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Abstract Background Adolescents with juvenile idiopathic arthritis (JIA) tend to engage in less physical activity than their typically developing peers. Physical activity is essential for bone development and reduced physical activity may detrimentally effect bone health. Thus, we examined differences in total body bone mineral content (BMC) and areal bone mineral density (aBMD) between adolescents with JIA and adolescent controls without JIA. We also examined associations between moderate-to-vigorous physical activity (MVPA), lean mass, and bone outcomes. Methods Participants included 21 adolescents with JIA (14 females, 7 males) and 21 sex- and age-matched controls aged 10–20 years. Assessments included: height; weight; triple-single-leg-hop distance (TSLH); MVPA by accelerometry; and total body BMC, aBMD, and lean mass measured using dual X-ray absorptiometry. Height-adjusted z-scores were calculated for BMC and aBMD and used for all analyses. Multiple linear mixed effects models examined group differences in BMC and aBMD, adjusting for sex, maturity, MVPA, TSLH, and lean mass. Participants clusters, based on sex and age (within 18 months), were considered random effects. Results Adolescents with JIA had lower total body aBMD z-scores [β (95% CI); -0.58 (-1.10 to -0.07), p = 0.03] and BMC z-scores [-0.47 (-0.91 to -0.03), p = 0.04] compared with controls. Mean daily MVPA was 22.0 min/day lower in adolescents with JIA than controls; however, MVPA was not associated with aBMD [-0.01 (-0.01 to 0.01), p = 0.32] or BMC [0.00 (-0.01 to 0.00), p = 0.39]. Lean mass was positively associated with aBMD [0.05 (0.01 to 0.09) g/cm2, p = 0.03] and BMC [0.06 (0.03 to 0.10) g, p

Introduction Ice hockey is a popular global sport with growing participation for boys and girls yet remains a high-risk sport for injury. While the evidence for some risk factors, such as bodychecking policy is well established, other risk factors such as player sex have been understudied. The objectives of this study were to examine factors associated with rates of game-related injury, game-related injury resulting in >7 days of time-loss, and practice-related injury in youth ice hockey.Materials and methods Safe2Play was a five-year prospective cohort study (2013–2018). All injuries were identified using validated injury surveillance methodology. Multilevel Poisson regression (adjusting for cluster by team and including multiple imputation of missing covariates) was used to estimate incidence rate ratios (IRRs) for player sex, age group, bodychecking policy, year of play, level of play, weight, previous injury within last 12 months, previous lifetime concussion history, and position.Results A total of 4418 male and female ice hockey players (representing 6584 player-seasons) participating in under-13 (ages 11–12), under-15 (ages 13–14) and under-18 (ages 15–17) age groups were recruited. There were 1184 game-related and 182 practice-related injuries. Factors associated with game-related injury included female sex (IRR = 1.57; 95% CI: 1.18–2.08), previous injury (IRR = 1.46; 95% CI: 1.26–1.70) and lifetime concussion history (IRR = 1.41; 95% CI: 1.23–1.62). Goaltenders had a lower rate of injury (IRR = 0.54; 95% CI: 0.40–0.72) relative to forwards, as did players exposed to policy disallowing bodychecking in games (IRR = 0.44; 95% CI: 0.35–0.55). Female sex (IRR = 1.90; 95% CI: 1.10–3.28) and lifetime concussion history were also significantly associated with practice-related injury (IRR = 1.53; 95% CI: 1.08–2.18).Conclusions Based on data from a large 5-year Canadian youth ice hockey longitudinal cohort, several factors associated with injury were identified. Future injury prevention strategies should consider age, sex, previous concussion and injury history, and body checking leagues. Future research in female youth ice hockey including female-only leagues should be a priority to inform prevention strategies in this understudied population.

