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Abstract
Objectives The primary objective of this paper is to examine terrain park (TP) feature compliance with recommendations from a ski area industry guide (are TP features compliant with the guide?) and determine factors that could be associated with TP feature compliance in Québec ski areas (do factors influence TP feature compliance?), Canada. These recommendations on the design, construction and maintenance are provided by the Québec Ski Areas Association Guide.
Methods A group of two to four trained research assistants visited seven ski areas. They used an evaluation tool to assess the compliance of 59 TP features. The evaluation tool, originally developed to assess the quality of TP features based on the guide, was validated in a previous study. Compliance was calculated by the percentage of compliant measures within a given feature. The potential influence of four factors on compliance (size of the TP, size of the feature, snow conditions and type of feature) were examined using a mixed-effects logistic regression model.
Results The average TP feature compliance percentage was 93% (95% CI 88% to 99%) for boxes, 91% (95% CI 89% to 94%) for rails and 89% (95% CI 86% to 92%) for jumps. The logistic regression showed that none of the four factors examined were associated with TP feature compliance with the guide.
Conclusion Our results suggest that TP features are highly compliant with the guide in Québec ski areas.
- passive safety
- standards
- implementation / translation
- process/impact evaluation
Data availability statement
Data are available on reasonable request.
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Introduction
Alpine skiing and snowboarding are very popular in the province of Québec, Canada, with an estimated 1.6 million participants (population 8 million), an average of 78 ski areas in operation (between 2000 and 2017), and 6–7 million visits registered every season.1–3 Like other physical activities, these activities contribute to the global health of the population. Although, paradoxically, they also contribute to the burden of injuries within the Québec healthcare system.1 Some aetiological and epidemiological studies report that injuries are more likely to be severe in terrain parks (TPs) than on regular slopes.4–8 A TP is a particular physical environment in ski areas where skiers and snowboarders can practice acrobatic manoeuvres on features like rails, boxes, kickers, mushrooms, tables, jumps, half-pipes or quarter pipes.9 Features promoting acrobatic manoeuvres or large drops to the ground are associated with higher feature-specific injury rates and increased odds of injury.9 10 Newton’s laws of motion established more than 300 years ago can help to perceive the underlying injury mechanism.11 In TPs, the height that users often achieve results in a significant transfer of force to the skier-snowboarder. These forces may be beyond the threshold for tissue damage (ie, injury). According to this theory, decreasing the amount of energy might be a relevant strategy to prevent injuries in TPs. This is also supported by the work of Haddon.12 Within this scope, the engineering approach of the Three E’s of injury prevention (ie, Education, Enforcement, Engineering) is most likely to reduce the risk of alpine skiing and snowboarding injuries in TPs.13–16 Passive measures protect all TP users without any action required from them.17 18 There is a paucity of evidence related to standards for TPs but, as seen for playground injuries, there are reasons to believe that the quality of TP features may be associated with the risk of injury.4 13 14 19–22
In 2006, the Association des stations de ski du Québec (ASSQ) (Québec Ski Areas Association) collaborated with the ministère de l’Éducation et de l’Enseignement supérieur du Québec (Québec Ministry of Education and Higher Education), the Canada West Ski Areas Association and the National Ski Areas Association to develop a guide providing recommendations on the design, construction and maintenance of TP features.23 Stakeholders from a variety of backgrounds were involved in its development (scientists, engineers, policy-makers, TP designers, managers, patrollers, ski area operators and other ski area employees who are responsible for the manual and mechanical maintenance of TPs). Subsequently, strategies such as theoretical and practical training, communication (eg, videoconferencing), advice and promotional activities were used to educate stakeholders on the safety recommendations with TP features and to implement the guide in Québec ski areas. During annual TP meetings, stakeholders were invited to share their experience with the guide (eg, difficulty to apply a recommendation to a specific feature, impact of a recommendation on skiers-snowboarders’ behaviour, etc). This feedback was used to continuously adapt the content of the guide to make it more relevant and to facilitate implementation. The community-centred model used by the ASSQ to implement the recommendations in the guide into Québec ski areas has been previously shown to be effective.24–26
In a previous study (Audet et al), the content validity of the ASSQ Guide (V.2017) was addressed.27 According to TP designers, ski area managers, patrollers and ski area operators, recommendations from the guide are likely to prevent injuries in TPs. However, even if these recommendations could prevent TP injuries (theoretically) in Québec ski areas, to date, there is no evidence supporting their implementation in a real-world setting. Although the recommendations are widely recognised as promoting safety, there is risk inherent in many sports, and this is particularly true when sports, such as skiing and snowboarding, include high levels of kinetic energy.
