Prevalence and incidence of injuries among female cricket players: a systematic review protocol : JBI Evidence Synthesis

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SYSTEMATIC REVIEW PROTOCOLS

Prevalence and incidence of injuries among female cricket players: a systematic review protocol

Jacobs, Jolandi1,2; Olivier, Benita1,2,3; Dawood, Muhammad1,4; Panagodage Perera, Nirmala Kanthi5,6,7,8

Author Information
JBI Evidence Synthesis 19(8):p 1977-1983, August 2021. | DOI: 10.11124/JBIES-20-00132
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Abstract

Introduction

Women have been playing cricket for more than 200 years. The first women's cricket match was played in 1745 in England.1 The Women's Cricket Association, founded in England on 4 October 1926, was the first international women's cricket body.2 Australia, New Zealand, and The Netherlands followed suit, establishing national women's cricket bodies. In 1973, the first women's Cricket World Cup was hosted in England.1,3 In February 1985, the International Women's Cricket Council was established, which then merged with the International Cricket Committee (ICC) in 2005, combining male and female cricket into one international organizing entity.4 The first women's Twenty20 match was held in 2004 between England and New Zealand.5 The first ICC World Twenty20 women's championship was held in conjunction with the men's tournament in England in 2009, bringing new excitement to the development of women's cricket.3,6

A new generation of young female players was inspired by the women's cricket success and increased visibility, increasing participation in countries such as India,7 the United Kingdom,8,9 Australia,10,11 and Bangladesh.12,13 Public interest in women's cricket grew, with more than 180 million spectators watching the 50-over One Day International Women's World Cup in 2017.1 The group stage of the 2020 ICC Women's Twenty20 World Cup became the most-watched women's cricket game, setting new broadcasting and streaming milestones.14 In August 2019, women's cricket was included in the 2022 Commonwealth Games, a first for women's cricket with a minimum of eight teams expected to participate.15

Engaging in team sports such as cricket contributes to the physical, psychological, and emotional well-being of individuals, regardless of their ability or level of participation. Further, at a population level, women's cricket has direct economic and educational benefits while contributing to social capital through resilience and connectivity to create stronger, cohesive communities. However, cricket participation carries a risk of injury. With an increase in the number of women playing cricket comes an increase in the risk of injury, which may adversely affect sport participation, preparation, and performance.16 Additionally, injuries can have a negative psychological impact as well as long-term health outcomes, such as early-onset osteoarthritis.

Many cricket injuries can be prevented. The first step of successful injury prevention is to identify the nature, risk factors, and etiology of injuries sustained by players.17 The international consensus statement on injury surveillance in cricket defines injury as an incident that either restricts a cricket player from being chosen for a match or prevents the player from engaging effectively in batting, bowling, or wicket keeping as required by the rules of the match or by the captain.18 Research on various sports have demonstrated contrasts in injury profiles between sexes. Muscle density and musculoskeletal kinematics vary between male and female players.6,19 Sex-specific differences in cricket include skill level, bowling pace, physical development, workloads, and the frequency of training and matches.20,21 Therefore, the existing evidence from male cricketers may not be directly extrapolated to female cricketers.9,16,22

A systematic review conducted by Perera et al.23 broadened the research field of female sport with similar injury potentials, and categorized them as team “bat-and-ball sports” (ie, baseball, cricket, field hockey, lacrosse, softball, T-ball). According to the International Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM), cricket can be listed as a team bat-and-ball sport.24 The authors reviewed a total of 27 studies; however, only two of these studies included female cricket players.25,26 In 2018, Munro et al.16 published a review on the existing literature of female cricket to identify research directions for the enhancement of female cricket. The narrative review of five papers was not subjected to the rigorous methodology associated with a systematic review, and no meta-analyses were performed. Because interest in female cricket research has expanded with a corresponding increase in published and unpublished literature on female cricket injuries, we found several articles not included in the previous reviews by Munro et al.16 and Perera et al.23 to justify a systematic review exclusively for female cricket.8-13

Epidemiological data obtained by injury surveillance systems are needed to provide a solid foundation for the successful prevention of injuries among female cricket players.9,10 However, despite the recent growth, an official injury surveillance system for women's cricket is lacking. Therefore, a systematic review to locate, appraise, and synthesize the existing evidence to obtain a comprehensive profile of injuries sustained by female cricket players is needed. Additionally, synthesizing evidence in a meaningful way can make this information more accessible to decision-makers and management staff of the relevant women's cricket bodies.

Understanding the incidence or prevalence of injuries can inform coaching and sport science staff to adjust current player conditioning strategies and workload management.11 Further, this data will inform the development of evidence-based targeted injury prevention strategies for women's cricket.16 Having a comprehensive understanding of the nature and type of injuries provides a clear framework for appropriately targeted and evidence-based screening and prevention strategies according to playing standard.23 Improved understanding of the nature of injuries can enable clinicians to provide medical services specific to female cricketers. Clinicians and other stakeholders may also use the findings to increase health literacy of female players to make them aware of the most common injuries.16

A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews, and the JBI Database of Systematic Reviews and Implementation Reports found no current or in-progress systematic reviews on the related research topic.

