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Year of Publication
1.  Risk factors for hand injury in hurling: a cross-sectional study 
BMJ Open  2013;3(5):e002634.
Objectives
Hurling is Ireland's national sport, played with a stick and ball; injury to the hand is common. A decrease in the proportion of head injury among emergency department (ED) presentations for hurling-related injury has coincided with voluntary use of helmet and face protection since 2003. A similar decrease in proportions has not occurred in hand injury. We aim to quantify hurling-related ED presentations and examine variables associated with injury. In particular, we were interested in comparing the occurrence of hand injury in those using head and face protection versus those who did not.
Design
This study utilised a retrospective cross-sectional study design.
Setting
This study took place at a university hospital ED over a 3-month period.
Outcome measures
A follow-up telephone interview was performed with 163 players aged ≥16 years to reflect voluntary versus obligatory helmet use.
Results
The hand was most often injured (n=85, 52.1%). Hand injury most commonly occurred from a blow of a hurley (n=104, 65%), and fracture was confirmed in 62% of cases. Two-thirds of players (66.3%) had multiple previous (1–5) hand injuries. Most patients 149 (91.4%) had tried commercially available hand protection, but only 4.9% used hand protection regularly. Univariate analysis showed a statistically significant association between wearing a helmet and faceguard and hand injury; OR 2.76 (95% CI 1.42 to 5.37) p=0.003. On further analysis adjusting simultaneously for age, prior injury, foul play and being struck by a hurley, this relationship remained significant (OR 3.15 95% CI 1.51 to 6.56, p=0.002).
Conclusions
We report that hurling-related hand injury is common. We noted the low uptake of hand protection. We found that hand injury was significantly associated with the use of helmet and faceguard protection, independent of the other factors studied. Further studies are warranted to develop strategies to minimise the occurrence of this injury.
doi:10.1136/bmjopen-2013-002634
PMCID: PMC3657669  PMID: 23793666
Sports Medicine
2.  Efficacy of acupuncture for chronic knee pain: protocol for a randomised controlled trial using a Zelen design 
Background
Chronic knee pain is a common and disabling condition in people over 50 years of age, with knee joint osteoarthritis being a major cause. Acupuncture is a popular form of complementary and alternative medicine for treating pain and dysfunction associated with musculoskeletal conditions. This pragmatic Zelen-design randomised controlled trial is investigating the efficacy and cost-effectiveness of needle and laser acupuncture, administered by medical practitioners, in people with chronic knee pain.
Methods/Design
Two hundred and eighty two people aged over 50 years with chronic knee pain have been recruited from metropolitan Melbourne and regional Victoria, Australia. Participants originally consented to participate in a longitudinal natural history study but were then covertly randomised into one of four treatment groups. One group continued as originally consented (ie natural history group) and received no acupuncture treatment. The other three were treatment groups: i) laser acupuncture, ii) sham laser or, iii) needle acupuncture. Acupuncture treatments used a combined Western and Traditional Chinese Medicine style, were delivered by general practitioners and comprised 8–12 visits over 12 weeks. Follow-up is currently ongoing. The primary outcomes are pain measured by an 11-point numeric rating scale (NRS) and self-reported physical function measured by the Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index subscale at the completion of treatment at 12 weeks. Secondary outcomes include quality of life, global rating of change scores and additional measures of pain (other NRS and WOMAC subscale) and physical function (NRS). Additional parameters include a range of psychosocial measures in order to evaluate potential relationships with acupuncture treatment outcomes. Relative cost-effectiveness will be determined from health service usage and outcome data. Follow-up assessments will also occur at 12 months.
Discussion
The findings from this study will help determine whether laser and/or needle acupuncture is efficacious, and cost-effective, in the management of chronic knee pain in older people.
Trial registration
Australian New Zealand Clinical Trials Registry reference: ACTRN12609001001280
doi:10.1186/1472-6882-12-161
PMCID: PMC3493360  PMID: 22992309
3.  A validation of the post concussion symptom scale in the assessment of complex concussion using cognitive testing and functional MRI 
Background
Clinical assessment of cerebral concussion relies on the presence and duration of post concussive symptoms (PCS). Given that these PCS are subjective reports and not always specific to concussion, their usefulness remains to be validated.
Objective
To evaluate the usefulness of self‐reported PCS by means of cognitive tests and functional MRI (fMRI).
Method
28 male athletes with and without concussion were grouped according to their PCS score. They were then administered a computerised cognitive test battery and submitted to an fMRI session where cerebral activations associated with verbal and non‐verbal working memory tasks were analysed.
Results
Behaviourally, response accuracy and speed on the cognitive test battery were comparable for the control and low PCS group. The moderate PCS group showed significantly slower response times than the control group on the matching (p<0.05) and one‐back tasks (p<0.05). The functional MRI study showed reduced task related activation patterns in the dorsolateral prefrontal cortex for both low and moderate PCS groups. Activation peaks outside the regions of interest, not seen in the control group, were also noted for both PCS groups. Regression analyses indicated an inverse relationship between PCS scores and performances on several CogSport subtests. Severity of PCS also predicted fMRI blood oxygen level dependent signal changes in cerebral prefrontal regions.
Conclusion
Self‐reported PCS is associated with an ongoing cerebral haemodynamic abnormality as well as with mild cognitive impairment. These results support the use of the PCS scale in the assessment of cerebral concussion and in monitoring recovery.
doi:10.1136/jnnp.2006.110395
PMCID: PMC2117618  PMID: 17371902
4.  Boxing and the risk of chronic brain injury 
BMJ : British Medical Journal  2007;335(7624):781-782.
