Evidence Syntheses on Preventative Factors for Sports Injuries: Identification of Priority Topics for Systematic Reviews and a Critical Analysis of Current Research Practice with Particular Emphasis on the Acute:Chronic Workload Ratio

  • Gregory MacMillan

Student thesis: Doctoral Thesis


Applied researchers aim to answer the most important questions that arise during real life situations. Formal methods are surfacing to determine consensus regarding the importance of a specific topic. Research priority setting studies are now becoming more common in health research and help to encourage open and transparent discussions about the relative importance of unanswered research questions. Such studies can aid researchers and policymakers in reducing research waste via the transfer of knowledge from the incorporation of differing stakeholder viewpoints. In turn, this enables future research to be more impactful for the end-users. Despite these potential advantages, research priority setting studies are not as regularly undertaken by sport and exercise scientists. The aim of my PhD programme is to identify priority topics for informing the scope and content of Cochrane Reviews on the prevention of sport and exercise-related injuries in adults. To help fulfil this aim, I collaborated with members of the Cochrane Bone, Joint and Muscle Trauma Group. I also aimed to scrutinise the quality of existing systematic reviews on a popular topic in injury prevention research; the Acute:Chronic Workload Ratio.
In Chapters 2, 3 and 4, three samples of key stakeholder populations were studied to help ascertain priority topics and associated scopes of Cochrane Reviews of the interventions used by individuals for preventing lower and upper limb injuries resulting from participation in sport and exercise-activities in adults (people aged over 16 years). The studies described in Chapters 2 and 3 involved online survey methods and sampled sports participants (Chapter 2) and support staff/practitioners (Chapter 3). A Delphi approach was followed in Chapter 4 to arrive at an informed set of research priority setting topics from a sample of experienced researchers on the topic of injury prevention. In each of these three studies, formal inductive content analysis was completed for ‘open- type’ questions. Means, standard deviations, percentages and frequency counts were calculated as appropriate for number-based questions. From a total of 20 individual themes, aspects relating to the individual athlete (sex-related differences, athlete age, genetic factors etc.), nutritional interventions, strength and conditioning interventions and mobility approaches were deemed to be most important by the sports participants studied in Chapter 2 (Study 1). These topics received 11.8%; 11.2% 11.1% and 11.1% of the total responses respectively. In Chapter 3 (Study 2), I identified 45 different research priority topics. The support staff/practitioner participants deemed training load to be the most important area for research to supply more evidence, with 18% of the participant cohort highlighting this topic. Topics relating to strength and conditioning, the individual athlete and nutrition ranged from 12%-6% of the total responses. In Chapter 4 (Study 3), consensus was reached on 11 identified research questions, which were deemed to be of critical importance (defined as being urgently required).
In Chapter 5, I undertook a critical analysis of the published evidence syntheses on the Acute:Chronic Workload Ratio as a correlate and/or predictor of the risk of musculoskeletal non-contact injuries in team sports participants. The AMSTAR-2 was used to assess the methodological quality of each included review and a narrative synthesis adhering to the guidance outlined by Pollock et al. (2017) was completed. A thorough appraisal of study quality assessment was also explored. The findings from Chapter 5 indicated that the methodological quality of the appraised systematic reviews was generally poor. A total of 7 systematic reviews were assigned quality scores of “very low”, and 2 reviews were deemed to be of a “low” quality.
In Chapter 6, I completed a critical analysis of the reporting quality of the published systematic reviews on the Acute:Chronic Workload Ratio as a predictor of musculoskeletal non-contact injury risk in team sports. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement was used to inform this scrutiny. Large variation in the quality of reporting was found, with reporting quality scores ranging from 48%-93%. Between review variation was especially wide in terms of the overall quality of reporting in the methods sections (11%-100%). In the synthesis and future research sections of my thesis, I arrived at general recommendations for future systematic reviews, original research on training load interventions and future evidence frameworks for exercise science research. The findings from this thesis are helpful in indicating what the relevant stakeholders perceive as the most important topics to be explored in future systematic reviews, and the findings also highlight common flaws within the existing systematic reviews on what was perceived to be a topic of major importance (training load influences). Taken together, these findings have helped elucidate both what is required to be systematically reviewed, and how they should be reviewed, in the future. My PhD programme also provides an example of how formal research priority setting approaches can be applied to topics relevant to the sport and exercise sciences.
Date of Award7 May 2023
Original languageEnglish
Awarding Institution
  • Teesside University
SupervisorMatthew Portas (Supervisor), Alan Batterham (Supervisor) & Paul Chesterton (Supervisor)

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