Randomized Evaluation of Centers for Disease Control and Prevention HEADS UP Concussion Education Materials for Youth Sport Coaches

The Centers for Disease Control and Prevention (CDC) HEADS UP youth sports coach materials are the most widely adopted form of concussion education for coaches across the United States-reaching millions of youth sports coaches over the last decade. These materials focus on concussion symptom identification, response, and management (e.g., return to school and sports), while also addressing the importance of communicating to athletes and their families about concussion safety. The purpose of this study was to assess the effectiveness of CDC HEADS UP materials on coach knowledge and communication with youth athletes about concussion safety. This is the first randomized control study of the CDC HEADS UP materials in real world youth sport conditions. Participants were 764 coaches at 15 YMCA associations. Cluster randomization was used to assign branches within associations to intervention (CDC HEADS UP) and control (treatment as usual) conditions. Coaches completed surveys prior to and at the end of the competitive season. Communication with athletes about concussion increased among coaches in the intervention group (adjusted risk ratio [aRR] = 1.24, 95% confidence interval [CI] = 1.14, 1.36) but not the control group (aRR = 1.09, 95% CI = 0.90, 1.31), in multi-variate analyses controlling for coach demographic characteristics and baseline communication practices. Concussion symptom knowledge and communication intentions also significantly increased in the intervention group but not in the control group. This study provides evidence that CDC HEADS UP materials increase the likelihood that youth sport coaches communicate with their athletes about concussion safety. As youth sports organizations increasingly mandate concussion education for coaches, CDC HEADS UP materials may be considered a leading resource for adoption and setting-relevant implementation.

"Train how you play": Using representative learning design to train amateur cricketers

Training task design with amateur female cricketers has typically comprised of deconstructed and monotonous approaches which may not maximise skill development. Clear guidelines to improve these practices in this cohort are lacking. The training environment should provide the same sources of information, decisions and variability as matches in order to prepare players for the match environment, which can be achieved through representative learning design (RLD). An RLD training intervention designed to promote skill development was performed over five weeks with two amateur female cricket teams to provide a framework for community coaches at the foundation stage of cricket. Skill development was recorded as changes in skilled actions for batting and bowling, with cognitions coded as themes for each skill during training. Six of ten batters and seven of eight bowlers exhibited increases in skill development ranging between 7-49%. Changes in batting and bowling behaviour improved substantially between moderately and extensively designed sessions. Batters' thoughts shifted from their own skill execution to objectives, while bowlers focused on their opponent's execution. Moderate to extensive RLD appears to promote skill development in amateur cricketers, making it a viable option for coach education and training design at the foundation level of cricket.

Effects of a Mentor Program for Coaches on the Coach-Athlete Relationship

The present study was designed to explore the effects of a one-year coach education program on coaches’ perceptions of their communication skills and co-orientation of their coach-athlete relationships. The study was designed with an experimental group and a control group. The experiment group consisted of 66 coaches (and 295 athletes) who received formal mentoring and the control group consisted of 41 coaches (and 148 athletes) who did not receive any mentoring. Data were analysed using structural equation modelling with autoregressive cross-lagged analysis. Results from the self-reported questionnaire at pre-test and post-test showed that the reciprocity of the coach-athlete relationships was not statistically significant. However, coaches’ experience of change in attention skills from the pre-test to the post-test positively predicted changes in their own perception of the coach-athlete relationship, whereas this association was not significant in the athletes’ perceptions. Moreover, the coach education programme increased coaches’ perception of their relational bonds with their athletes, but this increase did not correspond with an increase in athletes’ perception of the relational bonds with their coach. Practical implications and suggestions for further research are discussed in light of these findings.

Investigating Possible Effects from a One-Year Coach-Education Program

The main purpose of the current study was to examine possible effects from a coach education program over one year, in which each coach was supervised by a mentor who facilitated their learning based on coach-centered values. The current study was designed as an experiment with a control group, where the coaches in the experiment group received mentoring by a mentor over one year, whereas the coaches in the control group did not. Ninety-four coaches completed the study over one year from a variety of sports (n > 30), where cross-country skiing, soccer, biathlon, handball and swimming were the most represented sports. Among the coaches in the sample, 87% were coaches for athletes who competed or had ambitions to compete at an international level. The results from self-reported questionnaires at the pre-test and post-test show that the coach education program had a significant effect on the bond dimension in the coach–athlete working alliances and the coaches’ perceived coach performances. The analysis did not find any effects from the coach education program on the goal and task dimension in the coach–athlete working alliances. The findings are discussed in terms of applied implications and possible future research.