AbstractBackground Ankle sprains are the most common sports-related injuries. Individuals with time-loss ankle sprains often experience residual symptoms and chronic ankle instability years after injury. Up to 90% of post-traumatic ankle osteoarthritis cases are associated with severe ankle sprain. This study aimed to examine whether ankle injury severity sustained during youth sports participation is associated with ankle symptoms and function.Materials and Methods Cohort study included 50 young adults (mean age, 23 years) with a 3-to 15-year history of a youth-sport related ‘significant ankle sprain’ (SAS). The primary independent variable was injury severity, which was captured in the index SAS injury details through interviews. SAS was defined as ligament and other intra/extra-articular structure injuries that disrupted youth sport participation, at least 3 days of time loss, and required medical consultation. Severe SAS was defined as SAS involving >28 days of time loss, and non-severe SAS only involved ankle ligaments and/or with ≤28 days of time loss. The Foot and Ankle Outcome Score questionnaire was used to assess ankle symptoms and function. Descriptive statistics and multivariable linear regression models were used to examine the association between SAS severity and outcomes, with sex and time since injury as covariates.Results Compared to participants with non-severe SAS, participants with a history of severe SAS demonstrated significantly poorer outcomes in symptoms [-18.4 (99% CI: −32.2 to −4.6)], pain [-10.1 (99% CI: −19.2 to −1.1)] and QoL [-17.1 (99% CI: −33.1 to −1.1)] in multivariable linear regression models.Conclusions Severe ankle sprain with a loss of > 4 weeks from sports participation at the time of injury is independently associated with poorer ankle symptoms, pain, and ankle-related quality of life after 3–15 years. Secondary prevention measures are needed in individuals with a history of severe ankle sprains to mitigate the potential health consequences.

AbstractAn estimated 20 percent of adolescents in North America have sustained a concussion. Teachers and school administrators are responsible for supporting following concussion to return to school. The purpose of this study was to describe the perspectives of Canadian teachers and school administrators with supporting returning to school post-concussion. This qualitative study was guided by an interpretivist philosophy. Semi-structured interviews with grades 7–12 teachers (n = 13) and school administrators (n = 5) were coded inductively and analysed using reflexive thematic analysis. We organized the data into five themes: 1) Educator roles differ for administrators and teachers; 2) Students’ symptoms affect their learning; 3) Students should have access to academic accommodations; 4) Students benefit from social support, compassion, and empathy; and 5) Concussion education and management processes are lagging. In Canada, teachers and administrators have different roles when supporting students returning to school after a concussion and those roles influence their engagement with the students and their awareness of students’ needs. Lack of concussion education and concussion management processes at schools may affect how students are supported following a concussion. Our findings can inform the development and implementation of supports to facilitate return to school for students following a concussion.

Frequency-domain near-infrared spectroscopy (FD-NIRS) has been used for non-invasive assessment of cortical oxygenation since the late 1990s. However, there is limited research demonstrating clinical validity and general reproducibility. To address this limitation, recording duration for adequate validity and within- and between-day reproducibility of prefrontal cortical oxygenation was evaluated. To assess validity, a reverse analysis of 10-min-long measurements (n = 52) at different recording durations (1–10-min) was quantified via coefficients of variation and Bland–Altman plots. To assess within- and between-day within-subject reproducibility, participants (n = 15) completed 2-min measurements twice a day (morning/afternoon) for five consecutive days. While 1-min recordings demonstrated sufficient validity for the assessment of oxygen saturation (StO2) and total hemoglobin concentration (THb), recordings ≥4 min revealed greater clinical utility for oxy- (HbO) and deoxyhemoglobin (HHb) concentration. Females had lower StO2, THb, HbO, and HHb values than males, but variability was approximately equal between sexes. Intraclass correlation coefficients ranged from 0.50–0.96. The minimal detectable change for StO2 was 1.15% (95% CI: 0.336–1.96%) and 3.12 µM for THb (95% CI: 0.915–5.33 µM) for females and 2.75% (95%CI: 0.807–4.70%) for StO2 and 5.51 µM (95%CI: 1.62–9.42 µM) for THb in males. Overall, FD-NIRS demonstrated good levels of between-day reliability. These findings support the application of FD-NIRS in field-based settings and indicate a recording duration of 1 min allows for valid measures; however, data recordings of ≥4 min are recommended when feasible.

