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Prevention strategies and modifiable risk factors for upper extremity injury : a systematic review and meta-analysis for the female, woman and girl Athlete Injury pRevention (FAIR) consensus
Heming, Emily E.; Gibson, Eric S.; Friesen, Kenzie B.; Martin, Chelsea L.; Maitland, Martin; Asker, Martin; Blauwet, Cheri; Bullock, Garrett S.; Fredriksen, Hilde; Galarneau, Jean-Michel; Hayden, K. Alix; Lee, Jae Hyung; Mosler, Andrea Britt; Myklebust, Grethe; Pluim, Babette M.; Thornton, Jane S.; Whittaker, Jackie L.; Whiteley, Rod; Crossley, Kay M.; Moller, Merete; Emery, Carolyn A. (BMJ Publishing Group, 2025-12)
OBJECTIVES : To examine injury prevention strategies and potentially modifiable risk factors (MRFs) for upper extremity (UE) injuries in female, woman and/or girl athletes (female/woman/girl). DESIGN : Systematic review with meta-analysis, semiquantitative analyses and Grading of Recommendations Assessment, Development and Evaluation in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES : MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), APA PsycINFO (American Psychological Association Psychological Information Database), SPORTDiscus (Sports Discus Database), EMBASE (Excerpta Medica Database), and ERIC (Education Resources Information Center) (30 October 2023) and Cochrane Systematic Review Database and the Cochrane Central Register of Controlled Trials (CENTRAL) (25 November 2023). ELIGIBILITY : Primary data studies with comparison group(s) assessing the association of prevention strategies and/or MRFs for sport-related UE injury, with ≥1 female/woman/girl in each study group. RESULTS : 55 studies (n=20 intervention, n=35 MRF) were included with 33 228 athletes (8642 female/woman/girl; 26%). Of these, 17 (31%) reported female/woman/girl-specific estimates and included five injury locations (n=3 general UE, n=12 shoulder, n=3 elbow, n=3 wrist/hand). One prevention strategy (n=5 shoulder-specific exercise programmes) and seven MRFs were identified, including less range of motion (n=6), less shoulder muscle strength (n=8), high training load (n=1), presence of scapular dyskinesis (n=3), high sport specialisation (n=2), equipment differences (n=1) and less sport-specific conditioning (n=1). Pooled data from three studies suggest that shoulder exercise programmes consisting of strength, stability/control and sport-specific exercises reduce shoulder injury rates by 51% (95% CI 0.30 to 079; I2 0.0%; very-low certainty evidence) across paediatric (≤18 years) and adult handball and volleyball players. CONCLUSIONS : Conclusions Our understanding of female/woman/girl UE injury prevention is limited by heterogeneity across injury outcomes, interventions, MRFs and limited female/woman/girl athlete-specific data. Shoulder-specific strengthening and stability exercise programmes may be beneficial to reduce shoulder injury rates in female/woman/girl handball and volleyball players. Future research should prioritise female/woman/girl athletes to reduce the burden of UE injuries. PROSPERO registration number : PROSPERO CRD42024494967.