Evidence is inconclusive but the absolute risk in modern day boxing is still low
doi:10.1136/bmj.39352.454792.80
PMCID: PMC2034695  PMID: 17916810
5.  Problem‐based learning in sports medicine: the way forward or a backward step? 
British Journal of Sports Medicine  2007;41(10):623-624.
Self‐directed problem‐based learning vs traditional didactic courses
doi:10.1136/bjsm.2007.042333
PMCID: PMC2465152  PMID: 17890712
6.  Medical issues in women's football 
British Journal of Sports Medicine  2007;41(Suppl 1):i1.
doi:10.1136/bjsm.2007.039362
PMCID: PMC2465244  PMID: 17646244
7.  Head injuries in the female football player: incidence, mechanisms, risk factors and management 
British Journal of Sports Medicine  2007;41(Suppl 1):i44-i46.
Although all injuries in sports are a concern for participants, head injuries are particularly troublesome because of the potential for long‐term cognitive deficits. To prevent any specific injury, it is important to understand the basic frequency and incidence of injury and then the mechanism of injury. Once these are established, prevention programmes can be tested to see if the rate of injury changes. A primary problem with head injuries is recognising that the injury has occurred. Many athletes are not aware of the seriousness of concussive injury, thus this type of injury is probably under‐reported. Once the diagnosis of a concussion is made, the next difficult decision is when to return a player to the game. These two management issues dominate the continuing development of understanding of concussive head injury. This paper explores the known gender differences between head injuries and highlights the areas that need to be considered in future research.
doi:10.1136/bjsm.2007.037960
PMCID: PMC2465253  PMID: 17496069
8.  Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union 
Wide variations in the definitions and methodologies used for studies of injuries in rugby union have created inconsistencies in reported data and made interstudy comparisons of results difficult. The International Rugby Board established a Rugby Injury Consensus Group (RICG) to reach an agreement on the appropriate definitions and methodologies to standardise the recording of injuries and reporting of studies in rugby union. The RICG reviewed the consensus definitions and methodologies previously published for football (soccer) at a meeting in Dublin in order to assess their suitability for and application to rugby union. Following this meeting, iterative draft statements were prepared and circulated to members of the RICG for comment; a follow‐up meeting was arranged in Dublin, at which time all definitions and procedures were finalised. At this stage, all authors confirmed their agreement with the consensus statement. The agreed document was presented to and approved by the International Rugby Board Council. Agreement was reached on definitions for injury, recurrent injury, non‐fatal catastrophic injury, and training and match exposures, together with criteria for classifying injuries in terms of severity, location, type, diagnosis and causation. The definitions and methodology presented in this consensus statement for rugby union are similar to those proposed for football. Adoption of the proposals presented in this consensus statement should ensure that more consistent and comparable results will be obtained from studies of injuries within rugby union.
doi:10.1136/bjsm.2006.033282
PMCID: PMC2659070  PMID: 17452684
9.  Injuries in amateur horse racing (point to point racing) in Great Britain and Ireland during 1993–2006 
Objectives
To provide a breakdown of injury incidence from amateur jump racing (also known as point to point racing) in Great Britain and Ireland during 1993–2006 and to compare the injury epidemiology with professional horse racing in Great Britain, Ireland and France.
Design
Retrospective review.
Setting
Great Britain and Ireland.
Participants
Amateur jockeys.
Main outcome measures
Injury rates.
Results
Injury data suggest that point to point racing is more dangerous from an injury point of view than professional jump racing, which has previously been shown to be more dangerous than flat racing. Amateur jockeys have more falls than their professional counterparts, and this in turn puts them at greater risk of sustaining more serious injuries.
Conclusions
Amateur (point to point) jockeys represent a sporting population that previously has been little studied. They represent a group at high risk of injury, and hence formal injury surveillance tracking and counter measures for injury prevention are recommended.
doi:10.1136/bjsm.2006.033894
PMCID: PMC2465222  PMID: 17138629
10.  High school rugby players' understanding of concussion and return to play guidelines 
British Journal of Sports Medicine  2006;40(12):1003-1005.
Objective
To document high school players' understanding and attitudes towards concussion return to play guidelines.
Methods
A questionnaire based survey was performed of national high school rugby players as to their knowledge of existing concussion return to play guidelines.
Results
A total of 600 male players were surveyed, and 477 responded (response rate 80%). Half (237/477) were aware of concussion guidelines, and 60% (288/477) identified the mandated stand down period that is part of the regulations governing rugby football. Players obtained their information primarily from: teachers/coaches (239 responses), medical personnel (200), and other players (116). Of those players who suspected that they had been concussed (296/477, 62%), only 66 returned to play after medical clearance.
Conclusions and implications
This sample of high school players showed a limited knowledge of the concussion guidelines covering their sport, and even when concussed did not follow recommended protocols. This indicates the need for an increased focus on player education.
doi:10.1136/bjsm.2005.020511
PMCID: PMC2577443  PMID: 17124109
rugby; schoolboy; concussion; guidelines; return to play
12.  Who says you cannot get published? 
PMCID: PMC2492027  PMID: 16431992
13.  Brain injury and heading in soccer 
BMJ : British Medical Journal  2003;327(7411):351-352.
PMCID: PMC1126775  PMID: 12919964

Results 1-13 (13)