Table 3

Study characteristics

Author	Title	Country (publication year)	Journal	Study design	Study methodology	Study population	Measures assessed	Does study include athletes with impairment?	Are results specific to athletes with impairment reported?	Impairment	Level of competition	Type(s) of non-accidental harm studied?	Results	Conclusion(s)	CEBM level
Stafford et al 55	Playing through pain: children and young people’s experiences of physical aggression and violence in sport.	UK (2013).	Child Abuse Review Vol. 22.	Retrospective (mixed methods).	Survey and telephone interviews.	Students aged 18–22 years participating in extracurricular sports on the National Union of Students database (n=6124). A subset were selected for in-depth interviews (n=89). Six per cent considered themselves to have a disability; 1% participated in disabled sport.	Excessive intensive training and competing through injury or exhaustion, physical aggression and violence.	Y	N	Not delineated.	Recreational to elite.	Pressure to continue despite pain/exhaustion. Physical aggression and violence.	Most physical aggression and harm occurred between young people in the form of bullying. Coaches were not always aware of pressure to endure strenuous training or compete through injury; it often came from the individual or peers.	Young athletes were compelled by the normative sporting culture to train through exhaustion and compete despite injury.	4
Dane-Staples et al 56	Bullying experiences of individuals with visual impairment: the mitigating role of sport participation.	USA (2013).	Journal of Sport Behavior.	Retrospective (mixed methods).	In-person and telephone interviews.	Athletes from 2011 National Goalball Championships held in New York (n=30), mean age=24.6; non-athlete participants from online Listserv (n=19), mean age=48.7 years.	Nature, frequency and location of bullying experiences. Reflections on reactions to bullying and how it impacted their general well-being.	Y	Y	Visual.	Recreational.	Physical and verbal bullying.	76.6% athlete participants reported experiencing bullying in their lives compared with 94.7% of non-athletes. Forty-three per cent of athletes reported fighting back physically. A percentage of 77.8 of non-athletes did not retaliate.	Individuals from athlete group were more likely to take on a ‘bully-victim’ role of physical or verbal retaliation to bullying.	3
de Schipper et al 51	‘Kids like me, we go lightly on the head’: experiences of children with a visual impairment on the physical self-concept.	USA (2017).	British Journal of Visual Impairment.	Cross-sectional (qualitative).	In-person interviews.	Participants aged 9–11 years of sports camp and sports day (n=6).	Sports competence, body attractiveness, physical strength, physical condition, global physical self and global self-esteem.	Y	Y	Visual.	Recreational.	Bullying.	Four out of 6 participants reported bullying.	Bullying may lead to withdrawal from sports and physical activities. ‘The study found children with a visual impairment are satisfied and happy with their physical self despite bullying and lack of adaptations’.	4
McHugh and Howard57	Friendship at any cost: parent perspectives on cyberbullying children w/ intellectual and developmental disabilities.	USA (2017).	Journal of Mental Health Research in Intellectual Disabilities.	Cross-sectional (mixed methods).	Survey and in-person interviews.	Parents and grandparents of children 8 years of age or older who participated in Special Olympics Maryland (n=10).	Bullying prevalence, athlete’s use of electronic devices, athlete’s vulnerability, exposure to aggressive offenders and athlete’s online behaviour.	Y	Y	Intellectual and developmental.	Recreational.	Bullying and cyberbullying.	(%) parents perceiving risk of bullying: 50% physical. 60% verbal. 60% social. 60% cyber.	There is a potential for repeated cyberbullying because incidents may not be reported for fear of losing a friend.	4
Stafford et al 54	‘There was something that wasn’t right because that was the only place I ever got treated like that’: children and young people’s experiences of emotional harm in sport.	UK (2015).	Childhood.	Retrospective (mixed methods).	Survey and in-depth telephone interviews.	Students aged 18–22 years participating in extracurricular sports on the National Union of Students database (n=6124). A subset were selected for in-depth interviews (n=89). Six per cent considered themselves to have a disability, 1% participated in disabled sport.	Nature of emotional harm, sport of participation, level of sport and who was responsible for emotional harm.	Y	N	Not delineated.	Recreational to elite.	Emotional harm including bring criticised, shouted at, humiliated and bullied.	At all sporting levels, teammates and peers were the most common perpetrators of emotionally harmful behaviour. At higher levels, coaches were increasingly involved in creating and maintaining a culture of negative criticism about performance.	‘The study provides some evidence of a sporting culture in the UK which accepts and condones emotionally harmful behaviour between sporting adults and young people and which is condoned between young people themselves’.	4
Vertommen et al 53	Interpersonal violence against children in sport in the Netherlands and Belgium.	The Netherlands (2016).	Child Abuse & Neglect.	Retrospective (quantitative).	Online survey.	Participants aged 18–50 years in Netherlands (n=1999) and Flanders, Belgium (n=2049). Fifty per cent participated in organised sports for children with impairment.	Prevalence of interpersonal violence (type, frequency and severity) across demographic categories including disability, gender, age, ethnicity and nationality.	Y	Y	Not delineated.	Recreational to elite.	Sexual, physical, psychological and emotional abuse.	Among those having participated in disabled sports, prevalence estimates are remarkably high for all three types of violence: prevalence of psychological violence was 49.7%, physical violence 32.4%, sexual violence (33.5%). OR for physical violence was 3.225 and OR of sexual violence was 2.904.	Disability was a predictor for both physical and sexual violence.	3
Haegele et al 52	Physical education experiences at residential schools for students who are blind: a phenomenological inquiry	USA (2017).	Journal of Visual Impairment & Blindness.	Retrospective (qualitative).	Telephone interviews.	Visually impaired males aged 32–50 years who participated in physical education at residential schools in the USA (n=5).	Meaning that participants ascribed to their residential education experiences.	Y	Y	Visual.	Recreational.	Bullying.	Two broad themes emerged from the participants’ narratives: ‘being the only blind guy, to being one of the crowd’ and ‘the bullies and the bullied’. The former explained how differences in school settings contributed to participants’ feelings of inclusion. The latter described the social dynamics of physical education environments and showed perceptions of those who were ‘able’ and ‘less able’.	‘Bullying, related to differences in ability among students that are typically reported in public school settings, can also occur in residential schools’.	4
McPherson et al 58	Secrecy surrounding the physical abuse of child athletes in Australia	Australia (2017).	Australian Social Work.	Retrospective (mixed methods).	Survey and in-person versus telephone interviews.	Participants aged 18–25 years involved in sporting clubs and associations (n=107). Two per cent of survey respondents participated in sport for persons with a disability. A subset was selected for in-depth interviews (n=10).	Positive experiences in sport and physical harm (type, perpetrator and context).	Y	N	Not delineated.	Recreational.	Neglect and abuse (physical, psychological and emotional).	Coaches were the most common perpetrators of instances of physical abuse (65.8%) over peers (42.1%). More than a third of the respondents described experiences of overtraining, being forced to train when injured or of direct physical violence.	Children often did not disclose physical abuse at the time it occurred. The environment of secrecy surrounding cases of abuse should be addressed as part of protecting children’s safety and well-being.	4