Sports Medicine Research: In the Lab & In the Field: Overcoming Injury Prevention Barriers (Sports Med Res)

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Wednesday, February 28, 2018

Overcoming Injury Prevention Barriers

A concept mapping approach to identifying the barriers to implementing an evidence-based sports injury prevention programme

Donaldson A, Callaghan A, Bizzini M, Jowett A, Keyzer P, & Nicholson M. Inj Prev. 2018; Online Ahead of Print January 20, 2018.  

Take Home Message: To improve implementation of injury prevention programs, we need to adopt a multi-factorial approach that focuses on coach education and linking program benefits to game-related outcomes.

Despite significant evidence that injury prevention programs prevent injuries (see examples below), there is resistance to implementing these programs.  It remains unclear why there is a lack of implementation. Therefore, the authors performed a mixed-methods study to identify perceived barriers by coaches to implementing the FIFA 11+ injury prevention program among Australian female soccer teams.  The authors used concept mapping of 19 coaches’ brainstorming ideas, statement sorting, and importance/feasibility ratings.  The authors reported 65 brainstorming ideas that were classified into 6 categorical barriers in order of ranked importance to 11+ implementation: coaches’ 11+ knowledge, link to sport related goals, leadership, time at training, player enjoyment/engagement, and facilities/resources.  

This study emphasizes the importance of a multi-tiered approach to successful injury prevention implementation programming.  Education of coaches, players, and possibly the medical staff is critical towards injury prevention efforts.  Of significant interest is the fact that the coaches are the gatekeepers towards implementation.  A previous post identified the importance of coaches’ buy-in to influence player compliance and there is also plenty of research to link compliance to injury prevention programming effectiveness.  So, the question remains how to best create coach buy-in.  Educating our coaches about the programs is very important, in addition to educating or creating links between the injury prevention programming and sport-specific tasks.  This may include minor modifications of drills to include balls or more sport-specific drills to help bridge the gap between the goal of the drill and the sport activities.  Furthermore, it would be beneficial to teach coaches, players, and other stakeholders that these programs can also improve sport performance. The FIFA 11+ exercises are soccer focused – yet soccer coaches feel that there is little crossover to sport specific skills.  It would be interesting to see the effectiveness of the programming if coaches were able to provide input on the types of drills performed, particularly in some sports other than soccer. These authors did a great job identifying common barriers, and when implementing injury prevention programming clinically it is important to address these barriers proactively to increase buy in and adherence. 

Questions for Discussion:  What strategies do you utilize during injury prevention introduction?  Are there any modifications that you make based on coach or player feedback?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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5 comments:

Dana said...

Thanks for sharing Nicole. I encountered this most often when formerly working as a strength coach. My biggest ally was having supporting evidence of what I wanted to implement as well as using to my advantage the coach's communication style.
Yet even if you have the strongest evidence to support a change in care, if you are unable to 'sell it' to the coach then it may never come to fruition. It is a tough position to be in and I'm curious what others may say about this topic too.

Nicole Cattano said...

Thanks for the comment Dana. Do you have any advice on how to best "sell it" to coaches? I've gotten initial but -in, but I've sometimes struggled with sustained enforcement from the coaches down throughout the duration of the season.

Sarah said...

I really enjoyed this article! I think this is situation that several athletic trainers can relate to and will have to address. I think that as Dana mentioned, it is important to have research to support your idea for a change, but almost just as important to "sell it" to the coaches. I would really emphasize to the coaches that including the injury prevention program will improve sport performance; hopefully that will catch their attention. Nicole, I understand your comment about how it is sometimes difficult to enforce the program throughout the year. In this case, I would meet with the coaches and ask them for feedback on the program periodically, to and try to make adjustments so that the coaches and players continue to support and use the program.

Dan said...

Thanks for the post. I was apart of a FIFA 11+ research study as part of one of my clinical rotations back in undergrad. I was mainly focused at examining compliance rates, and I have to say they weren't great (but not terrible), which was expected. We were able to have clinicians out in the field as often as possible which I think is the best way to ensure compliance, however this is obviously not realistic to do for every practice, game, etc. If the coach saw that we were there to observe, they did the program. This was because they felt obligated. We were able to send a questionnaire at the end of the week asking the coaches to report the number of times that they completed the program, and although they all reported that they were doing at least parts of it each day, we obviously couldn't be 100% certain that they were telling the truth if we weren't there on the days that they said that they were doing it. We also sent out a survey asking for their feedback on the program. The reviews were mixed, some coaches liked it, and others didn’t quite see the point of it (as you mentioned in your post).

Overall, coach buy-in is definitely the most important part about implementing these programs. Educating them is the best way, however no matter what we do and no matter how involved we are as clinicians, in implementing these programs, I really don’t think that we will be able to satisfy every coach 100% of the time. This is unfortunate but reality. Some coaches are just stuck in the way they’ve “always been doing it.”

Nicole Cattano said...

Great points Dan! Thanks for sharing your personal clinical experience with the program.

Was there any approach that you felt the clinicians were most successful with?

I've had the opportunity to habe clinicians run the program every day and there is still varying commitment. They defintely DO it every day - but effort dwindles and resistance sends to grow. Any advice for my personal experience?

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