To summarize 16 years of National Collegiate Athletic Association (NCAA) injury surveillance data for 15 sports and to identify potential modifiable risk factors to target for injury prevention ...initiatives.
In 1982, the NCAA began collecting standardized injury and exposure data for collegiate sports through its Injury Surveillance System (ISS). This special issue reviews 182 000 injuries and slightly more than 1 million exposure records captured over a 16-year time period (1988-1989 through 2003-2004). Game and practice injuries that required medical attention and resulted in at least 1 day of time loss were included. An exposure was defined as 1 athlete participating in 1 practice or game and is expressed as an athlete-exposure (A-E).
Combining data for all sports, injury rates were statistically significantly higher in games (13.8 injuries per 1000 A-Es) than in practices (4.0 injuries per 1000 A-Es), and preseason practice injury rates (6.6 injuries per 1000 A-Es) were significantly higher than both in-season (2.3 injuries per 1000 A-Es) and postseason (1.4 injuries per 1000 A-Es) practice rates. No significant change in game or practice injury rates was noted over the 16 years. More than 50% of all injuries were to the lower extremity. Ankle ligament sprains were the most common injury over all sports, accounting for 15% of all reported injuries. Rates of concussions and anterior cruciate ligament injuries increased significantly (average annual increases of 7.0% and 1.3%, respectively) over the sample period. These trends may reflect improvements in identification of these injuries, especially for concussion, over time. Football had the highest injury rates for both practices (9.6 injuries per 1000 A-Es) and games (35.9 injuries per 1000 A-Es), whereas men's baseball had the lowest rate in practice (1.9 injuries per 1000 A-Es) and women's softball had the lowest rate in games (4.3 injuries per 1000 A-Es).
In general, participation in college athletics is safe, but these data indicate modifiable factors that, if addressed through injury prevention initiatives, may contribute to lower injury rates in collegiate sports.
Objective
To update the projected prevalence of arthritis and arthritis‐attributable activity limitations among US adults, using a newer baseline for estimates.
Methods
Baseline prevalence data were ...obtained from the 2010–2012 National Health Interview Survey. Arthritis was defined as an answer of “yes” to the question “Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus or fibromyalgia?” Arthritis‐attributable activity limitation was defined as an answer of “yes” to the question “Are you limited in any way in any of your usual activities because of arthritis or joint symptoms?” The baseline prevalence of arthritis and arthritis‐attributable activity limitation was stratified according to age and sex and was statistically weighted to account for the complex survey design. The projected prevalence of doctor‐diagnosed arthritis and arthritis‐attributable activity limitation was calculated by multiplying the age‐ and sex‐stratified population estimates projected for 2015–2040 (in 5‐year intervals; provided by the US Census Bureau) by the baseline estimates. Age‐ and sex‐specific prevalences were summed to provide the total prevalence estimates for each year.
Results
In 2010–2012, 52.5 million adults in the US (22.7% of all adults) had doctor‐diagnosed arthritis, and 22.7 million (9.8%) had arthritis‐attributable activity limitation. By 2040, the number of US adults with doctor‐diagnosed arthritis is projected to increase 49% to 78.4 million (25.9% of all adults), and the number of adults with arthritis‐attributable activity limitation will increase 52% to 34.6 million (11.4% of all adults).
Conclusion
Updated projections suggest that arthritis and arthritis‐attributable activity limitation will remain large and growing problems for clinical and public health systems, which must plan and create policies and resources to address these future needs.
To determine if surgical or nonsurgical treatment of anterior cruciate ligament rupture affects the prevalence of posttraumatic tibiofemoral osteoarthritis (OA).
Studies published between 1983 and ...April 2012 were identified via EBSCOhost and OVID. Reference lists were then screened in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
Studies were included if (a) treatment outcomes focused on a direct comparison of surgical versus nonsurgical treatment of anterior cruciate ligament rupture, (b) the prevalence of tibiofemoral OA was reported, and (c) they were written in English. Studies were excluded if (a) the included patients were treated with cast immobilization after surgery, (b) the mean follow-up was less than 10 years, or (c) the patients underwent anterior cruciate ligament revision surgery.
