Recurrence risk in shoulder instability

PROJECT PARTNERS

• OLVG, Amsterdam, the Netherlands

• Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, the Netherlands

• Faculty of Behavioural and Movement Sciences, VU, Amsterdam, the Netherlands

FUNDING

• AMC MD/PhD Scholarship: The AMC Medical School and Graduate School for Medical Sciences offer a grand to outstanding and scientifically promising students to participate in the MD-PhD program. The program combines the medical Master’s degree program with PhD research.

BACKGROUND

With 4000 new anterior shoulder dislocations annually in the Netherlands, it is the most dislocated joint. The trauma occurs mainly in young individuals and up to 60% of patients later experience a dislocation again (re-dislocation), which has a negative impact on quality of life. Determining risk of a re-dislocation is a difficult task, as there are a lot of factors that contribute to the stability of the shoulder. For example, glenoid bone loss, a Hill-Sachs lesion, neuromusculair control and muscle strength are factors that play an important role in stabilizing the shoulder. Currently, glenoid bone loss is used as a parameter to predict recurrence risk. However, this is not the only factor that determines this risk and how do you measure something that is not there? Advances in technology create the opportunity to analyze (dynamic) 3D-models of humerus and scapula. By analyzing the interaction between these bony structures, this project looks for parameters that can predict recurrence risk more accurately by taking more of the factors that determine stability into account.

OBJECTIVES

The main objective of this project is to improve our ability to estimate risk of a re-dislocation. This goal is achieved through multiple objectives:

1.     Identify and critically evaluate currently available methods and risk factors that are used to determine re-dislocation risk

2.     Determine if new factors can be identified through 3D analysis of the bony structures' interactions.

3.     Determine which patient-reported and clinical outcomes should be used in shoulder instability research. These outcomes will facilitate standardized research and setting up a prospective cohort.

Further Information

More can be found at http://www.shoulderelbowcenter.com/

Outcome of acute ankle ligament injuries with stable syndesmosis involvement in athletes

PROJECT PARTNERS

• Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar

FUNDING

• The study is funded by Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

BACKGROUND

Acute ankle sprains are one of the most common injuries in sports. Historically, ankle sprains were considered to primarily affect the lateral ankle ligaments. With increased understanding of the injury mechanism, we now know that other structures might be affected concomitantly (e.g. syndesmosis; cartilage). While many studies have investigated the diagnosis and outcome of acute lateral ligament injuries, few studies have evaluated the outcome of these concomitant injuries.

OBJECTIVES

The aim of the study is to evaluate the outcome of acute ligamentous ankle injuries in athletes. First, the diagnostic value of various diagnostic strategies for ligamentous ankle injuries will be evaluated. Using MR imaging as the reference standard, physical examination, clinical tests and (dynamic-) ultrasound in the diagnosis of ligamentous ankle injuries will be investigated. 

To determine the outcome of acute ligamentous ankle injuries, time to return to play and functional outcome questionnaires will be administered 6 weeks, 6 months and 12 months after the injury.

Impact of Continuing Medical Education on Clinical Practice in a Multidisciplinary Sports Medicine Hospital

PROJECT PARTNERS

• Aspetar orthopaedic and sports medicine hospital

FUNDING

• None

 BACKGROUND

In recent years, continuing medical education has gained significant attention in Qatar due to the implementation of the mandatory CME/CPD participation policy by the Qatar Council for Healthcare Practitioners (QCHP). Since the implementation, Aspetar has delivered various types of CME/CPD activities including conferences, symposia, workshops, journal clubs and lecture series. There is increasing focus to measure the impact of CME programs to determine their effectiveness on clinical performance and healthcare outcomes as some evidence has shown that CME activities lack such an effect. 

OBJECTIVES

The aim of the study is to determine the impact of a locally - accredited interprofessional lecture series on clinical practice among healthcare practitioners in a specialized orthopaedic and sports medicine hospital. Impact on clinical practice will be initially assessed through the Implementation and evaluation of the Aspetar Tuesday Lecture Series.

METHODS

Data is initially collected using an anonymous online questionnaire in which healthcare practitioners will provide information on demographics and assess their feedback relevant to the overall learning objectives of the lecture series including impact on clinical care, contribution to evidence-based medicine, and interprofessional education. Furthermore, healthcare practitioners will report on perceived barriers and facilitators in changing clinical practice and suggest topics to address perceived practice gaps. 

