Monitoring the beautiful adapted game: a 3-year prospective surveillance study of injuries in elite English Para football.

Para football is currently played in impairment-specific formats by thousands of people worldwide. To date, there have been no prospective longitudinal injury surveillance studies. This study aimed to implement a prospective injury surveillance study within elite English Para football and analyse the injury risk within the England Blind and Cerebral Palsy (CP) squads. Match and training injury data based on a 'time loss' definition were collected and analysed for each squad including incidence per 1,000 player hours, severity, injury location and associated event of injury. Injury incidence were lower in training than matches (CP 67.6/1000 player match hours (CI 33.8-135.2) and 5.7/1000 training hours (CI 3.8-8.7) and Blind 44.0/1000 player match hours (CI 26.1-74.3) and 5.5/1000 training hours (CI 3.5-8.6). Training injuries were more severe than match injuries across both squads (CP median 12 days lost in matches and 16 training and Blind median days 5 matches and 12 training). 73% Blind and 74% CP footballer injuries were to the lower limb and 17% head and neck equally across both Para football squads. 'Muscle and tendon injuries' (51%) represented the greatest proportion of injuries for CP footballers, and 'joint (non-bone)/ligament injuries' (43%) for Blind footballers. Collaboration and implementation of higher quality surveillance methodology and data collection in Para sport with greater athlete numbers are needed to inform injury prevention strategies.

Trends in match concussion incidence and return-to-play time in male professional Rugby Union: A 16-season prospective cohort study.

AIM: To describe trends in the incidence of match concussions and time to return-to-play in professional rugby union. METHODS: Match concussion incidence (injuries per 1000 player-match-hours) and time to return-to-play (mean and median days absence) were recorded in 3006 male professional rugby union players over 16 seasons (2002/03 - 2018/19). RESULTS: From 2002/03 to 2009/10, incidence of concussions was stable at 4.3/1000 player-match-hours. From 2009/10 to 2018/19, there was an increase in concussion incidence, with the highest incidence in 2016/17 at 20.9/1000 player-match-hours (95% CI: 17.9-24.3). Annual prevalence of concussion also increased, suggesting more players were concussed rather than the same players sustaining more concussions. Before the introduction of standardized graduated return-to-play (GRTP) guidelines in 2011, 27% of players returned to play in <6 days. After the introduction of the GRTP, this decreased to 7%, with no players returning in <6 days after 2014/15. Between 2002/03 and 2018/19, incidence of all other injuries remained stable. CONCLUSIONS: From 2009/10 onwards, the incidence of diagnosed concussions increased. Since the introduction of the GRTP, there has been a dramatic reduction in the number of players returning in <6 days.

Eight-season epidemiological study of match injuries in women's international rugby sevens.

This study aimed to describe anthropometry and incidence, nature and causes of match injuries in women's international rugby sevens and to compare these with results reported previously for men's international rugby sevens. The study comprised an 8-season, prospective study of World Rugby's women's Sevens World Series. Over the eight seasons, the overall incidence of injury was 105.6 (95% CI: 96.0 to 116.3) injuries/1000 player-match-hours with a mean injury severity of 53.4 (95% CI: 46.9 to 59.9) days-absence. There were no statistically significant trends for backs or forwards in the incidence (backs: p = 0.470; forwards: p = 0.242) or mean severity (backs: p = 0.098; forwards: p = 0.544) of injuries sustained over the 8-season period. Head/face (20.8%), knee (19.7%), ankle (11.3%) and shoulder/clavicle (8.4%) were the most common injury locations while ligament sprain (31.7%), concussion (15.6%), haematoma/bruise (11.5%) and fracture (11.5%) were the most common types of injury sustained. Being-tackled (35.4%), tackling (26.3%), collisions (13.8%) and rucks (8.8%) were the match events responsible for most injuries. The study indicates that injury burden in women's international rugby sevens (5,640 days-absence/1000 player-match-hours; 95% CI: 5,123 to 6,209) is similar to that reported previously for men's international rugby sevens (5,263 days-absence/1000 player-match-hours; 95% CI: 5,000 to 5,540).

