Groin injuries in women's premier league football in Norway: A two-season prospective cohort study describing clinical and imaging characteristics.

OBJECTIVE: To describe the prevalence, incidence, and burden of groin injuries in the Norwegian women's premier football league and to describe their clinical and imaging characteristics. METHODS: During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported groin injuries weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H2). We calculated weekly prevalence, incidence, and burden of groin injuries. The team physical therapists classified the player-reported injuries based on the Doha classification system. Injuries with more than 3 days' time loss or reported in 2 consecutive weeks were eligible for magnetic resonance imaging (MRI). RESULTS: On average, 3.9% (95% CI: 3.4-4.4) of players reported a groin injury at any time; of which 78% caused time loss. The incidence rate was 1.6 injuries/1000 h (95% CI: 1.3-2.0) and their burden was 11 days lost/1000 h. The physical therapists examined 67 of 124 player-reported groin injuries (53%). Adductor-related injury was most common (55%) followed by iliopsoas (15%) and rectus femoris-related (12%). Pubic-related injuries caused most time loss (median: 24 days, IQR: 5-133). In this study, 42 injuries were investigated with MRI; 8 (19%) showed no changes, 6 (14%) an acute musculotendinous lesion, and 32 (76%) a nonacute finding (e.g., central symphyseal disc protrusion, tendinopathies). CONCLUSION: The incidence rate and burden of groin injuries were high. Adductor-related injuries were most common, but pubic-related injuries caused most time loss. Most MRI examinations demonstrated nonacute findings.

#ReadyToPlay: health problems in women's football-a two-season prospective cohort study in the Norwegian premier league.

OBJECTIVES: To describe the prevalence, incidence and burden of all health problems in the Norwegian women's premier league. METHODS: During the 2020 and 2021 seasons, players in the Norwegian women's premier league reported all health problems (sudden-onset injuries, gradual-onset injuries and illnesses) weekly, using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Team medical staff diagnosed reported problems using the Sport Medicine Diagnostic Coding System. We calculated average weekly prevalence, incidence and burden of all health problems reported. RESULTS: We included 294 players (age: 22±4 years) from 11 teams. Response rate to the weekly questionnaire was 79%. On average, 32% (95% CI: 31% to 33%) of the players reported at least one health problem at any time and 22% (95% CI: 21% to 23%) reported a substantial health problem negatively affecting their training volume or performance. The overall incidence was 10.7 health problems per 1000 hours of football exposure. Sudden-onset injuries were most severe (68% of the total time loss), followed by gradual-onset injuries (25%) and illnesses (8%). Thigh was the most common injury location (26%), while knee injuries were most severe, causing 42% of the total injury time loss. Anterior cruciate ligament (ACL) injuries alone caused 30% of the total injury time loss. CONCLUSION: One in five players had a health problem negatively affecting their training volume or performance at any time. Sudden-onset injuries represented the most burdensome health problem. Thigh injuries were most frequent, while knee injuries, ACL injuries especially, were most severe.

Validity of Session Rating of Perceived Exertion for Measuring Training Load in Youth Team Handball Players.

ABSTRACT: Pedersen, A, Randers, MB, Luteberget, LS, and Møller, M. Validity of session rating of perceived exertion for measuring training load in youth team handball players. J Strength Cond Res 37(1): 174-180, 2023-Session rating of perceived exertion (sRPE) is a subjective self-reported measure of training load and is a popular method in several different team sports. This study aimed to investigate the validity of sRPE, by correlating sRPE load (sRPE × minutes of training) and heart rate (HR) expressed as Edwards Summated Heart Rate Zones (SHRZ) and PlayerLoad among Danish youth team handball players. Second, the study aimed to investigate sRPE load's ability to descriptively differentiate between a low and a high training load category. A comparative cross-sectional study was conducted in the in-season period. Fourteen training sessions were measured from 6 teams, in which PlayerLoad, Edwards SHRZ, and sRPE load were measured for the training session and collected from 47 subjects (23 males and 24 females). Pearson's product-moment correlation coefficients were calculated between sRPE load and Edwards SHRZ and PlayerLoad. Furthermore, a high and a low load category were made from PlayerLoad or Edwards SHRZ to investigate sRPE load's ability to discriminate between high and low objective load. Large correlations between sRPE load and Edwards SHRZ (0.52 [95% CI 0.27:0.70]) and between sRPE load and PlayerLoad (0.67 [95% CI 0.47:0.80]) were observed. Our findings further indicate that sRPE load can differentiate between a high and a low training load category in both Edwards SHRZ and PlayerLoad. Our results show that sRPE load reflects both internal and external load during team handball training sessions and seems to discriminate between high- and low-intensity training sessions. These results support the validity of sRPE load for measuring training load in young team handball players.

