High levels of coach intent to integrate a ACL injury prevention program into training does not translate to effective implementation

Independent data collectors decrease bias in the measurement of adherence to anterior cruciate ligament injury prevention programs

OBJECTIVES

Studies on adherence to neuromuscular training (NMT) for anterior cruciate ligament (ACL) injury prevention are frequently biased due to the use of self-reporting by coaches or the athletes themselves. Few NMT studies use data collectors (aside from the athletes or the individuals administering the NMT program) to decrease bias when assessing the adherence of coaches and sports teams. We hypothesized that the use of a data collector who is independent of the team to evaluate adherence to NMT programs would be reliable.

METHODS

In a prior a cluster-randomized controlled trial evaluating adherence to NMT training trial, twelve boys' and nine girls' high school athletic teams in a variety of sports were enrolled. Eight data collectors (unaffiliated with the NMT program) were hired specifically to record adherence of the athletes to the NMT exercises at each team's warm-ups 2-3 times a week, prior to practices and games. In addition to the data collectors, a control group of independent observers made visits throughout the season to also record adherence (solely for the purpose of this study, alongside the data collectors and in the same fashion) in order to evaluate the data collectors' performance and determine inter-observer reliability. The inter-observer reliability between data collectors and independent observers was measured using the Kappa statistic.

RESULTS

A total of 399 warm-ups for practices or games were observed by data collectors to obtain adherence data. Independent observers also measured adherence at 58 practices or games for inter-observer reliability. Exercise instruction and alignment cues for 29 different exercises were analysed. The Kappa values ranged from 0.63 to 1.0, indicating substantial to perfect agreement. The overall Kappa values of 0.89 and 0.90 for exercise instruction and alignment cues, respectively, indicated almost perfect agreement.

CONCLUSION

The use of a data collector who is independent of the team to evaluate adherence to NMT programs (rather than athlete or coach self-reporting), was shown to be a reliable method for measurement of adherence in studies of NMT for injury prevention. Avoiding self-reporting in adherence research to NMT training may decrease bias.

LEVEL OF EVIDENCE

I.

Best practices for the dissemination and implementation of neuromuscular training injury prevention warm-ups in youth team sport: a systematic review

OBJECTIVE

To evaluate best practices for neuromuscular training (NMT) injury prevention warm-up programme dissemination and implementation (D&I) in youth team sports, including characteristics, contextual predictors and D&I strategy effectiveness.

DESIGN

Systematic review.

DATA SOURCES

Seven databases were searched.

ELIGIBILITY

The literature search followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

INCLUSION CRITERIA

participation in a team sport, ≥70% youth participants (<19 years), D&I outcomes with/without NMT-related D&I strategies. The risk of bias was assessed using the Downs & Black checklist.

RESULTS

Of 8334 identified papers, 68 were included. Sport participants included boys, girls and coaches. Top sports were soccer, basketball and rugby. Study designs included randomised controlled trials (RCTs) (29.4%), cross-sectional (23.5%) and quasi-experimental studies (13.2%). The median Downs & Black score was 14/33. Injury prevention effectiveness (vs efficacy) was rarely (8.3%) prioritised across the RCTs evaluating NMT programmes. Two RCTs (2.9%) used Type 2/3 hybrid approaches to investigate D&I strategies. 19 studies (31.6%) used D&I frameworks/models. Top barriers were time restrictions, lack of buy-in/support and limited benefit awareness. Top facilitators were comprehensive workshops and resource accessibility. Common D&I strategies included Workshops with supplementary Resources (WR; n=24) and Workshops with Resources plus in-season Personnel support (WRP; n=14). WR (70%) and WRP (64%) were similar in potential D&I effect. WR and WRP had similar injury reduction (36-72%) with higher adherence showing greater effectiveness.

CONCLUSIONS

Workshops including supplementary resources supported the success of NMT programme implementation, however, few studies examined effectiveness. High-quality D&I studies are needed to optimise the translation of NMT programmes into routine practice in youth sport.

Injury prevention for women and girls playing Australian Football: programme cocreation, dissemination and early adopter coach feedback

Background

Adherence to injury prevention programmes may improve with greater end-user involvement and application of implementation frameworks during development. We describe the cocreation, initial dissemination and feedback from programme early adopters (coaches), to develop the first evidence-informed injury prevention programme for women playing community Australian Football (Prep-to-Play).

Methods

We used a pragmatic seven-step process for developing sports injury prevention programmes to (1) gain organisational support, (2) compile research evidence, (3) consult experts, (4) engage end-users, (5) test programme acceptability, (6) evaluate against theory and (7) gain early adopter feedback. All Australian Football-registered coaches of women's/girls' teams were sent a postseason survey to determine initial awareness, adoption and implementation (steps 5 and 6). Purposively selected coaches were invited to interviews/focus groups (step 7) to identify competency, organisational and leadership implementation drivers with a deductive thematic analysis applied.

Results

Prep-to-Play was cocreated using previous efficacious programmes and expert input (steps 1-4), and disseminated via the national sporting organisation in preseason 2019 to all registered coaches (step 5). 343 coaches (90 women) completed the postseason survey and 22 coaches (5 women) participated in an interview (n=9) or focus group (n=13) (steps 6 and 7). 268 coaches (78%) were aware of Prep-to-Play. Of those aware, 218 (81%) had used (at least one element) Prep-to-Play, and 143 (53%) used it at least twice per week. Competency drivers included local expert-delivered face-to-face workshops complimented by online content and ongoing support. Organisational drivers included coach education integrated into existing league/club. Leadership drivers included compulsory injury prevention education integrated into coach reaccreditation processes or incentivisation via recognition (eg, professional development points).

Conclusions

Cocreation and organisational support resulted in high programme awareness and adoption. However, high fidelity implementation and maintenance may need to be facilitated by competency, organisational and leadership drivers. Responsibility should be shared among all stakeholders.

Coach perspectives on factors that influence the implementation of injury prevention programs in community netball: A qualitative study

OBJECTIVE

The Netball KNEE Program is an injury prevention program (IPP) developed by Netball Australia. It is promoted to coaches, but implementation is limited. This study explored community netball coaches' perspectives on factors that influence IPP implementation, and ideas on how it could be improved.

METHODS

Twenty-four coaches from 16 netball clubs participated in semi-structured interviews that asked about their beliefs about injury prevention, use of and confidence in delivering IPP, barriers and facilitators to implementation, and suggestions to ease IPP implementation. Interviews were analysed using inductive thematic analysis.

RESULTS

Two themes were identified - Factors that influence IPP implementation (4 sub-themes), and Suggestions to improve IPP implementation (2 sub-themes). Coaches thought early development of injury prevention habits was important. Life roles, coaching experience and engagement with development courses influenced IPP delivery. Coaches expressed concerns about Netball KNEE program length and complexity and lack of implementation support. They suggested the need for a short simple IPP and engagement with health/exercise professionals for implementation.

