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Table 1 Study information

From: Winning at all costs: a review of risk-taking behaviour and sporting injury from an occupational safety and health perspective

Study Participants Sample size Player type Methods Awareness measured Methods validity Associations
Case-control study
 Barnard [23] 77 student athletes and 50 student non-athletes 127 Case group (athletes): 32 M 45F
Control group (non-athletes): 13 M 37F
Student-athletes Questionnaire Mental illness *** Athletes and non-athletes did not significantly differ in willingness to seek mental health treatment.
Discrimination to mental illness: non-athletes > athletes.
Willingness to seek psychological help: F > M.
Fedor and Gunstad [24] 382 college athletes and 230 college non-athletes 612 Case group (athletes): 228 M 154F
Control group (non-athletes): 77 M 153F
Student-athletes Questionnaire Concussion *** Concussion symptoms identification: athletes > non-athletes (p < 0.01)
Cohort study
 Kroshus et al. [25] 146 ice hockey players 146 M
6 teams
Elite Questionnaire Concussion **** No statistically significant changes were observed in knowledge (p = 0.38), attitudes (p = 0.78) or perceived norms (p = 0.11).
Inclination to play while concussed: before education > after education (lecture education: p = 0.02; email education p = 0.02).
Cluster-randomised controlled trial
 Cusimano et al. [26] 267 minor league hockey players 267; 10-year olds competitive, 106; 10-year olds recreational, 60; 14-year olds competitive, 54; 14-year olds recreational, 47. Elite Questionnaire Brain injuries ** Concussion knowledge: before video education < immediately after video education (p < 0.01).
Concussion knowledge at 2 months: no significance between video and no-video groups (controlling for prior knowledge level, age and competitive level) (p = 0.52).
Attitudes and behaviour scores at 2 months did not differ between groups p = 0.51.
 McKay et al. [27] 31 female soccer teams, 29 coaches,258 players Baseline: 47 coaches, 385 players
Post-season: 29 coaches, 258 players
Elite Questionnaire Extremity injuries **** Postseason: players > coaches considered “inadequate warm-up” as a risk factor for injury (p < 0.01).
The belief that injuries are preventable: coaches > players answer “yes” (p = 0.00).
Grounded theory study
 Hachfeld et al. [28] 23 student-athletes 23 M Student athletes Focus group Testicular cancer *** Student athletes were more likely to perform testicular self-examination than the general student population and physical awareness is the core structural process that influenced the action.
Cross-sectional study
 Azodo et al. [29] 156 basketball players 156
124 M
32 F
Mixed Questionnaire Orofacial injuries *** The prevalence of injury was not significantly associated with demography, category, competition and duration of participation (p = 0.26).
 Berry et al. [30] 158 players at 10 institutions of the Central Collegiate Hockey Association 158
68 defensive, 90 offensive.
Sex not indicated
Elite Questionnaire Orofacial injuries *** No one specific factor affecting attitudes was identified.
Negative attitudes towards mouthguard usage: defensive players > offensive players (p < 0.05).
 Bhambhani et al. [31] 99 Paralympians with spinal cord injuries 99
85 M, 11 F
3 not indicated sex
Elite Questionnaire Autonomic dysreflexia *** The awareness of the signs/symptoms and consequences of boosting was not associated with their education level (p = 0.58) or injury duration (p = 0.22).
 Blank et al. [32] 883 junior athletes’ parents 883
409 M
474 F
Student-athletes Questionnaire Medicine use *** Knowledge: Male parents > female parents; Parental sex did not demonstrate a significant influence on attitudes towards doping (p < 0.01).
 Bloodgood et al. [33] 252 youth athletes and 300 parents Parents: 90 M 210F
Youth: 207 M 45F
Student-athletes Questionnaire Brain Injury *** Agreed concussions are “a critical issue”: 13–15 years > 16–18 years (p < 0.05).
Concussions are “a critical issue”: mothers> fathers (p < 0.05).
Disagree “dumb for caring about concussions”: girls> boys (p < 0.05).
 Broglio et al. [34] 727 soccer professionals 727
650 athletes
43 coaches
34 medical staff
Sex not indicated
Professional Questionnaire Concussion *** The following are reasons for not reporting concussions:
Believe the injury was not serious (72.7%); not knowing it was a concussion (18.2%); not want the team down (4.5%); Believe concussions are part of the game (4.5%).
 Brown et al. [35] 240 high school athletes (cross-country, volleyball, soccer, tennis, drill, cheer, colour guard, band, and swimming) and their 10 coaches 240 F athletes, 10 coaches Student-athletes Questionnaire Female triad risk *** Average triad knowledge score differed among teams (p = 0.01); triad awareness among athletes (average knowledge score was 2.79 ± 1.61 out of 8).
 Chan et al. [36] 410 athletes from individual sports (athletics-track, athletics-field, badminton, gymnastics, swimming, and triathlon) and team sports (cricket, soccer, field hockey, basketball, rugby and water polo) 410
227 M
183 F
Elite Questionnaire Medicine use **** When controlled motivation is low: autonomous motivation ↓ → doping intention ↑ (p < 0.01).
