Concurrent Sessions 3: Mini Orals

Thursday, November 3, 2022 | 11:00 AM – 12:30 PM

Mini-oral presentations, held in the Coal Harbour Ballroom, will have presenters assigned to a numbered table with their presentation ready on their laptop. Similar to a traditional poster session, presenters will have 5 slides which they can present in 5 minutes, and engage in Q&A with conference delegates. Conference delegates are encouraged to circulate around the room.

The mini-oral presentations have been split into two halves: 11:00AM–11:45AM & 11:45AM–12:30PM.

Presenters are asked to be at their table during their assigned 45-minute time slot, but are also welcome to present throughout the entire 90-minute session.

For a brief overview of the mini orals occurring during Concurrent Sessions 3A and 3B, please consult the tables below.

View a map of the Mini-Oral session (PDF)

To view the full abstracts, please scroll down further or use the links in the tables below.

To view the orals, workshops, and panels occuring during Concurrent Sessions 3, please return to the Concurrent Sessions 3 page using the link below.

Overview

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Mini-Orals 3A | Location: Coal Harbour Ballroom | Time: 11:00 – 11:45 AM

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Mini-Orals 3B | Location: Coal Harbour Ballroom | Time: 11:45 AM – 12:30 PM

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List of abstracts

Mini-Orals 3A | Location: Coal Harbour Ballroom | Time: 11:00 – 11:45 AM

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Abstract #2279: Examination of the utility of haptic modalities during obstacle crossing

Presenting Author: Kenzie Friesen¹

Authors: Kenzie Friesen¹, Joel Lanovaz¹, Renatos Moraes², Alison Oates¹

¹University of Saskatchewan

²University of São Paulo

Abstract:

Introduction: Despite the intended use of haptic modalities to improve walking balance, research notes increasingly challenging tasks, such as obstacle (OBS) avoidance, require more attention. Given the frequent obstacle exposure during realistic walking scenarios, and the potential for increased attentional demand while crossing OBSs, the use of haptic modalities may be limited.

Objectives: To examine the use and attentional demands of haptic modalities during OBS crossing.

Methods: Nineteen healthy young adults walked across a 10m laboratory floor within two modality blocks: 1) light touch (LT) on a railing, 2) pulling haptic anchors. Randomly dispersed within these blocks were trials without added haptic input and verbal reaction time (VRT) tasks. VRT was compared across the 3 walking conditions. Gait characteristics, OBS crossing stability, OBS toe clearance, and foot distances from the OBS were compared across the three walking conditions (normal walking (NW), LT walking, anchored walking), and 2 VRT conditions (absence vs. presence).

Results: VRTs did not differ according to walking conditions (p>.05). Step length variability for the NW condition was significantly greater than for both the LT and anchored walking conditions (p=.026). Toe clearance for the trail leg was less during LT than NW (p=.020). Presence of the VRT resulted in greater toe clearance for both lead (p=.018) and trail limbs (p=.011). Presence of VRT also resulted in less lead foot distance from the OBS (p=.015). The NW condition resulted in the lead foot being placed further from the OBS (p<.001) and the trail foot being placed closer to the OBS (p=.003) than during LT walking.

Conclusion: Neither haptic modality required significantly increased attentional demand; however, LT walking results in less obstacle toe clearance and closer lead limb placement prior to OBS crossing. Haptic modalities likely provide greater benefit than risk to users during OBS crossing.

Abstract #2290: Development of provincially-aligned clinical practice standards for community fall prevention

Presenting Author: Jeanette Foreman^1,2

Authors: Jeanette Foreman^1,2, Natasha Thorne², Tysen Leblond², Talia Budlovsky², Gloria Fox²

¹BC Centre for Disease Control

²Northern Health

Abstract:

Introduction: Northern Health (NH) is one of five regional Health Authorities in British Columbia (B.C.).  Each Health Authority in B.C. is responsible for the development or selection of its own policy and practice standards. This enables fit with the unique contexts that exist across the province but can also lead to inefficiencies and lack of consistency.

Objective: To develop a clinical practice standard (CPS) for fall prevention in community, with the standards related to older adults aligning closely with new provincial physician guidelines for seniors fall prevention.

Approach: The Executive Lead for Rehabilitation Services sponsored a Development Team (DT) comprised of clinical leaders and representative practitioners and regional resource staff to develop the standards. DT members attended the Provincial Seniors Falls Prevention Community of Practice to receive routine updates on the provincial physician guideline.

Findings: By including representatives from across the continuum, the DT was able to develop a set of standards addressing all population groups living in community. The standards for seniors were aligned with the provincial physician guideline in terms of screening tools; multifactorial risk assessment and intervention for those who were screened positive; prioritization of exercise intervention; and recommendations for referrals to allied health professionals in community.

Conclusion: The availability of provincial guidelines for fall prevention practice can assist regional health authorities in developing high quality standards, and support consistency. If the evidence base for key standards was established provincially, then regionally developed standards documents could follow to ensure fit to context. This would require more provincial capacity for evidence synthesis or guideline development, and willingness of regions to align their regional policy development cycles.

Abstract #2291: Development of an integrated clinical practice standard for community fall prevention

Presenting Author: Tysen Leblond¹

Authors: Natasha Thorne¹, Jeanette Foreman^1,2, Tysen Leblond¹, Talia Budlovsky¹, Gloria Fox¹

¹Northern Health

²BC Centre for Disease Control

Abstract:

Introduction: Northern Health (NH) is one of five regional Health Authorities in British Columbia (B.C.).  We describe the NH development approach used for a Clinical Practice Standard (CPS) for fall prevention among community-dwelling individuals.

Objective: To develop an integrated CPS for community fall prevention across the lifespan.

Approach: The Executive Lead for Rehabilitation Services at NH sponsored a Development Team (DT) comprised of clinical leaders and representative practitioners and regional resource staff to develop the CPS. Three population groups were identified for inclusion: children, youth and adults under 65; adults 65+ living independently in community; and clients receiving NH community services. The DT met routinely over a period of 14 months. The standards were reviewed by patient partners and NH operational leaders.

Findings: The DT was able to develop a set of standards addressing all population groups living in community. The collaborative approach enabled a more integrated approach to CPS development than in the past. The CPS was published November 2021. To support implementation, team and educator presentations were made, online learning modules developed, and documentation supported within the community electronic medical record. Further implementation efforts are required as well as on-going monitoring and evaluation.

Conclusion: NH’s strategic priorities include a population health approach and integrated accessible health services, with a desire to shift services more upstream, based on a foundation of strong primary and community care. NH thus adopted an integrated approach to the development of a fall prevention strategy in community.  Such efforts are needed to reduce the burden of injury across all ages, support more active and independent aging in place, meet individuals where they are at and what setting they live in, and reduce demands for emergency care, hospitalization, surgery, and long-term care.

Abstract #2315: Call me: telephone exercises for fall prevention in Fraser Health Authority

Presenting Author: Ronda Field¹

Authors: Ronda Field¹, Ashley Kwon¹, Shianne Bains¹

¹Fraser Health Authority

Abstract: Fraser Health Authority recognizes falls as a strategic priority. The Falls Prevention Mobile Clinic (FPMC) assesses falls risks for community dwelling clients and provides risk reduction recommendations. The most common recommendation is exercise for balance and strength. However, clients frequently report that they find exercise recommendations difficult to achieve for various reasons including motivation, fear of falling, lack of confidence, and inability to access community classes.

Research indicates that Telehealth exercise (via videoconferencing, webinars or telephone) can be a viable delivery format in certain populations. However, there is little research to indicate whether it is feasible or meaningful to conduct balance exercises for fall prevention via telephone. While accessibility of video conferencing has dramatically increased since 2020, many people and communities still do not have access to reliable internet and many of the FPMC clients do not have access to videoconference or webinar platforms. Also, many seniors have significant anxiety and difficulty with use of technology.

The purpose of the TeleHealth Exercises for Fall Prevention study was to determine the feasibility, acceptability and potential impact of delivering fall prevention exercises (SAIL Standing or Moving) via telephone to clients who have previously been instructed to do the exercises at the FPMC. During the study, clients performed exercises twice weekly with telephone guidance. Upon completion, clients were reassessed at the FPMC and feedback was collected. This presentation will provide an overview of the results of the TeleHealth Exercise study which was conducted in 2018-2019.

Telephone exercise could provide a valuable alternative to traditional home-based fall prevention strategies to engage at-risk or isolated clients, and to increase client satisfaction and confidence. This intervention may significantly impact the cost and capacity of community care delivery.

Abstract #2223: The impact of COVID-19 restrictions on motor vehicle fatalities in British Columbia, Canada

Presenting Author: Minh Le¹,

Authors: Minh Le¹, Andrew Tu¹,Tej Sidhu¹

¹BC Coroners Service

Abstract:

Introduction: Recent research has suggested that social distancing restrictions and reduced travel may have played a role in motor vehicle fatalities. Results from previous studies have been inconsistent ranging from a decline to an increase in motor vehicle related deaths post-COVID restrictions. In British Columbia (BC), COVID-19 restrictions were implemented on March 17, 2020. The aim of this study is to determine the impact of COVID-19 restrictions on motor vehicle incident deaths in BC.

