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. 2019 Apr;53(8):487-492.
doi: 10.1136/bjsports-2018-099488. Epub 2018 Sep 14.

Controlled ecological evaluation of an implemented exercise-training programme to prevent lower limb injuries in sport: population-level trends in hospital-treated injuries

Caroline F Finch  1   2 , Shannon E Gray  3 , Muhammad Akram  2   4 , Alex Donaldson  2   5 , David G Lloyd  6   7 , Jill L Cook  2   8
Affiliations

Controlled ecological evaluation of an implemented exercise-training programme to prevent lower limb injuries in sport: population-level trends in hospital-treated injuries

Caroline F Finch et al. Br J Sports Med. 2019 Apr.

Abstract

Objective: Exercise-training programmes have reduced lower limb injuries in trials, but their population-level effectiveness has not been reported in implementation trials. This study aimed to demonstrate that routinely collected hospital data can be used to evaluate population-level programme effectiveness.

Method: A controlled ecological design was used to evaluate the effect of FootyFirst, an exercise-training programme, on the number of hospital-treated lower limb injuries sustained by males aged 16-50 years while participating in community-level Australian Football. FootyFirst was implemented with 'support' (FootyFirst+S) or 'without support' (FootyFirst+NS) in different geographic regions of Victoria, Australia: 22 clubs in region 1: FootyFirst+S in 2012/2013; 25 clubs in region 2: FootyFirst+NS in 2012/2013; 31 clubs region 3: control in 2012, FootyFirst+S in 2013. Interrupted time-series analysis compared injury counts across regions and against trends in the rest of Victoria.

Results: After 1 year of FootyFirst+S, there was a non-statistically significant decline in the number of lower limb injuries in region 1 (2012) and region 3 (2013); this was not maintained after 2 years in region 1. Compared with before FootyFirst in 2006-2011, injury count changes at the end of 2013 were: region 1: 20.0% reduction (after 2 years support); region 2: 21.5% increase (after 2 years without support); region 3: 21.8% increase (after first year no programme, second year programme with support); rest of Victoria: 12.6% increase.

Conclusion: Ecological analyses using routinely collected hospital data show promise as the basis of population-level programme evaluation. The implementation and sustainability of sports injury prevention programmes at the population-level remains challenging.

Keywords: exercise training; implementation; injury prevention.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Geographic location of the three FootyFirst regions in Victoria, Australia.
Figure 2
Figure 2
Trends in the monthly numbers of hospital-treated AF-related lower limb injury combined over time in each of the three FootyFirst regions and the rest of Victoria. In each component, the broken line is the fitted trend; vertical grey lines indicate the points at which FootyFirst was implemented in both 2012 and 2013. Region 1: FootyFirst+with ‘support’ (S) in both 2012 and 2013; region 2: FootyFirst+without ‘support’ (NS) in both 2012 and 2013; region 3: no FootyFirst in 2012, FootyFirst+S in 2013; rest of Victoria: no FootyFirst in either year.
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