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Lloyd D. The future of in-field sports biomechanics: wearables plus modelling compute real-time in vivo tissue loading to prevent and repair musculoskeletal injuries. Sports Biomech 2024; 23:1284-1312. [PMID: 34496728 DOI: 10.1080/14763141.2021.1959947] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/20/2021] [Indexed: 01/13/2023]
Abstract
This paper explores the use of biomechanics in identifying the mechanistic causes of musculoskeletal tissue injury and degeneration. It appraises how biomechanics has been used to develop training programmes aiming to maintain or recover tissue health. Tissue health depends on the functional mechanical environment experienced by tissues during daily and rehabilitation activities. These environments are the result of the interactions between tissue motion, loading, biology, and morphology. Maintaining health of and/or repairing musculoskeletal tissues requires targeting the "ideal" in vivo tissue mechanics (i.e., loading and deformation), which may be enabled by appropriate real-time biofeedback. Recent research shows that biofeedback technologies may increase their quality and effectiveness by integrating a personalised neuromusculoskeletal modelling driven by real-time motion capture and medical imaging. Model personalisation is crucial in obtaining physically and physiologically valid predictions of tissue biomechanics. Model real-time execution is crucial and achieved by code optimisation and artificial intelligence methods. Furthermore, recent work has also shown that laboratory-based motion capture biomechanical measurements and modelling can be performed outside the laboratory with wearable sensors and artificial intelligence. The next stage is to combine these technologies into well-designed easy to use products to guide training to maintain or recover tissue health in the real-world.
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Affiliation(s)
- David Lloyd
- School of Health Sciences and Social Work, Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), in the Menzies Health Institute Queensland and Advanced Design and Prototyping Technologies Institute, Griffith University, Australia
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Lindblom H, Åkerlund I, Waldén M, Sonesson S, Hägglund M. Players are positive regarding injury prevention exercise programmes, but coaches need ongoing support: a survey-based evaluation using the Health Action Process Approach model across one season in amateur and youth football. BMJ Open Sport Exerc Med 2024; 10:e002009. [PMID: 38933370 PMCID: PMC11202753 DOI: 10.1136/bmjsem-2024-002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives Implementation of injury prevention exercise programmes (IPEPs) in sports is challenging, and behaviour change among players and coaches is essential for success. The aim was to describe players' and coaches' motivation and coaches' goal pursuit when using IPEPs in amateur and youth football across a season. A secondary aim was to describe players' motivation to engage in IPEP use in relation to presence or absence of injury. Methods The study was based on questionnaires to amateur and youth, male and female football players and coaches at baseline, mid-season and post-season in a three-armed randomised trial in 2020 in Sweden. Questionnaires were based on the Health Action Process Approach (HAPA) model with questions about the motivational phase when intention for change is created (players and coaches) and a goal-pursuit phase when intention is translated into action (coaches). Results In total, 455 players (126 male), mean age 20.1 years (SD±5.8, range 14-46) and 59 (52 male) coaches took part. Players generally gave positive answers in the HAPA motivational phase (Likert 6-7 on a 1-7 Likert scale). Differences in ratings between injured and uninjured players were minor. Coaches had positive or neutral ratings (Likert 4-6) in the motivational and goal-pursuit phases. Ratings deteriorated across the season, with less positive responses from 40% of players and 38-46% of coaches post-season. Conclusion Positive ratings in the HAPA motivational phase indicated fertile ground for IPEP use. Neutral ratings by coaches and deterioration across the season in players and coaches suggest a need for ongoing support for IPEP use. Trial registration number NCT04272047.
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Affiliation(s)
- Hanna Lindblom
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Sport Without Injury ProgrammE (SWIPE), Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ida Åkerlund
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Sport Without Injury ProgrammE (SWIPE), Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Markus Waldén
- Sport Without Injury ProgrammE (SWIPE), Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Capio Ortho Center Skåne, Malmö, Sweden
| | - Sofi Sonesson
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Sport Without Injury ProgrammE (SWIPE), Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Martin Hägglund
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Sport Without Injury ProgrammE (SWIPE), Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Petrevska M, Wright FV, Khan A, Munce S, Fehlings D, Biddiss E. Evaluating the impact of movement tracking feedback on engagement with home exercise programmes of children with cerebral palsy using a new therapy app: a protocol for a mixed-methods single-case experimental design with alternating treatments. BMJ Open 2024; 14:e082761. [PMID: 38503423 PMCID: PMC10952875 DOI: 10.1136/bmjopen-2023-082761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) with alternating treatments, using a new home therapy exercise application, Bootle Boot Camp (BBCamp), offered with and without movement tracking feedback. This study will explore the impact of feedback on engagement, movement quality, lower limb function and family experiences to help understand how technology-supported HEPs should be translated and the added value, if any, of movement tracking technology. METHODS AND ANALYSIS In this explanatory sequential mixed-methods study using a SCED, 16 children with CP (aged 6-12 years, Gross Motor Function Classification System levels I-II) will set lower limb goals and be prescribed an individualised HEP by their physiotherapist to complete using BBCamp on their home television equipped with a three-dimensional camera-computer system. Children will complete four weekly exercise sessions over 6 weeks. Children will be randomised to 1 of 16 alternating treatment schedules where BBCamp will provide or withhold feedback during the first 4 weeks. The version of BBCamp that results in the most therapeutic benefit will be continued for 2 final weeks. Goals will be re-evaluated and families interviewed. The primary outcome is adherence (proportion of prescribed exercise repetitions attempted) as a measure of behavioural engagement. Secondary outcomes are affective and cognitive engagement (smiley face ratings), exercise fidelity, lower limb function, goal achievement and participant experiences. SCED data will be analysed using visual and statistical methods. Quantitative and qualitative data will be integrated using joint displays. ETHICS AND DISSEMINATION Ethical approval was obtained from the Research Ethics Boards at Bloorview Research Institute and the University of Toronto. Results will be distributed through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER NCT05998239; pre-results.
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Affiliation(s)
- Marina Petrevska
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - F Virginia Wright
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ajmal Khan
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Sarah Munce
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elaine Biddiss
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Gladdines S, Eygendaal D, van Boekel L, Verhagen E, Beumer A. How to optimise the fidelity of exercises in an unsupervised golf injury prevention programme? A pilot study. BMJ Open Sport Exerc Med 2024; 10:e001681. [PMID: 38347860 PMCID: PMC10860048 DOI: 10.1136/bmjsem-2023-001681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 02/15/2024] Open
Abstract
Background Golf is an individual sport that is usually done without the supervision of a trainer or coach. Therefore, an injury prevention programme in golf will primarily be performed without supervision and feedback. However, the effectiveness of any preventive exercise programme is determined by exercise fidelity. Objective To investigate the different instruction options of an injury prevention programme on exercise fidelity in individual golfers. Methods We randomly assigned golfers to one of three groups receiving different exercise instructions. One group received only instructional cards (A), one received only instructional videos (B) and a third group (C) received both instructional cards and videos. The golfers were allowed to familiarise themselves with the exercises based on the provided instruction option, after which we recorded their exercise execution on video. Two authors independently scored each exercise's fidelity from these recordings. Results In total, 18 golfers (12 women and 6 men, average age of 61.94 years) were equally divided across the 3 study groups completed 108 exercises. In group A 73.7% of exercises were executed as intended, in group B 88.6% and in group C 86.3%. Significantly more exercises were conducted correctly in groups B and C compared with group A (p<0.05). Conclusion Golfers who received instructions that included a video explanation had a higher exercise fidelity when compared to only written instructions.
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Affiliation(s)
- Saskia Gladdines
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Leonieke van Boekel
- Department of Orthopaedic Surgery, FORCE (Foundation for Orthopaedic Research Care Education), Breda, The Netherlands
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centres – Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annechien Beumer
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
- Coronel Institute of Occupational Health, Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Silvers-Granelli H, Bizzini M, Mandelbaum B, Arundale A, Pohlig R, Snyder-Mackler L. High Compliance with the 11+ Injury Prevention Program Results in Better Win-Loss Records. Int J Sports Phys Ther 2023; 18:1065-1075. [PMID: 37795333 PMCID: PMC10547084 DOI: 10.26603/001c.87502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/09/2023] [Indexed: 10/06/2023] Open
Abstract
Background The 11+ injury prevention program (IPP) has been shown to decrease injury rates. However, few studies have investigated compliance and its overall relationship to team performance. Hypothesis/Purpose To examine if level of compliance while implementing the 11+ would impact team performance outcomes (wins, losses and ties). The authors hypothesized that higher team compliance to the IPP would be consistent with improved overall team performance (more wins and fewer losses). Study Design Prospective, cluster randomized controlled trial. Methods This study was conducted in NCAA men's soccer teams for one season and examined the efficacy of the 11+ IPP. The outcome variables examined were levels of compliance and team performance record: wins, losses, and ties. Twenty-seven teams (n=675 players) served as the intervention group (IG) and used the 11+ program while 34 teams (n=850 players) served as the control group (CG). Compliance and team performance were recorded. There were three compliance categories that were defined prospectively, low (LC, < 1 dose/week), moderate (MC, >1 and <2 doses/week), and high (HC, >2 doses/week). Descriptive and inferential tests were used to compare the CG, the IG, and compliance to team performance. Three independent t-tests were used to analyze outcome to group (IG vs. CG). A one way-MANOVA test was used to analyze compliance to win/loss/tie record, followed up by one-way ANOVA tests to analyze how compliance impacted wins, losses and ties, independently. Partial η2 measures were calculated to determine the effect size of level of compliance on outcome. A Tukey post-hoc analysis was used to analyze specific differences between levels of compliance and specific outcome measures. Results There were significantly more wins (IG: 10.67±2.63 versus CG: 8.15±3.83, CI, 7.95 - 9.69, p = 0.005) and fewer losses (IG: 5.56±1.97 versus CG: 8.12±3.59, CI, 5.66 to 7.43, p = 0.002) recorded for the teams using the 11+ program. There was a statistically significant difference between levels of compliance (high, moderate or low) on the dependent variables (wins, losses, and ties), F(3, 22) = 3.780, p =0.004; Wilks' Λ = .435; partial η2 = .340. Conclusion The 11+ has the capacity to improve overall team performance in male collegiate soccer teams. The higher the compliance, the more favorable the team performance. This research may be a vital addition when attempting to persuade coaching staffs to adopt an IPP into their training regimen. Level of Evidence Level I.
