Browsing by Author "Brown, James Craig"

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    Open Access
    Coaches' perception of catastrophic injuries risks in South African Rugby Union : A qualitative exploration through a socio-ecological lens
    (2017) Joshua, Jonathan; Draper, Catherine E; Brown, James Craig
    Introduction: The annual rate of rugby-related catastrophic injuries (CIs) in South Africa has been classified as "acceptable". However, of all injuries, CIs are the most traumatic for all involved. Therefore, the BokSmart programme was introduced in South Africa to reduce CIs by training all coaches in safe coaching principles. South Africa presents a particularly difficult implementation context for injury prevention interventions due to large variations in socio-economic statuses (SES) of sport participants. In addition, individuals are known to accept perceived levels of risks and ignore the actual levels of risks. Thus, rugby policy makers, experts, coaches and players may have conflicting views regarding CIs risks associated with the sport. In rugby, objective measures of risks such as risk probability are well defined however; little is known about how rugby coaches perceive the risks of CIs in rugby. This is a concern for rugby governing bodies such as SARU because coaches' perceptions of CIs risks could play a role in their adoption of BokSmart coaching principles. Additionally, risk perceptions of South African rugby coaches may vary by SES. Socio-Ecological Models (SEM) give attention to the intrapersonal, interpersonal and societal influences that affect the perceptions of coaches from various SES settings. Using qualitative methods, the aim of this research was to explore South African rugby coaches' perceptions of CIs, through the lens of a SEM. Methods: Six semi-structured focus groups were conducted with junior and senior coaches from three tiers of SES settings: low, middle and high. An additional focus group was conducted with rugby referees' to corroborate evidence from the coaches' focus groups. For analysis, a thematic framework was developed based on factors that were found to influence risk perceptions from catastrophic event studies. Themes were: 1) SES, 2) Knowledge of rugby and CIs, 3) CIs experience, 4) Cognitive biases, 5) Attitudes and intentions, 6) Coach pressure, and 7) Mass media. Results and Discussion: This study's findings suggest that coaches' perceptions of CI risks vary according to SES. Low SES coaches predominantly implied that lack of adequate rugby infrastructure influenced beliefs that their players are at risks of CIs. For Middle SES coaches, lack of knowledge about CIs prevention influenced perceptions about their players' risks of CIs. Lastly, high SES coaches' were mainly influenced by cognitive biases, perceiving their players to be less vulnerable to CIs than players in lower SES settings. All coaches were influenced by 1) a lack of CIs experience that prompted perceptions of invulnerability to CIs, 2) 'win at all costs' attitudes and intentions, and 3) coaches' pressure, both of which lowered concerns for CIs risks and resulted in players 'playing on' despite injuries. In addition, the SEM provided the overall perspective of the ecological factors that influenced coaches' perceptions of CIs. Conclusion: Perceptions of CIs risk differ among coaches from various SES settings. Therefore interventions such as the BokSmart programme should be tailored towards targeting various SES groups.
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    Immediate post catastrophic injury management in rugby union. Does it have an effect on outcomes?
