee and ankle injuries. Most injuries were of mild severity. A greater number of anterior cruciate ligament injuries occurred in women (n = 11) than in men (n = 2). CONCLUSION: The injury incidence was significantly greater in female floorball players throughout the entire floorball year. Male players sustained mostly overuse injuries while female players suffered traumatic injuries. The majority of injuries in floorball were mild, irrespective of player sex. CLINICAL RELEVANCE: Knowledge of the incidence and severity of floorball injuries is an essential step in the sequence of injury prevention. Future research should focus on identifying injury mechanisms and risk factors for these injuries to develop injury prevention strategies.

Sports injury prevention in Swedish elite floorball players: evaluation of two consecutive floorball seasons.

PURPOSE: The objective was to evaluate the effect of a psychological group-based injury prevention, which was implemented throughout the first season, after the second season, in Swedish elite floorball teams (males and females). The secondary objective was to evaluate the effect of the intervention over the two consecutive floorball seasons as a whole. METHODS: Twenty-three teams in the premier leagues for males and females volunteered and were allocated to an intervention group, n = 175 players, and a control group n = 171 players. The intervention group participated in psychological skills training during the first season. The control group did not receive any alternative treatment. Neither of the groups received any intervention during the second season. All injuries were registered and documented according to time-loss definition and classified into either traumatic or overuse injuries. RESULTS: Ninety-three players (27 %) sustained 119 injuries during the second season. The intervention group 0.31 (95 % CI 0.22-0.39) and the control group 0.41 (95 % CI 0.29-0.53) injuries/player. The injury incidence decreased in the intervention group and was lower than the control group. The analysis showed no statistical differences when comparing the intervention group and the control group neither after the second season nor after the two seasons together, Cohen's d 0.2. CONCLUSION: This group-based training showed a small effect size after the second year resulting in fewer injuries, especially severe injuries, in the intervention group compared to the control group. It is, therefore, important not to overlook the potential of a group-based psychological injury prevention programme.

A psychological injury prevention group intervention in Swedish floorball.

PURPOSE: The main purpose of the study was to evaluate a psychological skills training intervention at group level aiming to prevent injuries, separated in traumatic and overuse, in male and female elite floorball players. METHODS: Twenty-three teams in the premiere leagues for males and females were volunteered, and the teams were allocated to an intervention group (n = 11, males n = 94, females n = 99) and a control group (n = 12, males n = 109, females n = 99). The teams in the intervention group participated in a psychological skills training programme consisting of six meetings with each team. The control group received no substitute. All injuries were registered and documented according to the time-loss definition and classified into either traumatic or overuse. RESULTS: In total, 142 players (35 %) out of the 401 players sustained 197 injuries, 0.49 injury/player: in the intervention group 0.45 injury/player and in the control group 0.53 injury/player. The analyses revealed no significant differences in injuries between intervention groups and control groups. The effect size of the influence of the psychological skills training in overuse injuries was considered to be small, Cohen's d 0.2. CONCLUSIONS: This study comprised the whole team for a group intervention and did not screen for at-risk athletes, e.g. scoring high in anxiety or low in coping skills, which might have influenced the result. A psychological injury prevention intervention forward to a whole team might not influence the injury occurrence significantly. Thus, this psychological intervention decreased the injury incidence which is of clinical interest. LEVEL OF INCIDENCE: Level II.

Current Status and Future Challenges in Psychological Research of Sport Injury Prediction and Prevention: A Methodological Perspective

El propósito de esta revisión crítica es proponer una serie de progresos metodológicos en la investigación sobre predicción y prevención de lesiones. Para ello, se analizaron conjuntamente 24 estudios (cuantitativos, cualitativos y de intervención preventiva) llevados a cabo desde el año 2006 en adelante relacionados con el "modelo de estrés-lesión". Los estudios de predicción de lesiones utilizaron mayoritariamente diseños prospectivos, utilizando el análisis de regresión y estudiando el rasgo ansiedad y los eventos vitales. Los estudios cualitativos utilizaron principalmente el análisis temático. Los estudios de intervención mostraron resultados promisorios, aunque todavía no definitivos. En este trabajo proponemos cinco necesidades específicas para la investigación futura: (a) centrarse en diferentes cohortes, (b) variar los diseños de intervención preventiva, incluyendo protocolos experimentales, (c) centrarse en las conductas relacionadas con las cogniciones, (d) utilización de diseños de medidas repetidas, y (e) utilización de estadísticos que puedan verificar las complejas interacciones y las diferencias individuales. El foco de la investigación futura también debe orientarse hacia la psicología de las lesiones por desgaste excesivo, las perspectivas biopsicosociales y las evaluaciones económicas del impacto en la salud. Si bien en los últimos 10-15 años se han conseguido importantes avances en la investigación sobre los antecedentes psicológicos de la lesión deportiva, la prevención y la intervención, algunas cuestiones metodológicas deben ser aún desarrolladas, tal y como se señala en este artículo (AU)

The purpose of this critical review was to propose methodological developments in sport injury prediction and prevention research. Altogether, 24 studies (e.g., quantitative, qualitative, and prevention intervention studies) conducted from 2006 forward were analysed, related to the "stress-injury model". The injury prediction studies were mostly based on prospective designs, using regression analysis, and studied trait anxiety and life stress. The qualitative studies used mainly thematic analysis, and the intervention studies showed some promising effects, but also inconclusive results. We proposed five specific needs for future research: (a) focus on separate research cohorts, (b) variation in preventive intervention designs, including sound protocols conducting experimental studies, (c) focus on behaviours in relation to cognition, (d) application of repeated-measure designs, and (e) use of statistics that could test complex interactions and intraindividual differences. Future research attention should also be oriented towards the psychology of overuse injuries, biopsychosocial perspectives, and health economic evaluations. While progress has been made in research on psychological antecedents of sport injury, prevention, and intervention in the last 10-15 years, several methodological issues still remain to be further developed, as outlined in this article (AU)