Self-report questionnaires remains a valuable tool to assess outcomes of CPD activities, but are known to be subject to limitations. Consequently, in addition we ask if healthcare practitioners are willing to participate in focus groups interviews; in which we will examine group perceptions towards the Tuesday Lecture Series and discuss strategies for improvement. 

SUB-PROJECTS

1.     Implementation and evaluation of an accredited lecture series in a sports medicine hospital: a retrospective cohort study;

2.     What makes an impactful presentation? An analysis of the lectures presented during the 2018/2019 Aspetar Tuesday Lecture Series; and

3.     Value of Tuesday Lectures, Journal Clubs to improve clinical outcomes.

Bringing Research To Real Life: Development, Implementation, and Evaluation of a Context-Specific Longitudinal Injury Monitoring System for the Maltese National Football Team - A Mixed-Method Study

FUNDING

• Malta Sports Scholarship Scheme

PROJECT PARTNERS

• Malta Football Association

• Cardiff University

BACKGROUND

National team sporting events are popular and exciting for spectators, however, they entail a risk of injury for the National team players. In order to mitigate the risk and prevent injuries, sporting organisational bodies have carried out injury surveillance under the guidance of the respective consensus statements to understand injury patterns during such tournaments. Yet, it has been reported that injury data obtained from these short events only provide a ‘snapshot’ of information with regards to the injury burden, thus emphasising the need for a long-term, continuous injury monitoring system for national team players. Therefore, this study will aim to bridge the gap in knowledge through the design of a prospective longitudinal injury monitoring system framework that aims to monitor injuries of national team players both while with their clubs and with the National team. However, designing and implementing an injury monitoring system as guided by sport-respective consensus statements will not translate effectively in non-elite settings –such as in Maltese football setting- due to different and various contextual determinants revolving around injury perceptions and injury reporting methods. Hence, there is a need to understand the role of contextual determinants in order to develop and implement a longitudinal injury monitoring system that best fit the context of the Maltese National team football players

Objectives of the project:

1.     Develop a longitudinal injury monitoring system tailored for Maltese National team football players

2.     Understand Injury Problem

3.     Evaluate the Injury monitoring system as a practical tool

This development of the injury monitoring system will be based on findings from the initial qualitative study, which will shed light on the perceptions of injuries and the current practices and barriers in injury reporting. The injury monitoring system will be implemented with the U-21 National Maltese Football Team and the Senior Female Maltese Football Team for 2 consecutive seasons. The monitoring system will be used both as a practical tool to monitor injuries throughout the study period and as a research tool to understand the injury problem. Thereafter, the injury monitoring system will be evaluated using the RE-AIM framework, triangulated with qualitative findings on the acceptability and utility of the system.

Long-term and Sports Outcomes of Osteochondral defects of the Ankle

PROJECT PARTNERS

• None

FUNDING

• Department of Orthopedic Surgery Amsterdam UMC

• Foundation Friends of Aces

BACKGROUND

An osteochondral defect (OCD) of the ankle can significantly impact the life of the athletic patient. Surgical intervention is a common tool to relieve pain, improve function and have patients return to sports. To date, consensus for surgical interventions for a range of morphological OCDs is slim and new techniques are being pioneered at a constant rate. However, for existing proven treatments long-term outcomes, as well as outcomes from its application in the distal tibia are lacking. These findings could question our understanding of the sustainability and long-term implications of the treatments for the often younger and active patients who sustain an OCD.

OBJECTIVES

To determine long-term treatment outcomes for established treatments and identify possible characteristics leading to osteo-arthritis after an ankle OCD. Another objective is to asses sport outcomes following ankle OCD treatment.

QRSMed: Qualitative Research in Sports Medicine

PROJECT PARTNERS

• University of Tubingen

• University of Bath

• University of Zurich

• Aspetar

• Linkoping University

FUNDING

• None

BACKGROUND

Over the past decades research within the field of sports medicine has yielded a large amount of evidence of the prevention and treatment of athletic injuries. Despite the availability of high quality evidence, compliance to interventions that protect athletes’ health is low. Consequently, evidence-based programs are not achieving their optimal effect in real-life athletic situations. Implementation and knowledge translation are the contemporary incantations to resolve this apparent gap between science and practice. This has provided us novel research questions and challenges that follow on efficacious outcomes. Most of these questions are not answered through quantifiable outcomes measures as they revolve around user behaviors. If we want to know why athletes and coaches behave as they do, and what barriers there may be to changing their behavior, qualitative research can be used to give athletes and coaches a voice.

