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InternationalParalympic Committee
THE PARALYMPIC INJURY AND ILLNESS SURVEILLANCE SYSTEM
Stuart Willick, MD, FACSM
Professor, University of Utah
University of Utah
DISCLOSURES/ACKNOWLEDGEMENTS
I have no industry relations.
I have received reimbursement and travel expenses from the International Paralympic Committee.
UNIVERSITY OF UTAH
THE PARALYMPIC INJURY AND
ILLNESS SURVEILLANCE SYSTEM
OUTLINE
History of the IPC Injury and Illness Surveillance
System (ISS)
Methods
Selected Results
(London, Sochi)
Limitations
Future Directions
Summary
WHY IS THIS IMPORTANT?
Sports injury epidemiology improves our preparation for events and our care of athletes.
Sports injury prevention research has been shown to decrease injury rates (e.g. ACL prevention programs in female athletes).
Sports participation has important physical and psychosocial benefits for individuals with an impairment.
However, sports participation is not free of risk.
The short and long term functional consequences of a sports injury may be greater for an athlete with an impairment compared with the same injury sustained by an athlete without an impairment.
Successful epidemiology that includes injury and illness prevention strategies will protect the health and welfare of Paralympic athletes.
WHY IS THIS IMPORTANT?
HISTORY OF THE
PARALMPIC ISS
The Paralympic Injury Surveillance Study was
successfully carried out during the 2002, 2006 and
2010 Winter Paralympic Games.
Prior to London 2012 Injury surveillance had not been
conducted at the Summer Paralympic Games; and
Illness surveillance had not formally been conducted
during the Winter or Summer Paralympic Games.
Injury and illness surveillance at the London and
Sochi Paralympic Games saw the introduction of a
comprehensive web-based tool (WEB-IISS) designed
to improve the quantity and quality of data.
HISTORY OF THE
PARALYMPIC ISS
2002 Salt Lake City Winter Paralympic Games:
Spearheaded by Nick Webborn, the IPC ISS had
its humble beginnings parallel to the IOC ISS.
HISTORY OF THEPARALYMPIC ISS
Webborn N, Willick S, Reeser J. Injuries Among Disabled Athletes During the 2002 Winter Paralympic Games. Med Sci Sprts Exerc 2006 38(5), 811-815
Webborn N, Willick SE, Emery CA. (01/01/2012). "The Injury Experience at the 2010 Winter Paralympic Games". Clin J Sport Med, 22(1), 3-9.
Taunton J, Wilkinson M, Celebrini R, Stewart R, Stasynuik T, Van de Vliet P, Willick SE, FerrerJM. (01/01/2012). "Paralympic Medical Services for the 2010 Paralympic Winter Games". ClinJ Sport Med, 22(1), 10-20.
HISTORY OF THE PARALYMPIC ISS
During the 2002 SLC Winter Paralympic Games, we identified a surprisingly high number of lower limb injuries in sled hockey athletes.
This led to two rules changes, including regulating equal heights of the sleds and more protective gear for the lower limbs.
The rules changes resulted in a dramatic decrease in lower limb injuries in sled hockey athletes during the 2006 and 2010 Winter Paralympic Games.
tp://www.youtube.com/watch?feature=player_embedded&v=uO_T7pC3eA4
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OBJECTIVES
General: To maximize
the health, wellness and
safety of Paralympic
athletes, both short and
long term.
Specific: To characterize
the nature and incidence
of athlete injuries and
illnesses during each
Paralympic Games.
OBJECTIVES
Specific:
To devise and
test injury
prevention
interventions
Ethics Board approval is through the University of Brighton in the UK, and the University of Cape Town in South Africa.
The Ethics Board approval is longitudinal and international.
DATA COLLECTION METHODS
ATOS Medical Encounter Form
15
ATOS MEDICAL REPORTING SYSTEM
PRIOR SUPPLEMENTARY INJURY FORMS
METHODS
LONDOND 2012 & SOCHI 2014
Prospective, epidemiologic cohort study;
Data is collected from several sources:- IPC athlete database;- ATOS Games Reporting System;
- Medical Encounter Forms used by the Organizing Committee Medical Services;- WEB-IISS*- OC Radiology Services- OC Pharmacology Services
Databases were cleaned, merged and de-identified.
