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The Sport Mental Health Assessment Tool 1 (SMHAT-1) was introduced as a critical component to the athlete health evaluation. However, the effectiveness of the initial triage step questionnaire (Athlete Psychological Strain Questionnaire (APSQ)) has yet to be analysed within a National Olympic and Paralympic Committee delegation. This study evaluated the ability of the APSQ to identify athletes at risk for mental health concerns. Athletes completed the APSQ and all subsequent screening questionnaires of the SMHAT-1 as part of their Tokyo and Beijing Olympic and Paralympic Games health history screening. Each questionnaire was scored according to published guidelines, and the false-negative rate (FNR) for the APSQ identifying athletes that were positively screened on the subsequent questionnaires was computed. 1066 athletes from 51 different Olympic and Paralympic and Summer and Winter sports completed the SMHAT-1. The FNRs for all athletes who were positively screened on a subsequent questionnaire with an APSQ score of <17 ranged from 4.8% to 66.7%. The global FNR for being positively screened on questionnaire was 67.5%. Female, Paralympic and Winter athletes scored higher on one or more questionnaires compared with male, Olympic and Summer athletes, respectively (p<0.05). Due to the high FNR of the APSQ detecting a potential mental health concern, we recommend athletes complete the APSQ and all subsequent questionnaires of the SMHAT-1 rather than using only the APSQ as an initial screening test.

The effects of injury and illness on sports performance remain incompletely understood in Olympic athletes. This study investigated whether sustaining an injury or illness at the 2024 Paris Summer Olympic Games affected the probability of winning a medal, which combinations of injuries or illnesses were most impactful on the probability of winning a medal, and how injury or illness influenced athletes’ final percentile ranking. Data from injury and illness events among Team USA athletes were merged with final event results and ex ante (i.e., based on forecasts) market-derived probabilities of success. Logistic and general linear regression models were used to assess the impact of injury and illness on outcomes, controlling for the expected probability of success. Results showed no significant effect of injury or illness on the probability of medaling ( p  = 0.945). However, sustaining an injury or illness was significantly associated with a lower percentile rank finish ( p  = 0.004), with a stronger effect among athletes with lower initial probabilities of success ( p  = 0.013). These findings highlight the measurable impact of injury and illness beyond only time loss and reinforce the importance of robust injury and illness prevention strategies for elite athletes.

BackgroundThe purpose of this report is to provide insight and details regarding the development and implementation of an injury and illness surveillance (IIS) system for the United States Olympic and Paralympic Committee (USOPC).MethodsThe development and deployment of the IIS employed a multiphase approach. First, researchers determined variables to include in the IIS using the recommendations from the 2020 IOC consensus statement for reporting sport epidemiological data. Second, the hosting and deployment platforms were comprehensively evaluated for their suitability, ease of use, flexibility, and backend data structure (for both capture and aggregation). Third, focus groups consisting of the Sports Medicine department leadership and clinicians piloted the IIS system and revisions were made based on their feedback. Pilot testing of the IIS and follow-up focus groups were then conducted among all departmental clinicians to solicit additional feedback and drive further revisions. Finally, the IIS system was piloted among providers working during the 2023 Pan American and Parapan American Games to refine the system for future Games. After reviewing all potential software platform options (electronic medical record [EMR] system, athlete management systems, secure data collection platforms), Qualtrics (Qualtrics, Provo, UT, USA) was selected to host the IIS system. This choice was made due to the inability of the EMR and athlete-management systems to make frequent updates, modify existing questions, and provide the necessary form logic for the variety of scenarios in which the IIS system would be deployed. Feedback from the department’s leadership and clinicians resulted in a number of changes, most notably being the ability to enter multiple diagnoses for a single injury event. Additionally, clinician feedback resulted in the creation of additional diagnostic codes not currently present in the OSIICS v14.0 diagnostic coding system, adding “non-sport” as an additional variable for injury setting, and developing a system for reporting return-to-sport date for time-loss injuries.DiscussionA multi-stage process of extensive planning, stakeholder feedback, and ongoing updates is required in order to successfully develop and implement an IIS system within a National Olympic and Paralynpic Committee. This process can be used to inform the development and implementation of IIS systems in other sporting organizations.

