Psychological injury prevention and cost analysis in elite floorball

Floorball is a growing indoor team sport. Like many sports with fast turns and stops, the likelihood to sustain injuries is evident. The epidemiology of sport injures is well documented and prevention strategies have been suggested. Elite players are probably experiencing stress due to high demands in their sport paralleling with studies or work. The relation between stress and risk for injury has been reported in earlier research. Consequently, a psychological injury prevention programme at team level is of interest. The injuries can be divided into either traumatic or overuse injuries. So far, the research has not been able to find possible psychological factors that may explain the onset of overuse injuries. Most individuals with sport-related injuries need some kind of rehabilitation. Examinations and rehabilitations of sport injuries are most likely afflicted to costs. The documentation of costs of floorball injuries is sparse. The primary objective with this project was to evaluate a psychological skills training programme in terms of injury prevention in Swedish elite floorball during the season that the intervention was implemented and also during the consecutive season. The project had two additionally objectives; to investigate possible psychological risk factors to overuse injuries and to estimate the cost of floorball injuries at elite level. For this purpose, 23 elite floorball teams were included in this project. The teams were allocated to an intervention group or a control group. The intervention group consisted of 11 teams (males n=94 and females n=99). The remaining 12 teams were included in the control group (males n=109 and females n= 99). The occurrence of injuries was prospectively recorded in both groups during two seasons. All injuries that occurred were registered according to time loss definition. The teams in the intervention group participated in a groupbased psychological skills training consisting of six sessions during the season 2010/2011. The control group did not receive any intervention. During the consecutive season, 2011/2012, injury recordings continued without any intervening. The injuries that occurred during the second season, 2011/2012, were followed up with a questionnaire regarding cost related to each injury. Eleven floorball players, who were diagnosed with overuse injuries, were interviewed regarding possible psychological factors that may have contributed to overuse injuries. In total, the first season, 142 players (35%) out of the 401 players sustained 197 injuries, 0.45/injuries per player in the intervention group and 0.53 injury/player in the control group. The second season resulted in 93 (27%) injured players out of the 346 participating players during the game season, 0.31/injuries per player in the intervention group and 0.41 injury/player in the control group. None of the analyses showed statistical significant group differences. The effect size Cohen’s d was considered as small 0.02. The estimated means of cost of injuries in floorball showed that mean costs per mild injuries ( 30 days off) was 2358 euro (SD 2122). Knee injuries were the most costly ones as well as the traumatic injuries in female players. The interviews resulted in five core themes with possible influencing factors that contributed to overuse injuries: history of stressors, person factors, psycho-physiological factors, psychosocial factors and ineffective coping. The conclusion of this project was that no statistical significant differences were shown after the intervention. The value, however, with fewer injuries in both the intervention group and the control group should be considered to be of clinical importance. The cost of floorball injuries increases with the level of severity. Those injuries are possible risk factors to new injuries or future complaints. Therefore, it is important to evaluate preventions strategies also from a health economic perspective. To minimise risk factors to sport injuries, also psychological factors must be considered when prevention strategies are planned