Methods: Motor vehicle fatality data from the BC Coroners Service was used for this analysis. Data from March 17, 2019 – March 16, 2020 (pre-COVID restrictions) was compared with data from March 17, 2020 – March 16, 2021 (post-COVID restrictions). Descriptive and logistic regression analyses were utilized to compare demographic and geographical data across these two timeframes.

Results: There were 286 motor vehicle incident deaths from March 17, 2019 – March 16, 2020, and 248 deaths from March 17, 2020 – March 16, 2021, corresponding to a 13.7% decrease in the number of fatalities. This represented the largest annual decline in motor vehicle fatalities compared to similar timeframes since 2011. Results from adjusted logistic regression indicated that pedestrians compared to other road users had lower odds of being involved in a fatal motor vehicle incident post-COVID restrictions (odds ratio [OR] 0.19, 95% CI: 0.04-0.89). No other significant differences across sex, age groups, health authority of injury, and urban vs. rural areas were found.

Conclusion: BC saw a decline in motor vehicle fatalities, specifically pedestrian fatalities, during the year after COVID restrictions were implemented. The results deepen our understanding of how social-distancing and travel restrictions can impact motor vehicle fatalities. Further analysis, including the addition of factors such as road type, alcohol and/or drug involvement, seatbelt use, and speed, will be presented at the conference.

Abstract #2260: Enhancing equity and road safety in Guelph, Ontario

Presenting Author: Lauren Short¹

Authors: Lauren Short¹, Liraz Fridman², Sam Laban², Adam Bonnycastle³, Matilda Oja³, Steve Anderson¹

¹City of Guelph

²Guelph Lab

³Univerisity of Guelph

Abstract:

Introduction: Equity is an important consideration for road safety policies. However, collisions are not evenly distributed amongst areas of high and low marginality in many Canadian cities. In the City of Guelph, traffic calming, and other road safety measures have historically been prioritized on a request basis. As the City moves towards a Vision Zero goal it is crucial to understand how equity data can be used to inform policy making.

Objectives: The purpose of this study was to examine the relationship between vulnerable road user collisions, location of traffic studies and marginality.

Methods: Low-marginality and high-marginality areas were identified using the Ontario Marginalization Index and spatially mapped according to the 2016 Statistics Canada Dissemination Areas (DAs). Road environment features including road length, crosswalks, sidewalks, bicycle facilities, and population, were mapped. Traffic study locations were provided by the Engineering and Transportation department and were overlayed onto maps with collisions and marginality data. DAs were grouped by high marginality/high walkability and low marginality/high walkability.  We aggregated spatial variables by DA and conducted two-tailed t-tests.

Results: A total of 381 vulnerable road users were involved in an injury-related collision between 2015 and 2019. On average neighborhoods with higher marginality had twice as high a rate of collisions involving a pedestrian or cyclist, 6.80 to 3.13 per 10 km road, respectively (p=.011). While there were 45% fewer traffic studies performed in high marginality areas of the city, these differences were not statistically significant (p=.110).  Mapped traffic studies did not appear to be a good predictor of vulnerable user collisions.

Conclusion: Vulnerable user collisions are inequitably distributed between high and low marginality neighborhoods. Future road safety interventions will be implemented by using equity data to inform decision making.

Abstract #2284: Safely transporting children with special healthcare needs: key lessons learned

Presenting Author: Katherine Hutka¹

Authors: Katherine Hutka¹

¹Child Safety Link IWK Health

Abstract:

Introduction: Evidence shows that children with special healthcare needs (CSHCN) are 2 to 3 times more likely to experience an injury than that of their peers. Safe transportation solutions for CSHCN are complex and require collaborative involvement from key stakeholders. An interdisciplinary team of occupation therapists and injury prevention centre staff identified a gap in the safe transport of CSHCN at IWK Health. Barriers included: lack of comprehensive inpatient and outpatient child passenger safety services; limited funding; varied discharge policies; and liability concerns.

Approach: We address the gap in safe transport of CSHCN under three pillars: Knowledge, Community, and Policy.

• Knowledge
  • Healthcare professionals who work with CSHCN took an evidence-based training
  • IWK Health staff were then mentored as instructors by experts in the field and brought training to an additional 16 participants
  • Offer education sessions for additional hospital departments who support safe discharge
  • Conducted a jurisdictional scan of all Canadian-approved child restraint systems and adaptive systems certified in other jurisdictions
• Community
  • Established a Canadian Community of Practice of health professionals
  • Maintain relationships with a network of injury prevention practitioners in the US
• Policy
  • Working to develop an internal policy to guide the safe transport of CSHCN.
  • Review existing guidance documents

Conclusion:

1. Engaging a multidisciplinary team of health professionals, medical equipment vendors, injury prevention centre staff and parents and caregivers of CSHCN ensured uptake of new knowledge.
2. Occupational therapists are uniquely positioned within health institutions to address barriers to accessing activities of daily living, including transportation challenges.

Comprehensive inpatient and outpatient child passenger policies are needed to create sustainable change.

Abstract #2311: Concussion prevention in motor vehicle collisions: are occupant safety systems doing enough?

Presenting Author: Olivia Scott¹

Authors: Olivia Scott¹, Umar Muhammed¹, Benjamin Elkin², Mozhgan Khodadadi¹, Emma Prentice¹, Carmela Tartaglia¹, Charles H. Tator¹

¹Canadian Concussion Centre, Toronto Western Hospital, University Health Network

²MEA Forensic Engineers and Scientists

Abstract:

Introduction: Motor vehicle collisions (MVCs) often cause concussions with persisting symptoms (CPS) lasting years. Understanding the relationship between MVCs and concussion can guide the development of occupant safety systems to prevent concussion.

Objectives: Identify factors that contribute to MVC-related CPS incidence, recovery, and prevention.

Methods: We identified 144 patients with CPS caused by MVC from the database at the Canadian Concussion Centre. Demographic and injury-related data were collected from medical chart review and questionnaires concerning occupant safety systems. Descriptive statistics were used.

Results: Our sample included 100 females (69.4%) and 44 males (30.6%) of whom 40 responded to the questionnaire. Of the 95 patients reporting seatbelt status, 93.7% were wearing a seatbelt. Rear-end collisions were the most common type of MVC overall (52.1%) that caused concussions, and for both females (56.0%) and males (43.2%). Where airbag deployment status was known (n=84), in 72.6% of collisions, airbags did not deploy, and rear-end collisions had the highest rate of non-deployment (92.7%). In general, patients were highly symptomatic after MVCs of all types with an average of 12 persisting symptoms. Indeed, at an average follow-up duration of 27 months, only 7 patients had fully recovered from their concussions.

Conclusion: Our study identified several prevention targets with respect to MVC-related CPS. There were more than double the number of females than males, suggesting that females are at greater risk of CPS. Weaker neck muscles and car safety design based on male anthropometric data may contribute to this. Additionally, rear-end collisions, which were the most common type of MVC leading to CPS, had the lowest airbag deployment rate. These findings indicate the need to re-examine occupant safety systems especially for females.

Abstract #2272: The value of guerilla marketing in public health messaging

Presenting Author: Samantha Bruin¹

Authors: Samantha Bruin¹, Shazya Karmali²,  Kevin La Freniere¹, Ian Pike¹

¹ The Community Against Preventable Injuries

² BC Injury Research and Prevention Unit

Abstract: Guerilla marketing tactics are unconventional ways that brands can gain the attention of consumers. This form of advertising is often creative, low-cost, emotionally appealing, and requires consumers to interact with the installation. These tactics, while popular with product companies and advocacy groups, are not a widely adopted communication strategy in public health, which typically resembles traditional marketing techniques. These include transactional marketing tactics: using expert testimony to convince the public to “buy into” a health intervention by changing their behaviour, such as stopping smoking or reducing their speed while driving, rather than allowing the public to draw their own conclusions based on their own value set and concern for society. This presentation will discuss the effectiveness of guerilla marketing tactics in a province-wide social marketing injury prevention campaign. The effectiveness of ambient messaging, guerilla sensations, and other forms of advertising will be discussed using examples from The Community Against Preventable Injuries (Preventable)’s guerilla marketing efforts: the purpose of these campaigns, their desired impact and effectiveness, lessons learned, and how health promotion departments and coordinators can use tactics such as these to influence public health outcomes.

Abstract #2273: Navigating “go dark” periods and return to market: social marketing case study

Presenting Author: Samantha Bruin^1,2

Authors: Samantha Bruin^1,2, Kevin La Freniere², Ian Pike²

¹ BC Injury Research and Prevention Unit

²The Community Against Preventable Injuries

Abstract: What happens to brand awareness when organizations cease advertisements for an extended period of time? And, how do these organizations return to market effectively, particularly following a global pandemic?

Disruptions in advertisements or marketing campaigns can be caused by a variety of factors, such as financial constraints or a shift in strategy, or economic pressures such as a recession. Typically, smaller brands experience a faster decline in sales and recognizability than larger brands. The coronavirus (COVID-19) global pandemic is one such disruption that impacted marketing strategies for companies, large and small, worldwide. It also negatively impacted people’s psychological states, causing feelings of uncertainty and powerlessness related to health, work, finances, and socializing. Researchers noted that the overload of information related to COVID-19, and the inability to process all the pandemic-related information, further exacerbated feelings of anxiety and uncertainty. This poses significant challenges to organizations aiming to address behaviour change using education and social marketing campaigns, especially following an ‘out of market’ period. Thus, it is important to understand the short- and long-term impact on brand awareness and recognizability, as well as how to effectively re-engage target audiences, following a ‘go dark’ period. Further, considerations must be made with respect to information overload, audience fatigue, new to market audiences, and tone and messaging when returning to market following a global crisis.