Changes in Self-Reported Physical Fitness, Performance, and Side Effects Across the Phases of the Menstrual Cycle Among Competitive Endurance Athletes

PURPOSE

To investigate changes in self-reported physical fitness, performance, and side effects across the menstrual cycle (MC) phases among competitive endurance athletes and to describe their knowledge and communication with coaches about the MC.

METHODS

The responses of 140 participants (older than 18 y) competing in biathlon or cross-country skiing at the (inter)national level were analyzed. Data were collected via an online questionnaire addressing participants' competitive level, training volume, MC history, physical fitness, and performance during the MC, MC-related side effects, and knowledge and communication with coaches about the MC and its effects on training and performance.

RESULTS

About 50% and 71% of participants reported improved and reduced fitness, respectively, during specific MC phases, while 42% and 49% reported improved and reduced performance, respectively. Most athletes reported their worst fitness (47%) and performance (30%) and the highest number of side effects during bleeding (P < .01; compared with all other phases). The phase following bleeding was considered the best phase for perceived fitness (24%, P < .01) and performance (18%, P < .01). Only 8% of participants reported having sufficient knowledge about the MC in relation to training, and 27% of participants communicated about it with their coach.

CONCLUSIONS

A high proportion of athletes perceived distinct changes in fitness, performance, and side effects across the MC phases, with their worst perceived fitness and performance during the bleeding phase. Because most athletes indicate a lack of knowledge about the MC's effect on training and performance and few communicate with coaches on the topic, the authors recommend that more time be devoted to educating athletes and coaches.

Content analysis of concussion education for coaches of youth and high school sport

OBJECTIVE

Describe the extent to which concussion education provided to coaches of US high school and youth sport is inclusive of information necessary for them to engage in target behaviors related to the prevention, identification and management of concussion.

METHODS

Sport organizations included in the sample were US state high school governing bodies and national governing bodies (NGBs) for youth sports with the highest concussion incidence rates. The concussion education resources made available online for coaches by these organizations were coded for content relevant to concussion prevention, identification and management.

RESULTS

All but one state high school governing body required coach concussion education, two NGBs required coach education, seven recommended it and only one did not require or recommend it. All educational materials covered at least 84% (n = 16/19) of the relevant knowledge domains.

DISCUSSION

Existing concussion education for coaches is addressing most, but not all, topics that may help coaches engage in concussion prevention, identification and management. Additional program development work is warranted to augment educational content related to coach communication about concussion safety with athletes and parents. Content appropriateness notwithstanding, further research is needed to understand the acceptability, efficacy, and implementation of concussion education for coaches.

Evidencing the impact of coaches' learning: Changes in coaching knowledge and practice over time

It is clear that sport coaches learn from multiple interconnected learning experiences, yet there is limited direct evidence to elucidate what is learned and how these combined experiences shape coaches' knowledge and day-to-day practice. This research aimed to investigate the impact of the learning of two groups of English youth soccer coaches over a period of a year and a half. Using the Coach Analysis and Intervention System (CAIS) and associated video-stimulated recall interviews, changes in the practice behaviours and knowledge use of coaches completing a formal coach education course, and equivalent coaches not undertaking formal education, were compared. Data indicated that the learning period had a different effect on coaches taking part in formal coach education versus those not in education. Changes in the use of knowledge about individual players and tactics were reflected in increased behaviours directed towards individuals, and an altered proportion of technical to tactically related questioning, linked to coaches' participation in education. Overall, more change was evident in coaching knowledge than in practice behaviours, suggesting an absence of deep learning that bridged the knowledge-practice gap.

Application of a Preventive Training Program Implementation Framework to Youth Soccer and Basketball Organizations

CONTEXT

Preventive training programs (PTPs) can reduce injury rates and improve neuromuscular control and sport performance. However, PTPs must be implemented correctly and consistently over time for athletes to benefit. Coaches represent the best long-term option for implementing PTPs. Youth athletes are at the optimal age for developing good habits before maturation. Although frameworks have been proposed to guide implementation efforts, little is known regarding the feasibility and real-world context of PTP implementation at the youth sport level.

OBJECTIVE

To evaluate the application of the 7-Step framework for promoting implementation of a preseason PTP workshop.

DESIGN

Descriptive epidemiology study.

SETTING

Youth soccer and basketball organizations.

PATIENTS OR OTHER PARTICIPANTS

Organizations with at least 1 team of athletes aged 8 to 14 years were invited to participate in a free preseason coaches' education workshop on PTP implementation.

INTERVENTION(S)

The 7-Step framework was used to guide PTP education and implementation for each organization. Personnel at organizations that agreed to participate attended a single preseason workshop for coaches. Research staff were available as a resource throughout the season but did not actively implement or monitor the PTPs.

