Socioeconomic deprivation and racialised disparities in competitive athletes with sudden cardiac arrest from the USA.

OBJECTIVE: To explore the association of socioeconomic deprivation and racialised outcomes in competitive athletes with sudden cardiac arrest (SCA) in the USA. METHODS: SCA cases from the National Center for Catastrophic Sports Injury Research (July 2014 to June 2021) were included. We matched Area Deprivation Index (ADI) scores (17 metrics to grade socioeconomic conditions) to the 9-digit zip codes for each athlete's home address. ADI is scored 1-100 with higher scores indicating greater neighbourhood socioeconomic deprivation. Analysis of variance was used to assess differences in mean ADI by racial groups. Tukey post hoc testing was used for pairwise comparisons. RESULTS: 391 cases of SCA in competitive athletes (85.4% male; 16.9% collegiate, 68% high school, 10.7% middle school, 4.3% youth) were identified via active surveillance. 79 cases were excluded due to missing data (19 race, 60 ADI). Of 312 cases with complete data, 171 (54.8%) were white, 110 (35.3%) black and 31 (9.9%) other race. The mean ADI was 40.20 (95% CI 36.64, 43.86) in white athletes, 57.88 (95% CI 52.65, 63.11) in black athletes and 40.77 (95% CI 30.69, 50.86) in other race athletes. Mean ADI was higher in black versus white athletes (mean difference 17.68, 95% CI 10.25, 25.12; p=0.0036) and black versus other race athletes (mean difference 17.11, 95% CI 4.74, 29.47; p<0.0001). CONCLUSIONS: Black athletes with SCA come from areas with higher neighbourhood socioeconomic deprivation than white or other race athletes with SCA. Our findings suggest that socioeconomic deprivation may be associated with racialised disparities in athletes with SCA.

Before hitting the slopes: athlete and staff perspectives on warm-up and activation in high-performance snowsports.

To explore warm-up and activation (W&A) practices in high-performance snowsports to describe their importance, application and potential improvements based on the perspectives of elite-level athletes and staff members. Qualitative study consisting of semistructured interviews with 13 international elite-level athletes, on-snow coaches, strength and conditioning coaches, sports physiotherapists and sports psychologists from different snowsports and subdisciplines: alpine skiing, freestyle skiing (park and pipe, aerials, moguls) and snowboarding (park and pipe, snowboard cross). The interviews were transcribed verbatim and analysed based on the principles of grounded theory. The main themes raised by the participants were (1) the importance of readiness for sports participation as the motive for W&A, (2) how readiness is reached with a structured W&A routine and (3) the different athlete-specific, task-specific and environmental-specific factors for optimal W&A. Athletes and staff members considered W&A an essential measure to get physically and mentally ready for sports participation. Being ready was described as a key factor for performance and injury prevention. For these athletes, adherence to W&A was the result of a process of experiencing the beneficial effects of W&A and learning from sustaining one or more injuries. Broad implementation of basic physical and mental W&A at the youth level was considered an important measure to increase the overall adoption of W&A as an inherent part of training and competition. At the elite level, W&A is performed to reach athletes' mental and physical readiness for performance enhancement and injury prevention. W&A is acknowledged as a complex and dynamic programme and is typically adapted to sport-specific demands, injury risks, environmental circumstances and individual needs and preferences. Overall, this study provides valuable contextual insights into the complexity of W&A and the factors that need to be considered to make sport-specific recommendations.

'Knowing we have these rights does not always mean we feel free to use them': athletes' perceptions of their human rights in sport.