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Affiliation(s)
| | | | - Bert Mandelbaum
- Orthopaedic Surgery Cedars-Sinai Kerlan-Jobe Institute - Santa Monica
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Hughes T, O'Hara J, Burton A, London N, Emmonds S. Evaluating the impact of injury prevention interventions in child and adolescent sports using the RE-AIM framework and CERT: A systematic review. PLoS One 2023; 18:e0289065. [PMID: 37478075 PMCID: PMC10361493 DOI: 10.1371/journal.pone.0289065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/11/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Participation in sport is a popular pastime for children and adolescents that improves their physical health, mental health and motor skills. Musculoskeletal injuries are a relatively common downside of sports participation and can have negative long-term consequences. Injury prevention programmes have demonstrated effectiveness in child and adolescent sports, provided compliance is adequate. However, little is known about the factors which relate to their impact on the wider community and whether the prevention programmes have been adopted and maintained in the long-term. The objective of this review was to assess the current literature on exercise-based injury prevention interventions in child and adolescent sports (aged under 19 years) against the 'Reach', 'Effectiveness', 'Adoption', 'Implementation', 'Maintenance' (RE-AIM) framework and Consensus of Exercise Reporting Template (CERT), to ascertain level of reporting for the components which relate to external validity. METHODS Seven electronic databases; PubMed, Medline, SPORTDiscus, PsycINFO, CINAHL, Scopus and The Cochrane Library, were searched from date of inception to July 2022 using the themes of: 'Child and Adolescent', 'Sport', 'Injury' and 'Prevention'. Eligibility criteria included: Experimental trial design, exercise-based intervention programmes, primary outcome of injury incidence and participants aged under 19 years. Two reviewers assessed each trial independently against the RE-AIM model dimension items checklist (RE-AIM MDIC) and Consensus on Exercise Reporting Template (CERT) before reaching a consensus on reporting. RESULTS Forty-five unique trials met the eligibility criteria. Mean reporting level for all studies across the whole RE-AIM MDIC was 31% (SD ± 16.2%, Range 7-77%). The domain of 'effectiveness' was the most comprehensively reported (60%), followed by 'implementation' (48%), 'reach' (38%), 'adoption' (26%) and 'maintenance' (7%). The mean reporting score for the CERT was 50% (SD ± 20.8, range 0-81%). CONCLUSION Published data on injury prevention in child and adolescent sports is highly focussed on the effectiveness of the intervention, with little consideration given to how it will be adopted and maintained in the long-term. This has led to considerable gaps in knowledge regarding optimal programme implementation, with a lack of data on adoption and maintenance contributing to the gap between research and practice. Future research needs to place greater focus on external validity and consider incorporating the study of implementation and feasibility as part of effectiveness trial design. This approach should provide the data that will help narrow the considerable gap between science and practice. TRIAL REGISTRATION PROSPERO Registration number CRD42021272847.
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Affiliation(s)
- Thomas Hughes
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
| | - John O'Hara
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
| | - Alan Burton
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
| | - Nick London
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- The Yorkshire Knee Clinic, Nuffield Health Leeds Hospital, Leeds, United Kingdom
| | - Stacey Emmonds
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
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Räisänen AM, Galarneau JM, van den Berg C, Eliason P, Benson LC, Owoeye OBA, Pasanen K, Hagel B, Emery CA. Who Does Not Respond to Injury Prevention Warm-up Programs? A Secondary Analysis of Trial Data From Neuromuscular Training Programs in Youth Basketball, Soccer, and Physical Education. J Orthop Sports Phys Ther 2023; 53:94-102. [PMID: 36484352 DOI: 10.2519/jospt.2022.11526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES: To identify factors associated with nonresponse to neuromuscular training (NMT) warm-up programs among youth exposed to NMT warm-ups. METHODS: This is a secondary analysis of youth (aged 11-18 years) in the intervention groups of 4 randomized controlled trials in high school basketball, youth community soccer, and junior high school physical education. Youth who were exposed to NMT and who sustained an injury during the study were considered nonresponders. Odds ratios (ORs) were based on generalized estimating equations logistic regression controlling for clustering by team/class and adjusted for age, weight, height, balance performance, injury history, sex, and sport (soccer/basketball/physical education). RESULTS: A total of 1793 youth were included. Youth with a history of injury in the previous year had higher odds (OR = 1.64; 95% CI: 1.14, 2.37) of injury during the study, and females were more likely (OR = 1.67; 95% CI: 1.21, 2.31) to sustain an injury than males who were participating in NMT. Age was not associated with the odds of sustaining an injury (OR = 1.10; 95% CI: 0.93, 1.30). Soccer players benefited most from greater adherence, with 81% lower odds of injury (OR = 0.19; 95% CI: 0.06, 0.57) when completing 3 NMT sessions a week compared with 1 session per week. CONCLUSION: Factors associated with nonresponse to an NMT warm-up program were female sex, history of injury during the previous 12 months, and lower weekly NMT session adherence in some sports (soccer). J Orthop Sports Phys Ther 2023;53(2):94-102. Epub: 9 December 2022. doi:10.2519/jospt.2022.11526.
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Patterson BE, Donaldson A, Cowan SM, King MG, Barton CG, McPhail SM, Hagglund M, White NM, Lannin NA, Ackerman IN, Dowsey MM, Hemming K, Makdissi M, Culvenor AG, Mosler AB, Bruder AM, Choong J, Livingstone N, Elliott RK, Nikolic A, Fitzpatrick J, Crain J, Haberfield MJ, Roughead EA, Birch E, Lampard SJ, Bonello C, Chilman KL, Crossley KM. Evaluation of an injury prevention programme (Prep-to-Play) in women and girls playing Australian Football: design of a pragmatic, type III, hybrid implementation-effectiveness, stepped-wedge, cluster randomised controlled trial. BMJ Open 2022; 12:e062483. [PMID: 36104145 PMCID: PMC9476120 DOI: 10.1136/bmjopen-2022-062483] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Due to the increase in participation and risk of anterior cruciate ligament (ACL) injuries and concussion in women's Australian Football, an injury prevention programme (Prep-to-Play) was codesigned with consumers (eg, coaches, players) and stakeholders (eg, the Australian Football League). The impact of supported and unsupported interventions on the use of Prep-to-Play (primary aim) and injury rates (secondary aim) will be evaluated in women and girls playing community Australian Football. METHODS AND ANALYSIS This stepped-wedge, cluster randomised controlled trial will include ≥140 teams from U16, U18 or senior women's competitions. All 10 geographically separated clusters (each containing ≥14 teams) will start in the control (unsupported) phase and be randomised to one of five dates (or 'wedges') during the 2021 or 2022 season to sequentially transition to the intervention (supported Prep-to-Play), until all teams receive the intervention. Prep-to-Play includes four elements: a neuromuscular training warm-up, contact-focussed football skills (eg, tackling), strength exercises and education (eg, technique cues). When transitioning to supported interventions, study physiotherapists will deliver a workshop to coaches and player leaders on how to use Prep-to-Play, attend team training at least two times and provide ongoing support. In the unsupported phase, team will continue usual routines and may freely access available Prep-to-Play resources online (eg, posters and videos about the four elements), but without additional face-to-face support. Outcomes will be evaluated throughout the 2021 and 2022 seasons (~14 weeks per season). PRIMARY OUTCOME use of Prep-to-Play will be reported via a team designate (weekly) and an independent observer (five visits over the two seasons) and defined as the team completing 75% of the programme, two-thirds (67%) of the time. SECONDARY OUTCOMES injuries will be reported by the team sports trainer and/or players. Injury definition: any injury occurring during a football match or training that results in: (1) being unable to return to the field of play for that match or (2) missing ≥ one match. Outcomes in the supported and unsupported phases will be compared using a generalised linear mixed model adjusting for clustering and time. Due to the type III hybrid implementation-effectiveness design, the study is powered to detect a improvement in use of Prep-to-Play and a reduction in ACL injuries. ETHICS AND DISSEMINATION La Trobe University Ethics Committee (HREC 20488) approved. Coaches provided informed consent to receive the supported intervention and players provided consent to be contacted if they sustained a head or knee injury. Results will be disseminated through partner organisations, peer-reviewed publications and scientific conferences. TRIAL REGISTRATION NUMBER NCT04856241.