To enhance performance, increase resilience and prevent injuries, training and testing (T&T) are the most important strategies for preparing athletes for the demands of their sport. However, for competitive snow sports such as alpine skiing, freestyle skiing and snowboarding, there is little evidence and a lack of international harmonisation of current best practices. This consensus statement, commissioned by the International Ski and Snowboard Federation (FIS), aims to provide recommendations for the physical and psychological T&T of competitive alpine and freestyle skiers and snowboarders within National Ski and Snowboard Associations. A diverse international consensus panel was selected to represent the subject matter regarding gender, nationality, expertise/background, level of competition and skiing and snowboarding discipline. Researchers, officials, physicians, physiotherapists, coaches and former athletes with extensive experience in the field were among the experts. However, the panel had a limited gender balance (seven women and 13 men) and was over-represented by European members (65%) and North American members (20%), whereas there was limited representation of perspectives from South American (5%), Australasian (5%) and African (5%) experts and a lack of experts from Asia. In the first step, the panel established an overarching structure of topics and questions to be addressed by the consensus statement. Following the RAND-UCLA appropriateness method, the consensus process subsequently included panellist ratings, discussions and revisions informed by statements derived from the literature or expert/panellist opinions. These two outcomes served as the basis for manuscript writing, which was finalised through two iterative rounds of manuscript feedback and revision. This consensus statement aims to help athletes, coaches and medical staff of international and national federations plan and implement effective T&T activities for competitive alpine and freestyle skiers and snowboarders.

Background Injury and illness surveillance is essential for understanding the relative risks of sports participation to develop effective strategies to optimize athlete health, wellness, and performance. Epidemiological studies examining injuries and illnesses among Team USA youth athletes are limited, particularly among athletes competing in Winter sports. The purpose of this study was to characterize the injury and illness incidence rate among Team USA athletes participating in the 2024 Winter Youth Olympic Games (YOG). Methods Injuries and illnesses among 101 Team USA youth athletes (40.6% female; age, 17 ± 1 years) were prospectively documented. Injury and illness prevalence, and incidence rate (IR) per 1,000 athlete-days (AD), and incidence rate ratios (IRR) were calculated with accompanying 95% confidence intervals ([95% CI]). Results Nineteen (18.8%) Team USA athletes reported at least one injury during the 2024 Winter YOG (38.0 [26.1, 53.3] injuries per 1,000 AD). Injury IR was highest among athletes competing in bobsled (166.7 [54.1, 388.9] injuries per 1,000 AD), and overuse was the most common mechanism of injury (17.3 [9.7, 28.5] injuries per 1,000 AD) among all athletes. There were no differences in injury IRs between male and female athletes (IRR [95%CI], 1.6 [0.7, 3.3]), but female athletes reported all time-loss injuries. Ten (9.9%) athletes reported at least one illness (15.0 [8.0, 26.5] per 1,000 AD), with respiratory illness (6%) being the most common type (6.9 [2.5, 15.0] per 1,000 AD). Conclusion This study highlights the need for focused efforts for injury and illness prevention for youth female athletes and athletes participating in high-risk sliding sports. Additionally, consideration for implementation of respiratory illness mitigation measures and load management strategies at and leading up to future competitions for youth athletes is key.

Background: Previous research has reported higher rates of both injury and illness among Paralympic athletes compared with Olympic athletes during the Winter Olympic and Paralympic Games, but no studies have directly compared injury and illness incidence between Olympic and Paralympic athletes competing in a Summer Games. Purpose: To compare injury and illness rates between Olympic and Paralympic Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games. Study Design: Descriptive epidemiology study. Methods: All injuries and illnesses that occurred among the Team USA athletes competing in the Tokyo 2020 Summer Olympic or Paralympic Games were documented. A total of 701 Team USA athletes (53.6% female) competed in the Tokyo 2020 Summer Olympic Games, across 34 different sports. For the Tokyo 2020 Summer Paralympic Games, a total of 245 athletes (51.6% female) competed across 20 sports. Incidence rates (IRs) per 1000 athlete-days were calculated according to sex, sport, anatomic location, and illness type. IR ratios (IRRs) were calculated to compare IRs between male and female athletes and between Olympic and Paralympic athletes. Results: Overall, there were no differences in injury incidence (IRR, 1.18; 95% CI, 0.84-1.68) or illness incidence (IRR, 0.68; 95% CI, 0.41-1.15) between Olympic and Paralympic athletes. Male Paralympic athletes were less likely to sustain an illness compared with female Paralympic athletes (IRR, 0.35; 95% CI, 0.11-0.90). Conclusion: There were no differences in injury or illness rates between Olympic and Paralympic Team USA athletes competing at the Tokyo 2020 Summer Games, contrary to previous comparisons among winter sport athletes. These results challenge the prevailing notion that Summer Paralympic athletes are at greater injury and illness risk, suggesting that factors beyond Olympic or Paralympic Games participation influence health concerns.

