A CROSS-SECTIONAL STUDY ON ANKLE SPRAIN

AND RISK FACTORS IN UNIVERSITY STUDENTS

IN HONG KONG

KWOK CHING YEE

14686260

DR. GAO YANG GEMMA

25th

APRIL 2016

HONG KONG BAPTIST UNIVERSITY LIBRARY

Honours Project Release Form

Thesis Title: A Cross-Sectional Study on Ankle Sprain and Risk Factors in

University Students in Hong Kong

Author:

KWOK Ching Yee

Student No.:

14686260

Department:

Physical Education

Programme:

Bachelor of Social Sciences (Honours) in Sport and Recreation

Leadership

Declaration:

I agree that the full text of my thesis may be consulted by the HKBU community

users in print version in the Hong Kong Baptist University Library according to the

circulation regulations currently in force. All Rights are reserved and governed by the

Hong Kong Copyright Ordinance.

Signature of Author : _________________________ Date : 25th

April, 2016

HONG KONG BAPTIST UNIVERSITY

25th APRIL, 2016

We hereby recommend that the Independent Project by Ms. KWOK Ching Yee

entitled “A CROSS-SECTIONAL STUDY ON ANKLE SPRAIN AND RISK

FACTORS IN UNIVERSITY STUDENTS IN HONG KONG” be accepted in partial

fulfillment of the requirement for the Bachelor of Social Science (Honours) in Sport

and Recreation Leadership.

________________________________

DR. GAO Yang Gemma

Chief Advisor

DECLARATION

I hereby declare that this honours project “A CROSS-SECTIONAL STUDY ON

ANKLE SPRAIN AND RISK FACTORS IN UNIVERSITY STUDENTS IN HONG

KONG” represents my own work and had not been previously submitted to this or

other institution for a degree, diploma or other qualification. Citations from the other

authors were listed in the references.

______________________________

KWOK Ching Yee

25th APRIL, 2016

ACKNOWLEDGEMENTS

I would like to express my deepest gratitude to my supervisor, Dr. GAO Yang

Gemma for guiding and supporting me throughout the entire study. Also, Dr. GAO

was providing me valuable suggestions in my thesis. Last but not the least, I would

like to thank the participants. My project would have not been conducted smoothly

without their participations and supports.

_________________________

KWOK Ching Yee

Department of Physical Education

Hong Kong Baptist University

Date: _25th APRIL, 2016_

ABSTRACT

AIMS: This cross-sectional study aimed to preliminarily examine the incidence rate of

and risk factors for ankle sprain in university student in Hong Kong by using

convenience sampling.

METHODS: 150 university students in the Hong Kong Baptist University were

invited to participate into this study. Students reported on their socio-demographic

characteristics (e.g. gender, age), physical activity-related variable (e.g. frequency,

intensity) and PARI and ankle sprain occurrences in the past 12 months with a

self-administered questionnaire. A PARI was defined some type of acute disorder in a

bone, muscle, joint, or connective tissue that is attributable to physical activity or

exercise. An ankle sprain was defined that the ligaments of the ankle practically or

completely tear due to sudden stretch. IBM SPSS statistic 23 was used for data

analysis. The distribution of all variables was presented with percentages. Chi-square

was performed to test between group differences of categorical and continuous

variables respectively. A significant level of 0.05 (a = 0.05) and two- tailed tests would

be adopted.

RESULTS: A total of 150 students aged 18 or above years (63 males, 87 females)

were invited and all of them participated into the study, with a participation rate of

100.0%. The overall incidence rate of PARI and ankle sprain in the past 12 months

was 72.7% and 56.7%. Compared to their counterparts, participants being high

frequency of moderate-intensity and vigorous-intensity physical activity (74.5% vs.

35.0%, P = 0.001; 73.7% vs. 38.6%, P = 0.001) were more likely to suffer from AS. In

addition, students of relatively study in sport major were more likely to suffer from

AS than non-sport major students (72.0% vs. 41.3%, P < 0.001) and student being a

team member also higher risk of AS than non-team member (P < 0.001).

CONCLUSIONS: Ankle sprain is prevalent in university students in Hong Kong. The

year 3 students, study major in sport, be a sport team member, higher frequency of

moderate and vigorous level physical activity were the risk factors of ankle sprains.

Future research with a large-scaled random sample should be conducted to confirm

the findings. At the same time, effective intervention should be developed for

university student in Hong Kong.

Keywords: Ankle Sprain (AS); Socio-demographic Characteristics; Physical Activity

(PA); Body Weight Status; University Student; Hong Kong

TABLE OF CONTENTS

CHAPTER Page

1. INTRODUCTION…………………………………………………… 1

Epidemic of Ankle Sprain...…………………………………….. 1

Sports Participation in Hong Kong……………………………... 2

Study Aims and Objectives………………………..……………. 5

Significance of the Study……………………………………….. 6

Hypotheses……………………………………………………… 6

2. LITERTURE REVIEW………………………………………………. 8

Problem Size of Physical Activity Related Injuries……….……. 8

Negative Effect of Physical Activity Related Injuries………..… 10

Incidence Rate of Ankle Sprain…………………………………. 11

Risk Factors of Ankle Sprain……………………………………. 13

3. METHODS…………………………………………………………... 16

Subjects and Sampling…………………………………………... 16

Measurements…………………………………………………… 17

Data Collection Procedures……………………………………… 21

Data Analysis……………………………………………………. 22

Timeline of the Project…………………………………………... 23

4. RESULTS…………………………………………………………….. 24

Participants………………………………………………………. 24

Distribution of Variables………………………………………… 24

Incidence Rate of PARI and Ankle Sprain……………………… 27

The Characteristic of Latest Ankle Sprain Episodes…………….. 29

Socio-demographic Characteristics and Ankle Sprain………….. 35

Frequency and Intensity of Physical Activity and Ankle Sprain... 38

Body Weight Status and Ankle Sprain...………………………… 39

5. DISCUSSION AND CONCLUSIONS………………………………. 40

Summary of the Main Results…………………………………… 40

Incidence Rate of PARI and Ankle Sprain………………….…… 40

The Latest Ankle Sprain Episodes………………………………. 41

Socio-demographic Characteristics and Ankle Sprain………….. 44

Frequency and Intensity of Physical Activity and Ankle Sprain... 47

Body Weight Status and Ankle Sprain...………………………… 48

Advantage of the Study………………………………………….. 49

Limitations of the Study…………………………………………. 50

Future Research Perspectives……………………………………. 51

Conclusions……………………………………………………… 51

REFERENCES…………………………………………………………….. 52

APPENDICES……………………………………………………………… 61

A. Student Questionnaire………………………………………………… 61

B. Informed Consent Form………………………………………………. 62

LIST OF TABLES

TABLE Page

3.1 Definition and Example of Moderate-Intensity and

Vigorous-Intensity PA by WHO………..………………………...

19

3.2 Timeline of the Project.………………………………………..… 23

4.1 Distribution of Socio-demographic Information, Physical

Activity-related Variable and Body Weight Status of the

Participants…….............................................................................

26

4.2 Distribution of Height, Weight and Body Weight Status of the

Participants……………………………………………………….

27

4.3 Distribution of the participant’s PARI and Ankle Sprain in the

Past 12 Months…………………………………………………...

28

4.4 Distribution of the times of experienced PARI and Ankle Sprain

in the Past 12 Months…………………………………………….

28

4.5 Distribution of Consequences of the Latest Ankle Sprain

Episodes………………………………………………………….

30

4.6 Distribution of Place and Type of Site when the Latest Ankle

Sprain Episodes Occurred…….………………………………….

31

4.7 Distribution of Sports Stage in which the Latest Ankle Sprain

Episodes Occurred………………………………………………..

33

4.8 Distribution of the Clinical Characters of the Latest Ankle Sprain

Episodes…………………………………………………………..

35

4.9 Ankle Sprain Occurrences in the Past 12 Months by

Socio-demographic Characteristics……………………………....

37

4.10 Distribution of Sport Team Member and PA-related Variables by

Study Major……..……………………………………………….

38

4.11 Ankle Sprain Occurrences in the Past 12 Months by PA-related

Variables………………………………………………………….

39

4.12 Ankle Sprain Occurrences in the Past 12 Months by Body

Weight Status……………………………………………………..

39

LIST OF FIGURES

FIGURE Page

4.1 Distribution of Type of Sports when the Latest Ankle Sprain

Episodes Occurred………………………………………………..

32

4.2 Distribution of the Highest Performance Level of Sport when the

Latest Ankle Sprain Episodes Occurred………………………….

32

4.3 Distribution of the Reason Leading to the Latest Ankle Sprain

Episodes…………………………………………………………..

33

1

Chapter 1

INTRODUCTION

Epidemic of Ankle Sprain

Injury is defined as the physical damage that results in when a human body is

suddenly subjected to energy in amounts that exceed the threshold of physiological

tolerance or the result of a lack of one or more vital elements such as oxygen. The

energy in question can be mechanical, thermal, chemical or radiated (WHO, 2008).

