A knowledge transfer scheme to bridge the gap between science and practice: an integration of existing research frameworks into a tool for practice

Effectiveness of exercise-based sports injury prevention programmes in reducing injury rates in adolescents and their implementation in the community: a mixed-methods systematic review

OBJECTIVE

Despite evidence supporting the efficacy of sport injury prevention programmes (SIPPs) in adolescents, implementation of SIPPs in community settings is low. This review aims to synthesise and integrate evidence on the efficacy of exercise-based SIPPs in reducing injury rates in adolescents with implementation strategies for such programmes in the community.

DESIGN

A systematic review with meta-analysis, narrative synthesis and meta-aggregation was conducted, followed by a convergent segregated approach to integrate the findings. Sensitivity and subgroup analyses were conducted. Study appraisal was performed using Joanna Briggs Institute Critical Appraisal Checklists and Mixed Methods Appraisal Tool.

DATA SOURCES

Literature search of nine databases was carried out to identify studies in English from January 2012 to December 2022.

ELIGIBILITY CRITERIA

Included were randomised controlled trials (RCTs), qualitative or mixed-methods studies. Population included adolescents (10-19 years). Interventions included SIPPs. Outcomes were injury rate and rate ratio (IRR). Phenomena of interest were facilitators and barriers to the implementation of SIPPs.

RESULTS

23 studies were included for analysis. Meta-analysis for 16 RCTs showed a protective effect of SIPP (IRR 0.63, 95% CI 0.53 to 0.74, p<0.00001) in adolescents. Meta-aggregation of seven qualitative/mixed-method studies revealed four sets of synthesised findings that impact implementation namely players' perceptions and beliefs, coaches as key facilitators, organisational support and characteristics of the SIPP.

CONCLUSION

Implementation of SIPPs provides a 37% risk reduction in adolescents but requires targeting key stakeholders through a top-down multifaceted approach for its efficacy to be translated. Future research should investigate the effectiveness of SIPPs and implementation strategies in adolescents in community settings.

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.

How to optimise the fidelity of exercises in an unsupervised golf injury prevention programme? A pilot study

Background

Golf is an individual sport that is usually done without the supervision of a trainer or coach. Therefore, an injury prevention programme in golf will primarily be performed without supervision and feedback. However, the effectiveness of any preventive exercise programme is determined by exercise fidelity.

Objective

To investigate the different instruction options of an injury prevention programme on exercise fidelity in individual golfers.

Methods

We randomly assigned golfers to one of three groups receiving different exercise instructions. One group received only instructional cards (A), one received only instructional videos (B) and a third group (C) received both instructional cards and videos. The golfers were allowed to familiarise themselves with the exercises based on the provided instruction option, after which we recorded their exercise execution on video. Two authors independently scored each exercise's fidelity from these recordings.

Results

In total, 18 golfers (12 women and 6 men, average age of 61.94 years) were equally divided across the 3 study groups completed 108 exercises. In group A 73.7% of exercises were executed as intended, in group B 88.6% and in group C 86.3%. Significantly more exercises were conducted correctly in groups B and C compared with group A (p<0.05).

Conclusion

Golfers who received instructions that included a video explanation had a higher exercise fidelity when compared to only written instructions.

Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction

Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).

Players', Head Coaches', And Medical Personnels' Knowledge, Understandings and Perceptions of Injuries and Injury Prevention in Elite-Level Women's Football in Ireland

BACKGROUND

To manage injuries effectively, players, head coaches, and medical personnel need to have excellent knowledge, attitudes, and behaviours in relation to the identification of risk factors for injuries, the implementation of injury prevention initiatives, as well as the implementation of effective injury management strategies. Understanding the injury context, whereby specific personal, environmental, and societal factors can influence the implementation of injury prevention initiatives and injury management strategies is critical to player welfare. To date, no qualitative research investigating the context of injuries, has been undertaken in elite-level women's football. The aim of our study was to explore the knowledge, attitudes, and behaviours of players, head coaches, and medical personnel in the Irish Women's National League (WNL) to injury prevention and injury management.

METHODS

We used qualitative research methods to explore the knowledge, attitudes, and behaviours of players, head coaches, and medical personnel in the Irish WNL to injury prevention and injury management. Semi-structured interviews were undertaken with 17 players, 8 medical personnel, and 7 head coaches in the Irish WNL. The data were analysed using thematic analysis. Our study is located within an interpretivist, constructivist research paradigm.

RESULTS

The participants had incomplete knowledge of common injuries in elite-level football, and many held beliefs about risk factors for injuries, such as menstrual cycle stage, which lacked evidence to support them. Jumping and landing exercises were commonly used to reduce the risk of injuries but evidence-based injury prevention exercises and programmes such as the Nordic hamstring curl, Copenhagen adduction exercise, and the FIFA 11+ were rarely mentioned. Overall, there was dissatisfaction amongst players with their medical care and strength and conditioning (S & C) support, with resultant inadequate communication between players, head coaches, and medical personnel.

CONCLUSION

Poor quality and availability of medical care and S & C support were considered to be a major obstacle in the effective implementation of injury risk reduction strategies and successful return-to-sport practices. More original research is required in elite-level women's football to explore injury risk factors, injury prevention initiatives, and contextual return-to-sport strategies, so that players, head coaches, and medical personnel can use evidence that is both up-to-date and specific to their environment.

A pragmatic strength and conditioning intervention for firefighters: Feasibility of the Tactical Athlete Resilience Program (TARP)

ISSUE ADDRESSED

Firefighting is physically and mentally taxing and recruits are expected to have optimal health and fitness. However, physical fitness tends to decline following initial training, placing firefighters at an increased risk for stress and injury. Efforts are needed to engage and support firefighters in maintaining adequate health and fitness to withstand the rigorous demands of their occupation. This study examined the feasibility of TARP, a pragmatic strength and conditioning intervention for metropolitan-based firefighters, delivered in collaboration with a professional National Rugby League club.

METHODS

A mixed-methods approach was utilised to examine program implementation, recruitment and sample characteristics, intervention satisfaction and acceptability, and participants' response to the intervention. Evaluation measures included field notes taken during steering committee meetings, participant flow data, baseline and follow-up outcome measures, self-report questionnaires, and telephone interviews with a sample of participants.

RESULTS

Participants (N = 113) were predominantly men (82%) with a mean age of 43 ± 9.3 years and BMI of 26.6 ± 2.9 kg/m² . Program satisfaction was high (95% very satisfied or somewhat satisfied) among program completers (42% retention). Key strengths of the program included delivery through the professional sports club, quality of facilities and equipment, and scheduling flexibility. Future programs should consider incorporating education or training to support behaviour change maintenance and strategies to retain participants at follow-up.

CONCLUSIONS

Results provide valuable insights into the design and delivery of interventions for firefighters and demonstrate the importance of strong partnerships between community stakeholders.

Effectiveness of a judo-specific injury prevention programme: a randomised controlled trial in recreational judo athletes

OBJECTIVES

To evaluate the effectiveness of a trainer-supervised judo-specific injury prevention warm-up programme on overall injury prevalence.

