Epidemiological Characteristics of Injuries Among Rowing Athletes Based on Gender and Age: A Retrospective Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I would like to express my gratitude for the opportunity to review this manuscript. The subject matter of the text is pertinent to the field and contributes to the advancement of scientific knowledge. The following section contains my detailed considerations on the study.

Abstract: The abstract presents the study's primary findings; however, it would benefit from enhanced objectivity and alignment with the results. The clarity and precision in the description of the methodology and findings could be improved. Minor adjustments to the grammatical structure and textual cohesion are recommended to enhance the readability of the text.

Introduction: The literature review reveals lacunae that substantiate the study's rationale. Nevertheless, it is recommended that the authors augment the justification of the study with more recent and pertinent references, thereby accentuating the originality of the proposed approach and underscoring its clinical significance.

The methodology section could be strengthened by including more detailed descriptions of the study's design and analysis. The study design is adequate to answer the research question, and the methodology used is in line with the proposed objectives. However, the section could be more detailed regarding data collection and variable processing. The authors should clarify whether they controlled for potential biases, such as confounding factors, which could impact the validity of the findings.

Results and Statistical Analysis: The presentation of the results is organized, but some points require greater clarity in the presentation of the findings. The statistical tests selected are not adequately justified and may not be the most suitable for addressing the research question. It is recommended that the authors provide a justification for the selection of these tests, or consider more robust alternatives, such as regression models, ANOVA or non-parametric tests, depending on the distribution of the data. Furthermore, the application of statistical corrections, such as Bonferroni or Holm-Sidak, should be indicated for multiple comparisons in order to avoid type I error. The presentation of statistical significance values should be more detailed, including confidence intervals and effect sizes when applicable. The results should be presented alongside appropriate measures of dispersion, such as standard deviation or standard error of the mean, as appropriate. The graphs used to illustrate the results could be improved by including confidence intervals and distributing the individual data to allow better visualization of the variability. The section on results interpretation should be revised to ensure that conclusions drawn from marginal findings are not unduly influenced. It is imperative to emphasize the clinical and statistical relevance of the findings.

The Discussion and Conclusion sections should address the clinical and statistical relevance of the findings. It is recommended that further discussion be undertaken on the applicability and impact of the findings. The conclusion is well aligned with the objectives but could be reinforced with practical implications and suggestions for future studies.

Comments on the Quality of English Language

The manuscript is generally well-written, yet some sentences lack clarity and precision. Minor grammatical and syntactical errors are present throughout the text, which may have a detrimental effect on readability. It is therefore recommended that the text undergoes a thorough proofreading process, ideally by  a professional language editor, with a view to enhancing its fluency, coherence, and technical accuracy. Furthermore, ensuring consistency in terminology and refining sentence structure would serve to enhance the manuscript's readability to a considerable degree.

Author Response

Please check the attached file.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This study on the epidemiological characteristics of injuries among Chinese rowing athletes provides valuable insights into injury patterns, incidence rates, and risk factors across different age and gender groups. The research stands out for its comprehensive approach to data collection and analysis, offering a detailed examination of injury types, anatomical sites, and severity levels. By focusing on a previously understudied population of Chinese rowers aged 12-24 years, the study fills an important gap in sports medicine literature. 

However, several limitations (which should be acknowledged in the discussion section of the manuscript) affect the interpretation and generalizability of the findings. The retrospective design introduces potential recall bias, as athletes self-reported injuries without medical validation. The study likely underestimates severe injuries since athletes who stopped training due to injury were excluded. Sample size issues are particularly concerning for the female over-18 subgroup (n=15), which may lead to overestimation of injury rates in this population. The lack of clinical diagnosis for reported injuries and absence of analysis regarding specific injury types (e.g., fractures, ligament tears) represent additional limitations. Furthermore, while the study notes discrepancies between its injury rates and previous research, it doesn't fully explore potential reasons beyond age differences. 

It is necessary to incorporate a binary logistic regression in this study. This statistical approach would be particularly valuable for examining the relationship between various risk factors and injury occurrence among rowing athletes. The method's ability to handle binary outcomes makes it ideal for analyzing injury data, where the primary outcome is often whether an athlete experienced an injury (yes/no) during the study period.

