Describing the appropriate use and interpretation of odds and risk ratios

In sport medicine, epidemiology of sport-related injury provides the foundation for understanding what types of injuries and illnesses occur and who is at the highest risk. Thus, accurate and transparent reporting and interpretation of risk metrics is essential to sports epidemiology. Odds ratios (OR) and risk ratios (RR) are two statistics used to quantify the association between exposure and outcome and are frequently seen in sports medicine literature. While similarities exist, there are optimal ways to use and interpret OR and RR based on the study design and outcome incidence in the target population. In this short communication, we will present common study designs (e.g. prospective cohort, case-control, cross-sectional) along with recommendations for the use and interpretation of OR and RR. This will ultimately assist practitioners in choosing and interpreting these frequently confused measures of association and also help journal reviewers better understand the appropriate use of these measures when evaluating a manuscript.

Athletic Trainers' Psychosocial Experiences During the COVID-19 Pandemic: A Qualitative Research Study

CONTEXT

Despite the many challenges posed by the COVID-19 pandemic, athletic programs have sought ways to persevere and deliver sport programming. This process has strained the psychosocial health of all sport stakeholders but especially those entrusted with promoting the health of participants and enforcing safety protocols. Athletic trainers (ATs) have been a major influence in striving to achieve these goals by expanding their typical roles to lead in promoting the safe delivery of sport programs.

OBJECTIVE

To examine the psychosocial lived experiences of ATs as they practiced during the COVID-19 pandemic.

DESIGN

Qualitative study.

SETTING

National Collegiate Athletic Association Divisions I, II, and III.

PATIENTS OR OTHER PARTICIPANTS

A total of 27 ATs practicing at the collegiate level (Divisions I, II, and III) who were actively involved in planning and implementing return-to-sport protocols during the COVID-19 pandemic.

DATA COLLECTION AND ANALYSIS

Semi-structured interviews were conducted via Zoom. Inductive conventional content analysis identified emerging themes that characterized participants' narratives. Three members of the research team were involved in the analysis process and used field notes, continuous member checking, peer review, and multiple-researcher triangulation to establish data credibility and confirmability.

RESULTS

Three higher-order themes related to ATs' psychosocial lived experiences emerged: (1) internalized experience, (2) interpersonal interactions, and (3) AT identity. Several subthemes were also identified to further organize elements that characterized or differentiated participants' lived experiences.

CONCLUSIONS

Athletic trainers encountered significant challenges in maintaining their psychosocial health during the pandemic as they strived to assist others in this regard. Providing effective psychological and social support resources and strategies for ATs may not only allow them to better support themselves but may also enhance their ability to deliver professional services and promote psychosocial health among their athletes and other stakeholders in their respective sport systems in the future.

Collegiate Athletic Trainers' Experiences Implementing Return-to-Sport Policies and Procedures During COVID-19: A Qualitative Research Study

CONTEXT

Athletic trainers (ATs) were critical personnel in the development of policies and procedures for the safe return to campus and resumption of sport during the 2020-2021 academic year. Policies focused on preventing the potential spread of COVID-19, as well as screening, testing, and management of cases; however, which aspects of implementation were successful or more challenging was unknown.

OBJECTIVE

To identify successes and challenges in the implementation of return-to-sport policies and procedures during the 2020-2021 academic year amid the COVID-19 pandemic.

DESIGN

Qualitative study.

SETTING

National Collegiate Athletic Association Divisions I, II, and III.

PATIENTS OR OTHER PARTICIPANTS

A total of 27 ATs (9 women [33.3%], mean age = 48.5 ± 9.8 years, years of experience = 25.0 ± 10.5) who were in positions of leadership or who were actively involved in developing and then implementing COVID-19 return-to-sport policies and procedures completed Zoom interviews.