METHODS

We conducted a two-arm, cluster randomised controlled trial; the Injury Prevention and Performance Optimization Netherlands (IPPON) study. Judo athletes aged≥12 years were randomised by judo school to IPPON intervention or control group who performed their usual warm-up. Primary outcome was overall injury prevalence (%) over the follow-up period (16-26 weeks) measured fortnightly with the Oslo Sports and Trauma Research Centre Questionnaire. A modified intention-to-treat analysis was performed due to COVID-19, with estimates for the primary outcome obtained using generalised linear mixed models. Secondary outcomes included: prevalence of severe injuries, overall incidence, time-loss injuries, exposure, adherence and experiences of trainers and athletes.

RESULTS

269 judo athletes (IPPON: 117, Control: 152) were included. Mean injury prevalence over 16-26 weeks was 23% (95% CI 20% to 26%) in the IPPON and 28% (95% CI 25% to 30%) in the control group. We observed no significant difference of all reported injuries (OR 0.72 in favour of the IPPON group; 95% CI 0.37 to 1.39). Secondary outcomes also demonstrated no significant differences between groups. Specifically, no significant difference of severe injuries was reported (OR 0.80 in favour of the IPPON group; 95% CI 0.36 to 1.78). All trainers and 70% of athletes perceived the IPPON intervention as successful.

CONCLUSION

The IPPON intervention did not significantly reduce the overall and severe injury prevalence. Despite this, we suggest the IPPON intervention be considered as an useful alternative to regular judo warm-up, given the high adherence and the positive clinical experiences of trainers and athletes.

TRIAL REGISTRATION NUMBER

NTR7698.

Low adoption in women's professional football: teams that used the Nordic Hamstring Exercise in the team training had fewer match hamstring injuries

Objectives

The primary objective was to study the reach, effectiveness, adoption, implementation and maintenance of the Nordic Hamstring Exercise (NHE) programme in women's elite teams in Europe in the 2020-21 season. The secondary objective was to compare hamstring injury rates between teams that used the NHE programme regularly in team training and teams that did not.

Methods

Eleven teams participating in the Women's Elite Club Injury Study during the 2020-21 season provided data about injury rates and the implementation of the NHE programme.

Results

One team (9%) used the full original NHE programme, and four teams used the programme in the team training during parts of the season (team training group, n=5). Five teams did not use the NHE, or used it only sporadically for individual players, and one team used NHE only for players with a previous or current hamstring injury (no team training group, n=6). The team training group had a lower incidence of hamstring injuries during match-play (1.4 vs 4.0, p=0.028) than the non-team training group while no difference between groups was shown for the hamstring injury incidence in training (0.6 vs 0.7, p=0.502).

Conclusion

A low adoption of the NHE programme was reported during the 2020-21 season. However, teams that used NHE for the whole team or most players had a lower hamstring injury incidence at match-play than teams that did not use the NHE or used it for individual players only.

Contributors to negative biopsychosocial health or performance outcomes in rugby players (CoNBO): a systematic review and Delphi study protocol

The importance of contributors that can result in negative player outcomes in sport and the feasibility and barriers to modifying these to optimise player health and well-being have yet to be established. Within rugby codes (rugby league, rugby union and rugby sevens), within male and female cohorts across playing levels (full-time senior, part-time senior, age grade), this project aims to develop a consensus on contributors to negative biopsychosocial outcomes in rugby players (known as the CoNBO study) and establish stakeholder perceived importance of the identified contributors and barriers to their management. This project will consist of three parts; part 1: a systematic review, part 2: a three-round expert Delphi study and part 3: stakeholder rating of feasibility and barriers to management. Within part 1, systematic searches of electronic databases (PubMed, Scopus, MEDLINE, SPORTDiscus, CINAHL) will be performed. The systematic review protocol is registered with PROSPERO. Studies will be searched to identify physical, psychological and/or social factors resulting in negative player outcomes in rugby. Part 2 will consist of a three-round expert Delphi consensus study to establish additional physical, psychological and/or social factors that result in negative player outcomes in rugby and their importance. In part 3, stakeholders (eg, coaches, chief executive officers and players) will provide perceptions of the feasibility and barriers to modifying the identified factors within their setting. On completion, several manuscripts will be submitted for publication in peer-reviewed journals. The findings of this project have worldwide relevance for stakeholders in the rugby codes. PROSPERO registration number CRD42022346751.

The effectiveness of a golf injury prevention program (GRIPP intervention) compared to the usual warm-up in Dutch golfers: protocol design of a randomized controlled trial

Background

Sixty million golfers around the world play golf. Golf injuries are most frequently located in the spine, elbow, wrist, hand and shoulder. Those injuries are often seen in golfers with more playing hours and suboptimal swing biomechanics, resulting in overuse injuries. Golfers who do not perform a warm-up or do not warm-up appropriately are more likely to report an injury than those who do. There are several ways to warm-up. It is unclear, which warm-up is most useful for a golfer to perform. Moreover, there is currently no evidence for the effectiveness of a warm-up program for golf injury prevention. We previously have developed the Golf Related Injury Prevention Program (GRIPP) intervention using the Knowledge Transfer Scheme (KTS). We aim to evaluate the effect of the GRIPP intervention on golf-related injuries. The hypothesis is that the GRIPP intervention program will reduce the number of golf-related injuries.

Methods and design

The GRIPP study is a two-armed randomized controlled trial. Twenty-eight golf clubs with 11 golfers per club will be randomly allocated to the intervention or control group. The intervention group will perform the GRIPP intervention program, and the control group will perform their warm-up as usual. The GRIPP intervention is conducted with the Knowledge Transfer Scheme framework, which is a systematic process to develop an intervention. The intervention consists of 6 exercises with a maximum total of 10 min. The primary outcome is the overall prevalence (%) of golf injuries measured with the Oslo Sports Trauma Research Center (OSTRC-H) questions on health problems every fortnight. The secondary outcome measures will be exposure to golf and compliance to the intervention program.

Discussion

In other sports warm-up prevention programs are effective in reducing the risk of injuries. There are no randomized trials on golf injury prevention. Therefore, an individual unsupervised golf athlete intervention program is conducted which reflects the daily practice of predominantly unsupervised exposure of amateur golfers.

Trial registration

The trial is retrospectively (28 October 2021) registered at the Dutch Trial Register: NL9847 (https://trialsearch.who.int).

Still poorly adopted in male professional football: but teams that used the Nordic Hamstring Exercise in team training had fewer hamstring injuries – a retrospective survey of 17 teams of the UEFA Elite Club Injury Study during the 2020–2021 season

Objectives

The primary objective was to study the adoption of the NHE programme in European football teams in the 2020/21 season and to compare it to the previous study. A second objective was to compare hamstring injury rates between teams that used the NHE programme in the team training and teams that used the NHE only for players with previous or current hamstring injuries.

Methods

Data about the implementation of the NHE programme and injury rates were included for 17 teams participating in the Elite Club Injury Study during the 2020/2021 season.

Results

One team (6%) used the full original NHE programme, and another four teams used it for all or most players in the team (team training group, n=5). Eleven teams used NHE only for players with a previous or current hamstring injury (individual training group), and one team did not use NHE. The team training group had fewer hamstring injuries (5 vs 11 per team, p=0.008) and a lower injury burden (12 vs 35 lay-off days per 1000 hours, p=0.003) than the individual training group.

Conclusion

Similar to previous reports, low adoption of the NHE programme was seen in the 2020/2021 season. The low adoption rate (13%) relates to the number of teams fully or partly using NHE programmes. Teams that used NHE for the whole team or most players had a lower hamstring injury burden than teams that used NHE only for individual players.

