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

10

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