Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial

Abstract

BackgroundInjury risk in youth rugby has received much attention, highlighting the importance of establishing evidence-based injury reduction strategies.AimTo determine the efficacy of a movement control exercise programme in reducing injuries in youth rugby players and to investigate the effect of programme dose on injury measures.MethodsIn a cluster-randomised controlled trial, 40 independent schools (118 teams, 3188 players aged 14–18 years) were allocated to receive either the intervention or a reference programme, both of which were to be delivered by school coaches. The intervention comprised balance training, whole-body resistance training, plyometric training, and controlled rehearsal of landing and cutting manoeuvres. Time-loss (>24 hours) injuries arising from school rugby matches were recorded by coaches and medical staff.Results441 time-loss match injuries (intervention, 233; control, 208) were reported across 15 938 match exposure-hours (intervention, 9083; control, 6855). Intention-to-treat results indicated unclear effects of trial arm on overall match injury incidence (rate ratio (RR)=0.85, 90% confidence limits 0.61 to 1.17), although clear reductions were evident in the intervention arm for concussion incidence (RR=0.71, 0.48 to 1.05). When trial arm comparisons were limited to teams who had completed three or more weekly programme sessions on average, clear reductions in overall match injury incidence (RR=0.28, 0.14 to 0.51) and concussion incidence (RR=0.41, 0.17 to 0.99) were noted in the intervention group.ConclusionA preventive movement control exercise programme can reduce match injury outcomes, including concussion, in schoolboy rugby players when compared with a standardised control exercise programme, although to realise the greatest effects players should complete the programme at least three times per week.

‘Pre-activity movement control exercise programme to prevent injuries in youth rugby’: some concerns

“…Hislop et al ’s advice that ‘further research is required to further understand the contexts into which the exercise programme would be implemented, as well as identifying what factors may facilitate or inhibit programme use’1 should be heeded by policy makers seeking to implement the findings. While a shift in focus towards the primary prevention of injuries in rugby is welcome, this preactivity exercise programme is not a sufficiently evidenced solution.…”

“…All efforts to reduce injuries in school rugby are welcome and the cluster randomised controlled trial by Hislop and colleagues deserves attention 1. Here, the authors presented a preactivity exercise programme that trained strength, agility and balance, with reductions in time-loss injuries and concussions claimed.…”

Some methodological issues in the design and analysis of cluster randomised trials

“…Hislop and colleagues4 do not mention the cluster randomised trial design effect in relation to either the sample size calculation or data analysis. Attwood et al 5 however, mention that the sample size calculation was adjusted for a cluster coefficient (between-cluster coefficient of variation which is closely related to intracluster correlation coefficient) of 0.26.…”

“…The risk of random confounding is generally greater in cluster randomised trials than individual randomised trials as the number of clusters is often small 3. Both Hislop et al 4 and Attwood et al 5 papers presented the baseline characteristics of participants in table 1, but they did not adjust for non-negligible imbalances in some baseline characteristics in their analysis 9. Confusingly, Hislop et al 4 paper reported p values for baseline comparisons (some of which were significant at 5% level), a common misuse of p values in the randomised trial literature.…”

The prevention of musculoskeletal injuries in field hockey: the systematic development of an intervention and its feasibility (Preprint)

“…As this intervention was found feasible by volleyball players and coaches, a randomized controlled trial has been initiated in order to evaluate its effectiveness on the occurrence of injuries among recreational adult volleyball players [25]. In rugby, a recent study showed that a preventive movement control exercise programme reduced match injury outcomes among young rugby players [26]. With regard to the conceptual similarities with especially the FIFA11+, one might be confident that 'Warming-Up Hockey' will lead to the reduction of lower extremity injuries among young and adult recreational field hockey players.…”