Currently health care pathways (the combination and order of services that a patient receives to manage their injury) following a mild traumatic brain injury vary considerably. Some clinicians lack confidence in injury recognition, management and knowing when to refer. A clinical expert group developed the Brain Injury Screening Tool (BIST) to provide guidance on health care pathways based on clinical indicators of poor recovery. The tool aims to facilitate access to specialist services (if required) to improve longer term prognosis. The tool was developed using a three-step process including: 1) domain mapping; 2) item development and 3) item testing and review. An online retrospective survey of 114 adults (>16 years) who had experienced a mild brain injury in the past 10 years was used to determine the initial psychometric properties of the 15-item symptom scale of the BIST. Participants were randomised to complete the BIST and one of two existing symptom scales; the Rivermead Post-concussion Symptom Questionnaire (RPQ) or the Sports Concussion Assessment Test (SCAT-5) symptom scale to determine concurrent validity. Participant responses to the BIST symptom scale items were used to determine scale reliability using Cronbach’s alpha. A principal components analysis explored the underlying factor structure. Spearman’s correlation coefficients determined concurrent validity with the RPQ and SCAT-5 symptom scales. The 15 items were found to require a reading age of 6–8 years old using readability statistics. High concurrent validity was shown against the RPQ ( r = 0.91) and SCAT-5 ( r = 0.90). The BIST total symptom scale (α = 0.94) and the three factors identified demonstrated excellent internal consistency: physical/emotional (α = 0.90), cognitive (α = 0.92) and vestibular-ocular (α = 0.80). This study provides evidence to support the utility, internal consistency, factor structure and concurrent validity of the BIST. Further research is warranted to determine the utility of the BIST scoring criteria and responsiveness to change in patients.
Sports-related concussion (SRC) is a risk across all sports. New Zealand physiotherapists are more frequently in attendance at sporting events than medical doctors. The aim of this study was to determine the knowledge, attitudes, and behaviours of physiotherapists working with SRC, using a 35-item, multi-choice questionnaire. The survey was completed by 122 physiotherapists (response rate 10%). Physiotherapists were knowledgeable regarding SRC and showed positive attitudes towards correct management of the injury. Of the respondents, 98% recognised the key signs and symptoms of SRC, and 88% would refer to a medical practitioner for further assessment of SRC. Physiotherapists indicated a strong desire to be more involved in sideline management and testing, and would like to see a more multidisciplinary approach to return-to-play decision-making after SRC. Given that the knowledge, attitudes, and behaviours of New Zealand physiotherapists to SRC were very good, it is suggested that the processes in New Zealand be reviewed to enable physiotherapists to be more involved in the assessment and management of concussion.
OBJECTIVE: To investigate the comparative cooling effect at the knee, of Crushed Ice and two commonly used commercial cryotherapy modalities, following a clinically relevant application of 20 minutes.
DESIGN: Within subjects, randomised cross over design.
SETTING: University Laboratory
PARTICIPANTS: Eleven healthy male participants
MAIN OUTCOME Measures: Skin temperature over the anterior knee measured by thermal imaging camera.
RESULTS: Mean absolute baseline skin surface temperature (Tsk) was 28.4oC (±1.2 oC). The greatest reduction in Tsk was produced by Crushed Ice D14.6 oC (±3.7 oC) resulting in an absolute Tsk of 13.8 oC; followed by Ice Man D12.3 oC (±2.4 oC) resulting in an absolute Tsk of 16.1oC and then Arctic Flow D4.9 oC (±1.3 oC) resulting in an absolute Tsk of 23.5oC. One-way ANOVA revealed significant differences (p<.05) between modalities for change in Tsk.
CONCLUSIONS: Crushed Ice and Ice Man produced very similar results following a 20 minute application to healthy adult male knees, however only Crushed Ice resulted in a skin temperature in the desired 10-15°C therapeutic range, results for Ice Man were just above this range. The resultant skin temperature following a similar application of Arctic Flow was well above the therapeutic range.