OBJECTIVES

Within the QRSMed initiative we aim to bring together sports medicine researchers with an expertise in qualitative research. The goal is to develop and implement qualitative research methods within sports medicine research.

Managing the Workload in Circus Arts

PROJECT PARTNERS

• Cirque du Soleil

FUNDING

• None

BACKGROUND

Cirque du Soleil is a major circus company that was founded by a group of street performers in Baie-Saint-Paul, Canada, in 1984. From its humble beginnings, it has grown into a major entertainment attraction and now employs over 1300 artists from 55 different countries performing in 27 various shows (Soleil, 2019). Some shows are stationary and perform in the same city throughout the year while others go on travel legs and perform all over the world. A travel leg typically consists of 10 straight show weeks of performances in different cities with a two-to-three week break before the next travel leg starts. A show week runs from Monday through Sunday, where the performances are condensed into 4 days from Thursday through Sunday. Each show features from 50 to 100 artists in different positions or acts, so it is important for all of them to remain healthy and available to perform their part of the show. 

OBJECTIVES

Cirque du Soleil wants to improve their load management monitoring and injury risk management. Finding the right balance between the business needs of a circus and the health aspects of the performing artists crew leads to the following research questions:

(1) Can we relate the injury incidence to the show week within a travel leg;

(2) Is there a relationship between the injury incidence rate and the average work load by position; and

(3) Can the ACWR be used to assess the probability of injury? 

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Leadership in Sports Medicine & Performance: Taking the lead towards healthy performance

PROJECT PARTNERS

• None

FUNDING

• None

OBJECTIVES

Sports has evolved rapidly over the past decades. With an increased economic value, a surge of professionalization has taken place across various levels of play and across a multitude of sports. In contemporary sports athletes have become high-value assets in a business that is driven by athletic performance. This development also affects the role of the sports medical professional. Where not too long ago we serviced athletes, nowadays we lead a multidisciplinary team that is mandated to protect the athletes’ health and full availability. We are dubbed from being the doctor to be the Director of Performance. In essence our roles have shifted from being a service provider to a health manager who steers a multidisciplinary team of specialists. The question is whether we really have the necessary skills to lead a ‘team’ like this effectively?

Over the years most research on leadership in sports has focused on the coach and manager and their roles and impact on performance. In contrast, little has been done in regard to effective leadership Sports Medicine roles. Some evidence exists though, e.g. from professional football, where it was shown that coaching style and team communication are linked to team injury risk and player availability. Other insights stem from recent qualitative research that described from athlete interviews that the entire staff needs to be engaged in athlete health protection and needs to effectively communicate with athletes about symptoms and injuries. Also, it was shown in artistic environments that most of the potential for targeting injury risk factors lies outside the realm of sports medical care and sits in other departments within an organization. In light of such evidence, it would only flow logically to assume that those who know how to communicate effectively and unlock the potential of their multidisciplinary teams will do a better job in having the athletes ready and in full health to perform. 

OBJECTIVES

This project aims to – through a qualitative study – explore the narrative of individuals with a leadership role in Sports Medicine and Sports Performance. Specifically this project aims to unravel the skills required to be an effective in Sports Medicine and Sports Performance, and develop a framework towards effective leadership in our field.

Athletes’ voices: a qualitative research study on injury, injury prevention and implementation of preventive measures in professional female football

PROJECT PARTNERS

• Federação Portuguesa de Futebol

FUNDING

• None

BACKGROUND

Professional football involves a high degree of athletic ability with extreme physical demands placed on players. Through this, playersare exposed to a high risk of injury. The prevention of injuries in sports in general and football in particular, has been researched over the past decades. This had led to a wide array of efficacious preventive measures for various injuries. However, real-world implementation and effective use of this evidence lags behind. 

Focused and effective injury prevention starts with a description of the injury problem. To understand the injury problem, however, in the first step of the sequence of prevention a broader research focus is needed. Looking not only at the isolated injury, but also at the underlying behavioral factors, taking into account the athlete and his / her context. Based on this reasoning, the players’ context should be explored to better understand the injury problem of players’ who perform in a professional environment.

OBJECTIVES

This project aims to – through a qualitative study – explore the narrative of professional female footballers and stakeholders (i.e. coaching, medical staff, strength & conditioning coaches) in regard to injury, injury prevention and implementation of preventive measures in professional female football.

