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Non-accidental harms (‘abuse’) in athletes with impairment (‘para athletes’): a state-of-the-art review
  1. Yetsa A Tuakli-Wosornu1,
  2. Qisi Sun2,
  3. Mark Gentry3,
  4. Kimberly E Ona Ayala2,
  5. Fiona C Doolan4,
  6. Taylor D Ottesen2,
  7. Blake Caldwell5,
  8. Nida Naushad2,
  9. Patrick Huang2,
  10. Sandi Kirby6
  1. 1 Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
  2. 2 Yale University School of Medicine, New Haven, Connecticut, USA
  3. 3 Harvey Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven, Connecticut, USA
  4. 4 Trinity College School of Medicine, University of Dublin, Dublin, Ireland
  5. 5 Department of Computer Science, University of Colorado Boulder, Boulder, Colorado, USA
  6. 6 University of Winnipeg, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Yetsa A Tuakli-Wosornu, Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven CT 06510, USA; yetsa.tuakli-wosornu{at}


Objective Para athletes reap significant health benefits from sport but are vulnerable to non-accidental harms. Little is known about the types and impacts of non-accidental harms Para athletes face. In this literature review, we summarise current knowledge and suggest priorities for future research related to non-accidental harms in Para athletes.

Design Six electronic databases were searched between August and September 2017. 2245 articles were identified in the initial title/abstract review, and 202 records were selected for full-text review following preliminary screening. Two independent examiners evaluated each full text, and eight citations were selected based on inclusion/exclusion criteria.

Data sources MEDLINE, Embase, PsycInfo, Cumulative Index to Nursing and Allied Health Literature, Scopus and Academic Search Premier.

Eligibility criteria for selecting studies Inclusion criteria: (A) human participants; (B) written in English; (C) descriptive, cohort and case series, case–control, qualitative, mixed methods studies and all clinical trials; and (D) data pertain to harassment/abuse of youth, recreational, collegiate, national-level and/or elite-level athletes with a physical and/or intellectual impairment.

Results Most studies focused on young, visually impaired athletes and approximately half of all studies described high rates of bullying and its social implications. One study confirmed remarkably high rates of psychological, physical and sexual harms in Para athletes, compared with able-bodied peers.

Conclusions Bullying in young, visually impaired athletes is described most commonly in the available literature. Due to the limited amount of data, the prevalence of non-accidental harms in Para athletes remains unclear and information on trends over time is similarly unavailable.

  • safeguarding
  • injury prevention
  • harassment and abuse
  • non-accidental harms
  • paralympic athletes

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  • Contributors YAT-W designed the study; monitored data collection for the review; processed, collated and summarised the data; and drafted and revised the manuscript. She is guarantor. QS, KEOA, FCD, BC, TDO, NN, PH and SK monitored data collection for the review, processed collated and summarised the data and drafted and revised the paper. MG designed the Ovid Medline search strategy, collated and summarised the data and drafted and revised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Correction notice This article has been corrected since it published Online First. The first heading in the introduction has been corrected.

  • Patient consent for publication Not required.