The Prevention of Sport Injury: An Analysis of 12 000 Published Manuscripts

Efficacy of multicomponent interventions on injury risk among ice and snow sports participants-a systematic review and meta-analysis

BACKGROUND

Ice and snow sports, which are inherently high risk due to their physically demanding nature, pose significant challenges in terms of participant safety. These activities increase the likelihood of injuries, largely due to reduced bodily agility and responsiveness in cold, often unpredictable winter environments. The critical need for effective injury prevention in these sports is emphasized by the considerable impact injuries have on the health of participants, alongside the economic and social costs associated with medical and rehabilitative care. In the context of ice and snow sports environments, applying the E principles of injury prevention to evaluate intervention measures can guide the implementation of future sports safety and other health promotion intervention measures in this field. When well executed, this approach can substantially reduce both the frequency and severity of injuries, thereby significantly enhancing the safety and long-term viability of these challenging sports.

OBJECTIVE

The objective of this study was to rigorously assess and statistically substantiate the efficacy of diverse injury prevention strategies in ice and snow sports, aiming to bolster future safety measures with solid empirical evidence.

DESIGN

Systematic review and meta-analysis.

METHODS

The overarching aim of this research was to meticulously aggregate and scrutinize a broad spectrum of scholarly literature, focusing on the quantifiable efficacy of diverse, multicomponent intervention strategies in mitigating the incidence of injuries within the realm of ice and snow sports. This endeavour entailed an exhaustive extraction of data from esteemed academic databases, encompassing publications up to September 30, 2023. In pursuit of methodological excellence and analytical rigor, the study employed advanced bias assessment methodologies, notably the AMSTAR 2 and GRADE approaches, alongside sophisticated random-effects statistical modelling. This comprehensive approach was designed to ensure the utmost validity, reliability, and scholarly integrity of the study's findings.

RESULTS

Fifteen papers, including 9 randomized controlled trials, 3 case‒control studies, and 3 cohort studies with 26,123 participants and 4,382 injuries, were analysed. The findings showed a significant reduction in injury rates through various interventions: overall injury prevention (RR = 0.50, 95% CI 0.42-0.63), educational training (RR = 0.50, 95% CI 0.34-0.73), educational videos (RR = 0.53, 95% CI 0.34-0.81), protective equipment (RR = 0.64, 95% CI 0.46-0.87), and policy changes (RR = 0.28, 95% CI 0.16-0.49). Subgroup analysis revealed potential heterogeneity in compliance (p = 0.347). Compared to controls, multicomponent interventions effectively reduced injury rates.

CONCLUSION

This systematic review and meta-analysis demonstrated that multicomponent interventions significantly prevent injuries in ice and snow sports. By applying the E principles of injury prevention and constructing a framework for practical injury prevention research in ice and snow sports, we can gradually shift towards a systemic paradigm for a better understanding of the development and prevention of sports injuries. Moreover, sports injury prevention is a complex and dynamic process. Therefore, high-quality experiments in different scenarios are needed in future research to provide more reliable evidence, offer valuable and relevant prevention information for practitioners and participants, and help formulate more effective preventive measures in practice.

We know a lot about little and little about a lot: A contextualized scoping review on injury prevention in alpine ski racing

BACKGROUND

Our goal was to summarize and contextualize the available literature on alpine ski racing injury epidemiology, injury etiology, injury prevention measures, injury prevention context, and implementation issues.

MATERIALS AND METHODS

We searched four electronic databases using predetermined search terms. We included original studies that assessed injury, injury risk factors, and injury mechanisms, and assessed and reported the effect of an injury prevention measure in alpine ski racing. Two authors independently conducted title-abstract screening, and one performed the full-text review. For data synthesis and categorization, we used the Translating Research into the Injury Prevention Practice framework and a modified and adapted version of the Haddon matrix.

RESULTS

Of the 157 included studies, most corresponded to injury epidemiology and etiology, whereas few studies encompassed injury prevention measure development, implementation and evaluation. Preventive interventions targeting equipment, rules and regulations, course design and snow preparation were the most prevalent in the literature. Furthermore, various contextual factors in the current literature have been found, including gender, competition level, countries and federations, and time periods within a season.

CONCLUSIONS

We provided an in-depth and comprehensive overview of the current state-of-the-art in the alpine ski racing context. We know a lot about little and little about a lot across all the areas associated with injury prevention in such context. The limitations in the literature yield a road map for designing future injury prevention studies to address the key gaps identified. A more comprehensive context-driven approach throughout all stages of injury prevention would benefit the ultimate implementation of effective preventive strategies.

Injury prevention programs including balance exercises with compliance and follow-up reduce the incidence of knee injuries in athletes: A systematic review and meta-analysis

BACKGROUND: The knee is one of the most common injuries in sports. However, the incidence of knee injuries can be decreased by enhancing balance and neuromuscular control. OBJECTIVE: The aim of this systematic review and meta-analysis was to investigate how injury prevention programs (IPPs) that include balance training influence knee injury rates in athletes. METHODS: Data were obtained from different databases (1985–2021). Only randomised controlled trials that used IPPs that include balance training, were considered. Two investigators extracted data from the qualifying documents. The critical outcome data elements derived from the included studies were the number of ACL/knee injuries, ACL/knee injury rates, exposure hours, compliance rate, and follow-up duration. RESULTS: Compared to the control groups, those who participated in the IPP had a 54% lower risk of knee injuries per 1000 hours of exposure (IRR 0.457 (95% CI 0.346–0.603), P= 0.001) and a 60% lower risk of ACL injuries per 1000 hours of exposure (IRR 0.401 (95% CI 0.215–0.750), P= 0.004). CONCLUSIONS: IPPs that include balance training may reduce the risk of knee injuries.

Going their own way–male recreational runners and running-related injuries: A qualitative thematic analysis

Objective

Recreational running is one of the most common physical leisure activities worldwide and is associated with high rates of running related injury (RRI). Little is known of the perceptions of male recreational runners regarding the aetiology and management of RRI.

Design

Utilising an interpretive phenomenological analysis framework, qualitative data was gathered from participants via interview, and reflexive thematic analysis was used to develop insights into the experiences and perceptions of the participants in relation to RRI.

Materials and methods

Two focus groups with a total of six (mean age 37.8 ± 9.5 years, 16.5 ± 13.1 years running experience) male recreational runners were used to obtain data regarding their understanding of RRI causation, prevention and management. Interviews were evaluated using a six-phase reflexive thematic analysis approach to generate and interpret themes within the data.

