The Exercise Right for Active Ageing Study: Participation in Community-Based Exercise Classes by Older Australians During the COVID-19 Pandemic.

The aim of this study was to determine factors associated with participation of community-dwelling older Australians (≥65 years) in the Exercise Right for Active Ageing program, consisting of 12 low- to moderate-intensity group exercise classes, delivered weekly, in person or online, by accredited exercise scientists and physiologists across Australia. Out of 6,949 participants recruited, 6,626 (95%) attended one or more classes and were included in the primary analysis, and 49% of participants attended all 12 classes. Factors associated with higher class attendance included participation in yoga/flexibility/mobility classes, attendance at a free trial class (adjusted incidence rate ratio [95% confidence interval]: 1.05 [1.03, 1.08]), and attending online classes (1.19 [1.11, 1.26]). Factors associated with lower class attendance included state of residence, living in inner regional areas (0.95 [0.93, 0.98]), and having two or more comorbidities (0.97 [0.95, 0.99]). High class attendance suggests that the Exercise Right for Active Ageing program was well received by older Australians, particularly in states less impacted by COVID-19 lockdowns.

Outcome domains measured in randomized controlled trials of physical activity for older adults: a rapid review.

BACKGROUND: Toward development of a core outcome set for randomized controlled trials (RCTs) of physical activity (PA) interventions for older adults, the purpose of this study was to identify outcome domains and subdomains ('what' was measured) in previously published RCTs of PA for older adults. METHODS: We conducted a rapid review and searched Ovid MEDLINE for recently- published (2015-2021), English-language, RCTs of PA interventions for older adults (mean age 60+ yrs). We limited to articles published in Web of Science top-10 journals in general and internal medicine, geriatrics and gerontology, rehabilitation, and sports science. Two reviewers independently completed eligibility screening; two other reviewers abstracted trial descriptors and study outcomes. We classified study outcomes according to the standard outcome classification taxonomy endorsed by the Core Outcome Measures in Effectiveness Trials Initiative. RESULTS: Our search yielded 548 articles; 67 articles were eligible to be included. Of these, 82% were efficacy/effectiveness trials, 85% included both male and female participants, and 84% recruited community-dwelling older adults. Forty percent of articles reported on interventions that involved a combination of group and individual PAs, and 60% involved a combination of PA modes (e.g., aerobic, resistance). Trial sample size ranged from 14 to 2157 participants, with median (IQR) of 94 (57-517); 28,649 participants were included across all trials. We identified 21 unique outcome domains, spanning 4/5 possible core areas (physiological/clinical; life impact; resource use; adverse events). The five most commonly reported outcome domains were physical functioning (included in n=51 articles), musculoskeletal and connective tissue (n=30), general (n=26), cognitive functioning (n=16), and emotional functioning/wellbeing (n=14). Under these five outcome domains, we further identified 10 unique outcome subdomains (e.g., fall-related; body composition; quality of life). No outcome domains or subdomains were reported consistently in all RCTs. CONCLUSIONS: We found extensive variability in outcome domains and subdomains used in RCTs of PA for older adults, reflecting the broad range of potential health benefits derived from PA and also investigator interest to monitor a range of safety parameters related to adverse events. This study will inform development of a core outcome set to improve outcome reporting consistency and evidence quality.

Impact of the Exercise Right for Active Ageing program on physical function in older adults: a quasi-experimental pre-post study.

