An Investigation Into the Measurement of Injury Severity in Running-Related Injury Research: A Scoping Review.

Understanding injury severity is essential to inform injury prevention practice. The aims of this scoping review were to investigate how running-related injury (RRI) severity is measured, compare how it differs across studies, and examine whether it influences study outcomes (i.e., injury rates and risk factor identification). This scoping review was prospectively registered with Open Science Framework. A systematic electronic search was conducted using PubMed, Scopus, SPORTDiscuss, MEDLINE, and Web of Science databases. Included studies were published in English between January 1980 and December 2023, investigated RRIs in adult running populations, and included a measure of injury severity. Results were extracted and collated. Sixty-six studies were included. Two predominant primary criteria are used to define injury severity: the extent of the effect on running and/or the extent of the physical description. When secondary definition criteria are considered, 13 variations of injury severity measurement are used. Two approaches are used to grade injury severity: a categorization approach or a continuous numerical scale. Overall, the measurement of RRI severity is relatively inconsistent across studies. Less than half of studies report incidence rates per level of injury severity, while none report specific risk factors across levels, making it difficult to determine if the approach to measuring injury severity influences these study outcomes. This lack of information is possibly contributing to inconsistent rates of RRIs reported, and the lack of clarity on risk factors.

Factors associated with concussion management behavior in Ladies Gaelic Football players.

BACKGROUND: Sport-related concussion (SRC) management may be poor in community sports such as Ladies Gaelic Football (LGF). This study examined factors associated with SRC management behavior in adult LGF players. METHODS: Participants (n = 657) answered an online survey on demographic factors, concussion knowledge, attitudes, and education, and SRC management behavior. Data from participants who reported sustaining an LGF-related SRC during the previous year (n = 115) were further analyzed. RESULTS: Being diagnosed with SRC was the main factor influencing subacute management behavior. Players with diagnosed SRCs had increased odds of following a graded return-to-play (RTP) programme (OR = 4.89), following a medically supervised graded RTP programme (OR = 10.16), and being medically cleared before full RTP (OR = 13.45) compared with those with suspected SRCs. Concussion history was associated with increased odds of informing a coach of a possible SRC (OR = 2.86). Demographic factors, previous use of Ladies Gaelic Football Association concussion education resources, and concussion knowledge and attitudes had minimal or no influence on management behaviors. CONCLUSION: Greater access to medical personnel at LGF training and matches is recommended. Due to limited medical resources in community sport, a clear referral pathway for players with SRC and comprehensive SRC education should be introduced to ensure players receive adequate medical care.

Concussion in Ladies Gaelic Football: Self-reported History, Clinical Profiles, and Management Behavior.

OBJECTIVE: To describe the prevalence, characteristics, and management behavior of self-reported sport-related concussion (SRC) in Ladies Gaelic Football (LGF) players. DESIGN: Cross-sectional study. SETTING: Online survey distributed to LGF clubs throughout Ireland. PARTICIPANTS: Elite and nonelite adult LGF players (n = 657). INTERVENTIONS: Participants were recruited by convenience sampling and answered an online survey. Questions on demographic characteristics, SRC history, symptoms, injury characteristics, and management behavior after SRCs that occurred while playing LGF during the previous season were included. MAIN OUTCOME MEASURES: Overall concussion history, occurrence of an SRC during the previous LGF season, clinical profile scores, characteristics (eg mechanism and setting), and management behavior (eg following a graded RTP program) after SRCs that occurred during the previous season. RESULTS: Approximately one-fifth (17.5%) of participants sustained a suspected or diagnosed SRC during the previous season, which was higher among elite (26.1%) than nonelite (15.3%) players ( P < 0.01). The highest scoring clinical profiles were the ocular and migraine profiles. Only 3.5% of respondents adhered to all SRC management recommendations. Although players who reported a medically diagnosed versus a suspected SRC more often followed these guidelines, SRC management beyond the initial phase of injury remained inadequate. CONCLUSION: SRC is common in LGF; however, adherence to recommended management guidelines is poor, even among players who receive medical assistance. In particular, few LGF athletes receive clinical concussion care beyond the initial diagnosis and acute management phase. Further research is needed to examine the underlying reasons for poor SRC management in LGF, which will guide the development of future sport-specific interventions.