Results

Three themes (Mind, Body and Education) were identified by the analysis as critical to RRI avoidance. Mind refers to the self-understanding and self-management of personal limits required for RRI prevention. Body reflects a degree of physical conditioning necessary for injury free running, while Education indicates an understanding of how to correctly structure a running program. When viewed together these themes can be seen to form an ‘internal locus of injury’ model which highlights the runners’ beliefs that RRI are related to their decisions regarding training and running, and that avoidance of injury lies within their personal control.

Conclusion

Recreational runners rely on self-management, in preference to professional advice, to manage training loads, fitness and RRI. Health care professionals involved with this population may consider the use of online resources, a preferred option of runners, to assist runners to build their knowledge base and support their development to experienced runners.

Video analysis of 100 matches in male semi-professional football reveals a heading rate of 5.7 headings per field player and match

INTRODUCTION

Heading is an integral part of football and frequent media reports and previous studies about potential danger of heading and head trauma in football fuelled discussions. Epidemiological data and video analyses regarding headings situation and associated head injuries are still missing in male adult professional football.

METHODS

In a prospective cohort study in the male fourth German football league, 100 official matches of the 2015-2016 season were assessed by video analysis and a standardized protocol. Heading situations and concomitant circumstances as well as incidents with a propensity of injury (critical incidents) were analyzed. Critical incidents (CI) and seasonal reported head injuries were cross-referenced.

RESULTS

Overall, 11,514 headings were analysed in detail. Video analysis yielded a mean of 5.7 headings per player and match (SD: 1.2; range 0-15). Heading was predominantly performed with the frontal part of the head (76.8%), and nearly two thirds of all headings occurred during defending (65.8%). 71.0% of all headings occured during tacklings, of which 71.9% involved body contact with the opponent player. Video analysis yielded 31 CI on the head due to heading (incidence: 1.02 per 1000 h match exposure and player). 29 CI occurred during heading duels (odds ratio: 5.91), 30 CI with body contact (odds ratio: 28.8) and 6 CI with elbow contact (odds ratio: 6.13).

CONCLUSION

Heading frequency in male semi-professional football could be determined with a rate of 5.7 headings per match and field player. Cross referencing CI and seasonal reported head injuries revealed a very low number of reported head injuries.

Effectiveness of the Activate injury prevention exercise programme to prevent injury in schoolboy rugby union

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.

More people more active, but there is a counter site. Novice athletes are at highest risk of injury in a large population-based retrospective cross-sectional study

Objectives

To evaluate whether in fitness-related activities and recreational running over time, there is an increase in the number of novice sports athletes and whether these novice athletes have an increased injury rate compared with their experienced counterparts.

Methods

Data were collected from a large population-based retrospective cross-sectional study, ‘Injuries and Physical Activity in the Netherlands’ (IPAN). Athletes aged ≥18 years were included. We used descriptive statistics to describe the characteristics of athletes and their injuries. The number of athletes and injuries were calculated for each year and, where applicable, for each sport separately. The injury incidence rate was expressed as the number of injuries per 1000 hours of exposure. Logistic regression analyses were performed with non-extrapolated data to analyse the differences in injury risk for novice and experienced athletes included in this study, separate for fitness-related activities and running.

Results

Over the 5 years, 9209 fitness athletes reported 370 fitness-related injuries, 5426 runners reported 537 running-related injuries. Weighted data showed that, in 2010–2014, the inflow of novice fitness athletes slightly decreased, whereas the inflow of novice runners slightly increased. In each year, injury risk was higher in novice athletes compared with experienced athletes for both fitness-related activities and running. The injury incidence rates in running are much higher than in fitness-related activities.

Conclusions

Over the years 2010–2014, the absolute number of novice athletes in fitness-related activities and running together increased. Although most injuries occurred in experienced athletes, injury risk was higher in novice athletes in both sports.

'I always considered I needed injury prevention to become an elite athlete': the road to the Olympics from the athlete and staff perspective

In this study, we explored the perspectives about sports injury prevention of Belgium Olympic level athletes, coaches, managers and healthcare providers from various Olympic sports. We conducted a qualitative study, including 17 semistructured interviews. All interviews were transcribed verbatim and analysed by two independent coders through constant comparative data analysis based on Grounded Theory principles. Our findings overview the athlete's journey to becoming an elite athlete, and how an elite sports context influences and modulates injury prevention practice at this level. Participants described an elite athletic career as a continuous and adaptive evolving process. According to athletes and all stakeholders, sports injury prevention is a learning process shaped by individual experiences. This embodiment provides athletes with insight into the importance of ownership of their bodies and self-awareness. Thus, experience, communication, empowerment, knowledge, education, the elite athlete context and sports culture, all play a fundamental role in sports injury prevention. Our findings support the importance of contextual factors in sports injury prevention in an elite sports context. These results also bring practical implications on how we should approach injury prevention differently along an athlete's journey to becoming an elite athlete. Considering specific contextual factors and influencing the process through awareness, communication and a shared responsibility is essential to develop a healthy and successful athlete.

Determinants of the adoption of injury risk reduction programmes in athletics (track and field): an online survey of 7715 French athletes

OBJECTIVES

To identify individual characteristics associated with the adoption of injury risk reduction programmes (IRRP) and to investigate the variations in sociocognitive determinants (ie, attitudes, subjective norms, perceived behavioural control and intentions) of IRRP adoption in athletics (track and field) athletes.

METHODS

We conducted a cross-sectional study using an online survey sent to athletes licensed with the French Federation of Athletics to investigate their habits and sociocognitive determinants of IRRP adoption. Sociodemographic characteristics, sports practice and history of previous injuries were also recorded. Logistic regression analyses and group comparisons were performed.

RESULTS

The final sample was composed of 7715 athletes. From the multivariable analysis, competing at the highest level was positively associated with IRRP adoption (adjusted OR (AOR)=1.66; 99.9% CI 1.39 to 1.99 and AOR=1.48; 99.9% CI 1.22 to 1.80) and presenting a low number of past injuries was negatively associated with IRRP adoption (AOR=0.48; 99.9% CI 0.35 to 0.65 and AOR=0.61; 99.9% CI 0.44 to 0.84), both during their lifetime and the current season, respectively. These results were supported by higher scores of sociocognitive determinants among athletes who reported IRRP adoption compared with other athletes.

