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 assist
ed the coach in implementing the 11+ program. The physiotherapist attended training sessions weekly
to implement correct technique and progression. Teams impleme
nted
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+ session
s, 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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Steffen K, Meeuwisse WH, Romiti M, Kang J, McKay C, Bizzini M, Dvorak J, Finch C, Myklebust G, & Emery CA (2013). 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-randomised trial. British Journal of Sports Medicine PMID: 23486935