SafeSport: Perceptions of Harassment and Abuse From Elite Youth Athletes at the Winter Youth Olympic Games, Lausanne 2020

OBJECTIVE

To analyze the Winter Youth Olympic Games (YOG) 2020 athletes' understanding and perceptions of harassment and abuse in sport and their knowledge of reporting mechanisms.

DESIGN

A cohort study.

SETTING

The Winter YOG2020 in Lausanne, Switzerland.

PARTICIPANTS

Accredited athletes at the YOG2020.

INTERVENTION

An athlete safeguarding educational program was delivered at the YOG2020. Participating athletes were encouraged to answer a survey embedded in the safeguarding educational materials during the YOG.

MAIN OUTCOME MEASURES

Perception of occurrence of harassment and abuse as well as knowledge of the term "safe sport" and reporting mechanisms.

RESULTS

The survey response rate of athletes attending the Safe Sport Booth was 69%. When asked to define Safe Sport, 10% of athletes at the YOG2020 correctly identified a sport environment free from harassment and abuse, 20% identified fair play/antidoping, and 19% safety. When presented with the definition of harassment and abuse, 30.4% expressed surprise, in contrast to 46% in the summer YOG2018. A third (32%) reported that harassment and abuse was either "likely" or "very likely" present in their sport, which was similar to the YOG2018 (34%). The group of athletes not knowing where to go to report harassment and abuse was greater than in the YOG2018 (26% vs 11%). There were no differences in responses between competitive sex (boys' vs girls' events) or type of sport (team vs individual).

CONCLUSIONS

Outcomes of this study, such as the development of youth-friendly terminology and emphasizing mechanisms for reporting of harassment and abuse, should inform the development of safeguarding educational materials for youth athletes.

Non-shoulder Injuries in Swimming: A Systematic Review

OBJECTIVE

The shoulder is the most common injury in swimming, followed by the knee and spine. The repetitive nature of swimming training may predispose a swimmer to injury. Several risk factors have been previously identified, but the level of evidence and level of certainty that these risk factors predispose a swimmer to injury risk has yet to be evaluated critically in a systematic review.

DESIGN

Systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

DATA SOURCES

Data were obtained through PubMed, Cochrane, and Google Scholar. The database search was limited to articles that were published between January 1980 and December 2019.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Level I, II, and III studies were included in this review. All studies must have been conducted in swimmers or swimming, a description of the specific pathology and provide at least one identified risk factor with an association (P < 0.05).

RESULTS

A total of 19 critically appraised articles identified 28 potential risk factors for musculoskeletal injuries in swimmers. The risk factors were grouped by the anatomical region: neck and back, pelvis and hip, and the knee. Only 2 risk factors were appraised at a moderate level of certainty, both occurring in the knee. The remaining 26 identified risk factors were appraised at a low level of certainty. There is a clear lack of research surrounding nonshoulder injuries in swimmers.

'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.

A lifespan approach to osteoarthritis prevention

Prevention is an attractive solution for the staggering and increasingly unmanageable burden of osteoarthritis. Despite this, the field of osteoarthritis prevention is relatively immature. To date, most of what is known about preventing osteoarthritis and risk factors for osteoarthritis is relative to the disease (underlying biology and pathophysiology) of osteoarthritis, with few studies considering risk factors for osteoarthritis illness, the force driving the personal, financial and societal burden. In this narrative review we will discuss what is known about osteoarthritis prevention, propose actionable prevention strategies related to obesity and joint injury which have emerged as important modifiable risk factors, identify where evidence is lacking, and give insight into what might be possible in terms of prevention by focussing on a lifespan approach to the illness of osteoarthritis, as opposed to a structural disease of the elderly. By targeting a non-specialist audience including scientists, clinicians, students, industry employees and others that are interested in osteoarthritis but who do not necessarily focus on osteoarthritis, the goal is to generate discourse and motivate inquiry which propel the field of osteoarthritis prevention into the mainstream.

The Altmetric Score Has a Stronger Relationship With Article Citations Than Journal Impact Factor and Open Access Status: A Cross-sectional Analysis of 4022 Sport Sciences Articles

OBJECTIVE

To assess the relationship of individual article citations in the sport sciences field with (1) Journal Impact Factor, (2) each article's open access status, and (3) Altmetric score components.

DESIGN

Cross-sectional.

METHODS

We searched the Web of Science Journal Citation Reports database in the sport sciences category for the 20 journals with the highest 2-year Journal Impact Factor in 2018. We extracted the impact factor for each journal and each article's open access status (yes or no). Between September 2019 and February 2020, we obtained individual citations, Altmetric scores, and details of Altmetric components (eg, number of tweets, Facebook posts, etc) for each article published in 2017. Linear and multiple regression models were used to assess the relationship between the dependent variable (citation number) and the independent variables (article Altmetric score and open access status and Journal Impact Factor).

RESULTS

Of the 4022 articles included, the total Altmetric score, Journal Impact Factor, and open access status respectively explained 32%, 14%, and 1% of the variance in article citations (when combined, the variables explained 40% of the variance in article citations). The number of tweets related to an article was the Altmetric component that explained the highest proportion of article citations (37%).

CONCLUSION

Altmetric scores in sport sciences journals have a stronger relationship with number of citations than Journal Impact Factor and open access status do. Twitter may be the best social media platform for promoting a research article. J Orthop Sports Phys Ther 2021;51(11):536-541. Epub 1 Jul 2021. doi:10.2519/jospt.2021.10598.

Can We Go Online for Sports Injury Prevention? A Systematic Review of English-Language Websites with Exercise-Based Sports Injury Risk Reduction Programmes

Background

Preventing sports injuries is at the forefront of sports medicine. Although effective preventive strategies in scientific literature exist, their implementation is lagging behind. The Internet could support the translation of knowledge from the literature to end-users, but the quality of the online resources would have to be assured. This online-based systematic review is to assess availability, readability, quality, and content of the websites presenting exercise-based sports injury risk reduction (prevention) programmes. Moreover, the quality of reporting and contents of the exercise programmes were assessed.

Methods

Google, Yahoo, and Bing were searched on 2 September 2018. We used ‘sports injury prevention program*’ and ‘sports injury prevention warm-up’ as search phrases. The owners/authors of the included websites were asked for further recommendations on online resources. Search updates were run in DuckDuckGo on 15 May 2020 and 22 August 2021. Eligible websites were active, in English, and contained instructions for the exercise/s aiming at sports injury prevention. Two reviewers independently screened the links and previews and performed an in-depth appraisal of included websites. The website quality was assessed using JAMA framework criteria and Health on the Net Foundation Code of Conduct (HONcode) certification. The readability of websites was assessed using the Flesch-Kincaid Reading Ease score. The reporting appraisal of exercise programmes was done using the modified Consensus on Exercise Reporting Template (CERT).

Results

Among 480 websites screened, 16 were eligible with an additional four recommended and nine found in search updates (29 in total). None of the websites was certified by HONcode. The overall quality of websites was low 2.1 ± 1.0/4, but overall readability was high 67 ± 17/100. The average quality of reporting of exercise programmes was low 5.79 ± 3.1/12. Websites with community input had the lowest readability, but the highest quality, and vice versa websites run by businesses had the highest readability, but the lowest quality. Eight websites presented programmes tested for effectiveness.

