Methodological advances in injury surveillance and injury inciting event analysis in elite UK netball

Abstract

Injury remains a persistent challenge in netball across all levels of participation, yet limitations in how injuries are defined, captured and described have constrained injury prevention efforts. To address these limitations, this thesis aimed to develop and apply robust methods to enhance injury surveillance and injury-inciting event analysis in elite UK netball, thereby improving methodological consistency and strengthening the injury prevention evidence base. To meet this aim, four interrelated studies were undertaken that synthesised existing evidence, implemented prospective injury surveillance, developed and evaluated a netball-specific injury-inciting event classification system, and piloted a preliminary biomechanical domain to support the system’s future extension. A scoping review demonstrated substantial methodological inconsistency in netball injury research, particularly in injury definitions, exposure measurement and inciting-event reporting. This informed recommendations to improve standardisation and guided the methodological approach adopted in subsequent studies. Prospective injury surveillance in the Vitality Netball Superleague (VNSL) showed match injury incidence was considerably higher than training, with match injuries predominantly acute lower-limb conditions resulting in high time-loss burden, whereas training injuries were largely overuse-related and frequently non–time-loss. Subsequently, the Netball Injury Inciting Event Classification System (NIIECS) was developed and evaluated to classify situational, behavioural and contextual characteristics of injury events using video-based or non-video (athlete- or clinician-reported) data sources. Acceptable inter- and intra-rater reliability and applied usability were demonstrated for video-based match injury events. Finally, a preliminary biomechanical domain was proposed to extend the NIIECS, with expert feedback indicating strong support for the inclusion of biomechanical descriptors while identifying key priorities for refinement to support future development and integration. Overall, this thesis advances methodological standards for injury surveillance and injury inciting event analysis in netball. It provides an improved foundation for consistent, context informed injury monitoring and interpretation in elite UK netball, supporting evidence informed decision-making to guide injury prevention efforts. This work also establishes a platform for future refinement, including biomechanical integration, to inform targeted injury prevention strategies.