"Yeah, I Mean, You're Going to Handball, so You Want to Use Balls as Much as Possible at Training": End-Users' Perspectives of Injury Prevention Training for Youth Handball Players

Perspectives on usability and adoption of a new ACL injury prevention programme for female handball players: a mixed methods approach

Effective injury prevention programmes (IPPs) hold promise for mitigating ACL injuries in female handball players, yet adherence remains a challenge. This mixed methods study explores the relationship between programme usability characteristics and the potential effectiveness of a newly developed ACL IPP through survey and interview data from 23 female handball players aged 15-18 and their four coaches. Players' knee abduction moment (KAM) was measured during a cutting task and used to measure potential effectiveness. Findings reveal significant correlations between reductions in KAM and players' perceived effectiveness of the programme in reducing ACL injury risk and their intention to use it (Spearman's rho (rs) -0.52, 95% CI -0.78 to -0.1, p=0.02 and rs -0.46, 95% CI -0.75 to -0.03, p=0.04, respectively). Coaches and players identified efficiency and perceived effectiveness as key factors influencing programme adoption. Concerns regarding programme length and doubts about exercise efficacy and transferability emerged as barriers, while perceived effectiveness, efficiency and enjoyability were facilitators for programme use. Players' suggestions for programme improvement included shortening the duration and incorporating playful elements. Design thinking sessions yielded strategies to optimise time efficiency and integrate IPPs into existing training routines. The study reaffirms the importance of balancing programme effectiveness with practicality and clear communication about its purpose and benefits to facilitate programme adoption. Enhancing programme usability and involving all end-users in the design process are crucial steps toward promoting the acceptance and adoption of IPPs among target populations.

Developing injury prevention programmes for ladies Gaelic football: a Delphi study

BACKGROUND

High injury rates are evident in the community sport of ladies Gaelic football, and the costs associated with these injuries have major implications for players and the governing body. Injury prevention programmes have been designed but are not being widely adopted. This study aimed to elicit the expert opinion of academics and practitioners on the content and format of injury prevention programmes for ladies Gaelic football.

METHODS

Twenty-four experts from the areas of coaching science, injury prevention, athletic therapy and physiotherapy took part in this three-round Delphi study. Each round contained multiple-choice, Likert scale and open-ended questions. For each question, consensus was defined as 67% or greater agreement among experts.

RESULTS

The experts agreed that 17 components (eg, agility, balance) should be included in injury prevention programmes for ladies Gaelic football, with 12 considered vital for inclusion in most or every session. Programmes should require minimal/no equipment, be 10-15 min in duration and contain 3-4 versions of each exercise for progression and variation purposes. Experts recommended when certain components should be completed but generally agreed that programmes should be capable of being delivered throughout sessions. There was consensus among experts for 13 items (eg, pictures, exercise volume) to be included in full versions of programmes and six in condensed versions.

CONCLUSIONS

The outcomes of this study provide the foundation for the development of future injury prevention programmes for ladies Gaelic football. Combining these findings with the preferences of end-users throughout programme development may enhance the efficacy of future injury prevention programmes.

"I'd rather do that (Knee Control) than be injured and not able to play": a qualitative study on youth floorball players' and coaches' perspectives of how to overcome barriers for injury prevention exercise programme use

This study explored youth floorball players' and coaches' perspectives on using the injury prevention exercise programmes (IPEPs) Knee Control or Knee Control+ (Knee Control programmes) and how to overcome barriers to programme use. We used a qualitative design with eight semistructured focus group discussions, six with players, 11-17 years old (n =42) and two with coaches (n =12). Data analysis followed the principles of qualitative content analysis. Three main categories emerged: challenges related to preventive training, promoting factors and solutions to facilitate the use of preventive training. To overcome barriers, players and coaches gave examples of how to tailor preventive programmes, such as adding joyful sport specific components. Player-perceived improved performance, with increased strength and speed from the preventive training, could be a promoting factor to increase motivation and enable IPEP use. Players and coaches offered examples of how to adapt and progress the preventive training by progressing gradually and choosing exercises that fit the team. Coaches emphasised that preventive training is important but difficult to prioritise in time-limited training sessions. Coaches' suggestions to overcome barriers were through collaboration and support from other coaches, to start using the IPEP at an early age, to keep it simple and motivating the players with, for example, positive role models. Players found the Knee Control exercises boring but necessary for injury prevention. Sometimes, coaches felt uncertain of their competence to use the Knee Control programmes and wished for support from the federation, club and other coaches. Players and coaches shared ideas on how to overcome barriers to IPEP use, such as to increase players' motivation, having a good structure, setting up routines for preventive training and to tailor the preventive training to the team. These findings can be used to further develop practical workshops and recommendations for programme use for players and coaches in youth team ball sports.