Conclusions

Overall, the quality of the websites was low, but their readability was high. Improvements required are relatively easy to implement (i.e. including the date when the website was updated, applying for HONcode certification) and extremely important (e.g. providing resources on which the website’s content is based). There are some sports injury risk reduction programmes reported with high quality and effectiveness-tested available online for team sports, but none for individual sports.

Trial Registration This review has been registered in the PROSPERO (CRD42019107104).

Implementing ACL Injury Prevention in Daily Sports Practice-It's Not Just the Program: Let's Build Together, Involve the Context, and Improve the Content

Although the benefits of current anterior cruciate ligament (ACL) injury prevention programmes have been demonstrated in efficacy studies, they, unfortunately, have had limited public health impact to date. For example, the incidence of ACL injuries continues to rise in adolescent athletes. Raising awareness and educating coaches and athletes is not enough to facilitate the widespread, sustained use of these programmes in the real-world setting. Considering the profound burden of ACL injuries, it is necessary to continue to improve the current ACL injury prevention programmes through co-creation. First, the uptake of the programmes should be optimized by a better appreciation and understanding of the individual, socio-cultural and environmental context (i.e., community). Second, the content of the programmes should be optimized to better reflect the demands of the sport by creating more ownership and increasing motivation (incorporating challenging, sport-specific and fun elements) with the end-users. In addition, implicit motor learning, random practice and differential learning are concepts that should be integrated when practising to obtain the most optimal results when learning or finetuning skills.

Rethinking innovation and the role of stakeholder engagement in sport and exercise medicine

In sport and exercise medicine, increasing pressure to improve athlete health outcomes and performance with limited resources has prompted an emphasis on innovation. A key component to innovation is stakeholder participation and engagement, that is, the involvement of those affected by the outcomes, such as end users and actors (the person(s) performing the required actions/behaviour change), of the research process. Several research frameworks in sport and exercise medicine highly recommend stakeholder engagement as part of the research process. There are, however, different levels to how engaged a stakeholder can be in a research project, and this level of engagement may be dependent on the researchers' goals. Stakeholder engagement can be organised on a continuum based on the stakeholder's relationship to the research and how involved they are in the project's decision-making process. This continuum can be used as a rating scale to evaluate and monitor the degree of perceived stakeholder participation in a research project. There are different paths to innovation in research, which are interlinked, and ideas and knowledge flow between them. Considering the continuum of stakeholder engagement and paths to innovation, this article highlights how different research types require different degrees of stakeholder engagement.

Help-seeking behaviours related to mental health symptoms in professional football

Objectives

The primary objective was to examine the attitudes of professional footballers towards help-seeking behaviours related to mental health symptoms and the impact of a mental health awareness video on these help-seeking behaviours. The secondary objective was to evaluate whether the mental health awareness video was feasible in professional football.

Methods

A quasi-experimental study based on a one-group pretest post-test was conducted using a questionnaire. Attitude, help-seeking behaviours and confidence were measured with validated questionnaires, including the Attitudes Toward Seeking Professional Psychological Help-Short Form (ATSPPH-SF) and General Help-Seeking Questionnaire (GHSQ).

Results

Sixty-five professional footballers (63% men; 37% women) were enrolled in the study. The mean ATSPPH-SF score was 18.1 at pretest and 19.4 at post-test (p=0.00). The mean GHSQ score was 47.6 at pretest and 48.9 at post-test (p=0.00). The level of confidence in helping someone experiencing mental health symptoms was 11.1 at pretest and 11.7 at post-test (p=0.00). All participants rated the mental health awareness video as relevant; 88% mentioned that it added value to raise awareness about mental health symptoms and disorders in professional football. Eighty-three per cent rated the design positively, 69% were positive about the duration of the video and 88% of participants reported an increase in their knowledge and understanding of mental health symptoms and disorders in professional football.

Conclusion

The mental health awareness video led to a better attitude of professional footballers towards mental health. We recommend the mental health awareness video be implemented in professional football to disseminate essential information related to mental health symptoms in professional football.

Recommendations for Movement Re-training After ACL Reconstruction

It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). Restoring movement quality during sporting-type movements is important prior to return-to-sport (RTS) after ACLR. Alterations in movement quality during an array of functional tasks are common amongst ACLR patients at or near the time of RTS and are associated with worse outcomes after ACLR. The inability to correct movement issues prior to RTS is likely due to the use of incomplete programmes or a lack of volume and intensity of movement re-training programmes. Although most clinicians and researchers understand that re-training movement after ACLR is important (e.g., the 'why'), there is often a disconnect with understanding the 'how' and 'what' of movement re-training post ACLR. The aim of this paper was to discuss factors relevant to movement dysfunction and re-training after ACLR and provide recommendations for clinicians to restore movement quality of patients after ACLR, prior to RTS. The paper recommends: (i) considering the factors which influence the expression of movement quality, which revolve around individual (e.g., neuromuscular, biomechanical, sensorimotor and neurocognitive factors), task-specific and environmental constraints; (ii) incorporating a three-staged movement re-training approach aligned to the ACLR functional recovery process: (1) addressing the neuromuscular and biomechanical and sensorimotor control factors which affect movement quality and motor learning, (2) including a progressive movement re-training approach to re-learn an array of functional tasks optimising coordination and motor learning (3) performing the final aspect of rehabilitation and movement training on the field, in realistic environments progressively simulating the sporting movement demands and environmental constraints; and (iii) effectively designing the movement programme for optimal load management, employing effective coach and feedback techniques and utilising qualitative movement analysis for transition between exercises, stages and for RTS.

Sports Injury Prevention is Complex: We Need to Invest in Better Processes, Not Singular Solutions

In recent years, an understanding has developed that sports injuries are the emergent outcomes of complex, dynamic systems. Thus, the influence of local contextual factors on injury outcomes is increasingly being acknowledged. These realisations place injury prevention research at a crossroads. Currently, injury prevention researchers develop universally applicable injury prevention solutions, but the adoption of these solutions in practice is low. This occurs because implementation contexts are both unique and dynamic in nature, and as a result singular, static solutions are often incompatible. In contrast, practitioners address injury prevention through iterative cycles of trial and error, aiming to optimise the injury prevention process within their own unique contexts. The purpose of this critical review is to draw attention to the misalignment between research and practice-based approaches to injury prevention. In light of this, we propose alternative research approaches that acknowledge the process-driven nature of injury prevention in practice. We propose that a core focus of sport injury prevention research should be to provide practitioners with useful and relevant information to support their decision making around their localised injury prevention practice. Through this approach, injury prevention research ceases to be about what works, and begins to engage with understanding what works in what contexts and why?

The feasibility of implementing an evidence-based physical training program during a Canadian Armed Forces basic infantry course

OBJECTIVES

Determine the feasibility of implementing an evidence-based training program compared to a control during a basic infantry training course, and compare their effectiveness on measures of injuries and associated burdens.

DESIGN

Prospective, cohort, feasibility study.

METHODS

Infantry candidates awaiting course between 01-April-2019 and 31-March-2020 were invited to participate while those releasing from the military, awaiting occupational transfer or having >5 medical employment limitation days were excluded. Consenting participants were allocated to an infantry course prospectively scheduled to host either the evidence-based program or a control. The evidence-based program adapted modified physical training strategies from previous studies reporting reduced injuries in recruits and was supervised by certified fitness professionals, while the control was at the discretion of infantry instructors.