CONCLUSIONS

This study engaged with stakeholders to identify barriers that need to be addressed to improve IPP implementation in netball. Coaches desired a short simple standardised IPP, and training from physiotherapists or exercise professionals on implementation.

Coaches of youth field sports as delivery agents of injury prevention programmes: how are we training the trainers? A scoping review

OBJECTIVE

To systematically map the coach education (CE) component of injury prevention programmes (IPPs) for youth field sports by identifying and synthesising the design, content and facilitation strategies used to address competency drivers and behaviour change.

DESIGN

Scoping review.

DATA SOURCES

PubMed, PsycInfo, EMBASE, CINAHL, SportDiscus and Google Scholar electronic databases were searched using keywords related to IPPs and youth field sports.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies of IPPs in youth field sports, that provided 'train-the-trainer' education to coaches as designated delivery agents.

RESULTS

20 studies from two field sports (soccer/football; n=17, Rugby Union; n=3) fulfilled the eligibility criteria. Eleven CE interventions occurred in the preseason and 18 occurred at one time-point (single day). Five studies cited use of a behavioural change theory or model in the design of their CE, most frequently the Health Action Process Approach model (n=5); and use of behavioural change techniques varied. Twelve of twenty studies (60%) reported some form of ongoing support to coaches following the CE primary intervention concurrent with IPP implementation.

CONCLUSION

CE that occurs on 1 day (one time-point) is most popular for preparing coaches as delivery agents of IPPs in youth field sports. While recognising pragmatic barriers, more expansive in-service training, support and feedback may enhance the effective implementation of IPPs.

TRIAL REGISTRATION NUMBER

https://doi.org/10.17605/OSF.IO/FMHGD.

High Compliance with the 11+ Injury Prevention Program Results in Better Win-Loss Records

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.

Focus of Attention During ACL Injury Prevention Exercises Affects Improvements in Jump-Landing Kinematics in Soccer Players: A Randomized Controlled Trial

ABSTRACT

Dalvandpour, N, Zareei, M, Abbasi, H, Abdoli, B, Mohammadian, MA, Rommers, N, and Rössler, R. Focus of attention during ACL injury prevention exercises affects improvements in jump-landing kinematics in soccer players: a randomized controlled trial. J Strength Cond Res 37(2): 337-342, 2023-Anterior cruciate ligament tears are severe and complex knee injuries that commonly occur in soccer. Prevent injuries enhance performance (PEP) is an exercise-based prevention program to effectively reduce anterior cruciate ligament injuries. It is, however, unclear how the delivery of the program contributes to its effectiveness. Therefore, we aimed to investigate the effect of the focus of attention that was emphasized during the delivery of the PEP program on jump-landing kinematics in male, elite-level, U21 soccer players. Forty-two players participated in this randomized controlled trial and were allocated to (a) the internal focus of attention (IF) group, receiving instructions focusing on the execution of the exercise (b), the external focus of attention (EF) group, receiving instructions focusing on the outcome of the exercise, or (c) the control group. Before and after the 8-week intervention, players performed a jump-landing task during which we measured hip and knee angles at the initial contact, peak knee flexion, and peak vertical ground reaction force using a 3-dimensional motion analyzer. A repeated-measures analysis of variance was used to compare groups over time. Significant time-by-group interaction effects with large effect sizes were found for hip flexion at all moments (p < 0.032; η2 > 0.15) and for the knee flexion angle at initial contact and maximum knee flexion (p < 0.001; η2 > 0.35), all in favor of the EF group. This shows that EF during PEP improves hip and knee joint kinematics in the sagittal plane more than IF. Therefore, EF during PEP instructions is preferred to increase the effectiveness of this injury prevention program.

Current Practices, Willingness and Perceived Ability to Implement an Injury Prevention Exercise Program Among Post-Primary Physical Education Teachers

BACKGROUND

Musculoskeletal injuries are common in adolescents, and recently schools have been suggested as an opportune location for injury prevention strategies. This study aimed to identify the current practices and perceptions of post-primary PE teachers in Ireland on injury prevention exercise programs (IPEP), which are key to informing potential implementation strategies.

METHODS

Post-primary PE teachers (n = 287) completed an online anonymous survey. Outcome measures included current IPEP practices in PE class, teachers' attitudes toward IPEPs, willingness to implement, and perceived ability to implement an IPEP in PE class. Descriptive statistics were calculated, and Mann-Whitney U tests were used to compare differences between groups.

RESULTS

Results indicated that only 1 in 5 PE teachers currently used an IPEP in class. Of these, no teacher used an existing IPEP exactly as intended, while most teachers were willing to implement an IPEP (80.5%). Those who previously received formal IPEP education or were aware of an existing IPEP had significantly higher perceived ability to implement an IPEP in class (p < .001).

CONCLUSIONS

This study demonstrates that despite a willingness among PE teachers to implement IPEPs in class, few currently do. Thus, post-primary PE class may be an under-utilized setting for adolescent injury prevention and warrants further investigation.

Barriers and facilitators to injury prevention in ladies Gaelic football: A qualitative study

OBJECTIVES

Injury rates have remained high in ladies Gaelic football over the last decade and treatment costs continue to increase significantly. Injury prevention programmes are a proposed solution and their efficacy has been demonstrated in Gaelic games, however, anecdotally their adoption is low. The aim of this study was to determine the barriers and facilitators to uptake, implementation, and long-term adoption of an injury prevention strategy for adult Ladies Gaelic football players and coaches.

DESIGN

Semi-structured interviews were conducted with 23 participants (13 coaches, 10 players). Four coaches were at intercounty level and nine were at club level, while two players competed at intercounty and club level and eight played solely at club level. The interviews were audio-recorded, transcribed verbatim and thematically analysed.

RESULTS

Stakeholder attitudes, accessibility, education, communication, and injury prevention programme characteristics were perceived as key barriers to an injury prevention strategy succeeding. Injury prevention promotion, injury prevention programme characteristics, leadership, and communication, were identified as the main factors that would facilitate the success of a strategy.

CONCLUSIONS

By utilising the views of stakeholders, the initial uptake, adherence, and long-term adoption of an injury prevention strategy in Ladies Gaelic football may be maximised.

Barriers and facilitators to the adoption and implementation of evidence-based injury prevention training programmes: a narrative review

While there is a multitude of evidence supporting the efficacy of injury prevention training programmes, the literature investigating the implementation of these programmes is, in contrast, rather limited. This narrative review sought to describe the commonly reported barriers and facilitators of the implementation of injury prevention training programmes among athletes in organised sport. We also aimed to identify necessary steps to promote the uptake and sustainable use of these programmes in non-elite athletic communities. We identified 24 publications that discussed implementing evidence-based injury prevention training programmes. Frequently reported barriers to implementation include the perceived time and financial cost of the programme, coaches lacking confidence in their ability to implement it, and the programme including exercises that were difficult or confusing to follow. Frequently reported facilitators to implementation include the coach being aware of programme efficacy, shared motivation to complete the programme from both coaches and athletes, and the ability to easily integrate the programme into practice schedules. The current literature is focused on high-income, high-resource settings. We recommend that future studies focus on understanding the best practices of programme dissemination in culturally and economically diverse regions. Programmes ought to be of no financial burden to the user, be simply adaptable to different sports and individual athletes and be available for use in easily accessible forms, such as in a mobile smartphone application.