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Affiliation(s)
- Brooke E Patterson
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Alex Donaldson
- Centre for Sport and Social Impact, La Trobe University, Melbourne, Victoria, Australia
| | - Sallie M Cowan
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Matthew G King
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Christian G Barton
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Steven M McPhail
- Australian Centre for Health Service Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Digital Health and Informatics, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Martin Hagglund
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linkopings Universitet, Linkoping, Östergötland, Sweden
| | - Nicole M White
- Australian Centre for Health Service Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Clayton, Victoria, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, St.Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Michael Makdissi
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Andrea B Mosler
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Andrea M Bruder
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Jessica Choong
- Medibank Better Health Foundation, Medibank Private, Melbourne, Victoria, Australia
| | | | | | - Anja Nikolic
- Australian Physiotherapy Association, Hawthorn, Victoria, Australia
| | - Jane Fitzpatrick
- Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
| | - Jamie Crain
- Sports Medicine Australia, Albert Park, Victoria, Australia
| | - Melissa J Haberfield
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Eliza A Roughead
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Elizabeth Birch
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Sarah J Lampard
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Christian Bonello
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Karina L Chilman
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
| | - Kay M Crossley
- Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia
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Barden C, Hancock MV, Stokes KA, Roberts SP, McKay CD. Effectiveness of the Activate injury prevention exercise programme to prevent injury in schoolboy rugby union. Br J Sports Med 2022; 56:812-817. [PMID: 35387776 DOI: 10.1136/bjsports-2021-105170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The efficacious Activate injury prevention exercise programme has been shown to prevent injuries in English schoolboy rugby union. There is now a need to assess the implementation and effectiveness of Activate in the applie setting. METHODS This quasi-experimental study used a 24-hour time-loss injury definition to calculate incidence (/1000 hours) and burden (days lost/1000 hours) for individuals whose teams adopted Activate (used Activate during season) versus non-adopters. The dose-response relationship of varying levels of Activate adherence (median Activate sessions per week) was also assessed. Player-level rugby exposure, sessional Activate adoption and injury reports were recorded by school gatekeepers. Rate ratios (RR), adjusted by cluster (team), were calculated using backwards stepwise Poisson regression to compare rates between adoption and adherence groups. RESULTS Individuals in teams adopting Activate had a 23% lower match injury incidence (RR 0.77, 95% CI 0.55 to 1.07), 59% lower training injury incidence (RR 0.41, 95% CI 0.17 to 0.97) and 26% lower match injury burden (95% CI 0.46 to 1.20) than individuals on non-adopting teams. Individuals with high Activate adherence (≥3 sessions per week) had a 67% lower training injury incidence (RR 0.33, 95% CI 0.12 to 0.91) and a 32% lower match injury incidence (RR 0.68, 95% CI 0.50 to 0.92) than individuals with low adherence (<1 session per week). While 65% of teams adopted Activate during the season, only one team used Activate three times per week, using whole phases and programme progressions. CONCLUSION Activate is effective at preventing injury in English schoolboy rugby. Attention should focus on factors influencing programme uptake and implementation, ensuring Activate can have maximal benefit.
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Affiliation(s)
- Craig Barden
- Department for Health, University of Bath, Bath, UK .,School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | | | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK.,Rugby Football Union, Twickenham, UK
| | | | - Carly D McKay
- Department for Health, University of Bath, Bath, UK.,Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UK
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2022 Bern Consensus Statement on Shoulder Injury Prevention, Rehabilitation, and Return to Sport for Athletes at All Participation Levels. J Orthop Sports Phys Ther 2022; 52:11-28. [PMID: 34972489 DOI: 10.2519/jospt.2022.10952] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is an absence of high-quality evidence to support rehabilitation and return-to-sport decisions following shoulder injuries in athletes. The Athlete Shoulder Consensus Group was convened to lead a consensus process that aimed to produce best-practice guidance for clinicians, athletes, and coaches for managing shoulder injuries in sport. We developed the consensus via a 2-round Delphi process (involving more than 40 content and methods experts) and an in-person meeting. This consensus statement provides guidance with respect to load and risk management, supporting athlete shoulder rehabilitation, and decision making during the return-to-sport process. This statement is designed to offer clinicians the flexibility to apply principle-based approaches to managing the return-to-sport process within a variety of sporting backgrounds. The principles and consensus of experts working across multiple sports may provide a template for developing additional sport-specific guidance in the future. J Orthop Sports Phys Ther 2022;52(1):11-28. doi:10.2519/jospt.2022.10952.
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11
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Räisänen AM, van den Berg C, Owoeye OB, McKay CD, Emery CA. Running Every Time, Planking Sometimes: Youth Adherence to a Neuromuscular Training Program. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2022. [DOI: 10.1249/tjx.0000000000000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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High compliance with the injury prevention exercise programme Knee Control is associated with a greater injury preventive effect in male, but not in female, youth floorball players. Knee Surg Sports Traumatol Arthrosc 2022; 30:1480-1490. [PMID: 34213586 PMCID: PMC9007760 DOI: 10.1007/s00167-021-06644-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/10/2021] [Indexed: 12/04/2022]
Abstract
PURPOSE Evaluate team and player compliance with the Knee Control injury prevention exercise programme, study the association between player compliance and injury rates, and compare coach demographics, baseline prevention expectancies, and programme utilisation between teams with high and low compliance. METHODS Prospective one-season cohort study based on a cluster randomised controlled trial on 301 (107 female) floorball players aged 12-17 years. Floorball exposure and injuries were self-reported weekly by players using the Oslo Sports Trauma Research Center questionnaire. Team and player compliance to Knee Control was reported monthly by coaches. Additionally, coaches answered pre- and post-season surveys. Teams were divided into a high (≥ 80%) or low (< 80%) compliance group based on their use of Knee Control during the season. Players were divided into three compliance groups based on their average weekly number of Knee Control sessions; high (≥ 2 sessions), intermediate (≥ 1 to < 2 sessions), and low dose (< 1 session). RESULTS Mean team compliance for the high and low compliance groups were 95% (range 82-100) and 50% (range 13-66), respectively. Mean ± SD weekly Knee Control dose in the three player compliance groups were 2.4 ± 0.3, 1.4 ± 0.3, and 0.7 ± 0.3 sessions, respectively. There were no differences in total injury incidence between the player compliance groups, but players in the high-dose group had a 35% lower prevalence of injuries overall [adjusted prevalence rate ratio (PRR) 0.65, 95% CI 0.48-0.89] and 60% lower prevalence of substantial injuries (adjusted PRR 0.40, 95% CI 0.26-0.61) compared with the low-dose group. Male players in the high-dose group had consistently lower injury incidence and prevalence, while no between compliance group differences were seen in female players. There were no differences in sex, years of coaching experience, or baseline prevention expectancies in general between coaches for teams in the high vs. low compliance groups, but teams in the high compliance group had a better utilisation fidelity. CONCLUSION There was a clear dose-response relationship between more frequent Knee Control use and lower injury rates in male floorball players, but not in female players. Teams with higher compliance also showed a better utilisation fidelity with the programme. LEVEL OF EVIDENCE Level II.
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Weir G. Anterior cruciate ligament injury prevention in sport: biomechanically informed approaches. Sports Biomech 2021:1-21. [PMID: 34965847 DOI: 10.1080/14763141.2021.2016925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 12/06/2021] [Indexed: 01/14/2023]
Abstract
This paper reviews a series of studies contributing to a framework for preventing anterior cruciate ligament (ACL) injuries in sport. As the majority of these injuries are non-contact in nature, theoretically, these injuries are preventable. The studies presented in this paper focus on understanding biomechanical countermeasures of ACL injury and how this knowledge can inform both screening and training intervention research and practice in sport. These countermeasures include: 1) modifying an athlete's technique to reduce externally applied loads to the knee; 2) increasing the muscle support around the knee and hip to counter elevated loads applied to the knee and; 3) improving an athlete's perception during dynamic sports tasks to increase planning time to coordinate desirable movement patterns. By furthering the empirical evidence of modifiable biomechanical countermeasures of ACL injury risk, we can better understand best practices for developing interventions on a mass scale to prevent ACL injuries in the sporting community.
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Affiliation(s)
- Gillian Weir
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA, USA
- School of Human Sciences, University of Western Australia, Perth, Australia
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14
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Befus K, McDonough MH, Räisänen AM, Owoeye OBA, Pasanen K, Emery CA. Player adherence to SHRed injuries Basketball neuromuscular training warm‐up program: Can exercise fidelity be objectively measured? TRANSLATIONAL SPORTS MEDICINE 2021. [DOI: 10.1002/tsm2.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kimberley Befus
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary Alberta Canada
| | - Meghan H. McDonough
- Faculty of Kinesiology University of Calgary Calgary Alberta Canada
- O’Brien Institute of Public Health University of Calgary Calgary Alberta Canada
| | - Anu M. Räisänen
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary Alberta Canada
- Department of Physical Therapy Education College of Health Sciences – Northwest Western University of Health Sciences Lebanon Oregon USA
| | - Oluwatoyosi B. A. Owoeye
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary Alberta Canada
- Department of Physical Therapy and Athletic Training Doisy College of Health Sciences Saint Louis University Saint Louis Missouri USA
| | - Kati Pasanen
- Alberta Children’s Hospital Research Institute University of Calgary Calgary Alberta Canada
- McCaig Institute for Bone and Joint Health University of Calgary Calgary Alberta Canada
- Tampere Research Center of Sports Medicine UKK Institute Tampere Finland
| | - Carolyn A. Emery
- Sport Injury Prevention Research Centre Faculty of Kinesiology University of Calgary Calgary Alberta Canada
- O’Brien Institute of Public Health University of Calgary Calgary Alberta Canada
- Alberta Children’s Hospital Research Institute University of Calgary Calgary Alberta Canada
- McCaig Institute for Bone and Joint Health University of Calgary Calgary Alberta Canada
- Department of Pediatrics Cumming School of Medicine University of Calgary Calgary Alberta Canada
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15
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Rowe PL, Bryant AL, Paterson KL. Current ankle sprain prevention and management strategies of netball athletes: a scoping review of the literature and comparison with best-practice recommendations. BMC Sports Sci Med Rehabil 2021; 13:113. [PMID: 34537083 PMCID: PMC8449445 DOI: 10.1186/s13102-021-00342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/11/2021] [Indexed: 11/20/2022]
Abstract
Background Ankle sprains are the most commonly reported injury in netball. Approximately four in five netball athletes will sustain an ankle sprain, up to half will go on to sustain recurrent ankle sprains, and nine in ten report perceived ankle instability. Historically, prevention and management strategies of ankle sprains and injuries have been investigated for a variety of sports, however, no literature reviews have investigated these in netball athletes, or compared these with current best-practice within the literature. Therefore, this scoping review aims to understand how netball athletes currently prevent and manage ankle sprains and to compare these approaches with best-practice recommendations. Methods A literature search was conducted using MEDLINE, CINAHL, and SPORTDiscus databases using keywords to capture studies with data or information related to the prevention and management of ankle sprains and injuries in netball. Results The search strategy captured 982 studies across all databases, with 30 netball studies included in this scoping review. Studies suggest netball athletes are not commonly referred to health professionals, do not undertake adequate rehabilitation, and almost immediately return to court following an ankle sprain or injury. Current best-practices suggest injury prevention programs and external ankle support effectively reduce ankle sprains and injuries; however, poor compliance and implementation may be a significant barrier. Currently, there is a lack of evidence that netball-specific footwear reduces the risk of ankle sprains. Conclusion The findings suggest netball athletes do not implement current best-practice prevention and management strategies following an ankle sprain. This is despite evidence of the effectiveness of injury prevention programs, external ankle support, and adequate rehabilitation in reducing ankle sprain rates. Current-best practice prevention and management of ankle sprains should be considered by clinicians, coaches, and athletes to reduce the prevalence and chronicity of ankle sprains in netball. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00342-9.