BACKGROUND: The Exercise Right for Active Ageing (ERAA) program was established to improve access to exercise classes for community-dwelling older Australians. The aims of this study were to determine whether older adults, who participated in ERAA exercise classes experienced a change in physical function, and identify factors associated with this change. METHODS: Participants included community-dwelling older adults, aged ≥ 65 years, from every state and territory of Australia. The ERAA program included 12 subsidised, weekly, low- to moderate-intensity exercise classes, delivered by accredited exercise scientists or physiologists (AESs/AEPs). Primary outcomes included the 30 s Sit-to-Stand (STS) and the 3-metre Timed Up and Go (TUG) tests. Secondary outcomes included grip strength, the Chair Sit and Reach test, and waist circumference. Linear mixed-effects regression models were used to evaluate the change in outcomes following program completion, and to determine factors associated with changes in the primary outcomes. RESULTS: 3,582 older adults (77% female) with a median (IQR) age of 72 (69-77) years completed follow-up testing. For all primary and secondary outcomes, there was a statistically significant improvement after program completion (p < 0.001). The STS increased by 2.2 repetitions (95% CI: 2.1, 2.3), the TUG decreased by 0.9 s (95% CI: -1.0, -0.8), right and left grip strength increased by 1.3 kg (95% CI: 1.2, 1.5) and 1.5 kg (95% CI: 1.3, 1.6), respectively, right and left reach increased by 1.7 cm (95% CI: 1.4, 2.0), and waist circumference decreased by 1.2 cm (95% CI: -1.4, -1.1). Greater improvements in STS were observed for participants aged 65-69 years, females, and those with greater socio-economic disadvantage. For the TUG, greater improvements were observed in participants reporting 2 + comorbidities, and residing in outer regional areas and areas with greater socio-economic disadvantage. CONCLUSIONS: Participation of older Australians in the ERAA program, led to statistically significant improvements in physical function. The program reached a large number of older Australians from every state and territory, including those from regional and remote parts of Australia, aged over 85 years, and with high levels of comorbidity, which supports the feasibility and acceptability of AES- and AEP-led exercise classes amongst community-dwelling older Australians. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN12623000483651). Registered 12 May 2023 - Retrospectively registered, https://www.anzctr.org.au/ACTRN12623000483651.aspx .

Barriers and facilitators to implementing self-directed therapy activities in inpatient rehabilitation settings.

BACKGROUND: Self-directed therapy activities are not currently part of routine care during inpatient rehabilitation. Understanding patient and clinician perspectives on self-directed therapy is key to increasing implementation. The aim of this study was to investigate barriers and facilitators to implementing a self-directed therapy programme ("My Therapy") in adult inpatient rehabilitation settings. METHODS: My Therapy was recommended by physiotherapists and occupational therapists and completed by rehabilitation inpatients independently, outside of supervised therapy sessions. Physiotherapists, occupational therapists, and patients were invited to complete an online questionnaire comprising open-ended questions on barriers and facilitators to prescribing and participating in My Therapy. A directed content analysis of free-text responses was undertaken, with data coded using categories of the Capability, Opportunity, and Motivation Model of Behaviour (COM-B model). RESULTS: Eleven patients and 20 clinicians completed the questionnaire. Patient capability was reported to be facilitated by comprehensive education by clinicians, with mixed attitudes towards the format of the programme booklet. Clinician capability was facilitated by staff collaboration. One benefit was the better use of downtime between the supervised therapy sessions, but opportunities for patients to engage in self-directed therapy were compromised by the lack of space to complete the programme. Clinician opportunity was reported to be provided via organisational support but workload was a reported barrier. Patient motivation to engage in self-directed therapy was reported to be fostered by feeling empowered, engaged, and encouraged to participate. Clinician motivation was associated with belief in the value of the programme. CONCLUSION: Despite some barriers to rehabilitation patients independently practicing therapeutic exercises and activities outside of supervised sessions, both clinicians and patients agreed it should be considered as routine practice. To do this, patient time, ward space, and staff collaboration are required. Further research is needed to scale-up the implementation of the My Therapy programme and evaluate its effectiveness.

Perceptions of an Interactive Trauma Recovery Information Booklet.

BACKGROUND: Previous research has shown that people with traumatic injuries have unmet information needs with respect to their injuries, management, and recovery. An interactive trauma recovery information booklet was developed and implemented to address these information needs at a major trauma center in Victoria, Australia. OBJECTIVE: The aim of this quality improvement project was to explore patient and clinician perceptions of a recovery information booklet introduced into a trauma ward. METHODS: Semistructured interviews with trauma patients, family members, and health professionals were undertaken and thematically analyzed using a framework approach. In total, 34 patients, 10 family members, and 26 health professionals were interviewed. RESULTS: Overall, the booklet was well accepted by most participants and was perceived to contain useful information. The design, content, pictures, and readability were all positively appraised. Many participants used the booklet to record personalized information and to ask health professionals questions about their injuries and management. CONCLUSION: Our findings highlight the usefulness and acceptability of a low-cost interactive booklet intervention to facilitate the provision of quality of information and patient-health professional interactions on a trauma ward.

Chronic Physical Health Conditions After Injury: A Comparison of Prevalence and Risk in People With Orthopedic Major Trauma and Other Types of Injury.

