BMJ Open Sport & Exercise Medicine最新文献

Decision-making for the optimal management of traumatic knee injuries can be challenging. Clinical trials reveal only small differences between surgical and non-surgical approaches, while patient and clinician biases, as well as healthcare access issues, may also influence management. Little is known about the real-world healthcare pathways for patients with a knee injury, as well as the person- and/or healthcare-related factors that influence management strategies and outcomes. The Australian Knee Injury Inception Cohort Study (KIICS) aims to: (1) describe healthcare pathways following acute knee injury (including the timing and type of healthcare consultations); (2) identify patient- and/or healthcare-related predictors of management strategy (ie, surgical vs non-surgical); and (3) examine the long-term outcome of different injury types, healthcare pathways and management strategies. KIICS is a nationwide prospective longitudinal inception cohort study recruiting Australians who have sustained an acute knee injury within the previous 6 months that disrupted daily activities or sports and led to a healthcare consultation. Participants will complete online questionnaires at enrolment and at 6 months, 1, 2, 5 and 10 years post-injury. The data to be collected will include sociodemographic characteristics, knee injury history, the sequence of healthcare consultations and referral patterns, and management strategies (ie, surgical vs non-surgical). Patient-reported outcomes will include knee pain and instability, knee-related quality of life, patient-acceptable symptom state, health-related quality of life, mental health, fear of reinjury, return-to-sport status and activity level. Detailed statistical analysis plans will be developed to address the study's key research questions, informing clinical practice, shared decision-making and healthcare policy.

Objectives: This study examined whether physical fitness at the point of police academy graduation predicts early-career outcomes, including job performance and musculoskeletal injury risk.

Methods: In a 12-month prospective cohort study, 240 police recruits (74.2% male; mean age 22.1 years) were assessed during the final week of academy training. Graduation-stage fitness was summarised by a composite fitness index (0-100; higher=better) from sex-standardised domain scores. Job performance was assessed using the Behaviourally Anchored Rating Scale (BARS) at 12 months, while injury incidence was monitored via official records, compensation claims and self-reported events. Multivariable linear regression and Cox proportional hazards models were used to examine associations, adjusting for age, sex, body mass index, baseline physical activity (measured by International Physical Activity Questionnaire-Short Form) and pre-existing musculoskeletal conditions.

Results: Graduation-stage fitness significantly predicted BARS-rated job performance (β=0.21; 95% CI 0.12 to 0.30; p<0.001), with specific effects in communication (p=0.042) and use-of-force judgement (p=0.017). Each 1-point increase in fitness score was associated with an 11% reduction in injury hazard (HR 0.89; 95% CI 0.83 to 0.95; p<0.001). High-fitness recruits remained injury-free significantly longer (median 9 vs 4 months; log-rank p<0.001).

Conclusions: Graduation-stage physical fitness is a strong and actionable predictor of early-career success and injury resilience in law enforcement. These findings support incorporating fitness assessments at academy exit into operational readiness protocols, guiding evidence-based deployment decisions and targeted postacademy conditioning programmes.

Objectives: Early protective motion (EPM) treatment, using a rigid functional knee brace for acute anterior cruciate ligament (ACL) injuries, has been reported to restore ACL function. This study aimed to investigate the probabilities of return to sports and reinjury rate associated with EPM treatment and the result of restoring ACL function and morphology in MRI more than 2 years after injury in patients with acute injured ACL.

Methods: This study included sports players with primary acute ACL injuries, straight-shaped tears and normal-volume bands on sagittal MRI, with a minimum of 2-year follow-up. If the ACL is treatable based on MRI, Lachman test and KT-1000 measurements after 3 months of knee brace use, EPM treatment can continue. The time of RTS, reinjury rate and KT measurements before and after treatment were analysed. In addition, the reinjury group and the non-reinjury group were compared.

Results: Thirty-one patients participated in this study. KT measurements at injury, brace removal and final follow-up were 5.8 mm (IQR, 4.5-7.0), 0.0 mm (IQR, -0.5-0.5) and 0.0 mm (IQR, 0.0-0.5), respectively. 77.4% returned to sports at their preinjury level and had ACL repair on MRI after more than 2 years post-injury. Reinjury occurred in 22.6%, with no significant demographic differences between the reinjury and non-reinjury groups.

Conclusion: After EPM treatment with at least 2 years of follow-up, 77.4% of patients returned to sports with restored ACL function. MRIs taken over 2 years post-injury confirmed ACL morphology repair, following strict case selection based on MRI within 2 weeks of injury.

Objective: Handgrip strength (HGS) is a simple, non-invasive measure associated with disability, frailty and disease activity in chronic conditions such as rheumatoid arthritis (RA). However, longitudinal changes in HGS and their implications in RA remain underexplored. This study aimed to systematically review changes in HGS over time and its associations with disease status and follow-up duration in patients with RA.

Design: Systematic review and meta-analysis.