Review question

What are the prevalence and incidence of injuries sustained by female cricket players participating in cricket at recreational, school, club, and elite levels?

Inclusion criteria

Participants

Studies on injuries in female cricket players participating in recreational-, school-, club-, and elite-level cricket will be considered for inclusion. Based on the limited evidence available on female cricket, participants of all ages and races will be included in this study. Studies where data on female cricket players can be distinguished from male players will be included. Studies that contain data of only male cricket players will be excluded.

Condition

Studies that report on the injuries sustained by female cricket players from all levels of play and across all age groups will be considered. Therefore, injuries sustained playing recreational or competitive cricket that are self-reported or diagnosed by a health care professional will be included. Studies that use definitions of injury including, but not limited to, medical-attention injuries, general time-loss injuries, or player-reported injuries will be considered for inclusion in this review. As far possible, injuries will be described as match time-loss or non-time-loss injuries. The different injury definitions used by the various studies will be considered during the meta-analyses as well as in the narrative review.

The international consensus statement on injury surveillance in cricket defines “medical-attention injury” as any health-related condition that potentially affects the training or match-play of a player and requires medical attention.18 Medical-attention injuries include both time-loss and non-time-loss injuries. A “match time-loss injury” is defined as an occurrence that either prevents a cricket player from being fully accessible for match selection or during a match, rendering the player unable to bat, bowl, or keep wicket as necessary by either the rules or the captain of the team.18 The remaining medical-attention injuries can be considered as non-time-loss injuries. A “general time-loss injury” is any injury that results in a player being declared unfit for a match, regardless of whether the match or training was already planned. “Player-reported injury” is any injury that is reported by the player or individuals on the player's behalf without a medical diagnosis.18

Context

Literature on female cricket players from any country, regardless of cultural or sub-cultural factors or geographical locations, will be included. Injuries sustained by female cricket players participating in recreational or competitive school/junior, club, and elite cricket will be included.

Type of studies

Observational studies (prospective and retrospective longitudinal cohort studies) and cross-sectional studies will be included. This review will also consider experimental study designs, such as randomized controlled trials and pre-post intervention studies, which report on the prevalence and incidence of injuries sustained by female cricket players. Gray literature will also be included as it may contain epidemiological data for prevalence and incidence. Epidemiological data can be found in dissertations or theses, vital statistical data, health care records, government surveillance reports, disease associations, and medical books.27

Methods

This systematic review will be conducted in accordance with JBI methodology for systematic reviews of prevalence and incidence.27 This study was registered in PROSPERO (CRD42020166052).

Search strategy

A three-step search strategy will be conducted with an initial search in MEDLINE, followed by a second comprehensive search in all the databases. The lead author will trial the search strategy and refine it by adding or removing duplicate or inadequate search terms, and retesting as necessary to ensure that it is sufficiently sensitive to identify all relevant studies. The search strategy will be adapted for each database searched. Keywords will be searched in titles and abstracts, index terms, and, if possible, MeSH terms (see Appendix I for complete search strategy for MEDLINE via PubMed). A secondary search of the reference lists of the selected studies will be performed to identify any additional studies to be included in the review. All languages will be eligible for inclusion. If the searches return non-English studies, these studies will be translated for inclusion in the review.

The search strategy will attempt to find both published and unpublished studies. MEDLINE (PubMed), SPORTDiscus (EBSCO), Physiotherapy Evidence Database (PEDro), MasterFILE Premier (EBSCO), CINAHL Complete (EBSCO), Health and Medical Complete (ProQuest), Scopus (Elsevier), and ScienceDirect (Elsevier) databases will be systematically searched from inception to the present.

Additionally, Cochrane Central Register of Controlled Trials (CENTRAL) and ClincalTrials.gov will be searched. EBSCO MegaFile Premier (EBSCO), OpenGrey (SIGLE), WorldCat, Grey Matters, Grey Literature, and Google Scholar databases will be searched for unpublished studies and gray literature. Theses or dissertations that are found from the searches in gray literature databases will be included in the review. Further, known experts will be contacted to identify any additional publications.

