Factors Affecting Ankle Protection Usage in

Young Basketball Players

Ahmed Faress, Michael D. Cusimano, Wilson P. Luong, Michael Yonas, Joanne Chehade, and Tamer Abdelshaheed

Background

Basketball is played by over 450 million participants in 213 countries (FIBA.com)

Popularity is growing worldwide –

has already

surpassed soccer in Asia and Australia (FIBA.com)

With growing popularity, has come a growing injury burden (CDC, 2002)

http://photos.upi.com/slideshow/lbox/213c0142b

76a94f3ed2e68b86c481566/OLYMPICS-

BASKETBALL.jpg

Ankle Sprains

Characterized by stretch or tear in ligament

Most common type of injury in basketball (Borowski

et al., 2008)

Meeuwisse

et al., 2003 : an average loss of 5.47 sessions/injury

http://upload.wikimedia.org/wikipedia/commons/5/5d/A

nkle.PNG

Importance of Ankle Injury Prevention

“critical to basketball players, coaches, athletic trainers, and team physicians, who wish to minimize time and money loss, and maximize success”

Ankle Protectors Prevent Ankle Injury1. Ankle tape

Garrick and Requa, 1973 : ankle sprain rate in taped group ~0.5 vs. non-taped group

2. Ankle braces

Sitler

et al., 1994 : ankle injury incidence ↓

by a factor of 3

http://injurysupplies.com/images/Category_Ankle_Brac

es_Maximum_support.jpg

http://img.medscape.com/pi/emed/ckb/sports_medicine/8

4611-86495-3.jpg

Protective Mechanisms

both ↓

ankle’s range of motion

(Verhagen

et al., 2001)

both ↓

resultant inversion caused by the

application of an external force (Shapiro et al., 1994)

Ankle Protection Rarely Used

Despite the demonstrated effectiveness of ankle braces and ankle tape…

a

study of recreational and elite athletes found that only 18.8% of basketball players used ankle support (McKay et al., 2001)

Study Aim

To understand the factors that affect a young basketball player’s decision to wear ankle protection

By identifying and understanding these factors, strategies may be devised to increase the likelihood of using ankle protection

http://marketingassassin.files.wordpress.com/2009/09

/objectives.jpg

Questionnaire Development Based on Health Belief Model

Perceived Severity and Perceived Susceptibility

Perceived Threat of Injury

Sum of Perceived Benefits Minus

Perceived Barriers for Preventive Action

Likelihood of Preventive Action

Demographic Variables

Sociopsychological Variables

Perceptions & Modifying Factors

Assessments Likelihood of Action

↑

likelihood of wearing ankle protection

Questionnaire Development Based on Health Belief Model

Perceived Severity and Perceived Susceptibility

Perceived Threat of Injury

Sum of Perceived Benefits Minus

Perceived Barriers for Preventive Action

Likelihood of Preventive Action

Demographic Variables

Sociopsychological Variables

Perceptions & Modifying Factors

Assessments Likelihood of Action

↓

likelihood of wearing ankle protection

Identifying Barriers

Conducted one-on-one interviews with:

6 athletes

2 coaches

1 sports medicine doctor

1 physiotherapist

2 athletic trainers

Compiled information:

Predicted 4 barriers to ankle protection use

Predicted Barriers

1.

Cost2.

Appearance•

aesthetic appearance and “appearance of weakness”

3.

Comfort•

physical comfort/discomfort

4.

Performance

Study Design

Survey given to athletes in 3 competition levels

19-point questionnaire

Modifying factors:

Previous ankle injuries

Coach enforcement

Barriers:

Cost

Appearance

Comfort

Performance

Perceptions of susceptibility, severity, benefit

http://www.alamo.edu/pac/faculty/pmyers/hist1302/qu

estionnaire.jpg

Participant Data

Table 1. Summary data for the participants in the study (n=140).

Recreational High School University Overall

Response Rate (%) 56 100 100 76.1

Participants n (%) 56 (40) 32 (23) 52 (37) 140 (100)

Males (%) 100 59 37 67

Females (%) 0 41 63 33

Age (years)Mean ± S.D. 14.9 ± 2.0 16.1 ± 1.7 20.6 ± 2.0 17.3 ± 3.3

Previous injury (%) 73.2 87.5 86.5 81.4

Coach Enforcement (%) 7.1a 12.5a 46.2b 22.9

*percentages with different superscripts (a,b) differ significantly at p < 0.05

Sample size = 140

Participants from 3 competition levels

Participant Data

Table 1. Summary data for the participants in the study (n=140).

Recreational High School University Overall

Response Rate (%) 56 100 100 76.1

Participants n (%) 56 (40) 32 (23) 52 (37) 140 (100)

Males (%) 100 59 37 67

Females (%) 0 41 63 33

Age (years)Mean ± S.D. 14.9 ± 2.0 16.1 ± 1.7 20.6 ± 2.0 17.3 ± 3.3

Previous injury (%) 73.2 87.5 86.5 81.4

Coach Enforcement (%) 7.1a 12.5a 46.2b 22.9

*percentages with different superscripts (a,b) differ significantly at p < 0.05

81.4% of athletes had a previous ankle injury

Prevalence of Ankle Protection Use

Figure 1. Rates of ankle protection usage across different competition levels.