Understanding Youth Sport Coaches' Perceptions of Evidence-Based Injury-Prevention Training Programs: A Systematic Literature Review

OBJECTIVE

To systematically review and summarize the knowledge, attitudes, beliefs, and contextual perceptions of youth sport coaches toward injury-prevention training programs by using the Theoretical Domains Framework to guide the organization of results.

DATA SOURCES

Systematic searches of PubMed and Google Scholar were undertaken in November 2021.

STUDY SELECTION

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed. Results were limited to full-text articles that were published in peer-reviewed journals and printed in English. Additional studies were added after a citation search of included studies. Studies were eligible for inclusion if researchers evaluated youth sport coaches' knowledge, beliefs, contextual perceptions, or all 3 of anterior cruciate ligament injury-prevention training programs.

DATA EXTRACTION

Data charting was performed by 1 author and confirmed by a separate author.

DATA SYNTHESIS

Of the 1194 articles identified, 19 were included in the final sample. Among articles in which researchers assessed knowledge (n = 19), coaches' awareness of the existence and components of injury-prevention training programs was inconsistent. Among articles in which researchers assessed beliefs (n = 19), many coaches had positive attitudes toward injury-prevention training programs, but few believed youth athletes are at a high risk of injury. Among articles in which researchers assessed contextual perceptions (n = 13), many coaches did not feel they had access to information about injury-prevention training programs and cited a lack of time, space, support, and other resources as barriers to implementation.

CONCLUSIONS

Our findings support the need for programs, protocols, and policies to enhance knowledge of and support for youth sport coaches who wish to implement injury-prevention training programs. A gap exists in the research about addressing the needs of youth sport coaches in the United States high school sports setting. The use of multilevel implementation science frameworks (such as the Theoretical Domains Framework) will be beneficial for identifying constructs that affect implementation and developing train-the-trainer programming to meet the needs of individual youth sport coaches.

The Effect of a Brief, Web-Based Animated Video for Improving Comprehension and Implementation Feasibility for Reducing Anterior Cruciate Ligament Injury: A Three-Arm Randomized Controlled Trial

Neuromuscular injury prevention training (IPT) has been shown to reduce anterior cruciate ligament (ACL) injury risk by approximately 50%, but the implementation rate is low. One of the most important modifiable barriers for implementation is coaches' comprehension of risk and intervention strategies. This study aimed to evaluate the effect of a brief, web-based, animated video on ACL injury prevention comprehension and IPT implementation feasibility. Coaches in landing and cutting sports were recruited and randomized into three groups. (1) Intervention: brief multimedia animated video about ACL injury and prevention. (2) Active control: commonly accessed, text-based web resource about ACL injury and prevention. (3) Placebo control: brief multimedia video about concussions. Overall ACL comprehension-composed of basic ACL knowledge, risk knowledge, prevention knowledge, and severity knowledge-as well as implementation feasibility were all measured prior to and immediately following the interventions. Overall ACL comprehension improved the most in the animated video group (Cohen's d = 0.86) and, to a lesser degree, in the active control web-based article group (Cohen's d = 0.39). Both video and web-based article groups had greater implementation feasibility compared to the control group (p = 0.01). Overall, these initial results suggest that a brief, web-based, animated video has the potential to be a superior method for informing stakeholders in order to reduce traumatic injuries in sport.

Canadian High School Rugby Coaches Readiness for an Injury Prevention Strategy Implementation: Evaluating a Train-the-Coach Workshop

Background: Canadian rugby coach injury prevention beliefs and attitudes have not been studied, yet are key to informing injury prevention strategy implementation. Despite neuromuscular training (NMT) warm-up success in reducing injury, adoption of these programs is variable. Therefore, objectives of this study included (1) describing Canadian youth rugby coach injury prevention beliefs and attitudes and current warm-up practices and (2) evaluating intention to use a rugby-specific NMT warm-up.

Methods: High school rugby coaches completed a questionnaire before and after a rugby-specific NMT warm-up workshop. The pre-workshop questionnaire captured demographics, current warm-up practice, and NMT warm-up knowledge and use. Both questionnaires captured injury prevention beliefs, attitudes and behavioral intention.

Results: Forty-eight coaches participated in the workshops. Pre-workshop, 27% of coaches were aware of NMT warm-ups. Coaches primarily included aerobic and stretching components, while balance components were not common in their warm-ups over the past year. Additionally, 92% of coaches agreed to some extent they would “complete a rugby-specific warm-up program prior to every game and training session this season.” Post-workshop, 86% of coaches agreed to some extent that they would use the program in every rugby session. No differences were observed between pre- and post-workshop intention to implement the warm-up (p = 0.10).

Interpretation: This is the first study to examine current Canadian youth rugby coach warm-up practices and intention to use NMT warm-ups. Canadian rugby coach intention to use a rugby-specific NMT warm-up is high, providing ample opportunity to investigate the efficacy of a NMT warm-up in youth rugby.

Utilising a Behaviour Change Model to Improve Implementation of the Activate Injury Prevention Exercise Programme in Schoolboy Rugby Union

The Health Action Process Approach (HAPA) is a behaviour change model showing promise in positively changing youth sport coaches’ injury prevention behaviours. This study incorporated the HAPA model into coach training workshops for Activate, an efficacious rugby injury prevention programme. Primary aims were to investigate the effect of the workshop on schoolboy rugby union coaches’ (1) perceptions towards injury risk and prevention, (2) Activate adoption and adherence. Secondary aims were to (3) assess the differences in post-season HAPA constructs between workshop attendees and non-attendees, (4) explore associations between HAPA constructs and Activate adherence. In the pre-season, all participants (n = 76) completed a baseline survey, with 41 coaches electing to attend a workshop. Participants completed a post-season survey assessing HAPA constructs and Activate adoption and adherence throughout the season. The workshop did not affect coach perceptions of injury risk and prevention. Attendees had significantly greater rates of Activate adoption (95% vs. 54% χ² = 17.42, p < 0.01) and adherence (median = 2 sessions vs. ≤1 session per week; z = 3.45, p = 0.03) than non-attendees. At post-season, attendees had significantly greater task self-efficacy (z = −3.46, p < 0.05) and intention (z = −4.33, p < 0.05) to use Activate. These results support the delivery of coach workshops that utilise a behaviour change model to maximise programme implementation.

