Difficulties in Addressing Diagnostic, Treatment and Support Needs in Individuals with Intellectual Disability and Persistent Challenging Behaviours: A Descriptive File Study of Referrals to an Expertise Centre.

Service providers may experience difficulties in providing appropriate care to optimize the functioning of individuals with intellectual disability and challenging behaviour. External consultation to identify and address the unmet support needs underlying the behaviour may be beneficial. Applying the multidimensional American Association Intellectual and Developmental Disabilities (AAIDD) model may facilitate this approach. We aimed to describe the content and outcomes of consultation for individuals with intellectual disability and challenging behaviour referred to the Dutch Centre for Consultation and Expertise in relation to the AAIDD model. Interventions were based on the clients' diagnostic, treatment, and support needs and were categorized according to the five dimensions of the AAIDD model. Outcomes of the consultations were assessed based on reports in the file and rated as 'clear improvement', 'improvement' or 'no improvement or deterioration'. In two-thirds of the 104 studied files, consultees were satisfied with the improvement in functioning. Interventions targeted the difficulties of the service providers in supporting their clients and were most often applied within the Health and Context dimensions of the AAIDD model. We may conclude that consultation of an expert team may be valuable to support the care providers, and the use of the AAIDD model may be helpful to address the unmet needs to improve the functioning of individuals with challenging behaviour.

Qualitative study evaluating the expectations and experiences of Dutch parents of children with chronic gastrointestinal symptoms visiting their general practitioner.

OBJECTIVES: Chronic gastrointestinal symptoms are common among children and affect their daily activities and quality of life. The majority will be diagnosed with a functional gastrointestinal disorder. Effective reassurance and education are, therefore, key components of the physician's management. Qualitative studies have shown how parents and children experience specialist paediatric care, yet less is known about general practitioners (GPs), who manage most cases in the Netherlands and have a more personal and enduring relationship with their patients. Therefore, this study evaluates the expectations and experiences of parents of children visiting a GP for chronic gastrointestinal symptoms. DESIGN: We conducted a qualitative interview study. Online interviews were audio and video recorded, transcribed verbatim and independently analysed by the first two authors. Data were collected and analysed concurrently until data saturation was reached. Using thematic analysis, we developed a conceptual framework reflecting respondent expectations and experiences. We performed a member check of the interview synopsis and the conceptual framework. SETTING: Dutch primary care. PARTICIPANTS: We purposively sampled participants from a randomised controlled trial evaluating the effectiveness of faecal calprotectin testing in children with chronic gastrointestinal complaints in primary care. Thirteen parents and two children participated. RESULTS: Three key themes emerged: disease burden, GP-patient relationship and reassurance. Often, the experienced disease burden and the pre-existing GP-patient relationship influenced expectations (eg, for further investigations or a sympathetic ear), and when a GP fulfilled these expectations, a trusting GP-patient relationship ensued that facilitated reassurance. We found that individual needs influenced these themes and their interrelationships. CONCLUSION: Insights provided by this framework could help GPs managing children with chronic gastrointestinal symptoms in daily practice and may therewith improve the consultation experience for parents. Further research should evaluate whether this framework also holds true for children. TRIAL REGISTRATION NUMBER: NL7690.

Home-based guided hypnotherapy for children with functional abdominal pain and irritable bowel syndrome in primary care: study protocol for a randomised controlled trial.