The primary objective of this paper is to examine TP feature compliance with recommendations from the ASSQ Guide (are TP features compliant with the guide?). We also sought to determine factors associated with TP feature compliance in Québec ski areas, Canada (do factors influence TP feature compliance?), although this exploratory analysis was not preplanned. The secondary objective was to measure the level of implementation of each TP feature recommendation in Québec ski areas TPs (are recommendations well implemented?). This allowed us to identify which recommendations from the guide were less implemented in TPs and explore barriers towards implementation.
Methods
Data collection
In the 2017–2018 season, a group of two to four research assistants went to seven ski areas to rate TP feature compliance with the guide. Theoretical and practical training was provided to the research assistants by the project coordinator (OA) before data collection. This training was used to make sure that the level of agreement was high between each research assistant for the understanding of each recommendations’ operational definition, as well as for each level of the Quality Assessment Scale (defined in the next section).
During the study period, there were an estimated 76 ski areas in operation, 110 TPs and nearly a thousand TP features in the province of Québec.2 Among all the ski areas in operation, 71 (93%) had at least one TP in their ski area. Therefore, our sample represents 9.9% of the Québec ski areas with at least one TP. Overall, the compliance of 59 features (18 jumps, 31 rails and 10 boxes) was assessed. Characteristics of the assessed features are presented in figures 1 and 2.
Jump, rail, and box components. Jump components (top figure): (1) Approach zone; (2) Transition of the approach zone; (3) Takeoff and step; (4) Deck; (5) Knuckle; (6) Calibration zone (the first one third of the landing zone); (7) Landing zone; (8) Run out or exit. Rail components (bottom left figure): (1) Takeoff and (2) Feature. Box components (bottom right figure): (1) Takeoff and (2) Feature. Illustration reproduced with permission from the Québec Ski Areas Association.
Specific design of features. (A) step down jump; (B) step up jump; (C) step over jump (note that the angle of the deck changes to each type of jump); (D) table top jump (there is no takeoff but only a deck); (E) ride on box (there is no gap between the takeoff and the feature); (F) box with a gap (there is a gap between the takeoff and the feature); (G) street style rail (the beginning the feature extends into the snow of the takeoff). Illustration reproduced with permission from the Québec Ski Areas Association.
Public involvement
Due to the nature of our study, the public was not involved in the design or conduct of our research.
Study variables
TP feature compliance
TP feature compliance with the ASSQ guide was measured using the instrument presented in online supplementary files 1; 3 (Audet et al). The evaluation tool was based on a five-level ordinal scale (0-not very well applied or not applied; 1-not well applied; 2-moderately applied; 3-well applied; 4-very well applied). This ordinal scale was our Quality Assessment Scale. The evaluation tool included 22 recommendations related to jumps and 10 related to rails and boxes. Based on this operational definition, and using the Quality Assessment Scale, each rater had to individually assess how well the recommendation was applied. Levels 0 and 1 of the Quality Assessment Scale were used for recommendations that were really not well applied. Whereas levels 2, 3 and 4 were used for recommendations whose level of application was rated moderate (2) to very well (4). The average score of raters (two to four raters) was calculated to determine if each recommendation was compliant or not within the same TP feature. Recommendations that were rated as at least moderately applied (scored ≥2) by raters were considered compliant, otherwise they were considered non-compliant (scored <2). An example of the calculation of the average score of four raters is presented below.
Supplemental material
Supplemental material
Three factors were considered to support our decision to create two levels of compliance. That is: (1) as it can be seen in the evaluation tool (online supplementary material; Audet et al), for some recommendations, only two levels of the Quality Assessment Scale are used. The creation of two levels of compliance allow to apply the same relative importance to each recommendation (same weight); (2) to be more representative of the type of evaluation that the raters had to make. That is to say, a dichotomous choice between ‘really badly applied’ or ‘applied’ and (3) for some features, the observed frequency for many categories was zero. Thus, based on an fine-grained examination of the distribution of the scores, it seemed to make more sense to use a two-level scale. Our previous research reported strong agreement between raters using the evaluation tool.