ObjectiveTo describe the incidence of injuries and illnesses among paediatric Team USA athletes competing in the Tokyo 2020 Olympic and Paralympic Games, and the 2022 Beijing Olympic and Paralympic Games.MethodsAn electronic medical record system documented all injuries and illnesses that occurred while competing in the four Games periods. Incidence (IR) with 95% CI per 1000 athlete days were calculated for both injuries and illnesses. Incidence rate ratios (IRR) were calculated to compare injury and illness rates based on age (paediatric vs non-paediatric) sex, Games period and sport type.ResultsTwo hundred paediatric athletes (age range, 15–21 years) competed across the four Games periods, representing 16.1% of all Team USA athletes. The overall injury IR (95% CI) was 13.4 (9.8 to 18.1), and the overall illness IR was 5.5 (3.3 to 8.7). There were no differences in incidence between paediatric and non-paediatric athletes for either injury (IRR (95% CI): 0.9 (0.6 to 1.2)) or illness (IRR (95% CI): 0.9 (0.5 to 1.5)). Female paediatric athletes were more likely to sustain an injury compared with male paediatric athletes (IRR (95% CI): 2.4 (1.1 to 5.3)). The most common mechanism of injury was gradual onset (IR, 4.3 (2.3 to 7.2)), and injuries most commonly occurred during practices (IR, 7.0 (4.5 to 10.5)).ConclusionPaediatric athletes account for a substantial proportion of Team USA athletes. It is essential that paediatric sports medicine experts are included in the medical team given that paediatric Team USA athletes are just as likely as their adult teammates to sustain an injury or illness.

ObjectivesTo assess the clinical competence of sports medicine physicians to recognise and report harassment and abuse in sports, and to identify barriers to reporting and the need for safeguarding education.MethodsWe implemented a cross-sectional cohort study design recruiting through social media and international sports medicine networks in 2023. The survey captured participant perceptions related to the harmfulness of harassment and abuse. The survey incorporated the reasoned action approach as a theoretical framework to design survey questions to identify attitudes and self-efficacy to detect and report suspicions of harassment and abuse and to identify barriers to reporting.ResultsSports medicine physicians (n=406) from 115 countries completed the survey. The situations of harassment and abuse presented in the survey were described by sports medicine physicians as having occurred in the 12 months before participating in the survey. Despite recognising the situations as harmful, sports medicine physicians were somewhat uncomfortable being vigilant for the signs and symptoms and reporting suspicions and disclosures of harassment and abuse (M=2.13, SD=0.67). In addition, just over one-quarter (n=101, 26.9%) was unaware of where to report harassment and abuse, and over half did not know (n=114, 28.1%), or were uncertain (n=95, 23.4%) of who the safeguarding officer was in their sports organisation. Participants identified many barriers to reporting harassment and abuse, including concerns regarding confidentiality, misdiagnosis, fear of reprisals, time constraints and lack of knowledge. Over half felt insufficiently trained (n=223, 57.6%), and most respondents (n=324, 84.6%) desired more education in the field.ConclusionsEducational programmes to better recognise and report harassment and abuse in sports are needed for sports medicine trainees and practising clinicians. An international safeguarding code for sports medicine physicians should be developed.

The neurocognitive health effects of repetitive head impacts have been examined in many sports. However, characterizations of head impacts for sliding-sport athletes are lacking. To describe head impact kinematics and injury epidemiology in elite athletes during the 2021-2022 Bobsleigh World Cup season. Cross-sectional study. On-track training and competitions during the Bobsleigh World Cup season. Twelve elite bobsleigh athletes (3 pilots [1 female], 9 push athletes [5 females]; age = 30 ± 5 years; female height and weight = 173 ± 8 cm and 75 ± 5 kg, respectively; male height and weight = 183 ± 5 cm and 101 ± 5 kg, respectively). Athletes wore an accelerometer-enabled mouthguard to quantify 6-degrees-of-freedom head impact kinematics. Isometric absolute and relative neck strength, number of head acceleration events (HAEs), workload (J), peak linear velocity (m·s-1), peak angular velocity (rad·s-1), peak linear acceleration (g), and peak angular acceleration (rad·s-2) were derived from mouthguard manufacturer algorithms. Linear mixed-effect models tested the effects of sex (male versus female), setting (training versus competition), and position (pilot versus push athlete) on the kinematic variables. A total of 1900 HAEs were recorded over 48 training and 53 competition days. No differences were found between the number of HAEs per run per athlete by sex (incidence rate ratio [IRR] = 0.82, P = .741), setting (IRR = 0.94, P = .325), or position (IRR = 1.64, P = .463). No sex differences were observed for workload (mean ± SD: males = 3.3 ± 2.2 J, females = 3.1 ± 1.9 J; P = .646), peak linear velocity (males = 1.1 ± 0.3 m·s-1, females = 1.1 ± 0.3 m·s-1; P = .706), peak angular velocity (males = 4.2 ± 2.1 rad·s-1, females = 4.7 ± 2.5 rad·s-1; P = .220), peak linear acceleration (male = 12.4 ± 3.9g, females = 11.9 ± 3.5g; P = .772), or peak angular acceleration (males = 610 ± 353 rad·s-2, females = 680 ± 423 rad·s-2; P = .547). Also, no effects of setting or position on any kinematic variables were seen. Male athletes had greater peak neck strength than female athletes for all neck movements, aside from right-side flexion (P = .085), but no sex differences were noted in relative neck strength. We provide a foundational understanding of the repetitive HAEs that occur in bobsleigh athletes. Future authors should determine the effects of repetitive head impacts on neurocognitive function and mental health.