Integrating neurocognitive challenges into injury prevention training: A clinical commentary

Despite the efforts of many traditional lower extremity injury prevention programs (IPP), the incidence of anterior cruciate ligament injuries in young athletes continues to rise. Current best practices for IPPs include training lower extremity neuromuscular control and movement quality during cutting, jumping, and pivoting. Emerging evidence indicates neurocognition may contribute to injury incidence and injury risk biomechanics. Therefore, IPP outcomes may improve if clinicians also consider neurocognitive contributions to neuromuscular control and athletic performance. A substantial barrier to neurocognitive challenge integration during injury prevention training in the group setting is the lack of structured neuromuscular and neurocognitive progressions. Therefore, our aim is to provide clinicians with a defined framework and recommendations from clinical experience for how to implement neurocognitive challenges within group IPPs that requires minimal extra time and resources. This clinical commentary proposes a three-phase model adopted from motor learning literature to simultaneously progress neuromuscular and neurocognitive challenges through a structured IPP.

Implementation of an injury prevention programme in community netball: An observational study

The Netball KNEE programme is a freely available, netball-specific injury prevention programme promoted to netball coaches. However, little is known about its implementation. This cross-sectional study aimed to evaluate the implementation of the Netball KNEE programme in community netball, and determine if implementation differed by player age. Four netball clubs participated. Training sessions (n = 67) were observed to determine if coaches used Netball KNEE programme activities as intended, modified or not at all during training, and whether feedback on technique was provided. No team performed the recommended number of activities without modification. On average, only 12%, 18% and 14% of the recommended number of activities were performed as intended in the 7-10, 11-13 and ≥14 years age groups, respectively. Warm-up/footwork activities (30%; 0-80%) were more frequently performed than strength (0%; 0-50%), balance/landing (0%; 0-50%), and agility (0%; 0-25%) activities (p < 0.001). Feedback was required in 65% of activities, but frequently not provided (56%). Netball KNEE programme implementation is low in community netball, particularly strength, balance/landing and agility activities. This finding, and lack of provision of feedback on technique, is concerning as improving movement patterns is a key aim of injury prevention programmes.

Can we explain running-related injury preventive behavior? A path analysis

BACKGROUND

Behavioral and social science theories/models have been gaining attention in sports injury prevention.

OBJECTIVE

To investigate the potential of the Theory of Planned Behavior in explaining running-related injury preventive behavior.

METHODS

Six-month prospective cohort study based on data gathered from a randomized controlled trial. From a total of 1512 invited trail runners, 232 were included in this study. Preventive behaviors and their determinants were assessed at baseline and two and six months after baseline. Five-point Likert scales were used to assess the determinants of preventive behavior. A Bayesian path analysis was conducted applying mixed models and mediation analysis.

RESULTS

A 1-point increase in intention, attitude, subjective norm, and perceived behavioral control predicted an increase of 54% (95% Bayesian credible interval [BCI]: 38, 71) in the rate of performing running-related injury preventive behavior, explaining 49% (R² 0.49; 95% BCI: 0.41, 0.56) of the variance around preventive behavior. Intention and perceived behavioral control predicted running-related injury preventive behavior directly, while 40% (95% BCI: 21, 61) and 44% (95% BCI: 20, 69) of the total effect of attitude was mediated by intention and perceived behavioral control, respectively. Attitude, subjective norm, and perceived behavioral control predicted intention.

CONCLUSIONS

The Theory of Planned Behavior may have the potential to explain half of the variance around running-related injury preventive behavior and intention. Therefore, such theory may be considered a relevant and useful tool in developing, investigating, and/or implementing programs aimed at preventing running-related injuries.

Heads Up Football Training Decreases Concussion Rates in High School Football Players

OBJECTIVE

The objective of this study was to determine whether football players receiving heads up (HU) training would display a lower rate of sport-related concussion (SRC) compared to those without HU training.

DESIGN

Prospective cohort.

SETTING

Scholastic football fields.

PATIENTS

Two thousand five hundred fourteen scholastic football players during the 2015 to 2016 football season were monitored throughout the football season.

INTERVENTIONS

Before the preseason, 1 coach from 14 schools received HU training from US football. These schools were matched with 10 control schools performing standard football training [non-heads up (NHU)]. Random monitoring for proper coaching instruction was performed during the season. School athletic trainers monitored injuries and return to sport over the season for all schools.

MAIN OUTCOME MEASURES

The outcome measures of concussions and associated time loss were determined before data collection began. Injury incidence and rate ratios were calculated to determine program effectiveness.

RESULTS

During the season, football players sustained 117 concussions (HU = 75; NHU = 42). The HU players displayed a significantly lower concussion rate (4.1 vs 6.0/100 players) compared with NHU teams [rate ratio = 1.5; 95% confidence interval (CI), 1.1-5.4]. The HU group returned to full participation 27% faster than athletes in the NHU group [time loss: 18.2 days (95% CI, 15.8-20.6) vs 24.8 days (95% CI, 19.9-29.7)], respectively.

CONCLUSIONS

This is the first study to evaluate the impact of the HU program on the incidence of SRC in high school football players. Our data demonstrated that the HU program reduced SRC rates by 33% supporting the use of US HU football training as an effective method to decrease the rate of SRCs in scholastic football.

CLINICAL RELEVANCE

This study is the first to prospectively explore the effect of HU training on the incidence and recovery from SRC in high school football players.

Perceived barriers to implementation of injury prevention programs among collegiate women's soccer coaches

OBJECTIVES

Knee injury prevention programs (IPPs) reduce knee and anterior cruciate ligament (ACL) injury rates in female athletes, however, implementation of IPPs is low. The purpose of this study was to identify barriers to implementation of IPPs among collegiate women's soccer coaches.

DESIGN

Cross-sectional survey.

METHODS

A custom survey based on the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework and existing literature was sent to 151 out of 153 women's National Collegiate Athletic Association (NCAA) soccer coaches in the NCAA's Eastern Region.

RESULTS

Ten respondents reported that they did not use an IPP (Non-users), and nineteen respondents reported that they did use an IPP (Users). "Cost" was the most highly ranked barrier (median rank: 2) to implementing an IPP among Non-users. For the statement, "Who should be responsible for completing an IPP," Users said "Coaches" (47%) and "Other" (21%), while Non-users said "Strength and conditioning" (50%) and "Athletic trainers" (30%). Respondents who marked "Other", elaborated that it was the responsibility of coaches, athletes, and additional staff members.

CONCLUSIONS

Cost was the primary barrier to implementation of an IPP. Since the majority of Non-users indicated that implementation of an IPP was the responsibility of a non-coaching staff member, cost may be a surrogate for the expense of hiring an additional staff member rather than the cost of performing the IPP itself. Additionally, using a team-based approach that encompasses athletes, coaches, and non-coaching staff members may support long-term implementation of IPPs.

Attitudes, beliefs and factors influencing football coaches' adherence to the 11+ injury prevention programme

Objective

To explore football coaches’ beliefs and attitudes about injury prevention and the 11+ injury prevention programme, and to investigate factors that may influence adherence to the 11+ injury prevention programme.

Methods

A total of 538 football coaches who had completed an injury prevention education workshop were invited to participate in a web-based nationwide survey. The survey questions explored beliefs and attitudes about injury prevention and the 11+ injury prevention programme, self-reported adherence to the 11+ programme, as well as perceived barriers and facilitators to the use of the 11+ programme.