Physical activity related injuries (PARI) can affect bones or soft tissues (such as

ligaments, muscles, and tendons). In United States, there are nearly 2,000,000 injuries

occurring every year in organized high school activities (Nelson et al., 2007).

Ankle is one of the most commonly reported body sites of PARI. One of the

primary functions of the ankle is to absorb energy when landing, and therefore it is

very easy to be injured in many types of sports. Ankle injuries include ankle fracture,

ankle sprain, Achilles tendinitis, Bone Spurs on the Ankle, etc., with ankle sprain

ranking the number one (Gotlin, 2008). According to previous studies, the most

commonly injured areas of the body included the ankle and the knee (Adirim & Cheng,

2003). A recent study on sports injury among basketball players indicated that the

most common injury site was the knee, followed by the ankle (Ito et al., 2015). An

article reviewed epidemiological studies on sports injury published from 1977 to 2005

2

and results showed that a total of 227 studies were conducted on injury patterns in 70

different sports from 38 countries. There were totally 201,600 patients, of whom

32,509 had ankle injuries. The ankle was the most commonly injured body site in 24

out of the 70 sports, especially indoor volleyball, netball and wall climbing (Fong et

al., 2007). In United States, more than 30 million athletes participated in sports each

year. The most common type of sport-related injuries was sprains especially ankle

sprains (Nelson et al., 2007). Also, ankle sprain was the major type of ankle injury in

33 out of 43 sports, especially in handball, orienteering, scooter and squash (Fong et

al., 2007). In United Kingdom, ankle sprains occurred in people approximately 5,600

times per day (Doherty et al., 2013). However, there is not much research on ankle

sprain in Hong Kong.

Sports Participation in Hong Kong

In Hong Kong, the Leisure and Cultural Services Department, cooperated with

Department of Health, initiated a program called “Healthy Exercise for All Campaign”

since 2000. It encourages the general public to participate regularly in sports and

physical activities, interest in sports and understand the health benefits of exercise

(Leisure and Cultural Services Department of Hong Kong, 2015). Since 2007, the

Sports Commission has organized the biennial Hong Kong Games in order to promote

3

“Sport for All” culture (Sports Commission of Hong Kong, 2014). In addition, data

from the Leisure and Cultural Services Department of Hong Kong annual report in

2007-2008 shows that the usage rate of Recreational and Sports Facilities is 76.8%,

which increases to 80.75% in 2013-2014. The results show that the Hong Kong people

are increasing the use of sport activities (Leisure and Cultural Services Department of

Hong Kong, 2008; Leisure and Cultural Services Department of Hong Kong, 2014).

For the Hong Kong Education System, all primary and secondary schools are required

physical education lessons and to allocate not less than 5% of total school hours

(Legislative Council, 2011).

Compared with primary and secondary schools, universities in Hong Kong are

not required to have physical education lessons. The universities can have their own

rights to establish physical education lesson. Hong Kong Baptist University (HKBU)

and The Chinese University of Hong Kong (CUHK) have regular physical education,

which are different with other universities. Students in HKBU and CUHK therefore

have more opportunities to participate in physical activity regularly. In recent years,

sports in universities become famous. In 2009, Hannah Jane Arnett Wilson, who is an

athlete in Hong Kong Swimming Team, won two XXV Summer Universiade gold

medals. This can promote sport in University. In 2011-2012, The University Sports

Federation of Hong Kong developed the sport competition that got the funded about

4

$1.35 million by the Leisure and Cultural Services Department of Hong Kong

(Legislative Council, 2011). In addition, university basketball teams only have two

competitions (Ball Game Competition of The University Sports Federation of Hong

Kong and Jackie Chan Challenge Cup) generally. In the 2014-2015, two commercial

organizations organized two more competitions for university basketball teams

(Jordan Brand Invitation Cup and AXA League). Also, those competitions invited

students of different universities, which increased the chances to promote sports. On

the other hand, all universities have inter-school competitions such as dodgeball,

badminton, football. All universities have opportunities to join the different sport

events. According to the report of Commission on Youth in 2011, youth aged 18-24

did exercise at least 1 times per week during work or spare time. Comparative data

between 2008 and 2009 revealed that youth who did exercise at least 4 times per week

increased from 10.8% to 14.4%, while those exercising 1-3 times per week increased

from 45.1% to 49.0% (Commission on Youth, 2011). The results indicated that sports

in local universities became more popular.

In summary, participations in any physical activity carry an inherent risk of injury.

As more university students participate in physical activity, the incidence rate of PARI

especially ankle sprain is also expected to increase. It is of essential importance to

conduct a study to understand the epidemic of ankle sprains and identify its risk

5

factors among them. Results from such a study can also help develop the effective

preventive measures.

Study Aims and Objectives

This study aimed to examine the incidence rate of ankle sprains and identify its

risk factors among university students in Hong Kong. Specifically, the objectives of

this study were:

(1) To investigate the overall incidence rate of PARI and ankle sprains among a

sample of university students in Hong Kong;

(2) To investigate characteristics of the latest ankle sprain episode among a

sample of university students in Hong Kong;

(3) To compare difference of ankle sprains by socio-demographic characteristics,

including gender, age, studying year, study major and team level in past 12

month;

(4) To compare difference of ankle sprains by frequency of physical activity,

including moderate level and vigorous level; and,

(5) To compare difference of ankle sprains by body weight status.

6

Significance of the Study

Ankle sprain is the most common PARI in the world. Injury may be the biggest

adverse effect from doing exercise. For example, affect the quality of training and

performance or may decrease the motivation of playing sport. Moreover, there are

many studies focusing on athletes and children, little research was conducted among

university students. There is a knowledge gap about the frequency and characteristics

of ankle sprains in local university students. This study provided preliminary

information about the incidence rate of PARI and ankle sprain among university

students in Hong Kong. In addition, the proposed study examined the relationship

between ankle sprain and socio-demographic characteristics, frequency of physical

activity and body weight status, which would help develop effective methods to

reduce ankle sprain among university student in Hong Kong in future.

Hypotheses

The hypotheses of this study were:

Hypothesis 1: There would be no association between ankle sprain and

socio-demographic characteristics in University students in Hong Kong;

Hypothesis 2: There would be no association between ankle sprain and frequency

of physical activity in University students in Hong Kong;

7

Hypothesis 3: There would be no association between ankle sprain and body

weight status in University students in Hong Kong

8

Chapter 2

LITERATURE REVIEW

This chapter presents the current situation of ankle sprains among university

students locally and internationally and reviews potential risk factors of ankle sprains

suggested by existing literature. In addition, knowledge gaps in ankle sprains and

future research directions were also discussed in this chapter.

Problem Size of Physical Activity Related Injuries

In recent years, sports participations have developed rapidly. For elite sports,

participation rates have increased in different competitions such as Olympic Game.

Also, the International University Sports Federation (FISU) organized the elite’s sport

competitions for university students from different countries. Like a small-sized

“Olympic Game”, the Universiade has been held every two years in different cities.

According to the yearbook of FISU, the number of participating athletes and countries

has increased from 7,805 and 131 in the 2005 Izmir Summer Uniersiade to 11,785 and

159 in the 2013 Kazan Summer Uniersiade (International University Sports

Federation, 2014). The number of athletes join the Winter Uniersiade have also

increased from 2,223 in 2005 Innsbruck Winter Uniersiade to 2,668 in 2013 Trentino

Winter Uniersiade (International University Sports Federation, 2014). In additional,

9

the FISU has organized other important sport events, such as the World University

Championships. There were total 28 events held between March and December in

2014 and had 6,448 participants (International University Sports Federation, 2014). In

Hong Kong, the University Sports Federation of Hong Kong provided 16 sport events

for the athletes from different university sport teams (University Sports Federation of

Hong Kong, 2010). It provided a platform for university athletes to compete.

Apart from the elite sports, data from the Leisure and Cultural Services

Department of Hong Kong annual report in 2007-2008 showed that the usage rate of

Recreational and Sports Facilities was 76.8%, which increased to 80.75% in

2013-2014. The results showed that the participation of sport activities of Hong Kong

people was increasing (Leisure and Cultural Services Department of Hong Kong,

2008; Leisure and Cultural Services Department of Hong Kong, 2014). The Sports

Federation and Olympic Committee of Hong Kong, China (SF&OC) encouraged

every citizen to engage in daily participations in physical activities for at least 30

minutes (Sports Federation and Olympic Committee of Hong Kong, China, n.d.).

Community Sports Club (CSC) Project was a program to promote the sports to citizen

in 18 districts. A total of 29 National Sports Association and around 430 Community

Sports Clubs have joined the CSC Project. There were 2,300 CSC programs organized

for about 50,000 participants in 2013-14. (Leisure and Cultural Services Department

10

of Hong Kong, n.d.). As a result, participation rate among local population has been

increasing in recent years.