CONCLUSION

Some characteristics of athletes seem to be associated with IRRP adoption either positively (competing at the highest level) or negatively (presenting a lower number of past injuries), whereas all the sociocognitive determinants tested appear to be linked to IRRP adoption. Since many athlete characteristics are difficult or impossible to change, IRRP promotion may be enhanced by targeting athletes' beliefs and intentions to adopt an IRRP.

Epidemiology of Injuries in Olympic Sports

Injuries effect the performance of athletes. Severity of injuries is determined by time loss and sporting performance reduction. To treat injuries adequately, it is necessary to get an overview of varied injuries types in different sports disciplines. In a retrospective study 7.809 athletes from Germany, Switzerland and Austria competing in competitive or recreational levels of sports were included. Injury prevalence was highest in team sports (75%), followed by combat (64%), racquet (54%) and track and field (51%). Knee (28%) and shoulder (14%) were the most at risk joints. Time loss in sporting activity after injury was longest in the region of knee (26 weeks). Of all reported injuries, 48% were accompanied by a reduced level of performance. The highest injury prevalence occurred in the year 2016 (45%). More injuries occurred during training (58%) compared to competition (42%). Across Olympic disciplines, a large number of injuries occurred during training sessions. Injury frequency increased as the Olympic games drew closer. Knee and shoulder injuries were the most severe injuries with respect to time loss and reduction sporting performance.

Understanding Injury and Injury Prevention in Para Sport Athletes

CONTEXT

Training loads, injury, and injury prevention in the Para sports population has not been well established.

OBJECTIVE

The purpose of this study was to survey elite-level swimming, cycling, and athletic Para sport athletes in the United States who were competing in the 2016 US Paralympic trials to better understand common injuries among athletes in each sport and to determine whether injury prevention programs were being utilized.

DESIGN

Cross-sectional, survey study.

SETTING

The 2016 US Paralympic trials for swimming, cycling, and athletics.

PARTICIPANTS

Athletes who competed in swimming, cycling, and/or athletics at the 2016 US Paralympic trials (N = 144; 83 males and 61 females).

MAIN OUTCOME MEASURES

Participants completed electronic survey using Qualtrics XM (Qualtrics, Provo, UT) with questions pertaining to average number of hours trained per week, number of cross-training hours performed each week, descriptive information regarding sport-related injuries, pain, whether athletes received treatment for injuries, and descriptive information regarding whether the athletes had participated in an injury prevention program.

RESULTS

Over 64% of respondents reported training greater than or equal to 11 hours per week, and 45% of athletes reported spending greater than or equal to 6 hours per week cross-training. Forty-two percent of athletes reported currently having pain with 34% reporting missing a competition because of injury. Only 24% of respondents reported having participated in an injury prevention program.

CONCLUSIONS

Many Para sport athletes train at similar durations as able-bodied counterparts and have pain that interferes with their ability to train and compete, however, only a small percentage consistently perform injury prevention programs.

Epidemiology of Patients with Dance-Related Injuries Presenting to Emergency Departments in the United States, 2014-2018

BACKGROUND

Updated rates and patterns associated with patients with dance-related injuries reporting to US emergency departments (EDs) is needed.

HYPOTHESIS

Between the years 2014 and 2018, there will be an observed rise of patients with dance-related injuries seen within US EDs.

STUDY DESIGN

Retrospective analysis.

LEVEL OF EVIDENCE

Level 4.

METHODS

Utilizing the National Electronic Injury Surveillance System (NEISS) database, data were abstracted for all structured dance-related injuries for all people who presented to a NEISS participating hospital from January 1, 2014, to December 31, 2018. Data were abstracted on age, sex, race, disposition, location on the body where the injury happened, and free text box regarding the mechanism and nature of the injury. Each patient case was associated with a weight to provide national incidence rate (per 100,000) estimates. Descriptive statistics were used to summarize counts, percentages, and rates across patient cases.

RESULTS

Between years 2014 and 2018, 4152 patients reported to the NEISS EDs with a dance-related injury. Most injuries occurred in female patients (83.3%; n = 3459) and among those who were 10 to 18 years old (76.2%; n = 3164). The most common injuries were ankle sprain/strain (12.7%; n = 527) and knee sprain/strain (10.4%; n = 431). Almost all patients were treated and released (97.1%; n = 4033). These data yielded population-weighted estimates of 125,618 injuries for the study period, with an increasing trend over time (19.2% increase over 5 years). Incidence rates were over 4 times higher for female (12.4) than for male patients (3.0) and highest in the 10- to 18-year-old age group (incidence rate = 46.4).

CONCLUSION

Patients with dance-related injuries reporting to EDs increased over a 5-year period from 2014 to 2018. The majority of dancers in the study were female patients, between the ages of 10 and 18 years, nearly half of the patients reported to the ED with a sprain/strain, and almost all patients were treated and released.

CLINICAL RELEVANCE

An increase in access to proper injury prevention medical services and education should be provided to female dancers between the ages of 10 and 18 years.

STRENGTH OF RECOMMENDATION TAXONOMY

B.

Injury Profile and Sex-Specific Differences in Bubble-Soccer - A First Scientific Survey of a Dangerous New Sports Trend

Purpose

Small-field soccer is a popular type of amateur sports worldwide. One type of small-field soccer growing in popularity is bubble-soccer, but injury risks and injury patterns are still unclear. This study investigates the factors influencing injuries in bubble-soccer for the first time.

Materials and Methods

This prospective cohort study of an outdoor tournament investigated the injury incidence and injury patterns as well as the factors influencing injuries in bubble-soccer matches. Data were collected according to the statement on data collection and injury definition. Preparation and physical outcome were assessed for both sexes.

Results

Of 145 players (104 men, 41 women), 58 players sustained 94 injuries during the tournament and 64% of injuries affected the lower extremities. The most common traumatic injuries were skin lesions (37.5%), acute pain (15.6%) and contusion (7.8%). More female players (3818.2/1000 h bubble-soccer) than male players (1474.4) were affected by injury, mostly to the knees or the head. Also, women significantly more often reported neck pain than men (p<0.042); 29.0% of players felt uncomfortable wearing the bubble, and 21.4% reported neurological symptoms such as headache or dizziness after the match.

Conclusion

Bubble-soccer shows a relatively high injury incidence. Women had a higher injury incidence and were more often affected by traumatic injuries to the head and neck including feeling of discomfort and headache or neck pain after the match. Adequate preparation seems to be essential for injury prevention, and players should recognise the high injury risk of bubble-soccer.