Results

There were 158 respondents. The majority believe that injury prevention is part of their coaching role (94%) that a structured warm-up is an important part of their team’s preparation for training and games (96%), and that the 11+ is effective (92%). While most respondents (95%) use the 11+, modifications are common. Participants with greater coaching experience are more likely to use the programme. Time constraints are the main barriers to adherence, while knowing that the programme enhances performance is seen as a major facilitator.

Conclusions

Coaches who attended an injury prevention workshop have positive attitudes towards injury prevention and the 11+ programme. However, coaches with less coaching experience may be less likely to use the 11+ and could therefore be the target population for future education workshops. Promoting the performance enhancing effects of the 11+ and encouraging modifications could improve acceptability and adherence.

Reducing Injuries in Soccer (Football): an Umbrella Review of Best Evidence Across the Epidemiological Framework for Prevention

Soccer is the most popular sport in the world. Expectedly, the incidence of soccer-related injuries is high and these injuries exert a significant burden on individuals and families, including health and financial burdens, and on the socioeconomic and healthcare systems. Using established injury prevention frameworks, we present a concise synthesis of the most recent scientific evidence regarding injury rates, characteristics, mechanisms, risk and protective factors, interventions for prevention, and implementation of interventions in soccer. In this umbrella review, we elucidate the most recent available evidence gleaned primarily from systematic reviews and meta-analyses. Further, we express the exigent need to move current soccer injury prevention research evidence into action for improved player outcomes and widespread impact through increased attention to dissemination and implementation research. Additionally, we highlight the importance of an enabling context and effective implementation strategies for the successful integration of evidence-based injury prevention programs into real-world soccer settings. This narrative umbrella review provides guidance to inform future research, practice, and policy towards reducing injuries among soccer players.

How much, how often, how well? Adherence to a neuromuscular training warm-up injury prevention program in youth basketball

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.

Use of Social or Behavioral Theories in Exercise-Related Injury Prevention Program Research: A Systematic Review

BACKGROUND

The use of social or behavioral theories within exercise-related injury prevention program (ERIPP) research may lead to a better understanding of why adherence to the programs is low and inform the development of interventions to improve program adherence. There is a need to determine which theories have been used within the literature and at what level theory was used to further the field.

OBJECTIVE

To determine which social or behavioral science theories have been incorporated within ERIPP research and assess the level at which the theories were used. The key question guiding the search was "What social or behavioral theories have been used within ERIPP research?"

METHODS

A systematic review of the literature was completed with an appraisal of bias risk using a custom critical appraisal tool. An electronic search of EBSCOhost (Academic Search Complete, CINAHL, Medline, Psychology and Behavioral Sciences Collection) and PubMed was completed from inception to October 2018. Studies investigating attitudes towards ERIPP participation with the use of a social or behavioral theoretical model or framework were eligible for inclusion.

RESULTS

The electronic search returned 7482 results and two articles were identified though a hand search, which resulted in ten articles meeting inclusion criteria. Four different behavioral or social theoretical models or frameworks were identified including the health action process approach model, health belief model, self-determination theory, and theory of planned behavior. Six studies utilized the theory at a B level meaning a theoretical construct was measured while four utilized the theory at the C level meaning the theory was tested. The mean critical appraisal score was 78%, indicating a majority of the studies were higher quality.

CONCLUSION

There has been an increase in the use of theory within literature that is specific to ERIPP participation. Additionally, the use of theory has shifted from guiding program design to the measurement of theoretical constructs and testing of the theoretical models.

Can we improve coaches' injury prevention views and implementation practices in the community female Gaelic sport of camogie?

Objectives

To evaluate the effect of a nationwide coach education workshop on the attitudes towards, willingness and perceived ability of camogie coaches to implement a Camogie Injury Prevention Programme (CIPP) and their implementation of this programme 4 weeks after the workshop.

Methods

Coaches (n=98) from all four provinces in Ireland were recruited and completed a questionnaire prior to and immediately following a developed workshop on the CIPP. Four weeks later 40 of the 98 coaches completed a follow-up questionnaire. Descriptive statistics were completed and a mixed between-within analysis of variance was conducted to examine the differences in willingness and perceived ability to conduct the CIPP over time and between genders. Non-parametric tests examined the differences in attitude scores. The implementation rate of the programme 4 weeks following the workshop was also assessed.

Results

Just 13.4% of coaches had previously heard of the CIPP. Significant improvements in attitudes towards, willingness and perceived ability to conduct the CIPP was noted (p<0.001) post-workshop. Ninety-one per cent of coaches reported that implementing the CIPP in a phased approach with their teams would be beneficial. The camogie coaches primarily viewed the CIPP content favourably, finding the exercises important, relevant and mostly enjoyable. However, some coaches reported that the Nordic hamstring curl is too challenging for players to complete (immediately following workshop: 28.7%; 4 weeks later: 53.3%). Four weeks after the workshop, 72.5% of coaches who responded were implementing the CIPP with their teams in the community.

Conclusions

Due to the success of the education workshop, the Camogie Association should incorporate this injury prevention workshop into all mandatory camogie coaching education courses.

Awareness of Anterior Cruciate Ligament Injury-Preventive Training Programs Among Female Collegiate Athletes

CONTEXT

Neuromuscular training programs can reduce the rate of noncontact anterior cruciate ligament (ACL) injuries, particularly in female athletes.

OBJECTIVE

To assess the awareness of, experience with, and factors associated with participation in preventive training programs (PTPs) among female collegiate athletes and their knowledge of ACL injuries.

DESIGN

Cross-sectional study.

SETTING

National Collegiate Athletic Association (NCAA) sports programs.

PATIENTS OR OTHER PARTICIPANTS

A total of 440 female NCAA athletes (age = 20 ± 1 years) representing 20 sports during the 2017-2018 academic year.

MAIN OUTCOME MEASURE(S)

We used a 12-item survey to collect data on each participant's age, sport, position, college, NCAA division, and awareness of and experience with PTPs. We performed descriptive statistics and used odds ratios (ORs) to assess relationships between demographic data and awareness of or interest in PTPs.

RESULTS

Of the 440 respondents, 85% (n = 373) knew that female athletes were at higher risk for sustaining ACL injuries than male athletes, and 89% (n = 391) knew that ACL injuries were preventable. Thirty-three percent (n = 143) were familiar with the concept of ACL PTPs. Only 15% (n = 64) had ever performed PTPs, but 89% (n = 391) reported they would perform a daily PTP if it could prevent ACL injuries. Fifty-two of the 64 respondents (81%) who had performed PTPs said athletic trainers or coaches oversaw the PTPs. Participants were more likely to be familiar with ACL PTPs if they (OR = 3.5; 95% confidence interval [CI] = 2.0, 5.8) or a teammate (OR = 4.6; 95% CI = 2.1, 9.8) had sustained an ACL injury. Respondents were more willing to perform PTPs if they (OR = 2.3; 95% CI = 0.80, 6.6) or a teammate (OR = 3.4; 95% CI = 1.8, 6.6) had sustained an ACL injury.

