Dataset Information

A study protocol for the development and internal validation of a multivariable prognostic model to determine lower extremity muscle injury risk in elite football (soccer) players, with further exploration of prognostic factors.

ABSTRACT: Background:Indirect muscle injuries (IMIs) are a considerable burden to elite football (soccer) teams, and prevention of these injuries offers many benefits. Preseason medical, musculoskeletal and performance screening (termed periodic health examination (PHE)) can be used to help determine players at risk of injuries such as IMIs, where identification of PHE-derived prognostic factors (PF) may inform IMI prevention strategies. Furthermore, using several PFs in combination within a multivariable prognostic model may allow individualised IMI risk estimation and specific targeting of prevention strategies, based upon an individual's PF profile. No such models have been developed in elite football and the current IMI prognostic factor evidence is limited. This study aims to (1) develop and internally validate a prognostic model for individualised IMI risk prediction within a season in elite footballers, using the extent of the prognostic evidence and clinical reasoning; and (2) explore potential PHE-derived PFs associated with IMI outcomes in elite footballers, using available PHE data from a professional team. Methods:This is a protocol for a retrospective cohort study. PHE and injury data were routinely collected over 5 seasons (1 July 2013 to 19 May 2018), from a population of elite male players aged 16-40?years old. Of 60 candidate PFs, 15 were excluded. Twelve variables (derived from 10 PFs) will be included in model development that were identified from a systematic review, missing data assessment, measurement reliability evaluation and clinical reasoning. A full multivariable logistic regression model will be fitted, to ensure adjustment before backward elimination. The performance and internal validation of the model will be assessed. The remaining 35 candidate PFs are eligible for further exploration, using univariable logistic regression to obtain unadjusted risk estimates. Exploratory PFs will also be incorporated into multivariable logistic regression models to determine risk estimates whilst adjusting for age, height and body weight. Discussion:This study will offer insights into clinical usefulness of a model to predict IMI risk in elite football and highlight the practicalities of model development in this setting. Further exploration may identify other relevant PFs for future confirmatory studies and model updating, or influence future injury prevention research.

SUBMITTER: Hughes T

PROVIDER: S-EPMC6751574 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A study protocol for the development and internal validation of a multivariable prognostic model to determine lower extremity muscle injury risk in elite football (soccer) players, with further exploration of prognostic factors.

Hughes Tom T Riley Richard R Sergeant Jamie C JC Callaghan Michael J MJ

Diagnostic and prognostic research 20190919

<h4>Background</h4>Indirect muscle injuries (IMIs) are a considerable burden to elite football (soccer) teams, and prevention of these injuries offers many benefits. Preseason medical, musculoskeletal and performance screening (termed periodic health examination (PHE)) can be used to help determine players at risk of injuries such as IMIs, where identification of PHE-derived prognostic factors (PF) may inform IMI prevention strategies. Furthermore, using several PFs in combination within a multi ...[more]

PMID: 31548994

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Project description:BACKGROUND:In elite football (soccer), periodic health examination (PHE) could provide prognostic factors to predict injury risk. OBJECTIVE:To develop and internally validate a prognostic model to predict individualised indirect (non-contact) muscle injury (IMI) risk during a season in elite footballers, only using PHE-derived candidate prognostic factors. METHODS:Routinely collected preseason PHE and injury data were used from 152 players over 5 seasons (1st July 2013 to 19th May 2018). Ten candidate prognostic factors (12 parameters) were included in model development. Multiple imputation was used to handle missing values. The outcome was any time-loss, index indirect muscle injury (I-IMI) affecting the lower extremity. A full logistic regression model was fitted, and a parsimonious model developed using backward-selection to remove factors that exceeded a threshold that was equivalent to Akaike's Information Criterion (alpha 0.157). Predictive performance was assessed through calibration, discrimination and decision-curve analysis, averaged across all imputed datasets. The model was internally validated using bootstrapping and adjusted for overfitting. RESULTS:During 317 participant-seasons, 138 I-IMIs were recorded. The parsimonious model included only age and frequency of previous IMIs; apparent calibration was perfect, but discrimination was modest (C-index = 0.641, 95% confidence interval (CI) = 0.580 to 0.703), with clinical utility evident between risk thresholds of 37-71%. After validation and overfitting adjustment, performance deteriorated (C-index = 0.589 (95% CI = 0.528 to 0.651); calibration-in-the-large = - 0.009 (95% CI = - 0.239 to 0.239); calibration slope = 0.718 (95% CI = 0.275 to 1.161)). CONCLUSION:The selected PHE data were insufficient prognostic factors from which to develop a useful model for predicting IMI risk in elite footballers. Further research should prioritise identifying novel prognostic factors to improve future risk prediction models in this field. TRIAL REGISTRATION:NCT03782389.

