Abstract
The use of head kinematic measurement devices has recently proliferated owing to technology advances that make such measurement more feasible. In parallel, demand to understand the biomechanics of head impacts and injury in sports and the military has increased as the burden of such loading on the brain has received focused attention. As a result, the field has matured to the point of needing methodological guidelines to improve the rigor and consistency of research and reduce the risk of scientific bias. To this end, a diverse group of scientists undertook a comprehensive effort to define current best practices in head kinematic measurement, culminating in a series of manuscripts outlining consensus methodologies and companion summary statements. Summary statements were discussed, revised, and voted upon at the Consensus Head Acceleration Measurement Practices (CHAMP) Conference in March 2022. This manuscript summarizes the motivation and methods of the consensus process and introduces recommended reporting checklists to be used to increase transparency and rigor of future experimental design and publication of work in this field. The checklists provide an accessible means for researchers to apply the best practices summarized in the companion manuscripts when reporting studies utilizing head kinematic measurement in sport and military settings.
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Introduction
Accelerometers were first implemented in studies of American football athletes to elucidate head impact biomechanics associated with sport-related concussion (SRC) in 1965.34 While initial designs were rudimentary by today’s standards, advances in technology (e.g., wireless communication, smaller electronics, gyroscopes, etc.) have resulted in helmet,3,9 mouthguard,16 ear,29 and epidermal38 mounted systems (see O’Connor et al.28 for review). Parallel to these advances have been the implementation of video analyses,2,23,27 rigid body reconstructions,24 dummy reconstructions,13,32 computer modeling,4,18,31 and increasingly sophisticated data analytics,10,44 paired with head acceleration measurement devices to quantify head impact exposure in sports. The result has been increased research to better understand the head kinematics of players participating in American football,6,11,14,20,36 football/soccer,19,21 ice hockey,12,25,43 rugby,17 and other sports.16,22,29 This research has also been extended to focus on blunt head impacts experienced during military training.35 Together, these studies have contributed to the body of literature that has moved concussion science forward. As the use of devices to measure head kinematics proliferates,30 the field is ready for guidelines pertaining to methodological rigor to improve the consistency of research and reduce the risk of scientific bias.
Consensus Head Acceleration Measurement Practices (CHAMP) Group Origins and Methods
The Consensus Head Acceleration Measurement Practices (CHAMP) group was founded to develop and recommend best practices for the collecting, analyzing, and reporting of head acceleration measurement data in sport. A leadership group (identified in the supplementary materials) formed and identified six areas of focus:
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Study Design and Statistical Analysis in Studies of Head Acceleration Measurement
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Laboratory Validation of Wearable Head Kinematic Devices
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On-Field Deployment and Validation of Wearable Head Kinematic Devices
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Video Analysis of Head Acceleration Events
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Physical Reconstruction of Head Acceleration Events
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Computational Modeling of Head Acceleration Events
The leadership group approached experts in the field to lead each section, and those team leaders were asked to recruit members to their working group, encouraging broad participation throughout the field. These teams of experts drafted documents (“chapters”) that outline currently recommended best practices for many aspects of head acceleration measurement—these are summarized by the other manuscripts in this series.
The workgroups, as well as a broader group of key stakeholders, convened at a consensus conference held in Philadelphia, Pennsylvania, USA on March 24–25, 2022. At the conference (held both in person and via a virtual option), workgroup leaders presented their work providing details and support for a set of consensus statements (5–7 statements for each “chapter”). All attendees at the conference participated in an open scientific discussion of the key concepts and then formally voted on each consensus statement. A priori, the following criteria were established for the voting procedures. Eighty percent or greater agreement with each statement would be required for a statement to be accepted with no further discussion. Less than 20% agreement with a statement would result in the statement being removed from consideration. Initial support between 20 and 80% for a statement would result in further discussion and revision of the statement, striving for at least 80% agreement. If 80% agreement could not be reached, a group of those that dissented would be identified and asked to draft a brief counterpoint to the statement. Of note, at least 80% agreement was reached for all statements, often with detailed discussion and revision; thus, no dissension statements were necessary. A summary of the voting results is contained in the Supplementary materials.
Transparency and Disclosure via Reporting Checklists
In addition to the scientific topics covered in the companion manuscripts in this series, an additional area of focus was identified: transparency and disclosure. Systematic and transparent disclosure of detailed methods used in head acceleration measurement studies is key to improved rigor and reproducibility of research in this area. Further, transparency around research conducted in partnership with industry sponsors and the use of proprietary algorithms to process head kinematic data from wearable devices is important to disclose. Transparency and disclosure can be achieved by identifying critical elements that require reporting. Suboptimal reporting of these elements allows authors, intentionally or inadvertently, to avoid highlighting any weakness in the methodological aspects of their studies. Other fields of scientific inquiry have enhanced transparency and disclosure through the development of checklists outlining reporting recommendations.5,7,42 Led by efforts such as CONSORT (www.consort-statement.org) and EQUATOR (www.equator-network.org), a series of reporting checklists exist for numerous study designs1,26,37,39,40 and their use has been shown to positively contribute to completeness and transparency of published work.8,15,33,41
The CHAMP Transparency and Disclosure working group adopted this approach and developed checklists that align with five of the technical manuscripts that are associated with a particular methodologic approach (Lab Validation, On-field Deployment and Validation, Video Reconstruction, Physical Reconstruction, and Computer Modeling) (Tables 1, 2, 3, 4, 5). These checklists were developed to assist authors in reporting the conditions under which studies utilizing head kinematic measurement were designed and implemented. The checklist elements also provide guidance to journal editors and manuscript reviewers on key components to consider when evaluating the scientific merit of the work and give structure to readers as they review the literature. Checklists are not intended to specify a particular study design, analytical method, or reporting format, nor are they intended to replace existing study reporting checklists like CONSORT that may apply to a given study. Rather, they outline the elements that are necessary for transparent reporting. For each item in each checklist, we include a brief explanation and elaboration of the items, along with examples of transparent reporting and disclosure in the existing literature. Not all items have existing examples to highlight.
