title: Health and Economic Burden of Running-Related Injuries in Dutch Trailrunners: A Prospective Cohort Study.
abstract: BACKGROUND
  Trailrunning is becoming very popular. However, the risk and burden of running-related injuries (RRI) in trailrunning is not well established.
  
  
  OBJECTIVE
  To investigate the prevalence, injury rate, severity, nature, and economic burden of RRIs in Dutch trailrunners.
  
  
  METHODS
  This prospective cohort study included 228 trailrunners aged 18 years or over (range 23-67), and was conducted between October 2013 and December 2014. After completing the baseline questionnaire, the Oslo Sports Trauma Research Center Questionnaire on Health Problems was administered every 2 weeks to collect data on RRIs. Participants who reported RRIs were asked about healthcare utilization (direct costs) and absenteeism from paid work (indirect costs). RRI was defined as disorders of the musculoskeletal system or concussions experienced or sustained during participation in running.
  
  
  RESULTS
  The mean prevalence of RRIs measured over time was 22.4 % [95 % confidence interval (CI) 20.9-24.0], and the injury rate was 10.7 RRIs per 1000 h of running (95 % CI 9.4-12.1). The prevalence was higher for overuse (17.7 %; 95 % CI 15.9-19.5) than for acute (4.1 %; 95 % CI 3.3-5.0) RRIs. Also, the injury rate was higher for overuse (8.1; 95 % CI 6.9-9.3) than for acute (2.7; 95 % CI 2.0-3.4) RRIs. The median of the severity score was 35.0 [25-75 %, interquartile range (IQR) 22.0-55.7], and the median of the duration of RRIs was 2.0 weeks (IQR 2.0-6.0) during the study. The total economic burden of RRIs was estimated at €172.22 (95 % CI 117.10-271.74) per RRI, and €1849.49 (95 % CI 1180.62-3058.91) per 1000 h of running. An RRI was estimated to have a direct cost of €60.92 (95 % CI 45.11-94.90) and an indirect cost of €111.30 (95 % CI 61.02-192.75).
  
  
  CONCLUSIONS
  The health and economic burden of RRIs presented in this study are significant for trailrunners and for society. Therefore, efforts should be made in order to prevent RRIs in trailrunners.
authors.affiliation: Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health and the EMGO+ Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. l.hespanhol@outlook.com.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Hespanhol Junior
authors.affiliation: Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health and the EMGO+ Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.|School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia.|UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.|School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland.
authors.forename: Willem
authors.initials: W
authors.lastname: van Mechelen
authors.affiliation: Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health and the EMGO+ Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.|UCT/MRC Research Unit for Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.|Australian Centre for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat, VIC, Australia.
authors.forename: Evert
authors.initials: E
authors.lastname: Verhagen
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D001265:Athletic Injuries / Q000191:economics* / Q000453:epidemiology*; D017281:Cost of Illness; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012420:Running / Q000293:injuries*; D011795:Surveys and Questionnaires; D015599:Trauma Severity Indices; D055815:Young Adult