Canadian High School Rugby Coaches Readiness for an Injury Prevention Strategy Implementation: Evaluating a Train-the-Coach Workshop

A Comparison of Suspected Injuries, Suspected Concussions, and Match Events in Male and Female Canadian High School 15s and 7s Rugby

OBJECTIVE

To compare match event rates and suspected injury and concussion rates between 7-a-side (7s) and 15-a-side (15s) female and male high school rugby union players using video analysis (VA).

DESIGN

Cross-sectional video analysis study.

SETTING

Alberta high school rugby competitions.

PARTICIPANTS

Senior high school rugby players (ages 14-18 years) in Calgary, Alberta, participating in the March to June 2022 season.

ASSESSMENT OF RISK FACTORS

Video analysis of high school rugby matches in 7s and 15s.

MAIN OUTCOME MEASURES

Univariate Poisson regression analyses were used to determine rates of match events, video-identified suspected injuries, and suspected concussions per 1000-player-hours. Incidence rates and incidence rate ratios (IRR) were used to compare between 7s and 15s (15s referent group) and females and males (male referent group).

RESULTS

Suspected injury rates ranged from 115.0 to 223.6/1000 match hours, while suspected concussion rates ranged from 61.5 to 93.2/1000 hours. The male 7s cohort reported the highest suspected injury and suspected concussion rate, with no significant differences between male or female cohorts across formats. The tackle accounted for 84.6% of all injuries. Despite 30% more tackles in female compared with male 15s, tackle-related injury rates were similar between sexes [IRR = 1.1 (95% CIs: 0.7-1.6)].

CONCLUSIONS

This study did not find any differences in suspected injury or suspected concussion rates between sexes or formats of the game. The proportion of injuries recorded in the tackle and the high reported suspected injury rates does suggest the need for further investigation into tackle proficiency, injury prevention intervention evaluation, and potential law changes.

What do coaches want? Exploring the preferences of youth rugby union coaches for education in the implementation of injury prevention programmes

OBJECTIVE

To explore youth Rugby Union coaches' preferences for education and support in the implementation of injury prevention programmes (IPPs).

METHODS

Twelve Rugby Union coaches involved with youth teams participated in five online focus groups. Conventional content analysis was used to determine preferences initially from transcripts, and thereafter main categories, generic categories and sub-categories.

RESULTS

Coach preferences were organised into three main categories: 'formal/non-formal learning', 'informal learning', and 'intrapersonal considerations'. The generic categories of 'logistics', 'content' and 'resources' featured substantially in coach preferences for education. Coaches prefer live structured group workshops in the pre-season period, which focus on the development of implicit knowledge. To do this, coaches prefer practical opportunities for coaching within the education session. In support of this education, coaches want resources (both physical and video) which assist in session planning.

CONCLUSIONS

The preferences of youth Rugby Union coaches towards IPP education and support are similar to that of other coaching domains. A live practical workshop held in the pre-season is preferred, although facilitator preferences varied. A mismatch is evident between coach preferences for IPP education and what is currently being offered through NGB coach education therefore further exploration of NGB perspectives is warranted.

Coaching the coaches: exploring the effectiveness of the 'Move Well Be strong' youth injury prevention programme for grassroot coaches and PE teachers

INTRODUCTION

Coaches play a major role in developing movement in their performers, especially at grassroots levels. However, there are significant knowledge gaps amongst grassroots coaches and physical education (PE) teachers regarding movement competency and injury prevention programs. This study aimed to explore the effectiveness of knowledge gain, adoption and implementation following a youth injury prevention workshop for grassroots coaches and PE teachers.

METHODS

56 grassroots coaches and PE teachers completed a validated questionnaire exploring use, knowledge, attitude towards and confidence to deliver youth movement competency training before and after an online workshop. Bayesian Wilcoxon signed-rank tests were used to assess the knowledge, attitude, and confidence to deliver an injury prevention programme following the workshop. For all the Bayesian inference tests run, the Bayesian factor (BF10) was interpreted using the evidence categories ranging from extreme evidence (BF10 > 100) to anecdotical evidence (BF10 < 1).

RESULTS

Post-workshop there was a 34% increase in respondents indicating that they had greater knowledge of injury prevention issues (55% pre-workshop vs 89% post-workshop) with statistically positive and moderate effects (BF10 > 100 [extreme evidence]). There was also a 25% increase in respondents indicating that they had a more sympathetic attitude towards injury prevention (67% sympathetic pre-workshop vs 93% sympathetic post-workshop) with statistically moderate effects (BF10 = 87.4 [very strong evidence]). A 19% increase in attendees' confidence to deliver an injury prevention programme was observed (69% high pre-workshop vs. 89% high post-workshop) with statistically moderate effects (BF10 = 85.9 [very strong evidence]). 100% of participants indicated an intent to adopt the injury prevention programme.