The percentage of TP feature compliance with recommendations from the ASSQ guide was calculated using the number of compliant recommendations as the numerator and the total number of recommendations assessed for that feature as the denominator (not applicable recommendations were excluded from total). For example, if 18 recommendations were compliant and 4 recommendations were not on the 22 assessed recommendations for a jump, then the TP feature compliance was 82% (18/22).
Factors related with TP features compliance
Factors that could be associated with TP feature compliance with the guide were explored. Specifically, four factors related to features (size, snow conditions and type of feature) or TPs (size) were analysed because these were considered to potentially influence compliance. The size of the rails and boxes was determined using the measures of the main observer for data collection (OA) whereas the size of jumps was determined using the sign displayed near the feature. The snow conditions were assessed using a grid within the following types of snow conditions: powder snow (0–15 cm); deep powder; wet snow; groomed snow; hard pack with possible icy spots; corn, crud; crusty. The type of feature was determined by raters. The size of TPs was determined considering the number of features (small TPs had 15 features or less, medium TPs had 16–30 features and large TPs had 31 features or more).
Level of implementation of safety recommendations in TPs
In addition to the TP feature compliance, the level of implementation of safety recommendations from the guide was observed in TPs. Compliance of recommendations was determined using the method described in a previous section ‘TP feature compliance’. Consequently, recommendations that were rated as at least moderately applied (scored ≥2) by raters were considered compliant, otherwise they were considered non-compliant (scored <2). The level of implementation of recommendations in TPs (%) was calculated using the number of features in which a recommendation was compliant as the numerator and the total number of features assessed for that recommendation as the denominator. For example, if the recommendation x was compliant in 16 of the 18 jumps assessed, the level of implementation for that specific recommendation was 89% (16/18).
Statistical analysis
For the TP feature compliance with recommendations from the guide, the percentages and CIs were calculated for each type of feature. A mixed-effects logistics regression model was generated to examine the potential influence of four factors related TP feature compliance.28 Logistic regression was chosen because our dependent variable was treated as binomial. The numerator was the recommendations for a given feature deemed compliant and the denominator was the total of assessed recommendations for a given feature. The four factors were treated with a fixed effect whereas an additional factor, the location of features (ski areas), was integrated in the model as a random effect. TP features in the same ski area are designed, constructed and maintained by the same group of individuals. Therefore, they are likely to be compliant (or not) with the same recommendations. Note that the developed model does not consider interaction between factors. The statistical analysis was performed using SPSS (V.21) and Excel (V.2010).
Results
TP features compliance with the guide
In the seven Québec ski areas visited, 59 TP features (18 jumps, 31 rails, 10 boxes) were evaluated. Compliance with recommendations from the guide was high (mean: 91%; ranged between 67% and 100%). For boxes, rails and jumps, the compliance percentages were, respectively, 93% (95% CI 88% to 99%), 91% (95% CI 89% to 94%) and 89% (95% CI 86% to 92%). The compliance percentage did not differ significantly among the three features.
On the 22 recommendations for jumps, 15 of the 18 jumps (83%) were not compliant with one to three recommendations and 3 (17%) were not compliant with four to five recommendations. On the 10 recommendations for rails and boxes, 14 (35%) features were compliant with all recommendations, 25 (61%) were not compliant with one recommendation and 2 (4%) were not compliant with two or three recommendations A box and whisker plots is presented at figure 3 to illustrate the dispersion of data. The skewness (−0.78) and kurtosis (1.8) values showed a normal univariate distribution of our dependent variable.
Box and whisker plots illustrating the data distribution of the dependent variable; the terrain park feature compliance with the guide. Outliers are represented by circles whereas extreme values are represented by asterisks.
Factors associated with TP features compliance
The potential influence of four factors on TP feature compliance with the guide was examined using a mixed-effects logistic regression model. As shown in table 1, there was no statistically significant association between the size of the TP, the size of the feature, the snow conditions, the type of feature and TP feature compliance.
