Perceptions, facilitators, and barriers regarding use of the injury prevention exercise programme Knee Control among players and coaches in youth floorball: a cross-sectional survey study

Moving Beyond the Checklist-An Enhanced Approach to Context-Driven Overuse Injury Prevention in Overhead Youth Athletes

The increasing discussions regarding the research-to-practice gap in sport injury prevention have led to a growing focus on the significance of context in injury prevention programs. A context-driven injury prevention program is advantageous to address and enhance injury prevention efforts in specific populations. Considering the prevalent concern for overuse injuries among overhead youth athletes, and the developmental and contextual factors unique to this population, this review introduces the OverHead Youth Athlete (OH-YA) overuse injury prevention process. Tailored to address the challenges of working with overhead youth athletes, the context-specific four-step framework includes the following: (1) development of a context-specific instrument with strong sample representation, (2) determination of the context-specific injury burden magnitude and associated factors, (3) development of a context-specific intervention with end-users, and (4) evaluation of the context-specific intervention. This framework would likely help maximize the use of typically limited resources in youth sports. Using shoulder overuse injuries among overhead youth athletes as a case study, the OH-YA overuse injury prevention process provides an enhanced approach to context-driven overuse injury prevention while illustrating the importance and integration of context to minimize the "research-to-practice" gap.

Health And Performance Promotion in Youth (HAPPY) hybrid effectiveness-implementation cluster randomised trial: comparison of two strategies to implement an injury prevention exercise programme in Danish youth handball

OBJECTIVE

To investigate if a combination of an online and onsite implementation strategy was superior to an online-only strategy in enhancing the use of an injury prevention exercise programme (IPEP) and in reducing the risk of shoulder, knee and ankle injuries in youth community handball players (age 11-17) over a handball season.

METHODS

In this 30-week hybrid effectiveness-implementation cluster randomised type 3 study, 20 youth handball clubs were randomly assigned 1:1 to either a combined online and onsite implementation strategy (coach workshop using the health action process approach behaviour change model and health service provider (HSP) support) or an online-only strategy (control group). The primary implementation outcome was coach-reported adherence, measured as the average IPEP exercise usage by the team over 30 weeks. The primary effectiveness outcome was player-reported handball playing time to any new handball-related shoulder, knee and ankle injuries, reported weekly using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems.

RESULTS

We enrolled 63 coaches (27% women) and 945 players (mean age 14.5 years, 55% girls). Intention-to-treat analyses showed no statistically significant difference between implementation strategies in adherence (between-group difference 1.4, 95% CI -0.5 to 3.4) or in cumulative injury risk (between-group difference 5.5% points, 95% CI -2.2 to 13.1).

CONCLUSION

Our findings demonstrate that in youth community handball, a combined online and onsite implementation strategy, including a coach workshop and HSP support, was not superior to an online-only strategy regarding adherence to an IPEP or in reducing shoulder, knee and ankle injury risk.

TRIAL REGISTRATION NUMBER

NCT05294237.

"I'd rather do that (Knee Control) than be injured and not able to play": a qualitative study on youth floorball players' and coaches' perspectives of how to overcome barriers for injury prevention exercise programme use

This study explored youth floorball players' and coaches' perspectives on using the injury prevention exercise programmes (IPEPs) Knee Control or Knee Control+ (Knee Control programmes) and how to overcome barriers to programme use. We used a qualitative design with eight semistructured focus group discussions, six with players, 11-17 years old (n =42) and two with coaches (n =12). Data analysis followed the principles of qualitative content analysis. Three main categories emerged: challenges related to preventive training, promoting factors and solutions to facilitate the use of preventive training. To overcome barriers, players and coaches gave examples of how to tailor preventive programmes, such as adding joyful sport specific components. Player-perceived improved performance, with increased strength and speed from the preventive training, could be a promoting factor to increase motivation and enable IPEP use. Players and coaches offered examples of how to adapt and progress the preventive training by progressing gradually and choosing exercises that fit the team. Coaches emphasised that preventive training is important but difficult to prioritise in time-limited training sessions. Coaches' suggestions to overcome barriers were through collaboration and support from other coaches, to start using the IPEP at an early age, to keep it simple and motivating the players with, for example, positive role models. Players found the Knee Control exercises boring but necessary for injury prevention. Sometimes, coaches felt uncertain of their competence to use the Knee Control programmes and wished for support from the federation, club and other coaches. Players and coaches shared ideas on how to overcome barriers to IPEP use, such as to increase players' motivation, having a good structure, setting up routines for preventive training and to tailor the preventive training to the team. These findings can be used to further develop practical workshops and recommendations for programme use for players and coaches in youth team ball sports.