This presentation will highlight the impact of pausing social marketing initiatives on target audience’s awareness, attitudes, and behaviours. Preliminary findings from the Community Against Preventable Injuries (Preventable)’s ongoing evaluation to assess recognizability and awareness of Preventable, and attitudes and behaviours towards preventable injuries among British Columbians will be presented.

Abstract #2302: What was the impact of COVID-19 restrictions on unintentional injuries, worldwide?

Presenting Author: Shazya Karmali¹

Authors: Shazya Karmali¹, Shikha Saxena , Olivia Richards², Wendy Thompson², Steven McFaull², Ian Pike¹

¹ BC Injury Research and Prevention Unit

² Public Health Agency of Canada

Abstract:

Background: Injuries are among the leading causes for hospitalizations and emergency department (ED) visits. COVID-19 restrictions ensured safety to Canadians, but also negatively impacted health outcomes, for instance increasing rates of certain injuries. These differences in trends have been reported internationally, and emphasize the need of injury surveillance to inform healthcare systems in preparing for future outbreaks and similar restrictions.

Objective: A scoping review was conducted to assess the impact of COVID-19 restrictions on unintentional injuries in Canada, compared to other countries.

Methods: Studies investigating unintentional injuries among all ages during COVID-19 from any country, published in English between December 2019 and July 2021, were included. Intentional injuries and/or previous pandemics were excluded. Four databases were searched (MEDLINE, Embase, Web of Science, SPORTDiscus).

Results: The search yielded 3041 results, and a total of 191 articles were selected for extraction. Final studies included research from: Europe (n = 85); North America (n = 43); Asia (n = 33); Oceania (n = 12); Africa (n = 8); South America (n = 4); and, multi-country (n = 6). The following mechanisms of injury were reported on most frequently: motor vehicle collisions (MVCs; n = 131), falls (n = 104), unintentional injuries overall (n = 74), sports/recreation (n = 65), cycling (n = 31), pedestrian versus vehicle (n = 22), and burns (n = 17). Injuries occurring at home (e.g., gardening, home improvement projects) increased, and injuries occurring at schools, workplaces, and public spaces decreased, and overall, MVCs decreased. Most studies reported higher occurrence of injuries/trauma in males, and the average age across studies was 40.4 years.

Implications: Findings from this review can inform interventions and policies to decrease the negative impact of future stay-at-home measures on unintentional injury among Canadians and populations worldwide.

Abstract #2230: Epidemiology of hospitalizations secondary to intentional injuries during the COVID-19 pandemic in Quebec

Presenting Author: Valerie Turcotte^1,2

Authors: Valerie Turcotte^1,2, Melanie Berube^2,3, Pascale Levesque⁴

¹ Nursing Department, CIUSSS du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal

² Faculty of Nursing, Laval University

³Population Health and Optimal Practices Research Unit (Trauma – Emergency – Critical Care Medicine), Laval University Research Center (Hôpital de l’Enfant-Jésus)

⁴Office of Information and Studies in Population Health, National Institute of Quebec Public Health

Abstract: Since the beginning of the COVID-19 health crisis, a disturbing increase in the prevalence of intentional injuries has been observed in the Quebec trauma sector. To assess trends in hospitalizations for traumatic injuries secondary to intentional physical violence before and during the pandemic in Quebec. This is a retrospective multicenter cohort study in which descriptive statistics are extracted via the “Info-centre” platform of the Institut national de santé publique du Québec, which contains medico-administrative data. Data were extracted for the entire province of Quebec. Variations in terms of types of trauma, proportions between intentional and unintentional injuries, and the distribution of subcategories of intentional trauma by age group and by sex were observed. In the first year of the pandemic (2020), compared to the previous year, a decrease of 8.6% for men and 9.8% for women is observed for all trauma. As with hospitalizations for unintentional trauma (10.3% men, 9.0% women), hospitalizations for intentional injuries decreased slightly (8.0% men, 6.6% for women). Intentional injuries, which were mainly suicide attempts (7.4% men, 6.5% women) and assaults (13.7% men, 6.5% women), also decreased, apart from assaults on women, which increased slightly but not significantly. For assaults on men, a decrease is noted for all age groups between 2019 and 2020. For female assaults an increase is seen for all age groups. Assaults requiring hospitalization do not appear to have significantly increased during the first year of the pandemic. It is possible that intentional injuries may have increased starting in 2021 as the prolonged pandemic created even more stress for the population. Analysis of the 2021 and 2022 data will be conducted to assess the correlation over time of the phenomenon. A better understanding of this prevalence will allow experts to adapt interventions in terms of prevention and thus reduce the scourge of social violence.

Abstract #2317: Starting small: six years of injury prevention seed grants in Vancouver Coastal Health

Presenting Author: Joanne Sadler¹

Authors: Joanne Sadler¹, Steven Dang², Nasira Lakha¹

¹Trauma Services, Vancouver General Hospital, Vancouver Coastal Health

²Community Investments, Population Health, Vancouver Coastal Health

Abstract:

Introduction: The Vancouver General Hospital (VGH) Trauma Program launched the ACTION Mini-Grant program in partnership with Vancouver Coastal Health (VCH) Community Investments in 2015.

Objectives: ACTION Mini-Grants support innovative community-driven projects, partnerships, and initiatives that promote injury prevention and improve the quality of life of residents living in the VCH region. The grant program is intended to address the following injury prevention priorities: seniors fall prevention, transport-related injuries, and youth suicide and self-harm.

Approach: ACTION Mini-Grants are awarded annually and intended as one-time-only funding. Grant funding is up to $2,500, and aims to support programs that build community capacity, provide injury prevention education, or support infrastructure change. Recipients are asked to complete a final evaluation report and in 2021, the first ACTION Mini-Grant Symposium was held, providing an opportunity for grantees to network and share successes from their projects.

Results: Since 2015, 34 ACTION Mini-Grants have been awarded to 31 organizations in the VCH health authority, providing over $52,000 in grant funds. The projects have been focused on senior fall prevention (n=13), road safety (8), mental wellness (8), alcohol-related injury (3), and sports injury (2).

Conclusion: The ACTION Mini-Grant program supports community action on injury prevention through seed funding, and builds capacity for ongoing injury prevention programming within the VCH health authority. The program also provides a direct link between community organizations, population health, and acute care, creating new partnerships and building a network of injury prevention initiatives in the greater Vancouver area.

Abstract #2319: Defining the role of injury prevention at trauma centres: a Canadian survey

Presenting Author: Joanne Sadler¹

Authors: Joanne Sadler¹, Brandy Tanenbaum², Jennifer Britton³, Tanya Charyk-Stewart³

¹ Trauma Services, Vancouver General Hospital, Vancouver Coastal Health

² Sunnybrook Hospital

³ London Health Sciences Centre

Abstract:

Introduction: Injury prevention (IP) is a fundamental component of trauma care delivery. Trauma program accreditation standards in Canada include IP requirements; however, the exact role of IP in a trauma program remains undefined.

Objectives: The Trauma Association of Canada (TAC) IP Committee conducted a national survey to assess the current structure of IP at trauma centres, describe the qualifications and experience of individuals filling those roles, and identify opportunities to advance IP in the Canadian trauma system.

Methods: An expert working group from the TAC IP committee adapted a survey developed by the American Trauma Society. The survey included 24 questions categorized into 4 domains: 1) trauma centre information; 2) current position; 3) injury prevention work; and 4) personal demographics.

Results: A total of 17 survey responses were received. The majority of respondents were associated with a Level I trauma facility (67% pediatric; 56% adult), with 38% identified as an IP Lead/Specialist or an IP Program Coordinator (19%). Most respondents work in a full-time capacity (65%) in the trauma program (63%) or ED (19%), with half reporting to be the only IP member on their team. The top IP priorities were falls (71%), motor vehicle collisions (65%),  followed by concussions, home safety, and youth injuries (all 38%). Respondents reported public education (71%), advocacy (65%), community engagement (59%), and research (59%) as common responsibilities of their position. The top barrier to injury prevention work was limited resources (82%),  followed by a lack of program strategy/direction (35%).

Conclusion: While standardization strengthens trauma systems in Canada, there are gaps in the area of IP infrastructure that impede efforts to reduce the incidence and severity of injury, a vital responsibility of trauma centres. This survey will help to establish the foundation for IP practice in Canadian trauma systems.