Post-injury fear-avoidance and confidence in readiness to return to sport in Irish collegiate athletes.

Fear avoidance and low confidence in their ability to return to sport can impede athletes' subsequent recovery and return to sport. This study aimed to identify fear avoidance and confidence in readiness to return to sport following injury in Irish collegiate athletes. Male (416) and female (256) athletes from 24 field-sport teams at one university were prospectively followed for one season. The Athlete Fear Avoidance Questionnaire (AFAQ) and pain on the Visual Analogue Scale was completed following a time-loss injury. Prior to return to sport, participants completed the AFAQ and the Injury Psychological Readiness to Return to Sport (I-PRRS). We recorded 179 injuries. Fear avoidance was evident post-injury (21.8 ± 6.7), and the mean total I-PRRS score was 48.4 ± 8.9. Those with severe injuries presented with higher fear avoidance and lower confidence. Higher pain was associated with greater fear avoidance following injury (r = 0.32, p < 0.0001), prior to return to sport (r = 0.38, p < 0.0001), and with lower confidence (r = -0.27, p < 0.0001).   Low confidence and fear avoidance was identified, particularly in those with a severe injury or high pain levels. Identifying, and providing psychosocial support to athletes experiencing, these issues is recommended.

The Effect of Hip Extension and Nordic Hamstring Exercise Protocols on Hamstring Strength: A Randomized Controlled Trial.

ABSTRACT: Whyte, EF, Heneghan, B, Feely, K, Moran, KA, and O'Connor, S. The effect of hip extension and Nordic hamstring exercise protocols on hamstring strength: A randomized controlled trial. J Strength Cond Res 35(10): 2682-2689, 2021-Lower and between-limb asymmetrical eccentric hamstring isokinetic strength may be associated with hamstring injuries, which mainly affect the biceps femoris. The 45° hip extension exercise (HEE) strengthens the hamstrings in the lengthened position where the biceps femoris experiences greatest loading during high-speed running. However, the effect of an HEE program on eccentric hamstring isokinetic strength has not been investigated or compared with the Nordic Hamstring Exercise (NHE) program. Twenty-four male, varsity, Gaelic footballers (22.4 ± 2.7 years; 182.1 ± 6.0 cm; 84.4 ± 7.9 kg) were randomly allocated to an HEE or NHE 4-week program. Isokinetic (60°·s-1) eccentric peak torque, functional hamstring-to-quadriceps ratio, and between-limb eccentric strength (absolute and percentage) asymmetries were recorded before and after intervention. Muscle soreness scores were reported after exercise using a visual analogue scale. A mixed between-within analysis of variance investigated group (HEE vs. NHE) by time (pre vs. post) interaction effects, and any main effects. An independent-samples t-test compared muscle soreness scores between the NHE and HEE groups. No interaction or group main effects were found. Main effects for time were observed on dominant and nondominant limbs for eccentric peak torque (p < 0.001, η2 = 0.21, p = 0.01, η2 = 0.51, respectively) and functional hamstring quadriceps ratio (p = 0.03, η2 = 0.59, p < 0.0001, η2 = 0.26, respectively). There were no main effects for time between-limb eccentric peak torque or percentage asymmetries (p = 0.41, η2 = 0.03, p = 0.20, η2 = 0.07, respectively), or differences in muscle soreness scores (p > 0.05). A 4-week HEE program increases eccentric hamstring isokinetic strength similar to a NHE program, which may be useful as part of a hamstring injury prevention program.

Reliability of a Smartphone Goniometric Application in the Measurement of Hip Range of Motion Among Experienced and Novice Clinicians.