Data sources: A search of PUBMED, EMBASE and WEB OF SCIENCE were searched for cohort studies up to July 2025.

Eligibility criteria: Studies including RA patients, assessing HGS and employing an observational design.

Results: From 4301 studies (including 737 identified through citation tracking), 27 met the inclusion criteria, comprising 2742 individuals (mostly women (1784; 65.1%)), aged 19-87 years, with disease duration ranging from 2 months to 47 years. Participants generally had low to moderate disease activity and moderate to severe physical disability. Overall, HGS slightly increased over time (standardised mean difference; SMD 0.25; 95% CI 0.07 to 0.43). Greater improvements were observed in early RA (SMD 0.46; 95% CI 0.30 to 0.61), while no significant changes were found in established RA. HGS increased in patients followed for ≤1 year (SMD 0.25; 95% CI 0.07 to 0.43) and >1-5 years (SMD 0.43; 95% CI 0.05 to 0.81), but not beyond 5 years.

Conclusion: Patients with early RA tend to improve HGS over time, whereas those with longer disease duration show stable strength levels. HGS may serve as a useful marker for monitoring function and guiding personalised care in RA.

Prospero registration number: CRD42023473416.

Introduction: Sports-related concussions (SRCs) are frequently under-reported in youth sports, especially football, due to limited awareness, inconsistent reporting practices and a lack of medical personnel at the grassroots level. Concussion management protocols vary widely across regions, highlighting the need for a standardised approach. This study aims to harmonise SRC education and management practices in European youth football through an interdisciplinary collaboration involving football associations, healthcare professionals and academic institutions from Norway, Germany, Croatia and Turkey. The project will develop and implement educational resources (eg, toolkits, workshops and a Massive Open Online Course (MOOC)) targeted at coaches, players, parents, referees and medical personnel.

Methods and analysis: Using a participatory action research design guided by the Logical Framework Approach, the project will develop, pilot and evaluate concussion education tools across diverse football contexts. Surveys, focus groups and participatory workshops will be used to assess changes in knowledge, attitudes and behaviours. Quantitative data will be analysed using descriptive statistics, while qualitative data from focus groups and interviews will undergo reflexive thematic analysis. Engagement metrics from MOOCs and toolkits will also be tracked.

Ethics and dissemination: Ethics approval has been obtained in all participating countries. Informed consent (or parental consent for minors) will be secured for all participants. Dissemination will occur through UEFA, national football associations and complemented by social media outreach and presentations at sports conferences. The project is expected to enhance stakeholder awareness, improve concussion management protocols and provide a scalable model for concussion education in grassroots football across Europe.

Objective: No valid patient-reported outcome measures (PROMs) exist to evaluate fear avoidance behaviour following concussion. This study developed a new PROM to evaluate fear avoidance behaviour following concussion and assessed the PROM content validity.

Design: PROM development was performed using a qualitative study, and content validation was performed using a mixed-methods approach.

Methods: The development phase consisted of compiling potentially relevant items (eg, questions) from other PROMs proposed to measure fear avoidance before proceeding to a series of one-on-one semistructured interviews with patient and professional participants. The content validity (relevance, comprehensibility and comprehensiveness) of the PROM was first assessed by professional participants using an online survey, before further assessment by patient participants during one-on-one semistructured interviews.

Results: For PROM development, seven patient participants (n=4 men) and seven professional participants (n=4 men) from six clinical professions were included, who generated 119 potentially relevant items under seven distinct domains. Key themes that emerged during development were a strong preference for a short PROM, with a simple scale, that has clinical utility. 38 professional participants (47% women) and seven patient participants completed the content validation. Thus, the final PROM (Fear Avoidance after Concussion Tool or FACT) has content validity, consists of 28 items, with four items per domain. The seven domains of the FACT are: general, physical, psychological, hypervigilance, cognitive, social and work.

Conclusion: The FACT has been developed to evaluate fear avoidance behaviour following concussion and has content validity. Future research should evaluate other measurement properties before implementation.

Effective youth sport injury interventions exist, but their use in applied settings is limited by low coach adherence and lack of contextual adaptation. To address this, the #Utviklingsklar intervention was developed, a club-based intervention for youth handball and football, based on interdisciplinary programme theory and collaboration with sport organisation partners and user groups (club leaders, coaches, parents, players). The intervention supports coaches and club leaders in developing team-specific plans to improve injury-preventive practices for warm-up, strength training and pain and injury management. This qualitative feasibility study, based on observation and interview data, examines the acceptability, practicality, possibilities and challenges of #Utviklingsklar's e-learning and workshop activities. Three workshops led by physiotherapists were observed, involving 23 participants (17 coaches, three club leaders and three workshop leaders). Subsequently, 15 participants consented to be interviewed, comprising 10 coaches, two club leaders and three workshop leaders. Data were analysed using deductive thematic analysis principles. The e-learning was found to be user-friendly, accessible and relevant, while the workshop was valued for fostering discussions and collaboration around team-specific injury prevention plans and practices. However, some coaches sought more tailored content (ie, topics related to their own specific training sessions and players), and workshop leaders expressed a need for additional preparation and practice time to feel confident in their roles. Improved communication of #Utviklingsklar's flexible approach, along with enhanced preparation and practice for workshop leaders in supporting coaches' and club leaders' development of team-specific plans and practices, is needed to enhance understanding and engagement across clubs.