INTRODUCTION: Children often present to primary care with functional abdominal pain (FAP) or irritable bowel syndrome (IBS), and around half still have abdominal complaints 1 year later. Hypnotherapy is an evidence-based treatment that is used in specialist care, but it lacks evidence in primary care. This study will investigate the (cost) effectiveness of home-based guided hypnotherapy for children with FAP or IBS in primary care. METHODS AND ANALYSIS: We report the design of a pragmatic randomised controlled trial among children aged 7-17 years, diagnosed with FAP or IBS by their general practitioner (GP), with assessments over 12 months. The control group will receive care as usual (CAU) by their GP (eg, communication, education and reassurance), while the intervention group will receive CAU plus 3 months of home-based guided hypnotherapy via a website. The primary outcome will be the proportion of children with adequate relief from abdominal pain/discomfort at 12 months, analysed on an intention-to-treat basis. Secondary outcomes will include the adequacy of pain relief at 3 and 6 months, pain/discomfort severity, pain frequency and intensity, daily functioning and impact on function, anxiety and depression, pain beliefs, sleep disturbances, school absence, somatisation, and healthcare use and costs. We must include 200 children to determine a 20% difference in those with adequate relief (55% control vs 75% intervention). ETHICS AND DISSEMINATION: The Medical Ethics Review Committee of the University Medical Center Groningen, the Netherlands, approved this study (METc2020/237). The results will be disseminated to patients, GPs and other stakeholders via email, a dedicated website, peer-reviewed publications and presentations at national and international conferences. We plan to collaborate with the Dutch Society of GPs to implement the results in clinical practice. TRIAL REGISTRATION NUMBER: NCT05636358.

Factors Associated With Running-Related Injuries in Recreational Runners With a History of Running Injuries.

OBJECTIVE: To identify the incidence and characteristics associated with a higher injury risk in recreational runners who suffered a running-related injury (RRI) in the previous 12 months. DESIGN: Prospective cohort study among recreational runners who registered for a Dutch running event (5-42.2 km) and suffered an RRI in the 12 months before inclusion. SETTING: Open population. PARTICIPANTS: Recreational runners with a previous reported injury. ASSESSMENT OF RISK FACTORS: At baseline, information on demographics, training characteristics, health complaints, and RRI history was collected. MAIN OUTCOME MEASURES: With 3 follow-up questionnaires (2 weeks before, 1 day after, and 1 month after the running event), the occurrence of new RRIs was registered. RESULTS: In total, 548 participants (55.1%) sustained a new RRI during follow-up. In total, 20.5% of the new RRIs was located at the same anatomical location as the previous RRI. Runners who registered for a marathon had a higher chance to sustain a new RRI [odd ratio (OR) 1.72; 95% confidence intervals (CIs), 1.17-2.53]. Also previous RRIs in the upper leg (OR 1.59; 95% CI, 1.15-2.19) and lower leg (OR 1.61; 95% CI, 1.18-2.21) were associated with an increased injury risk. CONCLUSIONS: Especially being a marathon runner and the anatomical location of previous RRIs seem to be associated with the injury risk in recreational runners with a previous RRI.

Feasibility and usability of GPS data in exploring associations between training load and running-related knee injuries in recreational runners.

BACKGROUND: The purpose of the present study was to explore the feasibility of collecting GPS data and the usability of GPS data to evaluate associations between the training load and onset of running-related knee injuries (RRKIs). METHODS: Participants of the INSPIRE-trial, a randomized-controlled trial on running injury prevention, were asked to participate in this study. At baseline, demographic variables were collected. Follow-up questionnaires assessed information on RRKIs. Participants with a new reported RRKI and uninjured participants were sent a GPS export request. Weekly GPS-based training distances were used to calculate Acute:Chronic Workload Ratios (ACWRs). RESULTS: A total of 240 participants (62.7%) tracked their running training sessions with the use of a GPS-enabled device or platform and were willing to share their GPS data. From the participants (N = 144) who received a GPS export request, 50.0% successfully shared their data. The majority (69.4%) of the shared GPS data were usable for analyses (N = 50). GPS data were used to present weekly ACWRs of participants with and without an RRKI eight weeks prior to RRKI onset or running event. CONCLUSIONS: It seems feasible to collect GPS data from GPS-enabled devices and platforms used by recreational runners. The results indicate that GPS data is usable to calculate weekly ACWRs to evaluate associations between training load and onset of RRKIs in recreational runners. Therefore, GPS-based ACWR measures can be used for future studies to evaluate associations between training load and onset of RRIs.

Educational online prevention programme (the SPRINT study) has no effect on the number of running-related injuries in recreational runners: a randomised-controlled trial.