Abstract Objectives To estimate the long term cost savings, return on investment, and gain in quality‐adjusted life years (QALYs) that could be achieved by a national anterior cruciate ligament (ACL) injury prevention program for amateur football (soccer) players in Australia. Study design Markov model decision analysis. Setting, participants Two hypothetical scenarios including all amateur football players in Australia (340 253 players): no intervention, and a national ACL injury prevention program. Transitions between health states, including ACL rupture, meniscal injury, knee osteoarthritis, and total knee replacement were made in one‐year cycles over 35 years from a societal perspective. Main outcome measures Cost savings, return on investment, and QALY gain achieved in the prevention program scenario relative to control scenario, by age group (10–17, 18–34, 35 years or older) and gender. Secondary outcomes: incidence of ACL rupture, knee osteoarthritis, total knee replacement, and total knee replacement revision. Results The total mean cost of an ACL injury was estimated to be $30 665. The national injury prevention program was projected to save $52 539 751 in medical and societal costs caused by ACL ruptures in amateur footballers over 35 years; the estimated return on each dollar invested in the program was $3.51. Over this period, the number of players with ruptured ACLs could be reduced by 4385 (9%), the number of knee osteoarthritis cases by 780 (8.1%), and the number of total knee replacements by 121 (8.1%); 445 QALYs were gained. Conclusion Our findings support investing in a national, evidence‐based program for the primary prevention of ACL injuries in amateur football players.
Females of reproductive age with concussion report a greater number of symptoms that can be more severe and continue for longer than age matched males. Underlying mechanisms for sex differences are not well understood. Short non-coding Ribonucleic Acids (sncRNAs) are candidate salivary biomarkers for concussion and have been studied primarily in male athletes. Female sex hormones influence expression of these biomarkers, and it remains unclear whether a similar pattern of sncRNA expression would be observed in females following concussion. This study aims to evaluate recovery time, the ratio of salivary sncRNAs and symptom severity across different hormone profiles in females presenting to emergency departments (ED) with concussion and, to investigate the presence of low energy availability (LEA) as a potential modifier of concussion symptoms.
Reducing lower-limb injuries in netball, particularly anterior cruciate ligament injuries, is a priority. The Accident Compensation Corporation (a no-fault national insurance system) partnered with Netball New Zealand to create the “NetballSmart” injury prevention program. Targeted research informed the successful implementation, dissemination, and adoption of the injury prevention program. Research included a nationwide epidemiological study, video analysis investigating netball injury risk maneuvers, and intervention studies exploring the effectiveness of injury prevention program warm-up resources on physical capability in youth netball. An identified spike in ankle-knee injury incidence of school-age netball players at season start and prior to tournaments along with a high overall prevalence within these ages led to the creation of age-specific educational workshops and resources focused on effective preparation, skill transition, strengthening, and balance. Observational video analysis highlighted behaviors that potentially increased the risk of anterior cruciate ligament injury and a progressive landing skills program was developed. The NetballSmart Dynamic Warm-up and Power Warm-up significantly improved player physical capability. Consequently, time to perform the Power Warm-up before all games at a national intermediate school tournament was incorporated into competition-time, reducing workload by 25%. A targeted social media and ambassador endorsement plan increased performance of the NetballSmart Dynamic Warm-up/Power Warm-up by 14% prior to games and 15% before trainings nationally. Accident Compensation Corporation injury data between 2018 and 2022 showed a 6,050 (32%) reduction of all body site and a 2,968 (33%) decrease of combined ankle-knee injury claims. Similarly, by 2021 there was a 11% decrease in fractures/dislocations, a 13% decrease in soft tissue injuries, and a 9% decrease in anterior cruciate ligament surgical repairs. During this delivery period, Accident Compensation Corporation reported that the whole of life returns on investment was NZD$4.10, for every dollar funded to the NetballSmart Injury Prevention Programme.
To determine knowledge, attitudes, and behavior toward concussion in cyclists and to identify predictors of concussion knowledge.Cycling organizations sent members a web link to online information about the study and a questionnaire. Anyone aged >16 years, living in New Zealand and engaged in a cycling activity was invited to participate. The 36-item questionnaire included sociodemographics, knowledge about concussion, helmet use, and personal concussion history. Data were collected between 15/05/19 and 30/06/19. A multiple linear regression model identified factors associated with levels of concussion knowledge.The questionnaire was completed by 672 participants aged between 16 and 82 years (x̄ = 48.6 years). Knowledge of concussion was high. However, knowledge that helmets are not able to prevent concussion was low and time to return to sport after injury was variable. Knowledge did not always translate to seeking of medical attention or replacement of helmet behavior. Younger age and having sustained at least one prior concussion were associated with higher levels of concussion knowledge F(df = 3) = 8.81, p < .001.Knowledge and attitudes toward concussion were positive. However, knowledge gaps and discrepancies between attitudes and behavior were identified. Consistent, clear messages are needed around return to sport timeframes.
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