A sports-related injury prevention program for Dutch youth volleyball players: Process evaluation alongside a quasi-randomized controlled trial.

OBJECTIVE: This process evaluation aimed to gain insight into the implementation of the VolleyVeilig Youth program by Dutch volleyball clubs within the context of an effectiveness trial. METHODS: We applied the UK Medical Research Council framework for process evaluations and assessed the context, implementation and mechanisms of impact. Trainers participating in the effectiveness trial were asked to complete a questionnaire at the end of the study. A subsample of the trainers based on the self-reported adherence score was invited to participate in an interview accordingly. We used a thematic analysis to present the data. RESULTS: Thirty-one trainers (100%) completed the questionnaire, and seven agreed to participate in an interview. Although adherence gradually decreased over the volleyball season, most trainers reported partially adhere with the program until the end of the study. The main themes included factors associated with the (1) VolleyVeilig Youth program, (2) trainer, (3) players, and (4) volleyball club. CONCLUSION: Although (partial) adherence to the VolleyVeilig Youth program was high in this study, implementation strategies must be developed to target the barriers reported by the trainers before the program can be successfully implemented nationwide in the Netherlands.

Effectiveness of a warm-up programme to reduce injuries in youth volleyball players: a quasi-experiment.

OBJECTIVES: To establish the effectiveness of the 'VolleyVeilig' programme on reducing injury rate, injury burden and injury severity in youth volleyball players. METHODS: We conducted a quasi-experimental prospective study over one season of youth volleyball. After randomisation by competition region, we instructed 31 control teams (236 children, average age 12.58±1.66) to use their usual warm-up routine. The 'VolleyVeilig' programme was provided to 35 intervention teams (282 children, average age 12.90±1.59). This programme had to be used during each warm-up before training sessions and matches. We sent a weekly survey to all coaches, collecting data on each player's volleyball exposure and injuries sustained. Multilevel analyses estimated differences in injury rates and burden between both groups, and we used non-parametric bootstrapping to compare the differences in injury numbers and injury severity. RESULTS: We found an overall reduction in injury rates of 30% for intervention teams (HR 0.72; 95% CI 0.39 to 1.33). Detailed analyses revealed differences for acute (HR 0.58; 95% CI 0.34 to 0.97) and upper extremity injuries (HR 0.41; 95% CI 0.20 to 0.83). Compared with control teams, the intervention teams had a relative injury burden of 0.39 (95% CI 0.30 to 0.52) and a relative injury severity of 0.49 (95% CI 0.03 to 0.95). Only 44% of teams fully adhered to the intervention. CONCLUSION: We established that the 'VolleyVeilig' programme was associated with reduced acute and upper extremity injury rates and lower injury burden and severity in youth volleyball players. While we advise implementation of the programme, programme updates to improve adherence are needed.

Effectiveness of a nationwide intervention to increase helmet use in Dutch skiers and snowboarders: an observational cohort study.

OBJECTIVE: Helmet use in Dutch recreational skiers and snowboarders (DRSS) remains low. This study evaluated the effects of exposure to a nationwide intervention on relevant determinants of helmet use and helmet use in DRSS. METHODS: The intervention mapping protocol was used to develop an in-season intervention programme targeted at adult DRSS. A prospective single-cohort study was conducted to evaluate the impact of intervention exposure on determinants of helmet use (ie, knowledge about head injury risk and preventive measures, risk perception, attitudes to head injury risk and helmet use and intention to helmet use) and self-reported helmet use. A random sample of 363 DRSS from an existing panel participated in this study. Data were collected using online questionnaires before and immediately after the 2010/2011 intervention season. In a separate sample of 363 DRSS, intervention reach was assessed after the 2010/2011 season. RESULTS: Overall, no significant associations were found between intervention exposure and the determinants of helmet use. However, subgroup analyses revealed intervention effects on risk perception and knowledge in specific subpopulations. Intervention exposure had a significant, positive effect on helmet use in DRSS (ß=0.23; 95% CI 0.017 to 0.44). Subgroup analyses revealed that this effect was found in: (1) skiers, (2) female DRSS, (3) young skiers and (4) intermediate skiers. Overall, intervention reach was 28.1%, with differences found between skiers and snowboarders. CONCLUSIONS: Exposure to a nationwide intervention programme was associated with increased self-reported helmet use in DRSS. Differences were found in intervention effectiveness and reach between subpopulations. These differences must be taken into account when developing and evaluating future interventions.