Dialectical behavioral therapy-based group treatment versus treatment as usual for adults with attention-deficit hyperactivity disorder: a multicenter randomized controlled trial.

BACKGROUND: Studies on structured skills training groups have indicated beneficial, although still inconclusive, effects on core symptoms of ADHD in adults. This trial examined effects of Dialectical Behavioral Therapy-based group treatment (DBT-bGT) on the broader and clinically relevant executive functioning and emotional regulation in adults with ADHD. METHODS: In a multicenter randomized controlled trial, adult patients with ADHD were randomly assigned to receive either weekly DBT-bGT or treatment as usual (TAU) during 14 weeks. Subsequently, participants receiving TAU were offered DBT-bGT. All were reassessed six months after ended DBT-bGT. Primary outcomes were the Behavior Rating Inventory of Executive Function (BRIEF-A) and the Difficulties in Emotion Regulation Scale (DERS). Secondary outcomes included self-reported ADHD-symptoms, depressive and anxiety symptoms, and quality of life. We used independent samples t- tests to compare the mean difference of change from pre- to post-treatment between the two treatment groups, and univariate linear models adjusting for differences between sites. RESULTS: In total, 121 participants (68 females), mean age 37 years, from seven outpatient clinics were included, of whom 104 (86%) completed the 14-week trial. Entering the study, 63% used medication for ADHD. Compared to TAU (n = 54), patients initially completing DBT-bGT (n = 50) had a significantly larger mean reduction on the BRIEF-A (-12.8 versus -0.37, P = 0.005, effect size 0.64), and all secondary outcomes, except for symptoms of anxiety. All significant improvements persisted at 6 months follow-up. Change on DERS did not differ significantly between the groups after 14 weeks, but scores continued to decrease between end of group-treatment and follow-up. CONCLUSIONS: This DBT-bGT was superior to TAU in reducing executive dysfunction, core symptoms of ADHD and in improving quality of life in adults with ADHD. Improvements sustained six months after ended treatment. The feasibility and results of this study provide evidence for this group treatment as a suitable non-pharmacological treatment option for adults with ADHD in ordinary clinical settings. TRIAL REGISTRATIONS: The study was pre-registered in the ISRCTN registry (identification number ISRCTN30469893, date February 19th 2016) and at the ClinicalTrials.gov (ID: NCT02685254, date February 18th 2016).

Methods matter: exploring the 'too much, too soon' theory, part 1: causal questions in sports injury research.

