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Sport, Age, And Sex Specific Incidence of Sports Injuries

Sport, Age, And Sex Specific Incidence of Sports Injuries

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doi: 10.1136/bjsm.34.3.188
2000 34: 188-194
Br J Sports Med 
Mark R Stevenson, Peter Hamer, Caroline F Finch, et al.
injuries in Western AustraliaSport, age, and sex specific incidence of sports
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group.bmj.comon January 4, 2010 - Published by bjsportmed.comDownloaded from 
Sport, age, and sex specific incidence of sportsinjuries in Western Australia
Mark R Stevenson, Peter Hamer, Caroline F Finch, Bruce Elliot, Marcie-jo Kresnow
 —To describe the trends in rec-reational sports injury in Perth, WesternAustralia.
 —A prospective cohort study of sports injuries during the 1997 winter sea-son (May to September).
 —Sample of Australian football,field hockey, basketball, and netball play-ers from the Perth metropolitan area,Western Australia.
 —A cohort of sports participantswas followed over the five month wintersports season. Before the season, partici-pants completed a baseline questionnaireand during the season were interviewedevery four weeks by telephone.
 —Overall,92% of participants (n =1391) who completed a baseline question-naire completed at least one follow uptelephone interview. About half (51%) of the cohort sustained one or more injuriesduring the winter season accounting for atotal of 1034 injuries.Most injuries were of moderate (58%, n = 598) or minor (40%, n= 412) severity, with only 3% (n = 24)requiring emergency department treat-ment or a hospital stay. The injuryincidence rate was greatest for football(20.3/1000 hours of participation), similarfor field hockey and basketball (15.2/1000hours and 15.1/1000 hours respectively),and lowest for netball (12.1/1000 hours).The incidence of injury was greatest in thefirst four weeks of the season, and partici-pants aged between 26 and 30 years hadabout a 55% greater risk of injury thanthose aged less than 18 years.
 —This is one of the first stud-ies to show that recreational sports aresafe. Although the likelihood of injury wasgreatest in the first month of the season,few injuries required admission to hospi-taloremergencydepartmenttreatment.Agreater emphasis on prevention in theearly part of the season should help toreduce the elevated incidence of injuryfound at this time.
Br J Sports Med 
:188–194)Keywords: injury incidence; prospective study; time atrisk
There has been an increase in participation inregular physical activity among Australians.
This is partly in response to the role it plays inthe management and prevention of a numberof conditions such as coronary heart disease,
diabetes, osteoporosis, hypertension,
andmental health disorders.
4 5
Although participa-tion in regular physical activity is beingpromoted, attention is also being focused onanother important health goal for Australia: todecrease the incidence and severity of injuriesassociated with sport and recreationalactivities.
With increased participation insport, the potential for an increase in thenumber of injuries is likely. As such, thebenefits attributed to sport and recreationalpursuitsshouldbeconsideredinthelightofthephysical risks as well as the direct and indirectcosts associated with injury.Sport related injuries are of concerninternationally,
as they have a significantsocial and economic impact on society. It isestimated that each year one in 17 Australiansis injured su
ciently while playing sport tomiss a game or training, to leave the field of play, or to seek medical or first aid attention.
Three quarters of these injuries have beenreported to occur in eight popular sports: Aus-tralian football, rugby league, rugby union,soccer, netball, basketball, field hockey, andcricket.
Sports injuries are estimated to costthe Australian community about one billionAustralian dollars a year.
Despite these figures, there are only limiteddata about the occurrence of sports injuries inAustralia, particularly at the community levelof participation.
One of the major reasons forthis is that surveillance of sports injuries is par-ticularly di
A review of emergencydepartment or hospital admission records willonly identify the more severe injuries.
Also,the records are not comprehensive because of the lack of appropriate classification of sportsinjuries under the
International Classification of Diseases,Ninth Revision
external cause of injurycodes. Furthermore, it is di
cult to define thepopulation at risk. Hence, it is virtually impos-sible to calculate the incidence of sports injury.Therefore, although there has been a docu-mented increase in the number of peopleactively involved in sport and recreationalactivities,
1 16
the full extent of the sports injuryproblem is still to be elucidated.Ingeneral,sportsinjuryresearchinAustraliahas been fragmented,
with most of theresearch focusing on a limited number of sports and often only including eliteathletes.
Consequently, few studies haveproducedinformationaboutthewidersportingcommunity. Furthermore, it is likely that inju-ries incurred at the community level of partici-pation di
er from those for elite and profes-sional players. It is important therefore tounderstand the incidence and nature of sportsinjuries at the community level. Continued
Br J Sports Med 
Department of Epidemiology andBiostatistics, School of Public Health, CurtinUniversity of Technology, Perth,Australia
M R Stevenson
National Center forInjury Prevention andControl, Centers forDisease Control andPrevention, Atlanta,Georgia, USA
M R StevensonM-J Kresnow
Department of HumanMovement andExercise Science,University of WesternAustralia, Perth,Australia
P HamerB Elliot
School of HealthSciences, DeakinUniversity, Melbourne,Australia
C F Finch
Correspondence to:Dr Stevenson, Departmentof Epidemiology andBiostatistics, School of Public Health, CurtinUniversity of Technology,GPO Box U1987, Perth, WA6845, AustraliaAccepted for publication11 November 1999