Negative Effect of Physical Activity Related Injuries

Despite the health benefits related with people sport participation, the rate of

injury is also increased and become common. PARI is a general concern among

professional and recreational athletes. The research indicated that the number of

sport-related injuries in the United States may be as high as 7 million per year (Tripp

et al., 2007). The main point was PARI would bring negative effect to the participants.

For elite athletes, injury would affect their practice and performance. In Ibadan, 43

hockey players had injury and repaired from 2001 to 2008. 80% of players would

return to play 2 or more full seasons. However, those players had statistically

significant decreased in games played, goal scored, and assists (Jakoi et al., 2013).

Also, a research indicated that injuries had a significant influence on performance of

male professional football players in the league play (Hägglund et al., 2013). It

provided PARI can affect the performance directly. Also, there are other negative

effects such as psychological problem. For example, an injured athlete tended to have

fears, anxieties or anger about being reinjured (Ogu & Adegbesan, 2013; Tripp et al.,

2007). This is a negative emotion of the athlete and they may loss the interest or fear

11

to join sport activities again. Also, ankle sprain were associated with significant

treatment costs such as doctor fee. Then, it may lead to participation loss and

long-term negative side effects (O’Brien & Finch, 2014).

For non-athletes, the current PARI may be become a barrier to being more

physically active (Siesmaa et al., 2010). Since the participants become physically

inactive, they may suffer from health problems easily such as overweight. Also, an

early sport-related injury can damage physical and mental health (Maas et al., 2009).

On the other hand, physical activity was especially important for the children and

adolescence. It determined an individual’s engagement with sport in later life

(Brühmann & Schneider, 2011). Therefore, people should prevent children and

adolescence from getting PARI in their early life. It can reduce the negative effects on

the motivation and remain physically active.

Incidence Rate of Ankle Sprain

Ankle sprains are the most common type of ankle injuries when playing sports.

Ankle sprain is a common musculoskeletal injury that the ligaments of the ankle

practically or completely tear due to sudden stretching. Ankle sprain are caused by

severe medial (e.g. supination or inversion) and lateral (e.g. pronation or eversion)

rotation motions. It is includes inversion and eversion sprain. The definition of

12

inversion sprain is the excessive supination of the foot such as adduction or plantar

flexion that results when the planter aspect of the foot is turned inward, toward the

midline of the body. The definition of eversion sprain is the excessive pronation such

as abduction, eversion or dorsiflexion that results when the plantar aspect of the foot is

turned laterally (Anderson et al., 2009). Many researches have provided data about the

relationship between sport participation and sport-related injury especially ankle

sprain. A total of 423,581 service members made ambulatory visits for ankle sprains

from 1998 to 2006. Overall, the incidence rate for ankle sprains among active-duty

United States service members was 34.95 per 1,000 person-years (Cameron et al.,

2010). For the world wide, there were approximately 1 ankle sprain occurs per 10,000

person-days. In the United States alone, it was estimated about 2 million acute ankle

sprains occur each year (Waterman, 2010). The study had a sample of 14,098 patients

who got injured during playing sports. And among them, 11,847 patients experienced

ankle sprains (Fong et al., 2007). In United Kingdom, ankle sprains occurred in people

approximately 5,600 times per day (Doherty et al, 2013). In United States, more than

30 million athletes participated in sports each year. The most common type of

sport-related injuries was sprains especially ankle sprains (Nelson et al., 2007). In

Canada, 93% student participated in sports in 2008. The rate was 60.85% student

reporting at least one sport injury, 29.4% student for medically treated injuries, and

13

12.28% student for injuries presenting to a hospital emergency department. Also, the

ankles were the most frequently injured body parts and the common injury types were

ligament sprain (Emery & Tyreman, 2009). A study among volleyball players reported

that ankle sprains accounted for most of the acute injuries (Mechelen et al., 2004).

Therefore, the incidence rate of ankle sprain is higher.

Risk Factors of Ankle Sprain

Several factors could be related with ankle sprain in university students. They

can be divided into two parts - personal (intrinsic) and environment (extrinsic) factors.

For the part of personal reason, age and gender would be a risk factor. For example,

the common injury sites in different gender and age group. According to the research,

male aged 10-19years old and 30-39years old gets foot and ankle injury easier than

female. However, the foot and ankle injury rate of 20-29years old female was higher

than male. Ankle sprain was the highest that male is 58.0% and female is 64.4% (Ito et

al., 2015). The result of other research showed female basketball athletes had the

highest risk of getting ankle injury and the risk was significantly greater than male

basketball athletes (Beynnon et al, 2005). Overweight is another risk factor. A research

observed that there was apparent higher injury risk associated with overweight in male

athletes (McHugh et al., 2006). Tyler indicated that an overweight player who had a

14

previous ankle sprain was easier to get a noncontact ankle sprain than was a

normal-weight player with no previous ankle sprain (Tyler et al., 2006). Buist and

Bredeweg (2011) found that overweight novice runners are more prone to get running

related injury. Moreover, Body mass index was also a risk factor. The normal body

mass of people had lower incidence rate of injury than overweight (Tyler et al.,

2006).Also, the muscle strength is another other personal risk factor. The result of

research pointed out male subjects with less balance, decreased dorsiflexion muscle

strength, decreased dorsiflexion range of motion were at greater risk of ankle sprain

(Willems et al., 2005). Functional strength asymmetries of the ankle flexor were

related to the occurrence of ankle sprain (Fousekis et al., 2012).

For the part of environmental part, the physical activity level is another risk

factor. It is talk about the level of competition or level of sporting expertise. For

example, higher level of competition was risk factor for ankle sprain during athletics

(Waterman et al., 2011). Moreover, the different type of sports is critical. The greatest

proportion of injuries occurred in basketball (14%) and then was soccer (12%) (Emery

& Tyreman, 2009). It is because basketball is a contact sport. The incidence rate of

ankle sprains was higher and it was caused by landing on an opponent’s foot or

sudden change of direction (Cumps et al., 2007). Another common sport is volleyball

that played by approximately 200 million players worldwide. Volleyball is a

15

non-contact sport. However, volleyball needs rapid and forceful movements of the

body as a whole. The incidence of sport injury was 3.0 per 1000 hours (Mechelen et

al., 2004). Also, the other risk factor is concern about the different type of site. For the

playing surface, a research investigated about the incidence rate of rugby players. The

ankle injuries occurred on firm or hard playing surface in 60% and on slippery to

heavy grass in 40% (Sankey, 2008). Therefore, different sites may affect the incidence

rates of ankle sprain.

In summary, the information about the ankle sprain among university students in

Hong Kong is not enough and needs to be updated. Further research is needed to

investigate the incidence rates of PARI especially ankle sprain and its potential risk

factors, which is of essential importance for designing different competitions or sport

events and also a prerequisite for developing effective intervention programs against

ankle sprain among local university students in future.

16

Chapter 3

METHODS

The study was a cross-sectional study.

Subjects and Sampling

This study targeted university students in Hong Kong. Targeted students came

from the Hong Kong Baptist University (HKBU). Other universities in Hong Kong

were not included. The method of recruiting students was through face to face

distribution and completion of questionnaire. By using convenience sampling, this

research recruited 150 university students. Now, almost all of the university students

from year one were born between January to December in 1997. Since the data

collection started in January 2016, almost all year one students were 18 years old.

Only a few special cases in which students were under 18 years old. Therefore, the

target students were aged 18 or above. It is because the number of students who are

below 18 years old is few and that were not affect the representativeness of this

research. A written informed consent (Appendix A) obtained from the participants in

advance.

17

Measurements

A self-administered questionnaire, the Student Questionnaire (Appendix B), was

developed to collect information of the participants.

The student questionnaire focused on physical activity (PA) levels and physical

activity related injuries (PARI) especially ankle sprain (AS) occurrences of university

students. The questionnaire consist of three parts that includes personal information,

physical activity levels and physical activity related injuries. The design of questions

was concerned the questionnaire used in the Hong Kong “Injury survey 2008”

(Department of Health of Hong Kong, 2010).

In the first part, the questionnaire asks the participants to provide information

about their socio-demographic characteristics. Socio-demographic information

includes gender, age, birthday, height (cm), weight (kg), studying year (2015-2016

academic year) and study major. For the study major, the question asked the

participants “whether they study in the department of physical education programs”.

The programs of physical education department include ‘Associate of Science in Sport

and Recreation Studies’ (SRS), ‘B.Soc.Sc. (Hons) in Sport and Recreation Leadership’

(SRL) and ‘B.A. (Hons) in Physical Education and Recreation Management’ (PERM).

