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

TLDR: Proper education of coaches during an extensive preseason workshop was more effective in terms of team adherence than an unsupervised delivery of the FIFA 11+ programme to the team.

Abstract: Background Injury prevention programme delivery on adherence and injury risk, specifically involving regular supervisions with coaches and players on programme execution on field, has not been examined. Aim The objective of this cluster-randomised study was to evaluate different delivery methods of an effective injury prevention programme (FIFA 11+) on adherence and injury risk among female youth football teams. Method During the 4-month 2011 football season, coaches and 13-year-old to 18-year-old players from 31 tier 1–3 level teams were introduced to the 11+ through either an unsupervised website (‘control’) or a coachfocused workshop with (‘comprehensive’) and without (‘regular’) additional supervisions by a physiotherapist. Team and player adherence to the 11+, playing exposure, history and injuries were recorded. Results Teams in the comprehensive and regular intervention groups demonstrated adherence to the 11+ programme of 85.6% and 81.3% completion of total possible sessions, compared to 73.5% for teams in the control group. These differences were not statistically significant, after adjustment for cluster by team, age, level and injury history. Compared to players with low adherence, players with high adherence to the 11+ had a 57% lower injury risk (IRR 0.43, 95% CI 0.19 to 1.00). However, adjusting for covariates, this betweengroup difference was not statistically significant (IRR=0.44, 95% CI 0.18 to 1.06). Conclusion Following a coach workshop, coach-led delivery of the FIFA 11+ was equally successful with or without the additional field involvement of a physiotherapist. Proper education of coaches during an extensive preseason workshop was more effective in terms of team adherence than an unsupervised delivery of the 11+ programme to the team. Trial registration ISRCTN67835569.

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Table 3: Adherence among players randomized to the control, and to the regular, coach-focused and comprehensive, player-focused intervention groups. The control group served as reference group. Mean differences in adherence are presented with 95% CI. Negative values for confidence intervals are truncated at 0.

Table 4: Injury risk (injury incidence per 1000 hours with 95% CI) among players randomized to the control, and to regular, coach-focused and comprehensive, player-focused intervention groups, and among players stratified into high, medium and low adherence groups. The control and low adherence groups served as respective reference groups. Crude and adjusted incidence rate ratios (IRR) are presented with 95% CI.

Table 2. Individual player exposure hours, injuries, team and individual adherence to the intervention for players in the control, and in the regular, coach-focused and comprehensive, player-focused intervention groups.

Table 1. Baseline characteristics for players in the control, in the regular, coach-focused, and in the comprehensive, player-focused intervention groups, presented as frequencies (%) and means (95% CI).