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

Abstract

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

Facilitators to support the implementation of injury prevention training in youth handball: A concept mapping approach

“…At least one statement from each cluster was located in the Go‐zone quadrant indicating that action is required across multiple levels of the sports delivery system to facilitate the implementation of injury prevention training in youth team handball. This is in accordance with previous research that highlights the importance of engaging intervention end‐users at the individual and organizational levels to plan, develop, and successfully implement any evidence‐based practice, including injury prevention training …”

“…This is in accordance with previous research that highlights the importance of engaging intervention end-users at the individual and organizational levels to plan, develop, and successfully implement any evidence-based practice, 24 including injury prevention training. 9,16 The cluster "Understanding and applying knowledge" had the highest mean rating for importance, followed by "Education, knowledge, and consistency", and both clusters had a high proportion of statements placed in the Go-zone. In contrast, the cluster "Set-up and exercises" received the lowest mean importance rating, had a relatively low proportion of statements in the Go-zone, and was the only cluster where mean feasibility was rated higher than mean importance (Table 1, Figure 3).…”

“…The need for research to identify effective implementation strategies for injury prevention training within real‐world community sports has increasingly been recognized . However, very few studies have examined or reported on the implementation of injury prevention interventions .…”

“…14,15 The need for research to identify effective implementation strategies for injury prevention training within real-world community sports has increasingly been recognized. [7][8][9]16 However, very few studies have examined or reported on the implementation of injury prevention interventions. 17,18 The current study addresses an important knowledge gap by investigating facilitators to support the implementation of injury prevention training.…”

Hamstring injuries have increased by 4% annually in men's professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study

“…Although the reach of the NH exercise was good among the club medical staff (88% were familiar with it),11 the coaching staff usually decide on training content, and coaches may not always be prepared to devote training time to preventive programmes 12. Thus, preventive measures proven highly efficacious in clinical trials do not necessarily work in real life on the football field 21 22. The measures have to be successfully implemented in the club, but if the players, staff and officials are not encouraged to use the measures, then the preventive efforts will fail 23.…”