Players are positive regarding injury prevention exercise programmes, but coaches need ongoing support: a survey-based evaluation using the Health Action Process Approach model across one season in amateur and youth football

Objectives

Implementation of injury prevention exercise programmes (IPEPs) in sports is challenging, and behaviour change among players and coaches is essential for success. The aim was to describe players' and coaches' motivation and coaches' goal pursuit when using IPEPs in amateur and youth football across a season. A secondary aim was to describe players' motivation to engage in IPEP use in relation to presence or absence of injury.

Methods

The study was based on questionnaires to amateur and youth, male and female football players and coaches at baseline, mid-season and post-season in a three-armed randomised trial in 2020 in Sweden. Questionnaires were based on the Health Action Process Approach (HAPA) model with questions about the motivational phase when intention for change is created (players and coaches) and a goal-pursuit phase when intention is translated into action (coaches).

Results

In total, 455 players (126 male), mean age 20.1 years (SD±5.8, range 14-46) and 59 (52 male) coaches took part. Players generally gave positive answers in the HAPA motivational phase (Likert 6-7 on a 1-7 Likert scale). Differences in ratings between injured and uninjured players were minor. Coaches had positive or neutral ratings (Likert 4-6) in the motivational and goal-pursuit phases. Ratings deteriorated across the season, with less positive responses from 40% of players and 38-46% of coaches post-season.

Conclusion

Positive ratings in the HAPA motivational phase indicated fertile ground for IPEP use. Neutral ratings by coaches and deterioration across the season in players and coaches suggest a need for ongoing support for IPEP use.

Trial registration number

NCT04272047.

Best practices for the dissemination and implementation of neuromuscular training injury prevention warm-ups in youth team sport: a systematic review

OBJECTIVE

To evaluate best practices for neuromuscular training (NMT) injury prevention warm-up programme dissemination and implementation (D&I) in youth team sports, including characteristics, contextual predictors and D&I strategy effectiveness.

DESIGN

Systematic review.

DATA SOURCES

Seven databases were searched.

ELIGIBILITY

The literature search followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

INCLUSION CRITERIA

participation in a team sport, ≥70% youth participants (<19 years), D&I outcomes with/without NMT-related D&I strategies. The risk of bias was assessed using the Downs & Black checklist.

RESULTS

Of 8334 identified papers, 68 were included. Sport participants included boys, girls and coaches. Top sports were soccer, basketball and rugby. Study designs included randomised controlled trials (RCTs) (29.4%), cross-sectional (23.5%) and quasi-experimental studies (13.2%). The median Downs & Black score was 14/33. Injury prevention effectiveness (vs efficacy) was rarely (8.3%) prioritised across the RCTs evaluating NMT programmes. Two RCTs (2.9%) used Type 2/3 hybrid approaches to investigate D&I strategies. 19 studies (31.6%) used D&I frameworks/models. Top barriers were time restrictions, lack of buy-in/support and limited benefit awareness. Top facilitators were comprehensive workshops and resource accessibility. Common D&I strategies included Workshops with supplementary Resources (WR; n=24) and Workshops with Resources plus in-season Personnel support (WRP; n=14). WR (70%) and WRP (64%) were similar in potential D&I effect. WR and WRP had similar injury reduction (36-72%) with higher adherence showing greater effectiveness.

CONCLUSIONS

Workshops including supplementary resources supported the success of NMT programme implementation, however, few studies examined effectiveness. High-quality D&I studies are needed to optimise the translation of NMT programmes into routine practice in youth sport.

If we build it together, will they use it? A mixed-methods study evaluating the implementation of Prep-to-Play PRO: an injury prevention programme for women's elite Australian Football

OBJECTIVES

We evaluated the implementation of Prep-to-Play PRO, an injury prevention programme for women's elite Australian Football League (AFLW).