TennisReady: Development and evaluation of a tennis specific injury prevention program

PROJECT PARTNERS

• VeiligheidNL

• Royal Dutch Lawn and Tennis Association

FUNDING

• The Netherlands Organisation for Health Research and Development

BACKGROUND

Exercise-based injury prevention strategies in sports have been frequently evaluated. A meta-analysis of 36 randomized controlled trials has shown that most of these interventions are effective in reducing the number of injuries. The majority of trials have been conducted in team sports, such as basketball, volleyball, football and tackle collision ball sports.

For individual sports, the literature is limited to running athletes. Only three randomised controlled trials for exercise-based prevention in runners have been published, which all showed no significant reduction in injury rates. Given the global individual sports participation exceeds team participation, the lack of evidence-based prevention intervention is a call for action. Tennis is one of the most practised individual sports in the world. Estimates show that approximately 75 million people practice tennis worldwide. Playing tennis has proven cardiovascular health benefits, and is even associated with decreased all-cause mortality. The downside is the injury rate of up to 3.0 injuries per 1,000 hours of tennis.

These injuries have an important (economic) impact. A recent Dutch report11 showed that 43% of the injuries among tennis players were treated (para)medically, leading to an emergency room treatment cost of €3.6 million. Indirect costs due to loss of work were estimated at €8.3 million. When taking into account that approximately 800 000 people play tennis in the Netherlands, impact of tennis-related injuries can be considered significant.

OBJECTIVES

To developed, using a systematic approach guided by the KTS, a tennis-specific app-based injury prevention programme, and to evaluate its effectiveness in a randomised controlled trial.

Shared decision-making knowledge and attitudes of healthcare practitioners in sports medicine

PROJECT PARTNERS

· Aspetar Orthopedic and Sports Medicine Hospital

FUNDING

None

BACKGROUND

Shared-decision making (SDM) has become the golden standard in making heath care decisions. It is defined as a process in which both clinician and patient bring their own expertise to reach an informed and personalized decision. The clinician is the expert on risks and benefits of options, the patient the expert on his or her personal preferences and values. Reconciling these two is the essence of shared decision making.

There is abundant research on shared-decision making in various specific and more general populations. But little is known about shared-decision making in sports medicine.

Results from research on shared-decision making in other populations cannot be immediately translated to the sports medicine population. The circumstances under which athlete health care decisions are made is significantly different. Athletes are often part of a multidisciplinary team, consisting not only of medically trained professionals such as a physician and physiotherapist but also of non-medical professionals such as a coach and trainer. My research will focus on how to implement shared-decision making in sports medicine.

OBJECTIVES

This first project aims to assess the knowledge of and attitude towards shared decision making of sports medicine healthcare practitioners. This will be the first step in researching the implementation of shared decision-making in sports medicine.

TIPAS: Tailored Injury Prevention in Adapted Sports

PROJECT PARTNERS

• Reade Rehabilitation Center

• Oslo Sports Trauma Research Center

• Inholland University of Applied Sciences

• VU Amsterdam

• DeSportartsengroep

• Leiden University

• Royal Dutch Lawn and Tennis Assocation

• Dutch Triathlon Association

• Royal Dutch Hockey Association

• Royal Dutch Soccer Association

FUNDING

• The Netherlands Organisation for Health Research and Development

BACKGROUND

Sports participation and a physically active lifestyle have been advocated for its health and social benefits and increased quality of life, both in able-bodied individuals and those with physical disabilities. Although sports participation lags behind in the latter group, it has increased over the past years.
Sports injuries do pose problems for all athletes and impact society, but often go hand-in-hand with additional problems in individuals with a disability as injuries can impose upon an already restricted lifestyle. With the relevance of studies on injury surveillance and epidemiology for preventive efforts widely acknowledged, there is a limited number of these studies in disability sports.

Injury prevention is relevant to enable long-time sports participation and continuation of activities of daily living. This may be even more important for athletes with a physical disability. The variability in disabilities, and their relationship with each individual athlete’s ability to participate in sports and injury risk, highlights the need for tailored preventive approaches. Such individual approaches are upcoming, enabled by current technologies for the prospective and continuous online monitoring of health and performance related measures in individuals.