CONCLUSIONS

Although 89% of respondents expressed interest in performing daily ACL PTPs, only 15% had performed such programs, and only 33% were familiar with the concept of ACL PTPs.

Controlled ecological evaluation of an implemented exercise training programme to prevent lower limb injuries in sport: differences in implementation activity

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.

Application of a Preventive Training Program Implementation Framework to Youth Soccer and Basketball Organizations

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.

Health Belief Model Scale and Theory of Planned Behavior Scale to assess attitudes and perceptions of injury prevention program participation: An exploratory factor analysis

OBJECTIVES

To examine the psychometric properties of the Health Belief Model Scale (HBMS) and Theory of Planned Behavior Scale (TPBS), and determine construct validity by evaluating which subscales were most associated with intention to participate in an Exercise-related Injury Prevention Program (ERIPP) within physically active adults.

DESIGN

Cross-sectional.

METHODS

Two hundred and eighty-four physically active individuals volunteered to participate in this study and completed the HBMS and TPBS on one occasion. The HBMS consisted of 39 items and the TPBS consisted of 22 items. Both scales aimed to assess attitudes and perceptions of ERIPP participation. Exploratory factor analysis evaluated the loading factors of the HBMS and TPBS. Linear regression determined if the HBMS and TPBS subscales were predictors of intention to participate in an ERIPP.

RESULTS

Nine factors were identified within the HBMS and five factors were identified within the TPBS. The subscales of the HBMS and TPBS had acceptable internal consistencies. Perceived benefits, social norms, and social influence from the TPBS and perceived benefits, individual self-efficacy, and general health cues from the HBMS were positively and significantly associated with intention to participate while perceived barriers had a negative association.

CONCLUSIONS

The HBMS and TPBS demonstrated strong psychometric properties to assess behavioral determinants of ERIPP participation within physically active adults. The social influence, social norm, and individual self-efficacy subscales were the best predictors of intention to participate followed by benefits, general health cues, and barriers.

Brief Education Intervention Increases Nutrition Knowledge and Confidence of Coaches of Junior Australian Football Teams

This study evaluated the impact of a brief (20-min) nutrition education intervention embedded in an existing mandatory coach education course for coaches of junior (8–12 years old) Australian football teams. A total of 284 coaches (68% of 415 coaching course participants) completed a presession questionnaire, and 110 coaches (27% of coaching course participants) completed an identical postsession questionnaire. The responses to the pre- and postsession surveys were matched for 78 coaches. Coaches’ ratings of their own understanding of the nutritional needs of young athletes (6.81, 8.95; p < .001), the importance of young athletes adhering to a healthy diet (9.09, 9.67; p = .001), their confidence in their own nutrition knowledge (7.24, 8.64; p < .001), and their confidence in advising young athletes on nutrition and hydration practices (6.85, 8.62; p < .001), all significantly improved following the education session. Nearly all coaches (>95%) provided a correct response to six of the 15 nutrition and hydration knowledge questions included in the presession questionnaire. Even with this high level of presession knowledge, there was a significant improvement in the coaches’ nutrition and hydration knowledge after the education session across five of the 15 items, compared with before the education session. The results of this study suggest that a simple, short nutrition education intervention, embedded in an existing coach education course, can positively influence the nutrition knowledge and self-efficacy of community-level, volunteer coaches of junior sports participants.

Head coaches' attitudes towards injury prevention and use of related methods in professional basketball: A survey

OBJECTIVES

To investigate the practices and attitudes of professional basketball head coaches towards injury prevention.

DESIGN

Survey.

SETTING

Elite-level basketball.

PARTICIPANTS

Head coaches of all 366 German professional teams.

MAIN OUTCOME MEASURES

Use of injury risk screening methods, rated importance of different musculoskeletal injuries and rated effectiveness of preventive interventions.

RESULTS

Eighty-three of 366 invited coaches (23%) responded to the survey. No non-response bias was detected. Only one of three teams conducts systematic injury screenings. The most commonly used test was the functional movement screen (73.1% of users), while balance and strength testing (both 38.5%) were least prevalent. Top-rated preventive interventions included balance and strength training, training of functional movement patterns, and stretching. In contrast, passive interventions, e.g. the use of orthoses, were not considered effective. The involvement of a health professional (e.g. physiotherapist) was associated with the performance of injury screening, but not with the choice of specific tests or preventive strategies.

CONCLUSIONS

The methods applied to conduct injury screening and prevent musculoskeletal disorders in German professional basketball teams seem only partially backed by scientific evidence. Although not correlated with the tests and interventions used, the involvement of health-related stakeholders might help to identify players at increased injury risk.

Working towards More Effective Implementation, Dissemination and Scale-Up of Lower-Limb Injury-Prevention Programs: Insights from Community Australian Football Coaches

Disseminating lower-limb injury-prevention exercise programs (LL-IPEPs) with strategies that effectively reach coaches across sporting environments is a way of preventing lower-limb injuries (LLIs) and ensuring safe and sustainable sport participation. The aim of this study was to explore community-Australian Football (community-AF) coaches' perspectives on the strategies they believed would enhance the dissemination and scale-up of LL-IPEPs. Using a qualitative multiple case study design, semi-structured interviews with community-AF coaches in Victoria, Australia, were conducted. Overall, coaches believed a range of strategies were important including: coach education, policy drivers, overcoming potential problem areas, a 'try before you buy approach', presenting empirical evidence and guidelines for injury-prevention exercise programs (IPEPs), forming strategic collaboration and working in partnership, communication and social marketing, public meetings, development of a coach hotline, and targeted multi-focused approaches. A shift to a culture whereby evidence-based IPEP practices in community-AF will take time, and persistent commitment by all involved in the sport is important. This will support the creation of strategies that will enhance the dissemination and scale-up of LL-IPEPs across community sport environments. The focus of research needs to continue to identify effective, holistic and multi-level interventions to support coaches in preventing LLIs. This could lead to the determination of successful strategies such as behavioural regulation strategies and emotional coping resources to implement LL-IPEPs into didactic curricula and practice. Producing changes in practice will require attention to which strategies are a priority and the most effective.

Health Belief Model and Theory of Planned Behavior: A Theoretical Approach for Enhancing Lower Extremity Injury Prevention Program Participation

The integration of theoretical models into exercise-related injury prevention research may advance our understanding of the reasons why adoption and compliance of exercise-related injury prevention programs (ERIPPs) is low. A new model which integrates the Health Belief Model and Theory of Planned Behavior has been developed to provide insights into the behavioral determinants of ERIPP participation. There are several steps which must be taken to begin utilizing these theoretical models within ERIPP research, including creating an effective assessment tool, assessing the behavioral determinants of ERIPP participation within the target population, and developing and testing interventions based on these theoretical models.