CONTEXT: Deficits in the hip range of motion are associated with hip and groin injuries. Accurate and reliable goniometric measurements are important in identifying those at risk of injury and determining the efficacy of treatment interventions. Smartphone goniometric applications are regularly used to assess joint ranges of motion; however, there is limited knowledge on the reliability of this method in relation to the hip, particularly between clinicians with different levels of experience. OBJECTIVE: To determine the intratester and intertester reliability of a smartphone clinometer application for the assessment of hip goniometric measurements in healthy volunteers by an experienced and novice clinician. DESIGN: Reliability study. SETTING: University Athletic Therapy facility. PARTICIPANTS: Physically active, university students. MAIN OUTCOME MEASURES: The study determined the intra- and intertester (experienced vs novice clinician) reliability of goniometric measurements of the hip joint (modified Thomas test and seated hip internal and external rotation) using a smartphone goniometric application. Intraclass correlation coefficients (ICCs), standard error of measurement, and minimal detectable change at a 95% confidence interval were used to assess reliability. RESULTS: Goniometric measurements demonstrated good to excellent relative intratester reliability for the modified Thomas test (ICC = .94), external rotation (ICC = .93-.95), and internal rotation (ICC = .80-.81). Intertester reliability for expert and novice clinicians was also excellent for the modified Thomas test (ICC = .98), external rotation (ICC = .95), and internal rotation (ICC = .92). Intratester and intertester standard error of measurement and minimal detectable change at 95% confidence interval values were similar for both testers and ranged from 1.9° to 3.6° and 5° to 10.1° and from 1.1° to 2.3° and 2.9° to 6.5°, respectively. CONCLUSION: Smartphone-based goniometric measurements of hip range of motion have high intratester and intertester reliability for novice and expert clinicians. It may be a useful, simple, and inexpensive resource for clinicians.

Can a Standardized Visual Assessment of Squatting Technique and Core Stability Predict Injury?

O'Connor, S, McCaffrey, N, Whyte, EF, and Moran, KA. Can a standardized visual assessment of squatting technique and core stability predict injury? J Strength Cond Res 34(1): 26-36, 2020-This study examined whether a standardized visual assessment of squatting technique and core stability can predict injury. Male adolescent and collegiate Gaelic players (n = 627) were assessed using the alternative core/trunk stability push-up test and a developed scoring system for the overhead squat and single-leg squat (SLS) that examined both overall impression and segmental criteria. A single summative score from the overall impression scores of all 3 tests was calculated. Sustained injuries were examined over a season. Results indicated that the single summative score did not predict those that sustained a lower-extremity injury, trunk injury, or whole-body injury, and receiver operating characteristic curves were also unable to generate an optimal cutoff point for prediction. When segmental criteria were included in multivariate analyses, the tests were able to predict whole-body injury (p < 0.0001) and lower-extremity injury (p < 0.0001). However, although specificity was high (80.6%, 76.5%), sensitivity of the models was low (40.2%, 44.2%). The most common score was "good" for the overhead squat (46.4%) and SLS (47.6%), and "good" and "excellent" for the alternative core stability push-up test (33.5%, 49.1%), with "poor" core stability increasing the odds of sustaining a lower-extremity injury (odds ratio = 1.52 [0.92-2.51]). The findings suggest that although segmental scoring could be incorporated by strength and conditioning coaches and clinicians, they should be used predominantly as a preliminary screening tool to highlight players requiring a more thorough assessment.

Injuries in Collegiate Ladies Gaelic Footballers: A 2-Season Prospective Cohort Study.