METHODS
Definitions
Injury/Illness: any musculoskeletal, neurologic or
medical complaint that prompted an athlete to
seek medical attention.
Incidence Proportion: Number of illnesses or
injuries per 100 athletes.
Incidence Rate: Number of illnesses or injuries
per 1000 athlete-days.
IOC DATA COLLECTION TOOL
Team physicians complete data entry on one side of one piece of paper daily.
Only able to capture a limited amount of detail.
Need to transcribe data from paper to computer. d information obtained.
WEB-IISS
WEB - IISS
• Completed daily by
team medical personnel
• If no illness or injury,
the daily report took
less than one minute
to complete
• A single illness or injury
survey took less then
five minutes to
complete
WEB - IISS
METHODS
Maximizing Data Capture
Some medical personnel were already aware of the
project from prior Games;
Information letters were mailed to OC Medical Services
and all NPCs ~2 months prior to the Games;
A detailed brochure was mailed to OC and NPC medical
personnel ~3 weeks prior to the Games;
The study was reviewed in detail at the Team Physicians
Meeting in the Paralympic Village;
Communications were made with OC and team medical
personnel in person.
PARALYMPIC ISS
CORE TEAM
Cheri Blauwet, MD Harvard University
Wayne Derman, MD, PhD University of Capetown
Carolyn Emery, PhD University of Calgary
J. Oriol Martinez, MD University Ramon Llull Barcelona
Martin Schwellnus, MD University of Capetown
Peter van de Vliet, PT, PhD IPC
Nick Webborn, MBBS University of Brighton
Stuart Willick, MD University of Utah
PARALYMPIC ISS
CORE TEAM
METHODS
Maximizing Data Capture Daily meetings every morning to review compliance;
Action plan developed with each MC member assigned to
contact various team physicians;
Contacts made in person, by phone and by email.
RESULTS - LONDON
Participants
160 of 164 delegations participated (97.6%).
3,565 of 4,167 total athletes were included (84%).
Athlete health was monitored daily over a 14-day period for a total of 49,910 athlete-days.
Exposure data – Illness & Injury
IPC Illness SurveillanceSchwellnus M, Derman W, Jordaan E, et al. Br J Sports Med Published Online First 2013 doi:10.1136/bjsports-2013-092371
RESULTS
657 illnesses were reported
in 505 athletes.
Overall Illness Proportion:
14.2%
(Overall Olympic Illness
Proportion: 7.2%)
Overall Illness Rate:
13.2 per 1000 athlete-days
Olympics: Respiratory > GI
> Skin
Illness by Organ System
RESULTS Illness by Sport
Highest Incidence Rates(per 1000 athlete-days):Equestrian: 20.7Powerlifting: 15.8Athletics: 15.4
Lowest Incidence Rates(per 1000 athlete-days):Football 7: 2.2Shooting: 4.3Football 5: 8.2Goalball: 8.4
RESULTSIllness Rates by Organ System and Time Period
IPC INJURY SURVEILLANCEWillick SE, Webborn N, Emery C, et al.Br J Sports Med Published Online Firstdoi:10.1136/bjsports-2013- 092374
Results
633 injuries identified in 539 athletes
Incidence proportion (IP) = 17.8 injuries/100 athletes (95% CI; 16.5-19.0)
Injury incidence rate (IR) = 12.7 injuries/1000 athlete-days (95% CI; 11.7-13.7)
*London Olympics IP:12.9/100 athletes.