Sport-related concussion (SRC) is a major concern among athletes and clinicians around the world. Research into fluid biomarkers of SRC has made significant progress in understanding the complex underlying pathophysiology of concussion. However, little headway has been made toward clinically validating any biomarkers to improve the clinical management of SRC. A major obstacle toward clinical translation of any fluid biomarker is the heterogeneity of SRC overlapping with multiple physiological systems involved in pathology and recovery. Neuroinflammation post-SRC is one such system that may confound fluid biomarker data on many fronts. Neuroinflammatory processes consist of cell mediators, both within the central nervous system and the periphery, that play vital roles in regulating the response to brain injury. Further, neuroinflammation is influenced by many biopsychosocial variables present in most athletic populations. In this commentary, we propose that future fluid biomarker research should take a systems biology approach in the context of the neuroinflammatory response to SRC. We highlight how biological variables, such as age, sex, immune challenges, and hypothalamic-pituitary-adrenal (HPA)-axis responses to stress, may alter neuroinflammation. Further, we underscore the importance of accounting for health and lifestyle variables, such as diet, exercise, sleep, and pre-morbid medical factors, when measuring inflammatory markers of SRC. To successfully move toward clinical translation, fluid biomarker research should take a more holistic approach in study design and data interpretation, collecting information on hidden variables that may be influencing the neuroinflammatory response to SRC.

Abstract Physical activity is a powerful modifiable risk factor for disease and mortality. Physical activity levels in people with spinal cord injury (SCI) have not been quantified relative to uninjured individuals in a large population-based sample. We aimed to quantify and compare physical activity in people with and without SCI, and to examine the associations between physical activity, lifestyle, and socioeconomic factors. The 2010 Canadian Community Health Survey (n > 57,000) was used, which includes three measures that assess physical activity levels (i.e., leisure time activity frequency, leisure time activity intensity, and transportation time activity intensity). Bivariable and multivariable logistic regressions were performed and odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were estimated. The odds of physical activity in people with SCI were 0.43 (95% CI 0.3–0.61), 0.53 (95% CI 0.36–0.75), and 0.42 (95% CI 0.28–0.61), across the three measures of physical activity, respectively. These differences persisted after adjustment for lifestyle, comorbidities, and socioeconomic factors. Physical activity is reduced in the SCI population compared with the general population. This knowledge is important to direct future research and guide the allocation of health care resources.

Magnetic resonance imaging (MRI) can provide a number of measurements relevant to sport-related concussion (SRC) symptoms; however, most studies to date have used a single MRI modality and whole-brain exploratory analyses in attempts to localize concussion injury. This has resulted in highly variable findings across studies due to wide ranging symptomology, severity and nature of injury within studies. A multimodal MRI, symptom-guided region-of-interest (ROI) approach is likely to yield more consistent results. The functions of the cerebellum and basal ganglia transcend many common concussion symptoms, and thus these regions, plus the white matter tracts that connect or project from them, constitute plausible ROIs for MRI analysis. We performed diffusion tensor imaging (DTI), resting-state functional MRI, quantitative susceptibility mapping (QSM), and cerebral blood flow (CBF) imaging using arterial spin labeling (ASL), in youth aged 12-18 years following SRC, with a focus on the cerebellum, basal ganglia and white matter tracts. Compared to controls similar in age, sex and sport (N = 20), recent SRC youth (N = 29; MRI at 8 ± 3 days post injury) exhibited increased susceptibility in the cerebellum (p = 0.032), decreased functional connectivity between the caudate and each of the pallidum (p = 0.035) and thalamus (p = 0.021), and decreased diffusivity in the mid-posterior corpus callosum (p < 0.038); no changes were observed in recovered asymptomatic youth (N = 16; 41 ± 16 days post injury). For recent symptomatic-only SRC youth (N = 24), symptom severity was associated with increased susceptibility in the superior cerebellar peduncles (p = 0.011) and reduced activity in the cerebellum (p = 0.013). Fewer days between injury and MRI were associated with reduced cerebellar-parietal functional connectivity (p < 0.014), reduced activity of the pallidum (p = 0.002), increased CBF in the caudate (p = 0.005), and reduced diffusivity in the central corpus callosum (p < 0.05). Youth SRC is associated with acute cerebellar inflammation accompanied by reduced cerebellar activity and cerebellar-parietal connectivity, as well as structural changes of the middle regions of the corpus callosum accompanied by functional changes of the caudate, all of which resolve with recovery. Early MRI post-injury is important to establish objective MRI-based indicators for concussion diagnosis, recovery assessment and prediction of outcome.