 

Additional comments:

1. What is the main question addressed by the research?
The main question addressed by this research is to investigate the epidemiological characteristics of rowing-related injuries among Chinese rowing athletes aged 12–24 years, with a focus on:
For example, the authors aim to determine which anatomical sites are most frequently injured (i.e., lower back, knee) and whether certain groups (i.e., female athletes > 18 years) are more vulnerable to injuries.

2. Do you consider the topic original or relevant to the field? Does it address a specific gap in the field?
·Originality/Relevance: The topic is highly relevant to the field of sports medicine and injury prevention. Rowing is a physically demanding sport with a high risk of musculoskeletal injuries, particularly in elite athletes. While previous studies have examined injury patterns in international and master rowers, there is limited research on Chinese rowing athletes, especially adolescents and young adults. This study fills a significant gap by focusing on a population that has been underexplored in the literature.
·Gap addressed: The manuscript explicitly states that no epidemiological studies on Chinese rowers have been conducted thus far. By providing data on injury incidence, types, and anatomical distributions in Chinese athletes aged 12–24 years, the study addresses this gap. It also highlights differences between genders and age groups, which are critical for tailoring injury prevention strategies.

3. What does it add to the subject area compared with other published material?
This manuscript contributes to the field by:
·Providing region-specific data on injury patterns among Chinese rowing athletes, which can inform localized prevention programs.
·Highlighting the higher vulnerability of female athletes > 18 years to injuries compared to males and younger females.
·Confirming earlier findings on the predominance of lower back and knee injuries in rowing athletes while offering insights into gradual-onset vs. acute-onset injuries.
·Offering practical implications for coaches and trainers to target high-risk groups (i.e., adult females) and high-risk anatomical sites i.e., lower back).

4. What specific improvements should the authors consider regarding the methodology?
While the methodology is generally robust, several areas could be improved:
·Recall Bias: As a retrospective study, it relies on self-reported data, which may introduce recall bias. The authors acknowledge this limitation but could mitigate it by cross-referencing self-reports with medical records or coach reports.
·Sample Size and Representation: The sample size is relatively small (n = 207), and the number of females > 18 years (n = 15) is particularly low. This imbalance may lead to overestimation of injury rates in this subgroup. Expanding the sample size, especially for older female athletes, would strengthen the findings.
·Injury Severity Analysis: The severity of injuries is categorized based on time loss, but the authors do not provide detailed analyses of injury types (i.e., strains, sprains) or their clinical diagnoses. Including objective medical assessments would enhance the reliability of the results.
·Training load measurement: Training hours and sessions are self-reported, which may lack accuracy. Using wearable devices or training logs could provide more precise data on training loads and their relationship to injury incidence.
Please, also address my previous concerns, which were previously sent.

5. Are the conclusions consistent with the evidence and arguments presented? Do they address the main question posed?
·Consistency with evidence: The conclusions are consistent with the data presented. For instance:
·Lower back injuries were the most common (39.7%), followed by knee injuries (20.6%), aligning with previous studies.
·Female athletes > 18 years showed significantly higher injury rates than males and younger females, which was supported by statistical analyses (e.g., OR = 6.11, p = 0.003).
·Most injuries were gradual-onset (61.1%), consistent with prior literature.
·Addressing the Main Question: The conclusions directly address the main research question by summarizing key findings on injury distribution, incidence, and gender/age differences. They also emphasize practical implications for injury prevention programs.
However, the authors could strengthen their conclusions by discussing potential causal mechanisms for the observed gender and age differences in greater depth.

6. Are the references appropriate?
The references are appropriate and well-selected. They include seminal works on rowing injuries (i.e., Hosea & Hannafin, 2012; Smoljanovic et al., 2009) and broader studies on sports injuries and gender differences (e.g., Arendt & Dick, 1995; Lloyd et al., 1986). The inclusion of recent systematic reviews (i.e., Martínez-Fortuny et al., 2023) ensures the manuscript is grounded in current knowledge.
One minor suggestion: The authors could include more studies on adolescent athletes to better contextualize their findings within this age group.

