Epidemiology and associated injury risk factors in figure skating : a systematic review

Abstract

Title: Epidemiology and associated injury risk factors in figure skating: a systematic review Candidate: Natasha Therese Schmidt Supervisor: Carel Thomas Viljoen Co-supervisor: Dina Christa Janse van Rensburg Co-authors on mansucript: Dina Christa Janse van Rensburg, Marlene Schoeman, Manuela Besomi, Audrey Jansen van Rensburg, Susan Scheepers, Dan Garnett, Carel Thomas Viljoen. Degree: M. PhysT Background: Figure skating is a mode of physical activity that is technically and aesthetically demanding, requiring athletes to perform jumps, spins, throws and lifts. The technical demand of figure skating has increased in recent years. The escalated technical demand is predicted to increase the number of figure skaters presenting with injuries. Objective: To identify and critically appraise the available evidence on the epidemiology of injury and injury risk factors in figure skating. Design: Systematic review. Data Source and search strategy: Eight databases were searched for relevant studies from inception 02 June 2022 to 28 April 2023 together with manual reference searching. The search strategy was developed by the lead author under the supervision of a Medical Librarian and the main supervisor. Two sets of keywords were developed to address our research aims. The results of the first set of keywords were combined with an OR operator followed by the second set. Thereafter, an AND operator combined the two sets of keywords. Study Selection Criteria and study selection: Studies reporting on the epidemiology of injury and/or investigating injury risk factors in figure skating were included. The identified studies were imported to EndNote 20 to identify and remove duplicates. Two researchers independently screened the titles and abstracts for potentially eligible studies. The two reviewers then independently screened the full texts of the studies identified as eligible based on title and abstract screening. Any discrepancies in selection between the two reviewers was resolved via consensus. To ensure all potentially relevant studies were included, one reviewer screened the reference lists of all included studies. Data Extraction: The included studies were distributed to four of the six authors for data extraction on a standardized data extraction sheet. One researcher extracted data from all included studies for quality control. Data Analysis: Meta-analysis could not be completed due to the heterogenous nature of the studies. Risk of Bias: Risk of bias (RoB) was assessed using the quality in prognostic factor studies tool. A meeting was held between two authors where each domain and signalling item of the tool was discussed to ensure inter-rater reliability and they optimised the tool for use. The RoB was assessed independently per domain and ranked as either high or a low RoB. Two authors independently assessed the RoB of each included study. Discrepancies were resolved through consensus meeting between the two authors. For the RoB assessment, an observed agreement of 73% for interrater reliability was recorded before the consensus meetings. There was a significant similarity in the ratings of RoB (p<0.001) between the two reviewers, with Cohen’s kappa=0.612 indicating a moderate level of agreement. Results: Twenty-nine studies were included. The prevalence range was 2.1%-34%, and the incidence, of injury was 1.72 per 1000 hours of ice training. The most frequently injured anatomical region was the lower limb, particularly the knee, foot and ankle with the most reported pathology types were fractures and sprains. Significant intrinsic injury risk factors included an older age, previous history of stress fracture and a higher body mass. Significant extrinsic injury risk factors included training more than 12 sessions per week, skipping meals, relative energy deficiency in sports indicators, hamstring and quadriceps immobility, training rather than competing, increased time on-ice time and boot-foot length difference. The quality of evidence on figure skating injuries and injury risk factors is poor. More than half of the studies did not use a validated outcome measure and many of the studies did not consider important confounders. None of the included studies defined injury according to the 2020 IOC consensus statement of recording and reporting injuries and many studies did not follow a recognized conceptual framework or model. Conclusion The incidence of figure skating injuries per 1000 hours was higher than in other artistic sports such as ballet. The most frequently injured anatomical region was the lower limb and the most common pathology types were fractures and sprains. Overall, our review identified three significant intrinsic and eight significant extrinsic risk factors. More consistent data reporting and injury definitions is needed. PROSPERO registration number: CRD42021293641