Illness and injury in athletes during the competition period at the London 2012 Paralympic Games: development and implementation of a web-based surveillance system (WEB-IISS) for team medical staff Wayne Derman, 1,2 Martin Schwellnus, 1,2 Esme Jordaan, 3 Cheri A Blauwet, 4,5 Carolyn Emery, 6,7 Pia Pit-Grosheide, 5 Norma-Angelica Patino Marques, 5,8 Oriol Martinez-Ferrer, 5,9 Jaap Stomphorst, 5,10 Peter Van de Vliet, 5,11 Nick Webborn, 12 Stuart E Willick 5,13 For numbered affiliations see end of article. Correspondence to Professor Wayne Derman, UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, 3rd Floor Sports Science Institute of South Africa Boundary Road, Newlands, Cape Town 7700, South Africa; ewderman@iafrica.com Accepted 25 February 2013 To cite: Derman W, Schwellnus M, Jordaan E, et al. Br J Sports Med 2013;47:420–425. ABSTRACT Background In this study we describe (1) the implementation of a novel web-based injury and illness surveillance system (WEB-IISS) for use by a team of physicians at multisport events and (2) the incidence and characteristics of injuries and illness in athletes during the London 2012 Paralympic Games. Methods Overall, 3565 athletes from 160 of the 164 participating countries were followed daily over a 14-day period, consisting of a precompetition period (3 days), and a competition period (11 days) (49 910 athlete- days). Daily injury and illness data were obtained from teams with their own medical support (78 teams, 3329 athletes) via the WEB-IISS, and without their own medical support through the London Organising Committee of the Olympic Games and Paralympic Games database (82 teams and 236 athletes). Results There were no differences between incidence rates (IR) of injury and illness, or between the precompetition and competition periods. The IR of injury during the competition period was 12.1/1000 athlete-days, with an incidence proportion (IP) of 11.6% (95% CI 11.0% to 13.3%). Upper limb injuries (35%), particularly of the shoulder (17%) were most common. The IR of illness during the competition period was 12.8/1000 athlete-days (95% CI 12.18 to 1421), with an IP of 10.2%. The IP was highest in the respiratory system (27.4%), skin (18.3%) and the gastrointestinal (14.5%) systems. Conclusions During the competition period, the IR and IP of illness and injury at the Games were similar and comparable to the observed rates in other elite competitions. In Paralympic athletes, the IP of upper limb injuries is higher than that of lower limb injuries and non-respiratory illnesses are more common. INTRODUCTION Participation in elite sporting competition for ath- letes with a disability has seen significant growth in recent years. Indeed, involvement by athletes in the London 2012 Paralympic Games included a record number of participants with respect to both coun- tries and athletes. There are relatively a few epi- demiological studies relating to the monitoring of injury and illness in this population of athletes. Thus, detailed understanding of patterns of illness and injury in this complex area of sport and exer- cise medicine remains poorly understood. 1–3 Injury and illness surveillance plays an integral role in the prevention of injury and the protection of athletes’ health. 4 5 In addition, it provides important information regarding the number, char- acteristics and aetiology of injury and illness and also provides an opportunity for monitoring long- term changes in their occurrence, thus allowing for the planning of interventions. 67 While the incidence and characteristics of injuries during able-bodied international sporting tourna- ments including the Summer 8 and Winter 9 10 Olympic Games, swimming, 11 Track and Field World Championships 12 13 and football 5 14 15 and Rugby Union events, 16 17 have been well documen- ted. There are a few epidemiological studies docu- menting injury at the Paralympic Games. 1 2 Webborn et al, 1 2 undertook injury surveillance studies at three consecutive editions of the Paralympic Winter Games and reported the inci- dence proportions (IP; percentage of athletes with injury) to be between 9% and 24% across all the winter sporting disciplines. Data from the Paralympic Summer Games have been mostly reported by team medical staff and have comprised the review of injuries from single countries. The IPs in these reports ranged from 56% to 110%, indi- cating that a number of athletes experienced mul- tiple injuries. 18–20 In comparison to injury, illness in able-bodied athletes during major competition has been less commonly studied. IPs of illnesses range from 6.7 to 75% in single and multisport settings. 11 12 14 16 17 21 22 Illness epidemiology during the Paralympic Games has never been studied. Yet, research to date has been fraught with sig- nificant limitations including a lack of consensus regarding the definition of reportable injury, uncon- firmed medical diagnoses, lack of exposure data and small sample size. In particular the use of IP does not allow for comparison of injury and illness rates in competitions of different durations, and the use of incidence rates (IR; injuries/illnesses per exposure, eg, 1000 athlete-days) would be a prefer- able methodology. In an attempt to address the lack of data in Paralympic athletes and to address some of the Editor’s choice Scan to access more free content Derman W, et al. Br J Sports Med 2013;47:420–425. doi:10.1136/bjsports-2013-092375 1 of 7 Original article