    (2017) Suter, Jason Alexander; Lambert, Michael I; Brown, James Craig
    Background: Rugby union ('rugby') has a high injury risk. These Injuries range from having minor consequences to catastrophic injuries with major life changing consequences. In South Africa, previous research indicated that the risk of catastrophic injury was high and that the immediate management was sub-optimal, worsening the injury outcome. In response, the South African Rugby Union launched the BokSmart nationwide injury prevention programme in 2008. Through education - mainly of coaches and referees - this programme aims to improve the prevention and management of catastrophic injuries. Moreover, the programme began administering a standardised questionnaire for all catastrophically injured players to assess the prevention and management of these injuries. Objectives: To assess whether factors in the immediate pre- and post-injury management of catastrophic injuries in rugby were associated with their outcome. In addition, as part of the BokSmart programme in Rugby in South Africa, there were modules developed as part of the education material delivered to referees and coaches in their workshops that deal specifically with safety in the playing environment, and the correct management of catastrophic injuries. We assessed whether these protocols within the modules were implemented. Design: A prospective, cohort study conducted on all catastrophic injuries in rugby collected through a standardised questionnaire by BokSmart between 2008 - 2014. Methods: Secondary analyses were performed on the information collected on all rugby-related catastrophic injuries in BokSmart's serious injury database. Injury outcomes were split into 'permanent' (permanently disabling and fatal) and 'non-permanent' (full recovery/ "near miss"). Immediate post injury management factors as well as protective equipment and ethnicity were analysed for their association with injury outcome using a Fisher's exact test. Results: There were 87 catastrophic injuries recorded between 2008 and 2014. Acute spinal cord injuries (ASCI) made up most of the catastrophic injuries (n=69) with traumatic brain injuries (TBI) the second most common (n = 11 injuries). There were 7 cardiac events. Black African players were associated with a 2.4 times higher proportion of permanent outcome that the injured White players (p=0.001). There was no association between any protective equipment or injury management (including optimal immobilization, time and method of transport taken to hospital) and ASCI outcome (non-permanent vs. permanent) Conclusions: Neither immediate post-injury management, nor the wearing of protective equipment was associated with catastrophic injury outcome in these South African rugby-related injuries. This might indicate that the initial injury is more important in determining the outcome than the post-injury management and associated secondary metabolic cascade, as proposed by some experts in this area. Moreover, that ethnicity was associated with ASCI outcome in this study is indicative of the wider problems in South Africa; not only specific to rugby. It is recommended that BokSmart continue to focus their programme in low socioeconomic areas that play rugby in South Africa.
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    Intrinsic and extrinsic factors associated with range of motion (ROM) with an emphasis on a novel genetic factor
    (2010) Brown, James Craig; Collins, Malcolm; Schwellnus, Martin
    Introduction: Although there are numerous health benefits associated with participating in regular physical activity, there is also an increased risk of sustaining injuries, in particular musculoskeletal soft tissue injuries. Both an increased and decreased joint range of motion (ROM) has been reported as one of the intrinsic risk factors for these injuries. Similarly to injury, the ROM trait has also been associated with various extrinsic and intrinsic factors. Extrinsic factors that are associated with ROM include level and type of sports participation and temperature. Intrinsic factors include age, gender, limb dominance, weight/BMI, height, prior injury, flexibility training, ethnicity and genotype. It has been reported that ROM is a largely (47-70%) heritable trait in both pathological and apparently healthy populations. Mutations within the COL5A1 gene cause classic Ehlers-Danlos Syndrome (EDS) which present with, among other clinical signs, generalised joint hypermobility. Furthermore, a COL5A1 gene sequence variant, the BstUI Restriction Fragment Length Polymorphism (RFLP), has previously been shown to be associated with ROM measurements in a cohort containing individuals with a history of Achilles tendon injuries. Objectives: The aim of this study was, therefore, to investigate the association between the COL5A1 BstUI (C/T) and DpnII (C/T) RFLPs, as well as non-genetic intrinsic and extrinsic factors, and ROM measurements in an apparently healthy and physically active population. 