 group.bmj.comon January 4, 2010 - Published by bjsportmed.comDownloaded from 
research that focuses only on high or elite levelsport, which is most of the published data,severely hampers the development and imple-mentation of public health strategies for sportsinjury prevention at the community level.This paper describes the epidemiology of sports injuries in Perth, Western Australia,reporting for the first time the incidence of injury per time spent participating in selectedsports. This is the first prospective study of sports injuries at the community level inAustralia.
A random sample of Australian football, fieldhockey, basketball, and netball clubs from thePerth metropolitan area (population of about1.3 million) was identified. Participants fromthese clubs were selected and followed over thefive month winter sports season between Mayand September 1997. To be eligible forinclusion in the study, participants needed tobe competing at a non-professional or firstclass level; they were also required not to havesustained a sports injury in the three monthsbefore the study. A sports injury was defined,according to the Council of Europe definition,as an injury that occurs while participating insport and leads to one of the followingconsequences: a reduction in the amount orlevel of sports activity, the need for advice ortreatment, and/or adverse economic or sociale
Study participants were approached to com-plete the questionnaire by research sta
beforeatrainingsessionoramatchatthebeginningof the winter season. The self report question-naire took about 30 minutes to complete andwas developed after an extensive review of theliterature and a critique of instruments used insimilar studies.
The questionnaires werereviewed and modified after consultations withfocus groups comprising health professionalsand sports participants.The questionnaire wasthen pilot tested on a sample (n = 16) of thetarget audience and further modified whenambiguity occurred. The questionnaire in-cluded items about previous sports injuryhistory, along with questions on preseasontraining, warm up, and cool down patterns.Specific questions about the equipment used,such as footwear and protective devices, wereincluded as well as general health,lifestyle,andphysical activity questions. To cover thedomain of sports psychology, two validatedinstruments were incorporated into the ques-tionnaire: the Five Factor Personality Inven-tory Test
and the Athletic Life ExperienceSurvey.
The sports injury risk and protectivefactors alluded to above are not examined inthis paper, but will be discussed in a futurepaper. Finally, demographic details were re-corded.Follow up of participants was undertakeneach month (over a five month period) by atelephone interview, which took about fiveminutes. The telephone interviews were con-ducted by supervised sta
from a telephonemarket research company using a computerassisted telephone interviewing (CATI) sys-tem. About 10% of all telephone interviewswere supervised, a further 10% of phone callswere validated by a follow up phone call by asecond interviewer, and no interviewer under-took more than 20% of the total telephoneinterviews. Structured questions were askedabout how many training sessions and ormatches were played during the preceding fourweeks. These questions provided informationabout exposure to the risk of injury.Theseverityoftheinjurieswasclassifiedintothree levels: severe, requiring hospital admis-sion; moderate, requiring health care attention(including treatment by a sports trainer);minor,requiring self treatment.The severity of injury was determined by self report. To assistwith recall of information,each participant wassupplied, at the time of recruitment, with adiary to record specific information on train-ing, participation, and injuries.If the participant was not available at thetime of the telephone call, a further threeattempts were made. The number of missedtelephone calls was minimised by schedulingthe calls at the most convenient time to theparticipant (this information was provided atthe time of recruitment).
The sample comprised participants in foursports that ranked in the top six in WesternAustralia on the basis of player registrations
and injury rates
: Australian football, netball,field hockey, and basketball. On the basis of a1993 census of Western Australian sportsparticipants,
a sampling frame of sports clubsacross these four sports was established. Thesports clubs were randomly selected with asampling probability in proportion to thenumber of registered teams in each club. Inaddition, the sampling frame reflected the dis-tribution of participation in the four sports:36% of the clubs were Australian football,25%netball, 25% field hockey, and 14% basketball.Depending on the number of participantsneeded to be recruited from each club,the clubprovidedaccesstoeitheroneorasmanyasfourteams. Research sta
approached the selectedteams to recruit participants.The sample size estimate was based on datataken from previous research.
On the basis of an injury rate of 10%, 1260 participants werenecessary. This number was adjusted for thedesign e
ect (necessary because of the e
ectsof clustering at the club and team level) and fora 10% attrition rate over the sports season. Asa result of these adjustments, a sample (fromthe four sports) of 1512 was recruited. Table 1reports the total sample size recruited and theproportion followed each month over theobservation period.
A description of the demographic characteris-tics of the cohort and their putative risk factorswas undertaken using SPSS software.
Uni-variate statistics were computed,and variationsin proportions were assessed using the Pearson
test, with continuity correction where
Incidence of sports injuries
 group.bmj.comon January 4, 2010 - Published by bjsportmed.comDownloaded from 

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