In the second part, it is about the physical activity levels of the university

students. The questionnaire requires student to answer whether they represent sport

18

team in the past 12 months including university team, district team, Hong Kong team

and other teams. In addition, frequency of physical activity and intensity of physical

activity were the independent variables for conducting the study. Also, the participant

indicated whether they did physical activities in the last week, answering questions

about the frequency of PA (including zero times per week, once per week, two times

per week, three times per week, four times per week and five times or above per week)

and intensity of PA (including moderate level and vigorous level). For clarifying the

definition of the above independent variables, the WHO defined about physical

activity, moderate level PA and vigorous level PA was provided to the subjects

answering the questionnaires. According to the WHO’s definition, physical activity is

defined as any bodily movement produced by skeletal muscles that require energy

expenditure. Regular moderate intensity physical activity – such as walking, cycling,

or participating in sports – has significant benefits for health. For the moderate level

PA, the WHO defined that moderate–intensity PA requires a moderate amount of

effort and noticeably accelerates the heart rate which includes approximately 3-6

metabolic equivalents (METs). The examples of moderate-intensity exercise include

brisk walking, dancing, gardening, housework, etc. For the vigorous level PA, the

WHO defined that vigorous-intensity PA requires a large amount of effort and causes

rapid breathing and a substantial increase in heart rate. The examples of

19

vigorous-intensity exercise include running, fast cycling, fast swimming, competitive

sports and games, etc. More examples of moderate- intensity and vigorous-intensity

PA were shown as Table 3.1 (WHO, 2015).

Table 3.1

Definition and Example of Moderate-Intensity and Vigorous-Intensity PA by WHO

Moderate-Intensity Physical Activity

(Approximately 3-6 METs)

Requires a moderate amount of effort and noticeably accelerates the heart rate.

Examples of moderate-intensity exercise include:

Brisk walking

Dancing

Gardening

Housework and domestic chores

Traditional hunting and gathering

Active involvement in games and sports with children / walking domestic

animals

General building tasks (e.g. roofing, thatching, painting)

Carrying / moving moderate loads (<20kg)

Vigorous-Intensity Physical Activity

(Approximately > 6 METs)

Requires a large amount of effort and causes rapid breathing and a substantial

increase in heart rate.

Examples of vigorous-intensity exercise include:

Running

Walking / climbing briskly up a hill

Fast cycling

Aerobics

Fast swimming

Competitive sports and games (e.g. Traditional Games, Football, Volleyball,

Hockey, Basketball)

Heavy shoveling or digging ditches

Carrying / moving heavy loads (>20kg)

20

The last part of questionnaire asked about the PARI and AS occurrences in the

past 12 months prior to the study. The injury rate was collected from the questionnaire

by using the two questions about the PARI and AS episode, regardless of its severity,

that occurred in the past 12 months when a student was doing any sports or

recreational activities. The definition about PARI and AS was provided to the subjects

answering the questionnaires. A physical activity related injury involves some type of

acute disorder in a bone, muscle, joint, or connective tissue that is attributable to

physical activity or exercise (Kohl & Murray, 2012). For the definition of AS, it is a

common musculoskeletal injury that the ligaments of the ankle practically or

completely tear due to sudden stretch. It is mainly separated into two groups that

include inversion and eversion sprain (Anderson et al., 2009). In addition, detailed

information was collected on the latest ankle sprain episodes, including consequences

(such as has to stop the PA, cannot participate in the next planned PA and/or absence

from school class, etc.), places, type of sites, type of sports and the highest

performance level of this sport, sports stage, reasons leading the AS and the clinical

characters (include feet, type of AS, level of AS. reoccurrence of previous of AS and

duration of recovery.)

Also, informed written consent form was attached to the questionnaire to inform

the participants about the purposes and nature of this research, the confidentiality and

21

their rights to withdraw.

Data Collection Procedures

There were two campuses to advance the data collection in HKBU that includes

Shek Mun and Kowloon Tong. An informed consent form (Appendix A), attached

with the questionnaire (Appendix B), was distributed to the 150 students of HKBU.

Firstly, the students signed the written informed consent forms and completed the

questionnaire immediately or at home. Secondly, the student submitted their complete

questionnaires to the researcher. For the other method, the researcher sent email to

different student unions. The email included informed consent forms and

questionnaires. The member of the student union distributed the questionnaires to the

students by email. The students printed the two attachments and signed the written

informed consent forms. Also, they completed the questionnaire immediately or at

home. Secondly, the students submitted their complete questionnaires to the member

of student union. Then, the researcher collected all the informed consent forms and the

questionnaire by face to face meeting the member of student union. Finally, the

researcher checked all answers once and confirmed that there is no missing value in

the completed questionnaire received.

22

Data Analysis

In this study, all data analysis were carried out using the IBM SPSS Statistic 23.

First, the original data from the questionnaires were regrouped into two or three

categories according to their distribution if there were four or more categories. The

distribution of all variables was presented with percentages. Also, Continuous

variables (include height, weight and body weight status) were presented with mean

and standard deviation (SD) values. Second, chi-square tests were performed to

examine whether there were significant differences in ankle sprain (occurred or not in

the past 12 months) in relations with socio-demographic characteristics, frequency and

intensity of physical activity and body weight status. The socio-demographic

characteristics included gender (male vs. female), age (18-21 vs. 22 or above),

studying year (1 vs. 2 vs. 3 vs. 4 or above), study major (sport vs. non-sport) and team

level in past 12 month (no vs. university team vs. district team vs. club vs. Hong Kong

team). For the physical activity, the intensity included moderate level and vigorous

level. The data of frequency of PA regroup to three categories (0 to 1 time per week vs.

2 to 3 times per week vs. 4 times or above). Also, the body weight status (kg/m2) was

separate to three groups that include underweight (BMI <18.5), normal weight (BMI

18.5 – 22.9) and overweight (BMI > 23.0). It is reference to the BMI for Asian

population charts. A significant level of 0.05 (a = 0.05) and two- tailed tests would be

23

adopted.

Timeline of the project

The project was conducted following the timeline below (Table 3.2):

Table 3.2

Timeline of the project

Time Completion of task

29 Sep,2015 – 12 Oct,2015 Writing up introduction

13 Oct,2015 – 9 Nov,2015 Literature Review

10 Nov,2015 – 6 Dec,2015 Writing up method and Develop questionnaire

25 Jan,2016 – 14 Feb,2016 Data collection

15 Feb,2016 – 7 Mar,2016 Entry Data and Data analysis

8 Mar,2016 – 21 Mar,2016 Writing up results

22 Mar.2016 – 11 Apr,2016 Writing up discussion and conclusions

24

Chapter 4

RESULTS

Participations

The focus of this study is on the university students of Hong Kong Baptist

University (HKBU). The major reason to focus the study on HKBU students is it is

difficult to find enough number of students to participate in the study at other

universities. A total of 150 university students in Hong Kong Baptist University were

invited and participated in the study, with a participation rate of 100.0%. This study

had 150 university student participants (63 males and 87 females, aged 18 or above

years old, from year one to year four, 75 sport major and 75 non-sport major).

Distribution of Variables

Table 4.1 presents the distribution of socio-demographic characteristics, physical

activity level, and body weight status of the participants. The socio-demographic

characteristics include gender, age, studying year, study major and team level in past

12 months of the participants. 58.0% of the participants were females. 58.0% of the

participants are aged 18-21 years old; the others were 22 or above. 15.3% were year

one students and 18.0% were year two students and half of the participants (50.0%)

study in year 4 or above; the others were year 3 students. For the studying program,

25

half of the participants major in sport department that includes SRS, SRL, PERM and

the others were non-sport major students. For the team level in past 12 months, most

of the participants (52.0%) did not join any sport teams; 17.3% of the participants

were university team representative; 12.7% were members of sport clubs and 13.3%

were members of Hong Kong Team; the others (4.7%) were district team members.

In this study, for the frequency of moderate level physical activity, 26.7% of the

participants were only doing 0 to 1 time of physical activity every week. 39.3% of the

participants were doing 2 to 3 times per week. The other were doing 4 times or above

per week. For the frequency of vigorous level physical activity, 57 participants (38.0%)

were doing 0 to 1 time of physical activity every week. 36.7% were doing 2 to 3 times

per week and 25.3% were doing 4 times or above per week.

For the body weight status, the participants BMI was calculated and were

classified into underweight, normal weight and overweight groups with reference to

the BMI for Asian population charts. 13.3% of the participants were classified as

underweight; 57.4% of the participants were classified as normal weight; the other

29.3% were classified as overweight.

26

Table 4.1

Distribution of Socio-demographic Information, Physical Activity-related Variable

and Body Weight Status of the Participants (N=150)

n %

Gender

Male 63 42.0

Female 87 58.0

Age

18 – 21 87 58.0

22 or above 63 42.0

Study Year (2015-2016)

1 23 15.3

2 27 18.0

3 25 16.7

4 or above 75 50.0

Study Major

Sport 75 50.0

Non-Sport 75 50.0

Team Level in past 12 months

No 78 52.0

University Team 26 17.3

District Team 7 4.7

Club 19 12.7

Hong Kong Team 20 13.3

Frequency of Moderate Level PA (time/week)

0 to 1 times 40 26.7

2 to 3 times 59 39.3

4 or above times 51 34.0

Frequency of Vigorous Level PA (time/week)

0 to 1 times 57 38.0

2 to 3 times 55 36.7

4 or above times 38 25.3

Body Weight Status

Underweight (BMI < 18.5) 20 13.3

Normal Weight (BMI 18.5 – 22.9) 86 57.4

Overweight + Obesity (BMI > 23.0) 44 29.3

27

Table 4.2 presents the mean and the standard deviation of height, weight and

body weight status of the participants. For the height, the mean is 166.9cm and

standard deviation is 7.8cm. For the weight, the mean is 61.9kg and standard deviation

is 13.7kg. For the body weight status, the mean is 22.1 kg/m2 and standard deviation is

3.9 kg/m2.

