Research study: Bone injury epidemiology in Australian Para athletes

Principal Researchers:  

Dr Jennifer Fleeton (Responsible Researcher)

Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health

Phone +61 2 9036 4019  | Email: jennifer.fleeton@sydney.edu.au

Ms Bing Liang (Bachelor of Physiotherapy Honours student) | Email: blia5724@uni.sydney.edu.au

We would like to invite you to participate in this postgraduate research project. You should only participate if you want to; choosing not to take part will not disadvantage you in any way. Before you decide whether you want to take part, it is important for you to understand why the research is being done and what your participation will involve. Please take time to read the following information carefully and discuss it with others if you wish. Ask us if there is anything that is not clear or if you would like more information.

What is this study about?

We are conducting a research study about bone injuries in Australian Para athletes. We will use de-identified injury records from the Australian Institute of Sport (AIS) Athlete Management System (AMS) to identify the occurrence of fractures and bone injuries and potential risk factors such as sport, athlete impairment category, sex, or training and competition factors. Taking part in this study is voluntary.

Please read this sheet carefully and ask questions about anything you don’t understand or want to know more about.

Who is running this study?

The study is being carried out by the following researchers:

• Dr Jennifer Fleeton, Lecturer Exercise Physiology, Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health
• Dr Ché Fornusek, Senior Lecturer, Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health

Ms Bing Liang is involved in this study as a basis for a Bachelor of Physiotherapy Honours at the University of Sydney.

Who can take part in the study?

We are seeking to include de-identified records for Para athletes whose injury surveillance data have been recorded in the Athlete Management System (AMS) since recording began in 2013. Basic demographic details and number of injuries will be included for all Australian Para athletes with records within the AMS, and detailed injury records will be included for any Para athlete with a fracture, bone stress injury, or bone contusion, or illness or injury record including a condition that is a known risk factor for poor bone health. These conditions include anorexia nervosa, Relative Energy Deficiency in Sport (RED-S), bulimia nervosa, nutritional or vitamin deficiency, female athlete triad, overexercising disorder, and diet and exercise associated amenorrhoea.

You have been invited to take part in this study because you have been identified as a Para athlete with records within the AMS of a bone injury or known risk factor for poor bone health.

What will the study involve for me?

This study is using an opt-out consent approach, which means that all records within the AMS that meet the inclusion criteria in section 3 will be included unless you complete the Participant Opt-Out Form to tell the AMS team that you do not wish for your records to be included in the study.

< please refer to the bottom of this page for the participant opt-out form >

If you decide to take part in this study, you will not need to do anything and you will not have any direct involvement with the research team, because the study will be analysing information that has been routinely recorded in the AMS by medical or allied health staff in the daily training environment. The AMS team will extract the relevant information from your AMS records and send it to the research team in de-identified format. This means that the research team will have access to health, demographic and non-personal information relevant to the research study but will not have access to personal information that could identify you.

The basic demographic and injury information that we will collect from AMS records for all Para athletes are:

• Dates active within the AMS
• Primary eligible impairment
• Sport(s) (including active dates in each sport where athletes have transitioned between sports or competed in multiple sports)
• Sport class/ classification
• Total number and year of occurrence of new injuries
• Total number of days where injury status is recorded as either ‘modified training or competition (orange)’ or ‘no training or competition (red)’ (also called time-loss days)

 As well as this basic information, we will also collect detailed information about an injury if the injury record includes a code recording a bone injury or a condition that is a known risk factor for poor bone health. This will include:

• Total days injured
• Total days of time-loss (modified or no training or competition)
• Diagnostic code indicating type of bone injury and body region affected
• If the injury is new or recurrent and occurred from an acute or repetitive event
• If the injury occurred during training, camp or competition either within Australia or internationally
• If it is available in the injury record, we will also collect additional sport-specific information about involved equipment and environmental or playing surface, and if the injury has been tagged as related to significant past medical history

Can I withdraw once I have started?