RESULTS

With the exception of intervention duration which was limited due to operational factors, all feasibility outcomes were met including a recruitment rate of 171/203=84.2% and an intervention adherence of 126/144=87.5%. Stakeholders reported that the evidence-based program implementation was feasible, posing a manageable demand on resources without compromising operations. Evidence-based program participants reported 68% fewer overuse musculoskeletal injuries, 296 fewer medical employment limitation days and 11 fewer attritions than control participants.

CONCLUSIONS

An evidence-based training program is feasible to implement on a basic infantry training course, and results in fewer musculoskeletal injuries, medical employment limitation days and attrition. Given these results, this program should be generalizable for a full experimental trial, and may be scaled for intermediate/advanced infantry and/or other combat occupation courses to promote an evolution towards evidence-based training.

Implementation science in nutrition: a summary and synthesis

Objective:

This paper aimed to summarise and critically synthesise the key findings of the articles included in the supplement entitled ‘Nutrition Implementation Science: The Experience of a Large-Scale Home Fortification in Bangladesh’.

Design:

Commentary, summary and synthesis.

Settings:

Low- and middle-income country.

Results:

The supplement included six articles, including this summary paper. The second article presented an implementation science framework that facilitated conceptualising and evaluating the home-fortification programme in Bangladesh implemented by the Bangladesh Rural Advancement Committee (BRAC). The framework encompasses five components: identifying an ‘effective’ intervention; scaling-up and implementation fidelity; course corrections during implementation and assessing the implementation’s effectiveness; promoting sustainability of interventions and consideration of a concurrent evaluation to identify ‘effective’ interventions and to assess the process and outcome indicators of implementation. The other four articles in this supplement addressed the different components of the framework. For example, the third article addressed the implementation fidelity of a home-fortification programme, and the fourth article described the use of concurrent evaluation to course correct the implementation plan that resulted in improved implementation fidelity. The fifth article explained the outcome of course correction in the programme coverage, and the sixth article described the cost-effectiveness of the BRAC home-fortification programme.

Conclusions:

Overall, the supplement provides a comprehensive understanding of nutrition implementation science, which is very new in the field. The lessons learned in this supplement may enhance the capacity of researchers, policymakers and key stakeholders in the nutrition field to scale up new nutrition interventions and sustain them until malnutrition is alleviated.

Recommendations for Hamstring Function Recovery After ACL Reconstruction

It is important to optimise the functional recovery process to enhance patient outcomes after major injury such as anterior cruciate ligament reconstruction (ACLR). This requires in part more high-quality original research, but also an approach to translate existing research into practice to overcome the research to implementation barriers. This includes research on ACLR athletes, but also research on other pathologies, which with some modification can be valuable to the ACLR patient. One important consideration after ACLR is the recovery of hamstring muscle function, particularly when using ipsilateral hamstring autograft. Deficits in knee flexor function after ACLR are associated with increased risk of knee osteoarthritis, altered gait and sport-type movement quality, and elevated risk of re-injury upon return to sport. After ACLR and the early post-operative period, there are often considerable deficits in hamstring function which need to be overcome as part of the functional recovery process. To achieve this requires consideration of many factors including the types of strength to recover (e.g., maximal and explosive, multiplanar not just uniplanar), specific programming principles (e.g., periodised resistance programme) and exercise selection. There is a need to know how to train the hamstrings, but also apply this to the ACLR athlete. In this paper, the authors discuss the deficits in hamstring function after ACLR, the considerations on how to restore these deficits and align this information to the ACLR functional recovery process, providing recommendation on how to recover hamstring function after ACLR.

Athlete health and safety at large sporting events: the development of consensus-driven guidelines

All sport events have inherent injury and illness risks for participants. Healthcare services for sport events should be planned and delivered to mitigate these risks which is the ethical responsibility of all sport event organisers. The objective of this paper was to develop consensus-driven guidelines describing the basic standards of services necessary to protect athlete health and safety during large sporting events. By using the Knowledge Translation Scheme Framework, a gap in International Federation healthcare programming for sport events was identified. Event healthcare content areas were determined through a narrative review of the scientific literature. Content experts were systematically identified. Following a literature search, an iterative consensus process was undertaken. The outcome document was written by the knowledge translation expert writing group, with the assistance of a focus group consisting of a cohort of International Federation Medical Chairpersons. Athletes were recruited to review and provide comment. The Healthcare Guidelines for International Federation Events document was developed including content-related to (i) pre-event planning (eg, sport medical risk assessment, public health requirements, environmental considerations), (ii) event safety (eg, venue medical services, emergency action plan, emergency transport, safety and security) and (iii) additional considerations (eg, event health research, spectator medical services). We developed a generic standardised template guide to facilitate the planning and delivery of medical services at international sport events. The organisers of medical services should adapt, evaluate and modify this guide to meet the sport-specific local context.

Systematic development of an injury prevention programme for judo athletes: the IPPON intervention

Objectives

To systematically develop an injury prevention programme in judo and test its feasibility: Injury Prevention and Performance Optimization Netherlands (IPPON) intervention.

Methods

We used the five-step Knowledge Transfer Scheme (KTS) guidelines. In the first two steps, we described the injury problem in judo and showed possibilities to reduce the injury rates. In the third step, the Knowledge Transfer Group (KTG) translated this information into actions in judo practice. Expert meetings and practical sessions were held. In the fourth step, we developed the injury prevention programme and evaluated its feasibility in judo practice in a pilot study. As a final step, we will evaluate the injury prevention programme on its effectiveness to reduce injuries.

Results

In the first two steps, information collected indicated the need for reducing judo injuries due to high incidence rates. Injury prevention programmes have shown to be effective in reducing injuries in other sports. For judo, no injury prevention programme has yet been systematically developed. In the third step, the KTG reached consensus about the content: a trainer-based warm-up programme with dynamic exercises focusing on the shoulder, knee and ankle. In the fourth step, the intervention was developed. All exercises were approved in the pilot study. Based on the pilot study’s results, the IPPON intervention was extended and has become suitable for the final step.

Conclusion

We developed the IPPON intervention using the systematic guidance of the KTS. This trainer-based programme focuses on the prevention of shoulder, knee and ankle injuries in judo and consists of 36 exercises classified in three categories: (1) flexibility and agility, (2) balance and coordination and (3) strength and stability. The effectiveness and feasibility of the intervention on injury reduction among judo athletes will be conducted in a randomised controlled trial.

International Olympic Committee (IOC) Sport Mental Health Assessment Tool 1 (SMHAT-1) and Sport Mental Health Recognition Tool 1 (SMHRT-1): towards better support of athletes' mental health

Objectives

To develop an assessment and recognition tool to identify elite athletes at risk for mental health symptoms and disorders.

Methods

We conducted narrative and systematic reviews about mental health symptoms and disorders in active and former elite athletes. The views of active and former elite athletes (N=360) on mental health symptoms in elite sports were retrieved through an electronic questionnaire. Our group identified the objective(s), target group(s) and approach of the mental health tools. For the assessment tool, we undertook a modified Delphi consensus process and used existing validated screening instruments. Both tools were compiled during two 2-day meeting. We also explored the appropriateness and preliminary reliability and validity of the assessment tool.