Our previous research has shown the ability to automatically provide online preventive advice to individual able-bodied runners tailored to their reported health status (monitored over time using the OSTRC-questionnaire on health problems), and the effectiveness of this systematic approach to increase prevention adherence and prevent injuries. This approach is applicable to disabled athletes and fits the challenges prevention faces in these athletes. Given the specific injury risk and health problems in athletes with a disability, this approach needs first to be adapted to make it valid and feasible for this specific population.

OBJECTIVES

This study will:

(1) adapt the systematic preventive approach to disability sports;

(2) implement and evaluate the online tailored approach aimed to increase preventive behaviours and reduce acute and overuse injuries in disability sports; and

(3) evaluate end-users’ perspectives on the intervention.

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MoveHealthy: Improving Health and Sustaining Participation of Youngsters in Sports

PROJECT PARTNERS

• Hanze University of Applied Sciences

• VeiligheidNL

• HEPA Europe

• European Network of Sport Education

• Lithuanian Basketball Federation

• VU Brussel

• University of Oradea

• International Council for Coaching Excellence

• Royal Dutch Football Association

FUNDING

• Erasmus+

BACKGROUND

Sport is an important aspect of social and cultural life in the European Union, and it is deeply embedded in Europe’s societies with some 300 million people regularly enjoying sport. Engaging in sport is one of the ways of being physically active and the sports movement has great influence on the level of health- enhancing physical activity of European citizens. This is why the European Commission made health- enhancing physical activity a cornerstone of its sport-related activities and policies from the very beginning. But participation in sports is not only recognized as a tool to stay healthy; it promotes social and educational values, and it has the potential to promote cohesion in societies and social inclusion.

But although the World Health Organisation identified that physical inactivity is the fourth leading risk factor for death globally and is responsible for 5-10% of deaths in the WHO European Region , and efforts to promote sport participation have been stepped up in some EU Member States, rates of physical inactivity across the EU still remain unacceptably high: the majority of citizens still does not engage in sufficient physical activity, with 60% never or seldom exercising.

One reason for non-participation in and drop-out from sports and physical education is sports related injuries. Where especially knee and ankle injuries contribute to this problem. Therefore, the project MOVE HEALTHY: Improving Health and Sustaining Participation of Youngsters in Sports around Europe seeks to develop free-of-charge education material to effectively support sport coaches and physical educators around Europe to prevent primary lower extremity injuries of the youngsters participating in their sport trainings and PE classes.

For it, MOVE HEALTHY seeks to develop an innovative, ICT based approach with external focus visual and verbal instructions and feedback on the movement effect which is based on the implicit motor learning theory. It is intended that the consortium develops – by the process of co- creation with sport coaches and physical education (PE) teachers – functional sports exercises that can be offered and will be integrated in real world sport training and physical education sessions. With it, the project directly contributes to an improved sharing of good practices and develops innovative instruments in order to lower the risks of injuries and enhance sports participation.

OBJECTIVES

The objective is to impact on the motor behaviour of the youngsters, as well as to change the training and attitudinal behaviours of the sport coaches and PE teachers. The ultimate goal of the MOVE HEALTHY project is that the youngsters can enjoy a lifelong, healthy sport participation.

Red card for injuries in Dutch amateur football: the implementation of the 11+ program

PROJECT PARTNERS

• Royal Dutch Football Association

• VeilgheidNL

• UMC Utrecht

• Athletic Skills Model

FUNDING

• The Netherlands Organisation for Health Research and Development

BACKGROUND

In the Netherlands, football is the sport with the highest absolute number of injuries: yearly, around 850,000 injuries on average are reported by youth and adult players (especially aged 10-34 years), leading to nearly 35,000 Emergency Department visits. Therefore, the Royal Dutch Football Association (KNVB) has allied with several leading partners in injury prevention research to work towards injury prevention in Dutch football. To prevent lower extremity injuries in amateur football players, the 11+ programme was developed as a complete warm-up programme, showing an overall 39% to 48% injury reduction among youth and adult amateur players. Therefore, the logical next step for the KNVB and partners is to work towards the implementation of the 11+ programme across the Netherlands, taking into account the lessons learnt in other countries about its implementation (facilitators and barriers such as concurring with the current language/practice/structure of the coaches).

APPROACH OF THE IMPLEMENTATION
The ‘Translating Research into Injury Prevention Practice’ framework (TRIPP) stages 5 and 6 underline the importance of a pertinent implementation plan and related evaluation for the future uptake of preventive measures. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Sport Setting Matrix (SSM) framework is widely accepted and applied for the evaluation of the implementation of preventive measures.