OBJECTIVES: The aim of this study was to examine the effectiveness of an enhanced online injury prevention programme on the number of running-related injuries (RRIs) in recreational runners. METHODS: We conducted a randomised-controlled trial in runners who registered for running events (distances: 10-42.195 km) in the Netherlands. Adult runners who provided informed consent were randomised into the intervention or control group. Participants in the intervention group received access to the online prevention programme, which included items to prevent RRIs. Participants in the control group followed their regular preparation for the running event. The primary outcome measure was the number of new RRIs from baseline to 1 month after the running event. To determine differences between injury proportions, univariate and multivariate logistic regression analyses were performed. RESULTS: This study included 4050 recreational runners (63.5% males; mean (SD) age: 42.3 (12.1) years) for analyses. During follow-up, 35.5% (95% CI: 33.5 to 37.6) of the participants in the intervention group sustained a new RRI compared with 35.4% (95% CI: 33.3 to 37.5) of the participants in the control group, with no between-group difference (OR: 1.03; 95% CI: 0.90 to 1.17). There was a positive association between the number of items followed in the injury prevention programme and the number of RRIs (OR: 1.05; 95% CI: 1.00 to 1.11). CONCLUSION: The enhanced online injury prevention programme had no effect on the number of RRIs in recreational runners, and being compliant with the programme paradoxically was associated with a slightly higher injury rate. Future studies should focus on individual targeted prevention with emphasis on the timing and application of preventive measures. TRIAL REGISTRATION NUMBER: NL7694.

Consequences and Prognosis of Running-Related Knee Injuries Among Recreational Runners.

OBJECTIVE: To investigate the consequences and prognostic factors of running-related knee injuries (RRKIs) among recreational runners. DESIGN: Prospective cohort study. SETTING: This study is part of a randomized-controlled trial (RCT) on running injury prevention among recreational runners. At baseline during registration for a running event (5-42 km), demographic and training variables were collected. Participants who reported a new RRKI during follow-up were sent a knee-specific questionnaire at 16 months (range 11.7-18.6) after baseline. PARTICIPANTS: One hundred thirty-eight runners who reported a new RRKI during the RCT on injury prevention responded to the knee-specific questionnaire. ASSESSMENT OF RISK FACTORS: To determine the association between potential prognostic factors and time to recovery of an RRKI, a Cox regression analysis was performed. MAIN OUTCOME MEASURES: Time to recovery and prognostic factors of RRKIs. RESULTS: At 16 months after registration, 71.0% of the participants reported full recovery, with a median time to recovery of 8.0 weeks. Most participants reported iliotibial band syndrome (23.2%) or osteoarthritis (OA)/degenerative meniscopathy (23.2%) as cause of their injury. Male sex was associated with a shorter time to recovery [hazard ratio (HR) 1.84; 95% confidence interval (CI), 1.14-2.97], while suffering knee OA was associated with a longer time to recovery (HR 0.17; 95% CI, 0.06-0.46). CONCLUSIONS: Nonrecovered participants adjusted running speed more often and had knee imaging more often than recovered participants. At follow-up, one-third of the participants were not recovered. This emphasizes the need for injury prevention programs for runners. More knowledge on the role of running in knee OA seems important, given the high number of participants with knee OA symptoms.

The socio-economic impact of running-related injuries: A large prospective cohort study.

OBJECTIVES: To evaluate the impact of running-related injuries (RRIs) on activities of daily living (ADL), work, healthcare utilization, and estimated costs. DESIGN: Prospective cohort study with data from a randomized controlled trial. METHODS: Adult recreational runners who registered for a running event (distances 5 to 42 km) were included in this study. Minimum follow-up duration was 3 months (preparation, event participation, and post-race period). Injuries were registered using a standardized definition. Primary outcome measure was a standardized 5-item survey on limitations in ADL. The survey data were categorized to the number of injured runners with complete/moderate/no limitations. This outcome was expressed as the percentage of injured runners with any limitation (complete or moderate limitations amalgamated). Secondary outcomes were work absenteeism, the number of healthcare visits per injured runner, and estimated direct medical and indirect costs per participant and per RRI. RESULTS: 1929 runners (mean [SD] age 41 [12] years, 53% men) were included in this study and 883 runners (46%) sustained a RRI during the course of the study. Injured runners reported the highest limitations (% with any limitation) of RRIs during the first week of injury on sports and leisure activities (70%) and transportation activities (23%). 39% of the injured runners visited a healthcare professional. Work absenteeism due to the RRI was reported in 5% of the injured runners. The total mean estimated costs were €74 per RRI and €35 per participant. CONCLUSIONS: Injured runners are mainly limited in their transportation activities and during sports and leisure. While the estimated costs of RRIs are not high when expressed per participant, the absolute costs may be substantial due to the popularity of running.