DATA COLLECTION AND ANALYSIS

Semistructured Zoom interviews were audio and video recorded and later transcribed. The data were analyzed by a team of 4 experienced researchers using the consensual qualitative research approach. Field notes, intercoder reliability, and multiple-analyst triangulation were used to establish data credibility.

RESULTS

Emerging themes were implementation of public health interventions, interprofessional collaboration, and advancing the profession of athletic training. Participants described establishing and strengthening collaborations with other health care professionals as well as key stakeholders on campus as a positive outcome of the pandemic, but variations in policies among institutions and states made policy communication and enforcement more challenging.

CONCLUSIONS

The ATs played a pivotal role in policy development, communication, and enforcement. Overall, participants took pride in serving as health care leaders for their universities and opening the eyes of colleagues to the breadth of their athletic training skill sets.

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

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

Hybrid effectiveness-implementation study designs in sports injury prevention research

Despite vast evidence supporting the effectiveness of lower extremity injury prevention programs in a variety of sport settings, age groups, and levels of competition, there is limited evidence on implementation strategies that positively impact the feasibility, scale-up and sustainability of such programs. Sport-related injury prevention is affected by the research-to-practice gap, a pervasive issue in healthcare, where high-quality experimental research is not used in routine clinical practice. An intervention shown to be efficacious in a controlled environment, such as a lab or in a field-study conducted by scientists, will demonstrate a decline in benefit when implemented in the intended clinical setting. Real-world considerations, such as foundational knowledge and training, time constraints, or end user motivation, influence the quality and consistency of implementation. Acknowledging and addressing implementation barriers in a systematic way is essential to promote effective program dissemination. Study design methods that measure both clinical effectiveness and implementation strategies need to be identified. Hybrid effectiveness-implementation designs simultaneously measure both an intervention's effect on clinical outcomes as well as critical information related to implementation strategy; however these study designs are not frequently utilized. The purpose of this mini-review is to describe: the basics of hybrid designs, rationale for using hybrid designs, and examples of how these designs could be used in athletic healthcare injury prevention research.

Preventive Training Program Feedback Complexity, Movement Control, and Performance in Youth Athletes

CONTEXT

Preventive training programs (PTPs) reduce injury risk by improving movement control. Corrective feedback is important; however, many cues at once may be too complicated for athletes.

OBJECTIVE

To compare movement control and long-jump (LJ) changes in youth athletes participating in a season-long PTP, with simplified feedback, traditional feedback, or a warmup of the coaches' choosing.

DESIGN

Cluster-randomized controlled trial.

SETTING

Soccer fields.

PATIENTS OR OTHER PARTICIPANTS

A total of 420 athletes (simplified feedback = 173, traditional feedback = 118, and control = 129; age = 11 ± 3 years).

INTERVENTION(S)

Teams were randomized into the simplified PTP, traditional PTP, or control group. Simplified and traditional PTPs lasted 10 to 12 minutes and used the same exercises. The simplified PTP provided only sagittal-plane feedback (eg, "get low"), and the traditional PTP provided feedback targeting all motion planes (eg, "don't let your knees cave inward"). Research assistants administered the PTP warmups 2 to 3 times/week for the season. Control team coaches chose and ran their own warmup strategies.

MAIN OUTCOME MEASURE(S)

Participants completed 4 sessions (preseason [PRE], postseason [POST] at approximately 8 weeks after PRE, retention 1 [R1] at 6 weeks postseason, and retention 2 [R2] at 12 weeks postseason). They performed 3 trials of a jump-landing task, which was evaluated using the Landing Error Scoring System (LESS) and 2 recorded standing LJ trials at each test session. A time series panel was used to evaluate group differences across time points for the LESS and LJ.

RESULTS

Change score analyses revealed improvements in the LESS score from PRE to POST for all groups. Improvements from PRE were retained at R1 and R2 for the intervention groups (simplified and traditional). The traditional group demonstrated better LJ performance at POST (P < .001) and R1 (P = .049) than the simplified or control group.

