prevention programs are effective in reducing anterior cruciate ligament injury
risk in female athletes: a number-needed-to-treat analysis.

Pfile KR
and Curioz B.
Scand J Med Sci Sports. 2017. [Epub Ahead of Print].

Take Home Message: Coach-led anterior cruciate ligament (ACL)
prevention programs were as effective as ACL prevention programs led by both
coaches and clinicians.

The efficacy of lower extremity prevention programs for
young athletes is widely documented. However, we know little about the impact
of the professional who implements a program. Many researchers pair clinicians
and coaches together to deliver a program. If a coach alone is just as
effective without a clinician then this could greatly improve the cost and
feasibility of an injury prevention program. Therefore, Pfile and colleagues
completed a systematic review and meta-analysis to assess whether a coach-lead
program or a mixed leadership group (coaches and clinicians) is more effective
at implementing an ACL injury prevention program. The authors completed a
comprehensive literature search and screened articles for inclusion. They included
articles if they were published in English, used both a preventative training
program and control group, included female participants, described who led the
training program, and reported ACL injury incidents and exposure data. The
authors included 11 articles in the final analysis and evaluated the articles using
PEDro scale
The quality of each article ranged from 2 to 7 points with a 10-point maximum. Five
of the 11 articles were cluster randomized trials. Overall, the authors
revealed that both coach-led and mixed leadership groups implemented a ACL
injury prevention program effectively. The number of athletes needed to treat
for benefit were ~120 in the mixed leadership programs and ~133 athletes in the
coach-led programs.

Overall, the results of this study may interest clinicians
because coach-led programs may be as effective as a mixed group led ACL injury
prevention program. Hence, members of the coaching staff may be able to
effectively administer an ACL prevention program. This could be especially
helpful for clinicians with a large number of athletes to treat or those with
limited time to supervise these programs. Importantly, all coaches that led
these programs received some education/training on how to deliver these
programs. Clinician should help ensure coaches receive adequate training before
they administer these programs. It may also be beneficial to periodically
monitor the program to ensure it is being administered correctly and
communicate openly and clearly with coaches when adjustments to the program
need to be made. It should also be noted though that this systematic review
included nonrandomized studies and failed to find any randomized trials that
directly compared coach-led vs mixed-leadership programs. Until more research
can be completed, clinicians may consider having coaches implement an ACL
prevention program after the coaches are trained to administer these programs.

for Discussion
: In your current position, do you administer ACL prevention
programs? Would you consider having a coach deliver injury prevention programs
for you?
Written by: Kyle Harris
Reviewed by:  Jeffrey Driban

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