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Affiliation(s)
- Patrick L Rowe
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Adam L Bryant
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Kade L Paterson
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
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16
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Krug MI, Vacek PM, Choquette R, Beynnon BD, Slauterbeck JR. Compliance and Fidelity With an Injury Prevention Exercise Program in High School Athletics. Sports Health 2021; 14:483-489. [PMID: 34490822 DOI: 10.1177/19417381211043120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Use of injury prevention programs (IPPs) by high school athletes has increased but their success in reducing injury depends on program compliance and fidelity of exercise performance. HYPOTHESIS Compliance with the 11+ IPP and exercise performance fidelity by high school athletic teams depend on sex, sport, and level of play. STUDY DESIGN Secondary analyses of data from a randomized controlled trial (RCT). LEVEL OF EVIDENCE Level 2. METHODS The 11+ IPP was implemented by 100 male and female high school athletic teams (American football, soccer, basketball, and lacrosse). Team compliance and fidelity with the program were evaluated by direct observation of warm-up routines and a weekly online survey completed by coaches. Differences in compliance and fidelity due to sport, sex, and level of play were assessed by analysis of variance. RESULTS Coaches reported that their teams performed the full IPP an average of 1.45 times per week, and 28% of observed warm-ups included all exercises in the IPP. Compliance differed by sport but not by level of play or the athletes' sex. At the end of the season, cueing was observed 19% of the time and differed by sport. Good technique was observed 66% of the time and varied by level of play. CONCLUSION Team compliance with the IPP varied by sport and was below the recommended number of sessions per week needed to reduce injury. Removal of implementation barriers and improved support from coaches are needed at all levels of play for IPPs to be effective. CLINICAL RELEVANCE Clinical and sports practitioners intending to implement an IPP at the high school level should anticipate and address barriers that affect program compliance and fidelity of exercise performance. Frequent follow-up and instruction may be necessary for successful adoption of the IPP.
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Affiliation(s)
- Mickey I Krug
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Pamela M Vacek
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
| | - Rebecca Choquette
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Bruce D Beynnon
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - James R Slauterbeck
- McClure Musculoskeletal Research Center, Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont
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Møller M, Zebis MK, Myklebust G, Lind M, Wedderkopp N, Bekker S. "Is it fun and does it enhance my performance?" - Key implementation considerations for injury prevention programs in youth handball. J Sci Med Sport 2021; 24:1136-1142. [PMID: 34167894 DOI: 10.1016/j.jsams.2021.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We aimed to determine the use of injury prevention exercises and injury prevention exercise programs in Danish youth handball and investigate coach and player experiences, beliefs and attitudes of injury and their prevention. DESIGN A mixed-methods design consisting of cross-sectional quantitative surveys and qualitative interviews. METHODS We surveyed 481 youth (14-18 years old) handball players and their 33 coaches about their use of injury prevention exercises, and attitudes towards injury and their prevention. Additionally, we interviewed five coaches and three players about barriers and motivational factors for implementing injury prevention programs. RESULTS Players (71%) and almost all coaches reported performing injury prevention exercises for the shoulder, knee, and ankle. Yet few players (4%) and coaches (1%) reported performing the established full injury prevention programs systematically. Players were willing to implement programs to reduce injury risk (84% agreed) and enhance performance (88% agreed). Key factors influencing program uptake were lack of awareness of evidence-based injury prevention programs and lack of handball-specific exercises. Coaches and players identified continued education and training as vital facilitators in this setting, and all coaches agreed that injury prevention should be an essential part of coach education. CONCLUSIONS While Danish youth handball players and coaches seemed to recognize the importance of injury prevention, the use of established programs was marginal. Experiences, beliefs, and attitudes about injury and injury prevention influenced program uptake and should be addressed through continued education and training in this context in combination with making the programs more handball specific.
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Affiliation(s)
- Merete Møller
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark.
| | - Mette K Zebis
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Denmark
| | - Grethe Myklebust
- Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Norway
| | - Martin Lind
- Div. of Sportstraumatology, Aarhus University Hospital, Denmark
| | - Niels Wedderkopp
- Orthopedic Department, University Hospital of South West Jutland, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Sheree Bekker
- Department for Health, University of Bath, United Kingdom
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18
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Barden C, Stokes KA, McKay CD. Implementation of the Activate injury prevention exercise programme in English schoolboy rugby union. BMJ Open Sport Exerc Med 2021; 7:e001018. [PMID: 34012555 PMCID: PMC8098930 DOI: 10.1136/bmjsem-2020-001018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives The implementation of the Activate injury prevention exercise programme has not been assessed in an applied context. This study aimed to (1) describe the knowledge and perceptions of school rugby coaches and players towards injury risk, prevention and Activate and (2) evaluate Activate implementation in schoolboy rugby using the reach, effectiveness, adoption, implementation and maintenance framework. Methods Bespoke electronic surveys were administered to coaches (including support staff) and players at participating English schools (2018–2020). Most questions and statements were answered using a 7-point Likert scale. At baseline, participants detailed their Activate awareness and perceptions of injury risk and prevention in schoolboy rugby. At postseason, participants reported Activate use throughout the study and their perceptions towards the programme. Results At baseline, significant differences existed between coaches (n=106) and players (n=571) in Activate awareness (75% and 13% respectively; χ2=173.5, p<0.001). Coaches perceived rugby had a significantly greater injury risk than players, while holding more positive perceptions towards injury prevention. At postseason, coaches reported greater Activate adoption compared with players (76% and 18% respectively; χ2=41.8, p<0.001); 45% of players were unaware if they used the programme. Median session adherence was twice weekly, with a median duration of 10–15 min. This suggests Activate was not implemented as intended, with recommendations of three 20 min sessions per week. Both groups identified common barriers to implementation, such as lack of time and inclusion of a ball. Conclusion Coaches are instrumental in the decision to implement Activate. Targeting behavioural change in these individuals is likely to have the greatest impact on intervention uptake.
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Affiliation(s)
- Craig Barden
- Department for Health, University of Bath, Bath, UK
| | - Keith A Stokes
- Department for Health, University of Bath, Bath, UK.,Rugby Football Union, Twickenham, London, UK
| | - Carly D McKay
- Department for Health, University of Bath, Bath, UK.,Centre for Motivation and Health Behaviour Change, University of Bath, Bath, UK
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19
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van der Horst N, Hoef SVD, Otterloo PV, Klein M, Brink M, Backx F. Effective But Not Adhered to: How Can We Improve Adherence to Evidence-Based Hamstring Injury Prevention in Amateur Football? Clin J Sport Med 2021; 31:42-48. [PMID: 30550415 DOI: 10.1097/jsm.0000000000000710] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate adherence to a Nordic hamstring exercise (NHE) program in a real-world context of male amateur football, and the perceptions of end users (players) and intervention deliverers (coaches and medical staff) about adherence to this proven effective program. DESIGN Retrospective cohort study. SETTING Dutch amateur football. PARTICIPANTS Two hundred sixty-four players, 23 coaches, and 29 medical staff from Dutch amateur football teams that participated in a national randomized controlled trial 2 years earlier. INDEPENDENT VARIABLES Nordic hamstring exercise program. MAIN OUTCOME MEASURES Nordic hamstring exercise program adherence during 2014 and 2015. Intervention or control group allocation during the trial, transfers, and personal perception about adherence to the program were also examined. RESULTS Of all players, 69% reported never, 16% sometimes, 6% frequently, 5% often, and 4% always performing exercises of the NHE program. Adherence to the NHE program was higher among players who had been in the NHE arm of the previous trial and among players who had not been transferred to another club compared with players who had been transferred. Key factors in stimulating players to adhere to the NHE program were knowledge of the NHE and personal motivation. Coaches and medical staff members also mentioned personal motivation and consensus with team staff as key factors to encourage NHE adherence. CONCLUSIONS Among high-level male amateur football players, adherence to an evidence-based hamstring injury-prevention program was very low. It is essential to recognize factors that stimulate or limit adherence to injury-prevention programs for effective programs to actually lead to a reduction in hamstring injuries in a real-world context.