Gender- and/or sex-specific considerations for sport-related injury : a concept mapping approach for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus
Crossley, Kay M.; Haberfield, Melissa J.; Ross, Andrew G.; Gracias, Libby J.; Bruder, Andrea M.; Whittaker, Jackie L.; Chintoh, Araba; Thornton, Jane S.; Davenport, Margie H.; Mountjoy, Margo; Hayman, Melanie; Patterson, Brooke E.; Blauwet, Cheri A.; Verhagen, Evert; Van den Berg, Carla; Okoth, Carole Akinyi; Bolling, Caroline; Janse van Rensburg, Dina Christina; Casey, Ellen; Constantini, Naama W.; Adom-Aboagye, Nana Akua Achiaa; Tomas, Rita; Tsukahara, Yuka; Emery, Carolyn A.; Dijkstra, H. Paul; Donaldson, Alex (BMJ Publishing Group, 2025-12)
OBJECTIVE : This study aimed to gather and represent experts' perspectives on the gender- and/or sex-specific factors relevant to injury risk for female/woman/girl athletes. METHODS : Mixed-methods concept mapping study. Sixty-six experts including cisgendered (1) athlete/coach/carers, (2) clinicians, (3) sports science/high-performance professional, (4) administrators and (5) researchers brainstormed statements to a prompt ('What gender-specific and/or sex-specific factors do you think contribute to injury risk among female, woman and girl athletes?') before thematically sorting and rating the statements/factors for importance and modifiability (5-point Likert scales). RESULTS : Ten clusters were constructed from 101 unique statements/factors. The clusters (number of statements) include: (1) Inequitable organisational funding and support (n=17); (2) Athletes' lack of, and access to, resources (n=7); (3) Lack of knowledge and expertise among support staff (n=6); (4) Lack of evidence for, and implementation of gender and sex-appropriate injury prevention (n=20); (5) Sex-related factors (n=14); (6) Gendered health (n=8); (7) Gendered expectations to conform to athletic ideals and norms (n=10); (8) Gendered harassment (interpersonal violence) and social biases (n=9); (9) Gendered sport environment (7); (10) Gendered communication (n=3). Lack of knowledge and expertise among support staff was deemed the most important and modifiable cluster to address gender- and/or sex-specific factors relevant to injury prevention for female/woman/girl athletes. CONCLUSION : Ten gender- and/or sex-specific clusters, ranging from organisational to biological considerations and societal influences, were defined that could impact female/woman/girl athlete injury risk factors. Advancing stronger evidence for gender and sex appropriate injury prevention is urgently needed.
The LoaD study : the association between different types of physical activity and the progression of knee osteoarthritis - a cohort study protocol
Van der Voort, Joris W.; Voogt, Lennard; Huisken, Sanne; Oei, Edwin; Van Oeveren, Ben; Van Meurs, Joyce; Pluim, Babette M.; Bierma-Zeinstra, Sita M.A.; Van Middelkoop, Marienke (BMJ Publishing Group, 2025-11)
BACKGROUND : The global prevalence of osteoarthritis (OA) is expected to rise as the population ages, leading to increased physical impairments that often reduce physical activity. Knee OA, in particular, is a leading cause of chronic pain and disability in people over 40. OA progression varies among individuals, with factors such as higher age and body mass index contributing to a more rapid progression. However, research suggests that engaging in physical activity such as hiking and running may help alleviate pain and slow OA progression. However, current literature on the relationship between physical activity and knee OA is largely retrospective, lacks comparative analyses across different physical activity types and rarely considers the intensity of physical activity. To address these gaps, the LoaD study was designed as a prospective cohort study aimed at examining how different physical activity types (ie, hiking, running, cycling and tennis) and their intensities relate to knee OA progression over 24 months in physically active individuals with early signs of the condition. METHODS AND ANALYSIS : This prospective cohort study will include 300 participants (75 per physical activity group), who will be followed for 24 months. Eligible participants are aged 45–65, meet the National Institute for Health and Care Excellence (NICE) criteria for clinical knee OA and engage in a minimum weekly activity level for either running (60 min), cycling (120 min), playing tennis (60 min) or hiking (1 hike of 10 km). Baseline and follow-up assessments will include MRI, physical examination (eg, biometrics, lower extremity strength) and blood sampling for molecular biomarker assessment (eg, genetics, inflammatory biomarkers). Participants will receive monthly online questionnaires (eg, demographics, lifestyle, general health, history of knee injuries) and their physical activities will be tracked continuously by global positioning system data from wearable devices. The study’s primary outcomes focus on knee OA progression and symptom changes. These will be assessed through (1) structural progression of knee OA, measured using the MRI Osteoarthritis Knee Score (MOAKS) and (2) clinical symptom progression evaluated by (a) the Knee Injury and Osteoarthritis Outcome Score sport and recreation function subscale and (b) Visual Analogue Scale for pain during an activity nominated by the participant to be the most aggravating for knee pain in the past month (VASNA, 0–10). Differences between groups on the primary outcomes will be analysed using mixed-effects models to determine the impact of activity type and intensity on knee OA progression. ETHICS AND DISSEMINATION : The study is approved by the Erasmus MC Medical Research and Ethics Committee (MREC) (MEC-2022-0420). The results of this study will be made publicly available through peer-reviewed international open-access scientific journals and national and international conferences. Participants will be informed about the results as soon as they are published. STRENGTHS AND LIMITATIONS OF THIS STUDY • This is the first prospective cohort study to compare the effects of different types of physical activity on the structural and clinical progression of knee osteoarthritis. • Structural progression is assessed using MRI-based scoring (MRI Osteoarthritis Knee Score), providing detailed evaluation of joint changes over time. • Continuous, objective measurement of physical activity via wearables and monthly questionnaires enhances the accuracy of sports exposure data. • Participants may switch activities during follow-up due to symptoms, which could introduce crossover effects in sports exposure assessment.
