Telemedicine in extreme sports

Purpose: The diffusion of telemedical technologies could provide the most significant advantages in outdoor sports that do not require a regulated playing field and may expose them to environmental variables and challenges in medical assistance. This systematic review describes the kind of interventions (e.g. consultation, data transmission) and the solution adopted. The aim is to stimulate further technological solutions and experiences promoting telemedicine in sports practice in outdoor environments. Methods: We searched the MEDLINE PubMed, Scopus, Web of Science, and Cochrane electronic databases, adopting a PICO strategy; and the PRISMA checklist. Two researchers independently reviewed the results. A specifically designed four- item telemedicine focused scoring system was set up to evaluate the studies qualitatively. Results: Out of 2,715 unique citations initially identified, 16 papers were included in the present review, and their quality was double blindly assessed using a specifically designed four-item scoring system. Telemedicine was used in high mountain sports (37.5%; n = 6), winter sports (18.7%; n = 3), watersports (25%; n = 4), and longdistance land sports (18.7%; n = 3). Telemedicine has been used for: monitoring vital signs and data transfer, teleconsulting, executing remote-controlled instrumental diagnosis and imaging guided procedures. The radio-transmitted electrophysiological data can be used in outdoor sports to analyze sport-specific muscle activity patterns, including complex and non-cyclical sporting gestures. These data may help identify less than optimal techniques to promote focused training, improve performance and reduce injury risk. Moreover, in seasonal sports practised on the water or the snow (i.e., windsurfing and alpine skiing), these data can help to set up a proper dry-land training modality. Conclusions: Telemedical technologies may be used to diagnose and treat sport- related and environmental conditions, including emergencies in extreme environments. By highlighting sport-specific, noncyclical sporting gestures in outdoor sports, physiological and pathological responses in extreme climatic conditions, and harsh environments, telemedicine may result in better preparation and management of sports practice, leading to performance improvement and injury prevention.