Physical Therapy in Sport 36 (2019) 62e67 Contents lists available at ScienceDirect Physical Therapy in Sport journal homepage: www.elsevier.com/ptsp Original Research Physical Therapy Service delivered in the Polyclinic During the Rio 2016 Paralympic Games Christiane S. Guerino Macedo a, b, Felipe F. Tadiello b, Leonardo T. Medeiros b, * Marcio C. Antonelo b, Marco A. Ferreira Alves b, c, Luciana D. Mendonça d, b, a Physical Therapy Department, State University of Londrina, Brazil b Sociedade Nacional de Fisioterapia Esportiva (SONAFE), Sao~ Paulo, Brazil c Physical Therapy Department, Universidade Santa Cecília (UNISANTA), Santos, Brazil d Physical Therapy Department, School of Biologic and Health Sciences, Universidade Federal dos Vales do Jequitinhonha e do Mucuri (UFVJM), Diamantina, Brazil article info abstract Article history: Objective: To characterize the Physical Therapy Services delivered at the Polyclinic during the Rio 2016 Received 10 August 2018 Paralympic Games. Received in revised form Design: Retrospective Cohort Study. 8 January 2019 Setting: Physical Therapy Services (PTS) of the Polyclinic. Accepted 10 January 2019 Participants: Athletes attended for Physical Therapy treatment at the Polyclinic during Rio 2016 Para- lympic Games. Keywords: Main outcome measures: The number of athletes treated, their nationalities, their sports modality, the Epidemiology Physical therapy modalities most frequently treated regions and the interventions applied. Rehabilitation Results: A total of 4504 interventions were delivered and 399 athletes were treated in the PTS. Athletes representing athletics and sitting volleyball were the most frequently attended for treatment. The main diagnoses were muscle tension and tendinopathy. Analgesia was the main purpose of treatment and myofascial release and electrotherapy was the most frequent interventions. Recovery service had a total of 1579 encounters and male athletes used cryo-immersion 3 times more when compared to female. Conclusion: Athletes representing athletics and sitting volleyball were the most frequently attended for treatment and the thoracic/lumbar spine and pelvis/hip were the most commonly affected regions. Muscle strain and tendinopathy were the most frequent diagnoses and myofascial release and electro- therapy were the most frequent therapies used to achieve analgesia. © 2019 Elsevier Ltd. All rights reserved. 1. Introduction Athletes with different etiologies/sequels compete in Paralympic modalities and each athlete has a functional classification accord- The Paralympic Games demonstrates that being an athlete with ing to an activity limitation resulting from impairment (Interna- an impairment does not preclude high-level sporting practice tional Paralympic Committee medical code. IPC Handbook; Phillips, (Muther, Williamson, & Williamson, 2014). In the Rio 2016 Para- Squair, & Krassioukov, 2017). Rio 2016 Paralympic Games had an lympic Games, 4328 athletes (2657 men and 1671 women) from increment of 2 modalities (triathlon and canoe) and an increased 159 countries competed in 22 modalities, with 220 world records number of athletes participating and records achieved comparing and 432 Paralympic records (www.paralympic.org/rio-2016). to London 2012 (www.paralympic.org/rio-2016). The increased level of competition and increment of new modalities requires a greater understanding of the most common sports injuries and the * Corresponding author. Physical Therapy Department, School of Biologic and type of demand that physical therapist need to deal during the Health Sciences, Universidade Federal dos Vales do Jequitinhonha e do Mucuri, competition. MGT 367 road Km 583, nº 5000 Alto da Jacuba, CEP 39100-000, Diamantina, Minas Knowledge about sports injuries and general health are Gerais, Brazil. considered the first step to promote prevention, immediate care E-mail addresses: [email protected], lucianademichelis@gmail. and rehabilitation (Palmer-Green & Elliott, 2015). London com (L.D. Mendonça). https://doi.org/10.1016/j.ptsp.2019.01.003 1466-853X/© 2019 Elsevier Ltd. All rights reserved. C.S.G. Macedo et al. / Physical Therapy in Sport 36 (2019) 62e67 63 Paralympic Games in 2012 had an overall injury rate of 12.7 in- improve the service flow for the next one. juries/1.000 days of training/competition (Willick et al., 2013). The The PTS in the Polyclinic was separated in seven rooms: three modality that had the highest injury rate was five-a-side football for assessments and individual procedures (physical therapy, (for athletes with visual disability) with 22.4 injuries/1.000 days. osteopathy, and chiropractic), one electrotherapy room, one cryo- The regions with the highest injury incidence were the shoulder immersion room, one massage room, and