Implementation of an app-based neuromuscular training programme to prevent ankle sprains: a process evaluation using the RE-AIM Framework.

BACKGROUND/AIM: The contemporary electronic media is regarded as a practical tool in the dissemination of preventive measures and interventions. For this purpose an App (free of charge) was developed including an efficacious programme for the prevention of ankle sprain recurrences. This study evaluated the implementation effectiveness of this 'Versterk je Enkel' App. METHODS: The App was evaluated within its practical context using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Framework. The launch of the App was accompanied by a press release, website banners, as well as online and offline advertisements. Data for the evaluation of the App were objectively registered through Google analytics. Data were obtained in February 2013 based on 25,781 users resulting in follow-ups of 18 months (iOS version) and 15 months (Android version), respectively. Users questionnaires provided a qualitative view of the objectively assessed measures (n=82) to gain insight into the demographics of users, reasons to download, user experience and how the information was used. RESULTS: The App reached only 2.6% of the projected target population. User ratings for the App's relevancy, clarity, usefulness, appeal, information and reliability were high. App usage indicates that compliance with the embedded programme was low. CONCLUSIONS: Although the App was well received by the users, targeted efforts are required to ensure proper uptake and usage of the App by the target population. This also holds true for eHealth and mHealth efforts aimed at athlete care and injury prevention in general.

The implementation effectiveness of the 'Strengthen your ankle' smartphone application for the prevention of ankle sprains: design of a randomized controlled trial.

BACKGROUND: Ankle sprains continue to pose a significant burden to the individual athlete, as well as to society as a whole. However, despite ankle sprains being the single most common sports injury and despite an active approach by various Dutch organisations in implementing preventive measures, large-scale community uptake of these preventive measures, and thus actual prevention of ankle sprains, is lagging well behind. In an attempt to bridge this implementation gap, the Dutch Consumer Safety Institute VeiligheidNL developed a freely available interactive App ('Strenghten your ankle' translated in Dutch as: 'Versterk je enkel; available for iOS and Android) that contains - next to general advice on bracing and taping - a proven cost-effective neuromuscular program. The 'Strengthen your ankle' App has not been evaluated against the 'regular' prevention approach in which the neuromuscular program is advocated through written material. The aim of the current project is to evaluate the implementation value of the 'Strengthen your ankle' App as compared to the usual practice of providing injured athletes with written materials. In addition, as a secondary outcome measure, the cost-effectiveness will be assessed against usual practice. METHODS/DESIGN: The proposed study will be a randomised controlled trial. After stratification for medical caregiver, athletes will be randomised to two study groups. One group will receive a standardized eight-week proprioceptive training program that has proven to be cost-effective to prevent recurrent ankle injuries, consisting of a balance board (machU/ MSG Europe BVBA), and a traditional instructional booklet. The other group will receive the same exercise program and balance board. However, for this group the instructional booklet is exchanged by the interactive 'Strengthen your ankle' App. DISCUSSION: This trial is the first randomized controlled trial to study the implementation effectiveness of an App for proprioceptive balance board training program in comparison to a traditional printed instruction booklet, with the recurrence of ankle sprains among athletes as study outcome. Results of this study could possibly lead to changes in practical guidelines on the treatment of ankle sprains and in the use of mobile applications for injury prevention. Results will become available in 2014. TRIAL REGISTRATION: The Netherlands National Trial Register NTR4027. The NTR is part of the WHO Primary Registries.

Sports-Related Health Problems in Para-Sports: A Systematic Review With Quality Assessment.