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Affiliation(s)
- Nick van der Horst
- Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands ; and
| | - Sander van de Hoef
- Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands ; and
| | - Paul van Otterloo
- Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands ; and
| | - Milan Klein
- Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands ; and
| | - Michel Brink
- Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands ; and
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Frank Backx
- Department of Rehabilitation, Physical Therapy Science and Sports, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Utrecht, the Netherlands ; and
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20
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Fortington LV, Bekker S, Finch CF. Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study. Emerg Med J 2020; 37:617-622. [PMID: 32546475 PMCID: PMC7525771 DOI: 10.1136/emermed-2019-208781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 01/27/2020] [Accepted: 05/02/2020] [Indexed: 12/03/2022]
Abstract
INTRODUCTION A voluntary State Government-led programme in Victoria, Australia 'Defibrillators for Sporting Clubs and Facilities Program' ran from 2015 to 2019, broadly aimed at increasing access to automated external defibrillators (AEDs), together with a greater number of community members trained for management of medical emergencies. This study aimed to understand whether participating sport clubs/facilities had successfully integrated an AED and medical planning with other club/facility safety practices, 12 months after delivery of the programme. METHODS This was a qualitative case study of 14 sport clubs/facilities in Victoria, Australia in 2017, underpinned by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We conducted observational audits of facilities (to locate AED placement, signage and other relevant location-specific factors) and semi-structured, face-to-face interviews with representatives of the clubs/facilities. Interview questions were designed to determine if and how the related, mandated emergency management programme was adapted for the long term (embedding), whether this aligned to ongoing organisational mission (active engagement), and whether or not it was still ongoing 6 months postinitial implementation (sustainability). Data were evaluated using qualitative descriptive methodology. For reporting, descriptive summaries of the audit were combined with interview data to contextualise and visualise the sport club/facility setting and key results. RESULTS Key issues identified were accessibility and visibility of the AED, with inadequate signage and challenges identifying an efficient location for access and storage. Most interviewees reported the AED and training were received with no further actions taken towards safety planning or integration with club/facility practice. Several challenges regarding remaining up to date with training and ensuring required routine checks of the AED take place were also raised. CONCLUSIONS This study identified several challenges for community sport clubs/facilities in the implementation of an AED and medical planning programme, including where to store the AED, how to make its presence known to the community and how to integrate changes alongside other club/facility practices.
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Affiliation(s)
- Lauren V Fortington
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sheree Bekker
- Department for Health, University of Bath, Bath, Somerset, UK
| | - Caroline F Finch
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Owoeye OBA, Emery CA, Befus K, Palacios-Derflingher L, Pasanen K. How much, how often, how well? Adherence to a neuromuscular training warm-up injury prevention program in youth basketball. J Sports Sci 2020; 38:2329-2337. [PMID: 32588750 DOI: 10.1080/02640414.2020.1782578] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Adherence is a key implementation outcome that determines the effectiveness of an intervention. This study, an observational design involving coaches and players from 33 high school basketball teams, evaluated the dimensions of adherence to a basketball-specific neuromuscular training (NMT) warm-up program in youth basketball. Coach adherence (daily report of team adherence) was collected prospectively. Adherence measures: cumulative utilization (proportion of total sessions possible), utilization fidelity (average # of exercises completed per NMT session), utilization frequency (average # of NMT sessions completed per week) were calculated and further evaluated for optimal adherence (≥80%, ≥10.4 exercises/session and ≥2 sessions/week, respectively) per coach. Additionally, exercise fidelity (proportion of players performing individual exercises correctly) was assessed. Coach (n = 31; 27-59 years) median cumulative utilization was 80%, utilization fidelity was 12 (of a possible 13 exercises per session) and utilization frequency was 2.3 sessions per week. Optimal adherence ranged from 52% to 71% across measures of adherence. Player exercise fidelity was 48%. Time constraint (47%) was the most frequently reported adherence barrier. While coach adherence to the NMT warm-up program was reasonably high across measures of adherence, a considerable proportion of coaches did not attain optimal adherence levels and player exercise fidelity was low.
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Affiliation(s)
- Oluwatoyosi B A Owoeye
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University , Saint Louis, MO, USA.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary , Calgary, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary , Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary , Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary , Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary , Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary , Calgary, Canada
| | - Kimberley Befus
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary , Calgary, Canada
| | - Luz Palacios-Derflingher
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary , Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary , Calgary, Canada
| | - Kati Pasanen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary , Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary , Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary , Calgary, Canada.,Tampere Research Center of Sport Medicine, UKK Institute , Tampere, Finland
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22
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Perera NK, Hägglund M. We have the injury prevention exercise programme, but how well do youth follow it? J Sci Med Sport 2020; 23:463-468. [DOI: 10.1016/j.jsams.2019.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/05/2019] [Accepted: 11/13/2019] [Indexed: 11/28/2022]
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23
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García–Fernández P, Guodemar–Pérez J, Ruiz-López M, Rodríguez-López E, García-Heras A, Hervás–Pérez J. Epidemiología lesional en jugadores españoles de padel profesionales y amateur. REVISTA INTERNACIONAL DE MEDICINA Y CIENCIAS DE LA ACTIVIDAD FÍSICA Y DEL DEPORTE 2019. [DOI: 10.15366/rimcafd2019.76.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Donaldson A, Gabbe BJ, Lloyd DG, Cook J, Finch CF. Controlled ecological evaluation of an implemented exercise training programme to prevent lower limb injuries in sport: differences in implementation activity. Inj Prev 2019; 25:480-486. [PMID: 29691316 PMCID: PMC6900239 DOI: 10.1136/injuryprev-2017-042579] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/03/2017] [Accepted: 12/06/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The public health benefits of injury prevention programmes are maximised when programmes are widely adopted and adhered to. Therefore, these programmes require appropriate implementation support. This study evaluated implementation activity outcomes associated with the implementation of FootyFirst, an exercise training injury prevention programme for community Australian football, both with (FootyFirst+S) and without (FootyFirst+NS) implementation support. METHOD An evaluation plan based on the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Sports Setting Matrix was applied in a controlled ecological evaluation of the implementation of FootyFirst. RE-AIM dimension-specific (range: 0-2) and total RE-AIM scores (range: 0-10) were derived by triangulating data from a number of sources (including surveys, interviews, direct observations and notes) describing FootyFirst implementation activities. The mean dimension-specific and total scores were compared for clubs in regions receiving FootyFirst+S and FootyFirst+NS, through analysis of variance. RESULTS The mean total RE-AIM score forclubs in the FootyFirst+S regions was 2.4 times higher than for clubs in the FootyFirst+NS region (4.73 vs 1.94; 95% CI for the difference: 1.64 to 3.74). Similarly, all dimension-specific scores were significantly higher for clubs in the FootyFirst+S regions compared with clubs in the FootyFirst+NS region. In all regions, the dimension-specific scores were highest for reach and adoption, and lowest for implementation. CONCLUSION Implementing exercise training injury prevention programmes in community sport is challenging. Delivering programme content supported by a context-specific and evidence-informed implementation plan leads to greater implementation activity, which is an important precursor to injury reductions.
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Affiliation(s)
- Alex Donaldson
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Edith Cowan University, Perth, Western Australia, Australia
- Centre for Sport and Social Impact, La Trobe University, Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- Prehospital, Emergency and Trauma Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Farr Institute, Swansea University Medical School, Swansea University, Swansea, UK
| | - David G Lloyd
- Gold Coast Orthopaedic Research and Education Alliance (GCORE), Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Jill Cook
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Edith Cowan University, Perth, Western Australia, Australia
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Edith Cowan University, Perth, Western Australia, Australia
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Ljunggren G, Perera NKP, Hägglund M. Inter-rater Reliability in Assessing Exercise Fidelity for the Injury Prevention Exercise Programme Knee Control in Youth Football Players. SPORTS MEDICINE - OPEN 2019; 5:35. [PMID: 31392441 PMCID: PMC6686029 DOI: 10.1186/s40798-019-0209-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/29/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND To receive maximum benefits from injury prevention exercise programmes (IPEP) such as Knee Control, players need to perform the exercises as prescribed. But, exercise fidelity in IPEPs is seldom evaluated. We developed a checklist to assess exercise fidelity in the Knee Control IPEP, and the primary aim was to evaluate its inter-rater reliability. The secondary aim was to study Knee Control exercise fidelity in youth football players and compare sex differences. METHODS This observational study included 11 teams with male and female youth players (11-18 years). On average, the players trained with the Knee Control IPEP for 7 weeks (SD 1.4, range 6-10 weeks). After the training period, two physiotherapists attended a team training session to observe players executing exercises and individually assessed their performance of these exercises as correct or incorrect based on standardised criteria set in the fidelity checklist. Agreement between observers was assessed using Cohen's kappa coefficient. RESULTS The observers agreed on 144 out of 160 (90%) observations (Kappa = 0.80, substantial agreement). Both observers agreed on correct exercise performance for 69 out of 144 observations (exercise fidelity 48%). Exercise fidelity was higher in females (56%) than males (40%), but the difference was not statistically significant (p = 0.18). CONCLUSION The Knee Control exercise fidelity checklist had high inter-rater reliability with substantial agreement. The exercise fidelity was low, which could hamper the preventive effects of an IPEP. Understanding the reasons for low exercise fidelity is important and more effort should focus on increasing exercise fidelity alongside the implementation of IPEPs.