Table 4.2

Distribution of Height, Weight and Body Weight Status of the Participants (N=150)

Mean SD*

Height (cm) 166.9 7.8

Weight (kg) 61.9 13.7

Body Weight Status (kg/m2) 22.1 3.9

*SD: Standard Deviation

Incidence Rate of PARI and Ankle Sprain

Table 4.3 presents the distribution of the physical activity related injury and ankle

sprain in the past 12 months. There were 150 valid data (100.0%) which were further

analyzed to test the relationship between ankle sprain and socio-demographic

characteristics, physical activity level, type of sport, type of site and body weight

status. Of the 150 valid data, there were 109 participants (72.7%) who experienced

physical activity related injury; the other participants (27.3%) reported that they have

not experienced any injury during physical activities. For ankle sprain cases, 85

students (56.7%) suffered from at least one ankle sprain in the past 12 months, with an

incidence rate of physical activity related injury of 56.7%.

28

Table 4.3

Distribution of the Participants’ PARI and Ankle Sprain in the Past 12 Months

(N=150)

n %

PARI

No 41 27.3

Yes 109 72.7

Ankle Sprain

No 65 43.3

Yes 85 56.7

In this study, 109 participants experienced physical activity related injury in the

past 12 month. 74 participants experienced injury 1 to 4 times; 25 participants

experienced injury 5 to 9 times; and the others experienced 10 times or above. 85

participants reported that they suffered from ankle sprain in the past 12 months.

Among them, 67 participants experienced ankle sprain only once; 13 experienced

twice; and the others experienced three times or above (Table 4.4).

Table 4.4

Distribution of the Times of Experienced PARI and Ankle Sprain in the Past 12

Months

n %

PARI (N=109)

1 to 4 times 74 67.9

5 to 9 times 25 22.9

10 or above times 10 9.2

Ankle Sprain (N=85)

1 times 67 78.8

2 times 13 15.3

3 or above times 5 5.9

29

The Characteristic of Latest Ankle Sprain Episodes

For their latest ankle sprain episodes, most of the participants were unable to

participate in the next planned physical activity (54 participants) and had to

immediately stop the ongoing activities (56 participants) after the injury. 16

participants took leave of absence from school classes and 25 participants seek for

medical care by first-aid after experiencing ankle sprain. In addition, 35 students

reported that they received medical care in a non-accident and emergency department.

Also, 10 students reported that they visited accident and emergency (A&E)

department to seek medical care. Two participants stayed overnight in the hospital and

one participants received hospital treatment due to the injury (Table 4.5).

Table 4.6 presents the place and type of site where the ankle sprain occurred.

Most of the participants (72.9%) experienced the last episode ankle sprain in public

sport playground or court; 8.2% of injury occurred in school and 4.7% occurred in

mountain and road; 3.5% occurred in other places. Also, 5 participants reported that

they forgot where the last episode of ankle sprain occurred. For the type of site, 58.8%

of participants experienced ankle sprains indoor and 37.7% experienced it outdoors;

the others (3.5%) forgot where the ankle sprain occurred.

30

Table 4.5

Distribution of Consequences of the Latest Ankle Sprain Episodes (N=85)

n %

Stop the Ongoing Activities Immediately

No 29 34.1

Yes 56 65.9

Unable to Participate in the Next Planned Physical Activity

No 31 36.5

Yes 54 63.5

Absence from School Class

No 69 81.2

Yes 16 18.8

Medical Care by First-Aid

No 60 70.6

Yes 25 29.4

Medical Care in A&E Department

No 75 88.2

Yes 10 11.8

Medical Care in non-A&E Department

No 50 58.8

Yes 35 41.2

Stayed Overnight in Hospital

No 83 97.6

Yes 2 2.4

Receive Hospital Treatment

No 84 98.8

Yes 1 1.2

31

Table 4.6

Distribution of Place and Type of Site when the Latest Ankle Sprain Episodes

Occurred (N=85)

n %

Place

Public Sport Playground/Court 62 72.9

School 7 8.2

Mountain 4 4.7

Road 4 4.7

Other 3 3.5

Can’t Remember 5 5.9

Type of Site

Indoor 32 37.7

Outdoor 50 58.8

Can’t Remember 3 3.5

Figure 4.1 presents the distribution of type of sport when the last episode ankle

sprain occurred. 32.9% of the participants got the ankle sprain when playing

basketball; 11.8% of the participants were playing football; 8.2% of the participants

were playing volleyball and badminton and 7.1% of the participants were running; the

others were playing other type of sports.

Figure 4.2 presents the distribution of the highest performance level of sport

when the last episode ankle sprain occurred. Most of the participants (40.0%) were at

the leisure stage; 22.4% of the participants at the university team level and 14.1% of

the participants were at the Hong Kong team as well as the club level; the others were

at the district team level.

32

Figure 4.1

Distribution of Type of Sport when the Latest Ankle Sprain Episodes Occurred (N=85)

Figure 4.2

Distribution of the Highest Performance Level of Sport when the Latest Ankle Sprain

Episodes Occurred (N=85)

Table 4.7 presents the distribution of sports stage in which the latest ankle sprain

episodes occurred. 19 participants experienced ankle sprain in the leisure stage; 33

participants experienced ankle sprain in training and competition stage. Also, there no

participants reported that the ankle sprain occurred during warm up, cool down and

other stages.

Others

32%

Basketball

33%

Football

12%

Volleyball

8%

Badminton

8%

Running

7%

Type of Sports

Leisure

40%

University

Team

22%

Club

14%

Hong Kong

team

14%

District team

10%

The Highest Performance Level

33

Table 4.7

Distribution of Sports Stage in which the Latest Ankle Sprain Episodes Occurred

(N=85)

n %

Leisure 19 22.4

Training 33 38.8

Competition 33 38.8

Figure 4.3 presents the distribution of the reasons leading to the last episode

ankle sprain. 43.5% of the participants reported that the main reason was body contact

with another athlete; other reasons were hit by an object (17.6%) and falling (31.8%).

Also, 5.9% of the participants got the ankle sprain due to muscle overuse and 1.2% of

the participants reported other reason.

Figure 4.3

Distribution of the Reasons Leading to the Latest Ankle Sprain Episodes (N=85)

Hit with

Human

44%

Hit with

Object

18%

Fall

32%

Overuse

6%

Others

1%

Reasons

34

Table 4.8 presents the distribution of the clinical characters of the last episode

ankle sprain. Among 85 participants, 42 participants (49.4%) got the ankle sprain in

the left feet and the other 43 participants (50.6%) in the right feet. For the type of

ankle sprain, most cases were inversion ankle sprain, with 56 participants (65.9%). 27

participants (31.8%) reported that they have eversion ankle sprain and 2 participants

(2.3%) reported high ankle sprain. For the level of ankle sprain, 43 participants

(50.6%) experienced mild grade of ankle sprain; 32 participants (37.6%) experienced

moderate grade of ankle sprain; the others were severe grade (11.8%). Also, most of

the participants (69.4%) reported that they had no reoccurrence of previous ankle

sprain. For the duration of recovery, 32 participants recovered within 1 week after the

ankle sprain; 26 participants recovered after 2 to 3 week and 18 participants recovered

after 4 weeks or above; the other participants (10.6%) reported that they were not yet

recovered from the ankle sprain.

35

Table 4.8

Distribution of the Clinical Characters of the Latest Ankle Sprain Episodes (N=85)

n %

Feet

Left 42 49.4

Right 43 50.6

Type of Ankle Sprain

Inversion 56 65.9

Eversion 27 31.8

High 2 2.3

Level of Ankle Sprain

Mild 43 50.6

Moderate 32 37.6

Severe 10 11.8

Reoccurrence of Previous Ankle Sprain

Yes 26 30.6

No 59 69.4

Duration of Recovery

Within 1 week 32 37.6

2 to 3 week 26 30.6

4 week or above 18 21.2

Not yet 9 10.6

Socio-demographic Characteristics and Ankle Sprain

Table 4.9 compares ankle sprain occurrence in the past 12 months by

socio-demographic. There were differences in ankle sprain incidence rate, reaching

marginal significance (P<0.05), in terms of studying years (P=0.018). More Year 3

students (80.0%) suffered from ankle sprain than year one (43.5%), two (40.7%) and

four or above (58.7%) students. Also, students studying in sport major (SRS, SRL,

PERM) were significantly at higher risk for ankle sprain compared to those studying

36

in non-sport majors, with the incidence rate in the former being nearly double than

that of the latter (72.0% vs. 41.3%, P<0.001). Also, different team levels in past 12

month led to significant difference in ankle sprain incidence rate (P < 0.001). In

addition to, there were significant difference between team level in past 12 month and

ankle sprain rate (P < 0.001). There was more incidence of ankle sprain with

university team level (73.1%), district team level (85.7%), club level (84.2%) and

Hong Kong team level (80.0%); others who were not in any teams had a lower ankle

sprain incidence rate (35.9%). Other socio-demographic characteristics did not found

the significant difference. For example, ankle sprain incidence rate in student with

gender or age (P=0.443 or P=0.151).

