A peek into the future of sports medicine: the digital revolution has entered our pitch

A peek into the future of sports medicine: the digital revolution has entered our pitch
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  A peek into the future of sportsmedicine: the digital revolution hasentered our pitch Evert A Verhagen, 1 B Clarsen, 2 R Bahr 2,3 The current wide-scale availability of theinternet and connected mobile devices isrevolutionising healthcare. Patients andpractitioners have unprecedented access tohealth information; they communicatewith each more than ever before. It seemsas if new technology is appearing dailyand with it comes the promise of greater(cost) ef  󿬁 ciency and quality of medicalpractise. 1 The sports medicine communityis currently buzzing about  ‘ eHealth ’ ,which may be de 󿬁 ned as the practise of medicine supported by electronic pro-cesses and communication. The newestbuzzword is  ‘ mHealth ’ , referring toeHealth driven by the use of mobiledevices, not limited to smartphones.Indeed, we are seeing an increased use of readily available technologies such as SMSmessaging, social media platforms, appsand online questionnaires in both clinicaland research settings. EXECUTING ON THE PROMISE:PATIENTS ENTERING THEIR OWNDATA! Grindem  et al 2 illustrate how online tech-nologies can aid clinical practice. Speci 󿬁 callythey monitored return-to-sport after ananterior cruciate ligament (ACL) injury; oneof the clinical  ‘ success ’  measures of postinjuryrehabilitation. Current methods that registersports activity after ACL injury are usuallyrestricted to knee-demanding sports alone tolimit the time-burden for patients and toensure valid data collection. Participation inmultiple sports is normally not considered,thereby ignoring potentially important infor-mation on treatment outcome. In contrast,Grindem  et al 2 therefore developed anonline activity survey to prospectively recordthe monthly participation in all sports rele-vant to their patient-group. They found thatthe survey was a highly reliable method tocapture sports participation, and also pro-vided more complete data than a routine ‘ paper ’  activity questionnaire. The studyauthors also hinted at the numerous bene 󿬁 tsof employing online questionnaires, both forclinical practise as well as research. 3 Theyfound that ▸  Data are entered directly into a data-base by the athlete/patient eliminatesmanual data entry by researchers. Thissaves time and money. ▸  Data  󿬁 elds can be prede 󿬁 ned tocontain a speci 󿬁 c range of entry possi-bilities, lowering the risk of errors. ▸  Respondents may receive notice whenthey forget to answer all questions,reducing the amount of missing data. ▸  Through branching of questions(guiding respondents through a ques-tionnaire based on their answers) thetime burden for the participant is mini-mised and this increases the likelihoodof continued study participation. WILL RESEARCH BECOME ANO-BRAINER? NOT SO FAST! The bottom line of what is outlined aboveis simple: electronic registration of data ishighly ef  󿬁 cient. Yet, there are also poten-tial drawbacks or weaknesses to onlinequestionnaires and surveys that should notbe ignored. Most revolve around validityand sampling issues, 3 with a particularconcern that such tools only reach a ‘ digitally-literate ’  population. Arguably,this may become less and less of aproblem as digital access and literacy con-tinues to grow. 4 However, validity issues continueposing a reason for concern. Often, whathappens is that a traditional  ‘ paper ’  ques-tionnaire is simply digitised, neglecting thefact that text is read differently onscreenthan on paper. Onscreen reading is de 󿬁 nedby short and concise text, while paperreading allows for longer paragraphs. Also,through branching, the interpretation of some questions may get lost while a subsetof questions remains hidden after a speci 󿬁 canswer. These are just two examples of why an established and valid traditionalquestionnaire might behave differentlywhen presented online. 5 6 FUTURE DIRECTIONS: IMPLICATIONSFOR SPORTS MEDICINE RESEARCH What in 󿬂 uence will these spectaculardigital developments have on the designand scope of sports medicine research?Kumar  et al 1 describe employing mHealthin almost all  󿬁 elds of medical research;big data, ecological measurement, remoteand portable diagnostics, implementationof treatment and preventive interventionsand information dissemination. 1 Most of these opportunities are highly applicableto sports medicine and inroads are cer-tainly being made in many areas. Themajority of data collected through mobileand online technologies can be obtainedremotely and, depending on the mode of registration, it may even be possible tocollect data in (near) real-time, movingtowards a  ‘ big data ’  approach. Big datarefers to a high volume, velocity andvariety of seemingly independent datapoints. 