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Affiliation(s)
- Gustav Ljunggren
- Department of Orthopaedics and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Nirmala Kanthi Panagodage Perera
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, United Kingdom Latrobe Sports and Exercise Medicine Research Centre, College of Science, Health and Engineering, Latrobe University, Bundoora, VIC 3086 Australia
| | - Martin Hägglund
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Birkett ST, Nichols S, Sawrey R, Gleadall-Siddall D, McGregor G, Ingle L. The effects of low-volume high-intensity interval training and circuit training on maximal oxygen uptake. SPORT SCIENCES FOR HEALTH 2019. [DOI: 10.1007/s11332-019-00552-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McMahon SA, Muula AS, De Allegri M. Response to the commentary "to the bone". SSM Popul Health 2019; 7:100380. [PMID: 31297433 PMCID: PMC6597888 DOI: 10.1016/j.ssmph.2019.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/03/2019] [Indexed: 11/30/2022] Open
Abstract
Presenting process data - even in the absence of outcome data - supports a timely understanding of new, complex programs. Seminal frameworks guided this research, but our emphasis on moderators was guided by data rather than frameworks. Complexity here refers to a gap between what seemed feasible (early on) vs. what ultimately was feasible (mid-intervention).
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Affiliation(s)
- Shannon A. McMahon
- Heidelberg Institute of Global Health at Heidelberg University, Germany
- Corresponding author. Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
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Comparison of the Effect of 5 Different Treatment Options for Managing Patellar Tendinopathy: A Secondary Analysis. Clin J Sport Med 2019; 29:181-187. [PMID: 31033610 DOI: 10.1097/jsm.0000000000000520] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Currently, no treatments exist for patellar tendinopathy (PT) that guarantee quick and full recovery. Our objective was to assess which treatment option provides the best chance of clinical improvement and to assess the influence of patient and injury characteristics on the clinical effect of these treatments. DESIGN A secondary analysis was performed on the combined databases of 3 previously performed double-blind randomized controlled trials. PATIENTS In total, 138 patients with PT were included in the analysis. INTERVENTIONS Participants were divided into 5 groups, based on the treatment they received: Extracorporeal shockwave therapy (ESWT) (n = 31), ESWT plus eccentric training (n = 43), eccentric training (n = 17), topical glyceryl trinitrate patch plus eccentric training (n = 16), and placebo treatment (n = 31). MAIN OUTCOME MEASURES Clinical improvement (increase of ≥13 points on the Victorian Institute of Sport Assessment-Patella score) after 3 months of treatment. RESULTS Fifty-two patients (37.7%) improved clinically after 3 months of treatment. Odds ratios (ORs) for clinical improvement were significantly higher in the eccentric training group (OR 6.68, P = 0.009) and the ESWT plus eccentric training group (OR 5.42, P = 0.015) compared with the other groups. We found evidence that a high training volume, a longer duration of symptoms, and older age negatively influence a treatment's clinical outcome (trend toward significance). CONCLUSIONS Our study confirmed the importance of exercise, and eccentric training in particular, in the management of PT. The role of ESWT remains uncertain. Further research focusing on the identified prognostic factors is needed to be able to design patient-specific treatment protocols for the management of PT.
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Root HJ, Frank BS, Denegar CR, Casa DJ, Gregorio DI, Mazerolle SM, DiStefano LJ. Application of a Preventive Training Program Implementation Framework to Youth Soccer and Basketball Organizations. J Athl Train 2019; 54:182-191. [PMID: 30855986 DOI: 10.4085/1062-6050-375-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Preventive training programs (PTPs) can reduce injury rates and improve neuromuscular control and sport performance. However, PTPs must be implemented correctly and consistently over time for athletes to benefit. Coaches represent the best long-term option for implementing PTPs. Youth athletes are at the optimal age for developing good habits before maturation. Although frameworks have been proposed to guide implementation efforts, little is known regarding the feasibility and real-world context of PTP implementation at the youth sport level. OBJECTIVE To evaluate the application of the 7-Step framework for promoting implementation of a preseason PTP workshop. DESIGN Descriptive epidemiology study. SETTING Youth soccer and basketball organizations. PATIENTS OR OTHER PARTICIPANTS Organizations with at least 1 team of athletes aged 8 to 14 years were invited to participate in a free preseason coaches' education workshop on PTP implementation. INTERVENTION(S) The 7-Step framework was used to guide PTP education and implementation for each organization. Personnel at organizations that agreed to participate attended a single preseason workshop for coaches. Research staff were available as a resource throughout the season but did not actively implement or monitor the PTPs. MAIN OUTCOME MEASURE(S) Retrospective evaluation of each organization's completion of steps 1 through 5 of the 7-Step framework. RESULTS A total of 62 youth soccer (n = 40) and basketball (n = 22) organizations were invited to participate. Twelve organizations completed steps 1 through 4 and steps 5a through 5d. The highest drop-off rate occurred during step 1, "Establishing Administrative Support." No organization completed all components of steps 1 through 5. CONCLUSIONS To better understand how to successfully promote PTP adoption, we must identify the implementation steps that may present the most challenges. Because the highest drop-off rate was seen during the initial step, establishing administrative support and strengthening initial engagement are necessary to improve PTP implementation.
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Affiliation(s)
- Hayley J Root
- Arizona School of Health Sciences, A.T. Still University, Mesa
| | - Barnett S Frank
- Sports Medicine Research Laboratory, University of North Carolina at Chapel Hill
| | - Craig R Denegar
- Department of Kinesiology, University of Connecticut, Storrs
| | - Douglas J Casa
- Department of Kinesiology, University of Connecticut, Storrs
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Abstract
Participation in sport and recreation has important positive implications for public health across the lifespan; however, the burden of sport-related musculoskeletal injury is significant, with the greatest risk being in youth and young adults. Moving upstream to primary prevention of injury is a public health priority that will have significant implications for reducing the long-term consequences of musculoskeletal injury including early post-traumatic osteoarthritis. The primary targets for the prevention of musculoskeletal injury in sport include neuromuscular training (NMT), rule modification, and equipment recommendations. Currently, there is significant high-quality evidence to support the widespread use of NMT warm up programs in team and youth sport, with an expected significant impact of reducing the risk of musculoskeletal injury by over 35%. Policy disallowing body checking in youth ice hockey has led to a >50% reduction in injuries, and rules limiting contact practice in youth American football has significant potential for injury prevention. There is evidence to support the use of bracing and taping in elite sport to reduce the risk of recurrent ankle sprain injury but not for use to prevent the primary injury, and wrist guards are protective of sprain injuries in snowboarding. Future research examining the maintenance of NMT programs across real-world sport and school settings, optimization of adherence, additional benefit of workload modification, and evaluation of rule changes in other sports is needed.
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Affiliation(s)
- Carolyn A Emery
- Chair Sport Injury Prevention Research Centre, Faculty of Kinesiology, Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, T2N1N4, Canada.
| | - Kati Pasanen
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, T2N1N4, Canada.
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Lauersen JB, Andersen TE, Andersen LB. Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. Br J Sports Med 2018; 52:1557-1563. [DOI: 10.1136/bjsports-2018-099078] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 12/24/2022]
Abstract
ObjectiveThis review aims to analyse strength training-based sports injury prevention randomised controlled trials (RCT) and present best evidence recommendations for athletes and future research. A priori PROSPERO registration; CRD42015006970.DesignSystematic review, qualitative analysis and meta-analysis. Sorting of studies and quality assessments were performed by two independent authors. Qualitative analyses, relative risk (RR) estimate with robustness and strength of evidence tests, formal tests of publication bias and post-hoc meta-regression were performed.Data sourcesPubMed, Embase, Web of Science and SPORTDiscus were searched to July 2017.Eligibility criteria for selecting studiesRCTs on strength training exercises as primary prevention of sports injuries.ResultsSix studies analysed five different interventions with four distinct outcomes. 7738 participants aged 12–40 years were included and sustained 177 acute or overuse injuries. Studies were published in 2003–2016, five from Europe and one from Africa. Cluster-adjusted intention-to-treat analysis established RR 0.338 (0.238–0.480). The result was consistent across robustness tests and strength of evidence was high. A 10% increase in strength training volume reduced the risk of injury by more than four percentage points. Formal tests found no publication bias.ConclusionThe included studies were generally well designed and executed, had high compliance rates, were safe, and attained consistently favourable results across four different acute and overuse injury outcomes despite considerable differences in populations and interventions. Increasing strength training volume and intensity were associated with sports injury risk reduction. Three characteristically different approaches to prevention mechanisms were identified and incorporated into contemporary strength training recommendations.
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Silvers-Granelli H, Bizzini M, Arundale A, Mandlebaum BR, Snyder-Mackler L. Higher compliance to a neuromuscular injury prevention program improves overall injury rate in male football players. Knee Surg Sports Traumatol Arthrosc 2018; 26:1975-1983. [PMID: 29556709 PMCID: PMC6415668 DOI: 10.1007/s00167-018-4895-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 03/08/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE The 11+ injury prevention program has been shown to decrease injury rate. However, few studies have investigated compliance and if it is correlated to time loss. The purpose of this study was to (1) analyze how differences in compliance may impact injury rate and (2) if compliance may impact time loss due to injury. METHODS This study was a Level 1 prospective cluster randomized controlled trial conducted in NCAA men's football (soccer) teams that examined the efficacy of the 11+ injury prevention program. The two outcome variables examined were number of injuries and number of days missed from competition. Twenty-seven teams (n = 675 players) used the 11+ program. Compliance, injuries and time loss were recorded. There were three compliance categories, low (LC, 1-19 doses/season), moderate (MC, 20-39 doses/season), and high (HC, > 40 doses/season). RESULTS There was a significant difference among the groups for injuries, p = 0.04, pη2 = 0.23. The LC group [mean (M) = 13.25, 95% confidence interval (CI) 9.82-16.68, injury rate (IR) = 10.35 ± 2.21] had a significantly higher injury rate than the HC group (M = 8.33, 95%CI 6.05-10.62, IR = 10.35 ± 2.21), p = 0.02. The MC group (M = 11.21, 95%CI 9.38-13.05, IR = 8.55 ± 2.46) was not significantly different than the LC group, p = 0.29, but was significantly greater than the HC group, p = 0.05. When examined as a continuous variable, compliance was significantly negatively related to injury rate (p = 0.004). It was also significantly negatively related to number of days missed (p = 0.012). CONCLUSIONS When compliance was high, there was a significant reduction in injury and time loss. This evidence reinforces the importance of consistent injury prevention program utilization. Clinically, these findings have important implications when discussing the importance of consistent utilization of an injury prevention protocol in sport. LEVEL OF EVIDENCE Level 1-Randomized controlled trial (RCT).