Objectives: Modern sport safeguarding strategies include published global rights declarations that enshrine athletes' entitlements at the policy level. It is unclear how these documents translate to athletes' lived experiences. The study aimed to determine athletes' knowledge, attitudes and beliefs about their human rights in sports settings. Setting: Web-based survey. Participants: 1159 athletes from 70 countries completed a validated web-based survey. Over half of participants (60.1%) were between 18 and 29 years, currently competing (67.1%), not members of players' unions (54.6%), elite (60.0%) and participating in individual (55.8%) non-contact (75.6%) Olympic (77.9%) sports. Gender distribution was equal. Primary and secondary outcome measures: Participant demographics (eg, gender, age) and athletes' knowledge, attitudes and beliefs about their human rights in sports settings. Results: Most (78.5%) were unaware of any athletes' rights declarations. Gender influenced participants' confidence in acting on their rights in sport significantly. Males were more likely to accept pressure from coaches and teammates than females, but age affected how likely males were to accept this pressure. Paralympic athletes were less likely to agree that violence is acceptable in sports, compared with Olympic. Player union membership increased confidence in freely expressing one's opinion in sports settings. Athletes' rights-related awareness, knowledge and beliefs were disconnected. Conclusions: Awareness raising is not enough to prevent human rights violations in sports. The cultural climate of the entire ecosystem must be targeted, using systems-level strategies to shift stakeholders' biases, beliefs and behaviours. This approach takes the onus of addressing abuse off athletes' shoulders and places accountability on sports organisations.

Physical prognostic factors predicting outcome following anterior cruciate ligament reconstruction: A systematic review and narrative synthesis.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are common. Many patients undergo ACL reconstruction (ACLR), with rehabilitation key to successful outcome. Understanding physical prognostic factors is integral to clinical decision-making, but factors predicting outcome are inadequately defined. The objective was to establish physical prognostic factors predicting outcome following ACLR. METHODS: A systematic review following a published protocol (CRD42019127732) searched MEDLINE, CINAHL, EMBASE, key journals and grey literature to November 28, 2020. Prospective cohort studies, participants ≥16 years of age who had undergone ACLR were included, with multi-ligament and/or ACL repair surgery, and studies not published in English excluded. Two independent reviewers conducted searches, extracted data, assessed risk of bias (QUIPS) and overall quality of evidence (GRADE). Meta-analysis was not possible, therefore narrative synthesis was performed. RESULTS: 13 studies (16 articles) were included (1 low, 12 high risk of bias). Low-level evidence supports postoperative degenerative changes and poor lower-limb strength predicting poorer outcome long term (KOOS). Very low-level evidence supports greater postoperative quadriceps strength predicting improved functional performance medium term; with lower body mass index predicting improvement of multiple outcome measures. CONCLUSION: Limited evidence of low or very low-level indicates multiple prognostic factors predicting outcome following ACLR. A high-quality prognostic study is required.

Advancing feminist innovation in sport studies: A transdisciplinary dialogue on gender, health and wellbeing.

Athlete health and wellbeing requires a holistic, multidimensional approach to understanding, supporting, and treating individual athletes. Building more supportive, inclusive, and equitable environments for the health and wellbeing of women and gender expansive people further requires gender-responsive approaches that promote broader cultural change. Feminist sport and exercise medicine practitioners, sports scientists, and social science researchers are increasingly coming together in their efforts to do this work. However, working across disciplines inevitably includes an array of ontological, epistemological, and political challenges. In this paper, we offer a curated 'dialogue' with a group of feminist scholars engaged in research and practice across disciplines, bringing them together to discuss some of the most pressing gendered issues in sport today (i.e., ACL injury, concussion, menstruation in sport, mental health, gender categories). In so doing, we amplify the voices of those working (empirically and clinically) at the disciplinary intersections of gender, sport and health, and learn about some of the current and future possibilities for transdisciplinary innovations and strategies for building (responsiveness to) cultural change.

Development and validation of the athletes' rights survey.

A recognised imbalance of power exists between athletes and sporting institutions. Recent cases of systemic athlete abuse demonstrate the relationship between power disparities and harassment and abuse in sport. Embedding human rights principles into sporting institutions is a critical step towards preventing harassment and abuse in sport. In 2017, the World Players Association (WPA) launched the Universal Declaration of Player Rights. A year later, the International Olympic Committee (IOC) developed their Athletes' Rights and Responsibilities Declaration. These two documents codify benchmarks 'for international sporting organisations to meet their obligations to protect, respect and guarantee the fundamental rights of players'. This paper is the first project exploring athletes' knowledge, understanding and awareness of rights in the sports context. This study presents the development and validation of a survey investigating athletes' knowledge of these declarations, associated attitudes/beliefs and understanding of how these rights can be enacted in practice. The survey includes 10 statements of athlete rights based on the WPA and IOC declarations. Face validation was assessed by distributing the survey to 10 athletes and conducting qualitative interviews with a subgroup of four athletes. The survey was reworked into 13 statements, and the tool was validated with 611 responses through confirmatory factor analysis. Key findings include a weak correlation between athletes' knowledge and their attitudes/beliefs, and challenges with the interpretation of words such as 'pressure,' 'violence,' 'harassment' and 'intimidation.' This validation puts forward the first survey instrument to directly test athletes' knowledge, attitudes and beliefs about rights in sport.