OBJECTIVES
The overall aim is to implement the 11+ program in the Dutch amateur football (youth and adult; male and female).

(1) To explore how the 11+ program fits the current language/practice/structure of the coaches within the Dutch amateur football context;

(2) To develop a structured and evidence-based implementation plan tailored to the Dutch football context to promote the structured implementation of the 11+ program;

(3) To initiate the implementation of the 11+ program in the Dutch amateur football according to the defined implementation plan and to evaluate its implementation.

Causation vs Association: Implications for Sports Medicine Clinicians

PARTNERS

• McGill University

• Calgary University

FUNDING

• Amsterdam Movement Sciences

BACKGROUND

Although physical activity reduces disability and mortality, and improves mental health, being active also entails a risk of injury. Injury is an important reason for dropout from exercise in adults. Also among youth, sport injuries are a relevant cause for reduced physical activity levels. In total, 30-40% of all injuries lead to medical attention, producing substantial health care costs.

Injury refers to tissue damage. Biomechanically, an injury occurs when the stress applied to a tissue (load) is greater than the stress the tissue can withstand (load capacity). Common injury prevention programs are mainly focused on increasing the load capacity. Overuse-related injuries occur when the load is too high over a longer period without the appropriate recovery. Traumatic injuries may occur due to fatigue (reduced load capacity) that decreases physical control and psychological focus. Therefore, an appropriate recovery time is required between activity sessions. 

Striking a balance between activity load and injury risk is a common goal for individuals and athletes of all levels and ages. However, there is currently little high-quality evidence on the association between activity load and injury risk, as existing studies are based on (too) small samples with short follow-up of a limited number of adult elite team sports. Further, the used analytical methods are known to produce biased estimates. 

OBJECTIVES

The goal is to establish sports injury risk profile charts. These charts will visualize the individual risk of sport participants based on their multifactorial risk profile. The outcomes will support sports and clinical practice in managing activity load and recovery to prevent injury. This aim will be achieved through three objectives:

(1) Combining existing large-scale prospective data sets on injury risk factors, activity load, and injury outcomes;

(2) Establishing a multifactorial injury risk model out of this combined data set, using state-of-the-art analytical approaches; and

(3) Translating the outcomes into clinically usable risk profiles.

Evaluating the Impact of the IOC Sports Medicine Statements on Olympic Athlete Health and Wellbeing

PROJECT PARTNERS

• Edith Cowan University, Australia

• University of Pretoria, South Africa

FUNDING

• International Olympic Committee

BACKGROUND

Over recent years, the International Olympic Committee (IOC) Sports Medical and Scientific Commission has strongly supported the development and dissemination of sports medicine consensus statements, produced in conjunction with peak sports medicine organizations and published across leading scientific journals. The statements cover a wide range of issues from use of platelet rich plasma to concussion management to youth athletic development. Since 2004, 24 consensus statements have been published, all of which were developed to provide consistent, evidence-based guidance for the promotion of athlete health and wellbeing across the IOC community. 

The number of consensus statements continues to grow. However, to date, the dissemination (where the documents have been used, by whom and how) and implementation (how are the documents used and what are the outcomes) of these statements has not been evaluated. This means that it is not known if there has been uptake of the consensus statements or if the goal of the documents has been achieved: to improve athlete health and wellbeing. 

Before continuing to invest, financially and academically, in the preparation of future statements, evidence for their usefulness and effectiveness is required. 

OBJECTIVES

The aim of this project is to formally evaluate the impact of the medical consensus statements, through three related phases. 

(1) Document analysis – summarizing the content and citations of the statements (no ethical approval for this phase is required) 

(2) Interviews with stakeholders in Australia and South Africa to understand if and how they have used the statements and/or what barriers they have faced in use of the statements 

(3) Survey of international sports federations and national olympic committee. The survey will be based on the issues identified in phase 2, to identify the scope of statement use (or non-use) worldwide. 

My Running Health: A qualitative analysis on the perceptions, beliefs and behaviors in regard to injury, injury risk and injury prevention practices across different levels of runners.

PROJECT PARTNERS

• None

FUNDING

• None

BACKGROUND

Running injuries are prevalent and lead to loss of participation and medical care for participants. With the growing number of participants, the absolute numbers of injuries are also increasing, but the increase in participation rates are not in line with the increase in injury rates. Dutch figures show that the novice runners have a relatively higher number of injuries than experienced runners. This higher risk of injury is also seen in the international literature. A few - but not substantiated - explanations have been given. As a result, injury prevention remains sub-optimal for this growing group of athletes.