Nationwide sports injury prevention strategies: A scoping review

National strategies to prevent sports injuries can potentially improve health outcomes at a population level and reduce medical costs. To date, a compilation of the strategies that countries have attempted, and their effectiveness, does not exist. This scoping review sets out to: identify nationwide attempts at implementing sports injury prevention strategies; examine the impact of these strategies; and map them onto the Translating Research into Injury Prevention Practice (TRIPP) framework. Using Levac's scoping review method, we: (a) identified the research questions, (b) identified relevant studies, (c) identified the study selection criteria, (d) charted the data, and (e) reported the results. A search of MEDLINE, Scopus, SPORTDiscus, CINAHL, and Web of Science databases for articles published pre-June 2019 was conducted. We identified 1794 studies and included 33 studies (of 24 strategies). The USA (n = 7), New Zealand (n = 4), Canada (n = 3), the Netherlands (n = 3), Switzerland (n = 2), Belgium (n = 1), France (n = 1), Ireland (n = 1), South Africa (n = 1), and Sweden (n = 1) have implemented nationwide sports injury prevention strategies with 29 (88%) of the included studies demonstrating positive results. Mapping the strategies onto the TRIPP framework highlighted that only four (17%) of the 24 included strategies reported on the implementation context (TRIPP Stage 5), suggesting an important reporting gap. Nationwide sports injury prevention efforts are complex, requiring a multidimensional approach. Future research should report intervention implementation data; examine the implementation context early in the research process to increase the likelihood of real-world implementation success; and could benefit from incorporating qualitative or mixed research methods.

Evaluating the Implementation of Injury Prevention Strategies in Rugby Union and League: A Systematic Review using the RE-AIM Framework

Rugby (union and league) has come under intense scrutiny due to its injury risk. Various interventions have been introduced to protect players from injury, with many deemed efficacious and advocated for use across various worldwide contexts. However, their implementation is less clear. The objective of this systematic review was to determine whether injury prevention interventions in rugby have evaluated their 'reach', 'effectiveness', 'adoption', 'implementation' and 'maintenance' as per the RE-AIM Multi-Dimension Item Checklist. Six electronic databases were searched in November 2019. Inclusion criteria included: English language, peer-reviewed journal article, original research, field-based rugby code, prospective intervention. Of the 4253 studies identified, 74 met the full inclusion criteria. Protective equipment, predominately mouthguards, was the intervention of interest in 44 studies. Other interventions included multimodal national injury prevention programmes, law changes and neuromuscular training programmes. 'Effectiveness' was the highest scoring RE-AIM dimension (55%), followed by 'reach' (26%). All other RE-AIM dimensions scored below 20%. Research currently focuses on determining intervention 'effectiveness'. For injury prevention strategies to have their desired impact, there must be a shift to address all determinants associated with implementation. Consideration should be given to how this can be achieved by adopting specific reporting checklists, research frameworks and study designs.

Prevention of severe knee injuries in men's elite football by implementing specific training modules

PURPOSE

Injury prevention of knee injuries by means of training and warm-up exercises has been investigated in several studies in amateur football. However, the number of investigations in elite football is limited despite the currently higher injury incidence of severe knee injuries. Therefore, the purpose of this study was to investigate whether specifically adapted preventive training modules may reduce severe knee injuries in elite football.

METHODS

In a prospective controlled cohort study of elite football players in Germany, an injury prevention programme with 5 modules was implemented in the season of 2015-2016. The training modules were specifically adapted to this skill level and based on scientific evidence, team coach preferences, and the specific environment of this playing level. Of the 62 teams taking part in this study, 26 used the new trainings modules and 36 continued their standard programme as a control group. Success of the programme was documented by means of an injury report over one season. The primary outcome was reduction in severe knee injuries.

RESULTS

A pre-seasonal investigation had identified five modules to be implemented in the training routine. Postural stability, mobilisation of lower extremity joints, leg and trunk stabilisation, jumping, and landing exercises as well as agility movements were incorporated into the programme to prevent severe knee injuries in elite football. Over the season, the study group (529 players) with the adapted training modules had sustained 52 severe knee injuries (incidence: 0.38 per 1000 h football exposure; prevalence: 9.8%) compared to 108 severe knee injuries in the control group (601 players) using the standard programme (incidence: 0.68 per 1000 h football exposure; prevalence: 18.0%; p < 0.05). The overall injury incidence for any other type of injury was comparable between the two groups (3.3 vs. 3.4 in h 1000 football, n.s.).

CONCLUSION

Appropriate preventive training modules reduce severe knee injuries in elite football significantly. The key for the sustainability of preventive training measures are programmes specifically adapted to the demands of the playing level and to the preferences of the coaches LEVEL OF EVIDENCE: II.

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.

Letting the cat out of the bag: athletes, coaches and physiotherapists share their perspectives on injury prevention in elite sports

Objectives

To explore how sports injury prevention takes place in elite sport practice and to describe the perspectives of athletes, coaches and physiotherapists regarding the most critical factors that help prevent injury in the elite sports context.

Methods

Qualitative study. Semistructured interviews with 19 international level athletes, coaches and physiotherapists, from different Olympic sports. Interviews were transcribed verbatim and analysed using comparative data analysis based on Grounded Theory.

Results

The participants perceived injury risk as an inherent part of elite sports, because athletes try to enhance performance by pushing their limits. Participants described injury prevention as a learning process that changed over time, based on their sports experience and the injuries that they had sustained along their career. Communication among the athletes, coaches and physiotherapists was described as a key component of the injury prevention process. Study participants emphasised the relevance of teamwork and shared responsibility. Performance was presented as the core of the athlete’s daily practice, indicating that injury prevention can be a means to that end but is not a goal in itself for this community.

Conclusion

Participants perceive injury prevention as part of elite sports and thus embrace the need for injury prevention. Injury prevention strategies in elite sports were described as a learning process, following the dynamic nature of training for maximal performance. Performance is the participants’ main goal.

Injury Prevention in Amateur Soccer: A Nation-Wide Study on Implementation and Associations with Injury Incidence

Prevention programmes can reduce injury risk in amateur soccer. Hence, we examined the implementation of injury prevention in the real-world context of Swiss amateur soccer. In 2004 (n = 1029), 2008 (n = 705) and 2015 (n = 1008), a representative sample of Swiss amateur soccer coaches was interviewed by telephone about the frequency of injuries in their teams, the implementation of preventive measures and the use of injury prevention programmes. In the 2015 survey, 86.1% of amateur coaches stated that injury prevention is important and 85.3% of amateur coaches reported that they would implement some kind of preventive measures. The proportion of teams which performed a prevention programme according to minimal standards remained unchanged between 2008 (21.7%) and 2015 (21.9%), although a second prevention programme was made available in 2011. Only 8.6% of the 30+/40+ league teams, which are composed as a function of age, implemented a programme. Overall, the level of implementation of prevention programmes in this real-world context is still unsatisfactory. Offering an additional programme did not lead to a higher willingness to implement such programmes among the coaches. Concerted efforts are needed to remove barriers that hinder the use of such programmes, particularly among coaches of 30+/40+ league teams.

