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Although participation in recreational sports can contribute to good health, a substantial number of injuries occur, resulting in illness, increased need for medical care, and absence from work. Prevention, in the form of education, is usually offered as the solution to this. However, health education is often not planned well. This article proposes that the effectiveness of prevention by health education is reliant upon the quality of planning. The steps needed to implement effective health education are reviewed and strategies for effective intervention to prevent recreational sports injuries are discussed. Ideally, a prevention program should start by evaluating the extent of the problem, such as rate of injuries among recreational skiers. Other steps to be addressed include identifying risky behaviors and their determinants (such as reasons for inappropriate binding settings), determining options for change, deciding upon implementation of the interventions, verifying that intervention has been performed, then evaluating the reception and effects of intervention on behavior, its determinants, and on the incidence of the sports injury. Frequently, some of these evaluations are omitted, leading to ineffective intervention. Six pitfalls related to these omissions are discussed. Other factors considered include determinants of behavior, which may be attitudinal, social, or related to self-effectiveness and details in the implementation of behavioral intervention. Ultimately, prevention of injuries is one of three components, along with early detection and patient care, in the total matrix of health promotion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Background The COSMIN checklist is a tool for evaluating the methodological quality of studies on measurement properties of health-related patient-reported outcomes. The aim of this study is to determine the inter-rater agreement and reliability of each item score of the COSMIN checklist (n = 114). Methods 75 articles evaluating measurement properties were randomly selected from the bibliographic database compiled by the Patient-Reported Outcome Measurement Group, Oxford, UK. Raters were asked to assess the methodological quality of three articles, using the COSMIN checklist. In a one-way design, percentage agreement and intraclass kappa coefficients or quadratic-weighted kappa coefficients were calculated for each item. Results 88 raters participated. Of the 75 selected articles, 26 articles were rated by four to six participants, and 49 by two or three participants. Overall, percentage agreement was appropriate (68% was above 80% agreement), and the kappa coefficients for the COSMIN items were low (61% was below 0.40, 6% was above 0.75). Reasons for low inter-rater agreement were need for subjective judgement, and accustom to different standards, terminology and definitions. Conclusions Results indicated that raters often choose the same response option, but that it is difficult on item level to distinguish between articles. When using the COSMIN checklist in a systematic review, we recommend getting some training and experience, completing it by two independent raters, and reaching consensus on one final rating. Instructions for using the checklist are improved.

Abstract Background The COSMIN checklist (COnsensus-based Standards for the selection of health status Measurement INstruments) was developed in an international Delphi study to evaluate the methodological quality of studies on measurement properties of health-related patient reported outcomes (HR-PROs). In this paper, we explain our choices for the design requirements and preferred statistical methods for which no evidence is available in the literature or on which the Delphi panel members had substantial discussion. Methods The issues described in this paper are a reflection of the Delphi process in which 43 panel members participated. Results The topics discussed are internal consistency (relevance for reflective and formative models, and distinction with unidimensionality), content validity (judging relevance and comprehensiveness), hypotheses testing as an aspect of construct validity (specificity of hypotheses), criterion validity (relevance for PROs), and responsiveness (concept and relation to validity, and (in) appropriate measures). Conclusions We expect that this paper will contribute to a better understanding of the rationale behind the items, thereby enhancing the acceptance and use of the COSMIN checklist.