CONCLUSIONS

Simplified cues were as effective as traditional cues in improving LESS scores from PRE to POST season. Participating in PTPs, regardless of their complexity, likely provides movement benefits.

Athletic Administrators' Reporting of Emergency Preparedness Regarding Policies and Procedures in Iowa Secondary Schools

CONTEXT

Secondary schools that offer school-sponsored athletic events should follow best-practice guidelines to provide policies that promote student health and safety.

OBJECTIVE

To assess emergency preparedness from the perspective of athletic administrators (AAs) in Iowa secondary schools.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

Ninety-eight AAs from Iowa completed the survey (age = 45.33 ± 10.22 years, years as an AA = 9.37 ± 8.14, years in current role = 7.72 ± 7.09).

MAIN OUTCOME MEASURES(S)

The 6-section survey contained with questions about access to athletic trainers (ATs), emergency action plans (EAPs), cardiopulmonary resuscitation (CPR), automated external defibrillators (AEDs), concussions, heat illness, and other general policies. Descriptive statistics (percentages and frequencies) were reported. Relative risk was calculated to compare schools with and those without access to ATs (P < .05).

RESULTS

Most respondents (76.5%, n = 75/98) reported their school had access to a licensed AT. The majority had a written EAP (83.3%, n = 70/84), but fewer than half (39.2%, n = 31/79) reviewed it annually and fewer than 10% (n = 6/85) reported practicing it each year. All respondents (100%, N = 78/78) stated they had an AED on campus. All respondents (N = 77/77) indicated that they were familiar with the Iowa High School Athletic Association's (IHSAA's) concussion policy and had a concussion guideline in place. Many respondents (95.9%, n = 71/74) described being familiar with the IHSAA's heat illness policy, but more than half (62.1%, n = 41/66) noted they did not have a heat illness policy in place at their school.

CONCLUSIONS

Most respondents indicated their school had access to ATs, followed the state-mandated concussion guidelines, and had an AED. Although participants reported having written EAPs in place, levels of annual EAP review and practice were low. These results suggest that schools would benefit from educational opportunities to improve safety policies.

Knowledge, Attitudes, and Beliefs of Parents of Youth Basketball Players Regarding Sport Specialization and College Scholarship Availability

Background:

Previous surveys of youth sport parents have revealed that while parents believe early sport specialization is beneficial for improving sport ability, they also overestimate their child’s chances of receiving a college scholarship.

Purpose:

To (1) describe knowledge, attitudes, and beliefs of parents of youth basketball players regarding sport specialization and college scholarships and (2) examine potential differences in child basketball participation characteristics based on parent income.

Study Design:

Cross-sectional study.

Methods:

A total of 805 parents (mean age, 39.9 ± 7.1 years; 353 female [43.9%]) of youth basketball players (mean age, 12.9 ± 2.5 years; 241 female [29.9%]) were recruited via Qualtrics Online Panels to complete an anonymous online questionnaire. Participants were required to be a parent of a child between 8 and 18 years of age who participated in organized youth basketball (ie, school, club, or recreational/local league). Participants were recruited to be nationally representative with regard to race/ethnicity (White, 62.7%; Hispanic/Latino of any race, 15.3%; African American/Black, 13.3%; Asian, 4.6%; ≥2 races, 2.9%; American Indian/Alaskan Native, 1.1%; Native Hawaiian/other Pacific Islander, 0.1%). The questionnaire was adapted from previous research on parent knowledge, attitudes, and beliefs and consisted of 3 sections: (1) parent and child characteristics; (2) child basketball participation information (months per year of basketball participation, sport specialization status, receiving private coaching, traveling regularly for basketball competitions, participating on multiple teams at the same time); and (3) parent attitudes, beliefs, and knowledge regarding sport specialization and college basketball scholarships.