Objective To quantify differences in fatigue and disordered sleep between adolescents with cerebral palsy (CP) and their typically developing peers. A secondary aim was to investigate the association between fatigue and disordered sleep in adolescents with CP. Methods A convenience sample of 36 youth with CP aged 10–18 years was matched for age and sex with 36 typically developing peers. The Fatigue Impact and Severity Self-Assessment (FISSA), the Patient-Reported Outcome Measurement Information System (PROMIS) fatigue profile, and the Sleep Disturbance Scale for Children (SDSC) were collected. Results Higher fatigue was reported in participants with CP than in their typically developing peers based on the FISSA total score (mean paired difference=19.06; 99% confidence interval [CI], 6.06–32.1), the FISSA impact subscale (mean paired difference=11.19; 99% CI, 3.96–18.4), and the FISSA Management and Activity Modification subscale (mean paired difference=7.86; 99% CI, 1.1–14.6). There were no differences between groups in the PROMIS fatigue profile (mean paired difference=1.63; 99% CI, -1.57–4.83) or the SDSC total score (mean paired difference=2.71; 99% CI, -2.93–8.35). Conclusion Youth with CP experienced significantly more fatigue than their peers as assessed by a comprehensive measure that considered both general and diagnosis-specific concerns. Sleep did not differ between youth with CP and their typically developing peers. These findings underscore the need to consider the clinical management of fatigue across the lifespan of individuals with CP to prevent the associated deterioration of functional abilities.

Background: Canadian rugby coach injury prevention beliefs and attitudes have not been studied, yet are key to informing injury prevention strategy implementation. Despite neuromuscular training (NMT) warm-up success in reducing injury, adoption of these programs is variable. Therefore, objectives of this study included (1) describing Canadian youth rugby coach injury prevention beliefs and attitudes and current warm-up practices and (2) evaluating intention to use a rugby-specific NMT warm-up.Methods: High school rugby coaches completed a questionnaire before and after a rugby-specific NMT warm-up workshop. The pre-workshop questionnaire captured demographics, current warm-up practice, and NMT warm-up knowledge and use. Both questionnaires captured injury prevention beliefs, attitudes and behavioral intention.Results: Forty-eight coaches participated in the workshops. Pre-workshop, 27% of coaches were aware of NMT warm-ups. Coaches primarily included aerobic and stretching components, while balance components were not common in their warm-ups over the past year. Additionally, 92% of coaches agreed to some extent they would “complete a rugby-specific warm-up program prior to every game and training session this season.” Post-workshop, 86% of coaches agreed to some extent that they would use the program in every rugby session. No differences were observed between pre- and post-workshop intention to implement the warm-up (p = 0.10).Interpretation: This is the first study to examine current Canadian youth rugby coach warm-up practices and intention to use NMT warm-ups. Canadian rugby coach intention to use a rugby-specific NMT warm-up is high, providing ample opportunity to investigate the efficacy of a NMT warm-up in youth rugby.