Sport Mental Health Assessment Tool 1 and Sport Mental Health Recognition Tool 1

The International Olympic Committee Sport Mental Health Assessment Tool 1 (SMHAT-1) was developed for sports medicine physicians and other licensed/registered health professionals to assess elite athletes (defined as professional, Olympic, Paralympic or collegiate level; aged 16 years and older) potentially at risk for or already experiencing mental health symptoms and disorders. The SMHAT-1 consists of: (i) triage with an athlete-specific screening tool, (ii) six subsequent disorder-specific screening tools and (iii) a clinical assessment (and related management) by a sports medicine physician or licensed/registered mental health professional (eg, psychiatrist and psychologist). The International Olympic Committee Sport Mental Health Recognition Tool 1 (SMHRT-1) was developed for athletes and their entourage (eg, friends, fellow athletes, family and coaches).

Conclusion

The SMHAT-1 and SMHRT-1 enable that mental health symptoms and disorders in elite athletes are recognised earlier than they otherwise would. These tools should facilitate the timely referral of those athletes in need for appropriate support and treatment.

Implementation of the Endocrine Society clinical practice guidelines for gestational diabetes mellitus to a knowledge tool

BACKGROUND

Despite the production of clinical practice guidelines (CPGs) in many medical areas, their use is not sufficiently adopted in clinical practice. Incorporation of CPGs in knowledge tools (KnowT) or decision support systems (DSS) for routine use can improve healthcare providers' compliance to CPGs.

MATERIALS AND METHODS

Clinical practice guidelines for gestational diabetes mellitus (GDM) were searched for, collected and compared. The CPG that met pre-specified criteria ([a] published by a European or American organization between 2010 and 2018, [b] being developed a systematic way and [c] having statements of "level of evidence" and "strength of recommendation") was chosen for implementation (Endocrine Society, 2013). Its recommendations were deconstructed, re-organized and reconstructed as an algorithm (in the form of a flowchart), which was integrated into a KnowT. Content completeness and evaluation of CPG by the Guideline Implementability Appraisal tool (GLIA) were performed as well. The primary objective was the development of a clinical algorithm in the field of GDM and its integration into a KnowT. The secondary objective was to demonstrate the completeness of the CPG content and evaluate its implementability in the KnowT.

RESULTS

Endocrine Society 2013 CPG was restructured as a flowchart, and a KnowT was constructed with the use of the "Openlabyrinth" software. The completeness of the content was confirmed, and GLIA appraisal demonstrated its implementability.

CONCLUSION

Endocrine Society 2013 CPG for GDM is a complete set of recommendations. Its structure makes possible the design of a clinical algorithm and its implementation into a KnowT.

The physical demands of mixed martial arts: A narrative review using the ARMSS model to provide a hierarchy of evidence

The physical demands of mixed martial arts (MMA) training and competition is not yet well quantified. The Applied Research Model for the Sport Sciences (ARMSS) provides a framework through which to conduct sport science, determining pertinent questions to test research findings in real-world settings. The aim of this review was to evaluate MMA research within the context of ARMSS to critically analyse our understanding of the physical requirements of MMA training and competition. Research databases were searched, with 70 peer-reviewed articles being discussed in relation to the specific stage of the ARMSS in which their results best fit. MMA research was found to be mostly foundational and descriptive in nature and has generally not developed along systematic lines. The internal and external loads and responses to training and competition have not been adequately identified. Therefore, it is not currently possible to state which variables are key predictors of success, or how coaches can optimally manipulate these variables. We propose that MMA research be refocused to be conducted within ARMSS. Specifically, stage 2 studies describing the physical, physiological and technical demands of MMA training and competition, and stage 3 studies determining the physiological predictors of performance should be initially prioritised.

Nobody says to you "come back in six months and we'll see how you're doing": a qualitative interview study exploring young adults' experiences of sport-related knee injury

Background

Regular exercise is vital for overall health, and key to the maintenance of joint health. However, whilst people are encouraged to participate in sport and exercise, many are unaware that they could be at risk of developing post-traumatic osteoarthritis (PTOA) in the years following sport-related injury. Younger adults (< 40 years) with PTOA can experience declining quality of life, comorbid health conditions, and symptoms that place a chronic burden on health services. Conserving knee health through careful self-management in the latency period between injury and the onset of PTOA may help to delay disease progression. In this regard, the development of self-management interventions can be facilitated by understanding the post-injury experiences of young adults and their attitudes towards joint health.

Methods

Semi-structured interviews were conducted with 13 young adults following a sport-related knee injury to explore their experiences of injury, and their attitudes and perceptions of self-managing knee health. The interviews were audio-recorded, transcribed and analysed systematically using an inductive approach.

Results

Four themes pertaining to participants’ experiences were identified: [1] perceptions of current care provision; [2] long-term impact of knee injury; [3] motivation to conserve knee health; and [4] opportunities for supplementary support. The expression “Nobody says to you ‘come back in six months and we’ll see how you’re doing’” personifies the long-term impact of knee injury on young adults and a paucity of care provision.

Conclusion

Participants did not perceive that they had adequate care in the aftermath of knee injury, leading to a sense of frustration and uncertainty. This had implications for continued participation in sport and exercise, negatively impacting their athletic identity and sense of wellbeing. Activity tracking, symptom monitoring, advice provision and peer support were identified as tools to enable individuals to self-manage knee health.

Patient Education for Patellofemoral Pain: A Systematic Review

OBJECTIVE

To evaluate the effect of education interventions compared with any type of comparator on managing patellofemoral pain (PFP).

DESIGN

Intervention systematic review. PROSPERO identifier: CRD42018088671.

LITERATURE SEARCH

MEDLINE, Embase, CINAHL, and Web of Science were searched for studies evaluating the effect of education on clinical and functional outcomes in people with PFP.

STUDY SELECTION CRITERIA

Two reviewers independently assessed studies for inclusion and quality. We included randomized controlled trials on PFP where at least 1 group received an education intervention (in isolation or in combination with other interventions).

DATA SYNTHESIS

Available data were synthesized via meta-analysis where possible; data that were not appropriate for pooling were synthesized qualitatively. Interpretation was guided by the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Nine trials were identified. Low-credibility evidence indicated that health education material alone was inferior to exercise therapy for pain and function outcomes. Low- and very low-credibility evidence indicated that health professional-delivered education alone produced outcomes similar to those of exercise therapy combined with health professional-delivered education for pain and function, respectively.

CONCLUSION

Health professional-delivered education may produce similar outcomes in pain and function compared to exercise therapy plus health professional-delivered education in people with PFP. J Orthop Sports Phys Ther 2020;50(7):388-396. Epub 29 Apr 2020. doi:10.2519/jospt.2020.9400.

Implementation of a behavioural change intervention to enhance oral health behaviours in elite athletes: a feasibility study

Background

Poor oral health of elite athletes is common and is associated with negative performance impacts. There is a need for oral health promotion strategies that are effective within the elite sport environment.

Aim

To develop, implement and evaluate a pragmatic oral health promotion intervention that integrated the capability, opportunity, motivation and behaviour model of behavioural change into the knowledge transfer system for effective implementation of preventive interventions.

Methods

Repeated measures study. Athletes and support team together viewed one 10 min presentation and three 90 s information films. Athletes alone received oral health screening, personalised advice and an oral health toolkit. Outcome measures included: (1) oral health knowledge, athlete-reported performance impacts (Oslo Sports Trauma Research Centre, OSTRC score), use of oral hygiene aids, gingival inflammation (bleeding) score, recorded at baseline, 4-6 weeks and 12-16 weeks and (2) athlete feedback.