This study reported that 77.8% of participant who was sport team member in past

12 months and also study in sport major in 2015-16 academic years; other participant

(24.4%) was not the member of sport team (Table 4.10). For the table 4.10, 58.8% of

students who doing moderate level physical activity 4 or above times per week and

they were studied in sport major in 2015-16 academic years; 57.6% of the student

study in sport major and doing moderate level physical activity 2 to 3 times per week;

27.5% of the student study in sport major and doing moderate level physical activity 0

to 1 times per week. For the frequency of vigorous level physical activity, it is similar

rate of the participants studying in sport major reported that they had doing vigorous

37

level physical activity 4 or above times per week (65.8%) and 2 to 3 times per week

(61.8). The other sport major students (28.1%) were doing 0 to 1 times per week.

Chi-square test indicated a P is 0.004 (moderate level) and P < 0.001 (vigorous level)

that there were significant different between three groups, suggesting that studying in

sport major being doing moderate and vigorous level physical activity more times per

week than the students studying in non-sport program.

Table 4.9

Ankle Sprain Occurrences in the Past 12 Months by Socio-Demographic

Characteristics

NO YES X² P

n % n %

Gender 0.590 0.443

Male 25 39.7 38 60.3

Female 40 46.0 47 54.0

Age 2.061 0.151

18 – 21 42 48.3 45 51.7

22 or above 23 36.5 40 63.5

Study Year (2015-2016) 10.083 0.018

1 13 56.5 10 43.5

2 16 59.3 11 40.7

3 5 20.0 20 80.0

4 or above 31 41.3 44 58.7

Study Major 14.362 <0.001

Sport (SRS, SRL, PERM) 21 28.0 54 72.0

Non-Sport 44 58.7 31 41.3

Team Level in past 12month

No 50 64.1 28 35.9 29.263 <0.001

University Team 7 26.9 19 73.1

District Team 1 14.3 6 85.7

Club 3 15.8 16 84.2

Hong Kong Team 4 20.0 16 80.0

38

Table 4.10

Distribution of Team Member and Physical Activity-related Variables by Study Major

Non-Sport Sport X² P

n % n %

Team Member in past 12 months

No 59 75.6 19 24.4 42.735 <0.001

Yes 16 22.2 56 77.8

Frequency of Moderate Level PA

(time/week)

0 to 1 times 29 72.5 11 27.5 11.061 0.004

2 to 3 times 25 42.4 34 57.6

4 or above times 21 41.2 30 58.8

Frequency of Vigorous Level PA

(time/week)

0 to 1 times 41 71.9 16 28.1 17.827 <0.001

2 to 3 times 21 38.2 34 61.8

4 or above times 13 34.2 25 65.8

Frequency of Physical Activity and Ankle Sprain

For the table 4.11, 74.5% of students who doing moderate level physical activity

4 or above times per week suffered from ankle sprain in past 12 months; 35.0% of the

incidence rate of ankle sprain in students doing moderate level physical activity 0 to 1

times per week; the other were 55.9%. For the frequency of vigorous level physical

activity, 73.7% of participants reported that they had doing vigorous level physical

activity; 63.6% were doing vigorous level physical activity 2 to 3 times per week and

the other were doing 0 to 1 times per week. Chi-square test indicated a P of 0.001 that

there were significant different between three groups, suggesting that being doing

moderate and vigorous level physical activity more times per week might increase the

39

risk of ankle sprain in Hong Kong University students.

Table 4.11

Ankle Sprain occurrence in the Past 12 Months by Moderate and Vigorous Physical

Activity Level

NO YES X² P

n % n %

Frequency of Moderate Level PA

(time/week) 14.272 0.001

0 to 1 times 26 65.0 14 35.0

2 to 3 times 26 44.1 33 55.9

4 or above times 13 25.5 38 74.5

Frequency of Vigorous Level PA

(time/week) 13.149 0.001

0 to 1 times 35 61.4 22 38.6

2 to 3 times 20 36.4 35 63.6

4 or above times 10 26.3 28 73.7

Body Weight Status and Ankle Sprain

For the body weight status, the incidence rate of ankle sprain in normal weight

students (63.6%) was higher than in students with underweight (40.0%) or overweight

(56.7%). However, chi-square test showed that there was non-significant difference

(P=0.208) between the group (Table 4.12).

Table 4.12

Ankle Sprain occurrence in the Past 12 Months by body weight status

NO YES X² P

n % n %

Body Weight 3.136 0.208

Underweight (BMI < 18.5) 12 60.0 8 40.0

Normal Weight (BMI 18.5 – 22.9) 37 43.0 49 63.6

Overweight + Obesity (BMI > 23.0) 16 36.4 28 56.7

40

Chapter 5

DISCUSSION AND CONCLUSIONS

Summary of the Main Results

In this study, 150 university students from Hong Kong Baptist University were

invited and participated with a participation rate of 100%. 109 students suffered from

PARI and 85 students suffered from ankle sprain in the past 12 months as responded

in the question. The incidence rate of ankle sprain during basketball activities was

32.9% (28/85). Hit with human was the main reason of the 43.5% participants got the

injury. Sixty-two participants reported that the ankle sprain occurred in public sport

playground or court. Also, 50 participants got the ankle sprain in the outdoor court.

Fifty-six victims needed to stop the ongoing activities immediately. Chi-square tests

revealed that university students who studied in sport major (SRS, SRL and PERM)

and did not join a sports team in the past 12 months were more likely to suffer from

ankle sprain. In addition, doing physically activities 4 or above times per week

included moderate and vigorous level were promising risk factors for ankle sprain,

with the tests reaching significance (P<0.05).

Incidence Rate of PARI and Ankle Sprain

The incidence rate of PARI for this study was 27.3%. The result of this study was

41

lower when compared with other study. For another study, it reported that the rate was

60.85% student reporting at least one physical activity related injury (Emery &

Tyreman, 2009). One of the reasons counting for the difference may be was the age

difference. It was because the age of the target group in the study of Emery and

Tyreman were from 12 to 15 years old. They were younger than this present study.

The incidence rate of ankle sprain for this study was 43.4%, appeared similar

findings to other earlier studies (41.0% in Mechelen et al. study in 2004 and 40.0% to

50.0% in Doherty et al. study in 2013). However, the result of other study was higher

than this present study. That study showed 84.0% of patients got ankle sprains during

playing sports (11,847/14,098) (Fong et al., 2007). The different in sample size could

be one of the reasons counting for the difference.

The Latest ankle Sprain Episodes

For the consequences, most of the participants stopped the ongoing activities and

unable to participate in the next planned physical activity when the injuries occurred.

There were 11.8% of students reported that they have visited accident and emergency

department to seek medical cares. It was similar to other study that 12.28% of students

presented to a hospital emergency department in Canada for injuries (Emery &

Tyreman, 2009).

42

For the place, the higher occurrence rate of ankle sprain was at public sport

playground or court in this study. According to the LCSD annual report, the usage rate

of recreational and sports facilities were increased in recent year that indicate the

incidence rate of PARI especially ankle sprain will increase too (Leisure and Cultural

Services Department of Hong Kong, 2008; Leisure and Cultural Services Department

of Hong Kong, 2014). For the type of site, this study reported that participants got

ankle sprains at outdoor courts more easily. Other study reported similar result that the

risk of injury was greater in outdoor compared with indoor (Emery, & Meeuwisse,

2006). Also, outdoor court may be effect by the weather. Therefore, outdoor court was

factor that increases the incidence rate of ankle sprain.

For the type of sports, most of the participants got the ankle sprains when they

were playing basketball. Then, the other types were football, volleyball and badminton.

There are similar studies reported the same result. Waterman et al. (2010) and

Waterman et al. (2011) showed that the intercollegiate sports of handball, basketball,

and football had the highest rates of ankle sprains. Also, a study reported that ankle

sprain was the most of acute injuries among volleyball players (Mechelen et al., 2004).

On the other hand, the major type of ankle injury among 33 different sports was ankle

sprain, especially significant in handball (Fong et al., 2007). Therefore, future study

can analyze the characteristics of theses sports and find the reasons for why these

43

players got ankle sprains easily.

For the sports stage, this study reported that the occurrence of ankle sprain was

higher in training and competition stages than leisure stage. The result was consistent

with other study. Sankey (2008) reported that ankle sprains were the most common

injury during matches and training. However, the other research had different results

between training and competition stages. It was the ankle sprain occurred at a

significantly higher rate during competition than during practice (Nelson et al., 2007).

In addition, the other study showed that the higher level of competition was a risk

factor for ankle sprain (Waterman et al., 2011).