Being in this study is completely voluntary and you do not have to take part.

Your decision will not affect your current or future relationship with the researchers or anyone else at The University of Sydney.

We do not anticipate your decision will affect your relationship with the Australian Sports Commission, your sporting organisation, your coaches, or your healthcare providers.

If you decide to take part in the study and then change your mind, you can withdraw by completing the Participant Opt-Out Form provided with this Participant Information Statement and sending it back to the AMS team.

If you choose to withdraw, the AMS team will notify us and we will remove your information from the study results if it is possible to do so.

Are there any risks or costs?

There are no direct costs to you for taking part in this study. The study will not require any of your time, as you will not be asked to attend appointments, answer surveys, or provide any new information. There are no expected physical risks because the study only uses existing data that is routinely recorded in the AMS by staff in your daily training environment.

The risks associated with this study are very minimal. There is a very small potential risk to privacy or confidentiality when using de-identified existing data. This risk is minimised because the AMS team will de-identify the data before sending it to the research team. To make sure that athletes cannot be identified by any of the information extracted from the AMS, when we first receive the data we will combine impairment types and sports with less than 15 athletes into larger groups, and re-code sport class into broad categories indicating body region affected and whether the athlete competes seated, standing, or with their bodyweight supported. Results will be reported using these combined groups and re-coding so that individual athletes cannot be identified.

Are there any benefits?

You will not receive any direct benefits from being in the study. However, the findings may help improve understanding of bone injuries in Para athletes and potentially identify patterns in injury occurrence, characteristics, and risk factors. This information may benefit the wider Para sport community by informing strategies to help reduce the risk of developing bone injuries, training load management needs for athletes with a bone injury, and additional athlete wellbeing and support strategies.

What will happen to information that is collected?

If you do not return the Participant Opt-Out Form to the AMS team, you are providing your consent and agreeing to us collecting information about you for the purposes of this study.

The data we receive from the AMS will be de-identified, and we will group and re-code information further to make sure that you will not be identifiable from the data during analysis. Research data will be stored securely and will only be disclosed with permission from the AIS Ethics Committee unless we are required by law to release it.

We will share the study findings directly with the Australian Sports Commission and key Para sport stakeholders to help improve risk management and athlete wellbeing strategies. We will write about the results and present the findings in a variety of ways for athletes, coaches, medical and support staff, academics, administrators, and the wider community. You will not be individually identifiable in these publications.

We will store this information and dispose of it securely following the University’s Recordkeeping Policy. For more details about how your information will be handled please see the University’s privacy webpage. 

The study may identify groups of Para athletes with high risk of bone injury, or factors that may increase injury risk. This information may be used for secondary analysis or to inform future projects that will extend the results or reach of the study.

Sharing research data is important for advancing knowledge and innovation. A re-coded and combined set of the de-identified data collected in this study may be made available for use in future research, with approval on a case-by-case basis from the AIS Ethics Committee. 

Will I be told the results of the study?

You have the right to receive feedback about the overall results of this study. We will provide the AMS team with a brief summary of the overall results to share with participants. You will not receive personalised feedback about your individual results.

What if I would like more information?

When you have read this information, the following researcher(s) will be available to discuss it with you further and answer any questions you may have:

• Dr Jennifer Fleeton, Discipline of Exercise and Sport Science, Sydney School of Health Sciences, Faculty of Medicine and Health, phone +61 2 9036 4019,  email: jennifer.fleeton@sydney.edu.au

What if I have a complaint or any concerns?

The ethical aspects of this study have been approved by the AIS Ethics Committee [ethics reference: 20260102] according to the National Statement on Ethical Conduct in Human Research.

If you are concerned about the way this study is being conducted or you wish to make a complaint to someone independent from the study, please contact the Ethics Committee:

Ethics Committee Secretary

Email: ethics@ausport.gov.au

Phone:  (02) 6214 7884

Mail: The Secretary AIS Ethics Committee PO Box 176 Belconnen ACT 2616.