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Affiliation(s)
- Holly Silvers-Granelli
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA. .,Velocity Physical Therapy, 11611 San Vicente Boulevard, GF-1, Los Angeles, CA, 90049, USA.
| | - Mario Bizzini
- Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Amelia Arundale
- Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA
| | - Bert R. Mandlebaum
- Santa Monica Orthopaedic Group, 1919 Santa Monica Boulevard, 4th Floor, Santa Monica, CA, 90404, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy and Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.,Department of Biomechanical and Movement Sciences, University of Delaware, Newark, DE, USA
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Owoeye OBA, McKay CD, Verhagen EALM, Emery CA. Advancing adherence research in sport injury prevention. Br J Sports Med 2018; 52:1078-1079. [DOI: 10.1136/bjsports-2017-098272] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2018] [Indexed: 11/04/2022]
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Fox AS, Bonacci J, McLean SG, Saunders N. Exploring individual adaptations to an anterior cruciate ligament injury prevention programme. Knee 2018; 25:83-98. [PMID: 29329889 DOI: 10.1016/j.knee.2017.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Individual responses to anterior cruciate ligament injury prevention programmes (ACL IPPs) have received little attention. This study examined the effects of an ACL IPP on neuromuscular control and lower limb biomechanics during landing at the group and individual levels. METHODS Sixteen female athletes were randomly allocated to training (n=8) or control (n=8) groups. Electromyography, and three-dimensional kinematic and kinetic data were collected during landing at two testing sessions. Repeated measures ANOVA and effect sizes (Cohen's d) examined the effect of the IPP at the group and individual levels. A sub-group analysis comparing the effect of the IPP on 'high-' (i.e. large peak knee abduction moment at baseline) versus 'low-risk' individuals was also conducted. RESULTS At the group level; the IPP increased activation of the medial hamstrings prior to landing (p<0.001; d=0.264) and the medial gastrocnemius at landing (p<0.001; d=0.426), and increased hip external rotation early after initial contact (p<0.001; d=0.476). Variable adaptations were seen across individuals within the training group for all variables (p<0.001). The IPP had a large effect in reducing frontal plane knee moments for 'high-risk' individuals (d>0.91), however these results did not reach statistical significance (p>0.05). CONCLUSIONS The IPP induced adaptations during landing, however, individual data revealed dissimilar responses to the programme. Individuals displaying a pre-existing high-risk strategy may incur greater benefits from IPPs, yet only if the programme targets the relevant high-risk strategy.
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Affiliation(s)
- Aaron S Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia.
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | | | - Natalie Saunders
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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35
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Hislop MD, Stokes KA, Williams S, McKay CD, England ME, Kemp SPT, Trewartha G. Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial. Br J Sports Med 2017; 51:1140-1146. [PMID: 28515056 PMCID: PMC5530334 DOI: 10.1136/bjsports-2016-097434] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Abstract
Background Injury risk in youth rugby has received much attention, highlighting the importance of establishing evidence-based injury reduction strategies. Aim To determine the efficacy of a movement control exercise programme in reducing injuries in youth rugby players and to investigate the effect of programme dose on injury measures. Methods In a cluster-randomised controlled trial, 40 independent schools (118 teams, 3188 players aged 14–18 years) were allocated to receive either the intervention or a reference programme, both of which were to be delivered by school coaches. The intervention comprised balance training, whole-body resistance training, plyometric training, and controlled rehearsal of landing and cutting manoeuvres. Time-loss (>24 hours) injuries arising from school rugby matches were recorded by coaches and medical staff. Results 441 time-loss match injuries (intervention, 233; control, 208) were reported across 15 938 match exposure-hours (intervention, 9083; control, 6855). Intention-to-treat results indicated unclear effects of trial arm on overall match injury incidence (rate ratio (RR)=0.85, 90% confidence limits 0.61 to 1.17), although clear reductions were evident in the intervention arm for concussion incidence (RR=0.71, 0.48 to 1.05). When trial arm comparisons were limited to teams who had completed three or more weekly programme sessions on average, clear reductions in overall match injury incidence (RR=0.28, 0.14 to 0.51) and concussion incidence (RR=0.41, 0.17 to 0.99) were noted in the intervention group. Conclusion A preventive movement control exercise programme can reduce match injury outcomes, including concussion, in schoolboy rugby players when compared with a standardised control exercise programme, although to realise the greatest effects players should complete the programme at least three times per week.
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Pfile K, Curioz B. Coach-led prevention programs are effective in reducing anterior cruciate ligament injury risk in female athletes: A number-needed-to-treat analysis. Scand J Med Sci Sports 2017; 27:1950-1958. [DOI: 10.1111/sms.12828] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2016] [Indexed: 11/26/2022]
Affiliation(s)
- K.R. Pfile
- Health and Human Performance; College of Charleston; Charleston SC USA
| | - B. Curioz
- Methodist University; Fayetteville NC USA
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Sewry N, Verhagen E, Lambert M, van Mechelen W, Brown J. Evaluation of the Effectiveness and Implementation of the BokSmart Safe Six Injury Prevention Programme: a study protocol. Inj Prev 2016; 23:428. [PMID: 27806997 DOI: 10.1136/injuryprev-2016-042188] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/24/2016] [Accepted: 09/20/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The injury burden in rugby union ('rugby') is high. While exercise-based injury prevention programmes have successfully reduced injuries in other sports such as football, there is minimal research on this topic in rugby union. OBJECTIVE To evaluate the effectiveness and implementation of an exercise-based intervention (BokSmart Safe Six) in junior rugby players that aims to reduce the injury risk profile and burden of injury. SETTING 14-16-year-old junior rugby players in two geographically separated locations in South Africa over the 2017 rugby playing season. METHODS A cluster-randomised controlled trial where the teams are allocated to groups that either (1) have a coach-delivered exercise intervention in their warm-up (BokSmart Safe Six) or (2) continue with their warm-up 'as usual' (control group). Injury risk profiles will be assessed through musculoskeletal screening on all players performed at the beginning, middle and end of the trial. Epidemiological measurements include injury surveillance at all matches and training sessions, and exposure to the various warm-up exercises (including BokSmart Safe Six exercises). Behavioural determinants of coaches will be assessed through standardised theory of planned behaviour questionnaires and focus groups before and after the intervention. OUTCOME MEASURES Comparison in injury risk profiles and burden of injury between the intervention and control groups. Changes in the behavioural determinants of coaches. TRIAL REGISTRATION NUMBER PACTR201608001730223. Pre-Results.
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Affiliation(s)
- Nicola Sewry
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Evert Verhagen
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Department of Public and Occupational Health and EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Mike Lambert
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Department of Public and Occupational Health and EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Department of Public and Occupational Health and EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - James Brown
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Department of Public and Occupational Health and EMGO+ Institute, VU University Medical Center, Amsterdam, The Netherlands
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O'Brien J, Young W, Finch CF. The use and modification of injury prevention exercises by professional youth soccer teams. Scand J Med Sci Sports 2016; 27:1337-1346. [PMID: 27714907 PMCID: PMC5763369 DOI: 10.1111/sms.12756] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 01/08/2023]
Abstract
The efficacy of injury prevention exercise programs (IPEPs) for amateur youth soccer has been established, but little is known about their adaptability to other soccer populations. This study aimed to assess the use of individual injury prevention exercises by professional youth soccer teams, against the industry‐standard, FIFA 11+ program. Four teams' chosen IPEPs were observed across one season and documented on a standardized form. The use of each FIFA 11+ exercise was coded as “performed”, “performed modified” or “not performed”. The proportion of the 160 observed sessions containing each individual exercise was calculated. Staff provided reasons for their use and modification of FIFA 11+ exercises. On average, individual FIFA 11+ exercises were conducted in original form in 12% of the sessions (range 0–33%), and in modified form in 28% of sessions (range 2–62%). The five most frequently observed exercises, in either original or modified form, were “bench” (72%), “squats” (69%), “running straight” (68%), “single‐leg stance” (66%), and “sideways bench” (64%). Staff modified exercises to add variation, progression, and individualization, and to align with specific training formats and goals. Professional youth soccer teams often use injury prevention exercises similar to those in the FIFA 11+, but tailor them considerably to fit their implementation context.
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Affiliation(s)
- J O'Brien
- Australian Collaboration for Research into Injury in Sport and Its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
| | - W Young
- Australian Collaboration for Research into Injury in Sport and Its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia.,Faculty of Health, Federation University Australia, Ballarat, VIC, Australia
| | - C F Finch
- Australian Collaboration for Research into Injury in Sport and Its Prevention (ACRISP), Federation University Australia, Ballarat, VIC, Australia
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Vercruysse S, Haerens L, Verhagen E, Goossens L, De Clercq D. Effects of a multifactorial injury prevention intervention in physical education teachers: A randomized controlled trial. Eur J Sport Sci 2016; 16:868-76. [PMID: 26848872 DOI: 10.1080/17461391.2016.1140812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Physical education (PE) teachers are at a high risk of musculoskeletal sports or work-related injuries because of the physical activity as inherent part of their profession. Such injuries have a negative impact on work and leisure time activities, and effective injury prevention interventions are needed. The present study aimed at testing the effectiveness of an injury prevention intervention that was developed and optimized according to PE teachers' wishes and values. Fifty-five PE teachers were randomly assigned to intervention or control group. Intervention group teachers engaged in two days of training during which they familiarized with eight injury prevention strategies (seven intrinsic and one extrinsic). A special feature of the intervention was that the way of delivery was based on the self-determination theory in order to stimulate participants' motivation to adhere to the proposed strategies. Prospective registrations during one school year were conducted concerning injuries and preventive behaviours. Results showed that the intervention group teachers had a lower number of injuries per 1000 h time of exposure (TOE) than the controls (INT: 0.49, CON: 1.14 injuries/1000 h TOE, OR: 2.32, 95% CI: 1.06-5.07), and applied a broader variety of strategies including dynamic and static stretching, core stability, balance and strength training, when compared to the controls who mainly engaged in warming-up. In conclusion, with the same amount of time, an injury reduction was found in PE teachers through a more balanced use of provided preventive strategies.