Results:

Most parents believed specialization increased their child’s chances of making a high school (71.4%) or college team (69.7%). Parents underestimated the availability of college basketball scholarships at the National Collegiate Athletics Association (NCAA) Division I and II levels (8.9 ± 5.1 vs reality of 13-15 per team) but overestimated availability at the Division III level (8.6 ± 5.7 vs reality of 0 per team). High-income parents spent significantly more money ($4748 USD [$1214-$10,246]) than middle-income ($2250 USD [$727-$5079]; P < .001) and low-income ($1043 USD [$368-$2444]; P < .001) parents.

Conclusion:

Parents believed specialization was important for sport success, but they underestimated college scholarship availability at the NCAA Division I and II levels while overestimating scholarship availability at the Division III level.

Patient-reported outcome measures for pediatric patients with sport-related injuries: a systematic review

Despite a call to incorporate PROMs into all aspects of health care, little is known about which instruments are best-suited for a pediatric patient population with sport-related injury. The objective of this article was to perform a systematic review of the currently available evidence to determine which patient-reported outcome measures (PROMs) are used for pediatric patients with sports-related injuries, and to identify the associated psychometric properties and considerations for clinical utility. We conducted a literature search for articles on PROMs used in the pediatric population through electronic databases and via a manual search of reference lists and authors between 1990 and 2020. Articles were grouped based off of the PROM(s) included, and considerations for clinical utility and psychometric properties were extracted from each article. Thirty-nine articles were included in this review, from which twenty-two PROMs were identified - twelve PROMs were developed specifically for the pediatric population, four were modified versions of an adult scale, and six instruments were adult measures used in a pediatric population. Of the PROMs included in this review, the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) and the Pediatric Quality of Life Inventory (PedsQL) were the most comprehensive in their development and assessment. Several outcome measures used for pediatric patients had missing or inadequate measurement properties and considerations for clinical utility, particularly in regards to readability, responsiveness and interpretability. Clinicians and researchers should consider the measure's feasibility, acceptability, appropriateness and psychometric psychometric properties when selecting a PROM for use with the pediatric population.

Sport Specialization Behaviors Are Associated With History of Reported Injury in Youth Basketball

BACKGROUND

There is significant emerging evidence that early sport specialization is a potential risk factor for injury in youth sports. Despite basketball being the most popular youth team sport in the United States, sport specialization research, specifically in youth basketball players, has been limited. The purpose of this paper was to examine the association of sport specialization behaviors with injury history by surveying a nationally representative sample of parents of youth basketball athletes. We hypothesized that athletes who specialized in basketball, participated on multiple teams at the same time, and traveled regularly for basketball competitions would be more likely to report a basketball-related injury in the previous year.

METHODS

A nationally representative sample of 805 parents of 805 youth basketball players (female N=241, 29.9%; age: 12.9±2.5 y old) completed an online questionnaire that had 3 sections: (1) parent/child demographics, (2) child basketball participation information for the previous year, and (3) child basketball injury history in the previous year. Multivariate logistic regression examined the associations between variables of interest and injury history, adjusting for covariates. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated for the variables of interest from the logistic regression model.

RESULTS

Highly specialized athletes were more likely than low specialization athletes to report history of basketball injury in the previous year [OR (95% CI): 2.47 (1.25-4.88), P=0.009]. The odds of reporting an injury in the previous year were twice as great among athletes who played on a basketball team at the same time as another sport team compared with those who played basketball only [OR (95% CI): 1.98 (1.30-3.01), P=0.001]. The odds of reporting an injury in the previous year were 3 times greater among athletes who received private coaching compared with those who did not receive private coaching [OR (95% CI): 2.91 (1.97-4.31), P<0.001].

CONCLUSION

Specialization in basketball, along with several other behaviors that have become typical of modern youth sport participation, were associated with reported injury history. Further prospective research is necessary to determine whether sport specialization behaviors increase the risk of injury in youth basketball.

LEVEL OF EVIDENCE

Level III-cross-sectional study.