CONTEXT: Participation in sports is associated with a risk of sports-related health problems. For athletes with an impairment, sports-related health problems further burden an already restricted lifestyle, underlining the importance of prevention strategies in para-sports. OBJECTIVE: To provide a comprehensive overview with quality assessment of the literature on sports-related health problems, their etiology, and available preventive measures in para-sports following the steps of the Sequence of Prevention. DATA SOURCES: A literature search (in PubMed, Embase, SPORTDiscus, CINAHL and the Cochrane Library) was performed up to December 8, 2021, in collaboration with a medical information specialist. STUDY SELECTION: The search yielded 3006 articles, of which 64 met all inclusion criteria. STUDY DESIGN: Systematic review with quality assessment. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Two independent researchers carried out the screening process and quality assessment. One researcher extracted data, and the Sequence of Prevention categorized evidence. RESULTS: A total of 64 studies were included, of which 61 reported on the magnitude and risk factors of sports-related health problems, while only 3 reported on the effectiveness of preventive measures. Of these, 30 studies were of high quality. Most studies (84%) included elite-level athletes. The reported injury incidence varied widely between sports (0-91 per 1000 athlete days) and impairment categories (1-50 per 1000 athlete days). The same applies to illness incidence with regard to different sports (3-49 per 1000 athlete days) and impairment categories (6-14 per 1000 athlete days). CONCLUSION: This review shows the current vast range of reported sport-related health problems in para-sports. There is limited evidence concerning the severity of these sports-related health problems and inconclusive evidence on the risk factors. Lastly, the evidence regarding the development and effectiveness of preventive measures for para-athletes is sparse.

Systematic development of an injury prevention programme for judo athletes: the IPPON intervention.

OBJECTIVES: To systematically develop an injury prevention programme in judo and test its feasibility: Injury Prevention and Performance Optimization Netherlands (IPPON) intervention. METHODS: We used the five-step Knowledge Transfer Scheme (KTS) guidelines. In the first two steps, we described the injury problem in judo and showed possibilities to reduce the injury rates. In the third step, the Knowledge Transfer Group (KTG) translated this information into actions in judo practice. Expert meetings and practical sessions were held. In the fourth step, we developed the injury prevention programme and evaluated its feasibility in judo practice in a pilot study. As a final step, we will evaluate the injury prevention programme on its effectiveness to reduce injuries. RESULTS: In the first two steps, information collected indicated the need for reducing judo injuries due to high incidence rates. Injury prevention programmes have shown to be effective in reducing injuries in other sports. For judo, no injury prevention programme has yet been systematically developed. In the third step, the KTG reached consensus about the content: a trainer-based warm-up programme with dynamic exercises focusing on the shoulder, knee and ankle. In the fourth step, the intervention was developed. All exercises were approved in the pilot study. Based on the pilot study's results, the IPPON intervention was extended and has become suitable for the final step. CONCLUSION: We developed the IPPON intervention using the systematic guidance of the KTS. This trainer-based programme focuses on the prevention of shoulder, knee and ankle injuries in judo and consists of 36 exercises classified in three categories: (1) flexibility and agility, (2) balance and coordination and (3) strength and stability. The effectiveness and feasibility of the intervention on injury reduction among judo athletes will be conducted in a randomised controlled trial.

The relationship between the use of running applications and running-related injuries.

OBJECTIVES: Training errors are suggested to be an important cause of running-related injuries (RRIs). As most runners train individually, digital coaching using running applications is becoming increasingly popular. However, the quality of these applications is unknown. The aim of the present cross-sectional study was to evaluate the relationship between the use of running applications and RRIs. METHODS: An online questionnaire was used to collect data on running activities of 1,029 runners, their injuries, and the association between the use of running applications and RRIs. Parametric and non-parametric tests for independent samples were used to analyze the baseline characteristics of the participants. Univariate logistic regression analyses and multiple logistic regression analysis (Enter procedure) were used to determine the association between the use of running applications and RRIs, while adjusting for confounding effects. RESULTS: Of all the 1,029 runners included in this study, 31% (n = 319) got injured and 44% (n = 453) used an application in the previous 12 months. Multiple logistic regression analysis showed no statistically significant association between the use of running applications and RRIs. CONCLUSIONS: Based on this study, the use of running applications was not associated with an increased or decreased risk of RRIs. Running applications can be used by runners without any further implications to guide their training activities. However, runners should be aware that the use of predefined running schemes is associated with RRI risk. It is important that following a previous RRI, athletes should be fully recovered before resuming their training sessions as hindrance from a previous RRI is highly associated with the occurrence of a new RRI.