Trends in match injury risk in professional male rugby union: a 16-season review of 10 851 match injuries in the English Premiership (2002-2019): the Professional Rugby Injury Surveillance Project.

OBJECTIVES: The Professional Rugby Injury Surveillance Project is the largest and longest running rugby union injury surveillance project globally and focuses on the highest level of rugby in England. METHODS: We examined match injuries in professional men's rugby over the period 2002/2003 to 2018/2019 and described trends in injuries over this time. RESULTS: Over the period 2002/2003-2018/2019, 10 851 injuries occurred in 1 24 952 hours of match play, equating to a mean of 57 injuries per club per season and one injury per team per match. The mean incidence, severity (days absence) and burden (days absence/1000 hours) of injury were 87/1000 hours (95% CI 82 to 92), 25 days (95% CI 22 to 28) and 2178 days/1000 hours (95% CI 1872 to 2484), respectively. The tackle accounted for 43% injuries with running the second most common activity during injury (12%). The most common injury location was the head/face with an incidence of 11.3/1000 hours, while the location with the highest overall burden was the knee (11.1 days/1000 hours). Long-term trends demonstrated stable injury incidence and proportion of injured players, but an increase in the mean and median severity of injuries. Concussion incidence, severity and burden increased from the 2009/2010 season onwards and from 2011 to 2019 concussion was the most common injury. CONCLUSION: The rise in overall injury severity and concussion incidence are the most significant findings from this work and demonstrate the need for continued efforts to reduce concussion risk as well as a greater understanding of changes in injury severity over time.

The epidemiology of kicking injuries in professional Rugby Union: A 15-season prospective study.

PURPOSE: While kicking in Rugby Union can be influential to match outcome, the epidemiology of kicking injuries remains unknown. This study therefore aimed to investigate the epidemiology of injuries attributed to kicking in professional rugby, including playing position-specific effects and differences in kicking volumes and kick types. METHODS: Fifteen seasons of injury surveillance data and two seasons of match kicking characteristics from professional rugby players were analyzed. Incidence, propensity, and severity of kicking-related injuries were calculated together with the locations and types of these injuries. Position-related differences in match kicking types and volumes were also established. RESULTS: Seventy-seven match and 55 training acute-onset kicking injuries were identified. The match kicking injury incidence for backs was 1.4/1000 player-match-hours. Across all playing positions, the propensity for match kicking injury was 0.57 injuries/1000 kicks. Fly-halves sustained the greatest proportion of match kicking injuries (47%) and performed the greatest proportion of match kicks (46%); an average propensity for match kicking injury (0.58/1000 kicks). Scrum-halves executed 27% of match-related kicks but had a very low propensity for match kicking injury (0.17/1000 kicks). All other positional groups executed a small proportion of match-related kicks but a high propensity for match kicking injury. Ninety-two percent of match kicking injuries occurred in the pelvis or lower limb, with the majority sustained by the kicking limb. 21% of all match kicking injuries were associated with the rectus femoris muscle. CONCLUSION: Match kicking profiles and kicking injuries sustained are position-dependent, which provides valuable insight for developing player-specific conditioning and rehabilitation protocols.

Ten-season epidemiological study of match injuries in men's international rugby sevens.

The aim of this study was to describe the incidence, nature and causes of match injuries in men's international rugby sevens and to compare these to values for international rugby fifteens. The study comprised a 10-season, whole population, prospective study of the Sevens World Series. Over the ten seasons, the overall incidence of injury was 122.4 (95% CI = 116.3 to 128.9) injuries/1000 player-match-hours and the mean severity of injury was 43.0 (95% CI = 40.3 to 45.7) days-absence. There was an increasing trend in the incidence of injury over the ten-season period (slope = 5.3 injuries/1000 player-hours/season, R2 = 0.68, p = 0.003) but no trend in the mean severity of injury (slope = 0.02 days/season, R2 < 0.01, p = 0.971). Head/face (15.7%), knee (15.6%), ankle (15.4%) and shoulder/clavicle (11.9%) were the most common injury locations and ligament sprain (30.5%), muscle strain (16.4%), concussion (12.6%) and haematoma/bruise (10.6%) the most common types of injury sustained. Being-tackled (33.1%), tackling (23.4%), running (16.1%) and collisions (12.4%) were the most common events leading to injury. These results indicate that the burden of injury in international rugby sevens is two to three times higher than that reported for international rugby fifteens.