OBJECTIVES: To determine (1) the prevalence of chronic physical health conditions reported preinjury, at the time of injury, up to 1 year postinjury, and 1 to 5 years postinjury; and (2) the risk of chronic physical health conditions reported 1 to 5 years postinjury in people with orthopedic and other types of major trauma. DESIGN: Cohort study using linked trauma registry and health administrative datasets. SETTING: This study used linked data from the Victorian State Trauma Registry (VSTR), the Victorian Registry of Births, Deaths and Marriages (BDM), the Victorian Admitted Episodes Dataset (VAED), and the Victorian Emergency Minimum Dataset (VEMD). PARTICIPANTS: Major trauma patients (N=28,522) aged 18 years and older who were registered by the VSTR, with dates of injury from 2007 to 2016, and who survived to at least 1 year after injury, were included in this study. Major trauma cases were classified into 4 groups: (1) orthopedic injury, (2) severe traumatic brain injury (s-TBI), (3) spinal cord injury, and (4) other major trauma. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Prevalence of chronic physical health conditions. RESULTS: The cumulative prevalence of any chronic physical health condition for all participants was 69.3%. The s-TBI group had the highest cumulative prevalence of conditions. The most common conditions were arthritis and arthropathies, cancer, and cardiovascular diseases. Preinjury chronic conditions were most common in people with s-TBI (19.3%) and were least common in people with other types of major trauma (6.6%). The highest prevalence of new-onset conditions after injury was found in people with s-TBI (21.7%) and orthopedic major trauma (21.4%), whereas the lowest prevalence was found in people with other types of major trauma (9.2%). For the orthopedic injury group, there were no significant differences in the adjusted risk of conditions reported 1 to 5 years postinjury compared with other major trauma groups. CONCLUSIONS: Chronic physical health conditions were common among all injury groups. There was no significant difference in the risk of chronic conditions among injury groups. Rehabilitation practitioners should be aware of the risk of chronic conditions in people with orthopedic and other types of major trauma. Long-term follow-up care after injury should include prevention and treatment of chronic conditions.

Adherence to Exercise Programs in Community-Dwelling Older Adults Postdischarge for Hip Fracture: A Systematic Review and Meta-analysis.

OBJECTIVE: To determine whether older adults adhere to exercise programs after discharge for hip fracture and how adherence relates to exercise program characteristics and intervention efficacy. DATA SOURCES: Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, Embase, Physiotherapy Evidence Database, Web of Science, SPORTDiscus, PsycINFO, PubMed, and Ovid MEDLINE were searched from inception to August 2020. STUDY SELECTION: Randomized controlled trials of exercise interventions in adults older than 60 years with a surgically managed hip fracture that provided a measure of adherence were selected by 2 independent reviewers. DATA EXTRACTION: Data were extracted independently by 1 reviewer and cross-checked by a second reviewer for accuracy. Risk of bias was assessed with 2 tools: a customized checklist was used to examine sources of bias and ambiguity for adherence data, and the Cochrane Risk of Bias tool was used to assess the interval validity of studies. DATA SYNTHESIS: Seventeen trials with 1850 participants (mean age, 78.8 years) were included in the review. The pooled estimate of adherence to exercise programs post hip fracture was 0.88 (95% CI, 0.78-0.95). Programs that were more than 6 months in duration were associated with a decrease in adherence (odds ratio, 0.29; 95% CI, 0.11-0.77). However, increased adherence was not associated with improvements in functional outcomes. None of the other program characteristics were associated with improvements in functional outcomes. CONCLUSIONS: Adherence to exercise programs after hip fracture appears to be high and may be related to program duration. However, there is a need for a standardized approach to measure and report adherence data in future studies to determine whether exercise adherence is associated with improvements in function for this population.

Can a new ward environment and intensive allied health staffing model enhance therapeutic opportunities in trauma care? A behavioural mapping study of patients' activities and interactions.