Health promotion by International Olympic Sport Federations: priorities and barriers

Objective

To identify changes in International Federations’ priorities and the barriers to implementing athlete and global health initiatives. Results should influence the work of the International Federation medical committees, the IOC and the Association of Summer Olympic International Federation.

Methods

The 28 Summer and 7 Winter International Federations participating in the most recent Olympic Games (2016; 2018) were surveyed to (i) identify the importance of 27 health topics, (ii) assess their progress on implementation health-related programmes and (iii) the barriers to implementation of these programmes. We compared International Federations’ activities in 2016 and 2017.

Results

The response rate was 83%. Health topics which most International Federations regarded as important and in which the International Federations felt insufficiently active were ‘team physician certification’, ‘prevention of harassment and abuse’, ‘eating disorders/disordered eating’, ‘mental health’ and ‘injury surveillance’. Compared with 2016, there was a decrease in International Federations’ activities in ‘injury surveillance’, ‘nutritional supplements’ and ‘hyperandrogenism’. The main barrier to implementing health-related programmes was ‘International Federation political support/willingness’, followed by ‘knowledge’. ‘Time’ and ‘coach support’ were more often reported than ‘finances’, or ‘IOC or Association of Summer Olympic International Federations partnership’.

Conclusion

If International Federations are going to promote health of athletes and global health promotion through physical activity (sport), International Federation leadership must change their focus and provide greater political support for related initiatives. Improving coach and athlete knowledge of the health issues could also facilitate health programme delivery. Time constraints could be mitigated by sharing experiences among the International Federations, Association of Summer Olympic International Federations and the IOC. International Federations should focus on those health-related topics that they identified as being important, yet rate as having insufficient activity.

Context Matters: Revisiting the First Step of the 'Sequence of Prevention' of Sports Injuries

It is possible to prevent sports injuries. Unfortunately, the demonstrated efficacy and effectiveness of injury prevention approaches are not translated into lasting real-world effects. Contemporary views in sports medicine and injury prevention suggest that sports injuries are ‘complex’ phenomena. If the problem we aim to prevent is complex, then the first step in the ‘sequence of prevention’ that defines the ‘injury problem’ already needs to have considered this. The purpose of this paper is to revisit the first step of the ‘sequence of prevention’, and to explore new perspectives that acknowledge the complexity of the sports injury problem. First, this paper provides a retrospective of the ‘sequence of prevention’, acknowledging contemporary views on sports injuries and their prevention. Thereafter, from the perspective of the socioecological model, we demonstrate the need for taking into account the complex nature of sports injuries in the first step. Finally, we propose an alternative approach to explore and understand injury context through qualitative research methods. A better understanding of the injury problem in context will guide more context-sensitive studies, thus providing a new perspective for sports injury prevention research.

Implementation science to reduce the prevalence and burden of MSK disorders following sport and exercise-related injury

Although safety in sports and physical activity is an important prerequisite for continuing participation and maintenance of a healthy, physically active lifestyle, to date little effort has been placed upon moving evidence into preventive practice. Amongst researchers it is still often assumed that a program will disseminate itself after proven to be effective. Recently, however, there has been an increased recognition of the importance of theory-driven approaches to enhance implementation research. This manuscript aims to provide guidance for sports and physical activity injury researchers and practitioners to perform implementation research and practice. First, we will discuss the differences between research questions across the research spectrum and explain the 'drop' in effect when moving controlled evidence to a practical context. We will discuss two ways of increasing real-world effectiveness of preventive programs, i.e. through targeting the users' behaviour or through revising the intervention. Finally, we will present various implementation frameworks and tools that can guide the reader in their own efforts towards implementation practice and research.

Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix

BACKGROUND

Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered.

OBJECTIVE

Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps.

METHODS

Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure.

RESULTS

A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5).

CONCLUSIONS

Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.

Facilitators to support the implementation of injury prevention training in youth handball: A concept mapping approach

There is a need for research to identify effective implementation strategies for injury prevention training within real-world community sports. The aim of this ecological participatory study was to identify facilitators, among stakeholders at multiple levels, that could help injury prevention training become part of regular training routines in youth team handball. Concept mapping, a mixed-method approach for qualitative data collection and quantitative data analysis, was used. Stakeholders (n = 196) of two community team handball clubs (29% players, 13% coaches, 38% caregivers, 11% club, district and national handball administrators, 9% unknown) participated in a brainstorming process. After the research team synthesized the 235 generated statements, 50 stakeholders (34% players, 22% coaches, 24% caregivers, 20% administrators) sorted 89 unique facilitator statements into clusters and rated them for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis yielded five clusters (stress value 0.231): "Understanding and applying knowledge," "Education, knowledge, and consistency," "Set-up and exercises," "Inspiration, motivation, and routines," and "Club policy and expert collaboration." The cluster "Understanding and applying knowledge" had the highest mean importance (3.17 out of 4) and feasibility (2.93) ratings. The 32 statements rated as both highly important and feasible (Go-zone) indicate action is required at the individual (end-users) and organizational (policymakers) levels to implement injury prevention training. Results suggest that developing evidence-based context-specific injury prevention training, incorporating physiological, biomechanical and psychological components, and an associated context-specific implementation plan in partnership with all stakeholders should be a high priority to facilitate the implementation of injury prevention training in youth team handball.

Injury prevention and return to play strategies in elite football: no consent between players and team coaches

INTRODUCTION

Injuries are a common problem in football. To improve prevention strategies, the players' (p) and coaches' (c) views need to be disclosed as they have a strong impact on return to play decisions. The aim of this study is to reveal current opinions with regard to injury prevention and return to play strategies to introduce new strategies in elite football.

MATERIALS AND METHODS

In a retrospective data analysis of elite salaried football players (n = 486) and team coaches (n = 88), a detailed investigation by means of a standardized questionnaire was carried out. In a preseason period of the 2015/16 season and as part of a large interventional research project in elite salaried German football, a request about players' and team coaches' knowledge and opinions was performed. Topics such as injury prevention, return to play after injuries, the importance of screening tests, general problems of injuries in football, or the decision-making in terms of prevention and return to play in elite football were investigated.