Patterns of training volume and injury risk in elite rugby union: An analysis of 1.5 million hours of training exposure over eleven seasons.

Rugby union is a popular team sport that demands high levels of physical fitness and skill. The study aim was to examine trends in training volume and its impact on injury incidence, severity and burden over an 11-season period in English professional rugby. Data were recorded from 2007/08 through 2017/18, capturing 1,501,606 h of training exposure and 3,782 training injuries. Players completed, on average, 6 h 48 minutes of weekly training (95% CI: 6 h 30 mins to 7 h 6 mins): this value remained stable over the 11 seasons. The mean incidence of training-related injuries was 2.6/1000 player-hours (95% CI: 2.4 to 2.8) with a mean severity rising from 17 days in 2007/08 to 37 days in 2017/18 (Change/season = 1.773, P <0.01). Rate of change in severity was dependent on training type, with conditioning (non-gym-based) responsible for the greatest increase (2.4 days/injury/season). As a result of increasing severity, injury burden rose from 51 days absence/1000 player-hours in 2007/08 to 106 days' absence/1000 player-hours in 2017/18. Despite the low incidence of injury in training compared to match-play, training accounted for 34% of all injuries. Future assessments of training intensity may lead to a greater understanding of the rise in injury severity.

Does the Reliability of Reporting in Injury Surveillance Studies Depend on Injury Definition?

BACKGROUND: Choosing an appropriate definition for injury in injury surveillance studies is essential to ensure a balance among reporting reliability, providing an accurate representation of injury risk, and describing the nature of the clinical demand. PURPOSE: To provide guidance on the choice of injury definition for injury surveillance studies by comparing within- and between-team variability in injury incidence with >24-hour and >7-day time-loss injury definitions in a large multiteam injury surveillance study. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Injury data were reported for 2248 professional rugby union players from 15 Premiership Rugby clubs over 12 seasons. Within-team percentage coefficient of variation and mean between-team standard deviation (expressed as a percentage coefficient of variation) in injury incidence rates (injuries per 1000 player match hours) were calculated. For both variables, a comparison was made between >24-hour and >7-day injury incidence rates in terms of the magnitude of the observed effects. RESULTS: The overall mean incidence across the population with a >24-hour time-loss injury definition was approximately double the reported incidence with the >7-day definition. There was a 10% higher between-team variation in match injury incidence rates with the >24-hour time-loss definition versus the >7-day definition. CONCLUSION: There was a likely higher degree of between-team variation in match injury incidence rates with a >24-hour time-loss definition than with a >7-day definition of injury. However, in professional sports settings, it is likely that the benefits of using a more inclusive definition of injury (improved understanding of clinical demand and the appropriate and accurate reporting of injury risk) outweigh the small increase in variation in reporting consistency.

Eight-season epidemiological study of injuries in men's international Under-20 rugby tournaments.

The aim of this study was to define the incidence and nature of match injuries sustained in men's international under-20 rugby. The study comprised an 8-season prospective study of 16 international under-20 rugby tournaments. Procedures complied with the consensus statement for epidemiological studies in rugby. Outputs included players' mean age, stature and body mass and incidence, severity, location, type and cause of match injuries. The overall incidence of injury was 49.7 injuries/1000 player-match-hours (backs: 48.3; forwards: 50.9) with a mean severity of 32.2 days-absence (backs: 29.4; forwards: 34.4). There were no significant changes in incidence or severity of injury over the study period. Shoulder/clavicle (18.3%), head/face (16.4%), knee (13.7%) and ankle (13.7%) were the most common injury locations and ligament sprain (35.4%), haematoma/bruise (15.9%), concussion (12.5%) and muscle strain (11.2%) the most common types of injury. Being-tackled (29.2%), tackling (24.0%) and collisions (14.3%) were the most common events leading to injury. The results confirm that international under-20 rugby has a high incidence and severity of injury but the incidence is half that reported for senior international players. There was no significant change in the overall incidence of injury at the Under-20 level in the period 2008 to 2016.