OBJECTIVE: The aim of this study was to assess changes in patient activities and interactions observed in response to a new trauma ward at a level 1 trauma centre, and subsequently, a new allied health staffing model. DESIGN: Explorative case study using behavioural mapping. SETTING: Level 1 trauma centre in Melbourne, Australia. PARTICIPANTS: Hospitalised trauma patients. MAIN MEASURES: Behavioural mapping of patients' activities and interactions was conducted by two observers over three 4-day observation phases: (i) at baseline, (ii) on the new ward and (iii) with the new staffing model. Changes in activities and interactions were assessed via negative binomial regression models and reported as incident rate ratios. RESULTS: In total, 1264 patient observations were recorded over an 18-month period. After moving to the new ward, patients were observed performing activities of daily living at a 2.1-fold higher rate than at baseline (95% confidence interval: 1.18, 3.81) but walking/standing/climbing stairs 54% less (95% confidence interval: 0.22, 0.94). Subsequent to the new staffing model, patients were observed in the gym at a 4.1-fold higher rate (95% confidence interval: 1.60, 10.32) and interacting with allied health professionals at a 9.1-fold higher rate (95% confidence interval: 4.88, 16.98), than at baseline. After COVID-19 restrictions were introduced, patients were observed lying down 22% more (95% confidence interval: 1.04, 1.43), with 73% fewer visitor interactions (95% confidence interval: 0.17, 0.43). CONCLUSIONS: Greater engagement in physical and social activities was observed following the implementation of the new allied health staffing model at a level 1 trauma centre. Whether these changes translate to improved trauma outcomes is important to investigate.

Nursing perspectives on reducing sedentary behaviour in sub-acute hospital settings: A mixed methods study.

AIM AND OBJECTIVES: To determine the factors influencing nurses' decisions and capacity to reduce sedentary behaviour in hospital inpatients in sub-acute hospital settings. BACKGROUND: Sedentary behaviour in hospital inpatients is a complex issue that can be resistant to resolution. There is little research investigating factors influencing nurses' promotion of reduced levels of sedentary behaviour in sub-acute hospital settings. DESIGN: An explanatory sequential design was employed, comprising quantitative and qualitative phases. METHODS: An online survey was conducted with a convenience sample of 138 nurses from five Australian states. Logistic regression modelling identified demographic and behavioural characteristics of nurses who often encouraged patients to reduce their sedentary behaviour. In-depth interviews were conducted with 11 ward nurses and nurse managers, with the content subjected to thematic analysis. STROBE and GRAMMS checklists were employed. RESULTS: Nurses recognised their role in promoting reduced sedentary behaviour but faced a range of personal and organisational barriers in achieving this outcome for patients. Few nurses were aware of national physical activity and sedentary behaviour guidelines. Five themes emerged from interviews (nursing role, care challenges, expectations of advocates, teamwork and improving the experience). Overall, many nurses experienced a lack of agency in promoting reduced sedentary behaviour and cognitive dissonance in feeling unable to undertake this role. CONCLUSIONS: The results of this study are significant in confirming that reducing sedentary behaviour in hospital inpatients is influenced by a range of complex and multi-level factors. There is a fundamental need for organisational and clinical leadership in building a culture and climate in which staff feel empowered to promote reduced sedentary behaviour in their patients. RELEVANCE TO CLINICAL PRACTICE: The results of this study highlight the importance of taking action to reduce sedentary behaviour in sub-acute hospital settings. A co-design approach to developing interventions in local health services is warranted.

Levels of Physical Activity and Sedentary Behavior During and After Hospitalization: A Systematic Review.

OBJECTIVES: To systematically review and synthesize the evidence on physical activity and sedentary behavior during and after hospitalization. DATA SOURCES: Electronic databases and reference lists of relevant articles were searched from 2000 to April 2020. STUDY SELECTION: Studies which continuously monitored physical activity and/or sedentary behavior in hospitalized adults across 2 settings (ie, without a break in measurement between settings). Monitoring could occur from an acute to a subacute or rehabilitation hospital setting, an acute setting to home, or from a subacute or rehabilitation setting to home. DATE EXTRACTION: Data extraction and methodological quality assessments were independently performed by 2 reviewers using standardized checklists. DATA SYNTHESIS: A total of 15 of the 5579 studies identified were included. The studies were composed of heterogenous patient populations. All studies monitored patients with either an accelerometer and/or pedometer and reported a variety of measures, including steps per day, sedentary time, and activity counts. The majority of studies (12 of 15) showed that patients engaged in 1.3 to 5.9 times more physical activity and up to 67% less daily sedentary behavior at home after discharge from acute or subacute settings. CONCLUSIONS: Patients engaged in more physical activity and less sedentary behavior at home compared to both the acute and subacute hospital settings. This may reflect the natural course of recovery or the effect of setting on activity levels. Enabling early discharge home through the implementation of home-hospitalization models may result in increased patient physical activity and reduced sedentary behavior. Further experimental studies are required investigating the effect of home-based models of care on physical activity and sedentary behavior.

Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation ('My Therapy'): protocol for a mixed-methods process evaluation.

BACKGROUND: Process evaluations have been recommended alongside clinical and economic evaluations to enable an in-depth understanding of factors impacting results. My Therapy is a self-management program designed to augment usual care inpatient rehabilitation through the provision of additional occupational therapy and physiotherapy exercises and activities, for the patient to complete outside of supervised therapy. The aims of the process evaluation are to assess the implementation process by investigating fidelity, quality of implementation, acceptability, adoption, appropriateness, feasibility and adaptation of the My Therapy intervention; and identify contextual factors associated with variations in outcomes, including the perspectives and experiences of patients and therapists. METHODS: The process evaluation will be conducted alongside the clinical and economic evaluation of My Therapy, within eight rehabilitation wards across two public and two private Australian health networks. All participants of the stepped wedge cluster randomised trial (2,160 rehabilitation patients) will be included in the process evaluation (e.g., ward audit); with a subset of 120 participants undergoing more intensive evaluation (e.g., surveys and activity logs). In addition, 24 staff (occupational therapists and physiotherapists) from participating wards will participate in the process evaluation. The mixed-methods study design will adopt a range of quantitative and qualitative research approaches. Data will be collected via a service profile survey and audits of clinical practice across the participating wards (considering areas such as staffing profiles and prescription of self-management programs). The intensive patient participant data collection will involve structured therapy participation and self-management program audits, Exercise Self Efficacy Scale, patient activity logs, patient surveys, and patient-worn activity monitors. Staff data collection will include surveys and focus groups. DISCUSSION: The process evaluation will provide context to the clinical and economic outcomes associated with the My Therapy clinical trial. It considers how clinical and economic outcomes were achieved, and how to sustain the outcomes within the participating health networks. It will also provide context to inform future scaling of My Therapy to other health networks, and influence future models of rehabilitation and related policy. TRIAL REGISTRATION: This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621000313831; registered 22/03/2021, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380828&isReview=true ).

Self-managed occupational therapy and physiotherapy for adults receiving inpatient rehabilitation ('My Therapy'): protocol for a stepped-wedge cluster randomised trial.

BACKGROUND: Ensuring patients receive an effective dose of therapeutic exercises and activities is a significant challenge for inpatient rehabilitation. My Therapy is a self-management program which encourages independent practice of occupational therapy and physiotherapy exercises and activities, outside of supervised therapy sessions. METHODS: This implementation trial aims to determine both the clinical effectiveness of My Therapy on the outcomes of function and health-related quality of life, and cost-effectiveness per minimal clinically important difference (MCID) in functional independence achieved and per quality adjusted life year (QALY) gained, compared to usual care. Using a stepped-wedge cluster randomised design, My Therapy will be implemented across eight rehabilitation wards (inpatient and home-based) within two public and two private Australian health networks, over 54-weeks. We will include 2,160 patients aged 18 + years receiving rehabilitation for any diagnosis. Each ward will transition from the usual care condition (control group receiving usual care) to the experimental condition (intervention group receiving My Therapy in addition to usual care) sequentially at six-week intervals. The primary clinical outcome is achievement of a MCID in the Functional Independence Measure (FIM™) at discharge. Secondary outcomes include improvement in quality of life (EQ-5D-5L) at discharge, length of stay, 30-day re-admissions, discharge accommodation, follow-up rehabilitation services and adverse events (falls). The economic outcomes are the cost-effectiveness per MCID in functional independence (FIM™) achieved and per QALY gained, for My Therapy compared to usual care, from a health-care sector perspective. Cost of implementation will also be reported. Clinical outcomes will be analysed via mixed-effects linear or logistic regression models, and economic outcomes will be analysed via incremental cost-effectiveness ratios. DISCUSSION: The My Therapy implementation trial will determine the effect of adding self-management within inpatient rehabilitation care. The results may influence health service models of rehabilitation including recommendations for systemic change to the inpatient rehabilitation model of care to include self-management. Findings have the potential to improve patient function and quality of life, and the ability to participate in self-management. Potential health service benefits include reduced hospital length of stay, improved access to rehabilitation and reduced health service costs. TRIAL REGISTRATION: This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621000313831; registered 22/03/2021, http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380828&isReview=true ).