INJURY RATE BY SPORT
Willick SE, Webborn N, Emery C, et al. Br J 2013
1. Football 5-a-side2. Powerlifting3. Goalball4. Wheelchair Fencing5. Wheelchair Rugby6. Athletics
INJURY RATE BY BODY PART
Willick SE, Webborn N, Emery C, et al. Br J Sports Med Published Online Firstdoi:10.1136/bjsports-2013- 092374
1. Shoulder
3. Elbow2. Wrist/Hand
4. Knee
INJURY RATE BY SEX
AND AGE GROUP
N = Number of athletes
IR = Incidence Rate (# injuries/1000 athlete-days)
Injury rates were similar in male and female athletes
Median age = 30 years (range 13–67)
Highest Injury Rate in 26-34 year old athletes
INJURY ONSET BY SPORT
New onset acute injuries = 51.5% of all reported injuries
Chronic overuse injuries = 31.8% of all reported injuries
Acute on chronic injuries = 16.7% of all reported injuries
SOCHI 2014ALPINE SKIING
SOCHI 2014 ALPINE SKIING
DISCIPLINE AIR TEMP C° (DNF) (%)
Downhill W 6.3° M 6.3° W 0/38/33 M 0/18/43
Super – G W 9.5° M 10.8° W 33/33/50 M 43/43/57
Giant Slalom W 10° M 4.4° W 33/25/8 M 22/40/45
Slalom W -0.4° M 4.0° W 30/33/9 M 35/30/62
SOCHI 2014 ALPINE SKIING
SOCHI 2014ALPINE SKIING
SOCHI 2014ALPINE SKIING
SOCHI 2014ALPINE SKIING
Medical attention only57%
More than 1 day missed from training or competition
43%
Time Lost from Injuries
SOCHI 2014ALPINE SKIING
SPECIFIC ANALYSES
IN PROGRESS
1. In-depth analysis of shoulder injuries
2. Injuries in athletes with visual impairment
3. Factors associated with injury sustained in goalball, football,
powerlifting and athletics
4. Video analysis of injuries
4. Influence of travel on injury/illness profiles
5. Factors associated with the development of urinary tract
infections in athletes with neurogenic bladder
LIMITATIONS
Compliance is increasing, but remains less than 100%.
There are missing data fields, particularly in the ATOS Medical Encounter Forms.
Merging databases is tedious and challenging.
Information is lacking concerning athlete status prior to and after the Games.
IPC ISS has primarily been used so far to determine injury rates and risk factors rather than to devise and evaluate prevention strategies.
Lack of methodological consistency: What is the best data collection tool? What are the best denominators to use? - per 100 athletes;- per 1000 athlete-days;- per game/event;- Other?
FUTURE DIRECTIONS
Pursue 100% compliance
Institute a smarter, single data collection toolwith ability to have smart forms and athlete/position/gender specific questions.*
FUTURE DIRECTIONS
What are the long term consequence of sports
participation for athletes with spinal hardware?
FUTURE DIRECTIONS
What are the long term health consequences of sports participation in the residual limbs and joints of athletes who compete with prosthetic devices and other adaptive equipment?
FUTURE DIRECTIONS
How do we make decisions
about what constitutes safe
(and fair) sports participation in
the future?
- Endoprostheses;
- Myoelectric prostheses;
- Exoskeletons;
- Snowboarding;
- Bobsled and skeleton;
- Kayaking;
- Nordic jumping;
- Minimum age?
IT IS IMPERATIVE THAT WE STRIVE TO MAKE SPORTS SAFER
SUMMARY
The Paralympic Injury and Illness Surveillance System was
devised to study ways to protect the short and long term health
of Paralympic Athletes.
The Paralympic ISS has developed into a more sophisticated
research project since its inception at the Salt Lake City 2002
Winter Paralympic Games.
With perseverance and increased resources, the Paralympic
ISS has the potential to make para-sports safer, and help
inform us on how to better care for para-athletes and all
individuals with impairments who participate in sports and
other recreational activities.
Thank you
The injury incidence at the London 2012 Summer
Paralympic Games was 12.7/1000 athlete-days.
The percent of new onset, acute injuries was
relatively high at 51.5%.
The illness incidence was 14.2/1000 athlete-days.
The information obtained adds to our knowledge
of injuries and illness in Paralympic athletes, and
can inform future health and safety initiatives
SUMMARY
PROPORTION OF INJURIES
BY IMPAIRMENT TYPE
23
23,5
24
24,5
25
25,5
26
Amputee Other Spinalinjury VI
AllInjury
AllInjury
INJURY ONSET
BY IMPAIRMENT
0
5
10
15
20
25
30
25 25 26 24
Amputa on/limb
deficiency
Other Spinalinjury Visualimpairment
Acute
AonC
Chronic
SOCHI 2014ALPINE SKIING
RESULTS –Number of Athletes by Sport
RESULTSIllnesses by Sport and Sex
RESULTSIllness Rates by age group
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