Abstract #2203: Access to medical care and its association with injury: a cross-national analysis

Presenting Author: Valerie Pagnotta¹

Authors: Valerie Pagnotta¹, Nathan King², Peter Donnelly³, Wendy Thompson⁴, Sophie Walsh⁵, Michal Molcho⁶, Kwok Ng⁷, Marta Malinowska-Cieślik⁸, William Pickett¹

¹Brock University

²Queens University

³University of St. Andrews

⁴Public Health Agency of Canada

⁵Bar-Ilan University

⁶National University of Ireland

⁷University of Limerick

⁸ Jagiellonian University

Abstract:

Background: Injuries in adolescents contribute to a substantial global health burden. Strong variations in rates of injury have been documented across and within countries. Historically, these have been attributed to social and physical factors of etiological importance. An alternative, yet understudied, possible determinant is varying access to medical care in different countries.

Objective: To examine whether variations in adolescent injury rates observed cross-nationally are attributable to variations in access to health care services.

Methods: Age- and gender-specific rates of medically treated injury (any, serious, by type) were estimated by country using the 2013/14 international Health Behaviour in School-aged Children Study, or HBSC (n=209,223). Available indicators of health care access included: (1) the Healthcare Access and Quality Index (HAQ; 39 countries); (2) the Universal Health Service Coverage Index (UHC; 37 countries); (3) hospitals per 100,000 (30 countries) then physicians per 100,000 (36 countries). Ecological analyses were used to relate country-specific rates of injury on to the available indicators of medical care access, and the proportion of between-country variation in reported injuries attributable to each macro indicator.

Results: Injuries risks were substantial and varied by country and socio-demographically. There was little correlation observed between national level injury rates and the HAQ and UHC indices, but modest associations observed between serious injury and physicians per 100,000, and then hospitals per 100,000. Individual macro indicators explained up to 6.3% of the total inter-country variation in medically treated injuries and 25.2% of the variation in more serious injuries.

Conclusions: Cross-national variations in risks for adolescent injury are in part attributable to national differences in access to health care services. This simple observation informs the interpretation of cross-national patterns of injury.

Abstract #2245: Atlantic Canada cost of injury report

Presenting Author: Peri Lockhart¹

¹Atlantic Collaborative on Injury Prevention

Abstract: ACIP has procured the Atlantic Canada Cost of Injury Report based off of 2018 data.  Share results and potential actions to support Atlantic partners reduce the cost of Injury in Atlantic Canada.

Abstract #2241: Connect and recover: building an injury management system from the ground up

Presenting Author: Chris Buchner¹, Kayla Welwood¹

Authors: Chris Buchner¹, Kayla Welwood¹

¹BC Emergency Health Services

Abstract: Attendees will be able to recognize the significance of an injury management program. Attendees will be able to recognize the expedited returns to work from active injury management. Attendees will be able to recognize the importance of workplace connection alongside injury management best practices.

Development of an injury management program to support employees, provide early recognition of injuries, early access to treatment, active recovery and an ongoing connection to the workplace in lieu of the previous system used which was based around insurance companies, delays in treatment, and delays in returning to the workplace all adding psychological, monetary and social complications to employees’ wellness. Injury management best practices identified and utilized in conjunction with partnering practitioners, a change in injury handling, and a change in culture around injury management for paramedics.

Mini-Orals 3B | Location: Coal Harbour Ballroom | Time: 11:45 AM – 12:30 PM

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Abstract #2209: Unintentional adult acetaminophen exposure calls during the Omicron wave of COVID-19

Presenting Author: Jacquline Burke¹

Authors: Jacqueline Burke, Sara Khan, Crisalina Amiana, Olwen Tennis, Emily Austin, Mabel Chan,  Jonathan Zipursky

¹SickKids

Abstract:

Introduction: In January 2022, during the 5th wave (Omicron) of Sars-CoV-2 infections, poison specialists at the Ontario Poison Centre anecdotally noted an increase of unintentional exposure calls with acetaminophen (APAP) products from adult home callers. Prior to COVID-19, most of the misuse calls were related to dental or menstrual pain.

Objective: To assess if there was a change in the incidence and severity of unintentional adult exposures of APAP-containing products during the Omicron wave of COVID-19 compared to pre-pandemic period.

Methods: We performed a cross-sectional analysis of calls received to OPC over a 9-week period between December 15, 2021 to February 15, 2022 and compared the same time period pre-pandemic (2017-2019). We identified consultation requests where the reason was encoded as unintentional for APAP exposures for individuals over 19 years of age. We excluded calls for exposures identified as intentional. To examine the severity of APAP exposures we also compared the percentage of calls coded as having a death, major or moderate outcome during the Omicron wave to the corresponding control period.

Results: There was a significant increase in the mean unintentional calls related to APAP during the Omicron wave compared to the pre-pandemic period. There was no difference in the percentage of calls categorized as severe during the Omicron wave as compared to the pre-pandemic period.

Conclusions: The incidence of unintentional APAP exposures among adults significantly increased during the Omicron wave of COVID-19 as compared to the pre-pandemic period.  Although, we did see a decline in calls back to baseline as the 5th wave subsided, the overall incidence for the same period during 2018-2019 was still approximately 9 exposures/1000 population, highlighting the need for more education for the public regarding therapeutic dosing of APAP and poison prevention information to help prevent and reduce the burden on the hospital system.

Abstract #2205:  Province-wide school closures and poison centre calls for pediatric intentional self-harm

Presenting Author: Crisalina Amiana¹,

Authors: Emily Austin¹, Sara Khan², Jacqueline Burke¹, Crisalina Amiana¹, Olwen Tennis¹ Mabel Chan¹, Allison Davis¹, Jonathan Zipursky³

¹Ontario Poison Centre

²Health Canada

³University of Toronto

Abstract:

Background: Whether school closures contributed to worse mental health among Ontario youth is currently unknown.

Objective: To determine if province-wide school closures in Ontario during the COVID-19 pandemic were associated with increases in intentional self-harm calls to our poison centre among school-aged children.

Methods: We performed a cross-sectional analysis of calls received to our poison centre between February 2017 to January 2022. We identified consultation requests for intentional human exposures for individuals 6-19 years. We used univariate tests to compare the mean weekly rate of calls during each of the three province-wide school-closure periods #1 (March 23- June 30, 2020), # 2 (April 12- June 30, 2021), #3 (January 3-17, 2022) to the rate in the corresponding period from 2017 to 2019 (control period). We also compared the percentage of calls coded as having a death or a major outcome during school closures to control time periods.

Results: There was an overall decrease in the weekly number of calls for intentional self-harm observed during the first school closure at the onset of the COVID-19 pandemic in 2020 (Figure 1). This decrease was not observed during closure #2 in Spring 2021 (Figure 2). The mean weekly rate of intentional calls was lower during closure #1 than in the control period (76.2 v. 111.6, p<0.01) (Table 1). There were no differences in the mean weekly rate of intentional calls during closure #2 (117.1 v. 110.0, p=0.25) and closure #3 (106.5 v. 105.0, p=0.89) compared to respective control periods. No significant differences in the proportion of intentional exposures coded as severe (death or major outcome) during school closures were noted as compared to the control periods.

Conclusions: Province-wide school closures during the COVID-19 pandemic were not associated with an increase in intentional self-harm exposure calls to our poison centre in school-aged children.

Abstract #2282: Setting the baseline: a description of cannabis poisonings at a Canadian pediatric hospital prior to the legalization of recreational cannabis

Presenting Author: Atousa Zargaran^1,2

Authors: Phoebe Cheng³, Atousa Zargaran^1,2, Fahra Rajabali², Kate Turcotte², Shelina Babul²

¹BC Injury Prevention and Research Unit

²University of British Columbia

³CFRI

Abstract:

Introduction: This study describes the events preceding children aged 16 years or younger being treated for cannabis poisoning in the emergency department (ED) of a Canadian pediatric hospital.

Methods: We extracted cannabis poisonings treated in the ED at British Columbia Children’s Hospital (BCCH) between 1 January 2016, and 31 December 2018, from the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. The poisonings were distinguished by the inadvertent or intentional ingestion of cannabis. We reviewed the hospital’s electronic health information system and the patients’ health records to obtain additional information.

Results: Of the 911 poisonings treated at BCCH, 114 were related to intentional cannabis use (12.5%). Fewer than 10 poisonings resulted from inadvertent ingestion by children, and the median age for these was 3 years. All inadvertent ingestions occurred at home and involved cannabis belonging to the patient’s family. The vast majority of poisonings resulted from the intentional use of cannabis only (28.9%) or cannabis use with other psychoactive substances (co-ingestions; 71.1%). The median patient age was 15 years. Most patients reported consuming cannabis through inhalation and with peers. Cannabis and co-ingestion poisonings were more often reported on weekdays than weekends. The consumption of cannabis leading to poisoning more often occurred in private residences. Patients with cannabis poisoning more often sought medical treatment themselves or by their family.

Conclusion: The characteristics of cannabis poisonings among children are described for the three-year period prior to recreational cannabis legalization in Canada in order to set a baseline for future comparisons. Implications for improving injury prevention initiatives and policies are discussed.

Abstract #2283:  Examination of alcohol use patterns in youth: a study of alcohol-related poisonings at a pediatric hospital in British Columbia, Canada

Presenting Author: Phoebe Cheng¹

Authors: Phoebe Cheng¹, Atousa Zargaran^2,3, Fahra Rajabali³, Kate Turcotte³, Shelina Babul³

¹CFRI

²BC Injury Research and Prevention Unit

³University of British Columbia

Abstract:

Objective: Identify alcohol use patterns among pediatric patients with alcohol-related poisonings to better inform current substance use programs on how youth poisonings could be addressed.

