Efficacy of Multi-Component Exercise-Based Injury Prevention Programs on Injury Risk Among Footballers of All Age Groups: A Systematic Review and Meta-analysis

Abstract

Background Playing football is associated with a high risk of injury. Injury prevention is a priority as injuries not only negatively impact health but also potentially performance. Various multi-component exercise-based injury prevention programs for football players have been examined in studies. Objective We aimed to investigate the efficacy of multi-component exercise-based injury prevention programs among footballers of all age groups in comparison to a control group. Methods We conducted a systematic review and meta-analysis of randomized and cluster-randomized controlled trials. CINAHL, Cochrane, PubMed, Scopus, and Web of Science databases were searched from inception to June 2022. The following inclusion criteria were used for studies to determine their eligibility: they (1) include football (soccer) players; (2) investigate the preventive effect of multi-component exercise-based injury prevention programs in football; (3) contain original data from a randomized or cluster-randomized trial; and (4) investigate football injuries as the outcome. The risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), respectively. The outcome measures were the risk ratio (RR) between the intervention and the control group for the overall number of injuries and body region-specific, contact, and non-contact injuries sustained during the study period in training and match play. Results Fifteen randomized and cluster-randomized controlled trials with 22,177 players, 5080 injuries, and 1,587,327 exposure hours fulfilled the inclusion criteria and reported the required outcome measures. The point estimate (RR) for the overall number of injuries was 0.71 (95% confidence interval [CI] 0.59–0.85; 95% prediction interval [PI] 0.38–1.32) with very low-quality evidence. The point estimate (RR) for lower limb injuries was 0.82 (95% CI 0.71–0.94; 95% PI 0.58–1.15) with moderate-quality evidence; for hip/groin injuries, the RR was 0.56 (95% CI 0.30–1.05; 95% PI 0.00–102.92) with low-quality evidence; for knee injuries, the RR was 0.69 (95% CI 0.52–0.90; 95% PI 0.31–1.50) with low-quality evidence; for ankle injuries, the RR was 0.73 (95% CI 0.55–0.96; 95% PI 0.36–1.46) with moderate-quality evidence; and for hamstring injuries, the RR was 0.83 (95% CI 0.50–1.37) with low-quality evidence. The point estimate (RR) for contact injuries was 0.70 (95% CI 0.56–0.88; 95% PI 0.40–1.24) with moderate-quality evidence, while for non-contact injuries, the RR was 0.78 (95% CI 0.55–1.10; 95% PI 0.25–2.47) with low-quality evidence. Conclusions This systematic review and meta-analysis indicated that the treatment effect associated with the use of multi-component exercise-based injury prevention programs in football is uncertain and inconclusive. In addition, the majority of the results are based on low-quality evidence. Therefore, future high-quality trials are needed to provide more reliable evidence. Clinical Trial Registration PROSPERO CRD42020221772.

Effectiveness of Multi-Component Interventions on Injury Risk Among Ice and Snow Sports Participants - A Systematic Review and Meta-Analysis

“…Emery et al's study showed protective effects for all injuries (RR = 0.30, 95% CI, 0.19-0.49), lower limb injuries (RR = 0.31, 95% CI, 0.19-0.51), ankle sprains (RR = 0.27, 95% CI, 0.15-0.50), and knee twists (RR = 0.36, 95% CI, 0.13-0.98). Emery et al's randomized control trial showed that adolescents who underwent 12 weeks of high-intensity NMT signi cantly reduced sports and muscle injury risks compared to the control group, with an RR of 0.82 (95% CI 0.71-0.94; 95% CI 0.58-1.15), though the effectiveness was not signi cant [24]. Rahnema et al's quasi-experimental study found signi cant correlations between improvements in balance and agility following 8 weeks of regular training and thrice-weekly core stability training among professional speed skaters (p < 0.05), indicating a positive impact on dynamic balance and agility [37,38].…”

A sports‐related injury prevention program for Dutch youth volleyball players: Process evaluation alongside a quasi‐randomized controlled trial

“…Most of the described programs focus on preventing injuries in a specific body part like the ankle 3 or the knee 4 . A growing body of evidence suggests that multi‐component programs, that is, programs that target multiple body parts, may benefit the health of youth athletes by reducing the risk of injury 5 . The scarcity of volleyball‐specific injury prevention programs urged the Dutch Volleyball Association (Nevobo) and the Dutch Consumer Safety Institute (VeiligheidNL) to join forces to develop a volleyball‐specific injury prevention program called “VolleyVeilig” using the principles of Intervention Mapping 6 …”

“…4 A growing body of evidence suggests that multi-component programs, that is, programs that target multiple body parts, may benefit the health of youth athletes by reducing the risk of injury. 5 The scarcity of volleyball-specific injury prevention programs urged the Dutch Volleyball Association (Nevobo) and the Dutch Consumer Safety Institute (VeiligheidNL) to join forces to develop a volleyball-specific injury prevention program called "VolleyVeilig" using the principles of Intervention Mapping. 6 The VolleyVeilig program was first developed for players 16 years and older to be used during the warm-up phase and consists of more than 50 distinct exercises.…”

Efficacy of a new injury prevention programme (FUNBALL) in young male football (soccer) players: a cluster-randomised controlled trial

“…Several meta-analyses supported the efficacy of IPPs 19–21. A more cautious interpretation of their efficacy emerged recently when other meta-analyses included the calculation of prediction intervals 22 23. Despite available evidence of their efficacy,9–14 16–18 24–26 and the importance of good compliance for injury reduction,27–29 many studies highlighted a low programme compliance 15 30 31.…”