Distinguishing between causal and non-causal associations: implications for sports medicine clinicians

Stovitz, Steven D.; Verhagen, Evert; Shrier, Ian

doi:10.1136/bjsports-2017-098520

Cited by 28 publications

(24 citation statements)

References 7 publications

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“…In the presence of only cross-sectional data and an absence of key known confounding variables, the conclusion “ For prevention and therapy, specific sensorimotor exercises addressing the transverse trunk muscles with e.g., 3-dimensional loading situations might be beneficial” (Mueller et al, 2017 ) is speculative. While cross-sectional data are useful in identifying associations, inferences regarding causality should not be made from these study designs (Stovitz et al, 2017 ). The mere presence of two findings at the same time does not mean they are related.…”

Section: How Should Results From Cross-sectional Designs Be Interpretmentioning

confidence: 99%

Commentary: Trunk Muscle Activity during Drop Jump Performance in Adolescent Athletes with Back Pain

et al. 2018

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Section: How Should Results From Cross-sectional Designs Be Interpretmentioning

confidence: 99%

Commentary: Trunk Muscle Activity during Drop Jump Performance in Adolescent Athletes with Back Pain

et al. 2018

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“…Taking into account confounders need to be done with caution, as some variables serve as mediators. Therefore, researchers should visualise the causal assumptions in a directed acyclic graph (DAG) or in a framework 38. The question remains—Have sports medicine/injury researchers adopted this train-of-thought regarding the alignment between DAGs/frameworks and causal interpretations, which has been well known in epidemiology for decades?39 40 If not, the first step for sports medicine and sports injury researchers is to use DAGs or frameworks prior to using PAF, as the PAF becomes meaningless if causal assumptions are violated.…”

Section: Part 3: Critical Discussion Of the Assumptions Underpinning mentioning

confidence: 99%

Methods matter: population attributable fraction (PAF) in sport and exercise medicine

2020

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“…When designing a sports injury research study, researchers must be explicit about the goal of the research 17. If the goal is causal inference, researchers need to clearly explain their causal assumptions18 and proceed to ask a research question that can provide direct answers to guide injury prevention activities. which is focused on either a population or individual/subgroup level 4.…”

Section: Discussionmentioning

confidence: 99%

“…We emphasise that it is not wrong to examine average/direct/indirect/total causal effects in sports injury research (eg, questions 1 and 2 in table 1) if the goal is population-based prevention. In this case, the sports injury researcher is encouraged (if not required) to disclose their causal assumptions prior to any analyses 18–20…”

Section: Discussionmentioning

confidence: 99%

Methods matter: exploring the ‘too much, too soon’ theory, part 1: causal questions in sports injury research

et al. 2020

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BackgroundIt is widely accepted that athletes sustain sports injury if they train ‘too much, too soon’. However, not all athletes are built the same; some can tolerate more training than others. It is for this reason that prescribing the same training programme to all athletes to reduce injury risk is not optimal from a coaching perspective. Rather, athletes require individualised training plans. In acknowledgement of athlete diversity, it is therefore essential to ask the right causal research question in studies examining sports injury aetiology.PurposeIn this first part of a British Journal of Sports Medicine educational series, we present four different causal research questions related to the ‘too much, too soon’ theory and critically discuss their relevance to sports injury prevention.ContentIf it is true that there is no ‘one size ﬁts all’ training programme, then we need to consider by how much training can vary depending on individual athlete characteristics. To provide an evidence-base for subgroup-specific recommendations, a stronger emphasis on the following questions is needed: (1) How much training is ‘too much’ before athletes with different characteristics sustain sports-related injury? and (2) Does the risk of sports injury differ among athletes with a certain characteristic (eg, high experience) compared with athletes with other characteristics (eg, low experience) depending on how much training they perform?ConclusionWe recommend that sports injury researchers aiming to examine the ‘too much, too soon’ theory should carefully consider how they, assisted by coaches, athletes and clinicians, pose their causal research question. In the light of the limitations of population-based prevention that intends to provide all athletes with the same advice, we argue that a stronger emphasis on research questions targeting subgroups of athletes is needed. In doing so, researchers may assist athletes, clinicians and coaches to understand what training advice/programme works best, for whom and under what circumstances.

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Distinguishing between causal and non-causal associations: implications for sports medicine clinicians

Cited by 28 publications

References 7 publications

Commentary: Trunk Muscle Activity during Drop Jump Performance in Adolescent Athletes with Back Pain

Commentary: Trunk Muscle Activity during Drop Jump Performance in Adolescent Athletes with Back Pain

Methods matter: population attributable fraction (PAF) in sport and exercise medicine

Methods matter: exploring the ‘too much, too soon’ theory, part 1: causal questions in sports injury research

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