Methods: Alcohol-related poisonings treated in the emergency department [ED] at British Columbia Children’s Hospital [BCCH] between January 1, 2016, and December 31, 2019, were extracted from the Canadian Hospitals Injury Reporting and Prevention Program. The sample included all youth aged 16 years or younger and had intentionally consumed alcohol prior to their ED arrival. The hospital’s electronic health information system and patient’s health records were reviewed to collect additional information on their drinking practices.

Results: Of the 1,289 total poisonings treated at the BCCH ED, 434 were alcohol-related [33.7%].

The sample consisted of a majority of female youth [59.0%] with a median sample age of 15 years [IQR: 14-16 years]. The youngest was 11 years old and the oldest youth was 16 years.

Most poisonings were unintentionally incurred. Few differences were observed in how male and female youth consumed alcohol. Overall, youth often binged on distilled alcohol, while with peers, in home environments, and at the end of the week. A few youths reported on the consumption of sweetened and/or flavoured alcohols. Intervention from bystanders, families, friends, and first responders was often needed to help the youth seek medical treatment at hospital.

Conclusion: Alcohol-related harm continues to be a prevailing public health problem despite the establishment of national drinking guidelines and laws to discourage underage drinking. Continued efforts to educate and disseminate safe drinking practices among youth are especially crucial to mitigate alcohol poisonings during and post-COVID-19 pandemic.

Abstract #2216: What’s new from Health Canada consumer product safety?

Presenting Author: Tina Wang¹

Authors: Tina Wang¹, Andress Lee²

¹Health Canada – Consumer Product Safety Program

²University of British Columbia

Abstract: Health Canada (HC) Consumer Product Safety Program (CPSP) administers the Canada Consumer Product Safety Act (CCPSA), its corresponding regulations, and the Cosmetic Regulations under the Food and Drugs Act (FDA). The purpose of the legislation is to protect the public by addressing or preventing risks to human health or safety that are posed by consumer products and cosmetics available in Canada. In order to prevent injuries, HC CPSP:

1. Creates the Health Canada Consumer Product and Cosmetic Incident Reporting Toolkits;
2. Implements of the Corded Window Coverings Regulations (CWCR);
3. Modernizes of outreach strategies through the Safe Sleep Integrated Marketing Communications Plan (IMCP).

HC CPSP uses the following approach to address each topic.

1. A key role of the HC CPSP’s mission is reviewing consumer products and cosmetics that could cause harm. To assist with this, Canadians should report any incidents related to consumer products or cosmetics, so the HC CPSP can review the safety and the risk of the products.
2. On May 1, 2021, the new CWCR under the CCPSA came into force. Requirements under the CWCR serve an important purpose to help eliminate the strangulation hazard associated with corded window coverings and help protect the health and safety of children.
3. The Safe Sleep IMCP aims to prevent future product-related incidents linked to a baby’s sleep environment through enhanced, coordinated and tailored messaging and communication strategies.

Two new digital incident reporting toolkits were developed. HC CPSP runs a national project to verify the industry’s compliance for corded window coverings. New safe sleep publications and promotions are developed from the modernization of outreach strategies.

HC CPSP will continue to prioritize and promote injury prevention.

Abstract #2292: BC AdventureSmart – outdoor recreation education and incident prevention

Presenting Author: Sandra Riches¹

Author: Sandra Riches¹

¹BC AdventureSmart

Authors:

Abstract: AdventureSmart is a national program, that started in BC 18 years ago by the BC Search and Rescue Association, dedicated to encouraging Canadians and visitors to Canada to “Get informed and go outdoors”. AdventureSmart balances key safety messages with an individual’s responsibility for safety; encouraging the public to obtain the knowledge, skills and equipment necessary for them to enjoy their outdoor pursuits. By being AdventureSmart, outdoor enthusiasts make informed decisions, reducing the frequency, severity and duration of search and rescue (SAR) incidents.

AdventureSmart combines online and on-site awareness with targeted outreach in order to reduce the number and severity of Search and Rescue Incidents in Canada.

In order to provide the largest possible number of Canadians and visitors to Canada with consistent and relevant safety information, and to ensure that opportunities to engage the public are maximized, AdventureSmart and its partners take a broad, encompassing approach to the delivery of adaptable safety information in-person and online.

Through the collaborative efforts of our various partners, regional coordinators, and volunteers, AdventureSmart is dedicated to encouraging participants to “Get informed and go outdoors”.

Heading outdoors in BC?

Start @BCAdvSmart

Abstract #2206: Context-enriched wearable sensor-based activity classification in soccer

Presenting Author: Suliat Yakubu¹

Authors: Suliat Yakubu¹, Calvin Kuo¹

¹University of British Columbia

Abstract:

Introduction: Soccer is a popular sport, but also has a high risk of injury. Evidence-based injury prevention routines have poor uptake. Additionally, injury incidence rate is reported in terms of total athlete time, however not all activities carry the same level of risk. Real time activity classification could provide a detailed history of exposure to high-risk activities. This would provide coaches with additional information to use in choosing from existing injury prevention routines.

Objectives: We aim to improve existing Inertial Measurement Unit (IMU) -based activity classification methods by incorporating contextual information, regarding player position using a Hidden Markov Model (HMM). IMU-based classifiers have successfully been used to identify activities in exercise and sport-based contexts. HMMs are a popular tool for pattern recognition in time serial data.

Approach: 11 collegiate varsity female soccer players will be instrumented with a single IMU, placed on the lower back, to capture on-field activity data. Ground truth activity labels will be determined using video footage. The collected sensor and video data will be used to train a Random Forest (RF) algorithm, and to develop an HMM to incorporate context. To assess the proposed framework, the accuracy of the generic RF classifier, the RF classifier combined with a general HMM, and the RF classifier combined with a position-specific HMM will be compared.

Impact: Developing systems capable of collecting, analyzing, and delivering this information on a personalized level could allow non-professional sports teams to have access to elite level physiological analytics, protecting athletes at all levels and stages of their careers, and enabling them to reach their full on-field potential.

Abstract #2275: Brain Waves program in British Columbia: virtual teaching during the pandemic 2021-2022

Presenting Author: Anita Yau¹

Authors: Anita Yau¹, Mojgan Karbakhsh¹, Laura Mar¹, Brendan Smith¹, Alyssa Wellar¹, Shelina Babul¹,

Abstract:

Introduction: Brain Waves is an engaging neuroscience program with the aim to promote brain safety among elementary school students. This program has been originally developed by Parachute as in-person presentations and the BC Injury Research & Prevention Unit (BCIRPU) is the delivery partner for the program in British Columbia (BC).

Objectives:  To present the statistics in pivoting and delivering the program virtually in 2021-2022, following the COVID-19 pandemic.

Approach: During the pandemic, nine Brain Waves video lessons were developed in BCIRPU. Phase 1 (July-Sep 2021) included SWOT analysis of the previous year’s implementation and the team decided to continue the online delivery of the program. In phase 2 (Sep-Dec 2021), volunteer presenters were recruited and BC schools were contacted to introduce the program. During phase 3 (Jan-Feb 2022), a training session for presenters were held and interested schools were scheduled for online presentations. In phase 4 (Feb-May), the program was delivered to the interested schools. A final report was developed in June and submitted to Parachute.

Results: A total of 476 schools were contacted with 33 expressing interest. A total of 16 volunteers participated in 39 presentations, educating an estimated number of 780 students across 33 schools (compared to a median of 12 annual presentations in the preceding 5 years). The virtual option allowed us to educate a greater number of students and communities which seemed out of our catchment area for in-person presentations, in the Okanagan, Vancouver Island, and Fraser Valley.

Conclusion: The Brain Waves program was successful in pivoting, and reaching a considerable number of schools across the province, using the virtual format.

Abstract #2253: Drowning Prevention though Social Media

Presenting Author: Kelly Carter¹

Authors: Kelly Carter, Kelsey Lalonde¹; Mabel Wong²

¹Lifesaving Society Alberta & Northwest Territories

²Northwest Territories Health

Abstract: In 2020 and 2021 the Lifesaving Society with guidance and support from the Government of Northwest Territories Health and Indigenous Health departments developed and distributed a series of social media drowning prevention campaigns. These became the primary means of delivering drowning prevention messaging throughout the Northwest Territories while COVID-19 public health restrictions were in place limiting travel into communities. In total 3 video campaigns were produced and distributed using Facebook, Instagram, Google, and Youtube. The results of the campaigns were encouraging with a total of 312,648 impressions, a reach of 38,036, and 865 clicks to further information. The drowning prevention messages were developed to be culturally appropriate and were reviewed by NWT health prior to their release. The messaging contained in the campaigns was driven by data from the NWT drowning report and stakeholder consultations. Upon evaluation we found that we were able to hit individuals multiple times during the campaign, we found that there were more females than males who saw the campaign, and the age category with the highest views were people aged 55-64 (2 videos) and 25-34 (1 video). We saw a trend that fewer young people (18-24, and 25-35) viewing the last 2 video campaigns which were released in 2021 that could be a result of the shift in use to other social media platforms.