Two independent investigators reviewed the included articles using the Newcastle-Ottawa Scale. Frequency of OA, surgical procedure, nonsurgical treatments, and participant characteristics were extracted and summarized. We calculated prevalence (%) and 95% confidence intervals for treatment groups for each individual study and overall. We developed 2 × 2 contingency tables to assess the association between treatment groups (exposed had surgery, referent was nonsurgical treatment) and the prevalence of OA.
Four retrospective studies were identified (140 surgical patients, 240 nonsurgical patients). The mean Newcastle-Ottawa Scale score was 5 (range = 4-6 of 10 points). Average length of follow-up was 11.8 years (range = 10-14 years). The prevalence of OA for surgically treated patients ranged from 32.6% to 51.2% (overall = 41.4%, 95% confidence interval = 35.0%, 48.1%) and for nonsurgical patients ranged from 24.5% to 42.3% (overall = 30.9%, 95% confidence interval = 24.4%, 38.3%).
Although OA prevalence was higher in the surgical treatment group at a mean follow-up of 11.8 years, no definitive evidence supports surgical or nonsurgical treatment after anterior cruciate ligament injury to prevent posttraumatic OA. Current studies have been limited by small sample sizes, low methodologic quality, and a lack of data regarding confounding factors.
Information regarding the relative risks of developing knee osteoarthritis (OA) as a result of sport participation is critical for shaping public health messages and for informing knee-OA prevention ...strategies. The purpose of this systematic review was to investigate the association between participation in specific sports and knee OA.
We completed a systematic literature search in September 2012 using 6 bibliographic databases (PubMed; Ovid MEDLINE; Journals@Ovid; American College of Physicians Journal Club; Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Review, Database of Abstracts of Reviews of Effects; and Ovid HealthStar), manual searches (4 journals), and reference lists (56 articles).
Studies were included if they met the following 4 criteria: (1) an aim was to investigate an association between sport participation and knee OA; (2) the outcome measure was radiographic knee OA, clinical knee OA, total knee replacement, self-reported diagnosis of knee OA, or placement on a waiting list for a total knee replacement; (3) the study design was case control or cohort; and (4) the study was written in English. Articles were excluded if the study population had an underlying condition other than knee OA.
One investigator extracted data (eg, group descriptions, knee OA prevalence, source of nonexposed controls).
The overall knee-OA prevalence in sport participants (n = 3759) was 7.7%, compared with 7.3% among nonexposed controls (referent group n = 4730, odds ratio OR = 1.1). Specific sports with a significantly higher prevalence of knee OA were soccer (OR = 3.5), elite-level long-distance running (OR = 3.3), competitive weight lifting (OR = 6.9), and wrestling (OR = 3.8). Elite-sport (soccer or orienteering) and nonelite-sport (soccer or American football) participants without a history of knee injury had a greater prevalence of knee OA than nonexposed participants.
Participants in soccer (elite and nonelite), elite-level long-distance running, competitive weight lifting, and wrestling had an increased prevalence of knee OA and should be targeted for risk-reduction strategies.
Previous randomized controlled trials have led to conflicting findings regarding the effects of exercise on depressive symptoms in adults with arthritis and other rheumatic conditions (AORC). The ...purpose of this study was to use the meta-analytic approach to resolve these discrepancies.
The inclusion criteria were: (1) randomized controlled trials, (2) exercise (aerobic, strength training, or both) ≥4 weeks, (3) comparative control group, (4) adults with osteoarthritis, rheumatoid arthritis, fibromyalgia or systemic lupus erythematosus, (5) published studies in any language since January 1, 1981 and (6) depressive symptoms assessed. Studies were located by searching 10 electronic databases, cross-referencing, hand searching and expert review. Dual-selection of studies and data abstraction was performed. Hedge's standardized mean difference effect size (g) was calculated for each result and pooled using random-effects models, an approach that accounts for heterogeneity. Non-overlapping 95% confidence intervals (CI) were considered statistically significant. Heterogeneity based on fixed-effect models was estimated using Q and I (2) with alpha values ≤0.10 for Q considered statistically significant.
