Search

Supplemental material, sj-pdf-2-sph-10.1177_19417381221109224 for The FIFA 11+ Kids Injury Prevention Program Reduces Injury Rates Among Male Children Soccer Players: A Clustered Randomized Controlled Trial by Wesam Saleh A. Al Attar, Mario Bizzini, Hosam Alzahrani, Saud Alarifi, Hussain Ghulam, Mashaer Alyami, Msaad Alzhrani and Ross H. Sanders in Sports Health: A Multidisciplinary Approach

Objective To define a plan for evaluating the feasibility of a hip/groin injury prevention program for ice hockey teams in preparation for a prospective cluster, randomized controlled trial. Background Ice hockey players are at high risk of sustaining traumatic and overuse injuries, especially around the hip/groin region. Muscle weakness surrounding the hip joint has been identified as a risk factor for groin-related pain. However, injury prevention research in ice hockey is scarce. Only one previous investigation showed that an exercise prevention program significantly reduced the incidence of adductor muscle strains in professional ice hockey players. The feasibility of a hip/groin injury prevention program applied to one youth ice hockey team during a preparatory phase and consecutive season needs to be evaluated. Design A cluster-randomized feasibility study protocol. Methods Participants will be cluster randomized to either the intervention or control group. Feasibility will be based on the recruitment and dropout rates, use and adherence to the intervention, responsiveness and number of adverse events. Intervention The hip/groin injury prevention program comprisesthe Copenhagen adduction exercise and ice hockey-specific functional strength and balance exercises. Each player will also perform individual strength exercises for each hip muscle group in the case of an identified hip muscle strength deficit. Discussion High participation and low dropout rates, high program use and adherence as well as high responsiveness of players and staff members are expected to be achieved. Biases, e.g. contamination, injury reporting, that may occur will be addressed to minimize their risk when evaluated on a larger scale.

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.

ObjectiveTo report the effectiveness of physiotherapist-led interventions in improving pain and function in young and middle-aged adults with hip-related pain.DesignSystematic review and meta-analysis.Data sourcesA comprehensive, reproducible search strategy was performed on five databases in May 2019. Reference lists and grey literature were also searched.Eligibility criteria for selecting studiesPopulation: people aged ≥18 years with hip-related pain (with or without a diagnosis of femoroacetabular impingement syndrome). Intervention(s): physiotherapist-led interventions for hip pain. Comparators: sham treatment, no treatment or other treatment (eg, hip arthroscopic surgery). Outcomes: primary outcomes included patient-reported hip pain and function. Secondary outcomes included physical function measures.Results1722 papers were identified. After exclusion criteria were applied, 14 studies were included for analysis. They had varied risk of bias. There were no full-scale placebo-controlled randomised controlled trials (RCTs) of physiotherapist-led treatment. Pooled effects ranged from moderate effects (0.67 (95% CI 0.07 to 1.26)) favouring physiotherapist-led intervention over no treatment post-arthroscopy, to weak effects (−0.32 (95% CI 0.57 to 0.07)) favouring hip arthroscopy over physiotherapist-led treatment.ConclusionPhysiotherapist-led interventions might improve pain and function in young and middle-aged adults with hip-related pain, however full-scale high-quality RCT studies are required.PROSPERO registration numberCRD42018089088.

Objective Vertigo, dizziness and visual problems are among the main symptoms of a prolong course after concussion. Adequate diagnostic tools are rare. The computerized sensory organization test (SOT) differentiates the sensory integration between somatosensory, vision, vestibular and visual preference. This analysis may help to create an individual rehabilitation program and observe the progress. Design Case series. Setting Rehabilitation center. Participants Among 31 post-injury tested athletes with a diagnosed concussion 5 male professional players completed a follow-up test by the end of April 2016. Interventions: 5 players performed a post-injury baseline on the computerized dynamic posturograph (Equitest) and repeated the test as follow-up after personalized vestibulo-oculomotor therapy and improvement of symptoms during the rehabilitation process. Outcome measures Outcome measures were total score (calculated by 6 SOT conditions) and identification of the integrational deficits (calculated by results of sensory analysis). Both values serve to guide and monitor the individual rehabilitation. Main results At post-injury baseline a deficient total score and vestibular impairment was verified in all 5 athletes. After specific individualized vestibulo-oculomotor therapy and a significant reduction of symptoms the follow-up test demonstrated improvement in total score (22% ± 10% SD) to a point where entering intensive training (return to play protocol stage 3) was recommended. Regarding the vestibular system patients improved their score 57% ± 20% SD. Conclusions The computerized SOT can be a useful tool to identify specific sensory deficits and to help specify post-injury therapy and observe the individual rehabilitation process regarding the return to play protocol. Further research is required. Competing interests None.

