DISABILITY SPORT: LESSONS FROM THE PARALYMPICS - Drs Tom Crisp & Nick Webborn
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DISABILITY SPORT: LESSONS FROM THE
PARALYMPICS
Drs Tom Crisp & Nick Webborn
2012 IMPACT AREAS • Medical • Practitioners – ParalympicsGB & LOCOG • Medical Community – Awareness/Publication • Research – Injury & Illness Surveillance • Public • Perception • Participation
INCREASE IN SEM DOCTORS WORKING IN
PARALYMPIC SPORT
• Atlanta Paralympic Games 1996
Now c. 100 Doctors with
• 3 Doctors with BPA
• No longitudinal support for sports
• Lead up to 2012
Paralympic Sport
• Drs employed within many sports part/full-time
• Career choice of choosing to work in Paralympic Sport
• SEM Trainees – provided mentored SEM support to minority sports who
experience in UK
previously had no medical support
• London Paralympic Games 2012
• PGB 11 Doctors - 4 in Core Team, 11 embedded within sports
• LOCOG – 80 Doctors involved in SEM / Field of Play
NOT JUST DOCTORS BUT ALL DISCIPLINES
-PARALYMPICS GB & SPORT SUPPORT STAFF 2012
Core Sport
•Doctors 4 •Doctors 7
•Physios 4 •Physios 19
•Nurses 3 •Nurses 5
•Physiologists 1
•Nutritionists 3
•Psychologists 2
•Physiologists 2
•Psychologists 11
IMPACT ON FUTURE HEALTHCARE
Improved
More Practitioners Athlete
Care
• Knowledge Improved Mx
• Skills Disability &
• Experience Physical Activity?
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Home | Journals | Content Collections
The Lancet, Volume 380, Issue 9836, Pages 65 - 71, 7 July 2012
doi:10.1016/S0140-6736(12)60831-9 Cite or Link Using DOI
This article can be found in the following collection: Public Health
Copyright © 2012 Elsevier Ltd All rights reserved.
Paralympic medicine
Dr Nick Webborn MBBS a b , Peter Van de Vliet PhD c d
Summary
Paralympic medicine describes the health-care issues of those 4500 or so at
sports at the Summer Paralympic Games and in five sports at the Winter Pa
six impairment groups: amputation or limb deficiencies, cerebral palsy, spin
intellectual impairment, or a range of physically impairing disorders that do
as les autres. The variety of impairments, many of which are severe, fluctu
rare), makes maintenance of health in thousands of Paralympians while the
health-care resources. The increased physical fitness of athletes with disab
reduction in a population for whom the prevalence of risk factors can be hi
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ILLNESS & INJURY SURVEILLANCE AT 2012 PARALYMPIC GAMES
SPORTS INJURY PREVENTION
1. Establishing the extent of
2. Establishing the
the problem:
aetiology and mechanism
•Incidence of sports injury
•Severity
4. Assess effectiveness of 3. Introducing a
intervention by repeating preventive measure
1.
van Mechelen W, Hlobil H, Kemper HC. Incidence, severity, aetiology and prevention of sports injuries.
A review of concepts. Sports Med. 1992;14:82-99.INJURY SURVEY
CO-AUTHORS
• Martin Schwellnus - South • Norma-Angelica Patino
Africa Marques - Mexico
• Wayne Derman • Oriol Martinez-Ferrer -
• Esme Jordaan Spain
• Jaap Stomphorst -
• Cheri A Blauwet - USA
Netherlands
• Stuart E Willick
• Carolyn Emery - Canada
• Pia Pit-Grosheide – Germany
• Nick Webborn - UK
• Peter Van de VlietINJURY & ILLNESS SURVEY Research ethics approval for the study: • University of Brighton (FREGS/ES/12/11) • University of Cape Town Health Sciences Research Ethics Committee (HREC/REF 436/2012).
DEFINITIONS • A medical illness was defined as ‘any newly acquired illness as well as exacerbations of pre-existing illness that occurred during training or competition, and during or immediately before the London 2012 Paralympic Games’. • An injury is defined as ‘any sport-related musculoskeletal or neurological complaint prompting an athlete to seek medical attention, regardless of whether or not the complaint resulted in lost time from training or competition’.
INJURY & ILLNESS SURVEY • Daily data obtained from: 1. Teams with their own medical support who completed a daily illness log (78 teams, 3329 athletes) on a web- based system 2. Teams without their own medical support through the local organising committee database (82 teams,236 athletes).
INJURY & ILLNESS SURVEY • 3565 athletes • 160 of the 164 participating countries • 14-day period ( precompetition period=3 days, competition period=11 days) • Total of 49 910 athlete-days
INJURY INCIDENCE & PROPORTION • The incidence of illness/injury was calculated as illness/injury per 1000 athlete-days (IR) • The incidence proportion (IP) refers to the percentage of athletes reporting an illness/injury by sport, gender or age group. IP was calculated as the number of illnesses/injuries per 100 athletes in the subgroup(s) (%).