How many runners with new-onset Achilles tendinopathy develop persisting symptoms? A large prospective cohort study.

BACKGROUND: Achilles tendinopathy (AT) occurs in half of the elite runners. AT is a difficult-to-treat tendon disease, which may progress from new onset to a chronic state. It is unknown how many runners with new-onset AT develop persisting symptoms and which prognostic factors are associated with this course. OBJECTIVE: To describe how many runners develop persisting symptoms 1 year after onset of reactive AT. STUDY DESIGN: Prospective cohort study. METHODS: Runners registering for a Dutch running event (5-42.2 km) were eligible for inclusion. Runners reporting new-onset AT between registration for the running event and 1 month after received a 1-year follow-up questionnaire. The 1-year follow-up questionnaire inquired about persisting symptoms (yes/no), running activity, and metabolic disorders. We calculated the percentage of runners with persisting symptoms and performed a multivariable logistic regression analysis to study the association between potential prognostic factors and persisting symptoms. RESULTS: Of 1929 participants, 100 runners (5%) reported new-onset AT. A total of 62 runners (62%) filled in the 1-year follow-up questionnaire. Persisting symptoms were reported by 20 runners (32%). A higher running distance per week before new-onset AT was associated with a lower risk of developing persisting symptoms (odds ratio (OR): 0.9, 95% confidence interval (CI): [0.9;1.0]). There was a positive trend toward an association between metabolic disorders and persisting symptoms (OR: 5.7, 95% CI: [0.9;36.2]). CONCLUSION: One third of runners develop persisting symptoms 1 year after new-onset AT. Interestingly, a higher running distance per week before new-onset AT potentially lowers the risk of developing persisting symptoms.

Enhanced injury prevention programme for recreational runners (the SPRINT study): design of a randomised controlled trial.

INTRODUCTION: Running-related injuries (RRIs) are frequent, but no effective injury prevention measures have been identified yet. Therefore, we have set up the INSPIRE trial in 2017, in which the effectiveness of an online injury prevention programme was tested. Although this programme was not effective in reducing the number of RRIs, we gained new insights from this study, which we used to design an enhanced, online multidisciplinary injury prevention programme. The aim of this study is to test the effectiveness of this enhanced injury prevention programme in a group of recreational runners. METHODS AND ANALYSIS: For this randomised controlled trial, we aim to include 3394 recreational runners aged 18 years or older who register for a running event (distances 10 to 42.2 km). During the preparation for the running event, runners in the intervention group get access to the enhanced online injury prevention programme. This online programme consists of 10 steps, all covering separate items of RRI prevention. Runners in the control group will follow their regular preparation. With three follow-up questionnaires (1 month before, 1 week before and 1 month after the running event), the proportions of self-reported RRIs in the intervention group and the control group are compared. ETHICS AND DISSEMINATION: An exemption for a comprehensive application has been obtained by the Medical Ethical Committee of the Erasmus MC University Medical Center, Rotterdam, the Netherlands. The results of the study will be disseminated among the running population, published in peer-reviewed international journals and presented on international conferences. TRIAL REGISTRATION NUMBER: NL7694.

Training for a (half-)marathon: Training volume and longest endurance run related to performance and running injuries.