Users' Perspectives, Opportunities, and Barriers of the Strengthen Your Ankle App for Evidence-Based Ankle Sprain Prevention: Mixed-Methods Process Evaluation for a Randomized Controlled Trial.

BACKGROUND: The "Strengthen Your Ankle" neuromuscular training program has been thoroughly studied over the past 8 years. This process evaluation is a part of a randomized controlled trial that examined both the short- and long-term effectiveness of this particular program. Although it was shown previously that the program, available both in a printed booklet and as a mobile app, is able to effectively reduce the number of recurrent ankle sprains, participants' compliance with the program is an ongoing challenge. OBJECTIVE: This process evaluation explored participants' opinions regarding both the methods of delivery, using RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) Framework to identify barriers and challenges to program compliance. Although Reach, Effectiveness, and Adaptation were the focus of a previous study, this paper focuses on the implementation and maintenance phases. METHODS: Semistructured interviews and online questionnaires were analyzed using qualitative content analysis. Fisher exact, chi-square, and t tests assessed between-group differences in quantitative survey responses. Interviews were assessed by thematic analysis to identify key themes. RESULTS: While there were no significant differences in the perceived simplicity, usefulness, and liking of the exercise during the 8 weeks of the neuromuscular training program, semistructured interviews showed that 14 of 16 participants agreed that an app would be of additional benefits over a booklet. After the 12-month follow-up, when asked how they evaluated the overall use of the app or the booklet, the users of the app gave a mean score of 7.7 (SD 0.99) versus a mean score 7.1 (SD 1.23) for the users of the booklet. This difference in mean score was significant (P=.006). CONCLUSIONS: Although both the app and booklet showed a high user satisfaction, the users of the app were significantly more satisfied. Semistructured questionnaires allowed users to address issues they would like to improve in future updates. Including a possibility for feedback and postponement of exercises, an explanation of the use of specific exercises and possibly music were identified as features that might further improve the contentment of the program, probably leading to increased compliance. TRIAL REGISTRATION: Netherlands Trial Register NTR4027; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4027 (Archived by Webcite at http://www.webcitation.org/70MTo9dMV).

Intervention Strategies Used in Sport Injury Prevention Studies: A Systematic Review Identifying Studies Applying the Haddon Matrix.

BACKGROUND: Prevention of sport injuries is crucial to maximise the health and societal benefits of a physically active lifestyle. To strengthen the translation and implementation of the available evidence base on effective preventive measures, a range of potentially relevant strategies should be considered. OBJECTIVE: Our aim was to identify and categorise intervention strategies for the prevention of acute sport injuries evaluated in the scientific literature, applying the Haddon matrix, and identify potential knowledge gaps. METHODS: Five electronic databases were searched (PubMed, EMBASE, SPORTDiscus, CINAHL, Cochrane) for studies that evaluated the effect of interventions on the occurrence of acute sport injuries. Studies were required to include a control group/condition, prospective data collection, and a quantitative injury outcome measure. RESULTS: A total of 155 studies were included, mostly randomised controlled trials (43%). The majority of studies (55%) focussed on strategies requiring a behavioural change on the part of athletes. Studies predominantly evaluated the preventive effect of various training programmes targeted at the 'pre-event' phase (n = 73) and the use of equipment to avoid injury in the 'event phase' (n = 29). A limited number of studies evaluated the preventive effect of strategies geared at rules and regulations (n = 14), and contextual modifications (n = 18). Studies specifically aimed at preventing re-injuries were a minority (n = 8), and were mostly related to ankle sprains (n = 5). CONCLUSIONS: Valuable insight into the extent of the evidence base of sport injury prevention studies was obtained for 20 potential intervention strategies. This approach can be used to monitor potential gaps in the knowledge base on sport injury prevention.