When controlled motivation is high: no significant between autonomous motivation and doping intention (p = 0.57).
When autonomous motivation was low: controlled motivation↓ → doping intention ↑ (p < 0.01); when autonomous motivation was low: no significant between controlled motivation and doping intention (p = 0.50).
 Coffey et al. [37] 149 professional and semi-professional soccer players 149 M Professional Questionnaire Concussion *** Concussion report odds: defenders > other playing positions (p = 0.05).
 Cournoyer and Tripp [38] 334 varsity high school soccer players 334
Sex not indicated
Student-athletes Questionnaire Concussion ** No correlations were found between the method of education and the knowledge of symptoms or consequences of concussion (1 − β = 0.82).
 Kerr et al. [39] 214 former NCAA collegiate athletes 214
140 M
74 F
Mixed Questionnaire Concussion *** In low/noncontact sports: self-identified sports-related concussions non-disclosure: M > F (PR = 2.88).
 Kuhl et al. [40] 94 equestrian riders 94
27  M, 67 F
64 amateurs
30 professionals
Mixed Questionnaire Concussion ** Experience level did not influence the rates of concussion (p value not reported).
 Kurowski et al. [41] 496 high school athletes 496
384 M 112F
212 American football
123 soccer
89 basketball
72 wrestling
Student-athletes Questionnaire Concussion *** No association found between improved concussion knowledge and improved self-reported behaviours (p = 0.63);
Age (p = 0.01) ↑ & female sex (p = 0.03) → concussion knowledge↑;
Age (p = 0.01) ↓ & female sex (p = 0.00) & soccer participation (p = 0.02) → self-reported behaviours ↑.
 Ma [42] 236 basketball players 236 M
77 professionals
159 semi-professionals
Mixed Questionnaire Orofacial injuries ** The incidence of dental and oral injuries was related to the length of training time (p value not reported).
 McCrea et al. [43] 1532 varsity soccer players from 20 high schools 1532
Sex not indicated
Student-athletes Questionnaire Concussion *** No significant relationship found between a player’s prior concussion history and the likelihood of concussion reporting during the season.
 Meyers et al. [44] 298 athletes in non-traditional non-NCAA sports (downhill skiing, martial arts, rock climbing, rodeo, skydiving and telemark skiing) and traditional NCAA sports (equestrian, golf, swimming/diving, tennis and track) 298 F
152 non-NCAA athletes
146 traditional NCAA athletes
Mixed Questionnaire Pain-coping *** Women athletes pain-coping traits: non-traditional individual-sport activity < coach-structured traditional NCAA sports (Wilks’ λ F6,291 = 12.92; p = 0.00).
 Miyashita et al. [45] 454 high school athletes 454
242 M
212 F
Student-athletes Questionnaire Concussion ** Participants were asked if the importance of a game/event should dictate when they are allowed to return to play, and 50.9% stated “yes” with no difference between sexes (p = 0.10) or age (p = 0.19).
 Muwonge et al. [46] 360 professional athletes (basketball, soccer, handball, rugby, athletics and cycling) 360
218 M
142 F
Professional Questionnaire Medicine use **** Female athletes mean PEAS scores: with a prior doping history > without doping history (p = 0.10)
 Norcross et al. [47] 66 soccer and basketball coaches from 15 high schools 66 coaches:
16 boys soccer
17 girls soccer
18 boys basketball
15 girls basketball
Student-athletes Questionnaire Lower extremity injury *** Coaches’ injury prevention programs awareness: girls’ team > boys’ team (p = 0.00);
Soccer > basketball (p = 0.05).
 Onyeaso and Adegbesan [48] 42 coaches of secondary school athletes 42
25 M
17 F
Student-athletes Questionnaire Orofacial injuries ** Statistically significant association (p < 0.05) was found between the sports and usage of mouthguards by the athletes as claimed by the coaches.
 Overbye [49] 775 elite athletes from 40 sports 775
465 M
310 F
Elite Questionnaire Medicine use *** Interests in anabolic-androgenic steroids use: M > F (p = 0.00);
Speed and power sports athletes> motor-skill sport athletes (p = 0.02);
Team sports athletes >motor-skill sport athlete (p = 0.08);
Endurance sport athletes > motor-skill sport athletes (p = 0.15).
 Register-Mihalik [50] 167 high school athletes 167
97 M
55 F
Student-athletes Questionnaire Concussion *** No association found between increased athlete knowledge and attitude and prevalence of playing while experiencing concussion symptoms (p = 0.84).
 Reuter and Short [51] 154 noncontact/limited-contact sports athletes 154
Swimming 27 M 18 FTrack 26 M 28 FBaseball 25 M
Elite Questionnaire Perceived risk of injury ** Uncontrollable injury scores showed a significant difference between 3 sports (all about p = 0.00) with baseball players fearing the most risk and swimmers fearing the least.
Risk of controllable injuries showed a significant difference between swimming and baseball (p = 0.01) with baseball players fearing the most risk and swimmers the least.