OBJECTIVE: Examine the associations of training volume and longest endurance run with (half-)marathon performance and running-related injuries (RRIs) in recreational runners. MATERIALS AND METHODS: During the preparation for and directly after the running event, 556 participants of a half marathon and 441 participants of a marathon completed three questionnaires on RRIs, average weekly training volume and the longest endurance run. With finish time, decline in pace during the running event and RRIs as dependent variables, linear and logistic regression analyses were performed to test the associations with weekly training volume and the longest endurance run. RESULTS: In half-marathon runners, a high training volume (>32 km/wk) (ß -4.19, 95% CI: -6.52;-1.85) and a long endurance run (>21 km) (ß -3.87, 95% CI: -6.31;--1.44) were associated with a faster finish time, while a high training volume (ß -1.81, 95% CI: -3.49;-0.12) and a long endurance run (ß -1.89, 95% CI: -3.65;-0.12) were also related to less decline in pace. In marathon runners, a low training volume (<40 km/wk) was related to a slower finish time (ß 6.33, 95% CI: 0.18;12.48) and a high training volume (>65 km/wk) to a faster finish time (ß -14.09, 95% CI: -22.47;-5.72), while a longest endurance run of <25 km was associated with a slower finish time (ß 13.44, 95% CI: 5.34;21.55). No associations between training characteristics and RRIs were identified. CONCLUSIONS: Preparation for a (half-)marathon with a relatively high training volume and long endurance runs associates with a faster finish time, but does not seem related to an increased injury risk.

Incidence of Achilles tendinopathy and associated risk factors in recreational runners: A large prospective cohort study.

OBJECTIVES: To determine the incidence of Achilles tendinopathy in a large group of recreational runners and to determine risk factors for developing AT. DESIGN: Observational cohort study. METHODS: Runners registering for running events (5-42 km) in the Netherlands were eligible for inclusion. Main inclusion criteria were: age ≥18 years, and registration ≥2 months before the running event. The digital baseline questionnaire obtained at registration consisted of demographics, training characteristics, previous participation in events, lifestyle and previous running-related injuries. All participants received 3 follow-up questionnaires up to 1 month after the running event with self-reported AT as primary outcome measure. To study the relationship between baseline variables and AT onset, multivariable logistic regression analyses were performed. RESULTS: In total, 2378 runners were included, of which 1929 completed ≥1 follow-up questionnaire, and 100 (5.2%, 95%CI [4.2;6.2]) developed AT. Runners registered for a marathon (7.4%) had the highest incidence of AT. Risk factors for developing AT were use of a training schedule (odds ratio (OR) = 1.8 (95%Confidence Interval(CI)[1.1;3.0])), use of sport compression socks ((OR = 1.7, 95%CI[1.0;2.8]) and AT in the previous 12 months (OR = 6.3, 95%CI[3.9;10.0]). None of the demographic, lifestyle or training-related factors were associated with the onset of AT. CONCLUSION: One in twenty recreational runners develop AT. AT in the preceding 12 months is the strongest risk factor for having AT symptoms. Using a training schedule or sport compression socks increases the risk of developing AT and this should be discouraged in a comparable running population. TRIAL REGISTRATION NUMBER: The Netherlands Trial Register (ID number: NL5843).

Opinions, Barriers, and Facilitators of Injury Prevention in Recreational Runners.

BACKGROUND: Effective injury prevention measures for running-related injuries (RRIs) have not yet been identified. More insight into the opinions of runners about injury prevention might help to develop effective injury prevention programs that are supported by the target population. OBJECTIVES: To describe the opinions of recreational runners on different components of injury prevention, and to identify the barriers to and facilitators of injury prevention in adult recreational runners. METHODS: In this comparative cross-sectional study, a single questionnaire was sent to 2378 recreational runners. The questionnaire contained questions about their interests, actions undertaken, and perceived barriers to and facilitators of injury prevention. Descriptive analyses were used to examine differences with regard to sex, age, and previous RRIs. RESULTS: One thousand thirty-four adult recreational runners (43.5%) responded to the questionnaire. Runners with previous RRIs were more likely to rate injury prevention as very useful than runners who had never sustained an RRI (76.8% versus 63.6%, P<.001). In total, 81.8% of the participants indicated that they already performed preventive measures, including changes to training schedules (65.4%) and warming up and cooling down (57.8%). Most frequently reported barriers to injury prevention were "not knowing what to do" (45.2%) and "no history of RRI" (34.6%). The most important facilitator was an injury (60.1%). Women more often preferred information via a trainer or running store than did men, while men more frequently preferred websites or e-mail. CONCLUSION: The majority of runners rated injury prevention as important. To increase effectiveness, future prevention programs should be developed with an awareness of the barriers and facilitators experienced by adult runners. J Orthop Sports Phys Ther 2019;49(10):736-742. Epub 23 Aug 2019. doi:10.2519/jospt.2019.9029.