RESULTS

The study revealed a high interest in injury prevention and screening tests among players and coaches (p 82.5%; c 99.1%). The participants of the study reported warm-up exercises (p 76.4%; c 74.7%), regeneration training (p 54.1%; c 56.3%), and core stability (p 53.8; c 70.1%) as the most important prevention methods, but the additional investigation of the teams' current daily training routine showed that the transfer is incomplete. Coaches are more familiar with scientific published warm-up programs like FIFA 11 + than players (42.5 vs. 12.6; p < 0.001). Knee injuries (p 90.7%; c 93.1%) and ACL injuries in particular were reported as the most severe and common problem in elite football. Players and coaches expressed different attitudes concerning return to play decisions. While players want to decide themselves (81.4%), team coaches consult medical advice ahead of the decision of return to play after injuries (83.5%; p < 0.001). Decisions against the doctor's recommendation are often made by both groups (p 64.4% vs. c 87.1%; p < 0.001).

CONCLUSION

The basic knowledge of prevention and injuries is sufficient in elite football, but the transfer from theoretical knowledge to practical routine is suboptimal. The study also shows possibilities to improve the prevention process and communication between players, coaches, doctors, and physiotherapists, while there is no consent between players and coaches regarding return to play decision.

Increased injury rates after the restructure of Germany's national second league of team handball

PURPOSE

Scientific injury data in men's professional team handball injuries are rare and even less scientific information exists on injury prevention. In 2011, Germany's national second team handball league was restructured by merging the existing two regional leagues into one league. This study evaluates the injury patterns in professional team handball and compares the injury rates between the first and second league before and after the restructure.

METHODS

All players of Germany's national first and second men's team handball leagues have mandatory trauma insurance with the same insurance company. This retrospective cohort study analysed the injury data of three consecutive seasons 2010-2013 using standardized injury definitions.

RESULTS

1194 professional team handball players were included in this study. The majority of severe injuries affected the lower extremities, shoulders, and hands. The average injury incidence significantly differed between the first (4.9 injuries per 1000 h) and the second league (3.9 per 1000 h, p < 0.01). The injury incidence in the restructured second league had increased from 3.7 to 4.1 per 1000 h (p < 0.01) and prevalence from 67.1 to 79.3% (p < 0.001), thus almost to the same levels of the first league. The second league showed more time-loss injuries at all severity levels.

CONCLUSION

This study yielded a high injury incidence after the restructure of the national second team handball league and presents details on prevalence, incidence, and patterns of injury in professional men's team handball. This study is an important basis for developing injury prevention strategies that should focus on the shoulders, hands, and lower extremities and on reducing the number of matches and travel burden.

LEVEL OF EVIDENCE

III.

Neuromuscular exercises prevent severe knee injury in adolescent team handball players

PURPOSE

Team handball is associated with a high risk of severe knee injury that needs to be reduced, particularly at the youth level. The purpose of this study was to show how an injury-prevention programme effectively reduces severe knee injury in adolescent team handball players.

METHODS

Of 23 adolescent handball teams of both sexes, 13 were randomly allocated into the intervention group (168 players) and 10 into the control group (111 players). Players of the intervention group regularly participated in an injury-prevention programme for one season. Handball exposure and sustained injuries were documented for both groups on a monthly basis. The primary outcome parameter of the injury-prevention programme was the incidence of severe knee injury.

RESULTS

Of the 279 included players, 68 (24%) sustained 82 injuries yielding an overall incidence of 1.85 injuries per 1000 h handball exposure (intervention group: 50 injuries/incidence: 1.90/1000 h; control group: 32 injuries/incidence: 1.78/1000 h). Knee injury was the second most frequent injury in adolescent team handball. The primary outcome parameter, severe knee injury occurred significantly more often in the control group [mean age (SD) 15.1 (1.0), injury incidence 0.33/1000 h] than in the intervention group [mean age (SD) 14.9 (0.9), injury incidence 0.04/1000 h]. The odds ratio was 0.11 (95% CI 0.01-0.90), p = 0.019. Other injuries to the lower extremities showed no significant difference between the two groups.

CONCLUSIONS

Frequent neuromuscular exercises prevent severe knee injury in adolescent team handball players and should thus be included in the practical routine as well as in the education of team coaches.

Injury mechanism of midfacial fractures in football causes in over 40% typical neurological symptoms of minor brain injuries

PURPOSE

The injury mechanisms of midfacial fractures may be typical causes of concussion, but hardly any scientific data on midfacial injuries sustained in football are available. Head and brain trauma represent frequent injuries in athletes of different sports that require appropriate treatment by sports and trauma physicians. This study investigated the management of midfacial fractures in football and the association of such fractures with concomitant brain injury.

METHODS

In a prospective cohort study lasting 24 months (2012 to 2013), midfacial injuries of football players were analysed with regard to the injury mechanisms, first aid procedures on the field, treatment and return-to-play. To analyse concomitant and potentially overlooked minor brain injuries due to the trauma, we retrospectively investigated the neurological symptoms of the study population.

RESULTS

The study included 132 football players (37 semi-professionals and 95 amateurs) with midfacial fractures. The main injury mechanisms were head-to-head and head-to-elbow trauma. The mean period of return-to-play after trauma was 33.5 days, which was significantly shortened if a protective face mask was worn (mean 10.4 days earlier, p = 0.0006). Semi-professional football players returned to play earlier (p = 0.009) and more often used protective face masks (p = 0.001). 55 players (41.6%) had neurological symptoms immediately after trauma as a possible sign of concomitant minor brain injury. 5 of 132 players with concussion had been hospitalised for 24 h, but no persistent neurological symptoms were detected.

CONCLUSION

In football, midfacial fractures represent moderate-to-severe injuries with time away from sports of more than 4 weeks. Over 40% of athletes with a midfacial fracture showed concomitant neurological symptoms as a sign of minor brain injury. Therefore, sports physicians and other staff supervising athletes in daily practice should be aware of the presence of neurological symptoms.

LEVEL OF EVIDENCE

Level III.

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.

A concept mapping approach to identifying the barriers to implementing an evidence-based sports injury prevention programme

Background and aim

Understanding the barriers to programme use is important to facilitate implementation of injury prevention programmes in real-word settings. This study investigated the barriers to coaches of adolescent female soccer teams, in Victoria, Australia, implementing the evidence-based FIFA 11+ injury prevention programme.