Physical Activity and Sedentary Behavior Subsequent to Serious Orthopedic Injury: A Systematic Review.

OBJECTIVE: To systematically review and synthesize the evidence on physical activity and sedentary behavior after serious orthopedic injury. DATA SOURCES: Eight electronic databases and reference lists of relevant articles were searched from inception to March 2016. STUDY SELECTION: Studies on physical activity and sedentary behavior measured objectively or via self-report among patients with a serious orthopedic injury (acute bone or soft tissue injury requiring emergency hospital admission and/or nonelective surgery) were included. DATA EXTRACTION: Data extraction and methodological quality assessment were independently performed by 2 reviewers using standardized checklists. DATA SYNTHESIS: Twelve of 2572 studies were included: 8 were on hip fractures and 4 on other orthopedic injuries. Follow-up ranged from 4 days to 2 years postinjury. When measured objectively, physical activity levels were low at all time points postinjury, with individuals with hip fracture achieving only 1% of recommended physical activity levels 7 months postinjury. Studies using objective measures also showed patients to be highly sedentary throughout all stages of recovery, spending 76% to 99% of the day sitting or reclining. For studies using self-report measures, no consistent trends were observed in postinjury physical activity or sedentary behavior. CONCLUSIONS: For studies using objective measures, low physical activity levels and high levels of sedentary behaviors were found consistently after injury. More research is needed not only on the impact of immobility on long-term orthopedic injury outcomes and the risk of chronic disease, but also the potential for increasing physical activity and reducing sedentary behavior in this population.

Comparing ICD-10 external cause codes for pedal cyclists with self-reported crash details.

Accurate coding of injury event information is critical in developing targeted injury prevention strategies. However, little is known about the validity of the most universally used coding system, the International Classification of Diseases (ICD-10), in characterising crash counterparts in pedal cycling events. This study aimed to determine the agreement between hospital-coded ICD-10-AM (Australian modification) external cause codes with self-reported crash characteristics in a sample of pedal cyclists admitted to hospital following bicycle crashes. Interview responses from 141 injured cyclists were mapped to a single ICD-10-AM external cause code for comparison with ICD-10-AM external cause codes from hospital administrative data. The percentage of agreement was 77.3% with a κ value of 0.68 (95% CI 0.61 to 0.77), indicating substantial agreement. Nevertheless, studies reliant on ICD-10 codes from administrative data should consider the 23% level of disagreement when characterising crash counterparts in cycling crashes.

Medical-attention injuries in community Australian football: a review of 30 years of surveillance data from treatment sources.

OBJECTIVE: In recent reports, Australian football has outranked other team sports in the frequency of hospitalizations and emergency department (ED) presentations. Understanding the profile of these and other "medical-attention" injuries is vital for developing preventive strategies that can reduce health costs. The objective of this review was to describe the frequency and profile of Australian football injuries presenting for medical attention. DATA SOURCES: A systematic search was carried out to identify peer-reviewed articles and reports presenting original data about Australian football injuries from treatment sources (hospitals, EDs, and health-care clinics). Data extracted included injury frequency and rate, body region, and nature and mechanism of injury. MAIN RESULTS: Following literature search and review, 12 publications were included. In most studies, Australian football contributed the greatest number of injuries out of any sport or recreation activity. Hospitals and EDs reported a higher proportion of upper limb than lower limb injuries, whereas the opposite was true for sports medicine clinics. In hospitals, fractures and dislocations were most prevalent out of all injuries. In EDs and clinics, sprains/strains were most common in adults and superficial injuries were predominant in children. Most injuries resulted from contact with other players or falling. CONCLUSIONS: The upper limb was the most commonly injured body region for Australian football presentations to hospitals and EDs. Strategies to prevent upper limb injuries could reduce associated public health costs. However, to understand the full extent of the injury problem in football, treatment source surveillance systems should be supplemented with other datasets, including community club-based collections.

Injury reporting via SMS text messaging in community sport.