Objective Apart from headache dizziness, vertigo or visual problems are common symptoms after a head trauma. Making an adequate diagnose of the symptoms remains challenging and only a few laboratory tests exist. The computerised sensory organisation test (SOT) differentiates the sensory integration between somatosensory, vision, vestibular and visual preference and therefore helps to objectify symptoms. Design consecutive case series. Setting rehabilitation centre. Participants 29 consecutive post injury symptomatic and asymptomatic athletes with a diagnosed concussion (n=24) or combined injury (concussion plus commotio/contusio labyrinthi (n=5)). Interventions All athletes performed a post injury SOT on the computerised dynamic posturograph (Smart Equitest, 6 conditions). The sensory scores (somatosensory, vestibular and vision) were compared to the normative data (n=112). Outcome measures The main aim was to determine the sensory source of post-concussive symptoms by application of the sensory analysis after performance of the SOT. Main results Half of the athletes (n=15) achieved a normal sensory score, the other half (n=14) were below average (−9.4%) in visual (n=2), vestibular system (n=5) or both (n=7). In these athletes an individual specific vestibulo-oculomotor therapy was recommended. Conclusions The computerised SOT is a useful tool to determine the specific sensory deficits in patients with or without symptoms after a head trauma. Competing interests None.

Objectives: To examine the efficacy of the FIFA 11+ injury prevention program in Men’s NCAA collegiate soccer. Methods: A prospective randomized controlled trial was conducted in Division I and Division II NCAA men’s soccer teams during the Fall, 2012 season. Every athletic director, head soccer coach and head athletic trainer from each Divion I and Division II member institution with a men’s collegiate soccer program (N=411) was contacted via a formal letter, email and phone call. Sixty-one member institutions consented to participate. Human ethics review board approval was obtained through Quorum IRB, Seattle, WA, USA. After randomization was completed, the intervention group received an instructional DVD, teaching manual and exercise placards thoroughly describing the FIFA 11+ intervention. An injury surveillance database was utilized (HealtheAthleteTM, Overland Park, Kansas). Every athletic exposure, injury incurred, utilization of the 11+ program and compliance data was entered weekly. Sixty-one institutions completed the study: 34 control institutions (N=850 athletes) and 27 intervention institutions (N=675 athletes). The FIFA 11+ program served as the intervention program over the course of one collegiate season. The warm-up was utilized two to three times per week for the duration of the season. Results: In the intervention Group (IG), 285 Injuries were reported (mean=10.56 injuries/team+/-3.64) compared to 665 Injuries (mean=20.15 injuries +/- 11.01) in the control group (CG). The number of athletic exposures was 35,226 (Games: 10,935 AE, Practice: 24,291 AE) for the IG and 44,212 (Games: 13,624 AE, Practice: 30,588 AE) in the CG). The incidence rate (IR) was 8.09/1,000 AE (95% CI) in the IG compared to 15.04/1000 AE (CI=95%) in the CG (p=0.00117). Total days missed due to injury was 2824 (mean=9.94) in the IG compared to 8776 days (mean =13.20) in the CG. Conclusion: The FIFA 11+ was shown to significantly reduce injury rates and time loss in the competitive male collegiate soccer player in a statistically significant manner. There was a significant reduction in ACL injuries, hamstring injuries and ankle sprains in the intervention group compared to the control group. A biomechanical analysis has been planned in order to fully understand the neuromuscular changes imparted onto the participating athlete by the FIFA 11+ program.