CONTEXT: Although Ladies Gaelic football is one of the most popular female sports in Ireland, just 2 previous injury surveillance studies have been completed, and both were retrospective in nature. OBJECTIVE: To prospectively examine the injury incidence and injury profile in collegiate Ladies Gaelic football over 2 seasons. DESIGN: Prospective cohort study. SETTING: College. Patients (or Other Participants): Adult Ladies Gaelic footballers from one collegiate institution (season 1: n = 50, season 2: n = 82). INTERVENTION(S): All time-loss injuries that occurred were recorded by certified athletic therapists and student-athletic therapists and trainers over 2 seasons. MAIN OUTCOME MEASURES: A standardized injury report form was used to record the injury onset, mechanism, location, nature, and outcome. Injury incidence proportion, repeat incidence proportion and total, match and training injury rates, and their 95% confidence intervals were calculated. The frequencies and proportions were also calculated. RESULTS: The match and training injury rates were 42.48 and 7.93 injuries per 1000 hours, respectively. A low repeat incidence proportion per season was noted (11.7% and 0.0%). The injuries were predominantly acute (74.68%) and noncontact (66.25%), with hamstring injuries (21.52%) and strains (36.71%) the most frequent location and nature of injuries noted. Strains (104.92 d absent per 1000 h) and knee injuries (106.46 d absent per 1000 h) led to the greatest injury burden. Further investigations were not frequently required, with an X-ray and magnetic resonance imaging ordered in 8.00% and 6.67% of the cases, respectively. Surgery was completed following one injury. CONCLUSIONS: This is the first study to provide prospective injury data on Ladies Gaelic football. Priority needs to be given to preventing hamstring and knee injuries due to their occurrence and negative impact on player availability to play. Collegiate Ladies Gaelic football teams should be encouraged to implement an injury-prevention warm-up, such as the GAA15+, at training and matches.

Is Poor Hamstring Flexibility a Risk Factor for Hamstring Injury in Gaelic Games?

CONTEXT: Hamstring injuries are a leading cause of injury in Gaelic games. Hamstring flexibility as a risk factor for hamstring injury has not yet been examined prospectively in Gaelic games. OBJECTIVE: To examine whether hamstring flexibility, using the modified active knee extension (AKE) test, and previous injury are risk factors for hamstring injury in Gaelic players and to generate population-specific AKE cutoff points. DESIGN: Prospective cohort study. SETTING: School and colleges. Patients (or Other Participants): Adolescent and collegiate Gaelic footballers and hurlers (n = 570). INTERVENTION(S): The modified AKE test was completed at preseason, and hamstring injuries were assessed over the course of one season. Any previous hamstring injuries were noted in those who presented with a hamstring injury. MAIN OUTCOME MEASURES: Bilateral AKE scores and between-leg asymmetries were recorded. Receiver operating characteristic curves were implemented to generate cutoff points specific to Gaelic players. Univariate and backward stepwise logistic regression analyses were completed to predict hamstring injuries, hamstring injuries on the dominant leg, and hamstring injuries on the nondominant leg. RESULTS: Mean flexibility of 64.2° (12.3°) and 64.1° (12.4°) was noted on the dominant and nondominant leg, respectively. Receiver operating characteristic curves generated a cutoff point of < 65° in the AKE on the nondominant leg only. When controlled for age, AKE on the nondominant leg was the only predictor variable left in the multivariate model (odds ratio = 1.03) and significantly predicted hamstring injury (χ2 = 9.20, P = .01). However, the sensitivity was 0% and predicted the same amount of cases as the null model. It was not possible to generate a significant model for hamstring injuries on the dominant leg (P > .05), and no variables generated a P value < .20 in the univariate analysis on the nondominant leg. CONCLUSIONS: Poor flexibility noted in the AKE test during preseason screening and previous injury were unable to predict those at risk of sustaining a hamstring strain in Gaelic games with adequate sensitivity.

The effect of high intensity exercise and anticipation on trunk and lower limb biomechanics during a crossover cutting manoeuvre.

We investigated the effects of high intensity, intermittent exercise (HIIP) and anticipation on trunk, pelvic and lower limb biomechanics during a crossover cutting manoeuvre. Twenty-eight male, varsity athletes performed crossover cutting manoeuvres in anticipated and unanticipated conditions pre- and post-HIIP. Kinematic and kinetic variables were captured using a motion analysis system. Statistical parametric mapping (repeated-measures ANOVA) was used to identify differences in biomechanical patterns. Results demonstrated that both unanticipation and fatigue (HIIP) altered the biomechanics of the crossover cutting manoeuvre, whereas no interactions effects were observed. Unanticipation resulted in less trunk and pelvic side flexion in the direction of cut (d = 0.70 - 0.79). This led to increased hip abductor and external rotator moments and increased knee extensor and valgus moments with small effects (d = 0.24-0.42), potentially increasing ACL strain. The HIIP resulted in trivial to small effects only with a decrease in internal knee rotator and extensor moment and decreased knee power absorption (d = 0.35), reducing potential ACL strain. The effect of trunk and hip control exercises in unanticipated conditions on the crossover cutting manoeuvre should be investigated with a view to refining ACL injury prevention programmes.