Subsequent Injuries and Early Recurrent Diagnoses in elite Rugby Union Players.

An eight-season (2005/06-2012/13) prospective cohort design was used to record time-loss injuries in 15 English Premiership teams. Data pertaining to a total of 1 556 players and 9 597 injuries (8 180 subsequent) were included in the analysis. Injuries subsequent to an index injury were classified as (1) New: different site; (2) Local: same site (and different type); or (3) Recurrent: same site and type. The severity of subsequent injuries (days missed) was compared with their related index injury. The proportions of early (<2 months), late (2-12 months) and delayed (>12 months) subsequent injuries were compared across injury classifications and diagnosis groupings. The majority of subsequent injuries (70%) were classified as new injuries, with 14% local and 16% recurrent. A large proportion of recurrent subsequent injuries (42%) occurred within two months of return-to-play. Subsequent injuries were not more severe than their corresponding index injury (effect sizes <0.20). Specific local and recurrent subsequent injury diagnoses with the highest risk of occurring within two months of return-to-play were: 'neck muscle strain', 'ankle joint capsule sprain', and 'cervical nerve root' injuries. These findings may be used to drive targeted secondary prevention efforts, such as reconsideration of return-to-play protocols for neck muscle strain injuries.

How Much Rugby is Too Much? A Seven-Season Prospective Cohort Study of Match Exposure and Injury Risk in Professional Rugby Union Players.

INTRODUCTION: Numerous studies have documented the incidence and nature of injuries in professional rugby union, but few have identified specific risk factors for injury in this population using appropriate statistical methods. In particular, little is known about the role of previous short-term or longer-term match exposures in current injury risk in this setting. OBJECTIVES: Our objective was to investigate the influence that match exposure has upon injury risk in rugby union. METHOD: We conducted a seven-season (2006/7-2012/13) prospective cohort study of time-loss injuries in 1253 English premiership professional players. Players' 12-month match exposure (number of matches a player was involved in for ≥20 min in the preceding 12 months) and 1-month match exposure (number of full-game equivalent [FGE] matches in preceding 30 days) were assessed as risk factors for injury using a nested frailty model and magnitude-based inferences. RESULTS: The 12-month match exposure was associated with injury risk in a non-linear fashion; players who had been involved in fewer than ≈15 or more than ≈35 matches over the preceding 12-month period were more susceptible to injury. Monthly match exposure was linearly associated with injury risk (hazard ratio [HR]: 1.14 per 2 standard deviation [3.2 FGE] increase, 90% confidence interval [CI] 1.08-1.20; likely harmful), although this effect was substantially attenuated for players in the upper quartile for 12-month match exposures (>28 matches). CONCLUSION: A player's accumulated (12-month) and recent (1-month) match exposure substantially influences their current injury risk. Careful attention should be paid to planning the workloads and monitoring the responses of players involved in: (1) a high (>≈35) number of matches in the previous year, (2) a low (<≈15) number of matches in the previous year, and (3) a low-moderate number of matches in previous year but who have played intensively in the recent past. These findings make a major contribution to evidence-based policy decisions regarding match workload limits in professional rugby union.