Risk of upper body injury scores indicated a significant difference between track and swimming (p = 0.00) and track and baseball (p = 0.00).
Swimmers reported the most fear of upper body injury while track athletes scored the lowest.
Risk of re-injury scores indicated a significant difference between track and baseball (p = 0.00), and baseball and swimming (p = 0.00).
 Shendell et al. [52] 1138 endurance athletes (full marathon, half marathon, and wheelchair athletes) 1138
499 M
639 F
Mixed Questionnaire Asthma **** About 12.10% participants reported physician-diagnosed asthma;
84.6% correctly knew an asthma action plan can prevent hospitalizations;
18.0% reported they had an asthma action plan;24.8% had ever been asked to demonstrate medication use (controller and/or rescue inhaler) but only 2 people performed daily peak flow measurements.
 Short et al. [53] 434 contact sports athletes 434
Hockey, 86 M 76 F
Soccer. 32 M 32 F
American football, 208 M
Elite Questionnaire Perceived risk of injury ** Worry/concern↑ → probability of injury↑ (p < 0.01).
Worry/concern ↑ → confidence in avoiding injury↓ (p < 0.01).
Perceived probability of injury↑ → confidence in avoiding injury↓ (p < 0.01).
Confidence in avoiding injury: M soccer previous injured< M hockey Previous injured (ES = 0.52).
Confidence in avoiding injury: M soccer uninjured > M hockey uninjured (ES = 0.68).
Confidence in avoiding injury: F uninjured > F previous injured (ES = 0.38.
Perceived probability of injury: F previous injured > M previous injured (ES = 0.72).
Confidence in avoiding injury: F soccer >F hockey (ES = 0.86).
Worry/concern about injury: F hockey >F soccer (ES = 0.85).
Worry/concern: M soccer> M hockey (ES = 0.25).
 Shroyer and Stewart [54] 53 rural high school coaches 53
17 M
36 F
Student-athletes Questionnaire Concussion ** 13% of coaches knew and 48% did not know high school athletes take longer to recover from a concussion than do older athletes.
 Sorkkila, Aunola and Ryba [55] 391 student-athletes from 6 upper secondary sport schools and their parents 391 student-athletes:
49% M 51% F
448 parents:
188 M 260 F
Student-athletes Questionnaire Burnout *** The higher success expectations in sport: school burnout group > mild sport burnout group (p < 0.01);
The higher success expectations in school: mild sport burnout group > school burnout group (p < 0.05).
 Strotmeyer and Lystad [56] 175 amateur Muay Thai fighters 175
114 M
61 F
High-performance amateur Questionnaire General injuries *** Muay Thai fighters perceived the risk of injury in their own sport to be average and significantly lower than that in other collision and contact sports (p < 0.01).
 Tiwari et al. [57] 320 national and international level players (wrestling, karate judo, boxing, Wushu, fencing, taekwondo, hockey, canoeing and kayaking, rowing, sailing, horse riding, and shooting) 320
213 M
2017 F
Professional Questionnaire Orofacial injuries ** Awareness and use of mouthguards: contact sports athletes > noncontact sports athletes (p = 0.00).
 Tulunoglu and Oezbek [58] 274 semi-professional or amateur boxers and taekwondo players 274
174 M
100 F
Mixed Questionnaire Orofacial injuries ** Mouthguard awareness: players with a dental trauma experience > players without a dental trauma experience (p = 0.00);
Players with a facial trauma experience > players without a facial trauma experience (p = 0.01).
 Therkorn and Shendell [59] 120 participants including college athletes, coaches and athlete parents/guardians 120
26 coaches
37 college athletes
57 athlete parents/guardians
Student-athletes Questionnaire Asthma ** The percentage of correct responses by coaches to 5 asthma knowledge questions ranged from 12% to 88%.
 Williams et al. [60] 26 professional soccer players 26 M Professional Questionnaire, interview Concussion **** The mean score on concussion knowledge was 16.4 ± 2.9 (range 11–22) and the attitude score was 59.6 ± 8.5 (range 41–71);
The interview responses identified inconsistencies between the concussion knowledge/attitude and the intended behaviours, endorsing multiple concussion misconceptions, and revealed barriers to concussion reporting.
 Zech and Wellmann [61] 139 professional and youth players 139
24 First Team players
18 U23 players
25 U19 players
17 U17 players
20 U16 players
35 U15 players
Sex not indicated
Mixed Questionnaire General injuries *** Perceptions on risk factors for injuries: athletes with previous injuries > athletes without previous injuries (fatigue: p = 0.04; previous injuries: p = 0.01; environment p = 0.00).
  1. M male, F female, U under, > more than/higher than, < less than/ lower than, ↑ increase, ↓ decrease, & and, % per cent, p p-value, PR prevalence ratio, ES effect size, NCAA National Collegiate Athletic Association;
  2. According to Mixed Methods Appraisal Tool (MMAT) [62], the score of study quality is presented using descriptors * (scores varying from 25% (*)—one criterion met—to 100% (****)—all criteria met);
  3. Mixed: player type is mixed by professional and non-professional players as the study indicated.