7. Any additional comments on the tables and figures?
·Strengths:
·The tables (i.e., Tables 1–7) are comprehensive and well-organized, providing detailed breakdowns of injury incidence, anatomical sites, and severity by gender and age.
·Figures 2 and 3 effectively visualize injury rates per 1,000 training hours and sessions, making it easy to compare groups.
·Areas for Improvement:
·Figure 1 ("Occurrence of injuries in rowing athletes") is mentioned in the text but not described in detail in the provided content. Clarifying its purpose and findings would enhance understanding.
·Some tables (i.e., Table 6 and Table 7) contain many zero values, which may reduce readability. Consolidating these tables or using graphical representations (i.e., bar charts) could improve clarity.
·Adding confidence intervals to the figures (i.e., error bars) would provide a clearer sense of variability in the data.

This manuscript makes a valuable contribution to the field by providing region-specific data on rowing injuries among Chinese athletes aged 12–24 years. While the study design and findings are consistent with prior research, the focus on gender and age differences offers practical insights for injury prevention. Addressing methodological limitations (i.e., recall bias, small sample size) and improving the presentation of tables and figures would further enhance the manuscript's impact.

Author Response

Please check the attached file.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

            This manuscript aims to better define the epidemiological characteristics associated with injury experienced by Chinese rowing athletes, including injury rates based on sex and age, severity of these injuries, and location of these injuries. In this study, the authors used retrospective data to identify athletes most at risk for experiencing injury, with hopes that this data will be able to be applied in the future to programs to help reduce the risk of rowing-related injuries. Overall, the manuscript describes a good amount of data that helps clarify relative injury risk for these athletes, which may one day be applied to help reduce overall risk.

I have included the following comments and suggestions to help strengthen the manuscript:

 

Lines 42-44: Related to these previously cited studies indicating 1.75-5.70 injuries per 1000 training sessions, it might be helpful to include some context to the populations that were studied to get these numbers (males vs. females, older or younger individuals, amateur versus professional athletes, etc.), just to help the reader understand the population that is being talked about.

Lines 63-74: Could you provide a brief overview in the methods session here about how study participants were selected/recruited?

Lines 86-87: As it is one of your key variables that you are looking at, I recommend including a brief statement here to help the audience understand how acute-onset versus gradual-onset injuries were defined in the case of the study.

Table 1: I thought this was a really important and useful table to include that really helps understand the demographics that were studied here!

Results Section: Were you able to look into if there was any connection between injury rate and average time spent training in a given training session? I would hypothesize that injuries are more common with longer workouts, but would be interested to understand if that was true or if that became true after a certain length of workout. This would also be useful to know for guiding future preventative guidelines to help reduce the risks of injury.

Lines 270 – 282: This was a good inclusion in the discussion section to propose why older females had a higher injury risk. Is there a hypothesis as to why this difference in injuries by age may have been more prominent in females relative to the male participants? Many of the explanations described in this section seem like they would apply similarly to male athletes.  

Author Response

Please check the attached file.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I would like to thank you for inviting me to review the submitted manuscript, which investigates the epidemiological characteristics of injuries in rowing athletes based on age and sex. This is a topic of practical and scientific relevance, with potential contribution to injury prevention strategies in high-performance sports, particularly among young athletes.

The article has undergone significant improvement since the initial revisions. However, there are a few points that still require attention. These are as follows:

• Please refer to page p. In the section entitled "Female Athletes Were More Susceptible...", lines 32 through 35, the author explores the topic of female athletes and their increased susceptibility to certain health concerns. It is imperative to consolidate the information presented, ensuring that the findings are not reiterated in two consecutive sentences.
• As indicated on page 3, lines 120–123, the formula employed to calculate the injury rate is as follows: It is necessary to indicate whether the denominator was individualized by athlete. Furthermore, the GEE model or negative binomial regression should be considered for the rate per individual.
• Please refer to page 11, table 8, regression models. A comparison of the models should be presented using the AIC/BIC, and the collinearity between height, weight, and BMI should be discussed.
• For further information, please refer to the discussion of BMI on pages 13–14. In future studies, it is recommended that the potential confounders of activity level and aerobic power be taken into consideration.

Author Response

Please check the attached file.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

All my concerns were addressed.

Author Response

Thank you very much.