2016 Rio Olympics: an epidemiological study of the men's and women's Rugby-7s tournaments.

OBJECTIVE: To determine the incidence, severity and nature of injuries sustained during the men's and women's 2014/2015 and 2015/2016 Sevens World Series (SWS) and 2016 Olympic Games Rugby Sevens tournaments. DESIGN: A prospective cohort study. PARTICIPANTS: All players from the core teams competing in the men's and women's 2014/2015 and 2015/2016 SWS (men: 15 teams; women: 11 teams) and all players from the men's (12 teams) and women's (12 teams) 2016 Rio Olympics tournaments. RESULTS: The gold, silver and bronze medal-winning women's teams contained bigger players (body mass and stature) than other teams but the men's medal winning teams came from across the size spectrum of men's teams competing at Rio 2016. The incidences of injury in the men's tournaments (2014/2015 SWS: 107.7 injuries/1000 player-match-hours (95% CI 90.9 to 127.4); 2015/2016 SWS: 109.7 (95% CI 93.7 to 128.6); Rio 2016: 124.5 (95% CI 73.7 to 210.2)) were higher but not statistically significant than those in the equivalent women's tournaments (2014/2015 SWS: 88.5 (95% CI 68.4 to 114.5), p=0.250; 2015/2016 SWS: 109.4 (95% CI 84.2 to 142.2), p=0.984; Rio 2016: 71.1 (95% CI 35.6 to 142.2), p=0.208). There were no statistically significant differences between the incidences of injury at the men's and women's 2016 Rio Olympics and the equivalent 2014/2015 (men: p=0.603; women: p=0.562) and 2015/2016 (men: p=0.652; women: p=0.254) SWS. CONCLUSIONS: The incidence, severity and nature of the injuries sustained during the men's and women's Rio 2016 Rugby-7s tournaments fell within the normal range of values for international Rugby-7s tournaments.

Rugby World Cup 2015: World Rugby injury surveillance study.

OBJECTIVE: To determine the incidence, severity and nature of injuries sustained during the Rugby World Cup (RWC) 2015 together with the inciting events leading to the injuries. DESIGN: A prospective, whole population study. POPULATION: 639 international rugby players representing 20 countries. METHOD: The study protocol followed the definitions and procedures recommended in the consensus statement for epidemiological studies in rugby union; output measures included players' age (years), stature (cm), body mass (kg) and playing position, and the group-level incidence (injuries/1000 player-hours), mean and median severity (days-absence), location (%), type (%) and inciting event (%) for match and training injuries. RESULTS: Incidence of injury was 90.1 match injuries/1000 player-match-hours (backs: 100.4; forwards: 81.1) and 1.0 training injuries/1000 player-training-hours (backs: 0.9; forwards: 1.2). The mean severity of injuries was 29.8 days-absence (backs: 30.4; forwards: 29.1) during matches and 14.4 days-absence (backs: 6.3; forwards: 19.8) during training. During matches, head/face (22.0%), knee (16.2%), muscle-strain (23.1%) and ligament-sprain (23.1%) and, during training, lower limb (80.0%) and muscle-strain (60.0%) injuries were the most common locations and types of injury. Being-tackled (24.7%) was the most common inciting event for injury during matches and rugby-skills-contact activities (70.0%) the most common during training. CONCLUSIONS: While the incidence, nature and inciting events associated with match injuries at RWC 2015 were similar to those reported previously for RWCs 2007 and 2011, there were increasing trends in the mean severity and total days-absence through injury.

Should player fatigue be the focus of injury prevention strategies for international rugby sevens tournaments?

OBJECTIVE: To assess the incidence, severity and nature of injuries, to determine risk factors for injury and to identify potential injury prevention strategies in men's international Rugby-7s tournaments. DESIGN: A prospective cohort study. PARTICIPANTS: Players from core teams competing in matches at 6 Sevens World Series from 2008/2009 to 2014/2015. RESULTS: The incidence of injury across all Series was 108.3 injuries/1000 player-match-hours (backs: 121.0; forwards: 91.5) with a mean severity of 44.2 days (backs: 46.1; forwards: 40.9) and a median severity of 28 days (backs: 29; forwards: 26). The proportion of injuries sustained in the second half was significantly higher (60%; p<0.001) than the first half of matches and the proportion increased from match to match and day to day in a tournament. The knee (17.4%), ankle (15.9%) and posterior thigh (13.2%) were the most common injury locations for backs and the knee (18.5%), head/face (17.3%) and shoulder/clavicle (13.0%) for forwards. The four most common injuries across all players were knee ligament (13.0%), ankle ligament (12.8%), concussion (10.4%) and posterior thigh muscle strains (9.8%). CONCLUSIONS: The incidence of injury in Rugby-7s suggests that teams require squads of around 20 players for a Sevens World Series. The higher incidence of injury in the second half of matches is probably the result of player fatigue; therefore, injury prevention strategies for teams and the Governing Body should address this issue. The results presented support the World Rugby trial allowing 'rolling substitutes' during Sevens World Series matches, as this approach may help to mitigate the effects of player fatigue during the second half of matches.