Abstract #2236: Developing an elementary school injury prevention toolkit – lessons learned

Presenting Author: Patti Stark¹

Authors: Patti Stark¹,Kathy Belton¹, Melanie Morgan-Redshaw¹,Natalie Malowany¹

¹ Injury Prevention Centre, School of Public Health, University of Alberta

Abstract:

Rationale: In Alberta, every year, 127 children and youth die due to an injury; 3,915 are hospitalized and 160,720 are treated in emergency departments. There is no standardized injury prevention curriculum in Alberta for elementary school aged children resulting in dissimilar exposures to safety messages and teaching. With funding support from Forbes Bros, IPC has designed the Elementary Injury Prevention Toolkit to assist educators in teaching children about the importance of safety and injury prevention to reduce their risk of injury.

Objectives:

1. Review research on effective injury prevention resources and best practices for achieving behaviour change in students.
2. Adapt/ develop and pilot test toolkit.

Approach: Background, learning objectives, key messages, and lesson plans were developed for ten different injury topics. While some content was adapted with permission from the RiskWatch Injury Prevention Curriculum, in most cases information was collected from expert organizations (i.e. Parachute, Lifesaving Society) and linked to and/or adapted to create lesson plans and support the learning objectives. Suggestions are made in each topic identifying community prevention professionals that could support learning activities and letters highlighting topics being discussed are provided to send home to parents.

Results: The toolkit has been completed and is ready for pilot testing in both urban and rural schools during the 2022/2023 school year.

Conclusions/Key Learnings:

• Project required more resources than anticipated.
• Limited research is available on changing attitudes and behaviours in children.
• There are many excellent injury prevention resources available to use but it requires time and expertise to find and assess their usefulness and quality.
• Aligning lesson plans with curriculum was challenging as Alberta is adopting a new curriculum in September 2022.

Abstract #2246: Implementing safe sleep initiative at London Health Sciences Centre

Presenting Author: Jennifer Britton¹

Authors: Kaitlyn Jacobs¹, Jennifer Britton¹, Fran Priestap¹, Shannen Mclean¹, Alison Armstrong¹, Neil Merritt¹

¹ London Health Sciences Centre

Abstract:

Introduction: According to Statistics Canada, there have been roughly 1,700 deaths per year from 2015-2020 in infants under the age of one. Of these deaths, 110 occurred during sleep and 83% were unexpected and sudden. Despite growing evidence of positive outcomes associated with safe sleep policy adoption, very few hospitals in Ontario have implemented their own policy.

Methods: Baseline data measuring safe sleep behaviour via crib audits identified target areas and informed safe sleep policy creation. An online education module on safe sleep was created for hospital staff. Post-intervention crib audits were conducted following implementation of the policy. All crib audits were performed on a convenience sample at London Health Sciences Centre (LHSC) in Ontario. All infants were less than one year of age.

Results: A total of 101 pre-intervention and 132 post-intervention crib audits were included in the evaluation. Nine audits (seven pre-intervention, two post-intervention) were excluded for not meeting audit requirements. Significant improvement was found in the proportion of infants placed in a safe sleep position (76.2% pre-intervention vs 92.4% post-intervention, p<0.01).  Significant improvements in safe sleep environment were also demonstrated by a decrease in percentage of cribs with loose items (78.7% pre-intervention vs 39.6% post-intervention, p < 0.01). Specifically, percentage of cribs that contained extra blankets significantly decreased from 68.2% to 17.9% (p<0.01). The presence of stuffed toys and diapers in the sleep environment were also observed to decrease between phases (26.9% vs 6.7% p<0.01and 34.3% vs 10.5% p<0.01, respectively).

Conclusion: Implementing a safe sleep program led to significant improvements in infant sleep positioning and crib environment at LHSC. Follow up is required to ensure lasting effects of this program.

Abstract #2281: Risk and protective factors associated with injury rates in youth ice-hockey

Presenting Author: Paul Eliason¹

Authors: Paul Eliason¹, Jean-Michel Galarneau¹, Shelina Babul², Martin Mrazik³, Constance Lebrun³, Brent Hagel¹, Carolyn Emery¹

¹University of Calgary

²University of British Columbia

³University of Alberta

Abstract:

Introduction: Risk and protective factors associated with injury in youth ice-hockey have been suggested yet some, including sex, remain inconclusive.

Objectives: To examine risk factors associated with game-related injury rates (IR) in youth ice-hockey players.

Methods: Data from the Safe2Play five-year longitudinal cohort study were examined, including 4419 youth ice-hockey players (6585 player-seasons; ages 10-18, 90% male, 9% female, all levels). All game-related injuries were identified using validated injury surveillance. Multilevel Poisson regression analysis was performed, adjusted for a priori evidence-informed covariates (i.e., body checking policy, age group, sex, year of play, level of play, concussion history, player weight, position of play) and random effect at a team level (offset by game-exposure hours), to estimate injury incidence rate ratios (IRR). Multiple imputation by chained equations accounted for missing covariate data.

Results: A total of 1184 game-related injuries [crude IR adjusted for cluster by team=6.59 injuries/1000 game-hours (95% CI: 6.02-7.21)] were sustained over 5 years. Relative to the U-13 age group, U-15 (IRR=1.44; 95% CI: 1.06-1.95) and U-18 (IRR=1.81; 95% CI: 1.27-2.58) had higher IRs. Female players (IRR Female/Male=1.40; 95% CI: 1.04-1.87) and players with a previous injury within the past year (IRR=1.63; 95% CI: 1.42-1.87) also had higher IRs. Policy disallowing body checking in games (IRR=0.47; 95% CI: 0.37-0.59) and being a goaltender (IRR Goaltenders/Forwards=0.57; 95% CI: 0.43-0.75) were protective against injury.

Conclusion: In youth ice-hockey, older age groups, female players (despite policy disallowing body checking), and players with an injury history had higher game-related IRs. Being a goaltender and playing in leagues where policy disallowed body checking was associated with lower IRs. Future studies should examine why female players are at elevated risk of injury to inform injury prevention strategies.

Abstract #2293: Older youth ice-hockey players have the greatest injury and subsequent injury risk

Presenting Author: Jean-Michel Galarneau¹

Authors: Jean-Michel Galarneau¹, Paul Eliason¹, Carolyn Emery¹

¹University of Calgary

Abstract:

Introduction: Factors associated with game-related injuries have been identified in youth ice hockey but factors associated with subsequent injury have not been examined extensively.

Objectives: To examine factors associated with injury and, for those with an injury history at the beginning of the season, subsequent injury.

Methods: Game related injuries were identified through injury surveillance in the Safe2Play five-year longitudinal prospective cohort study (n=4419 youth ice hockey players, ages 11-17; 6585 player-seasons). A multiple failure time Cox regression analysis, adjusting for important covariates and cluster by team, was utilized to estimate hazard ratios (HR) associated with injury and subsequent injury.

Results: A complete case analysis (n=3674 hockey players) included 689 injuries (67165 exposure weeks). There was a two-fold risk of injury in bodychecking leagues (HR=2.02, 95% CI: 1.57-2.59) and in older players (HRU15=1.89, 95% CI: 1.23-2.86; HRU18=2.14, 95% CI: 1.43-3.21) relative to U13. Those with an injury history at the start of the season had a higher risk of injury over the course of the season (HRinjuryhistory=1.46, 95% CI: 1.25-1.71); this was also suggestive for females (HRfemale=1.40, 95% CI: 0.98-1.99). Restricting to players with an injury history (n=1339 players; 339 subsequent injuries), the most prominent risk factors remained older age group (HRU15=1.69, 95% CI: 0.91-3.10; HRU18=1.86, 95% CI: 1.04-3.33) and playing in a bodychecking league (HRbodychecking=1.57, 95% CI: 1.13-2.14). Females also had a higher risk of subsequent injury than males but this was not significant (HRfemale=1.50, 95% CI: 0.96-2.36).

Conclusion: Game-related injury prevention efforts should target bodychecking leagues, older age groups, and players with an injury history. Females tended to have a higher risk of injury and subsequent injury than males and should also be considered.

Abstract #2301: A systematic review on facilitators and barriers to implement ACL injury prevention programs

Presenting Author: Yuba Raj Paudel¹

Authors: Yuba Raj Paudel¹, Mark Sommerfeldt², Nabil Khan², Bonaventure Oguaju², Olivia Antos², Don Voaklander²

¹ Injury Prevention Centre, School of Public Health, University of Alberta

²University of Alberta

Abstract:

Introduction: Despite a large body of evidence supporting effectiveness of neuromuscular training programs to reduce anterior cruciate ligament (ACL) injuries, the large-scale implementation of ACL injury prevention programs (IPP) has faced challenges. This study aimed to identify potential facilitators and barriers to implement ACL IPP.

Methods: We included both experimental and cross-sectional studies if they had ACL injury as an outcome measure and have reported at least one facilitator or barrier to ACL IPP. Quality appraisal of included studies was done by using PEDRO scale and AXIS criteria for experimental and cross-sectional studies, respectively. We used Consolidated Framework for Implementation research (CFIR) to guide extraction and synthesis of data.

