Modifiable risk factors for lower-extremity injury: a systematic review and meta-analysis for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus.
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Whittaker Jackie L, Räisänen Anu M, Martin Chelsea, Galarneau Jean-Michel, Martin Maitland, Losciale Justin M, Bullock Garrett S, Dubé Marc-Olivier, Bizzini Mario, Bourne Matthew N, Dijkstra H Paul, Girdwood Michael, Hayden K Alix, Hägglund Martin, McLeod Shreya, Mkumbuzi Nonhlanhla Sharon, Mosler Andrea Britt, Murphy Myles Calder, Myklebust Grethe, Møller Merete, Ocarino Juliana Melo, Owoeye Oluwatoyosi B A, Palmer Debbie, Pasanen Kati, Rio Ebonie Kendra, Thorborg Kristian, van Middelkoop Marienke, Verhagen Evert, Warden Stuart J, Whalan Matthew, Crossley Kay M, Emery Carolyn A
Аннотация
DESIGN: Systematic review with meta- or semiquantitative analyses and Grading of Recommendations, Assessment, Development and Evaluation.
DATA SOURCES: MEDLINE, CINAHL, APA PsycINFO, Cochrane Systematic Review Database, CENTRAL, SPORTDiscus, EMBASE, ERIC searched 30 October or 23 November 2023.
ELIGIBILITY: Primary data studies with comparison group(s) assessing the association of MRFs for sport-related lower-extremity injury(s) with ≥1 female/woman/girl per study group.
RESULTS: Across 195 studies (n=115; 58.9% female/woman/girl-specific estimates) including 1 525 662 participants (2.4% females/women/girls), eight injury outcomes were assessed (n=75 general lower-extremity, n=3 groin, n=6 hip, n=17 thigh, n=88 knee, n=17 lower-leg, n=27 ankle, n=9 foot). Sixty-six MRF categories were identified. Substantial heterogeneity in MRFs and injury outcomes exists, with high risk of bias present in 37.4% of studies. Considering female/woman/girl specific estimates, we performed meta-analyses for 10 MRFs (body mass, x (BMI), weekly training distance, muscle strength, artificial turf, off-season plyometric training, readiness to return-to-sport, single-leg hop asymmetry, vertical drop jump peak knee flexion angle and ground reaction force) and semiquantitative analyses for 26 MRFs for a variety of injuries. Meta-analyses suggest no association between any lower-extremity strength outcome (g=0.01, 95% CI -0.11 to 0.14; I2=37.3%; very low certainty evidence) or artificial turf (Incidence Rate Ratio=0.97, 95% CI 0.88 to 1.07; I2=2.4%; low certainty evidence) and various lower-extremity injuries. Higher body mass (g=0.19, 95% CI 0.00 to 0.38; I2=71.7%) and/or BMI (g=0.22, 95% CI 0.09 to 0.36; I2=37.0%) are associated with several lower-extremity injuries (very low certainty evidence).
CONCLUSION: This review synthesises a large body of exploratory research, exposes important knowledge gaps and provides a foundation for understanding MRFs for female/woman/girl athlete lower-extremity injuries.
PROSPERO REGISTRATION NUMBER: PROSPERO CRD42024486715.