What is risk management?

Transcription

1 From postseason injury analysis through pre-season screening risk management in the team setting Roald Bahr MD PhD Professor & chair, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, NORWAY Chief Medical Officer, Medical Department, Olympic Training Center & Norwegian Olympic Committee, Oslo, NORWAY What is risk management? 1

2 Stage 1: Risk factors (intrinsic/extrinsic) Epidemiological studies Preventive interventions Stage 2: Risk estimation Risk mitigation Risk perception Stage 3: Risk evaluation Unacceptable level of risk Therapeutic interventions Acceptable level of risk Communicate risks to the sports community Fuller. Clin J Sport Med 17: 182 7, 2007 Drawer & Fuller. Br J Sports Med. 36: ,

3 Injury days & team success Number of injury days Elite division (n=9) Division I (n=8) Final league standing Arnason et al. Med Sci Sports Exerc. 26: , 2004 Step 1: Risk identification Step 2: Season analysis Step 3: Athlete risk factor analysis Risk acceptance or mitigation McIntosh & Bahr. Sports Injury Prevention. Blackwell,

4 Step 1: Risk identification Step 2: Season analysis Step 3: Athlete risk factor analysis Risk acceptance or mitigation Reviewing injury reports from at least one season (NHL, Tippeligaen) Reviewing player turnover and availability within one or more seasons Reviewing the literature on injury risks in the specific sport McIntosh & Bahr. Sports Injury Prevention. Blackwell, 2008 Severity Catastrophic SCD Severe ACL injuries Major Hamstring Minor Ankle Insignificant Rare Cuts & bruises Unlikely Moderate Likely Almost certain Likelihood 4

5 Severity Catastrophic SCD Severe ACL injuries Major Hamstring Minor Ankle Insignificant Rare Cuts & bruises Unlikely Moderate Likely Almost certain Likelihood Severity Catastrophic SCD Severe Major ACL injuries ( ) Hamstring ( ) ACL injuries ( ) Hamstring ( ) Minor Ankle Insignificant Rare Cuts & bruises Unlikely Moderate Likely Almost certain Likelihood 5

6 Severity Catastrophic SCD Severe ACL injuries Major Hamstring Minor Ankle Insignificant Rare Cuts & bruises Unlikely Moderate Likely Almost certain Likelihood Step 1: Risk identification Step 2: Season analysis Step 3: Athlete risk factor analysis Formal review of competition & training plan Include review of past experiences Must include full coaching staff Also include player reps/all players? Risk acceptance or mitigation McIntosh & Bahr. Sports Injury Prevention. Blackwell,

7 - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Basic training Training camp 1 Competition Recovery 1. Training camp in Portugal: Two sessions a day Change of surface & climate Everyone very keen to finally train and play on grass high tempo - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Basic training Training camp 2 Competition Recovery 2. New training camp to polish form Several practice games Hard grassy playing fields on Cyprus Competition for a spot on the team - high intensity during competition and training 7

8 - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Basic training Training camp Competition 3 Recovery 3. Start of competitive season Higher tempo Packed competitive schedule Change of surface to soft grass - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Basic training Training camp 4 Competition Recovery 4. Transition to basic training Increase in running on gravel 8

9 Step 1: Risk identification Step 2: Season analysis Step 3: Athlete risk factor analysis Risk acceptance or mitigation PHE: Pre- or postseason? Full functional evaluation of all players Assess relevant risk factors Return-to-play procedures McIntosh & Bahr. Sports Injury Prevention. Blackwell, Precentage of new muscle p<0.001 OR= %CI p<0.001 OR= %CI /74 9/442 10/109 7/414 Previous hamstring No previous hamstring Previous groin No previous groin Arnason et al. Am. J. Sports Med. 32: 5S-16S,

10 18 Precentage of new muscle p=0.009 OR= %CI p=0.002 OR= %CI /212 3/305 7/74 9/445 Previous ankle No previous ankle Previous knee No previous knee Arnason et al. Am. J. Sports Med. 32: 5S-16S, 2004 Example: Hamstring No of players Previous injury No previous injury New injury No injury Total Incidence (%) Relative risk (RR): 13.5 / 2.0 = 6.8 Odds ratio (OR): (10/64)/(9/442) =

11 Example: Hamstring No of players New injury No injury Total (%) Previous injury No previous injury Positive predictive value: 14 % (10/74) Example: Hamstring No of players New injury No injury Total (%) Previous injury No previous injury Negative predictive value: 98% (433/442) 11

12 Step 1: Risk identification Risk acceptance: Insurance Increase team roster Step 2: Season analysis Step 3: Athlete risk factor analysis Risk acceptance or mitigation McIntosh & Bahr. Sports Injury Prevention. Blackwell, 2008 Step 1: Risk identification Step 2: Season analysis Step 3: Athlete risk factor analysis Risk acceptance or mitigation Risk mitigation: Develop prevention program Training program Therapeutic interventions Equipment & facilities Emergency management (staff & equipment) McIntosh & Bahr. Sports Injury Prevention. Blackwell,

13 Step 1: Risk identification Doable, easy Step 2: Season analysis Possible, never tested Step 3: Athlete risk factor analysis Possible, but low specificity Risk acceptance or mitigation Possible??? Roald Bahr and Lars Engebretsen Sports Injury Prevention A concise handbook full of practical information on the prevention of injuries for team physicians, physical therapists, trainers, and allied health personnel Describes how to assess risk factors, understand injury mechanisms and develop targeted programs to reduce the potential for injuries in your team Addresses specific joints and regions of the body while covering all of the Olympic sports and more ISBN pages 29.99/$54.95US Available from Wiley-Blackwell For further information on similar titles visit interscience.wiley.com/onlinebooks 13

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