15 Methods: The sit and reach (SR), passive straight leg raise (SLR) and shoulder internal (ShIR) and external rotation (ShER) assessments were performed on 325 (204 males, 121 females) white, apparently healthy and physically active subjects. Subjects were genotyped for the BstUI (SNP rs12722) and DpnII (SNP rs13946) RFLPs within the 3-untranslated region (UTR) of the COL5A1 gene. Level and type of sport participation, age, gender, limb dominance, height, weight, BMI, waist circumference, prior injury and flexibility training were also recorded to investigate possible associations with ROM. Results: There was a significant interaction between age and COL5A1 BstUI genotype with SR ROM. Subjects with a CC genotype were 'protected' against the commonly reported age-related decline in SR ROM. This divergence in response to aging resulted in a significant difference in the mean SR ROM between the BstUI RFLP genotype groups of the 'old' ('¥35 years) (TT=225 ± 96 mm, TC=245 ± 100 mm, CC=321 ± 108 mm, N=96, p=0.017), but not the 'young' (<35 years) (N=197, p=0.626) subjects. While the DpnII RFLP displayed a similar pattern of divergence in SR ROM with aging, this interaction was not significant. Nevertheless, the SR means were significantly different between DpnII genotypes in the 'old' group when the TT and TC genotypes (T allele) were combined and compared against the CC genotype (T allele=244 ± 98 mm, CC genotype=332 ± 15 mm, N=93, p=0.032). Furthermore, flexibility training (stretching) was associated with increased ROM only in the BstUI TT genotype, suggesting a genotype-specific response. Of all the intrinsic and extrinsic factors 16 investigated in this cohort, only gender and genotype (either BstUI or DpnII RFLPs) were shown to contribute to SR ROM variance through multivariate analysis. Some inconsistent associations with intrinsic and extrinsic factors were observed with the SLR and shoulder ROM assessments, although small sample size and poor reliability of these measures made the results difficult to interpret with confidence. Conclusion: The significant interaction of COL5A1 BstUI RFLP genotype with age explains the differences in SR ROM measurements observed in older, but not younger, apparently healthy and physically active individuals. A similar, non-significant pattern in the DpnII RFLP resulted in significantly different SR ROM for the T allele in comparison to the CC genotype. Besides genotype, gender also an contributed significantly to SR ROM variance in the 'old' cohort. Genetic sequence variants, in conjunction with commonly listed non-genetic intrinsic and extrinsic factors, need to be considered in order to understand the observed variance in ROM in apparently healthy and physically active populations. Keywords: COL5A1 genotype, range of motion (ROM), apparently healthy and physically active population, intrinsic and extrinsic factors, age, flexibility training.
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    Safer rugby through BokSmart? Evaluation of a nationwide injury prevention programme for rugby union in South Africa
    (2014) Brown, James Craig; van Mechelen, Willem; Lambert, Mike; Verhagen, Evert; Draper, Catherine
    Introduction and objectives: Rugby union ('rugby') is a popular sport that has a high risk of injury. The sport has particular popularity in South Africa with about 500,000 players. Based on concerns about the number of rugby-related catastrophic injuries, the BokSmart nationwide injury prevention programme was launched in July 2009 by South African Rugby Union (SARU). This programme educates coaches and referees on safe techniques during a Rugby Safety Workshop (RSW). To assess real-world injury prevention efforts, researchers have suggested using the six Translating Research into Injury Prevention Practice (TRIPP) stages. Stage 1 and 2 investigate the incidence, severity and aetiology of injuries. Stage 2 investigates the aetiology of injuries. Stage 3 is the introduction of an intervention. Stage 4 is an investigation of the effectiveness of the intervention under ideal conditions. Stages 5 and 6 investigate the real-world implementation of the intervention. Thus, the objective of this thesis is to comprehensively evaluate the BokSmart programme using the TRIPP framework. Methods: TRIPP stages 1 and 2 are investigated in Chapters 2, 3, 4 and 5. Chapter 2 investigates the incidence, severity and aetiology of injuries at four competitive youth tournaments. Chapter 3 used Chapter 2's data to investigate the economic burden of these injuries. Chapter 4 investigates the incidence and severity of catastrophic injuries. Chapter 5 investigates the risk of both general and catastrophic injury specific to the scrum phase of play using the data from Chapters 2 and 4. TRIPP stages 3 and 4 were conducted by SARU and are thus outside the scope of this thesis. TRIPP stages 5 and 6 are investigated in Chapters 6, 7 and 8. Chapter 6 evaluates the effect of BokSmart in on catastrophic injury rates. Chapter 7 evaluates the effect of BokSmart on targeted player behaviours. Chapter 