For the reason leading to ankle sprain, the main reasons were hit with other

person during the physical activity and then it was the fall. The other study supported

this present result that the incidence rate of ankle sprains was caused by landing on an

opponent’s foot or sudden change of direction (Cumps et al., 2007). For example,

team sport had more opportunities to contact with opponents during competitions.

Then, the injuries would cause by other team member easily.

For the clinical characters, the left and right feet had similar incidence rate of

ankle sprain (49.4% vs. 50.6%). The most common type of ankle sprain in this study

was inversion ankle sprain. The other study had the same result that the inversion

sprain was the most common type of ankle sprain (Tyler et al., 2006). Among 85

44

participants who reported they got ankle sprain in the past 12 months, 50.6% was

suffered from mild grade injury and 37.6% was suffered from moderate grade injury.

Therefore, few participants got the severe grade of ankle sprain. The study showed

that the most common level of ankle sprain was mild grade (Tyler et al., 2006). It was

the same with this present study. As a result, most participants in this study used

within 1 week to recover the ankle sprain. It was because the duration of recovery of

mild grade ankle sprain is shorter when compared with moderate and severe grade. On

the other hand, this present study showed that 69.4% do not reoccurrence of previous

ankle sprain. It was different with other studies that injury incidence was higher with

previous ankle injuries (Tyler et al., 2006; McKay et al., 2001). The small sample size

and gender difference may affect the result. Future research need to examine the detail

and relationship between injury history and ankle sprain.

Socio-demographic Characteristics and Ankle Sprain

This study showed that males had higher incidence rate of ankle sprain (60.3%)

than the females (54.0%), though the difference did not achieve significance (P =

0.443). The gender difference was also suggested by other studies (Ito, 2015; Beynnon,

2005). However, a study reported that the incidence rate of ankle sprain was the

highest in both sex that male was 58.0% and female was 64.4% (Ito et al., 2015). It

45

was not similar with this present study. Also, these studies indicated that occurred

ankle injury rate of female were higher than males (Doherty et al., 2013; Beynnon et

al, 2005; Cameron et al., 2010; Waterman et al., 2010). It may effect by the sample

size was too small and the ratio of the participant’s gender was not equal in this study.

In the age of participants, the present study found the older students (aged 22 or

above) had a higher ankle sprain incidence rate (63.5%) than the younger students

(aged 18 to 21) (51.7%). The difference of this result was not significantly (P = 0.151).

Moreover, another study was suggesting that the risk for ankle sprain decreases along

increasing age of students. The study showed that children had higher incidence rate

of ankle sprain than adolescents and adolescents had higher incidence rate of ankle

sprain than adults (Doherty et al., 2013). It was different from the result of this study.

In additional, the range of age group in this present study was very small when

compared with other research. According to the other study, the range of age group

always had at least 10years in between such as 10-19years, 20-29years and 30-39years,

etc. (Ito et al., 2015). It was significant different between different 10 years age groups.

In this present study, the participants had similar age that the result had not significant

different.

For the study year at 2015 to 2016 academic years, result implied that year 3

university students (80.0%) had a higher risk for ankle sprain than the group of

46

participants whose studied in year1 (43.5%), year2 (40.7%) and year4 or above

(58.7%). This study reached statistical significances (P = 0.018). The year 3 students

were most got the ankle sprain that this finding was surprised. It may be the year 4

students did physical active cause they needed to finish their final year project. Also,

year 1 and 2 students did not familiar with the university life.

About the major of study, the participants whose studied in sport major (SRS,

SRL, PERM) program had a higher risk for ankle sprain than those who studied in

non-sport major (41.3%). There was significant relationship between study major and

ankle sprain (P < 0.001). There were no previous study about the relationship between

study major and ankle sprain. In this present study, the result showed that the students

studied in sport major also were sports team members in the past 12 months (77.8%)

and it was higher than non-sport major. The result was significantly different

(P<0.001). Also, the students of sport major were more actively participated in

moderate level and vigorous level of physical activity than non-sport major. This

study reached statistical significances (P = 0.004; P <0.001). As more students

participated in sport team and joined the physical activity actively, the incidence rate

of PARI especially ankle sprain was also expected to increase.

For the team level in past 12 month, participants whose did not join any team

(35.9%) showed a lower risk for ankle sprain in this study. Also, it had statistical

47

significance different (P<0.001). According to the study, it reported that athletes were

more common in getting ankle sprain than non-athlete (64.1%) (Waterman et al.,

2010). In addition, this study reported that the students studied in sport major were

also a team member in past 12 month (77.8%) and it is higher than non-sport major.

The result was significant difference (P<0.001). Also, study in sport major student was

easier to get the ankle sprain than non-sport major. Therefore, the members of sport

team had higher incidence risk of ankle sprain than participants whose do not join any

sport team. Other research can analyze which type of team had higher incidence rate

of ankle sprain in the future. It was because this present study did not focus on this

part and the sample size was needed to increase.

Frequency and Intensity of Physical Activity and Ankle Sprain

For the frequency of moderate level physical activity, results showed that

participants who were doing physical activity 4 or above times per week (74.5%) had

double risk for ankle sprain when compared with the group of participants doing 0 to

1 times per week (35.0%). Also, there were higher risks for ankle sprain than doing 2

to 3 times per week (55.9%). For the frequency of vigorous level physical activity,

results showed that participants who were doing physical activity 4 or above times per

week (73.7%) had higher risks for ankle sprain than doing 0 to 1 times (38.6%) and 2

48

to 3 times (63.6%) per week. It was consistent with other study, there was evidence to

support an increased risk of injury with greater exposures to sport such as times per

week (Emery & Tyreman, 2009). On the other hand, the participants did physical

activities 4 or above time per week, it was high frequency that indicated them may not

enough time to recover and felt fatigue. It was let the students increase the incidence

rate of ankle sprain. Other study showed that the factor got the injury cause without

adequate rest (Myrick, 2015).

Body Weight Status and Ankle Sprain

In the present study, more participants had normal body weight (63.6%) than

underweight (40.0%) and overweight (56.7%). However, no statically significant

difference was found between ankle sprain and body weigh status. Although this

present study suggested that there was no relationship between BMI and ankle sprain.

There were different findings in the group who had suffered from ankle sprain in past

12 months. The people with normal body mass had lower incidence rate of injury than

overweight (Tyler et al., 2006). Also, the result of study showed that men with ankle

sprains would have higher mean height, weight, and BMI than uninjured men

(Waterman et al., 2010). Another research suggested that the injury group (ankle

sprain) had higher BMI when compared with the non-injured group (Gribble et al,

49

2016; Waterman et al., 2011). In addition, a study reported that increased in the BMI

of soccer players can lead to getting ankle sprains easily (Fousekis et al., 2012). It may

be affected by the small sample size in this study. For the body weight was overweight,

this study observed that there was apparent higher injury risk associated with

overweight (McHugh, 2006). Also, Buist and Bredeweg (2011) found that overweight

novice runners were having more opportunities to get running related injury. Further

research should be conducted to examine the relationship between ankle sprain and

overweight.

Advantage of the Study

For the advantage of this study, many studies were focusing on athletes and

children that little research was conducted among university students. There was a

knowledge gap about the frequency and characteristics of ankle sprains in local

university students. This study can provide preliminary information about the

incidence rate of PARI and ankle sprain among university students in Hong Kong. In

addition, the face to face distributed the questionnaire was another advantage of the

study. It was because this can allow immediate check of all the answers written by

participants to prevent missing value. Also, I can answer the question asked by the

participants immediately.

50

Limitations of the Study

There were several limitations for this study. The first limitation of this study was

lack of power to test difference due to the small sample size (n=150). For example, the

incidence rate of ankle sprain in gender that the chi square tests resulted in a P of

0.443. According to the significance level of 0.05, we did not regard the large

significant difference. Second, the limitation of this study was lack of time to

distribute the questionnaire to all university in Hong Kong. Therefore, this study only

collected the data in HKBU that the representative was decreased. Third, the data of

this study were based on the questionnaires. It was a self-reported assessment that the

result are subjective given by the participants. The subjects may have given incorrect

answers due to recall bias. In addition, the questionnaire in this study was developed

by ourselves and did not have enough time to do a pilot test. Therefore, validity and

reliability are limitation of this study. Apart from this, the question about the PA only

can asked the frequency and intensity level and cannot ask about the actual time to do

the physical activity because the length of questionnaire was limited. At last, the BMI

of the participants was calculated based on the data of body height and weight written

by them. The participants may have different method and time to measure their height

and weight. Therefore, this was the last limitation of this study.

51

Future Research Perspectives

Future research with a large-scaled random sample should be conducted to

confirm the findings. At the same time, effective intervention should be developed for

university student in Hong Kong.

Conclusions

It was concluded that ankle sprain was prevalent in university student in Hong

Kong. Most of the participants did not stayed overnight in hospital and receive

hospital administration. Inversion was the most common type of ankle sprain.

Basketball and football were the activities that involved with the ankle sprain most.