Investigation of the Effects of High-Intensity, Intermittent Exercise and Unanticipation on Trunk and Lower Limb Biomechanics During a Side-Cutting Maneuver Using Statistical Parametric Mapping.

Whyte, EF, Richter, C, O'Connor, S, and Moran, KA. Investigation of the effects of high-intensity, intermittent exercise and unanticipation on trunk and lower limb biomechanics during a side-cutting maneuver using statistical parametric mapping. J Strength Cond Res 32(6): 1583-1593, 2018-Anterior cruciate ligament (ACL) injuries frequently occur during side-cutting maneuvers when fatigued or reacting to the sporting environment. Trunk and hip biomechanics are proposed to influence ACL loading during these activities. However, the effects of fatigue and unanticipation on the biomechanics of the kinetic chain may be limited by traditional discrete point analysis. We recruited 28 male, varsity, Gaelic footballers (21.7 ± 2.2 years; 178.7 ± 14.6 m; 81.8 ± 11.4 kg) to perform anticipated and unanticipated side-cutting maneuvers before and after a high-intensity, intermittent exercise protocol (HIIP). Statistical parametric mapping (repeated-measures analysis of varience) identified differences in phases of trunk and stance leg biomechanics during weight acceptance. Unanticipation resulted in less trunk flexion (p < 0.001) and greater side flexion away from the direction of cut (p < 0.001). This led to smaller (internal) knee flexor and greater (internal) knee extensor (p = 0.002-0.007), hip adductor (p = 0.005), and hip external rotator (p = 0.007) moments. The HIIP resulted in increased trunk flexion (p < 0.001) and side flexion away from the direction of cut (p = 0.038), resulting in smaller (internal) knee extensor moments (p = 0.006). One interaction effect was noted demonstrating greater hip extensor moments in the unanticipated condition post-HIIP (p = 0.025). Results demonstrate that unanticipation resulted in trunk kinematics considered an ACL injury risk factor. A subsequent increase in frontal and transverse plane hip loading and sagittal plane knee loading was observed, which may increase ACL strain. Conversely, HIIP-induced trunk kinematic alterations resulted in reduced sagittal plane knee and subsequent ACL loading. Therefore, adequate hip and knee control is important during unanticipated side-cutting maneuvers.

The novel use of a SenseCam and accelerometer to validate training load and training information in a self-recall training diary.

Self-recall training diaries are a frequently used tool to quantify training load and training information. While accelerometers are predominantly used to validate training diaries, they are unable to validate contextual training information. Thus this study aimed to examine the novel use of data fusion from a wearable camera device (SenseCam) and accelerometer to validate a self-recall training diary. Thirty participants filled in a training diary for 1 day while simultaneously wearing a SenseCam and accelerometer. The training diary was validated using Bland-Altman plots, Spearman's rank-order correlation, percentage agreement and κ measure of agreement between the diary and the SenseCam and accelerometer. The results demonstrated overall agreement, and no bias, between the training diary and the accelerometer for training intensity, and the SenseCam for duration of activity and travel time. A positive correlation was found for duration (r = 0.82, P < 0.001) and intensity (r = 0.67, P < 0.001). Hundred per cent agreement was found between the SenseCam and training diary for activity, training surface and footwear (κ = 1, P < 0.0001), with a lower agreement noted for sports played (97.3%, κ = 0.91, P < 0.0001). The self-recall training diary was found to be a valid measure of capturing training load and training information using the combined wearable camera device and accelerometer.

The Development and Reliability of a Simple Field-Based Screening Tool to Assess for Scapular Dyskinesis.