CONCLUSIONS

An online workshop increased knowledge and confidence in grassroots coaches and PE teachers to deliver a youth injury prevention programme. Knowledge gained from training and upskilling created a positive attitude and confidence to deliver movement competency into coaching. Appropriate resources need to be developed and delivered in an accessible way to grassroots coaches and PE teachers via workshops and should be included in governing body coaching awards or as continuing professional development for youth coaches and PE teachers.

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.

Coaches of youth field sports as delivery agents of injury prevention programmes: how are we training the trainers? A scoping review

OBJECTIVE

To systematically map the coach education (CE) component of injury prevention programmes (IPPs) for youth field sports by identifying and synthesising the design, content and facilitation strategies used to address competency drivers and behaviour change.

DESIGN

Scoping review.

DATA SOURCES

PubMed, PsycInfo, EMBASE, CINAHL, SportDiscus and Google Scholar electronic databases were searched using keywords related to IPPs and youth field sports.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies of IPPs in youth field sports, that provided 'train-the-trainer' education to coaches as designated delivery agents.

RESULTS

20 studies from two field sports (soccer/football; n=17, Rugby Union; n=3) fulfilled the eligibility criteria. Eleven CE interventions occurred in the preseason and 18 occurred at one time-point (single day). Five studies cited use of a behavioural change theory or model in the design of their CE, most frequently the Health Action Process Approach model (n=5); and use of behavioural change techniques varied. Twelve of twenty studies (60%) reported some form of ongoing support to coaches following the CE primary intervention concurrent with IPP implementation.

CONCLUSION

CE that occurs on 1 day (one time-point) is most popular for preparing coaches as delivery agents of IPPs in youth field sports. While recognising pragmatic barriers, more expansive in-service training, support and feedback may enhance the effective implementation of IPPs.

TRIAL REGISTRATION NUMBER

https://doi.org/10.17605/OSF.IO/FMHGD.

Who Does Not Respond to Injury Prevention Warm-up Programs? A Secondary Analysis of Trial Data From Neuromuscular Training Programs in Youth Basketball, Soccer, and Physical Education

OBJECTIVES: To identify factors associated with nonresponse to neuromuscular training (NMT) warm-up programs among youth exposed to NMT warm-ups. METHODS: This is a secondary analysis of youth (aged 11-18 years) in the intervention groups of 4 randomized controlled trials in high school basketball, youth community soccer, and junior high school physical education. Youth who were exposed to NMT and who sustained an injury during the study were considered nonresponders. Odds ratios (ORs) were based on generalized estimating equations logistic regression controlling for clustering by team/class and adjusted for age, weight, height, balance performance, injury history, sex, and sport (soccer/basketball/physical education). RESULTS: A total of 1793 youth were included. Youth with a history of injury in the previous year had higher odds (OR = 1.64; 95% CI: 1.14, 2.37) of injury during the study, and females were more likely (OR = 1.67; 95% CI: 1.21, 2.31) to sustain an injury than males who were participating in NMT. Age was not associated with the odds of sustaining an injury (OR = 1.10; 95% CI: 0.93, 1.30). Soccer players benefited most from greater adherence, with 81% lower odds of injury (OR = 0.19; 95% CI: 0.06, 0.57) when completing 3 NMT sessions a week compared with 1 session per week. CONCLUSION: Factors associated with nonresponse to an NMT warm-up program were female sex, history of injury during the previous 12 months, and lower weekly NMT session adherence in some sports (soccer). J Orthop Sports Phys Ther 2023;53(2):94-102. Epub: 9 December 2022. doi:10.2519/jospt.2022.11526.

It Takes Two to Tango: High Rates of Injury and Concussion in Ball Carriers and Tacklers in High School Boys' Rugby

OBJECTIVE

To examine injury and concussion rates, mechanisms, locations, and types of injury in Canadian high school male rugby.

DESIGN

Prospective cohort study.

SETTING

High school male rugby.

PARTICIPANTS

A total of 429 high school players (2018: n = 225, 2019: n = 256) were recruited from 12 teams in 7 schools in Calgary, Canada.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Injury surveillance included baseline questionnaires, weekly exposure, and injury reports. Injuries included those requiring medical attention, resulted in time loss and/or inability to complete a session. Concussion was defined as per the fifth Consensus on Concussion in Sport, and all players with a suspected concussion were referred to a study sport medicine physician.

