Sports-related injuries and illnesses in Paralympic athletes Fagher, Kristina 2019 Document Version: Publisher's PDF, also known as Version of record Link to publication Citation for published version (APA): Fagher, K. (2019). Sports-related injuries and illnesses in Paralympic athletes. Lund University: Faculty of Medicine. 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LUND UNIVERSITY PO Box 117 221 00 Lund +46 46-222 00 00 KRISTINA FAGHER Author information Sports-related injuries and illnesses in Paralympic athletes As Paralympic athletes’ performances and professionalism are steadily impro- ving, there is an increasing need to understand the epidemiology of sports-re- lated injuries and illnesses in Paralympic athletes. Being injured or ill when you already have an existing impairment, sometimes even acquired from sports, can be particularly challenging for the athlete. Therefore, the overall aim of this thesis was to describe and gain an in-depth understanding of the epidemio- logy of sports-related injuries and illnesses in Swedish Paralympic athletes, in order to assist the future development of evidence-based preventive measures adapted for Paralympic athletes. Kristina Fagher (born 1986) is a certified Sports Physiothera- pist from Sweden. She started her studies in Physiotherapy at Lund University in 2007, was an exchange student at Melbourne Sports-related injuries and University in 2009, and com- pleted her bachelor degree in 2010. She has been working as illnesses in Paralympic athletes a clinical Physiotherapist within KRISTINA FAGHER orthopedics, sports medicine DEPARTMENT OF HEALTH SCIENCES | FACULTY OF MEDICINE | LUND UNIVERSITY and primary care since 2010, and she is since 2014 employed by Vårdhuset Malmö City. She completed her Master’s degree in Sports Science and Medicine at Lund University in 2012, and started her doctoral studies at the Department of Health Sciences, Lund University in 2014. In 2013, she started to work with Parasport Sweden and the Swedish Paralympic Committee, and has since then been supporting Paralympic athletes at several championships around the world. She is a current member of the medical committees of Pa- rasport Sweden and the Swedish Paralympic Committee, and the International Blind Sports Association (IBSA). Faculty of Medicine Department of Health Sciences Rehabilitation Medicine Research Group 198452 Lund University, Faculty of Medicine 2019:116 Doctoral Dissertation Series 2019:116 ISBN 978-91-7619-845-2 789176 ISSN 1652-8220 9 Sports-related injuries and illnesses in Paralympic athletes Kristina Fagher DOCTORAL DISSERTATION by due permission of the Faculty of Medicine, Lund University, Sweden. To be defended at H01, Health Sciences Centre, Baravägen 3, Lund. December 6th, 2019 at 1.00 p.m. Faculty opponent Professor Roland Thomeé, Department of Health and Rehabilitation at Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University Organization Document name LUND UNIVERSITY DOCTORAL DISSERTATION Department of Health Sciences Rehabilitation Medicine Research Group Date of issue 2019-12-06 Author(s): Kristina Fagher Sponsoring organization Title and subtitle: Sports-related injuries and illnesses in Paralympic athletes Abstract: Elite sport poses the athlete at a risk for sustaining a sports-related injury or illness. As Paralympic athletes’ performances and professionalism are steadily improving, there is an increasing need to understand the epidemiology of sports-related injuries and illnesses in Paralympic athletes. Therefore, the overall aim of this thesis was to describe and gain an in-depth understanding of the epidemiology of sports-related injuries and illnesses in Swedish Paralympic athletes, in order to assist the future development of evidence-based preventive measures adapted for Paralympic athletes. A methodological pluralism was used to assess sports-related injuries and illnesses in Paralympic athletes. First, 18 Swedish Paralympic athletes were interviewed to explore Paralympic athletes´ perceptions of experiences of sports- related injuries. Based on this a study protocol for epidemiological research was structured. An eHealth application for self-reported data collection of injuries and illnesses adapted to Paralympic athletes was developed and evaluated in a pilot feasibility and usability study. Finally, data on retrospective period and point prevalence and weekly annual incidence of injuries, illnesses and athlete health were collected from 107 Swedish Paralympic athletes. The results revealed that Paralympic athletes' perceptions of their experiences of sports-related injuries are complex, and in several ways differ from able-bodied athletes. It was common with injuries related to the impairment, overuse symptoms, and a risk behaviour. Accordingly, all these features need to be considered in epidemiological research of Paralympic athletes, which was described in the study protocol. The method to collect self-reported eHealth based data was feasible and usable, but the content and technique of data collection needed to be adapted to Paralympic athletes' pre-existing impairments and prerequisites. Retrospective data revealed that the 1-year period prevalence of severe injuries was 31%, and the point prevalence of all injuries was 32%. More severe injuries were reported by young athletes, and athletes reporting pain and using analgesics. The behaviours ‘continuing training injured’ and ‘feeling guilt when missing exercise’ were associated with a severe injury. A history of a previous severe injury, having pain, using analgesics and being upset when unable to exercise were associated with a current injury. The period prevalence of severe illnesses was 14%, and 13% of the athletes reported a current illness. A previous severe illness, being female and a history of feeling anxious/depressed were associated with an ongoing illness. Prospective data collected weekly during 52 weeks showed that the annual incidence proportion for injury was 68% and for illness 77%. The injury incidence rate was 6.9/1000 hours of sport exposure and the illness incidence rate 9.3/1000 hours of sport exposure. Most injuries occurred during training and 34% were classified as severe. For 59% of the injuries the impairment was involved in the injury mechanism. An increased injury risk was observed among athletes in team sports, athletes with a previous severe injury and male athletes. The most common illness type was infection (84%). For 28% of the illnesses the impairment was involved in the cause of illness. Athletes in team sports and males with a previous severe illness had a higher illness risk. In conclusion, this thesis reveals that it is feasible and usable to collect self-reported eHealth-based data on sports- related injuries and illnesses in Paralympic athletes. Qualitative and quantitative data demonstrate that sports- related injuries and illnesses among Swedish Paralympic athletes are a concern affecting both the individual athlete as well as athlete availability. The results from this thesis can be used in the development of preventive measures targeting Paralympic athletes. Key words Sports Medicine, Epidemiology, Qualitative research, eHealth, Prevention, Athletic injuries, Illnesses, Sports for persons with disabilities, Paralympic sport, Para sport, Paralympic athletes Classification system and/or index terms (if any) Supplementary bibliographical information Language English ISSN and key title 1652-8220 ISBN 978-91-7619-845-2 Recipient’s notes Number of pages 118 Price Security classification I, the undersigned, being the copyright owner of the abstract of the above-mentioned dissertation, hereby grant to all reference sources permission to publish and disseminate the abstract of the above-mentioned dissertation. Signature Date 2019-10-31 Sports-related injuries and illnesses in Paralympic athletes Kristina Fagher Cover photo by THE SWEDISH PARALYMPIC COMMITTEE Copyright pp 1-118 (Kristina Fagher) Paper 1 © Taylor & Francis, reprinted with permission Paper 2 © Springer Nature, open access Paper 3 © JMIR Publications, open access Paper 4 © Wiley, reprinted with permission Paper 5 © by the Authors (manuscript submitted) Faculty of Medicine Department of Health Sciences Rehabilitation Medicine Research Group ISBN 978-91-7619-845-2 ISSN 1652-8220 Printed in Sweden by Media-Tryck, Lund University, Lund 2019 “Sport has the power to change the world” (Nelson Mandela) Table of Contents Abstract ...................................................................................................................9 List