CONTEXT: Scapular dyskinesis has been identified as a possible risk factor for injury in overhead athletes. There is a need to develop a simple, inexpensive, time-efficient field-based test that can establish the presence and severity of both scapular dyskinesis and its individual components in a musculoskeletal preparticipation screening. To ensure confidence in the test results, high reliability must be displayed. OBJECTIVE: To establish the intertester and intratester reliability of a simple field-based screening tool for scapular dyskinesis. DESIGN: Reliability study. SETTING: Athletic therapy facilities. PARTICIPANTS: 15 physically active men (19.46 ± 0.63 y) free from any orthopedic or neurological disorders, recruited from a convenience sample of college students. INTERVENTION: Testers underwent 3 training sessions where the instructions and scoring system of the test were explained, demonstrations of the tests were given, and opportunities to practice the test were provided. Three testers independently rated 3 trials, and the process was repeated at the same time the following week. MAIN OUTCOME MEASURES: Scapular dyskinesis was assessed using the following components: winging, loss/lack of control when lifting, loss/lack of control when lowering, and scapular asymmetry. A 0-3 rating (0 = no issue, 1 = slight issue, 2 = moderate issue, 3 = severe issue) was provided by the tester independently on each side separately and on scapular asymmetry. The intraclass correlation coefficients (ICCs), 95% confidence intervals, and standard error of measurement (SEM) were computed to establish reliability. RESULTS: Excellent ICC values were found for intertester reliability (ICCs .80-1.00) and good to excellent intratester reliability (ICCs .60-1.00 for tester A, .63-1.00 for tester B, and .75-1.00 for tester C) for all components of the test. The SEM was not found to be clinically significant. CONCLUSIONS: The simple field-based screening tool developed to assess scapular dyskinesis demonstrates high reliability and so is a reliable tool to use in preparticipation screenings. Future research should establish its validity.

Effect of a High-Intensity, Intermittent-Exercise Protocol on Neurocognitive Function in Healthy Adults: Implications for Return-to-Play Management After Sport-Related Concussion.

CONTEXT: Determination of return to play (RTP) after sport-related concussion (SRC) is critical given the potential consequences of premature RTP. Current RTP guidelines may not identify persistent exercise-induced neurocognitive deficits in asymptomatic athletes after SRC. Therefore, postexercise neurocognitive testing has been recommended to further inform RTP determination. To implement this recommendation, the effect of exercise on neurocognitive function in healthy athletes should be understood. OBJECTIVE: To examine the acute effects of a high-intensity intermittent-exercise protocol (HIIP) on neurocognitive function assessed by the Symbol Digits Modality Test (SDMT) and Stroop Interference Test. DESIGN: Cohort study. SETTING: University laboratory. PARTICIPANTS: 40 healthy male athletes (age 21.25 ± 1.29 y, education 16.95 ± 1.37 y). INTERVENTION: Each participant completed the SDMT and Stroop Interference Test at baseline and after random allocation to a condition (HIIP vs control). A mixed between-within-subjects ANOVA assessed time- (pre- vs postcondition) -by-condition interaction effects. MAIN OUTCOME MEASURES: SDMT and Stroop Interference Test scores. RESULTS: There was a significant time-by-condition interaction effect (P < .001, η2 = .364) for the Stroop Interference Test scores, indicating that the HIIP group scored significantly lower (56.05 ± 9.34) postcondition than the control group (66.39 ± 19.6). There was no significant time-by-condition effect (P = .997, η2 < .001) for the SDMT, indicating that there was no difference between SDMT scores for the HIIP and control groups (59.95 ± 10.7 vs 58.56 ± 14.02). CONCLUSIONS: In healthy athletes, the HIIP results in a reduction in neurocognitive function as assessed by the Stroop Interference Test, with no effect on function as assessed by the SDMT. Testing should also be considered after high-intensity exercise in determining RTP decisions for athletes after SRC in conjunction with the existing recommended RTP protocol. These results may provide an initial reference point for future research investigating the effects of an HIIP on the neurocognitive function of athletes recovering from SRC.

