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Evaluation of an injury prevention programme (Prep-to-Play) in women and girls playing Australian Football: design of a pragmatic, type III, hybrid implementation-effectiveness, stepped-wedge, cluster randomised controlled trial

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posted on 2023-01-17, 06:00 authored by Brooke PattersonBrooke Patterson, Alex DonaldsonAlex Donaldson, Sallie CowanSallie Cowan, Matthew KingMatthew King, Christian BartonChristian Barton, Steven M McPhail, Martin Hagglund, Nicole M White, Natasha LanninNatasha Lannin, Ilana N Ackerman, Michelle M Dowsey, Karla Hemming, Michael Makdissi, Adam CulvenorAdam Culvenor, Andrea MoslerAndrea Mosler, Andrea BruderAndrea Bruder, Jessica Choong, Nicole Livingstone, Rachel K Elliott, Anja Nikolic, Jane Fitzpatrick, Jamie Crain, Melissa HaberfieldMelissa Haberfield, Eliza RougheadEliza Roughead, Elizabeth Birch, Sarah LampardSarah Lampard, Christian BonelloChristian Bonello, Karina ChilmanKarina Chilman, Kay CrossleyKay Crossley
Introduction Due to the increase in participation and risk of anterior cruciate ligament (ACL) injuries and concussion in women's Australian Football, an injury prevention programme (Prep-to-Play) was codesigned with consumers (eg, coaches, players) and stakeholders (eg, the Australian Football League). The impact of supported and unsupported interventions on the use of Prep-to-Play (primary aim) and injury rates (secondary aim) will be evaluated in women and girls playing community Australian Football. Methods and analysis This stepped-wedge, cluster randomised controlled trial will include ≥140 teams from U16, U18 or senior women's competitions. All 10 geographically separated clusters (each containing ≥14 teams) will start in the control (unsupported) phase and be randomised to one of five dates (or € wedges') during the 2021 or 2022 season to sequentially transition to the intervention (supported Prep-to-Play), until all teams receive the intervention. Prep-to-Play includes four elements: a neuromuscular training warm-up, contact-focussed football skills (eg, tackling), strength exercises and education (eg, technique cues). When transitioning to supported interventions, study physiotherapists will deliver a workshop to coaches and player leaders on how to use Prep-to-Play, attend team training at least two times and provide ongoing support. In the unsupported phase, team will continue usual routines and may freely access available Prep-to-Play resources online (eg, posters and videos about the four elements), but without additional face-to-face support. Outcomes will be evaluated throughout the 2021 and 2022 seasons (∼14 weeks per season). Primary outcome: use of Prep-to-Play will be reported via a team designate (weekly) and an independent observer (five visits over the two seasons) and defined as the team completing 75% of the programme, two-thirds (67%) of the time. Secondary outcomes: injuries will be reported by the team sports trainer and/or players. Injury definition: any injury occurring during a football match or training that results in: (1) being unable to return to the field of play for that match or (2) missing ≥ one match. Outcomes in the supported and unsupported phases will be compared using a generalised linear mixed model adjusting for clustering and time. Due to the type III hybrid implementation-effectiveness design, the study is powered to detect a improvement in use of Prep-to-Play and a reduction in ACL injuries. Ethics and dissemination La Trobe University Ethics Committee (HREC 20488) approved. Coaches provided informed consent to receive the supported intervention and players provided consent to be contacted if they sustained a head or knee injury. Results will be disseminated through partner organisations, peer-reviewed publications and scientific conferences. Trial registration number NCT04856241.


This work is funded by a National Health and Medical Research Council (NHMRC) Partnership Grant (GNT 1193733, 2020--2023). The NHMRC grant includes contributions from partner organisations, including the Australian Football League (AFL), Medibank Better Health Foundation and the Australian Physiotherapy Association (APA) (GNT 1193733, 2020--2023). In--kind support as part of the NHMRC grant (GNT 1193733, 2020--2023) was provided by Sports Medicine Australia (SMA), AFL Victoria and the Australasian College of Sport and Exercise Physicians (ACSEP).


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