one kinesiotherapy (17.7%), followed by wrist/hand (11.4%), elbow (8.8%), and knee gymnasium. The Physical Therapy room (approximately 140 m2) (7.9%). Although previous studies have been carried out about had 10 treatment tables with electrotherapy equipment including injury epidemiology during the Paralympic Games, no reports on ultrasound, interferential, laser, superficial heat, cryo-compression the Physical Therapy Service (PTS) characteristics, especially the and shockwave therapy. The kinesiotherapy gymnasium (approxi- Polyclinic according to our knowledge. Reynolds, Stirk, Thomas and mately 140 m2) had kinesiotherapy equipment and antigravity Geary (1994) described the organization of medical and PTS of the treadmills (AlterG). The cryo-immersion room (approximately English delegation during the Paralympic Games in Barcelona. 200 m2) had 12 bathtubs coupled to filtering and temperature Gawronski, Sobiecka, and Malesza (2013) described the character- control machines. Finally, the massage room had 10 treatment ta- istics of injuries and health conditions of Polish athletes during the bles and screens to allow athlete's privacy. Beijing and London Paralympic Games. Moreover, Derman et al. The referral system of the Polyclinic was the following: the (2018) analyzed the medical data of the teams and described the doctor was the first contact in case of any injury/complain, then he/ incidence of injury in the pre-competition and competition periods she referred the athlete to the physical therapist; in case of recovery of the Rio 2016 Paralympic Games. Information about injuries could (massotherapy and cryo-immersion), the physical therapist was the guide the Organizing Committee on the acquisition of proper first contact. The athlete was assessed and the physical therapist equipment and materials to treat the athletes and deliver a high- registered the information related to their characterization (name, quality service during the Games. age, sex, country, modality) and the assessment performed (injury The organization of the PTS during the Paralympic Games needs mechanism, region to be treated and intervention implemented). to offer the best interventions for prevention, rehabilitation and Some interventions followed a standardization procedure. For recovery. The proper care in the Polyclinic could influence athlete's example, cryo-immersion was applied according to Machado et al. performance and the competition level of the Paralympic Games (2016) protocol of 11e15 min with a controlled temperature be- (Grant et al., 2014). The knowledge about how previous games were tween 11 and 15 and massotherapy session was comprised by a organized and the type of demand delivered may help, together relaxation massage for 30 min maximum. with evidence-based interventions, future services during major sports events. Therefore, the purpose of this study was to charac- 2.3. Data collection terize the PTS delivered at the Polyclinic during the Rio 2016 Paralympic Games, specifically indicating the number of PTS en- The LOCOG trained the physical therapists about how to register counters per day, distribution of athletes' nationalities, their sports the information related to athlete's assessment and interventions modalities, regions treated, most frequent diagnoses, treatment delivered. To achieve a standardized registration, the LOCOG prin- purposes, most commonly applied interventions and recovery ted specific paper forms, prior to the games, for register the infor- characteristics. mation of each athlete. The form included the following items: name, country, sex, sport modality, clinical diagnosis, description 2. Materials and methods and localization of injury/complain, physical therapy assessment, treatment purposes, interventions performed on each session. At 2.1. Setting the end of each day, some members of the PTS transferred the in- ® formation of each form into Excel sheets, using codes to enhance This retrospective cohort study was developed using the data- data analysis. Since each session was signed by the physical ther- base of the Paralympic Games Rio 2016, in Rio de Janeiro city, Brazil. apist responsible for the treatment, a supervisor ensured that at the The Local Organizing Committee of the Games (LOCOG) authorized end of each session, the therapist fulfill all information about the our access to their database. All information was treated with strict treatment in the form. The supervisor checked all forms constantly confidence during the development of this study and the PTS and in case of missing data, he/she asked to the physical therapist database was anonymized at the end of the Paralympic Games. This responsible about the missing information. study was approved by The University's Ethics in Research