BACKGROUND: The use of text messaging or short message service (SMS) for injury reporting is a recent innovation in sport and has not yet been trialled at the community level. Considering the lack of personnel and resources in community sport, SMS may represent a viable option for ongoing injury surveillance. The aim of this study was to evaluate the feasibility of injury self-reporting via SMS in community Australian football. METHODS: A total of 4 clubs were randomly selected from a possible 22 men's community Australian football clubs. Consenting players received an SMS after each football round game asking whether they had been injured in the preceding week. Outcome variables included the number of SMS-reported injuries, players' response rates and response time. Poisson regression was used to evaluate any change in response rate over the season and the association between response rate and the number of reported injuries. RESULTS: The sample of 139 football players reported 167 injuries via SMS over the course of the season. The total response rate ranged from 90% to 98%. Of those participants who replied on the same day, 47% replied within 5 min. The number of reported injuries decreased as the season progressed but this was not significantly associated with a change in the response rate. CONCLUSIONS: The number of injuries reported via SMS was consistent with previous studies in community Australian football. Injury reporting via SMS yielded a high response rate and fast response time and should be considered a viable injury reporting method for community sports settings.

Coding OSICS sports injury diagnoses in epidemiological studies: does the background of the coder matter?

OBJECTIVE: To compare Orchard Sports Injury Classification System (OSICS-10) sports medicine diagnoses assigned by a clinical and non-clinical coder. DESIGN: Assessment of intercoder agreement. SETTING: Community Australian football. PARTICIPANTS: 1082 standardised injury surveillance records. MAIN OUTCOME MEASUREMENTS: Direct comparison of the four-character hierarchical OSICS-10 codes assigned by two independent coders (a sports physician and an epidemiologist). Adjudication by a third coder (biomechanist). RESULTS: The coders agreed on the first character 95% of the time and on the first two characters 86% of the time. They assigned the same four-digit OSICS-10 code for only 46% of the 1082 injuries. The majority of disagreements occurred for the third character; 85% were because one coder assigned a non-specific 'X' code. The sports physician code was deemed correct in 53% of cases and the epidemiologist in 44%. Reasons for disagreement included the physician not using all of the collected information and the epidemiologist lacking specific anatomical knowledge. CONCLUSIONS: Sports injury research requires accurate identification and classification of specific injuries and this study found an overall high level of agreement in coding according to OSICS-10. The fact that the majority of the disagreements occurred for the third OSICS character highlights the fact that increasing complexity and diagnostic specificity in injury coding can result in a loss of reliability and demands a high level of anatomical knowledge. Injury report form details need to reflect this level of complexity and data management teams need to include a broad range of expertise.

Effect of a novel movement strategy in decreasing ACL risk factors in female adolescent soccer players: a randomized controlled trial.

OBJECTIVE: To determine the effect of a novel movement strategy incorporated within a soccer warm-up on biomechanical risk factors for anterior cruciate ligament injury during 3 sport-specific movement tasks. DESIGN: Single-blind, randomized controlled clinical trial. SETTING: Laboratory setting. PARTICIPANTS: Twenty top-tier female teenage soccer players. INTERVENTIONS: Subjects were randomized to the Core Position and Control movement strategy (Core-PAC) warm-up or standard warm-up, which took place before their regular soccer practice over a 6-week period. The Core-PAC focuses on getting the centre of mass closer to the plant foot or base of support. MAIN OUTCOME MEASURES: Peak knee flexion angle and abduction moments during a side-hop (SH), side-cut, and unanticipated side-cut task after the 6 weeks with (intervention group only) and without a reminder to use the Core-PAC strategy. RESULTS: The Core-PAC group increased peak flexion angles during the SH task [mean difference = 6.2 degrees; 95% confidence interval (CI), 1.9-10.5 degrees; effect size = 1.01; P = 0.034] after the 6-week warm-up program without a reminder. In addition, the Core-PAC group demonstrated increased knee flexion angles for the side-cut (mean difference = 8.5 degrees; 95% CI, 4.8-12.2 degrees; ES = 2.02; P = 0.001) and SH (mean difference = 10.0 degrees; 95% CI, 5.7-14.3 degrees; ES = 1.66; P = 0.001) task after a reminder. No changes in abduction moments were found. CONCLUSIONS: The results of this study suggest that the Core-PAC may be one method of modifying high-risk soccer-specific movements and can be implemented within a practical, team-based soccer warm-up. The results should be interpreted with caution because of the small sample size.