Results of the logistic regression performed to examine the potential influence of four factors related terrain park feature compliance with the guide. During the 2017–2018 season, the compliance of 59 terrain park features was assessed in seven Québec ski areas (Canada)
Level of implementation of safety recommendations in TPs
In this study, 32 safety recommendations from the guide were considered. The level of implementation of these recommendations in Québec ski areas TPs is reported in online supplementary file 2. On the 32 recommendations, 81% (26/32) were considered as well implemented in TPs whereas 19% (6/32) were considered as not well implemented.
Supplemental material
Discussion
Highlights of the study
The ASSQ guide is an innovative document that provides recommendations related to the quality of TP features. Many strategies have been used by the ASSQ to implement the guide recommendations in Québec ski areas. As a primary objective, our original study aimed to examine TP feature compliance with recommendations from the ASSQ guide and determine factors that could be associated with TP feature compliance in Québec ski areas. Results showed that TP feature compliance was over 90%. Further analyses demonstrated that none of the factors studied (size of the TP, size of the feature, snow conditions, type of feature) was associated with TP feature compliance. As a secondary objective, our study aimed to measure the level of implementation of safety recommendations from the guide in Québec TPs. TP feature recommendations from the guide were generally well followed in the seven ski areas visited, but six appeared to be not well implemented in Québec TPs. This research is helpful to describe how the implementation process adopted by the ASSQ contributed to the implementation of the recommendations provided in the guide and to explore barriers towards implementation.
Exploring and addressing barriers towards implementation
Of the 32 observed safety recommendations from the guide, six were considered as not well implemented in Québec TPs (online supplementary material: recommendations 1, 6, 13, 20, 23, 24). More precisely, these were implemented in less than the three-quarter of the TP features assessed. At first, we noted that the requirement for sizing was problematic for jumps, rails and boxes (recommendations 1 and 23). This involves some objective measures that need to be accurate. This recommendation should be evaluated several times throughout the season because the integrity of features may change over time due to the fluctuation of climatic conditions. Furthermore, the display of a signage for rails and boxes (recommendation 24) was a recommendation not well implemented in the visited TPs. Observers noticed that the approach zone of features was generally not physically determined (recommendation 6) in TPs. In another study, we noted that the ASSQ members did not strongly believe in the relevance of this recommendation in a perspective of injury prevention (Audet et al). This should be discussed further with practitioners involved in the design, construction and maintenance of TPs. The last two recommendations that were not well implemented in TPs were recommendations 13 and 20. According to the guide, to design a safe jump, the tilt angle of the takeoff should be between 25° and 30° (less than 25° for a small jump) and the tilt angle of the landing zone should be the same as the takeoff. This was not observed. However, the dichotomous nature of the independent variable (1-compliant; 0-not compliant) causes a misinterpretation of the situation. Further analyses showed that the mean tilt angles of the measured takeoffs and landing zones were, respectively, 25.0° and 25.1°. Since the means were close to the cut-off point (25°), several features were not compliant (tilt angles lower than 25°) with recommendations 13 and 20. This preventive measure might be used by ski area employees to reduce the flight curve of a rider from the ground. The reasons why six recommendations from the guide were not well implemented in TPs should be explored further with the Québec ski areas industry.
Understanding the implementation context
In order to better understand the impact of an intervention in a real-world setting, the implementation context should be explored.24 29–32 However, studies on the implementation of sport injury interventions are rare.24 Little information exists on how to effectively implement and disseminate interventions in community sport settings.24 29 33–35 Results from this study support the community-centred model24–26 used by the ASSQ as a relevant strategy to implement recommendations, standards or measures in sports communities. It seems to facilitate the collaboration and the communication among all involved injury prevention partners from a variety of backgrounds. Stakeholders understanding of injury prevention strategies is an important factor related to the successful and broad implementation of the strategies.24 30 31 The ASSQ provided practical and theoretical training, communication, advice and promotion activities to educate their members about TP feature recommendations for safety, which led to a strong compliance with the guide. The original contribution of this study may help injury prevention stakeholders to implement interventions into similar sports community contexts.