Of the 500 citations reviewed, 2,449 participants (1,470 exercise, 979 control) nested within 29 studies were included. Length of training, reported as mean ± standard deviation (±SD) was 19 ± 16 weeks, frequency 4 ± 2 times per week and duration 34 ± 17 minutes per session. Overall, statistically significant exercise minus control group reductions were found for depressive symptoms (g = -0.42, 95% CI, -0.58, -0.26, Q = 126.9, P <0.0001, I(2) = 73.2%). The number needed-to-treat was 7 (95% CI, 6 to 11) with an estimated 3.1 million (95% CI, 2.0 to 3.7) United States adults not currently meeting physical activity guidelines improving their depressive symptoms if they began and maintained a regular exercise program. Using Cohen's U3 Index, the percentile reduction was 16.4% (95% CI, 10.4% to 21.9%). All studies were considered to be at high risk of bias with respect to blinding of participants and personnel to group assignment.
Exercise is associated with reductions in depressive symptoms among selected adults with AORC. A need exists for additional, well-designed and reported studies on this topic.
Arthritis is highly prevalent and is the leading cause of disability among older adults in the United States owing to the aging of the population and increases in the prevalence of risk factors ...(e.g., obesity). Arthritis will play a large role in the health-related quality of life, functional independence, and disability of older adults in the upcoming decades. We have emphasized the role of the public health system in reducing the impact of this large and growing public health problem, and we have presented priority public health actions.
Objective
To analyze trends for visits to office‐based physicians at which opioids were prescribed among adults with arthritis in the US, from 2006 to 2015.
Methods
We analyzed nationally ...representative data on patient visits to office‐based physicians from 2006 to 2015 from the National Ambulatory Medical Care Survey (NAMCS). Visit percentages for first‐ and any‐listed diagnosis of arthritis by age groups and sex were reported. Time points were grouped into 2‐year intervals to increase the reliability of estimates. Annual percentage point change and 95% confidence intervals (95% CIs) were reported from linear regression models.
Results
From 2006 to 2015, the percentage of visits to office‐based physicians by adults with a first‐listed diagnosis of arthritis increased from 4.1% (95% CI 3.5%, 4.7%) in 2006–2007 to 5.1% (95% CI 3.9%, 6.6%) in 2014–2015 (P = 0.033). Among these visits, the percentage of visits with opioids prescribed increased from 16.5% (95% CI 13.1%, 20.5%) in 2006–2007 to 25.6% (95% CI 17.9%, 34.6%) in 2014–2015 (P = 0.017). The percentage of visits with any‐listed diagnosis of arthritis increased from 6.6% (95% CI 5.9%, 7.4%) in 2006–2007 to 8.4% (95% CI 7.0%, 10.0%) in 2014–2015 (P = 0.001). Among these visits, the percentage of visits with opioids prescribed increased from 17.4% (95% CI 14.6%, 20.4%) in 2006–2007 to 25.0% (95% CI 19.7%, 30.8%) in 2014–2015 (P = 0.004).
Conclusion
From 2006 to 2015, the percentage of visits to office‐based physicians by adults with arthritis increased and the percentage of opioids prescribed at these visits also increased. NAMCS data will allow continued monitoring of these trends after the implementation of the 2016 Centers for Disease Control and Prevention Guideline for prescribing opioids for chronic pain.
To analyze trends in opioid prescriptions during visits to office-based physicians made by adults with arthritis in the US from 2006 to 2015.
We analyzed nationally representative data on patient ...visits to office-based physicians from the National Ambulatory Medical Care Survey (NAMCS) 2006-2015. Visit percentages for first- and any-listed diagnosis of arthritis by age groups and sex are reported. Time points were grouped into 2-year intervals to increase the reliability of estimates. Annual percentage point change and 95% CI were reported from linear regression models.