BACKGROUND: It is widely accepted that athletes sustain sports injury if they train 'too much, too soon'. However, not all athletes are built the same; some can tolerate more training than others. It is for this reason that prescribing the same training programme to all athletes to reduce injury risk is not optimal from a coaching perspective. Rather, athletes require individualised training plans. In acknowledgement of athlete diversity, it is therefore essential to ask the right causal research question in studies examining sports injury aetiology. PURPOSE: In this first part of a British Journal of Sports Medicine educational series, we present four different causal research questions related to the 'too much, too soon' theory and critically discuss their relevance to sports injury prevention. CONTENT: If it is true that there is no 'one size fits all' training programme, then we need to consider by how much training can vary depending on individual athlete characteristics. To provide an evidence-base for subgroup-specific recommendations, a stronger emphasis on the following questions is needed: (1) How much training is 'too much' before athletes with different characteristics sustain sports-related injury? and (2) Does the risk of sports injury differ among athletes with a certain characteristic (eg, high experience) compared with athletes with other characteristics (eg, low experience) depending on how much training they perform? CONCLUSION: We recommend that sports injury researchers aiming to examine the 'too much, too soon' theory should carefully consider how they, assisted by coaches, athletes and clinicians, pose their causal research question. In the light of the limitations of population-based prevention that intends to provide all athletes with the same advice, we argue that a stronger emphasis on research questions targeting subgroups of athletes is needed. In doing so, researchers may assist athletes, clinicians and coaches to understand what training advice/programme works best, for whom and under what circumstances.

Improved reporting of overuse injuries and health problems in sport: an update of the Oslo Sport Trauma Research Center questionnaires.

In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses-The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data.

Statement on methods in sport injury research from the 1st METHODS MATTER Meeting, Copenhagen, 2019.

High quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best practice methods-methods matter (greatly!). The 1st METHODS MATTER Meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting.

Estimating Throwing Speed in Handball Using a Wearable Device.

Throwing speed is likely a key determinant of shoulder-specific load. However, it is difficult to estimate the speed of throws in handball in field-based settings with many players due to limitations in current technology. Therefore, the purpose of this study was to develop a novel method to estimate throwing speed in handball using a low-cost accelerometer-based device. Nineteen experienced handball players each performed 25 throws of varying types while we measured the acceleration of the wrist using the accelerometer and the throwing speed using 3D motion capture. Using cross-validation, we developed four prediction models using combinations of the logarithm of the peak total acceleration, sex and throwing type as the predictor and the throwing speed as the outcome. We found that all models were well-calibrated (mean calibration of all models: 0.0 m/s, calibration slope of all models: 1.00) and precise (R2 = 0.71-0.86, mean absolute error = 1.30-1.82 m/s). We conclude that the developed method provides practitioners and researchers with a feasible and cheap method to estimate throwing speed in handball from segments of wrist acceleration signals containing only a single throw.

Time-to-event analysis for sports injury research part 1: time-varying exposures.

BACKGROUND: 'How much change in training load is too much before injury is sustained, among different athletes?' is a key question in sports medicine and sports science. To address this question the investigator/practitioner must analyse exposure variables that change over time, such as change in training load. Very few studies have included time-varying exposures (eg, training load) and time-varying effect-measure modifiers (eg, previous injury, biomechanics, sleep/stress) when studying sports injury aetiology. AIM: To discuss advanced statistical methods suitable for the complex analysis of time-varying exposures such as changes in training load and injury-related outcomes. CONTENT: Time-varying exposures and time-varying effect-measure modifiers can be used in time-to-event models to investigate sport injury aetiology. We address four key-questions (i) Does time-to-event modelling allow change in training load to be included as a time-varying exposure for sport injury development? (ii) Why is time-to-event analysis superior to other analytical concepts when analysing training-load related data that changes status over time? (iii) How can researchers include change in training load in a time-to-event analysis? and, (iv) Are researchers able to include other time-varying variables into time-to-event analyses? We emphasise that cleaning datasets, setting up the data, performing analyses with time-varying variables and interpreting the results is time-consuming, and requires dedication. It may need you to ask for assistance from methodological peers as the analytical approaches presented this paper require specialist knowledge and well-honed statistical skills. CONCLUSION: To increase knowledge about the association between changes in training load and injury, we encourage sports injury researchers to collaborate with statisticians and/or methodological epidemiologists to carefully consider applying time-to-event models to prospective sports injury data. This will ensure appropriate interpretation of time-to-event data.

Time-to-event analysis for sports injury research part 2: time-varying outcomes.