MAIN OUTCOME MEASURE(S)

Retrospective evaluation of each organization's completion of steps 1 through 5 of the 7-Step framework.

RESULTS

A total of 62 youth soccer (n = 40) and basketball (n = 22) organizations were invited to participate. Twelve organizations completed steps 1 through 4 and steps 5a through 5d. The highest drop-off rate occurred during step 1, "Establishing Administrative Support." No organization completed all components of steps 1 through 5.

CONCLUSIONS

To better understand how to successfully promote PTP adoption, we must identify the implementation steps that may present the most challenges. Because the highest drop-off rate was seen during the initial step, establishing administrative support and strengthening initial engagement are necessary to improve PTP implementation.

A Nationwide Follow-up Survey on the Effectiveness of an Implemented Neuromuscular Training Program to Reduce Acute Knee Injuries in Soccer Players

Background:

A cruciate ligament (CL) injury is a severe injury in soccer. Neuromuscular training programs have a well-documented preventive effect, but there are few studies on the effectiveness of such a program at a national level. The Swedish Knee Control Program (KCP) was found to be effective in preventing CL injuries in youth female soccer players. The KCP was implemented nationwide in Sweden in 2010.

Purpose:

To evaluate the effectiveness of the Swedish KCP in reducing acute knee injuries in soccer players at a nationwide level.

Study Design:

Descriptive epidemiology study.

Methods:

All licensed soccer players in Sweden are covered by the same insurance company. Using this insurance database, around 17,500 acute knee injuries that were reported to the insurance company between 2006 and 2015 were included in the study. By matching the number of licensed soccer players with the number of reported injuries each year, the annual incidence of knee and CL injuries was able to be calculated. To evaluate the spread of the KCP nationally, a questionnaire was sent to all 24 Swedish district football associations (FAs) with questions regarding KCP education. The number of downloads of the KCP mobile application (app) was obtained.

Results:

The incidence of CL injuries decreased during the study period for both male (from 2.9 to 2.4 per 1000 player-years) and female players (from 4.9 to 3.9 per 1000 player-years). The overall incidence of knee injuries decreased in both male (from 5.6 to 4.6 per 1000 player-years) and female players (from 8.7 to 6.4 per 1000 player-years). Comparing before and after the nationwide implementation of the KCP, there was a decrease in the incidence of CL injuries by 6% (rate ratio [RR], 0.94 [95% CI, 0.89-0.98]) in male players and 13% (RR, 0.87 [95% CI, 0.81-0.92]) in female players and a decrease in the incidence of knee injuries by 8% (RR, 0.92 [95% CI, 0.89-0.96]) and 21% (RR, 0.79 [95% CI, 0.75-0.83]), respectively (P < .01 for all). This trend corresponded to a reduction of approximately 100 CL injuries each year in Sweden. A total of 21 of 24 district FAs held organized KCP educational courses during the study period. The percentage of district FAs holding KCP courses was between 46% and 79% each year. There were 101,236 downloads of the KCP app.

Conclusion:

The KCP can be considered partially implemented nationwide, and the incidence of knee and CL injuries has decreased in both sexes at a nationwide level.

Who is coaching the coach? Knowledge of depression and attitudes toward continuing education in coaches

Background

The rate of depression among collegiate athletes ranges from 16% to 23%, with particularly high findings of prevalence in track and field athletes (34%). Collegiate athletes have also been found to underuse mental health resources. Given this high prevalence of depression and demonstrated reluctance to seek help, it is important to explore the awareness and understanding of depression among the individuals who work most closely with this population.

Objective

To assess coaches’ knowledge and awareness of depression among their athletes and describe their level of interest in receiving continuing education.

Method

All National Collegiate Athletic Association Division I cross-country and track and field coaches were invited to participate in an online survey. The sample consisted of 253 participants, of whom 56 (25%) identified themselves as female and 170 (75%) as male with 14 (±10.4) years of coaching experience. Respondents completed the Adolescent Depression Awareness Program (ADAP) questionnaire and related questions. Differences in depression knowledge and interest in continuing education were calculated by gender, event specialty, length of coaching experience and certification history using analysis of variance and χ² analysis.

Results

The mean score on the ADAP depression questionnaire was 83%. Significant differences were not observed by gender, length of coaching experience, coaching title or certification history. Distance coaches scored significantly higher on the test than sprints coaches. Coaches estimated that 11% of their former and current student-athletes have struggled with depression. 77% of coaches indicated a ‘strong interest’ in receiving continuing education.