Feasibility, efficacy and effectiveness of community health worker-facilitated hearing aid provision : a systematic review
Frisby, Caitlin; Manchaiah, Vinaya; Swanepoel, De Wet (BMJ Publishing Group, 2025-11)
OBJECTIVES : The WHO recommends task-sharing with community health workers (CHWs) to help overcome the limited access to hearing healthcare and hearing aids in low-income and middle-income settings (LMIs). This systematic review examined the feasibility, efficacy and effectiveness of CHW-facilitated hearing aid provision. DESIGN : Systematic review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. DATA SOURCES : PubMed, Scopus and Web of Science were searched through 4 June 2025. ELIGIBILITY CRITERIA : Studies in which CHWs facilitated hearing aid provision in any context. DATA EXTRACTION AND SYNTHESIS : Data on study characteristics, CHW training and roles, hearing-aid outcomes and implementation factors were extracted. Study quality was determined using the National Institute of Health quality assessment tool, and level of evidence was determined using the Centre for Evidence-Based Medicine. A narrative synthesis was conducted. RESULTS : Six studies published between 2013 and 2025 were included. Two were conducted in high-income countries but implemented in LMI communities. Four studies were conducted in LMI countries. All provided CHW training, though content and duration varied; only one used WHO-endorsed materials. Sustained device use was high as reported at follow-ups, though only one included 12-month outcomes. All studies included validated outcome measures, including the International Outcome Inventory for Hearing Aids, Hearing Handicap Inventory for the Elderly-Screening version, Abbreviated Profile of Hearing Aid Benefit and Self-Efficacy for Situational Communication Management Questionnaire. Implementation facilitators included use of local CHWs, delivery in participants' home languages, comprehensive CHW training and employing mHealth tools. Barriers included CHW scope constraints and unfamiliarity with outcome subscales in rural contexts. Only two studies used formal feasibility frameworks. CONCLUSIONS : CHW-facilitated hearing aid provision is feasible and effective. However, variation in training and implementation highlights the need for standardised training materials, supervision models and culturally adapted outcome measures. Further research should examine long-term outcomes, cost-effectiveness and scalability using formal implementation frameworks.
Provincialising global oncology
Surawy Stepney, Nickolas; Bhangu, Shagufta; Llewellyn, Henry; Fraser, Jennifer; Cochrane, Thandeka; Jagessar, Philip; Reubi, David; Caduff, Carlo; Bray, Freddie; Graber, Nils; Henke, Oliver; Iriart, Jorge Alberto Bernstein; Mulemi, Benson Azariah; Newton, Robert; Prince, Ruth; Schantz, Clemence; Sengar, Manju; Sirohi, Bhawna (BMJ Publishing Group, 2025-11-23)
Global Oncology is an important project and concept which has made significant strides in recent years. Its laudable achievements in tackling cancer’s medical and human impacts have worked to address the ‘oncological divide’. To strengthen the project’s core aims, we call to ‘provincialise’ its goals and techniques by bringing in voices of experts on the ground, in particular from the Global South. This is crucial to strengthening Global Oncology, setting its agendas, suturing its standards and norms with on-the-ground realities, and considering complex and diverse dynamics of difference and inequality. Through provincialising, we advocate for a move towards plural oncologies.