Background: Return to school supports are recommended to facilitate adolescents' re-entry to school following a concussion. However, little is known as to what school stakeholders prefer for a return-to-school process. This study sought to describe the preferences of high school students, parents, and educators for a Return-to-School Framework for adolescents following a concussion. Methods: We conducted qualitative semi-structured, 1-on-1 or group interviews with high school students (n = 6), parents (n = 5), and educators (n = 15) from Calgary, Canada. Interviews aimed to describe participants' preferences for a Return-to-School Framework for students following a concussion. Interviews were analyzed using conventional content analysis. Results: We organized the data into 4 main themes: (1) purpose of the Return-to-School Framework; (2) format and operation of the Return-to-School Framework; (3) communication about a student's concussion; and (4) necessity of concussion education for students and educators. Implications for School Health Policy, Practice, and Equity: A Return-to-School Framework following concussion should be developed in consultation with families, educators, and students and supports should be tailored to each student. Conclusions: Participants preferred a standardized and consistent Return-to-School Framework including ongoing communication between stakeholders as well as feasible and individualized school supports.

Abstract Background Active transportation, such as walking and biking, is a healthy way for children to explore their environment and develop independence. However, children can be injured while walking and biking. Many cities make changes to the built environment (e.g., traffic calming features, separated bike lanes) to keep people safe. There is some research on how effective these changes are in preventing adult pedestrians and bicyclists from getting hurt, but very little research has been done to show how safe various environments are for children and youth. Our research program will study how features of the built environment affect whether children travel (e.g., to school) using active modes, and whether certain features increase or decrease their likelihood of injury. Methods First, we will use a cross-sectional study design to estimate associations between objectively measured built environment and objectively measured active transportation to school among child elementary students. We will examine the associations between objectively measured built environment and child and youth pedestrian-motor vehicle collisions (MVCs) and bicyclist-MVCs. We will also use these data to determine the space-time distribution of pedestrian-MVCs and bicyclist-MVCs. Second, we will use a case-crossover design to compare the built environment characteristics of the site where child and youth bicyclists sustain emergency department reported injuries and two randomly selected sites (control sites) along the bicyclist’s route before the injury occurred. Third, to identify implementation strategies for built environment change at the municipal level to encourage active transportation we will conduct: 1) an environmental scan, 2) key informant interviews, 3) focus groups, and 4) a national survey to identify facilitators and barriers for implementing built environment change in municipalities. Finally, we will develop a built environment implementation toolkit to promote active transportation and prevent child pedestrian and bicyclist injuries. Discussion This program of research will identify the built environment associated with active transportation safety and form an evidence base from which municipalities can draw information to support change. Our team’s national scope will be invaluable in providing information regarding the variability in built environment characteristics and is vital to producing evidence-based recommendations that will increase safe active transportation.

Overuse injuries are common in basketball. Wearable technology enables the workload to be monitored in sport settings. However, workload–injury models lack a biological basis both in the metrics recorded and how workload is accumulated. We introduce a new metric for monitoring workload: weighted jump height, where each jump height is weighted to represent the expected effect of the jump magnitude on damage to the tendon. The objectives of this study were to use principal components analysis to identify distinct modes of variation in all workload metrics accumulated over 1, 2, 3, and 4 weeks and to examine differences among the modes of variation in workload metrics between participants before the injury and uninjured participants. Forty-nine youth basketball players participated in their typical basketball practices and games, and lower extremity injuries were classified as patellar or Achilles tendinopathy, other overuse, or acute. An inertial measurement unit recorded the number and height of all jumps, and session rating of perceived exertion was recorded. The previous 1-, 2-, 3-, and 4-week workloads of jump count, jump height, weighted jump height, and session rating of perceived exertion were summed for each participant-week. Principal components analysis explained the variance in the accumulated workload variables. Using the retained principal components, the difference between the workload of injured participants in the week before the injury and the mean workload of uninjured participants was described for patellar or Achilles tendinopathy, overuse lower extremity injury, and any lower extremity injury. Participants with patellar or Achilles tendinopathy and overuse lower extremity injuries had a low workload magnitude for all variables in the 1, 2, 3, and 4 weeks before injury compared with the weeks before no injury. Participants with overuse lower extremity injuries and any lower extremity injury had a high previous 1-week workload for all variables along with a low previous 3- and 4-week jump count, jump height, and weighted jump height before injury compared with the weeks before no injury. Weighted jump height represents the cumulative damage experienced by tissues due to repetitive loads. Injured youth basketball athletes had a low previous 3- and 4-week workloads coupled with a high previous 1-week workload.