Online multifactorial prevention programme has no effect on the number of running-related injuries: a randomised controlled trial.

OBJECTIVE: To examine the effect of a multifactorial, online injury prevention programme on the number of running-related injuries (RRIs) in recreational runners. METHODS: Adult recreational runners who registered for a running event (distances 5 km up to 42.195 km) were randomised into the intervention group or control group. Participants in the intervention group were given access to the online injury prevention programme, which consisted of information on evidence-based risk factors and advices to reduce the injury risk. Participants in the control group followed their regular preparation for the running event. The primary outcome measure was the number of self-reported RRIs in the time frame between registration for a running event and 1 month after the running event. RESULTS: This trial included 2378 recreational runners (1252 men; mean [SD] age 41.2 [11.9] years), of which 1196 were allocated to the intervention group and 1182 to the control group. Of the participants in the intervention group 37.5% (95% CI 34.8 to 40.4) sustained a new RRI during follow-up, compared with 36.7% (95% CI 34.0 to 39.6) in the control group. Univariate logistic regression analysis showed no significant difference between the intervention and control group (OR 1.08; 95% CI 0.90 to 1.30). Furthermore, the prevention programme seemed to have a negative impact on the occurrence of new RRIs in the subgroup of runners with no injuries in the 12 months preceding the trial (OR 1.30; 95% CI 0.99 to 1.70). CONCLUSION: A multifactorial, online injury prevention programme did not decrease the total number of RRIs in recreational runners. TRIAL REGISTRATION NUMBER: NTR5998.

Prognosis and prognostic factors of running-related injuries in novice runners: A prospective cohort study.

OBJECTIVES: To investigate the prognosis and possible prognostic factors of running-related injuries (RRIs) in novice runners. DESIGN: Prospective cohort study. METHODS: Participants of Start to Run, a 6-weeks course for novice runners in The Netherlands, were asked to participate in this study. Before the start of the course a baseline questionnaire, on demographics, physical activity and perceived health, was sent to runners willing to participate. The 26- or 52-weeks follow-up questionnaires assessed information on RRIs and their duration. Only participants that sustained a RRI during follow-up were included in the analyses. An injury duration of 10weeks or shorter was regarded as a relatively good prognosis, while an injury duration of more than 10weeks was defined as a poor prognosis. To determine the associations between baseline characteristics and injury prognosis and between injury location and injury prognosis, multivariable logistic regression analyses were performed. RESULTS: 347 participants (48.8%) sustained an RRI during follow-up. The RRIs had an overall median duration of eight weeks (range: 1-52weeks). Participants with a previous RRI were more likely to have a poor prognosis (OR 2.31; 95%CI 1.12-4.79), while a calf injury showed a trend towards an association with a relatively good prognosis (OR 0.49; 95%CI 0.22-1.11). CONCLUSIONS: The duration of RRIs in novice runners is relatively long, with only calf injuries being associated with a good prognosis. This emphasizes the need of injury prevention measures in novice runners and adequate support during and after an RRI, especially in runners with a previous injury.

Reasons and predictors of discontinuation of running after a running program for novice runners.

OBJECTIVES: To determine the proportion of participants of a running program for novice runners that discontinued running and investigate the main reasons to discontinue and characteristics associated with discontinuation. DESIGN: Prospective cohort study. METHODS: The study included 774 participants of Start to Run, a 6-week running program for novice runners. Before the start of the program, participants filled-in a baseline questionnaire to collect information on demographics, physical activity and perceived health. The 26-weeks follow-up questionnaire was used to obtain information on the continuation of running (yes/no) and main reasons for discontinuation. To determine predictors for discontinuation of running, multivariable logistic regression was performed. RESULTS: Within 26 weeks after the start of the 6-week running program, 29.5% of the novice runners (n=225) had stopped running. The main reason for discontinuation was a running-related injury (n=108, 48%). Being female (OR 1.74; 95% CI 1.13-2.68), being unsure about the continuation of running after the program (OR 2.06; 95% CI 1.31-3.24) and (almost) no alcohol use (OR 1.62; 95%CI 1.11-2.37) were associated with a higher chance of discontinuation of running. Previous running experience less than one year previously (OR 0.46; 95% CI 0.26-0.83) and a higher score on the RAND-36 subscale physical functioning (OR 0.98; 95% CI 0.96-0.99) were associated with a lower chance of discontinuation. CONCLUSIONS: In this group of novice runners, almost one-third stopped running within six months. A running-related injury was the main reason to stop running. Women with a low perceived physical functioning and without running experience were prone to discontinue running.