7 Through inductive statistics andconcepts from non-linear system identi 󿬁 -cation, relationships and dependencieswithin this data can be revealed.Ultimately predictions can be made.Real-time data analysis can be used, forinstance, to adapt a treatment protocolbased on (daily) patient-reported clinicaloutcomes. Additionally, from a researchperspective, such streaming data can beused for real-time predictive modelling.This may be of speci 󿬁 c interest to researchon overtraining or injuries without a clearonset. So far it has been dif  󿬁 cult to get agrip on the true onset of an overuseinjury, 8 let alone establish effective treat-ment or preventive protocols. Continuousmonitoring of injury risk factors andsymptoms may help us determine thecauses of overuse injuries and may openthe door for successful prevention strat-egies. The same holds true for injuryexacerbations and recurrences, 9 which arethought to be driven by changes in predis-posing factors over time. 10 By means of continuous monitoring longitudinalchanges in predisposing factors can becharted, allowing us to understand themultifactorial and dynamic nature of theirinteraction with injury risk.These are exciting developments but weare not there yet. Not even close.Technological developments are movingfaster than the  󿬁 eld can adapt. As such,the practical and scienti 󿬁 c use of eHealth technologies runs behind thetechnical possibilities. However, asshown by Grindem  et al 2 we are alreadyable to effectively encapsulate eHealthin sports medicine research by whichthey provided us a peek into an excitingfuture. 1 Department of Public and Occupational Health, EMGOInstitute for Health and Care Research, VU UniversityMedical Center, Amsterdam, The Netherlands;  2 OsloSports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway;  3 Aspetar, QatarOrthopaedic and Sports Medicine Hospital, Doha, Qatar Correspondence to  Dr Evert Verhagen, Departmentof Public and Occupational Health, EMGO Institute forHealth and Care Research, VU University MedicalCenter, Van der Boechorststraat 7, Amsterdam 1081BT, The Netherlands; e.verhagen@vumc.nlVerhagen EA,  et al  .  Br J Sports Med   Month 2013 Vol 0 No 0 1 Editorial   BJSM Online First, published on November 22, 2013 as 10.1136/bjsports-2013-093103 Copyright Article author (or their employer) 2013. Produced by BMJ Publishing Group Ltd under licence. group.bmj.comon November 26, 2013 - Published by bjsm.bmj.comDownloaded from   Contributors  EAV planned and managed the writingof this manuscript. All authors contributed equally tothe conception and writing of this manuscript. EAVsubmitted the study. Provenance and peer review  Commissioned;internally peer reviewed. To cite  Verhagen EA, Clarsen B, Bahr R.  Br J SportsMed   Published Online First: [  please include  Day MonthYear] doi:10.1136/bjsports-2013-093103Accepted 26 October 2013 ▸ Br J Sports Med   2013; 0 :1 – 2.doi:10.1136/bjsports-2013-093103 REFERENCES 1 Kumar S, Nilsen WJ, Abernethy A,  et al  . Mobilehealth technology evaluation: the mHealth evidenceworkshop.  Am J Prev Med   2013;45:228 – 36.2 Grindem H, Eitzen I, Snyder-Mackler L,  et al  . Onlineregistration of monthly sports participation afteranterior cruciate ligament injury: a reliability andvalidity study.  Br J Sports Med  . Published OnlineFirst: 11 November 2013. doi:10.1136/bjsports-2012-0920753 Evans JR, Mathur A. The value of online surveys. Internet Res  2005;15:195 – 219.4 Hohwü L, Lyshol H, Gissler M,  et al  . Web-basedversus traditional paper questionnaires: amixed-mode survey with a nordic perspective.  J Med Internet Res  2013;15:e173.5 Best SJ, Krueger BS. Internet survey design. In:Fielding NG, Lee RM, Blank G. eds.  The SAGE  handbook of online research methods . 1st edn.Londen: Sage Publications, 2008:217 – 35.6 Dillman DA, Smyth JD, Christian LM.  Internet, mail, and mixed-mode surveys: the tailored design method  . Hoboken, NJ: John Wiley & Sons, Inc,2007:1 – 15.7 Data, data everywhere. The Economist. 25 February2010. 16 September 2013.8 Clarsen B, Rønsen O, Myklebust G,  et al  . The OsloSports Trauma Research Center questionnaire onhealth problems: a new approach to prospectivemonitoring of illness and injury in elite athletes. Br J Sports Med  . Published Online First:11 November 2013. doi:10.1136/bjsports-2012-0920879 Finch C, Cook J. Categorising sports injuries inepidemiological studies: the subsequent injurycategorisation (SIC) model to address multiple,recurrent and exacerbation of injuries.  Br J SportsMed  . Published Online First: 11 November 2013doi:10.1136/bjsports-2012- 09172910 Meeuwisse WH, Tyreman H, Hagel B,  et al  . Adynamic model of etiology in sport injury: therecursive nature of risk and causation.  Clin J Sport Med   2007;17:215 – 19. 2 Verhagen EA,  et al  .  Br J Sports Med   Month 2013 Vol 0 No 0 Editorial  group.bmj.comon November 26, 2013 - Published by bjsm.bmj.comDownloaded from   doi: 10.1136/bjsports-2013-093103  published online November 22, 2013 Br J Sports Med   Evert A Verhagen, B Clarsen and R Bahr  the digital revolution has entered our pitchA peek into the future of sports medicine: Updated information and services can be found at: These include:  References This article cites 4 articles P<P Published online November 22, 2013 in advance of the print journal. serviceEmail alerting the box at the top right corner of the online article.Receive free email alerts when new articles cite this article. Sign up in Notes (DOIs) and date of initial publication. publication. Citations to Advance online articles must include the digital object identifier citable and establish publication priority; they are indexed by PubMed from initialtypeset, but have not not yet appeared in the paper journal. Advance online articles are Advance online articles have been peer reviewed, accepted for publication, edited and To request permissions go to: To order reprints go to: To subscribe to BMJ go to:  group.bmj.comon November 26, 2013 - Published by bjsm.bmj.comDownloaded from 
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