Time loss injuries compromise team success in Elite Rugby Union: a 7-year prospective study.

BACKGROUND: A negative association between injuries and team success has been demonstrated in professional football, but the nature of this association in elite Rugby Union teams is currently unclear. AIM: To assess the association between injury burden measures and team success outcomes within professional Rugby Union teams. METHODS: A seven-season prospective cohort design was used to record all time-loss injuries incurred by English Premiership players. Associations between team success measures (league points tally and Eurorugby Club Ranking (ECR)) and injury measures (injury burden and injury days per team-match) were modelled, both within (changes from season to season) and between (differences averaged over all seasons) teams. Thresholds for the smallest worthwhile change in league points tally and ECR were 3 points and 2.6%, respectively. RESULTS: Data from a total of 1462 players within 15 Premiership teams were included in the analysis. We found clear negative associations between injury measures and team success (70-100% likelihood), with the exception of between-team differences for injury days per team-match and ECR, which was unclear. A reduction in injury burden of 42 days (90% CI 30 to 70) per 1000 player hours (22% of mean injury burden) was associated with the smallest worthwhile change in league points tally. CONCLUSIONS: Clear negative associations were found between injury measures and team success, and moderate reductions in injury burden may have worthwhile effects on competition outcomes for professional Rugby Union teams. These findings may be useful when communicating the value of injury prevention initiatives within this elite sport setting.

Does long-distance air travel associated with the Sevens World Series increase players' risk of injury?

OBJECTIVE: To assess whether players who cross ≥6 time zones and/or undertake ≥10 h air travel prior to competition experience a higher risk of injury during the Sevens World Series than players not required to undertake this level of travel. DESIGN: Five-year, prospective, cohort study. PARTICIPANTS: All players from nine core teams competing in the Sevens World Series from 2008/2009 to 2013/2014. RESULTS: A total of 436 match injuries and 3363 player-match-hours of exposure were recorded in the study, which corresponds to an overall incidence of 129.6 injuries/1000 player-match-hours, irrespective of the nature of pretournament travel. The incidence of injury for those players crossing ≥6 time zones and undertaking ≥10 h air travel prior to competition (99.3 injuries/1000 player-match-hours) was significantly lower than that of players undertaking ≥10 h air travel but crossing ≤2 time zones prior to competition (148.8 injuries/1000 player-match-hours; p=0.003) and of those undertaking ≤3 h air travel and crossing ≤2 time zones prior to competition (146.4 injuries/1000 player-match-hours; p=0.004). There was no significant difference in the incidence of injury for players crossing ≤2 time zones in the week prior to competition, irrespective of whether the length of air travel was ≤3 h or ≥10 h (p=0.904). Precompetition air travel had no significant effect (p=0.879) on the performance of teams in terms of their final Tournament ranking positions. CONCLUSIONS: There was no evidence to suggest that players were exposed to a greater risk of injury following extensive air travel and crossing multiple time zones prior to Tournaments in the Sevens World Series.

Epidemiology of concussion in men's elite Rugby-7s (Sevens World Series) and Rugby-15s (Rugby World Cup, Junior World Championship and Rugby Trophy, Pacific Nations Cup and English Premiership).