Implementing injury prevention training in youth handball (I-PROTECT) in Sweden: study protocol for a cluster randomised trial

Introduction

Efficacy trials show that evidence-based injury prevention training reduces injuries in youth athletes but effectiveness, that is, outside the controlled setting, is lower and, consequently this training has had limited public health impact. Insufficient involvement of end-users at the individual and organisational levels is identified as a main barrier to successful implementation. The 'Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)' uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT research project, the specific aim of this study is to investigate the implementation of the end-user-targeted I-PROTECT programme.

Methods and analysis

This pragmatic two-armed cluster randomised controlled trial is conducted collaboratively with the Swedish Handball Federation that has overall responsibility for handball in Sweden. Randomly selected clubs in Sweden offering handball for both female and male youth players are invited to participate. 18 clubs are randomised (stratified by club size) to intervention (I-PROTECT plus tailored implementation support) or control (injury prevention programme currently available through the Swedish Handball Federation). The anticipated total number of potential participants (players, coaches, club administrators, parents/guardians) is ~3500. The I-PROTECT programme includes end-user-targeted information and physical and psychological injury prevention training available in a specifically developed interactive mobile application. Implementation strategies were selected from the Expert Recommendations for Implementing Change discrete implementation strategy compilation, based on feedback from end-users. Implementation outcomes will be investigated at the end of the handball season using the Reach, Effectiveness, Adoption, Implementation and Maintenance implementation evaluation framework. A study-specific questionnaire, app downloads and/or workshops will be used to collect data.

Ethics and dissemination

The Swedish Ethical Review Authority approved the study. Results will be disseminated in peer-reviewed scientific journals, as popular science articles, at international conferences and communicated via the Swedish Handball Federation.

Trial registration number

NCT05696119.

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.

Co-creating holistic injury prevention training for youth handball: Development of an intervention targeting end-users at the individual, team, and organizational levels

BACKGROUND

Interventions that are co-created with end-users, and that are informed by behavior change or implementation theories, support implementation in real world settings. However, injury prevention programs for youth athletes have typically been developed by experts with no, or insufficiently described, end-user involvement and without guidance by theories. The aim of the current study was to describe the development of a holistic injury prevention intervention for youth handball targeting end-users at different levels, through using knowledge from end-users and researchers/experts and applying relevant behavior change and implementation theories.

METHODS

Knowledge from researchers/experts (sports medicine, sport psychology, handball, physical therapy, strength and conditioning (n = 14)) and end-users (coaches, players, club administrators, n = 16), and applying relevant implementation (Consolidated Framework for Implementation Research, CFIR), behavior change (Health Action Process Approach, HAPA) and motivational (Self-Determination Theory, SDT) theories, were used to co-design the intervention. Early end-users (coaches (n = 6), players (n = 3) and a club administrator (n = 1)) were interviewed for initial feedback.

RESULTS

The intervention consisted of end-user-targeted information and training that was made available in a specifically developed interactive mobile application with modules for players, coaches, club administrators, and caregivers. Information for all end-users included benefits and principles of physical and psychological injury prevention training, load-management, motivation, and communication. Information about implementation was developed for club administrators specifically. For coaches, training to do with their teams included handball-specific injury prevention exercises (legs, shoulders, core) combined with psychological aspects (motivation, task focus, body awareness) to integrate within warm-up and handball skills training. Training for players included handball-specific multi-joint strength, power, and explosive exercises (legs, shoulders, core) and sport psychology exercises (self-awareness, relaxation, being in the present moment, prevent and handle stress). To support self-management, adoption, and motivation, programs were provided, and players and coaches could change, add, progress the difficulty of exercises, and build their own programs. Initial feedback from early end-users was generally positive.

CONCLUSIONS

Utilizing an approach where researchers/experts and end-users co-created injury prevention training specifically for youth handball, an intervention was generated that included information and holistic training targeting end-users at the individual (players, caregivers), team (coaches), and organizational (club administrators) levels.

Injury prevention in ladies Gaelic football referees: Understanding the barriers, facilitators, and preferences of referees

OBJECTIVES

The injury prevalence in Gaelic games refereeing is high, however few are adopting injury prevention programmes. This study aims to identify the barriers and facilitators to injury prevention strategy success and determine Ladies Gaelic Football referees' preferences for injury prevention strategies and education.

DESIGN

Semi-structured interviews were conducted with 11 Ladies Gaelic Football referees (10 men, 1 woman). Two were club level, two were provincial level and 7 were national level referees. Interviews were audio-recorded, transcribed verbatim, and reflexive thematic analysis was completed. This analysis involved examining the data repeatedly and gradually developing sub-themes, themes, and categories related to each core concept.

RESULTS

The barriers to injury prevention success included negative attitudes, accessibility issues, lack of education, the state of refereeing and undesirable injury prevention strategy characteristics. Injury prevention promotion, suitable strategy characteristics and open communication were believed to facilitate success. Referees gave their preferences for injury prevention programmes, strategy logistics, and stakeholder roles along with their preferred topics, delivery, educators, characteristics, rollout, and timing for injury prevention education.