During 2006-2015, the percentage of visits to office-based physicians by adults with a first-listed diagnosis of arthritis increased from 4.1% (95%CI: 3.5%-4.7%) in 2006-2007 to 5.1% (95% CI: 3.9%-6.6%) in 2014-2015 (p=.033). Among these visits, the percentage of visits with opioids prescribed increased from 16.5% (95%CI: 13.1%-20.5%) in 2006-2007 to 25.6% (95%CI: 17.9%-34.6%) in 2014-2015 (p=.017). The percentage of visits with any-listed diagnosis of arthritis increased from 6.6% (95%CI: 5.9%-7.4%) in 2006-2007 to 8.4% (95%CI: 7.0%-10.0%) in 2014-2015 (p=.001). Among these visits the percentage of visits with opioids prescribed increased from 17.4% (95%CI: 14.6%-20.4%) in 2006-2007 to 25.0% (95%CI: 19.7%-30.8%) in 2014-2015 (p=.004).
During 2006-2015, the percentage of arthritis visits by adults to office-based physicians increased and the percentage of opioids prescribed at these visits increased as well. NAMCS data will allow continued monitoring of these trends after guidelines were implemented.
Objective
To address knowledge gaps regarding the relationship between bone mineral density (BMD) and incident hip or knee osteoarthritis (OA); specifically, lack of information regarding hip OA or ...symptomatic outcomes.
Methods
Using data (n = 1,474) from the Johnston County Osteoarthritis Project's first (1999–2004) and second (2005–2010) followup of participants ages ≥45 years, we examined the association between total hip BMD and both hip and knee OA. Total hip BMD was measured using dual x‐ray absorptiometry, and participants were classified into sex‐specific quartiles (low, intermediate low, intermediate high, and high). Radiographic OA (ROA) was defined as development of Kellgren/Lawrence grade ≥2. Symptomatic ROA (sROA) was defined as onset of both ROA and symptoms. Weibull regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs).
Results
Median followup time was 6.5 years (range 4.0–10.2 years). In multivariate models, and compared with participants with low BMD, those with intermediate high and high BMD were less likely to develop hip sROA (HR 0.52 95% CI 0.31–0.86 and 0.56 95% CI 0.31–0.86, respectively; P = 0.024 for trend); high BMD was not associated (HR 0.69 95% CI 0.45–1.06) with risk of hip ROA. Compared with participants with low BMD, those with intermediate low and intermediate high total hip BMD were more likely to develop knee sROA (HR 2.15 95% CI 1.40–3.30 and 1.65 95% CI 1.02–2.67, respectively; P = 0.325 for trend); similar associations were seen with knee ROA.
Conclusion
Our findings suggest that higher BMD may reduce the risk of hip sROA, while intermediate levels may increase the risk of both knee sROA and ROA.
The harmful relationship of sedentary behavior to health may reflect an exchange of sedentary activity for moderate-to-vigorous physical activity (MVPA), or sedentary behavior may be a separate risk ...factor. We examined whether time spent in sedentary behavior is related to disability in activities of daily living (ADL), independent of time spent in MVPA in older adults.
The nationally representative 2003-2006 National Health and Nutrition Examinations Surveys (NHANES) included 2286 adults aged 60 years and older in whom physical activity was assessed by accelerometer. The association between ADL task disability and the daily percentage of sedentary time was evaluated by multiple logistic regression.
These adults on average spent 9h/d being sedentary during waking hours and 4.5% reported ADL disability. The odds of ADL disability were 46% greater (odds ratio, 1.46; 95% confidence interval, 1.07-1.98) for each daily hour spent in sedentary behavior, adjusted for MVPA and socioeconomic and health factors.
These US national data show a strong relationship between greater time spent in sedentary behavior and the presence of ADL disability, independent of time spent in moderate or vigorous activity. These findings support programs encouraging older adults to decrease sedentary behavior regardless of their engagement in moderate or vigorous activity.
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