RESULTS

A total of 134 injuries were captured, leading to an injury incidence rate (IR) of 57.9/1000 hours [95% confidence intervals (CIs): 45.4-73.8]. Median time loss was 6 days (range: 0-90). Injuries to the head were the most common (40%), followed by shoulder (12%) and ankle (10%). The concussion IR was 22.0/1000 hours (95% CIs: 15.9-30.4), which was the most common injury type (38%), followed by sprain (20%) and strain (15%). Sixty-five percent of injuries occurred in the tackle (ball carrier 35%, tackler 30%) and 76% of concussions (ball carrier 41%, tackler 35%).

CONCLUSIONS

The rate of injury and concussion in Canadian youth high school male rugby is high, with tackle-related injuries and concussions the most common. Given this, there is a critical need for implementation of prevention strategies, in particular targeting concussion and the tackle event (eg, neuromuscular, tackle training, and law changes).

Understanding Youth Sport Coaches' Perceptions of Evidence-Based Injury-Prevention Training Programs: A Systematic Literature Review

OBJECTIVE

To systematically review and summarize the knowledge, attitudes, beliefs, and contextual perceptions of youth sport coaches toward injury-prevention training programs by using the Theoretical Domains Framework to guide the organization of results.

DATA SOURCES

Systematic searches of PubMed and Google Scholar were undertaken in November 2021.

STUDY SELECTION

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed. Results were limited to full-text articles that were published in peer-reviewed journals and printed in English. Additional studies were added after a citation search of included studies. Studies were eligible for inclusion if researchers evaluated youth sport coaches' knowledge, beliefs, contextual perceptions, or all 3 of anterior cruciate ligament injury-prevention training programs.

DATA EXTRACTION

Data charting was performed by 1 author and confirmed by a separate author.

DATA SYNTHESIS

Of the 1194 articles identified, 19 were included in the final sample. Among articles in which researchers assessed knowledge (n = 19), coaches' awareness of the existence and components of injury-prevention training programs was inconsistent. Among articles in which researchers assessed beliefs (n = 19), many coaches had positive attitudes toward injury-prevention training programs, but few believed youth athletes are at a high risk of injury. Among articles in which researchers assessed contextual perceptions (n = 13), many coaches did not feel they had access to information about injury-prevention training programs and cited a lack of time, space, support, and other resources as barriers to implementation.

CONCLUSIONS

Our findings support the need for programs, protocols, and policies to enhance knowledge of and support for youth sport coaches who wish to implement injury-prevention training programs. A gap exists in the research about addressing the needs of youth sport coaches in the United States high school sports setting. The use of multilevel implementation science frameworks (such as the Theoretical Domains Framework) will be beneficial for identifying constructs that affect implementation and developing train-the-trainer programming to meet the needs of individual youth sport coaches.

Effectiveness of the Activate injury prevention exercise programme to prevent injury in schoolboy rugby union

OBJECTIVE

The efficacious Activate injury prevention exercise programme has been shown to prevent injuries in English schoolboy rugby union. There is now a need to assess the implementation and effectiveness of Activate in the applie setting.

METHODS

This quasi-experimental study used a 24-hour time-loss injury definition to calculate incidence (/1000 hours) and burden (days lost/1000 hours) for individuals whose teams adopted Activate (used Activate during season) versus non-adopters. The dose-response relationship of varying levels of Activate adherence (median Activate sessions per week) was also assessed. Player-level rugby exposure, sessional Activate adoption and injury reports were recorded by school gatekeepers. Rate ratios (RR), adjusted by cluster (team), were calculated using backwards stepwise Poisson regression to compare rates between adoption and adherence groups.

RESULTS

Individuals in teams adopting Activate had a 23% lower match injury incidence (RR 0.77, 95% CI 0.55 to 1.07), 59% lower training injury incidence (RR 0.41, 95% CI 0.17 to 0.97) and 26% lower match injury burden (95% CI 0.46 to 1.20) than individuals on non-adopting teams. Individuals with high Activate adherence (≥3 sessions per week) had a 67% lower training injury incidence (RR 0.33, 95% CI 0.12 to 0.91) and a 32% lower match injury incidence (RR 0.68, 95% CI 0.50 to 0.92) than individuals with low adherence (<1 session per week). While 65% of teams adopted Activate during the season, only one team used Activate three times per week, using whole phases and programme progressions.

CONCLUSION

Activate is effective at preventing injury in English schoolboy rugby. Attention should focus on factors influencing programme uptake and implementation, ensuring Activate can have maximal benefit.