Project description:Hamstring injuries remain the most common injury type across many professional sports. Despite a variety of intervention strategies, its incidence in soccer players playing in the UEFA Champions League has increased by 4% per year over the last decade. Test batteries trying to identify potential risk factors have produced inconclusive results. The purpose of the current study was to prospectively record hamstring injuries, to investigate the incidence and characteristics of the injuries, and to identify possible risk factors in elite male soccer players, playing in the Kosovo national premier league. A total of 143 soccer players from 11 teams in Kosovo were recruited. To identify possible prevalent musculoskeletal or medical conditions a widespread health and fitness assessment was performed including isokinetic strength testing, Nordic hamstring strength test, functional tests, and a comprehensive anamnesis surveying previous hamstring injuries. On average 27.9% of the players sustained at least one hamstring injury with three players suffering bilateral strains with the re-injury rate being 23%. Injured players were significantly older and heavier and had a higher body mass index compared to non-injured ones (p < 0.05). There was a lower passing rate in the Nordic hamstring strength test and a higher injury incidence among the previously injured players compared to non-injured ones (p < 0.05). Except for hamstring/quadriceps ratio and relative torque at 60°/sec (p < 0.05) for dominant and non-dominant leg, there were no other significant differences in isokinetic strength regardless of the angular velocity. No differences were observed for functional tests between cohorts. Regression analysis revealed that age, Nordic hamstring strength test, previous injury history, and isokinetic concentric torque at 240°/sec could determine hamstring injuries by 25.9%, with no other significant predicting risk factors. The battery of laboratory and field-based tests performed during preseason to determine performance related skills showed limited diagnostic conclusiveness, making it difficult to detect players at risk for future hamstring injuries.

Project description:The purpose of the present study was to investigate the explosive strength and endurance adaptations in young elite soccer players who underwent a supervised training program for a period of two years. Nineteen players, with seven years of training experience (age: 13.3 ± 0.1 years; body weight: 57.9 ± 4.9 kg; height: 168.9 ± 4.7 cm; BMI: 20.1 ± 1.1 kg/m2), voluntarily participated in the present study. The testing sessions were performed at the beginning of the preparation period in the first (T1), second (T2), and third year (T3). The following performance variables were measured: explosive strength [squat-jump (SJ) and counter-movement-jump (CMJ)], pre-stretch augmentation (CMJ-SJ), leg stiffness [hopping test (HT)], short sprint performance [15 m (SSP15) and 30 m (SSP30)], aerobic endurance [test of Leger (VO2max)], maximal heart rate [at the last step of Leger (HR)], and speed-strength endurance [continuous counter-movement-jumps (CCMJ)]. A significant main effect on the VO2Max (+5.72%; F(2.49) = 3.822; p = 0.029; ES = 1.00), HR (-1.70%; F(2.54) = 3.472; p = 0.038; ES = 0.97), CCMJ (+7.64%; F(2.54) = 5.438; p = 0.007; ES = 1.15), SJ (+10.26%; F(2.54) = 15.254; p = 0.0001; ES = 1.53), CMJ (+7.36; F(2.54) = 8.270; p = 0.001; ES = 1.33), HT (+8.34%; F(2.48) = 3.297; p = 0.046; ES = 1.01), SSP15 (-3.50%; F(2.44) = 12.760; p = 0.0001; ES = 1.53), and SSP30 (-4.44%; F(2.44) = 5.797; p = 0.006; ES = 1.16) was observed in the two soccer seasons. These results highlight that, in long-term training, the monitoring of the adaptive responses in relation to the training load may provide a guideline to optimize the trainability of some performance variables in young elite soccer players (13-15 years). In the present study, we cannot exclude the influence of growth and maturation on some performance variables; therefore, the monitored adaptive responses should be considered as the possible results of an interaction between the applied training load and maturation.

Project description:Soccer players are required to anticipate and react continuously in a changing, relatively unpredictable situation in the field. Cognitive functions might be important to be successful in soccer. The current study investigated the relationship between cognitive functions and performance level in elite and sub-elite youth soccer players aged 13-17 years. A total of 47 elite youth soccer players (mean age 15.5 years, SD = 0.9) and 41 sub-elite youth soccer players (mean age 15.2 years, SD = 1.2) performed tasks for "higher-level" cognitive functions measuring working memory (i.e., Visual Memory Span), inhibitory control (i.e., Stop-Signal Task), cognitive flexibility (i.e., Trail Making Test), and metacognition (i.e., Delis-Kaplan Executive Function System Design Fluency Test). "Lower-level" cognitive processes, i.e., reaction time and visuo-perceptual abilities, were also measured with the previous tasks. ANOVA's showed that elite players outscored sub-elite players at the "higher-level" cognitive tasks only, especially on metacognition (p < .05). Using stepwise discriminant analysis, 62.5% of subjects was correctly assigned to one of the groups based on their metacognition, inhibitory control and cognitive flexibility performance. Controlling for training hours and academic level, MANCOVA's showed differences in favor of the elite youth soccer players on inhibitory control (p = .001), and cognitive flexibility (p = .042), but not on metacognition (p = .27). No differences were found concerning working memory nor the "lower-level" cognitive processes (p > .05). In conclusion, elite youth soccer players have better inhibitory control, cognitive flexibility, and especially metacognition than their sub-elite counterparts. However, when training hours are taken into account, differences between elite and sub-elite youth soccer players remain apparent on inhibitory control and cognitive flexibility in contrast to metacognition. This highlights the need for longitudinal studies to further investigate the importance of "higher-level" cognitive functions for talent identification, talent development and performance in soccer.

Dataset Information

A study protocol for the development and internal validation of a multivariable prognostic model to determine lower extremity muscle injury risk in elite football (soccer) players, with further exploration of prognostic factors.

Publications

A study protocol for the development and internal validation of a multivariable prognostic model to determine lower extremity muscle injury risk in elite football (soccer) players, with further exploration of prognostic factors.

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