Dissemination and Implementation Strategies of Lower Extremity Preventive Training Programs in Youth: A Clinical Review

Context:

Neuromuscular preventive training programs effectively reduce injury and improve performance in youth athletes. However, program effectiveness is directly linked to program compliance, fidelity, and dosage. Preventive training programs are not widely adopted by youth sport coaches. One way to promote widespread dissemination and compliance is to identify implementation strategies that influence program adoption and maintenance. It is unknown how previously published programs have followed the elements of an implementation framework. The objective of this review was to evaluate how elements of the 7 steps of implementation, developed by Padua et al, have been performed in the evidence of lower extremity preventive training programs.

Evidence Acquisition:

A systematic review of the literature from 1996 through September 2016 was conducted using electronic databases. Investigations that documented implementation of a sport team-based neuromuscular preventive training program in youth athletes and measured lower extremity injury rates were included.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

A total of 12 studies met the inclusion criteria and were reviewed. Information regarding the completion of any of the 7 steps within the implementation framework developed by Padua et al was extracted. None of the 12 articles documented completion of all 7 steps. While each study addressed some of the 7 steps, no study addressed maintenance or an exit strategy for youth athletes. Program implementation appears limited in obtaining administrative support, utilizing an interdisciplinary implementation team, and monitoring or promoting fidelity of the intervention.

Conclusion:

Despite strong evidence supporting the effectiveness of preventive training programs in youth athletes, there is a gap between short-term improvements and long-term implementation strategies. Future interventions should include all 7 steps of the implementation framework to promote transparent dissemination of preventive training programs.

What Makes a Successful Survey? A Systematic Review of Surveys Used in Anterior Cruciate Ligament Reconstruction

PURPOSE

To characterize and assess the methodological quality of patient and physician surveys related to anterior cruciate ligament reconstruction, and to analyze the factors influencing response rate.

METHODS

The databases MEDLINE, Embase, and PubMed were searched from database inception to search date and screened in duplicate for relevant studies. Data regarding survey characteristics, response rates, and distribution methods were extracted. A previously published list of recommendations for high-quality surveys in orthopaedics was used as a scale to assess survey quality (12 items scored 0, 1, or 2; maximum score = 24).

RESULTS

Of the initial 1,276 studies, 53 studies published between 1986 and 2016 met the inclusion criteria. Sixty-four percent of studies were distributed to physicians, compared with 32% distributed to patients and less than 4% to coaches. The median number of items in each survey was 10.5, and the average response rate was 73% (range: 18% to 100%). In-person distribution was the most common method (40%), followed by web-based methods (28%) and mail (25%). Response rates were highest for surveys targeted at patients (77%, P < .0001) and those delivered in-person (94%, P < .0001). The median quality score was 12/24 (range = 8.5/24 to 21/24). There was high inter-rater agreement using the quality scale (intraclass correlation coefficient = 0.92), but there was no correlation with the response rate (Rho = -0.01, P = .97).

CONCLUSIONS

Response rates vary based on target audience and distribution methods, with patients responding at a significantly higher rate than physicians and in-person distribution yielding significantly higher response rates than web or mail surveys.

LEVEL OF EVIDENCE

Level IV, systematic review of Level IV studies.

Coach-led preventive training program in youth soccer players improves movement technique

Long-term implementation of preventive training programs (PTP) in youth sport requires coach involvement. However, the optimal training of coaches to effectively implement a PTP remains unknown. It is also unknown if the benefits of PTP can be enhanced with multiple sport seasons of exposure.

OBJECTIVES

To evaluate the influence of prior PTP exposure on movement technique in youth soccer players after completing a coach-led PTP.

DESIGN

Cluster-randomized controlled trial.

METHODS

Twelve youth soccer teams (n=89; age range 8-14 years) were divided into groups with (Experience (EXP); 6 teams [n=18 females, n=25 males]) and without (Novice (NOV); 6 teams [n=30 females, n=16 males]) previous professional-led PTP experience. The coaches and players of the EXP teams were exposed to an eight-week professional-led PTP before the coach-led PTP. EXP and NOV coaches attended the educational workshop prior to implementing the coach-led PTP. The Landing Error Scoring System (LESS) was used to evaluate movement technique.

RESULTS

Both groups improved LESS scores over time (mean difference±SD [post-pre]=-0.8±0.2, 95%CI [-1.2, -0.4], p=0.0001). Of the 64 participants classified as high risk for injury (LESS ≥5) prior to PTP implementation, a greater proportion of EXP (n=14) compared to NOV (n=7) participants changed risk classification from high to low (LESSΔ≥1 and LESS <5; p=0.03).

CONCLUSIONS

Our PTP enhanced movement technique regardless of PTP experience, but the benefits of the PTP impacted a proportionally greater number of players with previous PTP experience supporting continued PTP implementation. Coaches effectively implemented an exercise-based PTP after attending a training workshop regardless of previous PTP experience.

Injury Prevention Exercise Programs for Professional Soccer: Understanding the Perceptions of the End-Users

OBJECTIVE

To evaluate the perceptions of professional soccer players and staff members toward injury prevention exercise programs (IPEPs).

DESIGN

Self-report survey.

SETTING

Four professional soccer teams in 4 different countries.

PARTICIPANTS

126 players, coaches, physiotherapists, and fitness coaches were invited to participate, with 72 respondents.

MAIN OUTCOME MEASURES

Web-based survey detailing perceptions of lower limb (LL) injury susceptibility and seriousness, the value of IPEPs in general, and more specifically the International Federation of Association Football (FIFA) 11+.

RESULTS

The vast majority of the respondents believed that professional soccer players are at high risk of LL injuries (93%) and that players should perform evidence-based injury prevention exercises (98%). They also agreed that LL injuries can shorten a player's career (85%), cause physical problems later in life (82%), and negatively impact on team performance (77%). However, perceptions varied across teams regarding which types of injury prevention exercises are effective, who holds responsibility for injury prevention, and when IPEPs should be performed. Specific knowledge of the FIFA 11+ was very low and 47% of respondents believed the program would need modification for use in their team.

CONCLUSIONS

Players and staff members in professional soccer teams strongly support the use of evidence-based IPEPs. However, perceptions vary considerably between teams regarding which exercises can prevent injuries, who holds the responsibility for injury prevention, and when preventive exercises should be performed. Enhancing the ultimate impact of IPEPs in professional soccer requires a detailed understanding of each team's specific implementation context.

The use and modification of injury prevention exercises by professional youth soccer teams

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.