Results

We recruited 62 athletes; 44 (71%) male and 58 (93.5%) white British, 55 (88.7%) athletes completed the study. Mean knowledge score improved from 5.69 (1.59) to 6.93 (1.32) p<0.001. Mean OSTRC score reduced from 8.73 (14.54) to 2.73 (11.31) p<0.001. Athlete use of prescription strength fluoride toothpaste increased from 8 (12.9%) to 45 (80.4%) p<0.001. Athlete-reported use of interdental cleaning aids at least 2-3 x week increased from 10 (16.2%) to 21 (34%) p=0.013. Bleeding score remained unchanged.

Conclusion

This behavioural change intervention was successfully implemented within different elite sport environments. It was associated with an increase in athlete oral health knowledge, enhanced oral health behaviour, a reduction in self-reported performance impacts and high participant retention.

Hamstring Injuries Prevention in Soccer: A Narrative Review of Current Literature

Hamstring injuries and reinjuries are one of the most important sport lesions in several sport activities including soccer, Australian football, track and field, rugby, and in general in all sport activities requiring sprinting and acceleration. However, it is important to distinguish between the lesions of the biceps femoris and semitendinosus and semimembranosus. Indeed, three muscles representing the hamstring complex have a very different injury etiology and consequently require different prevention strategies. This fact may explain, at least in part, the high incidence of reinjuries. In soccer, hamstring injuries cause an important rate of time loss (i.e., in average 15–21 matches missed per club per season). The hamstring injury risk factors may be subdivided in three categories: “primary injury risk factors” (i.e., the risk factors mainly causing a first lesion), “recurrent injury risk factors” (i.e., the risk that can cause a reinjury), and bivalent injury risk factors” (i.e., the risk factors that can cause both primary injuries and reinjuries). The high incidence of hamstring lesions caused consequently an important increase in hamstring injury research. However, although the prevention has increased paradoxically, epidemiological data do not show a loss in injuries and/or reinjuries but, on the contrary, they show an increase in hamstring injuries. This apparent paradox highlights the importance both of the improvement in the prevention programs quality and the criteria for return to play after hamstring injury.

Injury burden differs considerably between single teams from German professional male football (soccer): surveillance of three consecutive seasons

PURPOSE

The purpose of this study was to analyse unique injury data of the national statutory accident insurance for the two highest divisions in German male football (Bundesliga and 2. Bundesliga) over three consecutive seasons regarding inter-season, inter-division and inter-team differences.

METHODS

This was a prospective observational open cohort study over the seasons 2014/2015, 2015/2016 and 2016/2017. Every acute injury that was registered by clubs or physicians with the German statutory accident insurance for professional athletes (VBG) as part of occupational accident reporting and that led to time loss and/or to medical attention, was included.

RESULTS

The complete sample consisted of 1449 players. The study covered 2663.5 player seasons with an observed match exposure of 69,058 h and a projected training exposure of 529,136 h. In total, 7493 injuries were included. The overall incidence rate was 12.5 (± 0.28) injuries per 1000 exposure hours, which translated into match and training rates of 47.0 (± 1.62) and 8.02 (± 0.24) injuries per 1000 h, respectively.

CONCLUSION

Findings of 2.7 injuries per player and season underline the need of effective preventive approaches. Higher injury incidences in seasons after international tournaments suggest an increasing risk of injury with increasing number of matches. However, large differences between the single teams from the same division indicate that a reduction in the injury burden is generally possible. Continuing the presented injury surveillance might be helpful to identify injury trends in the future and to evaluate the effectiveness of preventive approaches under real-life conditions.

LEVEL OF EVIDENCE

Level  II.

Criteria-Based Return to Sport Decision-Making Following Lateral Ankle Sprain Injury: a Systematic Review and Narrative Synthesis

OBJECTIVE

The aim of this systematic review was to identify prospective studies that used a criteria-based return to sport (RTS) decision-making process for patients with lateral ankle sprain (LAS) injury.

DESIGN

Systematic review and narrative synthesis.

DATA SOURCES

The PubMed (MEDLINE), Web of Science, PEDro, Cochrane Library, SPORTDiscus (EBSCO), ScienceDirect, and Scopus databases were searched to 23 November 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were included if they prospectively applied a criteria-based RTS decision-making process for patients with LAS injury, but were excluded if they merely gathered outcome measures at the RTS time point. Studies were also excluded if patients were recovering from ankle fracture, high ankle sprain, medial ankle sprain, chronic ankle instability or complex ankle injury.

RESULTS

No studies were identified that used a criteria-based RTS decision-making process for patients with LAS injury. We were unable to conduct a quantitative synthesis or meta-analysis, therefore we provide a narrative synthesis of relevant questionnaires, as well as clinical and functional assessments commonly used in studies retrieved in the search.

CONCLUSION

There are currently no published evidence-based criteria to inform RTS decisions for patients with an LAS injury. Based on our narrative synthesis, we propose a number of variables that could be used to develop a criteria-based RTS decision paradigm. Future research should aim to reach consensus on these variables and apply them to actual RTS decisions within prospective study designs. Furthermore, we suggest that complex systems theory and the RTS continuum could be used to inform the development of an RTS decision-making paradigm for athletes with LAS injury.

Developing a conceptual framework for implementation science to evaluate a nutrition intervention scaled-up in a real-world setting

Objective:

The aim of this paper is to identify and develop a comprehensive conceptual framework using implementation science that can be applied to assess a nutrition intervention in a real-world setting.

Design:

We conducted a narrative review using electronic databases and a manual search to identify implementation science frameworks, models and theories published in peer-reviewed journals. We performed a qualitative thematic analysis of these publications to generate a framework that could be applied to nutrition implementation science.

Results:

Based on this review, we developed a comprehensive framework which we have conceptualised as an implementation science process that describes the transition from the use of scientific evidence through to scaling-up with the aim of making an intervention sustainable. The framework consisted of three domains: Domain i – efficacy to effectiveness trials, Domain ii – scaling-up and Domain iii – sustainability. These three domains encompass five components: identifying an ‘effective’ intervention; scaling-up and implementation fidelity; course corrections during implementation; promoting sustainability of interventions and consideration of a comprehensive methodological paradigm to identify ‘effective’ interventions and to assess the process and outcome indicators of implementation. The framework was successfully applied to a nutrition implementation program in Bangladesh.

Conclusions:

Our conceptual framework built from an implantation science perspective offers a comprehensive approach supported by a foundational and holistic understanding of its key components. This framework provides guidance for implementation researchers, policy-makers and programme managers to identify and review an effective intervention, to scale it up and to sustain it over time.

Effectiveness of an e-health tennis-specific injury prevention programme: randomised controlled trial in adult recreational tennis players

BACKGROUND

Despite reported injury rates of up to 3 per 1000 hours exposure, there are no evidence-based prevention programmes in tennis.

PURPOSE

To evaluate the effectiveness of an e-health prevention programme for reducing tennis injury prevalence.

STUDY DESIGN

Two-arm, researcher-blinded randomised controlled trial.

METHODS

Adult tennis players of all playing levels were randomised in an unsupervised programme lasting 12 weeks (TennisReady group or control group). The primary outcome was the overall injury prevalence over a 16-week period, measured at 2 weekly intervals with the Oslo Sports and Trauma Research Centre questionnaire. Estimates for the primary outcome and associated 95% CIs were obtained using generalised estimating equation models. Secondary outcome scores included prevalence of substantial injuries, overall incidence, adherence and time-loss injuries.