To implement injury prevention strategies in real-world sports injury prevention contexts, it is necessary to understand those contexts.24 30 Interventions that have been scientifically evaluated to be effective to prevent injuries under ‘ideal conditions’ may not be applicable in real-world settings. It is important to gather this information to understand what works in ideal conditions (fundamental research) and what works in uncontrolled conditions (applied research in sports community contexts).24 30 32 As shown in another study (Audet et al), according to stakeholders’ opinions, the recommendations from the guide are likely to help preventing injuries in TPs and can be applied to TP features without much difficulty. Therefore, the guide should contribute to prevent injuries in ideal conditions. This research adds relevant information suggesting that Québec TP features are likely to be compliant with the Guide. Our results suggest a widespread use of the Guide in Québec ski areas. The next step for further research should aim to study the association between the quality of TP features and the risk of injury to understand if the compliance with the guide actually prevents injuries in a real-world setting.
Study limitations
According to our research, the 59 assessed features in Québec TPs were highly compliant with the recommendations of the ASSQ guide. Therefore, we can assume that the overall quality of these features was very good. This situation could have affected the results of the binary logistic regression. The association between the factors explored in this study and TP feature compliance should be examined using a more heterogeneous sample (features with different quality).
The weather conditions for the 2017–2018 season were particularly challenging (a large amount of ice and rain) and might have affected the maintenance of features. However, this allowed us to measure TP feature compliance with the guide under real-world conditions reflecting a worst-case scenario.
The developed evaluation tool does not consider the relative importance of the recommendations from the ASSQ guide within the scope of injury prevention. Some recommendations are likely to be more effective than others. This should be explored in further studies.
Conclusion
The main objective of this research was to examine TP feature compliance with the ASSQ guide in Québec ski areas and explore factors that could be associated with compliance. Our results suggest that TP features in Québec ski areas are highly compliant with the guide. The study showed that the size of the TP, the size of the feature, the snow conditions and the type of feature were not associated with TP feature compliance. The ASSQ is one of the rare organisations following recommendations for the design, construction and maintenance of TPs. Our study describes the context of the implementation of the ASSQ guide. The findings could help other organisations or associations to implement similar injury prevention strategies in sport communities.
What is already known on the subject
Some aetiological and epidemiological studies report that injuries are more likely to be severe in terrain parks (TPs) than on regular slopes.
Features promoting acrobatic manoeuvres or large drops to the ground are associated with higher feature-specific injury rates and increased odds of injury.
There is a paucity of evidence related to standards for TPs but, as seen for playground injuries, there are reasons to believe that the quality of TP features may be associated with the risk of injury.
What this study adds
Terrain park (TP) feature recommendations from the Association des stations de ski du Québec guide are well followed in Québec ski areas. Generally, features are compliant with 91% of these recommendations.
Our results show no association between the studied factors (the size of the TP, the size of the feature, snow conditions, type of feature) and TP feature compliance with the guide.
This original research describes the implementation of a community-centred intervention that can inform prevention strategies in similar sports communities.
Data availability statement
Data are available on reasonable request.
Ethics statements
Ethics approval
The project was approved by the Ethics Committee of Université Laval (approbation number: 2015–277 A-2 R-2/26–01–2018). Furthermore, permission to access TPs during data collection was obtained from the Association des stations de ski du Québec and each of the ski area manager visited.
Acknowledgments
We would like to thank the Association des stations de ski du Québec for its collaboration in all steps of the project, and to have helped us to coordinate communications with their members. We would also like to thank all stakeholders who were involved in this study (scientists, policy-makers, TP designers, managers, patrollers, ski area operators). Finally, a special thanks to the research assistants Jean-Raphaël Breton, Joscelyn Audet, Sabrina Roy, and Vivano Nget who collected data in ski areas during the 2017
–2018 season.
References
Footnotes
Contributors OA was responsible of the data collection and trained the research assistants. OA and CG developed the design of the original article and were responsible for the interpretation of results. OA, CG and AKM drafted the manuscript. All authors reviewed the manuscript critically and gave final approval of the manuscript.
Funding OA was funded through studentships provided by the Alberta Innovates Collaborative Research and Innovation Award held by Carolyn Emery and BEH from the University of Calgary and the Québec Ministry of Education and Higher Education. Alison Macpherson was funded by a CIHR Chair in Maternal and Child Health Services and Policy Research.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.