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Knowledge translation in sport injury prevention research: an example in youth ice hockey in Canada
  1. Sarah A Richmond1,
  2. Carly D McKay2,
  3. Carolyn A Emery2,3,4
  1. 1 Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2 Faculty of Kinesiology, Sport Injury Prevention Research Centre, Roger Jackson Centre for Health and Wellness Research, University of Calgary, Calgary, Alberta, Canada
  3. 3 Department of Pediatrics, Faculty of Medicine, Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, Alberta, Canada
  4. 4 Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Sarah A Richmond, Child Health Evaluative Sciences, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8; sarah.a.richmond{at}gmail.com

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There is a critical need for scientists to incorporate a knowledge translation (KT) perspective into research plans to demonstrate the relevance of research findings and evaluate their implications for health practice and policy. Since 2011, the British Journal of Sport Medicine (BJSM) has had a focus on implementation and dissemination research.1 This field is consistent with KT, which is the term used by the Canadian Institutes of Health Research (CIHR). As the following research example was conducted in Canada, the terminology KT is used, acknowledging similarities to implementation and dissemination concepts referred to elsewhere in BJSM.

Using an interdisciplinary approach, the knowledge exchange process should influence healthcare professionals, community members and other decision-making groups. On the basis of the original model developed by van Mechelen et al,2 injury prevention research in sport includes identification of injury burden, examination of risk factors, and development, implementation and evaluation of prevention strategies to reduce injury risk. As sport injury prevention programmes cannot be impactful without acceptance and adoption by targeted individuals, an extension of this model must include real-world implementation contexts and evaluation of their effectiveness in a broader, ecological context (figure 1).3

Figure 1

Sport Injury Prevention Research Centre adapted integrated knowledge translation model. The prevention of injuries and their long-term consequences.

The Sport Injury Prevention Research Centre (SIPRC) aims to influence policy and practice through the communication of risks and context-specific prevention initiatives to reduce sport and recreational injuries in youth (figure 1). SIPRC has adopted a knowledge-to-action model that follows the CIHR KT process.4 ,5 SIPRC believes that KT functions through an iterative exchange process between researchers and key knowledge users (eg, parents, coaches, referees, youth participants, clinicians, researchers and policy makers) in an accessible, timely and context-relevant manner.

SIPRC first identifies target knowledge users and builds key relationships with groups that will be impacted by the research findings. Researchers establish stakeholder information needs by engaging all invested groups in the planning, producing, disseminating and application of research. Establishing the means to build capacity in end-users and influence their decision making is critical in our research process. Setting dissemination goals while considering how key messages will be delivered to the broader audience is important. This includes qualitative and quantitative evaluation to determine the impact of our work.

An example of our KT approach comes from our research programme in youth ice hockey. In brief, concussion and other significant injuries have been an increasing concern in Canada, particularly in age groups where body checkingi (BC) is permitted. Hockey Canada allows BC nationally starting in Pee Wee (age 11–12 years), but specific BC policy is determined provincially. More conservative policy has been in place since 1998 in Hockey Quebec, where BC has been first introduced in Bantam (age 13–14 years). There was a high risk of injury and concussion in Pee Wee players exposed to rules allowing BC, prompting the first prospective evaluation of BC policy differences between provinces. In a cohort study in the 2007/2008 season (n=2154), we found a three- to fourfold greater risk of injury and concussion in Alberta Pee Wee players, compared with that in Quebec.7 Further, in a cohort study in the 2008/2009 season, evaluation of BC experience on the risk of injury and concussion in Bantam (n=1971) demonstrated similar risk among Bantam players in Alberta and Quebec.8 These findings suggest  there is no greater increase in injury without previous BC experience, and have informed policy change in USA Hockey where nationally, BC has been delayed until Bantam. In Canada, changes have not been made nationally, but some jurisdictions now allow BC only at the most elite levels of Pee Wee play.

The research proposal for these studies was developed in consultation with local, provincial and national associations (ie, Hockey Calgary, Hockey Alberta, Hockey Quebec and Hockey Canada) and community stakeholders (eg, Max Bell Foundation). Project activities were shared with these partners, who were actively engaged to ensure research relevance to the community. Barriers were identified between knowledge users and existing best practice evidence in a collaborative process. For example, support to change Pee Wee BC policy has been variable and jurisdictional. Common concerns are related to players being inadequately prepared to perform at elite levels if BC is not introduced, and resistance to change is persistent. Stakeholders therefore guided the research context to inform the application of our results through medical organisations, hockey associations and the media. Collaboration was reinforced through regular meetings and written and verbal updates.

As results became evident, we engaged stakeholders in the development of our dissemination plans. We shared our findings through public forums locally, nationally and internationally (eg, Provincial Hockey Association annual meetings, Ice Hockey Summit: Action on Concussion (Mayo Clinic, Rochester, Minnesota, USA, 2009)), and through websites (eg, University of Calgary, Hockey Calgary, Hockey, Thinkfirst), presentations to hockey communities and media engagements. Finally, we disseminated results using peer-reviewed publications7 ,8 and presentations at national and international sport injury conferences.

The success of KT practice is ideally evaluated using both qualitative and quantitative indicators. For example, we used online surveys to elicit feedback from study participants (eg, players, parents and coaches) to estimate knowledge and behavioural changes in the sport community following our studies. The impact of research findings and success in capacity building can also be assessed through future collaborative opportunities, high-impact academic and non-academic publications, website activity and invitations to share findings with related networks.

This KT experience in youth ice hockey is one example of the strategies utilised to maximise research impact on injury risk reduction in child and adolescent sports. Collaboration among researchers, clinicians, trainees and community stakeholders is the key to maximising the public health impact of injury prevention research.

References

Footnotes

  • Contributors All authors contributed substantially to the conception, drafting, researching intellectual content and final approval of this manuscript to be published.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • i BC is defined as an individual defensive tactic designed to legally separate the puck carrier from the puck. This tactic is the result of a defensive player applying physical extension of the body towards the puck carrier moving in an opposite or parallel direction. The action of the defensive player is deliberate and forceful in an opposite direction to which the offensive player is moving and is not solely determined by the movement of the puck carrier.6

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