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Prevalence and incidence of injuries in para athletes: a systematic review with meta-analysis and GRADE recommendations
  1. Larissa Santos Pinto Pinheiro1,
  2. Juliana Melo Ocarino1,
  3. Fernanda Oliveira Madaleno1,
  4. Evert Verhagen2,
  5. Marco Túlio de Mello3,
  6. Maicon Rodrigues Albuquerque3,
  7. André Gustavo Pereira Andrade3,
  8. Carla Patrícia da Mata3,
  9. Rafael Zambelli Pinto1,
  10. Andressa Silva3,
  11. Renan Alves Resende1
  1. 1School of Physical Education, Physical Therapy and Occupational Therapy, Department of Physical Therapy. Rehabilitation Sciences Graduate Program, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
  2. 2Amsterdam Collaboration on Health & Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  3. 3School of Physical Education, Physical Therapy and Occupational Therapy, Department of Sports, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
  1. Correspondence to Dr Renan Alves Resende, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; renan.aresende{at}


Objective To investigate prevalence, incidence and profile of musculoskeletal injuries in para athletes.

Design Systematic review.

Data sources Searches were conducted in MEDLINE, EMBASE, AMED, SPORTSDiscus, CINAHL and hand searching.

Eligibility criteria Studies were considered if they reported prevalence or incidence of musculoskeletal injuries in para athletes. Study selection, data extraction and analysis followed the protocol. Meta-analyses were conducted to estimate the prevalence and incidence rate among studies and subgroup analyses investigated whether methodological quality and sample size of the studies influenced on the estimated injury prevalence and incidence. The Grading of Recommendations Assessment, Development and Evaluation system determined the strength of evidence.

Results Forty-two studies were included. The prevalence of musculoskeletal injuries was 40.8% (95% CI 32.5% to 49.8%). Because of imprecision, indirectness and inconsistency, the strength of evidence was very low quality. The incidence of musculoskeletal injuries was 14.3 injuries per 1000 athlete-days (95% CI 11.9 to 16.8). The strength of evidence was low quality because of imprecision and indirectness. The subgroup analyses revealed that the sample size influenced on estimated injury prevalence and methodological quality influenced on estimated incidence. Injuries were more prevalent in the shoulder, for non-ambulant para athletes, and in the lower limbs, for ambulant para athletes.

Summary/conclusion Para athletes show high prevalence and incidence of musculoskeletal injuries. Current very low-quality and low-quality evidence suggests that future high-quality studies with systematic data collection, larger sample size and specificities of para athletes are likely to change estimates of injury prevalence and incidence in para athletes.

PROSPERO registration number CRD42020147982.

  • epidemiology
  • sports
  • disabled
  • injuries

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  • Twitter @Evertverhagen

  • Contributors All authors were fully involved in the study and preparation of the manuscript and agreed with the content in the final manuscript.

  • Funding Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)—428735/2018-5, Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG)—CDS - APQ-01017-17, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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