Methods

Concept mapping with data collected from 19 soccer coaches and administrators.

Results

Brainstorming generated 65 statements as barriers to 11+ implementation. After the statements were synthesised and edited, participants sorted 59 statements into groups (mean, 6.2 groups; range, 3–10 groups). Multidimensional scaling and hierarchical cluster analysis identified a six-cluster solution: Lack of 11+ knowledge among coaches (15 statements), Lack of player enjoyment and engagement (14), Lack of link to football-related goals (11), Lack of facilities and resources (8), Lack of leadership (6) and Lack of time at training (5). Statements in the ‘Lack of 11+ knowledge among coaches’ cluster received the highest mean importance (3.67 out of 5) and feasibility for the Football Federation to address (3.20) rating. Statements in the ‘Lack of facilities and resources’ cluster received the lowest mean importance rating (2.23), while statements in the ‘Lack of time at training’ cluster received the lowest mean feasibility rating (2.19).

Conclusions

A multistrategy, ecological approach to implementing the 11+—with specific attention paid to improving coach knowledge about the 11+ and how to implement it, linking the 11+ to the primary goal of soccer training, and organisational leadership—is required to improve the uptake of the 11+ among the targeted coaches.

Trends in Medically Attended Injuries in Czech Adolescents

OBJECTIVE

Due to the importance of surveillance of injuries and accidents in the Czech Republic, the purpose of this study was to report the temporal trends of injuries of Czech adolescents between 2002 and 2014.

METHODS

Adolescents (N=20,038) from the Czech Republic, that took part in the 2002, 2006, 2010 and 2014 HBSC study, reported the frequency of medically attended injuries in the past 12 months. Repeated binary logistic regressions with different years as reference categories were performed.

RESULTS

Less than half (44.7%) of all Czech adolescents reported they had experienced at least one medically attended injuries in the past 12 months, with boys experiencing more injuries than girls (p<0.001), and the injuries were more common in older adolescents. Fewer boys reported injury in 2014 when compared to 2002 (OR, CI: 0.81, 0.72-0.90), there was also a significant decrease in injuries among girls between 2014 and 2006 (OR, CI: 0.77, 0.69-0.86).

CONCLUSIONS

The trend was not linear amongst boys. Along with improved safety promotion education, the rate of injuries decreased among adolescents between the years 2002 and 2014.

Compliance with Sport Injury Prevention Interventions in Randomised Controlled Trials: A Systematic Review

INTRODUCTION

Sport injury prevention studies vary in the way compliance with an intervention is defined, measured and adjusted for.

OBJECTIVE

The objective of this systematic review was to assess the extent to which sport injury prevention randomised controlled trials (RCTs) have defined, measured and adjusted results for compliance with an injury prevention intervention.

METHODS

An electronic search was performed in MEDLINE, PubMed, the Cochrane Center of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database) and SPORTDiscus. English RCTs, quasi-RCTs and cluster-RCTs were considered eligible. Trials that involved physically active individuals or examined the effects of an intervention aimed at the prevention of sport- or physical activity-related injuries were included.

RESULTS

Of the total of 100 studies included, 71.6 % mentioned compliance or a related term, 68.8 % provided details on compliance measurement and 51.4 % provided compliance data. Only 19.3 % analysed the effect of compliance rates on study outcomes. While studies used heterogeneous methods, pooled effects could not be presented.

CONCLUSIONS

Studies that account for compliance demonstrated that compliance significant affects study outcomes. The way compliance is dealt with in preventions studies is subject to a large degree of heterogeneity. Valid and reliable tools to measure and report compliance are needed and should be matched to a uniform definition of compliance.

Do adolescents with long-term illnesses and disabilities have increased risks of sports related injuries?

Background

The aim of this study is to examine the rates of sports related injuries in adolescents based on the severity of their long-term illnesses or disabilities (LTID). Few injury prevention strategies in sports and health promotion have explored disaggregation by disability.

Methods

Data obtained from the 2014 Finnish Health Behaviour in School-aged Children survey (n = 3716, mean age = 14.8, SD = 1.03) were grouped into adolescents with and without LTID. A further indicator or severity was determined when adolescents reported their LTID affected their participation (affected LTID). Odds ratio (95% CI) were used to determine the associations between sports related injuries and LTID, daily moderate to vigorous physical activities (MVPA), being a sports club member, physical competence, and family encouragement, after controlling for age, gender and family affluence.

Results

One in four adolescents (25%) reported to have LTID and one in eight adolescents (12.5%) reported sports injuries. The odds for adolescents with chronic conditions, functional and learning difficulties was the highest (OR 3.55, CI = 2.3–5.4) for overall injuries, when compared with adolescents without LTID. Adolescents with affected LTID (OR = 2.08, CI = 1.5–2.9) were more likely to report medically attended injuries than adolescents without LTID. Sports-related injuries (OR = 0.33, CI = 0.1–0.8) were lower in adolescents with affected LTID than those without LTID after adjusting for personal and environmental factors.

Conclusions

Taking part in sport clubs increases the risk of sports related injuries in adolescents with and without LTID, but not with affected LTID. Few adolescents with affected LTID participate in sports clubs and were less likely to report the most serious type of injury to be from sports. These results could be used for devising sports based injury prevention and health promotion strategies for children with LTID.

Scientific evidence is just the starting point: A generalizable process for developing sports injury prevention interventions

BACKGROUND

The 2 most cited sports injury prevention research frameworks incorporate intervention development, yet little guidance is available in the sports science literature on how to undertake this complex process. This paper presents a generalizable process for developing implementable sports injury prevention interventions, including a case study applying the process to develop a lower limb injury prevention exercise training program (FootyFirst) for community Australian football.

METHODS

The intervention development process is underpinned by 2 complementary premises: (1) that evidence-based practice integrates the best available scientific evidence with practitioner expertise and end user values and (2) that research evidence alone is insufficient to develop implementable interventions.

RESULTS

The generalizable 6-step intervention development process involves (1) compiling research evidence, clinical experience, and knowledge of the implementation context; (2) consulting with experts; (3) engaging with end users; (4) testing the intervention; (5) using theory; and (6) obtaining feedback from early implementers. Following each step, intervention content and presentation should be revised to ensure that the final intervention includes evidence-informed content that is likely to be adopted, properly implemented, and sustained over time by the targeted intervention deliverers. For FootyFirst, this process involved establishing a multidisciplinary intervention development group, conducting 2 targeted literature reviews, undertaking an online expert consensus process, conducting focus groups with program end users, testing the program multiple times in different contexts, and obtaining feedback from early implementers of the program.