Youth Perceptions of Sport-Confidence

ABSTRACT

Zuk, EF, Maksymiw, K, Evanovich, J, McGarry, JE, Root, HJ, and Distefano, LJ. Youth perceptions in sport-confidence. J Strength Cond Res XX(X): 000-000, 2021-Sport-confidence is an important construct that is often missed during physical activity interventions in youth. Male and female children might display differences in sport-confidence that influences their activity levels. The purpose of this study is to assess any association between sport-confidence and gender in elementary school and middle-school children. All 286 children {(boys [ES: n = 71, age = 8±1 years; MS: n = 63, 11±1 years]; girls [ES: n = 67, 7±1 years; MS: n = 85, 11±1 years])} completed the Physical Literacy Assessment for Youth-Self Questionnaire. Separate chi-square tests of the association were used to evaluate the association between gender and sport-confidence among elementary (grades K-4) and middle-school (grades 5-8) children because of varying injury and participation rates for these groups, for each relevant question with a significance set at p ≤ 0.05. For elementary school children, there were no significant associations between genders and sport-confidence (p > 0.05). In middle-school children, there were significant associations detected for learning new skills (ϕ = 0.12; p = 0.031), perception of skill (ϕ = 0.12; p = 0.054), confidence in activity (ϕ = 0.17; p = 0.035), and being the best in the class (ϕ = 0.15; p = 0.048) between genders and sport-confidence. For all results, boys displayed more sport-confidence than girls. Education for key stakeholders about the importance of including sport-confidence in physical activity interventions is integral in promoting life-long activity, specifically in middle-school girls.

Movement Technique During Jump-Landing Differs Between Sex Among Athletic Playing Surfaces

Pryor, JL, Burbulys, ER, Root, HJ, and Pryor, RR. Movement technique during jump-landing differs between sex among athletic playing surfaces. J Strength Cond Res XX(X): 000-000, 2020-Whether athletic surface type affects movement technique, a causal factor for lower extremity injury, is unclear. This study evaluated the influence of 4 common athletic surfaces on movement technique using the Landing Error Scoring System (LESS). Secondarily, we aimed to evaluate differences in movement technique between men and women among surfaces. Recreationally active men and women (n = 38) completed jump-landing tests on 4 common athletic surfaces in a quasi-randomized crossover fashion. Vertical jump height, perceptual fatigue, and muscle soreness were evaluated before jump-landing movement analyses and were similar across testing sessions (p > 0.05). Men achieved higher LESS scores on hardwood and artificial pellet turf compared with women (p ≤ 0.037). Women exhibited lower LESS scores on grass and artificial turf vs. concrete (p ≤ 0.048). Data indicate differential lower extremity movement technique and therefore injury risk across athletic surface types and sex, challenging the generalizability of the LESS construct. Athletic playing surface should be considered during movement technique assessment and implementation of injury prevention programs.

The relationship between single-limb squat and jump-cut kinematics

No objective criteria exist for progressing athletes into cutting manoeuvres following ACL reconstruction (ACLR). The purpose of this study was to evaluate the relationship between a jump-cut task (JC) and the single-limb squat (SLS) in both ACLR and healthy controls. Case-control, laboratory based. Twenty-three participants with a history of ACLR (Age = 21 ± 3 years; Height = 174.5 ± 7.2 cm; Mass = 76.2 ± 9.9 kg) and 23 healthy controls participants (Age = 21 ± 3 years; Height = 173.8 ± 9.2 cm; Mass = 75.0 ± 10.5 kg) were included. Kinematics were collected bilaterally. Correlations between tasks were evaluated for kinematics. Independent sample t-tests were used to evaluate differences between groups for each dependent variable. Peak trunk rotation and medial knee displacement were strongly correlated (p < 0.001, r² = 0.63), between tasks. ACLR group performed SLS and JC tasks with less sagittal plane motion compared to healthy controls (p < 0.05). Lack of frontal and transverse plane control during SLS resulted in positions of increased lateral trunk flexion, hip adduction, and medial knee displacement during JC. The SLS may be considered for use as a clinical predictor of JC during rehabilitation following ACLR.