Results: A total of 30 studies were included in this review. Included studies were moderate to low quality. The findings suggest capacity enhancement and motivation of coaches and athletes; and  minimal requirement of additional cost and resources are critical facilitators for IPP implementation. Secondary factors included the program’s adaptability, collaborative design, and timing of implementation, as well as duration of the program per session. Furthermore, the inner setting (availability of supportive resources and people, enabling environment), outer setting (policy environment, media role, favourable evidence) and process of program implementation (frequent supervision, feedback, and support) were also important facilitators for IPP implementation. Major barriers were related to lack of motivation among coaches and athletes, perceived time constrains, lack of information and often being exposed to misinformation, as well as lack of communication.

Conclusion: Wide scale implementation of ACL IPP requires action at multiple levels with collaboration among stakeholders. Future studies can use CFIR framework to standardize reporting of implementation issues.

Abstract #2316: Neuromuscular training injury prevention programs in youth sport: A focus on implementation

Presenting Author: Destiny Lutz¹

Authors: Destiny Lutz¹, Carla van den Berg¹, Anu M Räisänen^1,12, Isla Shill^1,2, Kenzie Vaandering¹, Jemma Kim⁴, K. Alix Hayden⁸, Kati Pasanen^1,3,5,6, Kathryn Schneider^1-3,5,7-9, Carolyn Emery^1-3,5,7,9-11, Oluwatoyosi Owoeye^1,4

¹Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Canada

²Hotchkiss Brain Institute, University of Calgary, Canada

³Alberta Children’s Hospital Research Institute, University of Calgary, Canada

⁴Department of Physical Therapy & Athletic Training, Doisy College of Health Sciences, Saint Louis University, United States of America

⁵McCaig Institute for Bone and Joint Health, University of Calgary, Canada

⁶Tampere Research Center of Sports Medicine, UKK Institute, Tampere, Finland.

⁷Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Canada

⁸Libraries and Cultural Resources, University of Calgary, Calgary, Canada

⁹O’Brien Institute for Public Health, University of Calgary, Canada

¹⁰Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada

¹¹Department of Paediatrics, Cumming School of Medicine, University of Calgary, Canada

¹²Department of Physical Therapy Education, College of Health Sciences, Northwest, Western University of Health Sciences, Lebanon, OR, United States

Abstract:

Background: Neuromuscular training (NMT) programs are effective sport injury prevention strategies when used. Best practices for implementation of NMT strategies in youth team sports are core to success for injury prevention.

Objectives: To evaluate dissemination and implementation (D&I) strategies for NMT programs in youth team sport (<19 years) and their effectiveness for injury prevention.

Methods: The search strategy for this systematic review included eight databases [search term domains: injury prevention (NMT), youth, sport, implementation]. Two reviewers completed screening (title/abstract, full-text), data extraction, and Downs & Black (D&B) risk of bias. A third reviewer resolved any disagreements. (See Prospero Ref: CRD42021271734).

Results: Fifty of 4848 screened studies were included. Sports included soccer (52%), basketball (12%), multisport (12%), and rugby (10%). Study designs included randomized controlled trials (RCT) (15) (of which only 2 focused primarily on D&I strategies), cross-sectional (12), quasi-experimental (7) and cohort (7). Common D&I strategies were workshops combined with resources (WR), workshops combined with resources and personnel support (WRP), and resources only (R). RCTs using WR (n=5) or WRP (n=2) reported adherence ranging from 1.3-2x/week. WR and WRP RCTs reported 32-68% lower injury rates compared to control. The RCT evaluating R only reported no significant differences in injury rates between groups. A behaviour change model was only reported in 16 (32%) studies (e.g., Health Action Process Approach, Theory of Planned Behaviour, Health Belief Model). Scores on D&B ranged from 4 to 24/32.

Conclusion: WR was the most common D&I strategy in reducing injury rates in youth sport. There has been a focus on soccer and expansion to other youth sports is key. Future research should highlight D&I strategy evaluation and outcomes for NMT programs.

Abstract #2324: Suspected injury rates in Canadian youth rugby: sex and age matter

Presenting Author: Taylor Price¹

Authors: Taylor Price¹, Stephen West^1,2, Isla Shill^1,3, Sharief Hendricks⁵, Keith Stokes^6,7, Carolyn Emery1^-3,8-11

¹Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Canada

²O’Brien Institute of Public Health, University of Calgary, Canada

³Hotchkiss Brain Institute, University of Calgary, Canada.

⁴University of Calgary Sport Medicine Centre, Faculty of Kinesiology, Canada

⁵Division of Exercise Science and Sport Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town

⁶Department for Health, University of Bath, Bath, United Kingdom

⁷Rugby Football Union, Twickenham, London

⁸Alberta Children’s Hospital Research Institute, University of Calgary, Canada

⁹McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada

¹⁰Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada

¹¹Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada.

Abstract:

Introduction: Youth participation in rugby union has increased over the past decade in Canada, despite high injury rates globally. Video-analysis in elite males has identified high risk events to target injury prevention initiatives. Application to the youth population is required.

Objectives: To examine the suspected injury rates (IR) during one season (2021) in Canadian male and female youth rugby players.

Methods: 77 games (37 boys, 40 girls) were filmed in U13, U16, and U18 age groups. Suspected injuries and concussions were coded with Nacsport software.

Results: 90 suspected injuries (boys=46, girls=44) were evaluated based on previously validated methods. Overall suspected IRs did not differ by sex [Incidence Rate Ratio (IRR)=1.13 (95% CIs;0.73-1.75))], however for U13 only there was a 3-fold high IR for girls compared to boys (IRR:2.91, 95% CIs;1.16-7.19). For girls, the IR was highest in U13 (IR=234.0/1000 player-hours, 95% CIs;116.8-418.8) and U18 (IR=209.7/1000 player-hours 95% CIs; 111.6-358.6) compared to U16 (IR=51.1/1000 player-hours, 95% CIs; 31.2-79.0) (IRRU13= 4.58, 95% CIs; 1.98-10.01, IRRU18=4.09 95% CIs; 1.87-8.66). For boys, compared to U16 (IR=64.0/1000 hours 95% CIs: 39.6-97.9), the injury IR was also higher for U18 (IR=116.1/1000 hours 95% CIs: 61.8-198.5) and U13 (IR=80.5/1000 hours 95% CIs; 41.6-140.7), but not significant (IRRU13= 1.26, 95% CIs; 0.56-2.68, IRRU18=1.81 95% CIs; 0.83-3.79). Suspected concussions accounted for a large proportion of injuries (U13: girls=55%, boys=33%; U16: girls=25%, boys 33%; U18: girls=31%, boys=23%). The tackle was the most common event leading to injury (boys=72%, girls=91%).

Conclusion: Suspected IRs are high in youth rugby, with U13 and U18 groups having significantly higher injury than U16 age group in girls. Concussions account for a significant proportion of injuries for youth. Injury prevention targeting U13 players, girls, and the tackle in youth rugby is a priority for player welfare.

Abstract #2322: Concussion awareness training tool for youth: impact on concussion knowledge

Presenting Author: Heather Shepherd^1-4

Authors: Heather Shepherd^1-4, Jean-Michel Galarneau^1-4, Matthew Neill^1-4, Shazya Karmali⁵, Kate Turcotte⁵, Stephanie Cowle⁶, Alison McPherson^7,8, Nick Reed^9-11, Kathryn Schneider^1-3,12,13, Jeffrey Caron^14,15, Kathy L. Belton¹⁶, Isabelle Gagnon^17,18, Michael Robinson¹⁹, Amanda M. Black^1-4, Ian Pike^5,20, Carolyn A. Emery^1-4,21, Shelina Babul^5,20

Author Affiliations:

¹Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta;

²Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta

³Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta

⁴O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta

⁵BC Injury Research and Prevention Unit, BC Children’s Hospital, Vancouver, British Columbia

⁶Parachute, Toronto, Ontario

⁷School of Kinesiology and Health Science, York University, Toronto, Ontario

⁸LaMarsh Centre for Child and Youth Research, York University, Toronto, Ontario

⁹Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario

¹⁰Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario

¹¹Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario

¹²Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta

¹³Evidence Sport and Spine, Calgary, Alberta

¹⁴School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montreal, Quebec;

¹⁵Center for Interdisciplinary Research in Rehabilitation, Montreal, Quebec

¹⁶Injury Prevention Centre, School of Public Health, University of Alberta, Edmonton

¹⁷School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec

¹⁸Department of Pediatrics, Division of General Pediatrics, McGill University Health Centre, Montreal, Quebec

¹⁹School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario

²⁰Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia

²¹Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta

Abstract:

Rationale: Concussion education is recommended to support concussion knowledge and behaviour changes. The Concussion Awareness Training Tool (CATT) for Youth is a 60-minute online concussion education module designed for youth.

Objectives: To evaluate the CATT for youth by examining changes in concussion knowledge [general and signs and symptoms (S&S)] in grade 10-12 students.

Methods: This study used a stepped-wedge trial design. High school classes were randomly assigned to an Intervention (Ix) or delayed Intervention group (dIx). Ix completed a pre-test, the CATT, then a post-test 2-6 weeks following CATT completion. DIx completed a pre-test, 2 weeks later another pre-test, the CATT, then a post-test 2-6 weeks following CATT completion. Pre- and post-tests a were the same. A complete case analysis using a multilevel model with a flexible correlation structure accounting for sex, grade, group, weeks since entry into trial, and concussion history was conducted. For knowledge score, a multilevel interval regression accounted for ceiling effects.