Letter to the editor concerning the article "Relationship between school rhythm and physical activity in adolescents: the HELENA study" by Vanhelst et al. (2017).

Recently Vanhelst et al. published a study on the relationship between school rhythm and physical activity patterns in European adolescents in the Journal of Sports Sciences. With this Letter to the Editor we would like to comment on the practical implementation and further perspectives of the study.

Preventing running-related injuries using evidence-based online advice: the design of a randomised-controlled trial.

INTRODUCTION: Running-related injuries (RRIs) are frequent and can lead to cessation of health promoting activities. Several risk factors for RRIs have been identified. However, no successful injury prevention programme has been developed so far. Therefore, the aim of the present study is to investigate the effect of an evidence-based online injury prevention programme on the number of RRIs. METHODS AND ANALYSIS: The INSPIRE trial is a randomised-controlled trial with a 3-month follow-up. Both novice and more experienced runners, aged 18 years and older, who register for a running event (distances 5 km up to 42.195 km) will be asked to participate in this study. After completing the baseline questionnaire, participants will be randomised into either the intervention group or control group. Participants in the intervention group will get access to the online injury prevention programme. This prevention programme consists of information on evidence-based risk factors and advices to reduce the injury risk. The primary outcome measure is the number of self-reported RRIs in the time frame between registration for a running event and 1 month after the running event. Secondary outcome measures include the running days missed due to injuries, absence of work or school due to injuries, and the injury location. ETHICS AND DISSEMINATION: An exemption for a comprehensive application is obtained by the Medical Ethical Committee of the Erasmus University Medical Centre Rotterdam, Netherlands. The results of the study will be published in peer-reviewed journals and presented on international congresses. TRIAL REGISTRATION NUMBER: NTR5998. Pre-results.

Reliability and Validity of Ten Consumer Activity Trackers Depend on Walking Speed.

PURPOSE: To examine the test-retest reliability and validity of ten activity trackers for step counting at three different walking speeds. METHODS: Thirty-one healthy participants walked twice on a treadmill for 30 min while wearing 10 activity trackers (Polar Loop, Garmin Vivosmart, Fitbit Charge HR, Apple Watch Sport, Pebble Smartwatch, Samsung Gear S, Misfit Flash, Jawbone Up Move, Flyfit, and Moves). Participants walked three walking speeds for 10 min each; slow (3.2 km·h), average (4.8 km·h), and vigorous (6.4 km·h). To measure test-retest reliability, intraclass correlations (ICC) were determined between the first and second treadmill test. Validity was determined by comparing the trackers with the gold standard (hand counting), using mean differences, mean absolute percentage errors, and ICC. Statistical differences were calculated by paired-sample t tests, Wilcoxon signed-rank tests, and by constructing Bland-Altman plots. RESULTS: Test-retest reliability varied with ICC ranging from -0.02 to 0.97. Validity varied between trackers and different walking speeds with mean differences between the gold standard and activity trackers ranging from 0.0 to 26.4%. Most trackers showed relatively low ICC and broad limits of agreement of the Bland-Altman plots at the different speeds. For the slow walking speed, the Garmin Vivosmart and Fitbit Charge HR showed the most accurate results. The Garmin Vivosmart and Apple Watch Sport demonstrated the best accuracy at an average walking speed. For vigorous walking, the Apple Watch Sport, Pebble Smartwatch, and Samsung Gear S exhibited the most accurate results. CONCLUSION: Test-retest reliability and validity of activity trackers depends on walking speed. In general, consumer activity trackers perform better at an average and vigorous walking speed than at a slower walking speed.