BACKGROUND: Time-to-event modelling is underutilised in sports injury research. Still, sports injury researchers have been encouraged to consider time-to-event analyses as a powerful alternative to other statistical methods. Therefore, it is important to shed light on statistical approaches suitable for analysing training load related key-questions within the sports injury domain. CONTENT: In the present article, we illuminate: (i) the possibilities of including time-varying outcomes in time-to-event analyses, (ii) how to deal with a situation where different types of sports injuries are included in the analyses (ie, competing risks), and (iii) how to deal with the situation where multiple subsequent injuries occur in the same athlete. CONCLUSION: Time-to-event analyses can handle time-varying outcomes, competing risk and multiple subsequent injuries. Although powerful, time-to-event has important requirements: researchers are encouraged to carefully consider prior to any data collection that five injuries per exposure state or transition is needed to avoid conducting statistical analyses on time-to-event data leading to biased results. This requirement becomes particularly difficult to accommodate when a stratified analysis is required as the number of variables increases exponentially for each additional strata included. In future sports injury research, we need stratified analyses if the target of our research is to respond to the question: 'how much change in training load is too much before injury is sustained, among athletes with different characteristics?' Responding to this question using multiple time-varying exposures (and outcomes) requires millions of injuries. This should not be a barrier for future research, but collaborations across borders to collecting the amount of data needed seems to be an important step forward.

First-line managers' experience of the use of audit and feedback cycle in specialist mental health care: A qualitative case study.

BACKGROUND: Audit and feedback was the main strategy to facilitate implementation of The National Guideline for Persons with Concurrent Substance Use Disorders and Mental Disorders in specialist mental health services. Studies have shown that leadership support contributes to implementation success. The aim of the study was to explore how first-line managers in a District Psychiatric Centre experienced using audit and feedback cycle. METHOD: The study had a qualitative case study design with individual interviews with five first-line managers from a District Psychiatric Centre in Norway. Qualitative content analysis was conducted. RESULTS: First-line managers were positive to contribute to better practice for the patient group and apply available tools. Four themes emerged: 1) Lack of endurance, where first-line managers saw their role as being process leaders, but failed to persist, 2) Lack of support in the process, where first-line managers called for a stronger organisational focus 3) Lack of ownership, where first-line managers felt the process was imposed on them, and 4) Lack of leader autonomy, where first-line managers seemed insecure about their role between professional leadership and own management. CONCLUSION: First-line managers were not sufficiently experienced or equipped to solve the implementation process satisfactorily. They were torn between different commitments, without the autonomy to act as process drivers or facilitators, and without taking the necessary leadership role. The potential impact of the use of audit and feedback may thus not be fully realized, in part, because of limited organisational support and capacity to respond effectively.

Screening for viral extraneous agents in live-attenuated avian vaccines by using a microbial microarray and sequencing.

The absence of extraneous agents (EA) in the raw material used for production and in finished products is one of the principal safety elements related to all medicinal products of biological origin, such as live-attenuated vaccines. The aim of this study was to investigate the applicability of the Lawrence Livermore Microbial detection array version 2 (LLMDAv2) combined with whole genome amplification and sequencing for screening for viral EAs in live-attenuated vaccines and specific pathogen-free (SPF) eggs. We detected positive microarray signals for avian endogenous retrovirus EAV-HP and several viruses belonging to the Alpharetrovirus genus in all analyzed vaccines and SPF eggs. We used a microarray probe mapping approach to evaluate the presence of intact retroviral genomes, which in addition to PCR analysis revealed that several of the positive microarray signals were most likely due to cross hybridization with the EAV-HPΔpol and ALV-E ev1, ev3 and ev6 loci sequences originating from the chicken genome. Sequencing of the vaccines on a MiSeq instrument verified the microarray findings and showed similar cross hybridization. Our results suggest that genomic microarrays and sequencing of avian attenuated vaccines may be applied in tests for EA.

Acting on audit & feedback: a qualitative instrumental case study in mental health services in Norway.