Compliance with Sport Injury Prevention Interventions in Randomised Controlled Trials: A Systematic Review.

INTRODUCTION: Sport injury prevention studies vary in the way compliance with an intervention is defined, measured and adjusted for. OBJECTIVE: The objective of this systematic review was to assess the extent to which sport injury prevention randomised controlled trials (RCTs) have defined, measured and adjusted results for compliance with an injury prevention intervention. METHODS: An electronic search was performed in MEDLINE, PubMed, the Cochrane Center of Controlled Trials, CINAHL (Cumulative Index to Nursing and Allied Health Literature), PEDro (Physiotherapy Evidence Database) and SPORTDiscus. English RCTs, quasi-RCTs and cluster-RCTs were considered eligible. Trials that involved physically active individuals or examined the effects of an intervention aimed at the prevention of sport- or physical activity-related injuries were included. RESULTS: Of the total of 100 studies included, 71.6 % mentioned compliance or a related term, 68.8 % provided details on compliance measurement and 51.4 % provided compliance data. Only 19.3 % analysed the effect of compliance rates on study outcomes. While studies used heterogeneous methods, pooled effects could not be presented. CONCLUSIONS: Studies that account for compliance demonstrated that compliance significant affects study outcomes. The way compliance is dealt with in preventions studies is subject to a large degree of heterogeneity. Valid and reliable tools to measure and report compliance are needed and should be matched to a uniform definition of compliance.

Shinguards effective in preventing lower leg injuries in football: Population-based trend analyses over 25 years.

OBJECTIVES: The majority of football injuries are caused by trauma to the lower extremities. Shinguards are considered an important measure in preventing lower leg impact abrasions, contusions and fractures. Given these benefits, Fédération Internationale de Football Association introduced the shinguard law in 1990, which made wearing shinguards during matches mandatory. This study evaluated the effect of the introduction of the shinguard law for amateur players in the Netherlands in the 1999/2000-football season on the incidence of lower leg injuries. DESIGN: Time trend analyses on injury data covering 25 years of continuous registration (1986-2010). METHODS: Data were retrieved from a system that records all emergency department treatments in a random, representative sample of Dutch hospitals. All injuries sustained in football by patients aged 6-65 years were included, except for injuries of the Achilles tendon and Weber fractures. Time trends were analysed with multiple regression analyses; a model was fitted consisting of multiple straight lines, each representing a 5-year period. RESULTS: Patients were predominantly males (92%) and treated for fractures (48%) or abrasions/contusions (52%) to the lower leg. The incidence of lower leg football injuries decreased significantly following the introduction of the shinguard law (1996-2000: -20%; 2001-2005: -25%), whereas the incidence of all other football injuries did not. This effect was more prominent at weekends/match days. No gender differences were found. CONCLUSIONS: The results significantly show a preventive effect of the shinguard law underlining the relevance of rule changes as a preventive measure and wearing shinguards during both matches and training sessions.

Epidemiological data and ranking home and leisure accidents for priority-setting.

OBJECTIVE: To determine how to use the multitude of available epidemiological data to rank accidents for prioritisation of prevention. METHODS: A stepwise method to rank accidents for priority-setting at any time is proposed. The first step is to determine the overall objectives of injury prevention. Based on these objectives, the relevant epidemiological criteria are determined. These criteria need to be weighed by experts in such a way that these weights can be used for every new cycle of priority-setting. Thus, every time the method is applied: first, the relevant types of accidents are identified; second, the epidemiological criteria are determined per type of accident; and third, the types of accidents are ranked by means of standardised weights per criterion. The proposed indirect method is illustrated by an empirical example. The results were compared with a direct method, i.e. ranking by an expert panel. RESULTS: In the pilot, we ranked four age groups of victims of a home and leisure accident: 0-4, 4-19 and 20-54 years of age, and victims aged 55 years or older. The resulting rankings differ largely per application; number one are victims older than 55 years or those of 20-54 years. CONCLUSIONS: The proposed method enables a structured, transparent way to set priorities for home and leisure accidents. It is a promising method, although further development is clearly necessary, based on the actual application of the model.