Perspectives in Public Health

Every year over 35,000 children under 15 in the UK are admitted to hospital with injuries caused by toys. Accidents will happen, but are recent, potentially dangerous crazes such as Heelys, trampolines, scooters and even Nintendo Wiis contributing too much to the statistics? And how can we get the balance right by keeping kids safe at play without wrapping them in cotton wool and discouraging physical activity? JRSH's Mandy Murphy finds out.

Due to their high incidence and associated morbidity and mortality, musculoskeletal injuries place an enormous burden on society. For example, in the 2004 to 2005 period 62,000 people with hip fracture accounted for 2.9% of the total number of hospital bed days in England. Between 12% and 37% of people with hip fracture die in the first year. Of the survivors, most are less mobile and many lose their independence. Soft-tissue joint injuries during sports and exercise-related activities in young adults constitute another important group. Of these, ankle sprain is the most common single injury and it predisposes people to further recurrence.

Members of the Cochrane Bone, Joint and Muscle Trauma Group prepare systematic reviews (Cochrane Reviews) of the evidence for interventions used in the prevention and management of musculoskeletal injuries. These reviews serve to facilitate evidence-based decision making by policy makers, healthcare professionals and consumers, and to guide future research.

This article focuses on two major groups of injuries: osteoporotic fractures and soft-tissue joint injuries, and discusses some of the fundamental issues and questions associated with the prevention and management of these. Drawing insights from relevant Cochrane Reviews, this article examines the different approaches used for preventing, and the role of surgery and immobilisation for treating, these injuries. Brief illustrations of the inherent complexity of rehabilitation are also provided.

This article also gives examples of how these reviews are helping to inform healthcare choices and practice, and guide research in this area.

Research has attempted to examine the psychological impact of athletic injury to assist rehabilitation personnel when treating injured athletes. Sports trainers, sports therapists, physiotherapists, medical staff and sports psychologists should be aware of psychological factors impacting on the injury experience when involved in an athlete's rehabilitation. A number of models have been proposed as useful frameworks for investigating and describing the psychological response to athletic injury. Many researchers have relied upon applying or adapting grief and cognitive appraisal models originally derived from the clinical and stress related psychology literature in an attempt to describe the psychological response to athletic injury. This article provides an overview of these models and offers a critical appraisal of this research, specifically focusing on the grief response models and the integrated model of response to sport injury and rehabilitation. Criticisms focus on the lack of research supporting a uniformed sequence of stages as a feature of response to athletic injury. Further grief criticisms centre on the absence of denial in much of the research to date. The article then focuses on the dynamic core of the integrated response to sport injury and rehabilitation model. It is argued that the interrelationships between emotional responses, behavioural responses, cognitive appraisals and recovery outcomes are not as simple as suggested in the model.

Aims: Adopting effective injury prevention practices continues to be problematic within snowboarding and the participation of older individuals is associated with an appreciable injury burden. The Haddon Matrix provides an important framework for developing injury prevention interventions. Since prevention behaviour must `fit' within individual aspirations, our study investigated the meanings and behaviours associated with snowboarding and injury prevention and then applied the findings to the established Haddon Matrix approach.

Methods: Nine, older adult recreational participants living in south-west England each contributed two interviews. These progressively focused on experiences and reflections. Verbatim transcripts were analysed and interpreted using the hermeneutic phenomenological themes of time, space, body and human relations. A further wave of analysis reinterpreted the findings in relation to the Haddon Matrix.

Findings: Snowboarding was conducted within a holiday when participants were seeking happiness by positively re-evaluating their lives. In a frame of connection-and-disconnection , beginners (time) were concerned with being-on the slopes (body and space), while more experienced (body and time) participants blended this with being-in the mountains (space). Snowboarding is a bumps-and-bruises activity and this guided the limited prevention practices. Importantly, all prevention practices were time-limited, due to a concern for learning-by-doing within a holiday. At home, more experienced boarders paid careful attention to fitness, whereas in the resorts they actively selected the soft, off-piste areas and wore protective clothing to cushion their inevitable falls. Group experiences were associated with heightened injury risks. Being seen and judged by others helped to determine the quality of the snowboarding experience. Treatment was avoided for all but the most severe injuries.

Conclusion: The findings confirm the exploratory value of mixing van Manen's four-dimensional approach with Haddon's well-established injury prevention framework. The diverse subjective meanings associated with snowboarding limit the potential for prevention approaches and suggest that resort-based `injury control' may be more appropriate for addressing the spectrum of prevention in older snowboarders.