Brooks John H M, Fuller Colin W
Rugby Football Union, Twickenham, UK.
Sports Med. 2006;36(6):459-72. doi: 10.2165/00007256-200636060-00001.
Data obtained from epidemiological studies of sports injuries are an essential requirement for developing injury prevention, treatment and rehabilitation strategies. Although many authors have discussed the strengths and weaknesses of research methods employed in epidemiology, the potential effects that variations in research design and methods of analysis can have on study conclusions have not been clearly illustrated. This article addresses a number of methodological issues and illustrates their potential effects using examples based on injury data obtained from a single, large epidemiological study in professional rugby union. The examples demonstrate that conflicting conclusions can be reached depending on how the data are collected and analysed. The pivotal roles played by injury definition (loss-of-time, missed matches, diagnostic assessment and surgery), recurrent injury definition (clinical judgement and same injury/same location/same season), method of reporting injuries (number, proportions and incidence) and method of calculating incidence (injuries per 1000 player-hours, per 1000 athlete-exposures and per 1000 matches) are highlighted and illustrated. Other examples show that if training and match injuries are combined, the incidence of injury is more likely to reflect the incidence of training injuries but the distributions of injuries are more likely to reflect the distributions of match injuries. An example is presented that demonstrates that the identification of injuries causing the greatest concern within a sport depends on whether the assessment is based on injury incidence, severity or risk. Finally, examples are presented to show that the relationships identified between sports injuries and risk factors may be dependent on whether case-control or cohort study designs are used. Although there are no simple solutions available to resolve the issues raised, the discussion demonstrates the importance, at least within a sport, of reaching consensus agreements on acceptable study designs and methods of data analysis in sports epidemiology.
从运动损伤流行病学研究中获得的数据是制定损伤预防、治疗和康复策略的基本要求。尽管许多作者讨论了流行病学研究方法的优缺点，但研究设计和分析方法的变化对研究结论可能产生的潜在影响尚未得到清晰阐述。本文探讨了一些方法学问题，并以从一项针对职业英式橄榄球联盟的大型流行病学研究中获取的损伤数据为例，说明这些问题的潜在影响。这些例子表明，根据数据的收集和分析方式，可能会得出相互矛盾的结论。文中强调并举例说明了损伤定义（失时、错过比赛、诊断评估和手术）、复发性损伤定义（临床判断以及同一损伤/同一部位/同一赛季）、损伤报告方法（数量、比例和发生率）以及发生率计算方法（每1000运动员小时、每1000运动员暴露次数和每1000场比赛中的损伤数）所起的关键作用。其他例子表明，如果将训练损伤和比赛损伤合并，损伤发生率更有可能反映训练损伤的发生率，但损伤分布更有可能反映比赛损伤的分布。文中给出了一个例子，说明在一项运动中确定最令人担忧的损伤取决于评估是基于损伤发生率、严重程度还是风险。最后，给出的例子表明，运动损伤与风险因素之间确定的关系可能取决于使用的是病例对照研究设计还是队列研究设计。虽然没有简单的解决方案来解决所提出的问题，但讨论表明，至少在一项运动中，就运动流行病学中可接受的研究设计和数据分析方法达成共识协议非常重要。