0%

10%

20%

30%

40%

50%

60%

70%

Recreational(n=56)

High School(n=32)

University (n=52) Total (n=140)

Perc

enta

ge U

sing

Ank

le P

rote

ctio

n

> 60% of university athletes wore ankle protection

Perceptions

Figure 2. Perceptions regarding ankle protection usage in each group.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

PerceivedSusceptibility to

Ankle Injury

PerceivedSeverity of Ankle

Injury

PerceivedBenefits of Ankle

Protection

Perc

enta

ge o

f Ath

lete

s

RecreationalHigh SchoolUniversity

University athletes reported the highest levels of each

Perceived Barriers to Ankle Protection

Table 2. Barriers to ankle protection usage in order of reported frequency.Barrier to Ankle Protection Usage No. (%)

Recreational (n=56)Comfort –

Ankle BraceComfort –

Ankle TapePerformanceAesthetic appearanceCostAppearance of weakness

19 (33.9)a

19 (33.9)a

15 (26.8)12 (21.4)8 (14.3)6 (10.7)b

High School (n=32)Comfort –

Ankle BraceCostComfort –

Ankle TapeAesthetic AppearancePerformance Appearance of weakness

13 (40.6)13 (40.6)12 (37.5)11 (34.4)10 (31.3)10 (31.3)

University (n=52)Comfort –

Ankle TapeComfort –

Ankle BraceCostAesthetic AppearancePerformanceAppearance of weakness

29 (55.8)a

25 (48.1)a

19 (36.5)18 (34.6)11 (21.2)b

11 (21.2)b

*percentages with different superscripts (a,b) differ significantly at p < 0.05

Comfort is the most frequently reported barrier

Effect of Coach + Previous Injury

0%10%20%30%40%50%60%70%80%90%

100%

Prev. Inj. +Coach

Enforcement(n=29)

CoachEnforcementAlone (n=3)

Prev. InjuryAlone (n=85)

No Prev. Inj. +No Coach

Enforcement(n=23)Pr

opor

tion

of A

thle

tes

Wea

ring

Ank

le

Prot

ectio

n

Figure 3. Effect of personal ankle injury history and coach enforcement on ankle protection usage.

Prev. Inj

+ coach enforcement: ~90% of athletes wore ankle protection

Regression Model

Table 3. Multivariable regression model assessing the relation of outcome (use or no use of ankle protection) to four principal components.

Construct Odds ratio p-value 95% C.I.

Perceived Severity 1.63 0.027 1.06 to 2.50

Willingness to wear ankle protection

1.42 0.083 0.96 to 2.11

Perceived Benefit 1.75 0.011 1.14 to 2.68

Positive Perception of Ankle Braces

1.63 0.018 1.09 to 2.45

1.63 times more likely to wear ankle protection

Regression Model

Table 3. Multivariable regression model assessing the relation of outcome (use or no use of ankle protection) to four principal components.

Construct Odds ratio p-value 95% C.I.

Perceived Severity 1.63 0.027 1.06 to 2.50

Willingness to wear ankle protection

1.42 0.083 0.96 to 2.11

Perceived Benefit 1.75 0.011 1.14 to 2.68

Positive Perception of Ankle Braces

1.63 0.018 1.09 to 2.451.75 times more likely to wear ankle protection

Regression Model

Table 3. Multivariable regression model assessing the relation of outcome (use or no use of ankle protection) to four principal components.

Construct Odds ratio p-value 95% C.I.

Perceived Severity 1.63 0.027 1.06 to 2.50

Willingness to wear ankle protection

1.42 0.083 0.96 to 2.11

Perceived Benefit 1.75 0.011 1.14 to 2.68

Positive Perception of Ankle Braces

1.63 0.018 1.09 to 2.45

1.63 times more likely to wear ankle protection

Regression Model

Table 3. Multivariable regression model assessing the relation of outcome (use or no use of ankle protection) to four principal components.

Construct Odds ratio p-value 95% C.I.

Perceived Severity 1.63 0.027 1.06 to 2.50

Willingness to wear ankle protection

1.42 0.083 0.96 to 2.11

Perceived Benefit 1.75 0.011 1.14 to 2.68

Positive Perception of Ankle Braces

1.63 0.018 1.09 to 2.451.42 times more likely to wear ankle protection

Summary of Results

Perceived severity, perceived benefit, willingness, positive perception of ankle braces are predictors of ankle protection use

Comfort is the main barrier to ankle protection use

Influential role for coaches

Discussion

Our results were largely consistent with predictions from the Health Belief Model

Influence of role models

Importance of experience (Social Learning Theory)

Cultural and economic factors may influence the results

http://www.best-basketball-

tips.com/images/basketball-player-putting-

on-ankle-braces.jpg

Limitations

There may have been other barriers we did not identify

There may be geographic/cultural differences

Sample size

Did not stratify based on whether athletes owned ankle protection or not

Sample may have not been representative

Future Directions

Efforts are needed to increase ankle protection use in youth

Coaches should play a central role in these initiatives

Opportunities for manufacturers to address barriers such as comfort and cost

http://coachyouthbasketball.com/Basketball%20Coac

h%20PhotoSmall.jpg

Acknowledgements

Dr. Cusimano

Depeng

Jiang

Injury Prevention Research Office

Thank you for your attention!

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Questions?

Supplemental SlidesRecreational High School University Overall

Response Rate (%) 56 100 100 76.1

Participants n (%) 56 (40) 32 (23) 52 (37) 140 (100)

Males (%) 100 59 37 67

Females (%) 0 41 63 33

Age (years)Mean ± S.D. 14.9 ± 2.0 16.1 ± 1.7 20.6 ± 2.0 17.3 ± 3.3

Use ankle protection, n (%) 8 (14.3)a 7 (21.9)a 31 (59.6)b 46 (32.9)

Previous injury (%) 73.2 87.5 86.5 81.4

Coach Enforcement (%) 7.1a 12.5a 46.2b 22.9