Evaluation of how different implementation strategies of an injury prevention programme (FIFA 11+) impact team adherence and injury risk in Canadian female youth football players: a cluster-randomized trial

Steffen K, Meeuwisse WH, Romiti M, Kang J, McKay C, Bizzini M, Dvorak J, Finch C, Myklebust G, and Emery CA. Br J Sports Med. 2013; [Epub Ahead of Print].

Take Home Message: Coaches who are well trained to implement injury prevention, warm-up programs are as effective as the
supervision of a physiotherapist at training sessions.

Injury prevention programs typically are multifaceted warm-up programs which focus on neuromuscular recruitment. While many programs exist it is difficult to assess their efficacy due to varying levels of adherence to the injury prevention program. Therefore, Steffen and colleagues completed a cluster-randomized trial to determine if implementation strategies of an effective injury prevention program influenced adherence and injury risk among female youth soccer teams. The authors’ goal was to optimize both team and player adherence to the injury prevention program. A total of 29 football clubs (285 athletes, ages 13-18) were included. The authors’ excluded athletes if they had an injury, systemic disease, or neurological disorder. Teams were randomized into 1 of 3 groups; “unsupervised control group,” “regular, coach focused intervention group,” or “comprehensive, player-focused intervention group.” All groups completed the FIFA 11+ injury prevention program (approximately 20 minutes, 15 exercises). Coaches from the “unsupervised control group” were provided with the details of how to perform the 11+ but no additional details were given. Conversely  coaches in the “coach-focused intervention group” attended a preseason 11+ workshop with the research team and had access to the 11+ material on the website (posters, DVD’s, etc.). In the “comprehensive, player-focused intervention group” a physiotherapist assisted the coach in implementing the 11+ program. The physiotherapist attended training sessions weekly to implement correct technique and progression. Teams implemented the 11+ program over the course of 1 season (April to August) and chose a team designate to be responsible for exposure data (player attendance, number of 11+ sessions, number of 11+ exercises performed, etc.). Team designates also recorded injury exposure and injury severity data. Overall, the “regular, coach focused intervention group,” and “comprehensive, player-focused intervention group” may have had slightly higher team adherence (12% and 18%respectively), when compared with the control group. The injury incidence rate ratios were not different between study groups, but there was a hint that higher adherence may reduce the risk of injury. Further, most injuries were considered to be mild resulting in no more than 7 days before a return to play.

This study presented clinicians with an interesting look at team and player adherence in terms of implementing a
comprehensive neuromuscular warm-up program like the 11+. The data of this study may suggest that a coach workshop, detailing proper technique and succession of the program, can improve team and player adherence. Interestingly, this was no more successful than the regular presence of a physiotherapist at training sessions. This finding is of particular interest and may suggest that coaches, educated in program technique, can be as effective as clinicians when implementing injury prevention, warm-up programs. The key, however, will still ultimately lie in the hands of the clinicians, as they will be the ones educating the coaches.. Therefore, it may be advantageous for clinicians to attend continuing education on how to best communicate and teach injury prevention programs to coaching staffs. Conceivably, cooperation between the clinician and coaching staff could optimize adherence to injury prevention programs, allowing the clinician to focus on other aspects of patient care.
Tell us what you think. Do you try to educate and utilize your coaching staff in the implementation of injury prevention programs? Do you feel comfortable with the level of training they receive and their ability to carry out these programs?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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