RESULTS

A total of 579 (83%) (TennisReady n=286, control n=293) participants were included in the primary analysis. The mean injury prevalence was 37% (95% CI 33% to 42%) in the TennisReady vs 38% (95% CI 34% to 42%) in the control group (adjusted p-value 0.93). The prevalence of substantial injuries was 11% (95% CI 9% to 14%) in the TennisReady vs 12% (95% CI 9% to 15%) in the control group (p value of 0.79). Analysis of the secondary outcome scores showed no difference between groups. The mean prevalence rates between high (8%) and low (92%) adherent groups were 32% (95% CI 23% to 44%) and 37% (95% CI 33% to 42%), respectively (p value 0.36).

CONCLUSION

Providing an unsupervised e-health tennis-specific exercise programme did not reduce the injury rates and should not be implemented.

TRIAL REGISTRATION NUMBER

NTR6443.

Stimulating injury-preventive behaviour in sports: the systematic development of two interventions

Background

In addition to the beneficial health effects of being active, sports are also associated with a risk of sustaining injuries. To avoid the occurrence of sports injuries, preventive measures can be applied. The aim of the current article is to provide insight into the systematic developmental process of two evidence-based interventions designed to stimulate injury-preventive behaviour in runners and skiers, in which Intervention Mapping (IM) and Knowledge Transfer Scheme (KTS) are used as developmental protocols. However, the ultimate steps in the process are adjusted to meet requirements of the intervention and the target group.

Methods

Using a three-step process, we developed two interventions to stimulate injury-preventive behaviour in runners and skiers. Sports participants, sports experts and behaviour experts contributed throughout steps two and three of the developmental process.

Results

In step one we started with a problem statement in which we used information about the number and the burden of running-related and skiing-related injuries in the Netherlands. In step two, in-depth research was performed using four research strategies. During this step we tried to answer the following question: Which preventive measures or actions should be executed to prevent what injuries by whom, and how should we do that? A desk research/systematic review of the literature, expert meetings, target user surveys, and target user focus group meetings were conducted. In step three of product development, both interventions were developed. During the developmental process, co-creation sessions with target users were held. Before finalizing the interventions, pre-tests of the interventions were performed with target users.

Conclusions

Through a three-step approach, we developed two interventions to stimulate injury-preventive behaviour in runners and skiers. To develop an intervention that fits the needs of the target population, and will be used by them, it is necessary to involve this population as soon and as much as possible. Several steps in the IM and KTS protocols have thus been adjusted in order to establish an optimal fit between intervention and target group.

Educational concussion module for professional footballers: from systematic development to feasibility and effect

Objectives

To describe: (1) how we developed a concussion module and (2) whether the concussion module is feasible (in terms of relevance, added value and suitability) and enhances knowledge and changes attitude of professional footballers about concussion.

Developing the concussion module

We developed the concussion module based on two structured and systematic processes. First, our needs assessment (questionnaire and interviews) in professional football (especially players) revealed that a 5–10 min concussion module was needed, ideally disseminated during club visits. Second, the objectives were defined (from published literature and by experts) as to disseminate essential information about what concussion is (definition), how to recognise it and the importance of removing a player with (suspected) concussion from the football field. We included an introductory video featuring a high-profile professional footballer and an animated educational component on defining concussion, recognising it and removing affected players from the field.

Feasibility and effect

A quasiexperimental study (pretest post-test design) was conducted among 61 professional footballers. These players were asked to complete two questionnaires related to knowledge about and attitude towards concussion and feasibility of the module: one before and one after viewing the concussion module. Potential increase in knowledge and attitude was explored by comparing the pretest and post-test scores of the Rosenbaum Concussion Knowledge and Attitudes Survey with the non-parametric Wilcoxon signed-rank test (p<0.05). The mean knowledge score of the participants was stable between tests (Z=213; p=0.16), while mean attitude score increased significantly (Z=331; p=0.01). Nearly all participants (85%–100%) were positive about the relevance, added value, duration and form of the concussion module.

Conclusion

The developed educational concussion module leads to better attitude of professional footballers towards concussion.

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.

Current trends in sport injury prevention

Participation in sport and recreation has important positive implications for public health across the lifespan; however, the burden of sport-related musculoskeletal injury is significant, with the greatest risk being in youth and young adults. Moving upstream to primary prevention of injury is a public health priority that will have significant implications for reducing the long-term consequences of musculoskeletal injury including early post-traumatic osteoarthritis. The primary targets for the prevention of musculoskeletal injury in sport include neuromuscular training (NMT), rule modification, and equipment recommendations. Currently, there is significant high-quality evidence to support the widespread use of NMT warm up programs in team and youth sport, with an expected significant impact of reducing the risk of musculoskeletal injury by over 35%. Policy disallowing body checking in youth ice hockey has led to a >50% reduction in injuries, and rules limiting contact practice in youth American football has significant potential for injury prevention. There is evidence to support the use of bracing and taping in elite sport to reduce the risk of recurrent ankle sprain injury but not for use to prevent the primary injury, and wrist guards are protective of sprain injuries in snowboarding. Future research examining the maintenance of NMT programs across real-world sport and school settings, optimization of adherence, additional benefit of workload modification, and evaluation of rule changes in other sports is needed.

Empowering the health of retired professional footballers: the systematic development of an After Career Consultation and its feasibility

Objectives

This article describes (1) the systematic development of the intervention and (2) the assessment of its feasibility (in terms of relevancy, suitability, satisfaction and added value).

Methods

The intervention was developed based on the first four steps of the Intervention Mapping and Knowledge Transfer Scheme processes. Subsequently, a qualitative research based on a one-group post-test cross-sectional design was conducted. Eight retired professional footballers underwent the developed intervention and its feasibility (operationalised in relevancy, suitability, satisfaction and added value) was assessed by means of a questionnaire and interview.

Results

An After Career Consultation (ACC) was developed with a focus on five main domains: (1) detraining from professional football; (2) remission of osteoarthritis; (3) promotion of healthy lifestyle; (4) preventing mental and cognitive health problems; and (5) employment and education. The ACC relies on three components: (1) raising self-awareness about potential physical, mental and social health problems after a career in professional football; (2) medical examination (60 min) with thorough medical history and general physical examination; and (3) follow-up during 3 months (if necessary) about optimal skills and strategies to empower physical, mental and social health and quality of life. The relevancy, suitability, satisfaction and added value of the ACC were positively evaluated by the retired professional footballers.

Conclusion

The ACC was developed with a focus on five main health-related domains. The feasibility of the ACC was positively assessed by retired professional footballers, while the suggestion was made to repeat the ACC in the initial years after football retirement.

Injury prevention in kids' adventure and extreme sports: future directions

Youth have very high participation and injury rates across sport and recreational activities, including in adventure and extreme sports. Sport and recreation is the leading cause of injury in youth and may lead to lower levels of physical activity, higher adiposity, and long-term consequences such as overweight/obesity, post-traumatic osteoarthritis, and post-concussion syndrome which can adversely affect future health. Injuries are predictable and preventable in youth sport, including adventure and extreme sport. However, injury prevention strategies can have a significant impact in reducing the number and severity of injuries in many sports. This article provides an evidence-informed overview on what is known about injury prevention strategies which have been evaluated in youth adventure and extreme sports. Recommendations to contribute to effective and sustainable injury prevention in youth adventure and extreme sports have been summarized.