"Is it fun and does it enhance my performance?" - Key implementation considerations for injury prevention programs in youth handball.

OBJECTIVES: We aimed to determine the use of injury prevention exercises and injury prevention exercise programs in Danish youth handball and investigate coach and player experiences, beliefs and attitudes of injury and their prevention. DESIGN: A mixed-methods design consisting of cross-sectional quantitative surveys and qualitative interviews. METHODS: We surveyed 481 youth (14-18 years old) handball players and their 33 coaches about their use of injury prevention exercises, and attitudes towards injury and their prevention. Additionally, we interviewed five coaches and three players about barriers and motivational factors for implementing injury prevention programs. RESULTS: Players (71%) and almost all coaches reported performing injury prevention exercises for the shoulder, knee, and ankle. Yet few players (4%) and coaches (1%) reported performing the established full injury prevention programs systematically. Players were willing to implement programs to reduce injury risk (84% agreed) and enhance performance (88% agreed). Key factors influencing program uptake were lack of awareness of evidence-based injury prevention programs and lack of handball-specific exercises. Coaches and players identified continued education and training as vital facilitators in this setting, and all coaches agreed that injury prevention should be an essential part of coach education. CONCLUSIONS: While Danish youth handball players and coaches seemed to recognize the importance of injury prevention, the use of established programs was marginal. Experiences, beliefs, and attitudes about injury and injury prevention influenced program uptake and should be addressed through continued education and training in this context in combination with making the programs more handball specific.

Anterior cruciate ligament injury: towards a gendered environmental approach.

BACKGROUND: The anterior cruciate ligament (ACL) injury rate for girls/women has not changed in over 20 years, and they remain 3-6 times more likely to experience injury compared with boys/men. To date, ACL injury prevention and management has been approached from a sex-based biological point of view which has furthered our understanding of injury risk factors, mechanisms, and prevention and rehabilitation programmes. However, the traditional sex-based approach does not take into account the growing recognition of how sex and gender (a social construct) are 'entangled' and influence each other. OBJECTIVE: This paper discusses the curious absence of gender as an influencer in the dialogue surrounding ACL injuries. We propose adding gender as a pervasive developmental environment as a new theoretical overlay to an established injury model to illustrate how gender can operate as an extrinsic determinant from the presport, training and competition environments through to ACL injury and the treatment environment. APPROACH: We draw on social epidemiological theories of the embodiment of gender and health to provide plausible examples of how gender may influence ACL injury, and demonstrate the opportunity for new, interdisciplinary research in the field. CONCLUSION: Over 20 years of research has failed to decrease the ACL injury rate disparity between girls/women and boys/men. Embedding gender in the study of ACL injury will heighten awareness of possible influences outside the traditional biological elements, challenge us to think about the inextricable 'entanglement' of sex and gender, and inform more effective approaches to ACL injury prevention and treatment.

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

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

Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study.

INTRODUCTION: A voluntary State Government-led programme in Victoria, Australia 'Defibrillators for Sporting Clubs and Facilities Program' ran from 2015 to 2019, broadly aimed at increasing access to automated external defibrillators (AEDs), together with a greater number of community members trained for management of medical emergencies. This study aimed to understand whether participating sport clubs/facilities had successfully integrated an AED and medical planning with other club/facility safety practices, 12 months after delivery of the programme. METHODS: This was a qualitative case study of 14 sport clubs/facilities in Victoria, Australia in 2017, underpinned by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We conducted observational audits of facilities (to locate AED placement, signage and other relevant location-specific factors) and semi-structured, face-to-face interviews with representatives of the clubs/facilities. Interview questions were designed to determine if and how the related, mandated emergency management programme was adapted for the long term (embedding), whether this aligned to ongoing organisational mission (active engagement), and whether or not it was still ongoing 6 months postinitial implementation (sustainability). Data were evaluated using qualitative descriptive methodology. For reporting, descriptive summaries of the audit were combined with interview data to contextualise and visualise the sport club/facility setting and key results. RESULTS: Key issues identified were accessibility and visibility of the AED, with inadequate signage and challenges identifying an efficient location for access and storage. Most interviewees reported the AED and training were received with no further actions taken towards safety planning or integration with club/facility practice. Several challenges regarding remaining up to date with training and ensuring required routine checks of the AED take place were also raised. CONCLUSIONS: This study identified several challenges for community sport clubs/facilities in the implementation of an AED and medical planning programme, including where to store the AED, how to make its presence known to the community and how to integrate changes alongside other club/facility practices.