IPC INJURY SURVEY Willick SE, Webborn N, Emery C, et al. Br J Sports Med 2013
IPC INJURY SURVEY • 633 injuries in 539 athletes • Overall IR was 12.7 injuries/1000 athlete days (95% CI 11.7 to 13.7). Willick SE, Webborn N, Emery C, et al. Br J Sports Med Published Online First doi:10.1136/bjsports-2013- 092374
IPC INJURY SURVEY • Injury rates were similar in male and female athletes. • Overall 51.5% of injuries were new onset acute traumatic injuries. • The most commonly injured region ( percentage of all injuries) was the shoulder (17.7%), followed by the wrist/hand (11.4%), elbow (8.8%) and knee (7.9%). Willick SE, Webborn N, Emery C, et al. Br J Sports Med Published Online First doi:10.1136/bjsports-2013- 092374
INJURY RATE BY SPORT
IPC INJURY SURVEY • Higher injury rates were found in older athletes • Higher injury rates in certain sports : ! Football 5-a-side - 22.4 injuries/1000 athlete-days ! Goalball – 19.5 injuries/1000 athlete-days ! Powerlifting - 19.3 injuries/1000 athlete-days ! Wheelchair fencing - 18.0 injuries/1000 athlete-days ! Wheelchair rugby- 16.3 injuries/1000 athlete-days Willick SE, Webborn N, Emery C, et al. Br J Sports Med Published Online First doi:10.1136/bjsports-2013- 092374
5% OF INJURIES IN COMPETITION DUE TO FOUL PLAY
IPC ILLNESS SURVEY Schwellnus M, et al. Br J Sports Med 2013;00:1–8. doi:10.1136/bjsports-2013-092371
INCIDENCE RATE OF ILLNESSES • 657 illnesses were reported in 505 athletes (IP=14.2%) • Pre-competition period - 156 illnesses were reported in 140 athletes (IP=3.9%) • Competition period - 501 illnesses were reported in 401 athletes (IP=10.2%) • The overall IR of illness in female athletes was 14.4 (95% CI 12.6 to 16.3) and in male athletes 12.5 (95% CI 11.4 to 13.8; NS; p=0.158) • Similar IP male and female athletes athletes
Sports > 20% Sports < 10%
SPORT – HIGHEST RISK OF ILLNESS • Athletes in the sport of athletics (independent of age and gender) have a significantly higher risk of illness compared with Paralympic athletes participating in other sports (p=0.012). • Why??
INCIDENCE RATE OF ILLNESSES
SUMMARY OF FINDINGS • Age and gender were not independent predictors of illness in Paralympic athletes • Illness rates generally higher than studies in able-bodied athletes • Overall respiratory illnesses most common but… • Non-respiratory illnesses overall are more common than respiratory - higher than studies in able-bodied athletes • Skin and subcutaneous tissue were the most commonly affected system in wheelchair basketball, powerlifting and sitting volleyball
Additional 5472 steps / day when at a Paralympic Games (83% increase over normal day)
STRENGTHS & LIMITATIONS
• Largest study to date reporting injuries • A similar number of illnesses can
and illnesses in summer Paralympic be anticipated
sports
• Different data sources
• Illness and injury rates and proportions
• Difficulty assessing severity
reported
• No impairment / classification
• Good compliance; 98% of delegations
data – 110 different classes
84% of athletes
across 20 sports
• Direct clinical relevance - A clinician
travelling to a 10-day event with 100
Paralympic athletes can anticipate
seeing about 12–13 injuries, about half
of which will be new onsets, acute
injuries.WHY ILLNESS & INJURY SURVEILLANCE?
• Individual
• Squad/Team Translational Research
Identifying problem areas
Highlights areas for further research
in Van Mechelen model
Translates into improving athlete healthPUBLIC PERCEPTION
DID THE 2012 GAMES BRING ABOUT
CHANGES IN PARTICIPATION/PERCEPTION
OF DISABILITY?CHANGES IN SPORT PARTICIPATION/INTEREST • Local Government Association survey in March 2013 showed 5% of councils saw a large increase in users with a disability, and 28% a small increase. • 8 out of 10 disabled people are considering taking up sport following the Games (C4 and EFDS) • 70% of disabled people agree that the London 2012 Paralympic Games was inspirational for them (C4 and EFDS)
CHANGES IN SPORT PARTICIPATION/INTEREST • During 2012 402% increase in the number of people using the Club Finder on Parasport compared to activity in the same period the previous year • During 2012 725% increase in people using the self-assessment wizard on the site • During Games 800 new clubs loaded onto Parasport website www.parasport.org.uk
CHANGES IN PERCEPTIONS • Three Paralympians nominated for BBC Sports Personality of the Year – first time ever. • The London 2012 Paralympics were “more inspiring” for kids than the Olympics, according to more than 50% of the 8-12 year-olds asked by Newsround. • The survey also suggests that the Paralympics also had a profound effect on children across the UK. Nearly 7/10 said that the Paralympic Games had changed the way they view disabled people.
CHANGES IN PERCEPTIONS • Two thirds of British workers believe London 2012 created a lasting legacy for disabled. • Research by Nationwide Building Society found 65 per cent of Britons believe disabled people are better recognised as being able to lead normal lives and achieve at work, while 35 per cent said the barriers disabled people have faced in work, including access to work and promotion, are less significant than they were before the Games.
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