CONCLUSIONS

Reducing referee injury is critical to the success of Ladies Gaelic Football and other community sports. Governing bodies must develop and support injury prevention programmes and education for referees. These should be designed according to referees' preferences and consider the barriers and facilitators referees have identified to maximise adoption.

Perceptions, facilitators, and barriers regarding use of the injury prevention exercise programme Knee Control among players and coaches in youth floorball: a cross-sectional survey study

BACKGROUND

Youth participation in team ball sports is associated with a risk of both acute and gradual onset injuries but today there are several efficacious injury prevention exercise programmes (IPEPs). However, there is limited research about how to implement those programmes and the perceived barriers and facilitators among end-users.

OBJECTIVE

To investigate perceptions of the IPEP Knee Control and facilitators and barriers to programme use among coaches and youth floorball players, and explore factors associated with planned maintenance of Knee Control.

METHODS

This cross-sectional study is a sub-analysis of data from the intervention group of a cluster randomised controlled trial. Perceptions about Knee Control and facilitators and barriers to programme use were evaluated with surveys pre-intervention and post-season. 246 youth floorball players aged 12-17 years, and 35 coaches that reported no use of IPEPs during the preceding year were included. Descriptive statistics and univariate and multivariate ordinal logistic regression models were undertaken with the dependent variables: coaches' planned maintenance and players' opinions of maintenance of Knee Control. Independent variables were perceptions, facilitators and barriers regarding use of Knee Control and other potential influencing factors.

RESULTS

88% of the players believed that Knee Control can reduce injury risk. Common facilitators to Knee Control use among coaches were support, education and high player motivation, and common barriers were that injury prevention training was time-consuming, lack of space to execute the exercises and lack of player motivation. Players who planned to maintain use of Knee Control had higher outcome expectancies and belief in one's ability to use Knee Control (action self-efficacy). Coaches who planned to maintain Knee Control had higher action self-efficacy and to a lesser extent considered that Knee Control takes too much time.

CONCLUSIONS

Support, education, and high player motivation are key facilitators, while lack of time and space for injury prevention training and boring exercises are key barriers for coaches and players to use Knee Control. High action self-efficacy among coaches and players seems to be a prerequisite for maintained use of IPEPs.

A qualitative examination of injury prevention strategy and education in Ladies Gaelic football: Understanding the preferences of players and coaches

The high rates of injury in Ladies Gaelic football impact the wellbeing of players and are a major financial burden for the Ladies Gaelic Football Association. Effective injury prevention programmes have been developed for Gaelic games, but these are not currently widely adopted. The aim of this study was to qualitatively investigate adult Ladies Gaelic football players and coaches' preferences for injury prevention strategies and injury prevention education using a constructivist grounded-theory approach. Semi-structured interviews were conducted with 23 currently active Ladies Gaelic football coaches and adult players. The core strategy preferences discussed by participants were the properties of an injury prevention programme, the role of stakeholders, strategy logistics and the need for guidance and support. If the uptake and long-term adoption of an injury prevention programme is to be maximised, the preferences of the players and coaches who will ultimately utilise the programme must be understood and integrated into a wider implementation strategy developed around their needs. For education preferences, the core categories identified were the focus of education, who needs education, the format, educator, roll-out strategy, and time required. Future educational strategies must incorporate the preferences of stakeholders into their design if they are to be successful in spreading injury prevention knowledge and achieving change. To give injury prevention strategies, programmes, and education the best chances at successful adoption, it is crucial that the preferences of end-users are addressed and implemented.

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

OBJECTIVES

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

DESIGN

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

RESULTS

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

CONCLUSIONS

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

Context of injury prevention strategies in Swiss basketball: survey of athletes, medical staff and coaches

Objectives

This project aims to assess opinions, attitudes, knowledge, beliefs, practices and perceived barriers and facilitators of injury prevention (IP) strategies in Swiss basketball teams.

Methods

An online survey was sent to athletes, coaches and medical staff of the three best basketball leagues in Switzerland. The survey was subdivided in four sections: (1) characteristic of participants, (2) knowledge, opinions, attitudes and beliefs, (3) practices and (4) barriers and facilitators.

Results

Among 105 persons (n=45 female, n=60 male) who answered the survey, more than 60% (n=68) considered the risk of injury for basketball athletes as being high to very high. The ankle, knee and the hand were considered as being the most at risk. More than 80% of participants considered that recovery, training load and the warm-up quality were very important factors for IP. More than 90% of participants considered IP as either important or very important with 53 (50.5%) of the participants indicating using exercise-based IP in their clubs. Athletes and coaches' motivation and compliance were judged as either important or very important for successful IP implementation by more than 80% of participants, with the coach being reported as the most influential person. Environmental barriers towards human or infrastructural resources were also reported as factors influencing IP strategies, namely by female participants.

Conclusion

Good knowledge and positive attitude towards IP were reported by participants, but exercise-based IP strategies lack implementation. The coach was considered as the most influential person and was reported with the athletes as playing an important role towards successful implementation.

Cocreating injury prevention training for youth team handball: bridging theory and practice

Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants’ contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.