Ankle sprains often occur in outdoor court. The major reason leading to the ankle

sprain was hit with human. The year 3 students, study major in sport, be a sport team

member, higher frequency of moderate and vigorous level physical activity were the

risk factors of ankle sprains.

52

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APPENDIX A

Informed Consent

研究知情同意書

親愛的先生/小姐，我是香港浸會大學社會科學學院-運動及康樂領袖學系的

四年級學生，現正進行大學生體能活動以及其運動時受傷的調查研究。特此邀

請閣下參加是項研究。本研究是旨在通過了解本地大學生日常的體能活動情況

以及這一年的受傷情況，為制定更佳的活動環境和運動場所給予大學生提供科

學依據。調查主要內容包括是邀請同學填寫有關體能活動以及其受傷情況之問

卷。

本研究所收集的所有資料絕對保密，並只作研究之用。本研究完全遵照自

願參加的原則，閣下有權決定是否參加本研究，並隨時可以退出。一經要求，

我會向閣下提供資料以及本研究的主要研究結果，以供參考。

閣下的幫助和支持是本次研究得以順利進行和達到預期目的的根本和前

提。望閣下同意參加本次研究。敬請閣下盡早填妥《研究知情同意書》並交回

本人。收到閣下的同意書後，我會派發問卷給閣下，讓閣下填寫有關體能活動

以及運動時受傷之問卷。

敬請合作，非常謝謝！

如有疑問，可查詢：

香港浸會大學運動及康樂領袖學系學生郭清儀

電話: 98732983 電郵: 14686260@life.hkbu.edu.hk

香港浸會大學運動及康樂領袖學系講師高楊博士

電話: 3411 3082 電郵: gaoyang@hkbu.edu.hk

-------------------------------------------------------------------------------------------------------

《研究知情同意書》

敬請閣下在下方空格 打剔：

我已經仔細閱讀過上面的說明，明白本次研究的目的和內容，並同意參加

本次研究。

我已經仔細閱讀過上面的說明，明白本次研究的目的和內容，但不同意參

加本次研究。

簽名：＿＿＿＿＿＿＿聯絡電話：＿＿＿＿＿＿＿

日期：＿＿＿＿＿＿＿

62

APPENDIX B

Student Questionnaire

編號:________

<<大學生參與體能活動與運動損傷調查問卷>>

問卷填寫說明

1. 所有答案請依據自己的實際情況填寫．所有答案絕對會保密。

2. 選擇題：請圈出最適合的答案。

3. 填充題：請在”________”填上適當的內容。

4. 如在作答時有任何問題，請與本人聯絡解答疑難。

甲部 個人資料

性別: 0= 男; 1= 女 年齡:______ 出生日期: _____年___月___日

身高:______________cm 體重:_______________kg

年級:________ 是否就讀體育學系: 0= 否; 1= 是

乙部 參加體能活動的習慣

相關定義的註釋:

體能活動：是指所有會消秏能量的身體活動，包括運動及日常生日的活動，例

如上體育堂、參與校內外各項體育活動(例如球類活動、跳舞等)、參與校內外

各體育活動興趣班或小組(例如游泳班、武術班等)、休閒娛樂時的遊戲或其他

體能活動(例如行山、遠足、慢跑等)、以及上下學時步行或踩單車等。

1. 在過去的 12 個月中，你是否參加過以下各類運動代表？

1.學校運動代表隊 0= 否; 1= 是，(請說明)___________

2.地區運動代表隊 0= 否; 1= 是，(請說明)___________

3.香港運動/香港青年運動代表隊 0= 否; 1= 是，(請說明)___________

4.其他(請說明)_____________ 0= 否; 1= 是，(請說明)___________

2. 在過去的 12 個月中，通常的一週進行中強度體能活動*的次數? (中強度體能

活動 = 進行活動時需要適量的運動和心跳率少量提高。例如：急步行、跳舞

(休閒)或在平地或微斜的道路踏單車)，如活動少於 10 分鐘將不計算為一次。

0=沒有; 1=一次; 2=兩次; 3=三次; 4=四次; 5=五次或以上

1

63

3. 在過去的 12 個月中，通常的一週進行高強度體能活動*的次數? (高強度體能

活動 = 進行活動時需要大量的運動，並導致呼吸急促和心跳率大幅提高。例

如：跑步(訓練)、踩單車(訓練)、游泳(訓練)、競技運動如籃球, 排球等。)

如活動少於 10 分鐘將不計算為一次。

0=沒有; 1=一次; 2=兩次; 3=三次; 4=四次; 5=五次或以上

丙部 運動損傷的情況

相關定義的註釋:

體能活動損傷：是指在進行體能活動時，身體突然地或意外地受到的各種損

傷。有些損傷比較輕微，好像輕微割損、擦傷、撞瘀等，嚴重的損傷（例如骨

折）可能要到急症室，什至會引致身體永久受損或者死亡。體能活動損傷也包

括中暑和曬傷，但不包括做家務時發生損傷。

1. 在過去 12 個月中，你是否經歷過上述體能活動損傷（包括輕微擦傷、中暑、

曬傷等）?如果有，總共多少次？

0= 否; 1=是，______次

2. 在過去 12 個月中，你是否經歷過腳踝扭傷（俗稱咬柴）*？如果有，總共多

少次？

0= 否; 1=是，______次

*(腳踝扭傷是指腳踝和足部因過度運動而導致踝關節意外受傷，可以分為三類分

別是內翻腳踝扭傷、外翻腳踝扭傷和高腳踝扭傷。傷者可能會覺得疼痛，而且走

路有困難，另外更有機會有局部的紅腫及瘀傷。)

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3. 如果你在本部份第 2 題中選擇了*是*，請回憶你最近一次(即最後一次)經歷的

腳踝扭傷(以下簡稱”是次損傷”)的情況，回答以下問題。如果你在本部份第

2 題中選擇了*否*，請停止回答第 3 題，並前往第 3 題繼續作答。

3.1 是次損傷是否導致了以下情況的發生?

1.需要立即停止進行中的體能活動 0= 否 ; 1= 是

2.不能參加已經計劃好的下一項體能活動(任何活動) 0= 否 ; 1= 是

3.第二天不能返校上課 0= 否 ; 1= 是

4.現場接受急救服務(不包括貼膠布) 0= 否 ; 1= 是

5.在醫院急症室接受治療 0= 否 ; 1= 是

6.在醫院的非急症室或在其它醫療服務機構接受治療

(包括 普通科、專科、中醫或物理治療等服務) 0= 否 ; 1= 是

7.在醫院裡過夜觀察或治療 0= 否 ; 1= 是

8.住院接受治療 0= 否 ; 1= 是

3.2 是次損傷是發生在什麼地方?

1= 學校； 2= 家中； 3= 公共體育館/運動場;

4= 其他地方:__________ ； 5= 不記得

3.3 是次損傷是發生在室內還是室外?

1= 室內； 2= 室外； 3= 不記得

3.4 是次損傷發生時，你正在從事那種運動或體能活動？

1= 籃球; 2= 足球; 3= 跳舞; 4= 體操; 5= 遠足; 6= 網球;

7=羽毛球; 8= 手球; 9= 壁球; 10= 游泳; 11= 跳繩; 12= 欖球;

13= 溜冰; 14= 跆拳道; 15= 武術; 16= 散步; 17= 其他(請註明，可列多

項:____________)

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3.4.a. 你從事該項體能活動的性質或最高水平是：

1= 業餘愛好者； 2= 學校代表隊成員； 3= 地區代表隊成員；

4= 香港代表隊或香港青年代表隊隊員； 5= 其他代表隊成員(請註

明:__________)

3.5 是次損修發生時，你正在進行下述那個階段的活動/運動?

1= 休閒娛樂運動(如行山); 2= 平時訓練； 3= 賽前訓練；

4= 比賽前； 5= 比賽中； 6=比賽後； 7= 熱身運動； 8= 整理運動；

9= 其他(請註明:_________)

3.6 造成是次損傷的主要原因/途徑是什麼?

1. 是否與人或物體撞擊? 0= 否; 1= 與人體撞擊; 2= 與物體撞擊

2. 是否被輾壓? 0= 否 ; 1= 是

3. 是否跌倒? 0= 否 ; 1= 是

4. 是否過度使用性損傷? 0= 否 ; 1= 是

5. 其他原因? 0= 否 ; 1= 是，請說明:_______________

3.7 是次損傷中，是左腳還是右腳受傷? 1= 左; 2= 右

3.8 是次損傷中，是向外還是向內的扭傷? 1= 外; 2= 內; 3= 高

3.9 是次損傷中，受傷程度屬於? 1= 輕度; 2= 中度; 3= 嚴重; 4= 不知道

3.10 是次損傷是舊傷復發還是新傷?

1= 舊傷復發； 2= 新傷

3.11 是次損傷用了多少時間完全康復?

1= 1 週或以內; 2= 2-3 週; 3= 4 週或以上; 4= 至今未康復

全卷完，多謝合作!