Recent research from our group has shown that the definition of an injury depends on the context of the individual. This means that the perceived risk factors and preventive strategies are inherently different between levels of experience. This means that athletes from different sports and experience levels view their injuries differently and deal with injuries in a different way.

Perhaps the same applies to runners, where starting runners, due to a lack of experience and a different motivation, view injuries differently than experienced runners. If this is the case then we are not dealing with a difference in injury risk, but with a difference in perception and experience. This would require an inherently different preventive approach between running target groups.

OBJECTIVES

Exploring and describing the context and vision regarding injuries and the prevention of injuries among recreational runners of various levels. We will have a specific focus on:

(1) Vision and perception of what a running injury is;

(2) Perceived risk factors and mechanisms of a running injury; and

(3) Preventive measures implemented and the motivation with regard to the implementation of preventive measures.

A qualitative research study on injury, injury prevention and implementation of preventive measures in Olympic Athletes

PROJECT PARTNERS

• The Australian Centre for Research into Injury in Sport and its Prevention (Edith Cowan University and La Trobe University Sport and Exercise Medicine Research Centre, Australia)

• Sport Injury Prevention Research Centre (University of Calgary, Canada)

• Institute of Sports Medicine & Sports Orthopedic Research Center-Copenhagen (SORC-C) (Copenhagen University Hospital, Denmark)

• French-speaking Research Network for Athlete Health Protection & Performance (French Institute of Sport; University and University Hospital of Liège; Luxembourg Institute of Research in Orthopedics, Sports Medicine and Science; National Sport Institute of Quebec; Geneva University Hospitals)

• Yonsei Institute of Sports Science and Exercise Medicine (Yonsei University, Wonju Severance Christian Hospital, Korean Sports and Olympic, Sol Hospital, Korea National Sport University, Republic of Korea)

• Aspetar Orthopaedic and Sports Medicine Hospital (Qatar)

• Sport, Exercise Medicine and Lifestyle Institute (University of Pretoria, University of Stellenbosch, South African Medical Research Council, South Africa)

• London’s Institute for Sports, Exercise and Health and National Centre for Sports Exercise and Medicine (United Kingdom)

• United States Coalition for the Prevention of Illness and Injury in Sport (United States Olympic Committee, Steadman Philippon Research Institute, The University of Utah, USA)

FUNDING

• None

BACKGROUND

It has been argued that, for better and more effective ‘real-world’ injury prevention and athlete health protection, a broader research focus is needed – moving from the isolated problem and the underlying factors, towards the athlete as a whole. As such, there is a need to take into account the demands, wishes, needs, possibilities, and motivations of the athlete and other stakeholders. For this purpose, a large-scale qualitative study was initiated in the Netherlands to explore the narrative of athletes, and their respective coaches and medical staff (stakeholders), in regard to injury and illness definitions, perceived causal factors, and preventive practices. This study has elicited varying definitions of injury, the breadth of perceived risk factors, and – most importantly – the complex system around the elite athletes.

Although vital for future directions in intervention translation, these results and insights remain restricted to a specific local non-Olympic context. Given the fact that across countries support and development by Olympic programs differs (i.e. budget, sports culture, support, talent development, etc.) these initial local findings beg the question how differences between national Olympic programs affect athlete and stakeholder perceptions, and to what extent evidence and interventions require tailoring across countries and international Olympic settings. For this reason, we now extend the Dutch study to an international setting, including Olympic athletes, coaches and medical staff from the United Kingdom, South Africa, Canada, South Korea, Australia, France / Belgium, Qatar, and Denmark.

OBJECTIVES

The goal of the proposed project is to explore the narrative of Olympic athletes, coaches, and health care providers in relation to their perceptions of injury and illness prevention. Based on this narrative, this project aims to explore and understand the practicalities of sports related injury and illness prevention based on beliefs, attitudes and knowledge from key stakeholders in different countries:

Specific research questions to be answered across elite athletic cultures are:

(1) How do Olympic athletes and stakeholders define injury and illness, and are there differences in definitions between stakeholders?

(2) Which factors and mechanisms are related to risk of injury and illness from the Olympic athletes’ and stakeholders’ perspective?