Study selection

All citations will be compiled and uploaded to EndNote v.X9.3.3 (Clarivate Analytics, PA, USA), and duplicates will be deleted. Two independent reviewers will screen the titles and abstracts of the studies to select studies for full-text review. Two reviewers will independently evaluate the full text of the references selected against the pre-determined inclusion criteria. Potentially relevant studies and their citation information will be incorporated into the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI; JBI, Adelaide, Australia). Reasons for excluding full-text studies that do not meet the inclusion criteria will be described and reported in the systematic review. Any disputes that might occur at any point in the study selection process between the two reviewers will be resolved by discussion or with a third reviewer. In the final systematic review, the search results will be reported in detail and summarized in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.28

Assessment of methodological quality

The eligible studies that meet the inclusion criteria will be objectively evaluated by two independent reviewers using the standardized critical appraisal instruments for prevalence studies from JBI.27 For studies reporting incidence data, but not prevalence data, the instrument selected will be based on the specific study design of the paper. The authors of the studies will be contacted to request incomplete or additional data for clarification, if necessary. Any disputes that occur between the reviewers will be settled by a conversation or with a third reviewer. The results of the critical appraisal instrument will be described narratively and in a table. Studies will not be excluded based on the critical appraisal score. Studies with low methodological rigor, accounting for a score of less than 50% as measured by the critical appraisal instrument, will be described in narrative form and omitted from the meta-analysis.

Data extraction

Data will be extracted from studies included in the review by two independent reviewers using the standardized data extraction instrument from JBI.27 The data to be extracted will include descriptions of the prevalence and incidence, the role of cricket in the injury, the injured regions of the body, the research methods, the geographical location, and other aspects of interest applicable to the review question. The two trained JBI reviewers will do independent data extraction, and cross-checking of results will be implemented to ensure consistency and minimizing errors during the extraction process. Where applicable, the authors of papers will be contacted to request missing information or supplementary details for clarification. Any disagreements that arise during the data extraction will be addressed by discussion between the two reviewers or with a third reviewer.

Data synthesis

JBI SUMARI will be used to manage data and assist with meta-analysis. Meta-analysis will be carried out if the studies are sufficiently close (homogeneity) to combine. Where sufficient data are available, subgroup analyses by body region (eg, shoulder, lower back), playing level (eg, school, club, elite), and cricket role (eg, batting, bowling) will be conducted. Because female cricket players of all ages will be included, the data will be pooled into subgroups to compare similarities and disparities across age groups. Effect sizes will be expressed around the summary estimate as a proportion with 95% confidence intervals. The random-effects model will include within-study as well as between-study variability. Results will be presented graphically using forest or funnel plots to analyze the publication bias and systematic heterogeneity of the included studies.

Findings will be tested for heterogeneity by the I2, χ2 (P > 0.05), or Cochran's Q tests. Tests of heterogeneity will determine if variations in prevalence and incidence estimates across studies are greater than would be expected by chance. Match injury incidence will be presented as injuries per player or team days of play. Seasonal injury incidence will be presented as injuries per player per year. Injury prevalence will be presented as a percentage of players injured. Injury prevalence will be calculated, where possible, as match day injuries.14 Time-loss injuries, non-time-loss injuries, and medical-attention injuries will be presented. Statistical analysis to compare the level of evidence between published and unpublished studies will be included in the data syntheses.

Effect size and standard error squared (SE2) will be used to perform the meta-analyses. The effect size will change depending on the design of the studies pooled. Three types of meta-analyses will be conducted if sufficient data are available. The first meta-analysis will pool studies that report sufficient results (number of injuries and number of participants) to calculate the injury incidence as a numerical total for all the injuries sustained. The second meta-analysis will pool studies that calculate the injury rate and present the result as injuries per 1000 team-days of play per 100 players per year of all the injuries sustained. The third meta-analysis will pool studies that report sufficient results (number of injuries and number of participants) to calculate the injury prevalence as a percentage of players injured or missing matches. Where statistical pooling is not possible, the results will be presented in a narrative form. Narrative summary will contain tables and figures to aid the presentation of data.

Appendix I: Search strategy

Keywords

figure1

Where possible, terms were searched for in MeSH as well as all text words.

Where possible “humans”[Filter] will be applied.

MEDLINE via PubMed

Search conducted on 2020/04/06

(((((female[MeSH Terms]) OR women[MeSH Terms])) AND cricket sport[MeSH Terms]) AND (((wounds and injuries[MeSH Terms])) OR pain[MeSH Terms]))) OR ((((((((female[Text Word]) OR women[Text Word]) OR woman[Text Word]) OR lad[Text Word]) AND cricket[Text Word]) AND (((injur[Text Word]) OR pain[Text Word]) OR wound[Text Word])) AND “humans”[Filter]) OR ((((((female[Text Word]) OR women[MeSH Terms])) AND cricket sport[MeSH Terms]) AND (((wounds and injuries[MeSH Terms])) OR pain[MeSH Terms]))) OR ((((((((female[Text Word]) OR women[Text Word]) OR woman[Text Word]) OR lad[Text Word])) AND cricket[Text Word]) AND (((injur[Text Word]) OR pain[Text Word]) OR wound[Text Word])) AND “humans”[Filter]))

Records retrieved: 68

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Keywords:

girl; injury; sport; women; woman

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