METHODS

The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of Prep-to-Play PRO were assessed based on the proportion of AFLW players and/or staff who: were aware of the programme (R), believed it may reduce anterior cruciate ligament injury (E), attempted to implement any/all programme components (A), implemented all intended components as practically as possible (I) and intended future programme implementation (M). Quantitative and qualitative data were triangulated to assess 58 RE-AIM items (evidence of yes/no/unsure/no evidence) and the 5 RE-AIM dimensions (fully achieved=evidence of yes on >50% dimension items, partially achieved=50% of items evidence of yes and 50% unsure or 50% mix of unsure and unanswered, or not met=evidence of yes on <50% dimension items).

RESULTS

Multiple sources including AFLW training observations (n=7 total), post-implementation surveys (141 players, 25 staff), semistructured interviews (19 players, 13 staff) and internal programme records (9 staff) contributed to the RE-AIM assessment. After the 2019 season, 8 of 10 (80%) AFLW clubs fully met all five RE-AIM dimensions. All 10 clubs participating in the AFLW fully achieved the reach (R) dimension. One club partially achieved the implementation (I) dimension, and one club partially achieved the effectiveness (E) and adoption (A) dimensions.

CONCLUSION

The Prep-to-Play PRO injury prevention programme for the AFLW achieved high implementation, possibly due to the programme's deliberately flexible approach coupled with our pragmatic definition of implementation. Engaging key stakeholders at multiple ecological levels (organisation, coaches, athletes) throughout programme development and implementation likely enhanced programme implementation.

Motivation and goal-pursuit for injury prevention training in amateur football coaches: a cross-sectional study using the Health Action Process Approach

BACKGROUND

Adoption of injury prevention exercise programmes (IPEPs) in team sports is contingent on behaviour change among coaches. The aim was to study motivation and goal-pursuit in IPEP use among coaches of amateur football players.

METHODS

A cross-sectional study using web-based questionnaires was administered to coaches in one Swedish regional football district. The study was carried out one season after dissemination of the IPEP Knee Control+. The questionnaire was based on the Health Action Process Approach and covered perceptions and beliefs about using Knee Control+. Questions were rated on 1-7 Likert scales.

RESULTS

440 coaches participated (response rate 32%). Coaches were neutral about injury risks (median 4-5) and knowledge about preventing injuries (median 5) but had positive outcome expectancies of preventive training (median 6). Coaches who had used an IPEP perceived they had more knowledge about preventing injuries than non-users (median 5 vs 4, small effect size d=0.43). Coaches who used Knee Control+ were positive about their practical ability to use it (median 6) and had high intention to prioritise continuous use (median 7). Highly adherent coaches to higher extent believed that specific training may prevent injuries and had plans for how to instruct the players and how to work around barriers compared with low adherent coaches.

CONCLUSION

Coaches need more knowledge and support on IPEP usage and how to structure training. Coaches who had adopted Knee Control+ had high belief in their abilities but may need constructive plans on how to use the programme and to overcome barriers.

Developing the Singapore youth shoulder overuse injury prevention program

OBJECTIVES

To develop the Singapore Youth Shoulder Overuse Injury Prevention Program specifically for competitive overhead youth athletes in Singapore.

DESIGN

Two-round online Delphi technique with experts and a feasibility assessment questionnaire with youth athletes who represented end-users.

SETTING

Volleyball for youth athletes.

PARTICIPANTS

Experts were recruited through purposive sampling based on their knowledge and experience. Youth athletes were recruited though a volleyball club.

MAIN OUTCOME MEASURES

The main outcome measure was the level of consensus on the proposed (1) exercise program for the overhead youth athletes, (2) education program regarding overuse injuries for coaches of overhead youth athletes, and (3) education program regarding overuse injuries for overhead youth athletes. Consensus was set at 75% agreement in this study.

RESULTS

Eighteen experts completed the two Delphi rounds with 100% response rate. Consensus was achieved for the exercise program and both education programs. Twelve youth athletes completed the feasibility assessment questionnaire and found the exercises to be feasible in terms of usefulness, practical use, instructions, duration, and ease of execution.

CONCLUSION

Consensus was reached for the Singapore Youth Shoulder Overuse Injury Prevention Program, and feasibility of execution by end-users was successfully determined.