A context-specific injury surveillance system for the Maltese national football team

Football is a high-risk sport for injuries and therefore a comprehensive understanding of the injury problem is required for the development of tailored injury prevention strategies. Injury surveillance studies conducted during short national football team tournaments have provided only a partial view of the actual injury problem faced by national team players during the football season. This limited knowledge hampers the development of injury preventive strategies at this elite level of play. Concurrently, the reliance on consensus-based injury surveillance systems (ISSs) has hindered the ability to practically address the ‘real-life’ injury problem encountered by those involved in dealing with this issue. This poses a challenge to the effective translation of injury prevention knowledge into practical application. Therefore, the overarching purpose of this thesis was to provide national team stakeholders with year-round relevant and usable injury-related information. To achieve this, the thesis aim was to develop, implement, and evaluate a context-specific ISS for the U/21 Maltese National football team. To fulfil this aim, this thesis employed a multiphase mixed-methods research design encompassing four sequential studies. Each of this study entailed the involvement of key stakeholders, specifically Maltese national team players, coaches and clinicians affiliated with the Malta Football Association. Study one aimed to explore how the context of Maltese national team football players, coaches and clinicians influenced their perceptions of football injuries, as well as their reporting and management practices. Through interviews, participants (n=15) defined a football injury as a process but mainly based on its consequence on performance. Players’ perception of an injury influenced how they reported and managed them, with this perception further shaped by various player and socio-ecological factors. The insights gathered from study one informed the development and piloting of a context-specific ISS, that is, a tailored ISS grounded in the perspectives of stakeholders in study two. The developed context-specific ISS, utilising the Oslo Sports Trauma Research Health Questionnaire to capture injuries, was found to be feasible and useful for the stakeholders. Study three aimed to implement this context-specific ISS to gain a comprehensive understanding of the injury problem among U/21 Maltese national team football players over a 60-week period, with a specific focus on their perception of a football injury. The injury epidemiological data, including the quantitative delineation of players’ perception of 3 an injury was gathered through the weekly administration of the Oslo Sports Trauma Research Health Questionnaire to all players of the U/21 national team (n=52). Over the 60-week period, a total of 262 musculoskeletal problems were reported, with a mean of 31% of players reporting such issues weekly, affecting them in both club and national team commitments. In line with qualitative findings indicating that pain was considered an injury only when it affects performance, musculoskeletal problems perceived as injuries by players were more severe in nature and lasted longer in duration than those not perceived as injuries. Sudden-onset problems perceived as injuries by players, specifically at the knee, ankle and thigh were the most burdensome. Following the 60-week data collection period, which achieved a high player response rate (100%) to the Oslo Sports Trauma Research Health Questionnaire, study four aimed to elucidate the factors contributing to this high level of player adherence in reporting their injury-related information. This was accomplished by investigating the perspectives and experiences of the U/21 Maltese national team players’, coaches’, and clinicians’ regarding their engagement with the context-specific ISS. Qualitative insights gathered from interviews carried out with a purposeful sample of end-users of the ISS (n=17) indicated that a combination of a welldesigned simple questionnaire, collaborative efforts from clinicians’ and coaches’ in enhancing player medical care, along with players’ perceived performance improvements resulting from such efforts were motives for the players’ continued adherence to reporting. Given the pervasive influence of injuries on national team football players throughout the entire football season, the findings from this thesis emphasise the importance of maintaining continuous player monitoring through injury surveillance. By incorporating the perspectives of stakeholders as the end-users of the ISS, this thesis has laid a strong foundation for the practical development and implementation of a year-round contextspecific ISS tailored to national football teams. In sporting contexts where performance is considered the main perception of an injury, data from ISS should be used to open communication pathways with players and coaches, focusing on minimising the impact of pain on performance. Furthermore, injury prevention strategies should shift their emphasis from injury reduction to providing tangible performance benefits.