8 uses qualitative methods to investigate coaches and referees' perceptions of BokSmart. Results: Through TRIPP Stages 1 and 2 it was established that South Africa has comparable general and catastrophic injury rates to other countries. Senior players were at significantly (p<0.05) greater risk of suffering a catastrophic injury than younger players. The economic investigation indicated that injury rehabilitation was affected by whether the player had medical insurance or not – this may be unique to South Africa. Through TRIPP stages 5 and 6 BokSmart was associated with a reduction in catastrophic injuries in junior, but not senior players. BokSmart was also associated with a significant improvement in targeted player behaviours. Coaches' perceptions of the programme varied by socioeconomic status (SES). All coaches and referees agreed that the programme was capable of reducing catastrophic injuries in players. However, high SES coaches described difficulties in changing coach and player behaviour, while low SES coaches mentioned their lack of necessary infrastructure as barriers to adoption. There was also negativity about the delivery of BokSmart: coaches and referees felt the course was not practical enough, was too long and should not be compulsory. Conclusions: From BokSmart's perspective, the lack of effectiveness of the programme in senior players should be of concern, considering this age group's greater risk of catastrophic injury. This greater effect in juniors could be explained either by the higher number of players, or greater adoption in this age group. Future research should attempt to elucidate this reason. The barriers and suggestions described by low and high SES coaches and referees should be addressed to optimise the programme's impact. The programme should continue to be evaluated to assess the impact of these suggestions.
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    Socioeconomic status (SES), food insecurity and the double burden of malnutrition within South African households
    (2018) Brown, James Craig; Alaba, Olufunke
    The co-existence of under- and over-nutrition, termed the double burden of malnutrition (DBM), is associated with a high prevalence of both communicable and non-communicable diseases and is becoming a large public health concern. In general, DBM development is associated with populations undergoing a nutrition transition and urbanisation. DBM can exist at a population, household or individual level. The household form is particularly difficult to target with interventions, because households, and particularly mother-child pairs, are often consuming the same foods. For example, frequent consumption of energy dense and nutrient poor ('junk’) foods can concurrently result in overweight adults, but underweight children. Although, household DBM is linked with poverty and food insecurity and its prevalence is steadfastly increasing it is yet to be investigated in South Africa, despite this country being one of the most inequitable in the world. In addition, South Africa has a high prevalence of obesity (34% of adult females obese), undernutrition (9% of children underweight) and poverty (25% unemployment). with a high prevalence of poverty and food insecurity. Therefore, this study aims to estimate the prevalence, and examine the associated factors of DBM, in South African households. Using the nationally representative data from 2014, South Africa National Income Dynamic Survey wave 4, , the prevalence of household DBM pairs (overweight/obese mother and underweight/stunted child) was estimated. Multivariate logistic regression was applied to examine the relationship between mother-child DBM pairs and (i) socioeconomic status (per capita household income, number of household residents, and mother’s race, education, marital status, household head status), (ii) food security (per capita food expenditure), and (iii) potentially important confounders (mother’s age and urban/rural household). The regression was adjusted for mother’s age as a potential confounder. Mother-child DBM prevalence was 11% in this nationally representative sample of South Africa. Mother’s characteristics of being African (adjusted odds [aOR]: 1.3; 95% confidence intervals [95%CI]: 1.0-1.7) and married (aOR: 1.4, 95%CI: 1.1-1.6) were associated with increased odds of DBM. In contrast mother’s having tertiary education (aOR: 0.7, 95%CI: 0.5-1.0) and greater household per capita income (aOR: 0.9, 95%CI: 0.8-1.0) were protective against DBM. This South African household DBM prevalence is higher than most other developing countries and is associated with mother’s being African, married and having less education; as well as households with less per capita income. This high prevalence warrants urgent attention by policy makers to further investigate this issue in South Africa. Moreover, interventions such as Brazil’s “Green my Favela” should be considered to reduce the cost and increase the supply of nutritious foods to impoverishes households of South Africa.