Predictors of FIFA 11+ Implementation Intention in Female Adolescent Soccer: An Application of the Health Action Process Approach (HAPA) Model

The Fédération Internationale de Football (FIFA) 11+ warm-up program is efficacious at preventing lower limb injury in youth soccer; however, there has been poor adoption of the program in the community. The purpose of this study was to determine the utility of the Health Action Process Approach (HAPA) behavior change model in predicting intention to use the FIFA 11+ in a sample of 12 youth soccer teams (coaches n = 10; 12–16 year old female players n = 200). A bespoke cross-sectional questionnaire measured pre-season risk perceptions, outcome expectancies, task self-efficacy, facilitators, barriers, and FIFA 11+ implementation intention. Most coaches (90.0%) and players (80.0%) expected the program to reduce injury risk but reported limited intention to use it. Player data demonstrated an acceptable fit to the hypothesized model (standardized root mean square residual (SRMR) = 0.08; root mean square of error of approximation (RMSEA) = 0.06 (0.047–0.080); comparative fit index (CFI) = 0.93; Tucker Lewis index (TLI) = 0.91) Task self-efficacy (β = 0.53, p ≤ 0.01) and outcome expectancies (β = 0.13 p ≤ 0.05) were positively associated with intention, but risk perceptions were not (β = −0.02). The findings suggest that the HAPA model is appropriate for use in this context, and highlight the need to target task self-efficacy and outcome expectancies in FIFA 11+ implementation strategies.

We have the programme, what next? Planning the implementation of an injury prevention programme

Background and aim

The impact of any injury prevention programme is a function of the programme and its implementation. However, real world implementation of injury prevention programmes is challenging. Lower limb injuries (LLIs) are common in community Australian football (community-AF) and it is likely that many could be prevented by implementing exercise-based warm-up programmes for players. This paper describes a systematic, evidence-informed approach used to develop the implementation plan for a LLI prevention programme in community-AF in Victoria, Australia.

Methods

An ecological approach, using Step 5 of the Intervention Mapping health promotion programme planning protocol, was taken.

Results

An implementation advisory group was established to ensure the implementation plan and associated strategies were relevant to the local context. Coaches were identified as the primary programme adopters and implementers within an ecological system including players, other coaches, first-aid providers, and club and league administrators. Social Cognitive Theory was used to identify likely determinants of programme reach, adoption and implementation among coaches (eg, knowledge, beliefs, skills and environment). Diffusion of Innovations theory, the Implementation Drivers framework and available research evidence were used to identify potential implementation strategies including the use of multiple communication channels, programme resources, coach education and mentoring.

Conclusions

A strategic evidence-informed approach to implementing interventions will help maximise their population impact. The approach to implementation planning described in this study relied on an effective researcher-practitioner partnership and active engagement of stakeholders. The identified implementation strategies were informed by theory, evidence and an in-depth understanding of the implementation context.

Injury Risk Estimation Expertise: Interdisciplinary Differences in Performance on the ACL Injury Risk Estimation Quiz

Background:

Simple observational assessment of movement is a potentially low-cost method for anterior cruciate ligament (ACL) injury screening and prevention. Although many individuals utilize some form of observational assessment of movement, there are currently no substantial data on group skill differences in observational screening of ACL injury risk.

Purpose/Hypothesis:

The purpose of this study was to compare various groups’ abilities to visually assess ACL injury risk as well as the associated strategies and ACL knowledge levels. The hypothesis was that sports medicine professionals would perform better than coaches and exercise science academics/students and that these subgroups would all perform better than parents and other general population members.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 428 individuals, including physicians, physical therapists, athletic trainers, strength and conditioning coaches, exercise science researchers/students, athletes, parents, and members of the general public participated in the study. Participants completed the ACL Injury Risk Estimation Quiz (ACL-IQ) and answered questions related to assessment strategy and ACL knowledge.

Results:

Strength and conditioning coaches, athletic trainers, physical therapists, and exercise science students exhibited consistently superior ACL injury risk estimation ability (+2 SD) as compared with sport coaches, parents of athletes, and members of the general public. The performance of a substantial number of individuals in the exercise sciences/sports medicines (approximately 40%) was similar to or exceeded clinical instrument-based biomechanical assessment methods (eg, ACL nomogram). Parents, sport coaches, and the general public had lower ACL-IQ, likely due to their lower ACL knowledge and to rating the importance of knee/thigh motion lower and weight and jump height higher.

Conclusion:

Substantial cross-professional/group differences in visual ACL injury risk estimation exist. The relatively profound differences in injury risk estimation accuracy and their potential implications for risk screening suggest the need for additional training and outreach (see http://www.ACL-IQ.org).

Clinical Relevance:

Parents and sport coaches would likely benefit from training or use of decision support tools such as the ACL nomogram to assess ACL injury risk. In addition, physicians and other sports medicine professionals may also benefit from improving risk estimation performance to reach clinical biomechanical standards.

Injury prevention exercise programmes in professional youth soccer: understanding the perceptions of programme deliverers

BACKGROUND

There are well-known challenges to implementing injury prevention strategies in amateur soccer, but information from other soccer settings is scarce. This cross-sectional survey analysed the injury prevention perceptions of soccer coaches, fitness coaches and physiotherapists from 4 male teams in a professional youth soccer academy.

METHODS

The respondents (n=18) completed a web-based survey relating to lower limb (LL) soccer injuries, the value and practicality of injury prevention exercise programmes (IPEPs) in general and, more specifically, the IPEP endorsed by FIFA, the FIFA 11+.

RESULTS

There were very high levels of agreement regarding players' susceptibility to LL injury and the seriousness of these injuries. Respondents agreed unanimously that players should perform evidence-based injury prevention exercises. Despite 61% of respondents having previously heard of the FIFA 11+, just 6% reported current use of the full programme, with a further 22% reporting modified use. 22% believed the FIFA 11+ contained adequate variation and progression for their team and 78% felt it needed improvement. Respondents identified multiple barriers and facilitators to maintaining IPEPs, relating either to the programme content (eg, exercise variation), or the delivery and support of the programme (eg, coach acceptance).

CONCLUSIONS

The coaches, fitness coaches and physiotherapists of professional youth teams support the use of IPEPs, but enhancing their impact requires tailoring of programme content, along with adequate delivery and support at multiple levels. The findings suggest that the FIFA 11+ needs modification for use in professional youth soccer teams.

Enhanced retention of drop vertical jump landing technique: A randomized controlled trial

External focus instructions have been shown to result in superior motor performance compared to internal focus instructions. Using an EF may help to optimize current anterior cruciate ligament (ACL) injury prevention programs. The purpose of the current study was to investigate the effects of instructions on landing technique and performance by comparing an external focus (EF), internal focus (IF), video (VI) and control (CTRL) group. Subjects (age 22.50±1.62years, height 179.70±10.43cm, mass 73.98±12.68kg) were randomly assigned to IF (n=10), EF (n=10), VI (n=10) or CTRL group (n=10). Landing was assessed from a drop vertical jump (DVJ) in five sessions: pretest, two training blocks (TR1 and TR2) and directly after the training sessions (post test) and retention test 1week later. Group specific instructions were offered in TR1 and TR2. Landing technique was assessed with the Landing Error Scoring System (LESS) and jump height was taken as performance measure. The results show that males in the VI group and females both in the VI and EF groups significantly improved jump-landing technique. Retention was achieved and jump height was maintained for males in the VI group and females both in the VI and EF groups. It is therefore concluded that EF and VI instructions have great potential in ACL injury prevention.