BACKGROUND: The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014. METHODS: This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings. RESULTS: The discussions provided health professionals with insight into their own and their colleagues' practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working. CONCLUSION: Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups.

Audit and feedback in mental healthcare: staff experiences.

PURPOSE: Audit and feedback (A&F) often underlie implementation projects, described as a circular process; i.e. an A&F cycle. They are widely used, but effect varies with no apparent explanation. We need to understand how A&F work in real-life situations. The purpose of this paper, therefore, is to describe and explore mental healthcare full A&F cycle experiences. DESIGN/METHODOLOGY/APPROACH: This is a naturalistic qualitative study that uses four focus groups and qualitative content analysis. FINDINGS: Staff accepted the initial A&F stages, perceiving it to enhance awareness and reassure them about good practice. They were willing to participate in the full cycle and implement changes, but experienced poor follow-up and prioritization, not giving them a chance to own to the process. An important finding is the need for an A&F cycle facilitator. PRACTICAL IMPLICATIONS: Research teams cannot be expected to be involved in implementing clinical care. Guidelines will keep being produced to improve service quality and will be expected to be practiced. This study gives insights into planning and tailoring A&F cycles. ORIGINALITY/VALUE: Tools to ease implementation are not enough, and the key seems to lie with facilitating a process using A&F. This study underscores leadership, designated responsibility and facilitation throughout a full audit cycle.

Exploring the interplay of interpersonal and contextual dynamics in youth sports injuries: a comprehensive narrative review.

Injuries are recognised in sports and exercise medicine as not isolated incidents but complex outcomes. This is because an athlete's health trajectory is understood to be shaped by dynamic, complex linkages between individual performance, biology, and the wider social and cultural contexts and systems in which individuals perform. Despite this recognition, little attention has been paid to how interpersonal and contextual dynamics can potentially affect the risk of injury by influencing the choices and decisions made by coaches, parents and athletes. To address this gap, this narrative review bridges insights from sociocultural studies in sports with the findings of sports injury research. The narrative review aims to identify and summarise how interpersonal and contextual dynamics influence the risk of youth sports injuries. The results reveal the pressures faced by athletes, often leading to compromised health. Moreover, the review underscores the importance of designing complex interventions and strategies to promote healthier practices in youth sports. Specifically, intervention programmes should prioritise raising awareness of injury risks, cultivating effective communication skills and fostering supportive training environments.

Popping pills in youth elite sports - fact or fiction? A 36-week prospective cohort study of analgesic use in 1195 youth elite athletes and student controls.

OBJECTIVE: To investigate analgesic use in a cohort of Danish youth elite athletes, and compare weekly analgesic use over 36 weeks to student controls. We also investigated and compared reasons for analgesic use and types of analgesics used. DESIGN: Prospective cohort study. METHODS: 690 youth elite athletes (44% females) and 505 student controls (59% females) (age 15-20 years) provided weekly reports on analgesic use over 36 weeks. We asked about number of days with analgesic use, reasons for use, and types of analgesics used. Prevalence and frequency of analgesic use was compared between youth elite athletes and student controls using mixed effects logistic regression and mixed effects Poisson regression models. Reasons for and types of analgesics used was compared between groups using Chi-square tests. Subgroup analyses were performed, stratified by sex. RESULTS: Overall, athletes had lower odds of analgesic use (OR 0.78, 95% CI 0.64 to 0.95) compared with student controls. The overall usage rate was similar between the groups (IRR 1.04, 95% CI 0.99 to 1.11). Subgroup analyses suggested no statistically significant differences in the odds of analgesic use. Significantly more athletes reported using analgesics to prevent or treat pain or injury in relation to sports participation and to use topical gels compared with student controls. CONCLUSION: Participating in youth elite sports was associated with lower odds of analgesic use compared to student controls, but usage rate was similar between the groups. Reasons for use and types of analgesics use differed between athletes and student controls.