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Affiliation(s)
- Sien Vercruysse
- a Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
| | - Leen Haerens
- a Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
| | - Evert Verhagen
- b Amsterdam, Collaboration on Health & Safety in Sports, Department of Public and Occupational Health , EMGO+ Institute for Health and Care Research, VU University Medical Center , Amsterdam , The Netherlands
| | - Lennert Goossens
- a Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
| | - Dirk De Clercq
- a Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences , Ghent University , Ghent , Belgium
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Van Reijen M, Vriend I, Zuidema V, van Mechelen W, Verhagen EA. Increasing compliance with neuromuscular training to prevent ankle sprain in sport: does the ‘Strengthen your ankle’ mobile App make a difference? A randomised controlled trial. Br J Sports Med 2016; 50:1200-5. [DOI: 10.1136/bjsports-2015-095290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 12/26/2022]
Abstract
BackgroundE-health has the potential to facilitate implementation of effective measures to prevent sports injuries.AimWe evaluated whether an interactive mobile application containing a proven effective exercise programme to prevent recurrent ankle sprains resulted in higher compliance as compared with regular written exercise materials.Methods220 athletes participated in this randomised controlled trial with a follow-up of 8 weeks; 110 athletes received a booklet explaining an 8-week neuromuscular training programme; 110 athletes participated in the same programme in an interactive mobile App (Strengthen your ankle). The primary outcome was compliance with the exercise programme. Secondary outcome measure was the incidence density of self-reported recurrent ankle sprains.ResultsThe mean compliance to the exercise scheme was 73.3% (95% CI 67.7% to 78.1%) in the App group, compared with 76.7% (95% CI 71.9% to 82.3%) in the Booklet group. No significant difference in compliance was found between groups. The incidence densities of self-reported time-loss recurrences were not significantly different between both groups (HR 3.07; 95% CI 0.62 to 15.20).SummaryThis study shows that the method of implementing the exercises by using an App or a Booklet does not lead to different compliance rates.New findingsThe use of a mobile App or a Booklet lead to similar compliance and injury rates in the short term.Trial registration numberThe Netherlands National Trial Register NTR 4027. The NTR is part of the WHO Primary Registries.
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Finch CF, Twomey DM, Fortington LV, Doyle TLA, Elliott BC, Akram M, Lloyd DG. Preventing Australian football injuries with a targeted neuromuscular control exercise programme: comparative injury rates from a training intervention delivered in a clustered randomised controlled trial. Inj Prev 2015; 22:123-8. [PMID: 26399611 PMCID: PMC4819647 DOI: 10.1136/injuryprev-2015-041667] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/24/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Exercise-based training programmes are commonly used to prevent sports injuries but programme effectiveness within community men's team sport is largely unknown. OBJECTIVE To present the intention-to-treat analysis of injury outcomes from a clustered randomised controlled trial in community Australian football. METHODS Players from 18 male, non-elite, community Australian football clubs across two states were randomly allocated to either a neuromuscular control (NMC) (intervention n=679 players) or standard-practice (control n=885 players) exercise training programme delivered as part of regular team training sessions (2× weekly for 8-week preseason and 18-week regular-season). All game-related injuries and hours of game participation were recorded. Generalised estimating equations, adjusted for clustering (club unit), were used to compute injury incidence rates (IIRs) for all injuries, lower limb injuries (LLIs) and knee injuries sustained during games. The IIRs were compared across groups with cluster-adjusted Injury Rate Ratios (IRRs). RESULTS Overall, 773 game injuries were recorded. The lower limb was the most frequent body region injured, accounting for 50% of injuries overall, 96 (12%) of which were knee injuries. The NMC players had a reduced LLI rate compared with control players (IRR: 0.78 (95% CI 0.56 to 1.08), p=0.14.) The knee IIR was also reduced for NMC compared with control players (IRR: 0.50 (95% CI 0.24 to 1.05), p=0.07). CONCLUSIONS These intention-to-treat results indicate that positive outcomes can be achieved from targeted training programmes for reducing knee and LLI injury rates in men's community sport. While not statistically significant, reducing the knee injury rate by 50% and the LLI rate by 22% is still a clinically important outcome. Further injury reductions could be achieved with improved training attendance and participation in the programme.
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Affiliation(s)
- Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Dara M Twomey
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia
| | - Lauren V Fortington
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Tim L A Doyle
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Bruce C Elliott
- School of Sport Science, Exercise and Health, the University of Western Australia, Perth, Western Australia, Australia
| | - Muhammad Akram
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - David G Lloyd
- Centre for Musculoskeletal Research, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia School of Sport Science, Exercise and Health, the University of Western Australia, Perth, Western Australia, Australia
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Taylor KL, Weston M, Batterham AM. Evaluating intervention fidelity: an example from a high-intensity interval training study. PLoS One 2015; 10:e0125166. [PMID: 25902066 PMCID: PMC4406743 DOI: 10.1371/journal.pone.0125166] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 03/20/2015] [Indexed: 11/30/2022] Open
Abstract
Aim Intervention fidelity refers to the degree to which an experimental manipulation has been implemented as intended, but simple, robust methods for quantifying fidelity have not been well documented. Therefore, we aim to illustrate a rigorous quantitative evaluation of intervention fidelity, using data collected during a high-intensity interval training intervention. Design Single-group measurement study. Methods Seventeen adolescents (mean age ± standard deviation [SD] 14.0 ± 0.3 years) attended a 10-week high-intensity interval training intervention, comprising two exercise sessions per week. Sessions consisted of 4-7 45-s maximal effort repetitions, interspersed with 90-s rest. We collected heart rate data at 5-s intervals and recorded the peak heart rate for each repetition. The high-intensity exercise criterion was ≥90% of individual maximal heart rate. For each participant, we calculated the proportion of total exercise repetitions exceeding this threshold. A linear mixed model was applied to properly separate the variability in peak heart rate between- and within-subjects. Results are presented both as intention to treat (including missed sessions) and per protocol (only participants with 100% attendance; n=8). Results For intention to treat, the median (interquartile range) proportion of repetitions meeting the high-intensity criterion was 58% (42% to 68%). The mean peak heart rate was 85% of maximal, with a between-subject SD of 7.8 (95% confidence interval 5.4 to 11.3) percentage points and a within-subject SD of 15.1 (14.6 to 15.6) percentage points. For the per protocol analysis, the median proportion of high-intensity repetitions was 68% (47% to 86%). The mean peak heart rate was 91% of maximal, with between- and within-subject SDs of 3.1 (-1.3 to 4.6) and 3.4 (3.2 to 3.6) percentage points, respectively. Conclusions Synthesising information on exercise session attendance and compliance (exercise intensity) quantifies the intervention dose and informs evaluations of treatment fidelity.
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Affiliation(s)
- Kathryn L. Taylor
- Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom
- * E-mail:
| | - Matthew Weston
- Department of Sport & Exercise Sciences, School of Social Sciences, Business & Law, Teesside University, Middlesbrough, United Kingdom
| | - Alan M. Batterham
- Health and Social Care Institute, Teesside University, Middlesbrough, United Kingdom
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Padua DA, Frank B, Donaldson A, de la Motte S, Cameron KL, Beutler AI, DiStefano LJ, Marshall SW. Seven steps for developing and implementing a preventive training program: lessons learned from JUMP-ACL and beyond. Clin Sports Med 2014; 33:615-32. [PMID: 25280612 PMCID: PMC4185282 DOI: 10.1016/j.csm.2014.06.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Musculoskeletal injuries during military and sport-related training are common, costly and potentially debilitating. Thus, there is a great need to develop and implement evidence-based injury prevention strategies to reduce the burden of musculoskeletal injury. The lack of attention to implementation issues is a major factor limiting the ability to successfully reduce musculoskeletal injury rates using evidence-based injury prevention programs. We propose 7 steps that can be used to facilitate successful design and implementation of evidence-based injury prevention programs within the logical constraints of a real-world setting by identifying implementation barriers and associated solutions. Incorporating these 7 steps along with other models for behavioral health interventions may improve the overall efficacy of military and sport-related injury prevention programs.
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Affiliation(s)
- Darin A. Padua
- Department of Exercise and Sport Science, University of North Carolina, 204 Fetzer Hall, CB #8700, Chapel Hill, NC, USA 27599-8700, (o) 919.843.5117; (fax) 919.962.0489
| | - Barnett Frank
- Human Movement Science Curriculum, Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC USA
| | - Alex Donaldson
- Deputy Director, Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, SMB Campus, Ballarat VIC AUS
| | - Sarah de la Motte
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | - Kenneth L. Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, West Point, NY USA
| | - Anthony I. Beutler
- Consortium for Health and Military Performance, Uniformed Services University of the Health Sciences, Bethesda, MD USA
| | | | - Stephen W. Marshall
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC USA
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