Concussion Assessment and Management Self-efficacy Among Irish Clinicians.

BACKGROUND: This study explored concussion assessment and management self-efficacy and practices of allied healthcare professionals in Ireland. HYPOTHESES: (1) Self-efficacy levels and practices vary across different concussion assessment and management skills, (2) the ability to practice skills impacts self-efficacy most. STUDY DESIGN: Cross-sectional. LEVEL OF EVIDENCE: Level 3. METHODS: Survey of allied healthcare professionals (285 responders), investigating (1) demographics, (2) concussion assessment (immediate and office) and management (postconcussion advice and management/rehabilitation) self-efficacy levels and practices, and (3) factors affecting self-efficacy. RESULTS: Levels of self-efficacy among clinicians were 64.5 ± 26.6 (immediate assessment) and 56.6 ± 25.4 (postconcussion advice) (highest scores: concussion symptom checklist [80 ± 28.4], physical rest advice [80.1 ± 27.8]; lowest: Child Sport Concussion Assessment Tool [44.6 ± 41.2] and nutrition advice [34.1 ± 33.7]). Overall levels of self-efficacy among Certified Athletic Therapists and Chartered Physiotherapists were 51.5 ± 20.1 (assessment) and 62.1 ± 20.9 (management) (highest scores: history/clinical evaluation nonspecific to concussion [86.6 ± 16.2], physical rest advice [86.3 ± 20]; lowest: paper/pencil neuropsychological test [16.7 ± 28.6], advice on medication use [39.2 ± 35]). A strong positive correlation was observed between clinician self-efficacy and frequency of use of overall (r = 0.795; P < 0.01) and immediate (r = 0.728; P < 0.01) assessment, advice (r = 0.805; P < 0.01), and management (r = 0.812; P < 0.01) skills. Factors with greatest positive impact on clinician self-efficacy were the ability to practice skills during clinical placement (3.3 ± 0.9) and remaining emotionally (3.3 ± 0.8) and physically (3.3 ± 0.8) calm while practicing. CONCLUSION: Clinicians in Ireland had moderate self-efficacy in concussion care. Those who used concussion-relevant skills frequently in practice displayed higher self-efficacy for those skills. CLINICAL RELEVANCE: Concussion-related self-efficacy can be enhanced through practice in a clinical environment and through experiencing composure while practicing.

An investigation into perceived autonomy support, motivation and competence in chronic pain patients in Ireland: A cross-sectional study.

Autonomy supportive healthcare settings are associated with enhanced behaviour change and self-management strategies in individuals living with chronic disease. The level of autonomy support provided by healthcare professionals to individuals living with chronic pain in Ireland is unknown. A cross-sectional study was completed on participants living with chronic pain (>3 months) in Ireland. Participants (n = 389) completed an anonymous survey constructed of patient reported outcome measures relating to autonomy support (HCCQ), motivation (TSRQ), competence in physical activity (PCS), pain interference (BPI) and psychological factors (PHQ-9, GAD-7). Results showed the median HCCQ (H = 39.287, p < .001), Autonomous Motivation (H = 13.568, p = 0.019) and PCS (H = 30.701, p < .001) scores were significantly different when patients received care from different healthcare professionals. There was a negative correlation between PCS and pain severity (r = -0.32, <0.01), pain interference (r = -0.44, p = <0.01), PHQ-9 (r = -0.50, p = <0.01) and GAD-7 (r = -0.34, p = <0.01). This study has identified that perceived healthcare support in Ireland varies according to the healthcare professional leading pain care. Furthermore, higher levels of self-determination were associated with decreased depression and anxiety in individuals with chronic pain. Given the limited number of multidisciplinary team clinics to provide pain management programs, an alternative cost-effective community led solution is required. The results of this study indicate that allied health professionals may be well placed to fill this void. Future research exploring the barriers to providing healthcare supportive settings is required.

Current Concussion Knowledge, Beliefs, Education, and Management Practices Among Irish Post-Primary PE Teachers.

