A systematic review of core implementation components in team ball sport injury prevention trials

O’Brien, James; Finch, Caroline F.

doi:10.1136/injuryprev-2013-041087

Cited by 42 publications

(40 citation statements)

References 44 publications

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“…To maximise preventive impact, IPEP implementation needs to target multiple levels of the team ball sport system, including players (the health beneficiaries), coaches and other staff (the IPEP deliverers) and administrators (the policymakers) 6 8. Reaching the target audience can be enhanced by embedding IPEPs in coach education, using social media and endorsement of IPEPs by sporting organisations and high-profile figures.…”

Section: Reach the Target Audiencementioning

confidence: 99%

It will take more than an existing exercise programme to prevent injury

2015

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In 1983, Ekstrand et al 1 published the first randomised controlled trial (RCT) of an injury prevention programme for team ball sport. Three decades on from this landmark study, it is worth reflecting on the progress made and the current 'state-of-play' in the field of team ball sport injury prevention research. The volume of published research has grown considerably with a recent systematic review of team ball sport injury prevention exercise programmes (IPEPs) identifying over 50 published trials. 2 The scale, quality and outcomes of recent RCTs are also encouraging with a Swedish trial including over 4500 female soccer players and demonstrating a 64% reduction in the rate of anterior cruciate ligament (ACL) injuries. 3 In 2013, a subsequent subanalysis of the original Swedish RCT, published in this journal, highlighted the importance of adequate IPEP compliance in preventing injuries. The ACL injury rate was 88% lower in highly compliant players, compared to those with low compliance. 4 A 3-year follow-up, 5 also published in this journal, investigated if coaches from the original trial and others in the same target population were still using the IPEP, and found that many had modified it (74-77%) or had not implemented it regularly across the season (52-60%). Others did not know about the programme, or had chosen not to adopt it. 5 HOW BIG IS THE PROBLEM?Considering that only compliant players had a reduced injury rate in the original RCT, the results of the above implementation study are of concern and demonstrate that it takes more than the existence of an IPEP to prevent injury. Even highly efficacious IPEPs risk losing much of their effect under real-world conditions, unless they are successfully adopted, implemented and maintained. A major challenge currently facing injury prevention in team ball sports is translating the positive outcomes of RCTs into injury reductions under real world, less controlled conditions. Unfortunately, little guidance is available in the sports medicine literature to help researchers and clinicians tackle this challenge. Our recent systematic review evaluating 52 published IPEP trials using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework 2 identified major gaps in the reporting of key implementation aspects, particularly those relating to Adoption and Maintenance. The proportion of trials reporting the RE-AIM's eight items of adoption averaged just 4%. The corresponding figure across the nine measures of maintenance was less than 1%. 2

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Section: Reach the Target Audiencementioning

confidence: 99%

It will take more than an existing exercise programme to prevent injury

2015

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“…The RE-AIM framework has been developed to describe five key components to successfully close the gap: Reach, Efficacy, Adoption, Implementation and Maintenance 31 32. A recent review concludes that information on the RE-AIM components in published trials on injury-prevention exercise programmes in team ball sport is scarce, especially regarding the adoption and maintenance of programmes 31…”

Section: Introductionmentioning

confidence: 99%

Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey

2015

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BackgroundThe Nordic hamstring (NH) exercise programme was introduced in 2001 and has been shown to reduce the risk of acute hamstring injuries in football by at least 50%. Despite this, the rate of hamstring injuries has not decreased over the past decade in male elite football.AimTo examine the implementation of the NH exercise programme at the highest level of male football in Europe, the UEFA Champions League (UCL), and to compare this to the Norwegian Premier League, Tippeligaen, where the pioneer research on the NH programme was conducted.DesignRetrospective survey.Setting/participants50 professional football teams, 32 from the UCL and 18 from Tippeligaen.MethodsA questionnaire, based on the Reach, Efficacy, Adoption, Implementation and Maintenance framework, addressing key issues related to the implementation of the NH programme during three seasons from 2012 through 2014, was distributed to team medical staff using electronic survey software.ResultsThe response rate was 100%. Of the 150 club-seasons covered by the study, the NH programme was completed in full in 16 (10.7%) and in part in an additional 9 (6%) seasons. Consequently, 125 (83.3%) club-seasons were classified as non-compliant. There was no difference in compliance between the UCL and Tippeligaen in any season (χ2: 0.41 to 0.52).ConclusionsAdoption and implementation of the NH exercise programme at the highest levels of male football in Europe is low; too low to expect any overall effect on acute hamstring injury rates.

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“…Poor compliance with prevention programs with documented effect may be considered as a potential barrier to implementation, indicating a gap between science and real‐world implementation. The RE‐AIM framework has been developed to describe five key components to successfully close the gap: reach, efficacy, adoption, implementation, and maintenance . The framework is a useful tool that allows decision‐makers to assess how interventions are implemented in practice, and their impact at the individual and organizational levels.…”

Section: Introductionmentioning

confidence: 99%

“…The framework is a useful tool that allows decision‐makers to assess how interventions are implemented in practice, and their impact at the individual and organizational levels. Furthermore, it can help determine which interventions are feasible in real‐world settings . A recent systematic review concluded that information on the RE‐AIM components in published trials on injury prevention exercise programs was insufficient, especially regarding the adoption and maintenance of the programs .…”

Section: Introductionmentioning

confidence: 99%

Implementation of the Adductor Strengthening Programme: Players primed for adoption but reluctant to maintain — A cross‐sectional study

Harøy

Wiger

Bahr

et al. 2019

Scandinavian Med Sci Sports

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Groin injuries represent a considerable problem in male football, accounting for 4%‐19% of all time‐loss injuries. The Adductor Strengthening Programme is the first groin‐specific prevention program shown to reduce the risk of groin problems. We aimed to use the RE‐AIM framework to examine the players’ experiences with the implementation of the program and player attitude toward groin injury prevention in football. Of the 632 players involved in the trial examining the effect of the Adductor Strengthening Programme, 501 agreed to participate in a survey at the end of the season. Most players thought that footballers are at moderate to high risk for groin injuries (87%) and that there is a need for preventive measures (96%). They also believed that a preventive program with strengthening exercises would reduce the risk of groin injuries (91%). Majority of the players reported using <5 minutes to complete the program (73%), and only 11% wanted additional exercises. However, only 46% reported to have performed the program as recommended, and an even smaller proportion (31%) planned to continue using it as recommended the next season. Our results suggest that footballers believe that prevention of groin injuries is needed. Attitude toward implementation of the Adductor Strengthening Programme was positive, and the single‐exercise approach was considered an important facilitator. However, in future dissemination of the program, the players’ reluctance to maintain the exercise protocol may be a potential barrier to implementation that should be addressed.

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A systematic review of core implementation components in team ball sport injury prevention trials

Cited by 42 publications

References 44 publications

It will take more than an existing exercise programme to prevent injury

It will take more than an existing exercise programme to prevent injury

Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey

Implementation of the Adductor Strengthening Programme: Players primed for adoption but reluctant to maintain — A cross‐sectional study

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