Objective: Recovery duration following adolescent sport-related concussion (SRC) is variable. Previous research revealed exercise intolerance is associated with delayed recovery (predominantly male Australian cohort). Additional sport contexts and considerations of sex are necessary. This study investigated sex-specific associations between exercise intolerance and time-to-medical clearance to return-to-sport (RTS) following SRC in adolescents (ages 10-19).

Methods: Adolescent athletes participating in the pan-Canadian SHRed Concussions cohort study were included within 14 days following a physician diagnosed SRC. Participants completed the Buffalo Concussion Treadmill Test (BCTT). Pre-BCTT Sport Concussion Assessment Tool 5 (SCAT5) Symptom Severity Score (SSS;/132) and concussion Overall Condition score (OC;/10) were recorded. Termination criteria for BCTT were participants who experienced ≥3/10 increase for OC (exercise intolerant) or reached volitional fatigue (≥180bpm, ≥18/20 rating of perceived exertion, exercise tolerant).

Results: 281 adolescents (126 male and 155 female), of whom 204 (72.6%) (100 male (79.4%), 104 female (67.1%)) were exercise tolerant and 77 (27.4%) (26 male (20.6%), 51 female (32.9%)) were intolerant following SRC. Based on the point estimate, females had a 1.45 times higher risk of exercise intolerance compared with males (risk ratio=1.45, 95% CI 0.96 to 2.20). Exercise intolerance was associated with a 36% longer medical clearance time to RTS following SRC for females (time ratio=1.36, 95% CI 1.12 to 1.64), while for males, no association was observed (time ratio=1.13, 95% CI 0.90 to 1.42) (adjusted for age, BCTT duration, SCAT5 SSS and days from SRC to BCTT).

Conclusion: Exertion testing may identify female adolescents at higher risk of delayed medical clearance recovery to RTS, informing the comprehensive clinical management of SRC.

Despite the developmental benefits of sport in adolescence, injury is common and can have a profound impact beyond just physical symptoms. This qualitative study aims to explore the lived experiences of adolescent athletes with sports- related injury in Ireland. This was a qualitative study using one-on-one semi-structured interviews and a phenomenology method. Twenty-one secondary school students from across the Island of Ireland aged 15-18 years who had experienced a sports-related injury within the last 2 years agreed to take part. Reflexive thematic analysis was used to analyse the collected data. Seventeen adolescents (eight female, mean age 16.2 (range 15-18) years) from five different sports were included for analysis. Predominantly negative experiences were described with four overarching themes identified through thematic analysis: playing through pain and injury, the social influence on playing through pain and injury behaviour, the psychological impact of sports injury and player confidence and its role in returning to sport. In conclusion, a culture of playing through pain and even injury is widely accepted in adolescent sports and is influenced by the social circles that surround these young athletes. The impact of sports injury goes beyond just the physical, with these athletes experiencing devastation and a loss of identity due to their absence from sport. Sports coaches can help reduce this negative impact by keeping injured players involved in the team/sport as much as possible. Conversely, sports injury also provided opportunity for personal growth in some cases, improving mental resilience and self-reliance.

Objective: Junior Australian football players with sport-related concussion (SRC) often do not access optimal healthcare. We aimed to evaluate the feasibility of an industry-supported healthcare programme that removed financial and logistical barriers to accessing care for SRC and adherence to the Australian Football League's (AFL) SRC management guidelines.

Methods: Junior Australian football players (from a Melbourne-based league of 9852; under 8-18 competitions) who sustained a suspected or diagnosed SRC during the 2023 season were recruited. Players underwent assessment and management for SRC by a sport and exercise medicine registrar, including return to school and play planning in accordance with the AFL guidelines. Outcomes included programme demand, implementation, acceptability and adherence to the AFL's guidelines (median, (range) days for return to school, training and play).

Results: From 154 eligible players, 58 (37.7%) participated, resulting in a weekly demand of 4.1 players (95% CI 3.1 to 5.2). 49 players were diagnosed with an SRC, and 9 players were cleared for SRC at their initial appointment. 44 players with SRC (89.8%) adhered to all medical advice and returned to play after receiving a medical clearance. All players returned to school (1 (0-10) days), unrestricted training (16 (2-53) days) and play (21 (7-63) days).

Conclusion: The low programme demand indicates financial constraints and/or access to medical practitioners are not the main barriers for players with suspected SRC to formally seek healthcare in a metropolitan context. Those who did participate demonstrated high levels of appointment attendance, acceptability and adherence to AFL guidelines.