CONCLUSION

This systematic yet pragmatic and iterative intervention development process is potentially applicable to any injury prevention topic across all sports settings and levels. It will guide researchers wishing to undertake intervention development.

Increase in ACL and PCL injuries after implementation of a new professional football league

PURPOSE

In the season 2008-2009, a third professional football league was established in Germany. This study analysed the influence of increased training and playing intensity on severe knee injuries in football players.

METHODS

In a prospective controlled one-season trial, injury incidence and injury patterns of players of the newly established professional football league were analysed, particularly with regard to ruptures of the anterior (ACL) and posterior (PCL) cruciate ligaments. Players of the highest amateur level served as a control group.

RESULTS

Four hundred and eight players of 24 teams were allocated to two groups. The overall training exposure was significantly (p < 0.001) higher in the new professional league (335.3 h per player) than at the amateur level (286.6 h per player). Players at both levels showed similar overall injury rates and injury patterns. However, players in the professional league had a significantly higher (p = 0.04) incidence of ACL and PCL injuries, than players at the amateur level. More than 90 % of all ACL and PCL ruptures in both groups were sustained by players, who had played at least one level lower in the previous season. In addition, injuries of players who had sustained repeat injuries over the season were more severe.

CONCLUSION

The introduction of a new professional football league increased the training and playing intensity of players as well as the number of ACL and PCL ruptures. A specific injury prevention concept, particularly for players facing rapidly increasing training and playing intensity, seems to be mandatory.

LEVEL OF EVIDENCE

Prospective controlled cohort study, Level II.

Foot and Ankle Injuries in Professional Soccer Players: Diagnosis, Treatment, and Expectations

Soccer is one of the most popular sports in the world. It has undergone many changes in recent years, mainly because of increased physical demands, and this has led to an increased injury risk. Direct contact accounts for half of all injuries in both indoor and outdoor soccer and ankle sprains are the most common foot and ankle injury. There is a spectrum of foot and ankle injuries and their treatment should be individualized in these high-demand patients. An injury prevention program is also important and should the players, the trainer, responsible physician, and physical therapists.

Too much information? A document analysis of sport safety resources from key organisations

OBJECTIVES

The field of sport injury prevention has seen a marked increase in published research in recent years, with concomitant proliferation of lay sport safety resources, such as policies, fact sheets and posters. The aim of this study was to catalogue and categorise the number, type and topic focus of sport safety resources from a representative set of key organisations.

DESIGN

Cataloguing and qualitative document analysis of resources available from the websites of six stakeholder organisations in Australia.

SETTING

This study was part of a larger investigation, the National Guidance for Australian Football Partnerships and Safety (NoGAPS) project.

PARTICIPANTS

The NoGAPS study provided the context for a purposive sampling of six organisations involved in the promotion of safety in Australian football. These partners are recognised as being highly representative of organisations at national and state level that reflect similarly in their goals around sport safety promotion in Australia.

RESULTS

The catalogue comprised 284 resources. More of the practical and less prescriptive types of resources, such as fact sheets, than formal policies were found. Resources for the prevention of physical injuries were the predominant sport safety issue addressed, with risk management, environmental issues and social behaviours comprising other categories. Duplication of resources for specific safety issues, within and across organisations, was found.

CONCLUSIONS

People working within sport settings have access to a proliferation of resources, which creates a potential rivalry for sourcing of injury prevention information. Important issues that are likely to influence the uptake of safety advice by the general sporting public include the sheer number of resources available, and the overlap and duplication of resources addressing the same issues. The existence of a large number of resources from reputable organisations does not mean that they are necessarily evidence based, fully up to date or even effective in supporting sport safety behaviour change.

Shedding Light on the Etiology of Sports Injuries: A Look Behind the Scenes of Time-to-Event Analyses

The etiological mechanism underpinning any sports-related injury is complex and multifactorial. Frequently, athletes perceive "excessive training" as the principal factor in their injury, an observation that is biologically plausible yet somewhat ambiguous. If the applied training load is suddenly increased, this may increase the risk for sports injury development, irrespective of the absolute amount of training. Indeed, little to no rigorous scientific evidence exists to support the hypothesis that fluctuations in training load, compared to absolute training load, are more important in explaining sports injury development. One reason for this could be that prospective data from scientific studies should be analyzed in a different manner. Time-to-event analysis is a useful statistical tool in which to analyze the influence of changing exposures on injury risk. However, the potential of time-to-event analysis remains insufficiently exploited in sports injury research. Therefore, the purpose of the present article was to present and discuss measures of association used in time-to-event analyses and to present the advanced concept of time-varying exposures and outcomes. In the paper, different measures of association, such as cumulative relative risk, cumulative risk difference, and the classical hazard rate ratio, are presented in a nontechnical manner, and suggestions for interpretation of study results are provided. To summarize, time-to-event analysis complements the statistical arsenal of sports injury prevention researchers, because it enables them to analyze the complex and highly dynamic reality of injury etiology, injury recurrence, and time to recovery across a range of sporting contexts.

Influence of preparation and football skill level on injury incidence during an amateur football tournament

INTRODUCTION

Scientific studies on injury characteristics are rather common in professional football but not in amateur football despite the thousands of amateur football tournaments taking place worldwide each year. The purpose of this study was to evaluate the preparation and injury patterns of players of two different football skill levels who participated in an international amateur football tournament.

METHODS

In a prospective cohort study, an international amateur football tournament of medical doctors in 2011 was analysed with regard to training and warm-up preparation, the level of football played before the tournament and injury data during the tournament by means of standardised injury definitions and data samples for football.

RESULTS

Amateur players of registered football clubs had higher training exposure before the tournament (p < 0.001) than recreational players and had more frequently performed warm-up programmes (p < 0.001). Recreational football players showed a significantly higher overall injury incidence (p < 0.002), particularly of overuse injuries (p < 0.001), during the tournament than amateur players. In almost 75% of players in both groups, the body region most affected by injuries and complaints was the lower extremities. Orthopaedic and trauma surgeons had the lowest overall injury incidence and anaesthetists the highest (p = 0.049) during the tournament.

CONCLUSION

For the first time, this study presents detailed information on the injury incidence and injury patterns of an amateur football tournament. Less-trained recreational players sustained significantly more injuries than better-trained amateur players, probably due to the lack of sufficient preparation before the tournament. Preventive strategies against overuse and traumatic injuries of recreational football players should start with regular training and warm-up programmes in preparation for a tournament.

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.