Introduction: Regular use of neuromuscular training (NMT) warm-up programs improves performance and prevents injuries. However, low level of adoption of these programs remains a problem. Understanding the current warm-ups in youth basketball and coaches' perceptions on injury prevention can guide the design of superior implementation strategies. This study describes warm-ups in youth basketball and coaches' injury prevention-related knowledge, attitudes, beliefs, and information sources.Methods: Youth basketball coaches (n = 50) completed a preseason questionnaire. The questionnaire covered warm-up length, use of aerobic/agility/balance/strength/other exercises in the warm-up, injury-related knowledge, attitudes, beliefs, and sources of information.Results: Typical warm-up duration was ≤ 10 min (48.0% of coaches, 95% CI: ±13.8%). All coaches included aerobic exercises in their warm-up. Agility, strength, and balance exercises were utilized by 80.0% (95% CI: ±11.7%), 70.7% (95% CI: ±13.6%), and 26.8% (95% CI: ±13.6%) of coaches, respectively. Most coaches agreed to some extent that basketball injuries are preventable (94%) and that participating in a NMT warm-up program would reduce player's risk of injury (92%). Other coaches were identified as the most common source of information on warm-ups and injury prevention.Discussion: Coaches use parts of effective NMT warm-up programs, but balance exercises are not well adopted. Considering the level of evidence supporting the importance of balance exercises in injury prevention, it is crucial to improve the implementation of NMT warm-up programs in youth basketball, for example, through educational courses. As fellow coaches were identified as the most important source of information, coaches' role in knowledge translation should be emphasized.

Objectives To examine the association between self-reported exposure to concussion education and knowledge, beliefs and self-reported behaviour among parents and coaches of youth ice hockey players.Design Cross-sectional.Setting Community ice hockey teams from Calgary and Edmonton, Alberta, Canada.Participants Parents and coaches of ice hockey players (ages 11–17, all divisions of play).Primary and secondary outcome measures Participants completed a questionnaire developed and validated to measure concussion knowledge, beliefs and concussion management behaviour (ie, coaches removing athletes from play; parents taking children with suspected concussions to physicians) consistent with the Health Action Process Approach (HAPA). The questionnaire examined specific HAPA constructs (ie, risk perception, outcome expectancies, action self-efficacy, intention, action planning, maintenance self-efficacy, recovery self-efficacy) relevant to concussion management behaviour.Results Participants included 786 parents (31.8% with coaching experience) and 10 non-parent coaches. Of the participants, 649 (82.6%) previously received concussion education. Based on a multivariable regression analysis adjusting for coaching experience, previous history of a child sustaining one or more concussions, first aid experience and cluster by team, exposure to concussion education was associated with a mean score difference of 1.36 (95% CI 0.68 to 2.03), p

Youth ski racers spend a considerable amount of time on snow and this may detract from other activities known to influence fundamental movement skills and overall health related outcomes. Parents of racers (n = 52 F; n = 44 M; age range 9–14 years) registered in the Canadian club system completed a baseline medical questionnaire during preseason testing in 2017. We describe physical activity volume and sport participation outside of physical education classes over the previous 12 months and report on injuries, medication use and health care utilization. The mean number of activities participated was five (range 1–14) with cycling, hiking, and swimming as the preferred choice and a cumulative mean of just under 400 h of activity was reported (range F 27–1,015; M 62–869 h/year) in the past year. During the past 12 months 16% of the athletes reported being injured and injury severity impacted return to sport with range of reported days missed from 1 to 365 days. Thirteen non-concussive injuries were reported in alpine skiing and females (12%, 6/52) reported more lower limb injuries than males (7%, 3/44). More males were concussed over their lifetime, with alpine skiing accounting for 46% and mountain biking 15%. Most athletes (85%) did not take medication on a regular basis and those that did had a medical diagnosis. The frequency of respiratory conditions was 13% (12/96) with males reporting slightly more cases than females. No difference in emergency visits occurred (25%) between males and females in the past 12 months, however females reported more (n = 102) allied health care, sport medicine and x-rays appointments when compared to males (n = 65). In summary, a high volume of physical activity (an hour plus per day) over the previous 12 months was reported with racers participating in several activities outside of skiing, likely honing their fundamental movement skills. Close proximity to the mountains may have influenced their choices of activity outside of ski racing, and their injuries and a variety of health conditions were typical of their age group. Future research employing wearable technology to objectively quantify the volume and intensity of physical activity participation is recommended.