Results: 471 participants [69% female; 29% had a previous concussion; Ix: 16 classes (n=337) and dIx: 6 classes (n=134)] completed a pre-test. Estimation from the full model showed that mean general concussion knowledge pre-test scores (Ix=6.83/8, dIx=6.33/8) increased following the CATT by a mean change of 0.58 points (95% CI: 0.26-0.91) with no heterogeneity between groups. Mean pre-test scores for knowledge of S&S (Ix=11.19/15, dIx=10.54/15) did not improve on the post-test for either group. In the delayed group, no significant changes were observed between pre-tests for either general knowledge or S&S score.

Conclusions: The CATT for Youth module improves general concussion knowledge in a youth sample. Further research is needed to tailor the module to improve changes in knowledge of concussion S&S. Further research examining the association between concussion knowledge and behaviour is needed.

Abstract #2294: Penalizing head contacts: a priority for injury prevention in Canadian university basketball?

Presenting Author: Christy Fehr¹

Authors: Carolyn Emery¹, Brent Hagel¹, Claude Goulet², Stephen West¹

¹University of Calgary

²Université Laval

Abstract:

Rationale: Little research examines concussion, injury, and head contacts in Canadian basketball and potential differences between males and females at the university level.

Objective: To examine rates of head contacts (HCs), [direct (HC1) and indirect (HC2)], physical contacts (PCs: mild, moderate, severe level of PC), and suspected injury and concussion in male and female Canadian university basketball players.

Methods: Ten university basketball games (five male, five female) were analyzed using Dartfish video analysis software and face validated criteria from other sports. Univariate Poisson regression analyses, clustering by team and offset by game length (minutes) was used to estimate incidence rates (IRs) and incidence rate ratios (IRRs) for HCs and PCs.

Results: 611 PCs occurred to defenders (38% mild, 56% moderate, 6% severe) and 698 PCs occurred to the offense (28% mild, 69% moderate, 3% severe). The suspected injury IR did not differ significantly for females (IR=0.10/10-player-minutes; 95% CI: 0.06-0.20) compared with males (IR=0.09/10-player-minutes; 95% CI: 0.04-0.20; IRRm/f=0.75; 95% CI: 0.27-2.08). 230 HCs (89% HC1s, 11% HC2s) were observed (52% to offensive players 48% to defense). The suspected HC1 IR was 1.55-fold higher in males (IR=0.62/10-player-minutes; 95% CI: 0.50-0.76) than females (IR=0.40/10-player-minutes; 95% CI: 0.34-0.48; IRRm/f=1.55; 95% CI: 1.19-2.02). Suspected concussion IRs did not differ for males (IR=0.02/10-player-minutes; 95% CI: 0.005-0.07) and females (IR=0.01/10-player-minutes; 95% CI:0.001-0.07; IRRm/f=2.0; 95% CI: 0.20-19.8). Only 10% of HC1s to defenders and 24% of HC1s to offensive players were assessed as a foul.

Conclusion: Suspected HC injury rates were higher for male players; however, suspected concussion and injury rates did not significantly differ between males and females. A priority for injury prevention may be penalization of HCs, as 90% of defensive HCs and 75% of offensive HCs were not penalized.

Abstract #2259: Telemedicine Advanced Practice Physiotherapy: A Promising Health Promotion Strategy for Deployed Soldiers

Presenting Author: Anne-Marie Lambert¹

Authors: Anne-Marie Lambert¹, François Desmeules¹

¹Université de Montréal

Abstract:

Introduction: Musculoskeletal (MSK) disorders are the leading causes of non-combat health issues in deployed Special Operations Forces (SOF) members. During deployment, soldiers commonly neglect and/or inappropriately treat their MSK injuries leading to chronicity and negatively affecting their operational readiness and careers. Considering the small footprint of SOF deployments, having a physiotherapist on site at all times is not cost-effective. In the case of MSK injuries, an advanced practice physiotherapy (APP) telemedicine assessment, where a physiotherapist with enhanced training independently manages the condition, could positively affect the course of an injury, reducing risk of chronicity and further negative impact on Canadian Special Operations Forces Command (CANSOFCOM).

Objective: The aim of this presentation is to describe the implementation of telemedicine APP model for deployed CANSOFCOM military personnel using the nine-step PEPPA framework.

Methods: The PEPPA framework is a participatory, evidence-based, patient-focused process, for guiding the development, implementation, and evaluation of advances practices. Stakeholders were involved from the beginning of the APP telemedicine project, identifying barriers and facilitators throughout the implementation.

Results: To date, seven steps of framework have been completed leading to updated Special Operations Medical Technician (SOMT) course curriculum, video resources produced and provided to SOMT as well as presentation of APP telemedicine model at key touch points of the deployment and education cycle of CANSOFCOM military personnel.

Conclusion: The implementation of telemedicine APP intervention for deployed military personnel has the potential to prevent injuries and improve operational readiness of CANSOFCOM members. Should the evaluative portion of the framework yield positive results, this intervention could be extended across the CAF and lower the number of veterans living with chronic pain.

Abstract #2325: Circumstances of falls causing head impact in mountain biking

Presenting Author: Rickie Ma¹

Authors: Rickie Ma¹, Sukhman Gosal¹, Stephen N. Robinovitch¹

¹Simon Fraser University

Abstract:

Introduction: Falls and head injuries are common in mountain biking (MTB) (Becker et al., BJSM, 2013). Improved understanding of the modifiable factors that separate injurious and non-injurious falls may contribute to injury prevention.

Objective: We analyzed video footage of falls in MTB to determine the prevalence and situational factors associated with head impact.

Methods: We accessed publicly available falls in MTB posted to the Pinkbike website. We sent notices to posters of 700 videos, and analyzed 101 videos where posters provided information on rider characteristics. Each video was analyzed with a validated questionnaire coded with DataVyu software. Chi Square (in JMP Version 16) was used to compare the characteristics of falls that did, versus did not result in head impact.

Results: Participants captured falling included 93 men, seven women and one non-binary. Their mean age was 26.8 years (SD 11.2) and they had an average of 7.1 years of mountain biking experience (SD 7.0). 62 of the 101 falls occurred while performing jumps. The head was impacted in 47% of falls from jumps and 49% of falls not involving jumps.

The probability for head impact was higher for falls caused by wheel slippage (p=0.031) or forward tilting of the bike (p=0.029), and for falls involving high speeds (p=0.015) or more narrow paths (p=0.032). The probability for head impact was lower for falls where riders dismounted (p=0.039) or stepped (p=0.021), but was not affected by upper limb bracing (p=0.109). We found no differences in age, gender, and sex between participants who did versus did not impact their head in falls.

Conclusions: Nearly half of falls in MTB posted to Pinkbike involved head impact. The probability for head impact depended on speed, path width, mechanism of the fall, and protective responses in dismounting and stepping. There was no effect of age, sex or gender on probability of head impact. Our study reveals new insights on how riders respond to falls to avoid head impact.

Abstract #2326: Development and validation of a questionnaire for analyzing falls in mountain biking

Presenting Author: Sukhman Gosal¹

Authors: Sukhman Gosal¹, Rickie Ma¹, Stephen N. Robinovitch¹

¹Simon Fraser University

Abstract:

Introduction: Mountain biking (MTB) involves high risk for falls and injuries (Ehn, 2021; Nelson 2011). Improved understanding of the mechanisms of falls may lead to improvements in injury prevention. Video footage of real-life falls in MTB is widely available, but valid and reliable approaches are required for analysis.

Objective: To develop and assess the inter-rater reliability of a questionnaire for analyzing video footage to characterize falls in MTB.

Methods: We screen captured videos of falls posted to the PinkBike website, having a minimal resolution of 640 x 480 and frame rate of 60 fps, and showing a third-person view of the fall with minimal obstruction.

We developed a questionnaire (FVAQ-MTB) having 28 items for classifying the causes of imbalance (bike tilt, wheel slip, abrupt deceleration, incorrect body weight shift, and loss of contact), environmental and situation factors (speed, slope, grade, surface terrain, path width, protective gear), body part impacts (head, torso, pelvis, hands) and protective responses (dismount, stepping, upper limb fall arrest, reach to grasp). The FVAQ-MTB was incorporated into DataVyu software (Version 1.5.3) for coding. Raters were trained by the authors on how to interpret each question and response category.

We assessed inter-rater reliability of the FVAQ-MTB by comparing responses for each question between two independent raters who each reviewed the same 22 falls. We calculated Total Percent Agreement, Cohen’s fixed marginal kappa (Cohen, 1960) and Brennan-Prediger free marginal kappa (Brennan and Prediger, 1981).

Results: We observed substantial to near perfect agreement between raters (0.61 ≥ kn ≥ 1.00) in 20 of 28 questions, and moderate agreement (0.60 ≥ kn ≥ 0.41) in the remaining 8 questions. Among the 28 questions, the average total percent agreement was 85%, and the average Free Marginal Kappa was 0.76.

Summary: The FVAQ-MTB is a reliable tool for analyzing the circumstances of falls in MTB from video footage.

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