OBJECTIVE: To determine the incidence, nature and causes of concussions sustained during men's elite professional Rugby-7s and Rugby-15s. DESIGN: A prospective cohort study recording injuries classified as a time-loss concussion. POPULATION: Players competing in the following tournaments: Rugby 15s-English Premiership (2007/2008 to 2010/2011), Rugby World Cup (2007, 2011), Pacific Nations Cup (2012, 2013), Junior World Championship (2008, 2010-2013), Junior World Rugby Trophy (2008, 2010-2013); Rugby 7s-Sevens World Series (2008/2009, 2010/2011 to 2012/2013). METHOD: The study was implemented according to the international consensus statement for epidemiological studies in rugby union; the main outcome measures included the number, incidence (number of concussions/1000 player-match-hours), mean and median severity (days absence) and cause of concussion. RESULTS: The incidence of concussion in Rugby-7s was significantly higher than that in Rugby-15s (risk ratio=1.84; p<0.001). The severity of concussions were significantly higher in Rugby-7s than Rugby-15s (mean-Rugby-7s: 19.2, Rugby-15s: 10.1; median-Rugby 7s: 20, Rugby-15s: 7; p<0.001). The main causes of concussion were tackling (44.1%) in Rugby-7s and collisions (43.6%) in Rugby-15s. Significantly more (risk ratio=1.49; p=0.004) concussed players were removed immediately from the game in Rugby-7s (69.7%) compared to Rugby-15s (46.7%). CONCLUSIONS: Six actions were identified to improve the management of concussion in rugby: implement a pitch-side concussion assessment protocol; improve compliance with return-to-play protocols; work with referees to review the nature and consequences of collisions; improve players' tackle technique; investigate the forces involved in tackles and collisions; and evaluate reasons for the higher incidence of concussions in Rugby-7s.

United Kingdom survey of current management of juvenile localized scleroderma.

OBJECTIVES: Juvenile localized scleroderma (JLS) is a rare condition that is often difficult to assess and for which a variety of monitoring tools have been described. We aimed to describe how monitoring tools are used and perceived by clinicians in the UK, to ascertain treatments used for JLS and to provide a description of transition arrangements to adult care. METHODS: An e-survey of UK paediatric rheumatologists and dermatologists managing children and young people (CYP) with JLS was distributed using the national organisations representing these clinician groups. We asked respondents for their views and experience using 15 JLS monitoring tools, about transition services and about treatments used. RESULTS: Thirty-five dermatologists and 13 paediatric rheumatologists responded. Paediatric rheumatologists managed more CYP with JLS than dermatologists (median 16-20 and 3, respectively). Transition arrangements were reported by 43% of dermatologists and 91% of paediatric rheumatologists. Medical photography was the most frequently regularly used monitoring tool (73% respondents). The modified Rodnan skin score was the skin score used most commonly: 33% of paediatric rheumatologists and 3% of dermatologists reported using this tool frequently. Topical treatments and ultraviolet light were used by 49-80% of dermatologists and 0-8% paediatric rheumatologists. Biologic drugs and CYC were used by 0-3% of dermatologists and 31-46% of paediatric rheumatologists. CONCLUSION: How monitoring tools are accessed, used and perceived by paediatric rheumatologists and dermatologists in the UK varies between and within clinician groups, as do treatment prescribing patterns and transition arrangements. These differences will impact on the feasibility of conducting multicentre clinical trials and on standardising clinical care.

Scrum injury risk in English professional rugby union.

OBJECTIVE: To assess and evaluate the injury risk associated with the scrum in English professional rugby union in the 2011-2012 season. DESIGN: Prospective, cohort. PARTICIPANTS: Players at English Premiership rugby union clubs. OUTCOME MEASURES: Frequency of team scrum-events per match; incidence (injuries per 1000 player-hours; propensity (injuries/1000 events); risk (days absence per 1000 player-hours and days absence per 1000 events). RESULTS: 31% of scrums in competitive matches resulted in collapse. Injury incidence associated with collapsed scrum-events (incidence: 8.6 injuries/1000 scrum-events) was significantly higher than those scrums that did not collapse (incidence: 4.1/1000 scrum-events). CONCLUSIONS: The injury risk associated with collapsed scrum supports the continued focus on reducing scrum collapse through changes in, and strict application of, the laws surrounding the scrum.