Purpose: Physical education (PE) teachers play an important role in concussion recognition and management in schools both in an academic and activity based setting. This study aimed to identify Irish post-primary PE teachers' concussion knowledge, beliefs, education and management practices. Methods:  An anonymous online survey, adapted to the Irish context from the validated BAKPAC-TEACH, was completed by 128 PE teachers (female = 74/123; 60.2%; male = 49/123; 39.8%, 36.1 ± 10.9 years), representing 4% of registered PE teachers in Ireland. Results: PE teachers reported 3.5 ± 4.7 students suffer with a sports-related concussion in their classroom annually and 43.9% previously had a student sustain a concussion during their PE class. Most received concussion education (58.6%), largely provided by sporting bodies. They frequently identified dizziness (93.0%) and headaches (92.2%) as concussion symptoms, but less commonly emotional (more emotional = 36.5%, nervous or anxious = 33.6%, sadness = 28.9%) or sleep (35.2%) symptoms. All PE teachers knew that a concussion requires immediate removal from a game/practice. PE teachers demonstrated less perceived knowledge and confidence relating to academic adjustments and return to learn criteria. Just 31.3% reported their school facilitates academic adjustments. Conclusion: Tailored concussion education addressing knowledge gaps highlighted in this study should be developed. A concussion policy and an academic support team in each school should be established and widely publicised to enhance the support of concussed students in returning to school.

Implementing hamstring injury prevention programmes remotely: a randomised proof of concept trial.

Objectives: This study aimed to (1) compare the effectiveness of a Nordic hamstring exercise (NHE) versus single-leg Romanian deadlift (SLRDL) exercise programme on a hamstring injury risk surrogate; (2) compare the muscle soreness experienced by both exercise programmes; and (3) assess compliance to remote injury prevention exercise protocols through video software. Methods: Twenty participants (10 women and 10 men: 21.45±1.6 years; 176±23 cm; 70±10 kg) were randomised into an NHE or SLRDL programme for 6 weeks. Single-leg hamstring bridge (SLHB), a hamstring injury surrogate, was the primary outcome for exercise efficacy. Muscle soreness and exercise adherence were also assessed. Significance was set at p<0.05. Results: Both exercises increased SLHB performance resulting in an overall effect (p=0.013) with no effect for group (p=0.470) and no interaction effect (p=0.709), indicating both groups improved but there was no difference in improvement between interventions. There was no difference in muscle soreness between groups (p=0.087). Finally, both groups had 100% adherence to the programme. Conclusions: Both the NHE and SLRDL are equally effective in increasing SLHB performance and demonstrate a similar level of muscle soreness. This suggests that SLRDL may be a viable option as a preventative exercise to mitigate the risk of hamstring injury. Finally, implementing injury prevention programmes remotely has the potential to enhance adherence.

Definitions and surveillance methods of running-related injuries: A scoping review.

Inconsistent and restricted definitions of injury have contributed to limitations in determining injury rates and identifying risk factors for running-related injuries (RRIs). The aim of this scoping review was to investigate the definitions and surveillance methods of RRIs. A systematic electronic search was performed using PubMed, Scopus, SPORTDiscuss, MEDLINE, and Web of Science databases. Included studies were published in English between January 1980 and June 2023 which investigated RRIs in adult running populations, providing a definition for a general RRI. Results were extracted and collated. 204 articles were included. Three primary criteria were used to define RRIs: physical description, effect on training and medical intervention, while three secondary criteria are also associated with definitions: cause/onset of injury, location, and social consequences. Further descriptors and sub-descriptors form these criteria. The use of Boolean operators resulted in nine variations in definitions. Inconsistency is evident among definitions of RRIs. Injury definitions seem to be important for two main reasons: firstly, determining accurate injury rates, and secondly, in research examining risk factors. For the latter, definitions seem to be very limited, only capturing severe injuries and failing to recognise the full development process of RRIs, precluding the identification of conclusive risk factors. A potential two-approach solution is the initial use of a broad definition acting as a gatekeeper for identifying any potential injury, and follow-up with an extensive surveillance tool to capture the specific consequences of the varying severity of RRIs.