We suggest that authors, peer-reviewers, and journal editors refer to these checklists as the “CHAMP 2022 Reporting Guidelines” and use them in describing studies of head acceleration measurement in the peer-reviewed literature. Manuscript structure should follow specific journal instructions and stylistic requirements for authors. Authors should simply report checklist items within the article with enough detail for reviewers, authors and readers to discern study rigor. We suggest authors who wish to cite CHAMP 2022 checklists should cite this manuscript. If a journal supports CHAMP 2022, it can cite these manuscripts in their “Instructions for Authors” and require submission of the relevant checklist along with identification of the page number on which each item is reported.
The CHAMP 2022 guidelines will likely evolve and are not all-encompassing. We encourage professional organizations to collaborate on updates to checklist items that warrant revision as the science and technology of head kinematic measurement continues to develop.
Industry Involvement in Research
In addition to the checklists presented above, another important aspect of Transparency and Disclosure in head acceleration measurement studies is the involvement and/or relationship of the study authors to head kinematic sensor manufacturers or device suppliers. Most scientific journals require authors to disclose real and perceived conflicts of interest, as well as sources of funding related to the research, to allow the reader to evaluate real or potential bias. However, in head acceleration measurement studies, a company’s involvement may extend beyond the provision of in-kind or financial support for a study, and its role may be more nuanced than in other fields (See Table 6 for examples). It is important to note that disclosing a company’s involvement in study funding, design, analysis, or interpretation of data does not necessarily mean the study is biased; instead, disclosure is key to transparency. Specifically, disclosure may promote trust by assuring the readers there are no hidden conflicts of interest influencing the research. Therefore, disclosure of all sources of support, including the six types listed in Table 6 is a critical component of head acceleration measurement studies and should be considered a key aspect of CHAMP 2022 reporting guidelines.
Summary
The Consensus Head Acceleration Measurement Practices (CHAMP) group was founded to develop and recommend best practices for the collecting, analyzing, and reporting of head acceleration measurement data in sport. Comprised of a diverse group of scientists, the CHAMP group, through its workgroups, developed consensus methodologies and companion summary statements which were discussed, revised and voted upon at the CHAMP conference in March 2022 and are summarized in the companion manuscripts in this series. Herein, we summarize the motivation and methods of the consensus process and introduce recommended reporting checklists to be used to increase transparency and rigor of future experimental design and publication of work in this field. The checklists provide an accessible means by which to: (a) translate the rich details of best practice summarized in the other manuscripts in this series; (b) improve the reporting of studies utilizing head acceleration measurement in sport and military applications; and (c) evaluate and interpret published work in this field. Aligned with the goal of improving the rigor, quality and consistency of research in this area, they also serve as a tool for authors as they prospectively consider design of their study.
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Acknowledgments
The authors acknowledge the support of Patricia Harris and Megan Fisher-Thiel, Children’s Hospital of Philadelphia, and Geraldine Chapey, National Football League, in the conduct of this effort.
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Support for the CHAMP consensus conference was obtained from the National Football League and Football Research Inc.
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The following competing interests are disclosed. KBA received support for attendance and participation in the CHAMP conference from Football Research Inc (payments made to institution), JBC received support for attendance in the CHAMP conference from the NFL, JRC and JRF received support for attendance and participation in the CHAMP conference from the NFL and Football Research Inc (payments made to institution). The following authors received grants or contracts from relevant entities paid to their institution: KBA (Football Research Inc., Chuck Noll Brain Research Foundation), SPB (NCAA), TAB (State Space Labs, Henry M. Jackson Foundation for the Advancement of Military Medicine, NCAA, University of Nevada COBRE), JBC (American College of Sports Medicine), JRC (Football Research Inc., NFL). The following authors received consulting fees from the following entities: KBA (NFL Players Association), JRC (NASCAR Head, Neck and Spine Committee), JRF (Football Research Inc.), ASM (Racing Australia, Transport for New South Wales, Australian Football League, Worksafe Victoria, International Olympic Committee, Cricket Australia), GS (NFL). The following authors received payment for lectures or presentations: KBA (American Academy of Pediatrics), TAB (Journal of Sport and Health Sciences, Precision Athletic Training, Eastern Athletic Trainers Association, Pennsylvania Athletic Trainers Society, Shandong Sport University), JBC (Child Neurology Society, Eastern Athletic Trainers Association), JRF (Football Research Inc.), The following authors received support for attending meetings: KBA (NFLPA, Football Research Inc., NOCSAE Scientific Advisory Committee), JBC (American College of Sports Medicine, Child Neurology Society, Eastern Athletic Trainers Association), JRC (Football Research Inc., NFL), JRF (NFL), ASM (International Olympic Committee). The following authors serve on the following advisory boards or committees: KBA (NOCSAE Scientific Advisory Board, NFL Engineering Committee, NFL Sensor Committee), JRC (NASCAR Head, Neck, and Spine Committee, NFL Engineering Committee), ASM (Standards Australia Committee, ISO working group on occupational protective helmets).
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Arbogast, K.B., Caccese, J.B., Buckley, T.A. et al. Consensus Head Acceleration Measurement Practices (CHAMP): Origins, Methods, Transparency and Disclosure. Ann Biomed Eng 50, 1317–1345 (2022). https://doi.org/10.1007/s10439-022-03025-9
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DOI: https://doi.org/10.1007/s10439-022-03025-9