Physical prognostic factors predicting outcome following anterior cruciate ligament reconstruction: protocol for a systematic review.

INTRODUCTION: Injuries of the anterior cruciate ligament (ACL) are a common musculoskeletal complication and can cause significant reduction in patient function and quality of life. Many undergo ACL reconstruction, with high-quality rehabilitation key to successful outcome. Knowledge of physical prognostic factors, such as quadriceps strength, is crucial to inform rehabilitation and has important implications for outcome following ACL reconstruction. However, these factors predicting outcome are poorly defined. Therefore, the aim of this systematic review is to establish physical prognostic factors predictive of outcome in adults following ACL reconstruction. Outcome will be subdivided into two groups of outcome measures, patient-reported and performance-based. Physical prognostic factors of interest will reflect a range of domains and may be modifiable/non-modifiable. Results will help decide most appropriate management and assist in planning and tailoring preoperative and postoperative rehabilitation. METHODS AND ANALYSIS: This systematic review protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. MEDLINE, CINAHL and EMBASE databases, key journals and grey literature will be searched from inception to July 2019. Prospective cohort studies including participants aged ≥16 years who have undergone ACL reconstruction will be included, with articles focusing on multi-ligament reconstructions and ACL repair surgery, or not published in English excluded. Two independent reviewers will conduct searches, assess study eligibility, extract data, assess risk of bias (Quality in Prognostic Studies tool) and quantify overall quality of evidence (modified Grading of Recommendations, Assessment, Development and Evaluation guidelines). If possible, a meta-analysis will be conducted, otherwise a narrative synthesis will ensue focusing on prognostic factors, risk of bias of included studies and strength of association with outcomes. ETHICS AND DISSEMINATION: Findings will be published in a peer-reviewed journal, presented at conferences and locally to physiotherapy departments. Ethical approval is not required for this systematic review. PROSPERO REGISTRATION NUMBER: CRD42019127732.

"It Doesn't Make Sense for Us Not to Have One"-Understanding Reasons Why Community Sports Organizations Chose to Participate in a Funded Automated External Defibrillator Program.

OBJECTIVE: Implementation of automated external defibrillators (AEDs) in community sports settings is an important component of emergency medical planning. This study aimed to understand motivations for why sports organizations participated in a government-funded program that provided AEDs and associated first-aid training. DESIGN: Face-to-face interviews. SETTING: Community sports organizations in Victoria, Australia. PARTICIPANTS: Representatives from 14 organizations who participated in a government-funded AED program. MAIN OUTCOME MEASURES: Motivations to participate in the AED program were explored using a qualitative descriptive approach. RESULTS: Two overarching themes emerged: awareness of the program and decision to apply. Awareness was gained indirectly through grant advertising in newsletters/emails/web sites and directly through their sporting associations. For most organizations, there was no decision process per se, rather, the opportunity to apply was the key determinant for participating in the program. A duty of care also emerged as a key driving factor, with recognition of AEDs as a valuable asset to communities broadly, not just the participants' immediate sports setting. Reflecting on participation in the program, these participants identified that it was important to increase awareness about AED ownership and use. The program benefits were clearly summed up as being best prepared for a worst-case scenario. DISCUSSION: This study provides new understanding of why community sports organizations apply for an AED and training. The strongest reason was simply the opportunity to acquire this at no cost. Therefore, for wider implementation of AEDs, additional funding opportunities, targeted awareness of these opportunities, and continued promotion of AED importance are recommended.