Conclusions

The findings of this study indicate the participating coaches have a good knowledge of depression for individuals without formal education on the topic but may lack depression awareness. This hypothesis is supported by the finding that coaches in the sample found out an athlete was suffering from depression most often by the athlete self-reporting.

Career Development and Learning Pathways of Paralympic Coaches With a Disability

The purpose of this study was to gain an understanding of the career development and learning pathways of Paralympic head coaches who previously competed as Paralympic athletes. Each coach participated in a semistructured interview. A thematic analysis of the data revealed three higher order themes, which were called becoming a coach, learning to coach, and lifelong learning and teaching. Across these themes, participants discussed interactions with other coaches and athletes with a disability, learning from mentors and coaching clinics, as well as limited formal educational opportunities they experienced transitioning from athlete to head coach. The findings revealed that they acquired most of their knowledge from a combination of knowledge gained as athletes and informal sources, including trial and error. They also stressed the need for enhanced recruiting of parasport coaches and parasport coach education opportunities that would enhance programs for athletes with physical disabilities, from grassroots to Paralympic levels.

The Value of Indirect Teaching Strategies in Enhancing Student-Coaches' Learning Engagement

This study aimed to examine the indirect teaching strategies adopted by a coach educator in terms of promoting student-coaches' engagement in a positive and active learning environment. The participants were an expert coach educator and seven student-coaches from an academic coaching setting. A mix method approach was used to collect data. Whilst video-recording and participant observations were used to collect data from the lessons, focus groups were adopted to recall the perceptions of student-coaches. The results showed that indirect teaching strategies (i.e., asking questions, showing signs of autonomy by monitoring the pace at which they completed tasks and actively engaging in the search for solutions to tasks) implemented by the coach educator promoted a supportive and challenging learning environment which, in turn, encouraged student-coaches to be more actively involved in the lessons. Additionally, the affective aspects of the relationship established with student-coaches (tone of voice, gestures, facial expressions, eye contact, physical contact and humor) led them to feel confident in exposing their doubts and opinions, and in learning in a more autonomous manner. Moreover, the practical lessons proved to be crucial in helping student-coaches to reach broader and deeper forms of understanding by allowing the application of theory to coaching practice. In conclusion, this study reinforces the value of indirect teaching strategies to stimulate an active learning environment. It further highlights the value of practical learning environments to better prepare neophyte coaches for dealing with the complex and dynamic nature of their professional reality. Key pointsBoth instructional and affective teaching indirect strategies used by the coach educator promoted a positive and challenging learning environment to student-coaches.The directness profile used by this coach educator (questioning, giving autonomy for problem solving and responsibility to regulate the learning tasks development) promoted the awareness and the ability of student-coaches to explore alternative solutions and self-regulate their own learning.Using humor, touch, gestures and tone of voice, the coach educator showed great care for student-coaches, which impacted positively on their enthusiasm, confidence and desire to be actively engaged in their own learning.

Increasing girls' physical activity during an organised youth sport basketball program: a randomised controlled trial protocol

BACKGROUND

Participation in organised youth sports (OYS) has been recommended as an opportunity to increase young peoples' moderate-to-vigorous physical activity (MVPA) levels. Participants, however, spend a considerable proportion of time during OYS inactive. The purpose of this study, therefore, was to investigate whether coaches who attended coach education sessions (where education on increasing MVPA and decreasing inactivity during training was delivered) can increase players' MVPA during training sessions over a 5-day basketball program compared to coaches who did not receive coach education sessions.

METHODS/DESIGN

A convenience sample of 80 female players and 8 coaches were recruited into the UWS School Holiday Basketball Program in Greater Western Sydney, Australia. A two-arm, parallel-group randomised controlled trial was employed to investigate whether coaches who attended 2 coach education sessions (compared with a no-treatment control) can increase their players' MVPA during training sessions over a 5-day basketball program. Objectively measured physical activity, directly observed lesson context and leader behaviour, player motivation, players' perceived autonomy support, and coaching information (regarding training session planning, estimations on player physical activity and lesson context during training, perceived ability to modify training sessions, perceived importance of physical activity during training, intention to increase physical activity/reduce inactivity, and likelihood of increasing physical activity/reducing inactivity) were assessed at baseline (day 1) and at follow-up (day 5). Linear mixed models will be used to analyse between arm differences in changes from baseline to follow-up on all outcomes.

DISCUSSION

The current trial protocol describes, to our knowledge, the first trial conducted in an OYS context to investigate the efficacy of an intervention, relative to a control, in increasing MVPA. This study's findings will provide evidence to inform strategies targeting coaches to increase MVPA in OYS, which could have major public health implications, given the high proportion of children and adolescents who participate in OYS globally.

TRIAL REGISTRATION

This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613001099718.