(3) How do Olympic athletes and stakeholders deal with health problems and their prevention in everyday practice?

(4) Which contextual factors influence actual preventive behavior, and do these factors differ between Olympic programs, sports and stakeholders?

Patellofemoral Pain: opening the black box

PROJECT PARTNERS

· Physiotherapy YsveldFysio, Berg en Dal, The Netherlands

· Physiotherapy Utrecht Oost, Utrecht, The Netherlands

FUNDING

None

BACKGROUND

Patellofemoral pain (PFP) is a challenging condition from both the athlete’s and clinician’s perspective. Multimodal treatment regimes are advised but the results are far from optimal which is reflected by the 50% positive outcomes of this type of intervention.

The majority of PFP research focuses on the results of exercise regimes whether or not combined with foot support (insoles). The exercise regimes target lower limb alignment and strength production from the greater kinetic chain. The role of soft tissue flexibility in PFP was only assessed in a small number of studies. New insights in lower limb function and multi-segmental tissue flexibility showed that flexibility of a musculo-tendinous structure is related to positions of other adjacent body segments and thereby can negatively affect patellofemoral joint kinematics.

The pathogenesis of PFP is still unknown. Increased innervation (vessels and nerves) of peripatellar tissue and increased intra-osseous pressure in the patella were previously reported. A homeostasis theory was proposed but this is still not adopted as the pain mechanism for this condition.

OBJECTIVES

In the first part of this PhD we investigate soft tissue flexibility in the kinetic chain in patients with PFP and healthy controls and how this may relate to pain-free knee function. As weight bearing knee flexion is provocative in this condition we developed a test incorporating this construct, which can then be used in the clinical evaluation of PFP patients. We studied the reliability and validity of this test.

In the second part of this PhD project, we investigate changes in arterial blood flow of the patellar bone.

The results of these studies likely assist in developing more targeted treatment regimes for PFP in order to increase the overall treatment effect in this common musculo-skeletal condition.

FURTHER INFORMATION

Publications of this project thus far:

The decline step-down test measuring the maximum pain-free flexion angle: A reliable and valid performance test in patients with patellofemoral pain.

The ACTIVE trial: (cost-)effectiveness of a transmural integrated care program for knee arthroplasty patients in the working population

PROJECT PARTNERS

· Amphia Hospital, Breda, The Netherlands.

· St. Anna, Geldrop, The Netherlands

· Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands

· Maastricht UMC, Maastricht, The Netherlands

· Alrijne Ziekenhuis, Leiderdorp, The Netherlands

· Flevoziekenhuis, Almere, The Netherlands

· Kliniek ViaSana, Mill, The Netherlands

· Bergman Clinics, Naarden, The Netherlands

· Maxima Medisch Centrum, Eindhoven, The Netherlands

FUNDING

· The study was funded by ZonMw Efficiency

BACKGROUND

Knee osteoarthritis is the most prevalent joint disease in the Netherlands with 571,600 patients in 2016 suffering from it. This burden is particularly high for those undergoing knee arthroplasty (KA). Due to the ageing population and the obesity epidemic, it is expected that there will be about 57,900 knee arthroplasties in the Netherlands in 2030. Half of these patients are expected to be in the working population. Currently, the care as usual post-surgery is not aimed at (work) participation, and three out of ten Dutch knee arthroplasty patients do not return to work (RTW). Additionally, only 50% of the patients accomplish RTW within three months. This is accompanied by a significant impact on patients’ quality of life as periods of being off work not only lead to a high risk of work disability, but also contribute to poor general and mental health of the patient and increasing health care and work productivity loss costs for society. Hence, improving perioperative care for KA patients, with a primary focus on societal participation, could contribute to more (cost) effective care.

OBJECTIVES

The aim of the study is to assess the (cost-)effectiveness of a new transmural integrated care program for KA patients aiming to increase (societal) participation post-surgery. In this transmural integrated care intervention, we will combine identified effective elements (e.g. referral to a case-manager, rehabilitation with personalized goals and eHealth) aiming to increase (work and sport) participation and thereby quality of life of KA patients. In a multi-center randomized controlled trial, we will examine whether this integrated care program will be (cost) effective as compared to the care as usual on resumption of (working) activities and improving quality of life in knee arthroplasty patients. The results from this study will provide health care providers and policy makers with guidance to improve arthroplasty patients’ care and future implementation of this integrated care program in Dutch orthopaedic practices and hospitals.