Design: Prospective cohort study.Background: The recommendations regarding the optimal amount and type of rest for promoting recovery following concussion are based on expert opinion rather than evidence-based guidelines due to current a lack of high-level studies. There is an evident need for more research into the parameters of rest and activity and its effects on recovery from concussion.Objective: To evaluate the association between the amount of moderate and vigorous physical activity (MVPA) during the first 3 days following concussion diagnosis and time to medical clearance (days) to return to play in youth ice hockey players.Methods: Thirty youth ice hockey players (12–17 years) that were diagnosed with a concussion sustained during ice hockey were recruited to participate. The exposure was the cumulative amount of MVPA (minutes), measured using a waist-worn Actigraph accelerometer. Participants were dichotomized into high (≥148.5) and low (

Background The objective was to summarize the methodology used to reach consensus for recommended minimum data elements that should be collected and reported when conducting injury surveillance research in military settings. This paper summarizes the methodology used to develop the international Minimum Data Elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement. Methods A Delphi methodology was employed to reach consensus for minimum reporting elements. Preliminary steps included conducting a literature review and surveying a convenience sample of military stakeholders to 1) identify barriers and facilitators of military musculoskeletal injury (MSKI) prevention programs, 2) identify relevant knowledge/information gaps and 3) establish future research priorities. The team then led a sequential three-round Delphi consensus survey, including relevant stakeholders from militaries around the world, and then conducted asynchronous mixed knowledge user meeting to explore level of agreement among subject matter experts. Knowledge users, including former and current military service members, civil servant practitioners, and global-wide subject matter experts having experience with policy, execution, or clinical investigation of MSKI mitigation programs, MSKI diagnoses, and MSKI risk factors in military settings. For each round, participants scored each question on a Likert scale of 1-5. Scores ranged from No Importance (1) to Strong Importance (5). Results Literature review and surveys helped informed the scope of potential variables to vote on. Three rounds were necessary to reach minimum consensus. Ninety-five, 65 and 42 respondents participated in the first, second and third rounds of the Delphi consensus, respectively. Ultimately, consensus recommendations emerged consisting of one data principle and 33 minimum data elements. Conclusions Achieving consensus across relevant stakeholders representing military organizations globally can be challenging. This paper details the methodology employed to reach consensus for a core minimum data elements checklist for conducting MSKI research in military settings and improve data harmonization and scalability efforts. These methods can be used as a resource to assist in future consensus endeavors of similar nature.

An estimated 20 percent of adolescents in North America have sustained a concussion. Teachers and school administrators are responsible for supporting following concussion to return to school. The purpose of this study was to describe the perspectives of Canadian teachers and school administrators with supporting returning to school post-concussion. This qualitative study was guided by an interpretivist philosophy. Semi-structured interviews with grades 7-12 teachers (n = 13) and school administrators (n = 5) were coded inductively and analysed using reflexive thematic analysis. We organized the data into five themes: 1) Educator roles differ for administrators and teachers; 2) Students' symptoms affect their learning; 3) Students should have access to academic accommodations; 4) Students benefit from social support, compassion, and empathy; and 5) Concussion education and management processes are lagging. In Canada, teachers and administrators have different roles when supporting students returning to school after a concussion and those roles influence their engagement with the students and their awareness of students' needs. Lack of concussion education and concussion management processes at schools may affect how students are supported following a concussion. Our findings can inform the development and implementation of supports to facilitate return to school for students following a concussion.