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

CONTEXT

Preventive training programs (PTPs) can reduce injury rates and improve neuromuscular control and sport performance. However, PTPs must be implemented correctly and consistently over time for athletes to benefit. Coaches represent the best long-term option for implementing PTPs. Youth athletes are at the optimal age for developing good habits before maturation. Although frameworks have been proposed to guide implementation efforts, little is known regarding the feasibility and real-world context of PTP implementation at the youth sport level.

OBJECTIVE

To evaluate the application of the 7-Step framework for promoting implementation of a preseason PTP workshop.

DESIGN

Descriptive epidemiology study.

SETTING

Youth soccer and basketball organizations.

PATIENTS OR OTHER PARTICIPANTS

Organizations with at least 1 team of athletes aged 8 to 14 years were invited to participate in a free preseason coaches' education workshop on PTP implementation.

INTERVENTION(S)

The 7-Step framework was used to guide PTP education and implementation for each organization. Personnel at organizations that agreed to participate attended a single preseason workshop for coaches. Research staff were available as a resource throughout the season but did not actively implement or monitor the PTPs.

MAIN OUTCOME MEASURE(S)

Retrospective evaluation of each organization's completion of steps 1 through 5 of the 7-Step framework.

RESULTS

A total of 62 youth soccer (n = 40) and basketball (n = 22) organizations were invited to participate. Twelve organizations completed steps 1 through 4 and steps 5a through 5d. The highest drop-off rate occurred during step 1, "Establishing Administrative Support." No organization completed all components of steps 1 through 5.

CONCLUSIONS

To better understand how to successfully promote PTP adoption, we must identify the implementation steps that may present the most challenges. Because the highest drop-off rate was seen during the initial step, establishing administrative support and strengthening initial engagement are necessary to improve PTP implementation.

Sport Sampling Is Associated With Improved Landing Technique in Youth Athletes

Background:

Sport sampling is recommended to promote fundamental movement skill acquisition and physical activity. In contrast, sport specialization is associated with musculoskeletal injury risk, burnout, and attrition from sport. There is limited evidence to support the influence of sport sampling on neuromuscular control, which is associated with injury risk, in youth athletes.

Hypothesis:

Athletes who participated in only 1 sport during the previous year would demonstrate higher Landing Error Scoring System (LESS) scores than their counterparts.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 3.

Methods:

A total of 355 youth athletes (age range, 8-14 years) completed a test session with a jump-landing task, which was evaluated using the LESS. Participants were categorized as single sport (SS) or multisport (MS) based on their self-reported sport participation in the past year. Their duration of sport sampling (low, moderate, high) was determined based on their sport participation history. Participants were dichotomized into good (LESS <5) or poor (LESS ≥5) categories. Chi-square tests were performed to evaluate for the association between control category (good, poor) and participation (MS, SS), as well as sport-sampling duration (low, moderate, high).

Results:

The MS group was 2.5 times (95% CI, 1.9-3.1) as likely to be categorized as having good control compared with the SS group (χ²₍₃₅₅₎ = 10.10, P < 0.01). Recreational participants in the “high” sport-sampling duration group were 5.8 times (95% CI, 3.1-8.5) and 5.4 times (95% CI, 4.0-6.8) as likely to be categorized as having good control compared with the moderate and low groups (χ²₍₂₁₆₎ = 11.20, P < 0.01).

Conclusion:

Sport sampling at a young age is associated with improved neuromuscular control, which may reduce injury risk in youth athletes.

Clinical Relevance:

Youth athletes should be encouraged to try participating in multiple sports to enhance their neuromuscular control and promote long-term physical activity.

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

Context:

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

Evidence Acquisition:

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

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

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

Conclusion:

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