Occurrence of injuries and illnesses in athletes with a physical impairment; a forty-week prospective cohort study
Prepared by: Marianne Mousigian, MD
Adaptive Sport/Recreation Categories
- Sports for persons with disabilities
- Athletic injuries
- ParathleticsEpidemiology
Study Type: Prospective cohort study
Summary: In order to better understand the prevalence of injuries and illnesses in athletes with disabilities, 99 athletes with a physical impairment were followed for a 40-week health monitoring period during a summer sport season in the Netherlands. Athletes (mean age: 45.5 years, mean years of sports experience: 11.4 years) participated in regular sport or exercise at least once per week and had a physical impairment in one of the following categories: impaired range of motion, limb deficiency, brain disorder, neuromuscular disorder, and spinal cord related disorder. Athletes completed a baseline questionnaire and then completed the Dutch translation of the Oslo Sports Trauma Research Centre Questionnaire on Health Problems every week during this monitoring period. Based upon these self-reports, information regarding injury and illness prevalence, incidence, weekly cumulative severity score, weekly time loss from sport, and the total burden were calculated.
Ultimately, 368 health problems (258 injuries and 110 illnesses) were reported by the 95 athletes who participated in the study. The average weekly prevalence of injuries was 34.6% while the average weekly prevalence of illnesses was 13.4%. Only 3% of athletes reported no health problems over this 40-week period. The overall highest injury prevalence was found in athletes with spinal cord related disorders, though the highest injury burden was seen in athletes with impaired range of motion. The shoulder was the body region most commonly injured except for athletes with a limb deficiency; those with limb deficiencies tended to have residual limb injuries. Wheelchair users had the highest prevalence of upper extremity injuries while ambulatory athletes had their lower extremities affected more commonly. Athletes with neuromuscular disorders had the highest weekly illness prevalence while athletes with a spinal cord related disorder had the highest weekly cumulative severity score. Athletes with impaired passive range of motion reported the highest median time loss of 4.5 days and the highest illness burden.
When evaluating health concerns based upon athlete experience, athletes competing at the national level had the highest weekly injury prevalence, but athletes at the recreational level Reviewer: Marianne Mousigian, MD AACPDM Adapted Sports/Rec Committee July 2024 Journal Article Digest Sub-Committee had the highest average weekly severity score, time loss, and total burden of injuries. Athletes participating at the international competitive level reported highest illness prevalence, but highest illness severity, burden and days lost from sports were reported by athletes participating at a recreational level.
Article Strengths
- The study included a heterogeneous study population in terms of age (19 to 80 years) and experience level (0.5 to 50 years).
- Included a range of sporting activities from recreational to international levels.
- The study was able to determine prevalence of specific injuries and illnesses along with measures of severity based upon athlete impairment and experience level.
Article Weaknesses
- Study relied upon athlete self-report of injuries or illness via emailed survey as opposed to diagnosed health problems made by a health care professional, potentially introducing information bias or incorrect diagnoses.
- Small sample size
- Occurrence of injuries and illnesses was only studied for summer sports
- Athletes with visual, hearing, or intellectual disabilities were excluded, potentially limiting generalizability to these populations.
- The study took place during the COVID-19 pandemic, which could have impacted the number of reported illnesses (risk of falling ill with circulating COVID-19 variant vs possibly decrease in incidence of illness given many risk mitigation measures).
- Challenging categorization of impairments, as not all participants had an International Paralympic Committee (IPC) classification. Some participants may have also had multiple impairments.
- The reported injuries and illnesses may not have been directly related to adaptive sport participation.
Take Home Messages
- This study demonstrates an overall high prevalence of injuries and illnesses over a sport season for athletes with physical impairments across recreational, national, and international athletes.
- The type of injury or illness may be significantly influenced by specific impairment type or by level of sport experience.
Impacts on Clinical Practice
Understanding the extent and severity of health problems encountered by athletes during a sport season is the first step in tailoring measures to prevent these concerns. Furthermore, understanding of specific injury or illness types based upon impairment or experience level may allow for improved individualization of preventative measures. This information will provide valuable education for coaches, individuals with disabilities and their families given the prevalence of these health concerns for athletes competing at recreational, national and international levels.