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ObjectiveTo evaluate the effectiveness of a junior high school-based sports injury prevention programme to reduce injuries through neuromuscular training (NMT).MethodsThis was a cluster randomised controlled trial. Students were recruited from 12 Calgary junior high schools (2014–2017). iSPRINT is a 15 min NMT warm-up including aerobic, agility, strength and balance exercises. Following a workshop, teachers delivered a 12-week iSPRINT NMT (six schools) or a standard-of-practice warm-up (six schools) in physical education classes. The definition of all recorded injuries included injuries that resulted in participants being unable to complete a sport and recreation (S&R) session, lost time from sport and/or seek medical attention. Incidence rate ratios (IRRs) were estimated based on multiple multilevel Poisson regression analyses (adjusting for sex (considering effect modification) and previous injury, offset by S&R participation hours, and school-level and class-level random effects were examined) for intent-to-treat analyses.Results1067 students (aged 11–16) were recruited across 12 schools (6 intervention schools (22 classes), 6 control schools (27 classes); 53.7% female, 46.3% male). The iSPRINT programme was protective of all recorded S&R injuries for girls (IRR=0.543, 95% CI 0.295 to 0.998), but not for boys (IRR=0.866, 95% CI 0.425 to 1.766). The iSPRINT programme was also protective of each of lower extremity injuries (IRR=0.357, 95% CI 0.159 to 0.799) and medical attention injuries (IRR=0.289, 95% CI 0.135 to 0.619) for girls, but not for boys (IRR=1.055, 95% CI 0.404 to 2.753 and IRR=0.639, 95% CI 0.266 to 1.532, respectively).ConclusionThe iSPRINT NMT warm-up was effective in preventing each of all recorded injuries, lower extremity injuries and medically treated S&R injuries in female junior high school students.Trial registration numberNCT03312504

ObjectivesMoving innovations into healthcare organisations to increase positive health outcomes remains a significant challenge. Even when knowledge and tools are adopted, they often fail to become integrated into the long-term routines of organisations. The objective of this study was to identify factors and processes influencing the sustainability of innovations in cancer survivorship care.DesignQualitative study using semistructured, in-depth interviews, informed by grounded theory. Data were collected and analysed concurrently using constant comparative analysis.Setting25 cancer survivorship innovations based in six Canadian provinces.ParticipantsTwenty-seven implementation leaders and relevant staff from across Canada involved in the implementation of innovations in cancer survivorship.ResultsThe findings were categorised according to determinants, processes and implementation outcomes, and whether a factor was necessary to sustainability, or important but not necessary. Seven determinants, six processes and three implementation outcomes were perceived to influence sustainability. The necessary determinants were (1) management support; (2) organisational and system-level priorities; and (3) key people and expertise. Necessary processes were (4) innovation adaptation; (5) stakeholder engagement; and (6) ongoing education and training. The only necessary implementation outcome was (7) widespread staff and organisational buy-in for the innovation.ConclusionsFactors influencing the sustainability of cancer survivorship innovations exist across multiple levels of the health system and are often interdependent. Study findings may be used by implementation teams to plan for sustainability from the beginning of innovation adoption initiatives.

Background Bicycling is a popular means of recreation and transportation for children; however, it is a leading cause of recreational injury. Bicycle skill development and safety education are important methods of bicycle injury prevention. Objective To determine the effectiveness of bicycle skills training programmes in reducing bicycle-related injuries in children and youth. Methods Sixteen databases were systematically searched to include studies involving children less than 19 years of age who participated in interventions that targeted bicycle skills and safety education. Outcome measures included injury, behaviour, knowledge and attitudes. Data extraction included study characteristics, intervention and outcomes. Quality of evidence was assessed using the Downs and Black criteria. Results Twenty-five studies, including both observational (ie, case–control) and experimental (ie, randomised controlled trials) designs met the inclusion criteria. Overall, there was no statistically significant intervention effect on measures of injury. Eight of 16 studies measuring knowledge reported significant knowledge gains as a result of the intervention. Of 13 studies evaluating behavioural and attitude changes, five reported significant improvement. There was no significant difference in quality index scores between studies that showed an improvement in knowledge or behaviour (61%, 95% CI 49% to 74%) and studies that did not (57%, 95% CI 48% to 66%). Conclusions There is a paucity of high-quality research in the area of bicycle skills training programmes. Educational and skills training bicycling programmes may increase knowledge of cycling safety, but this does not seem to translate into a decrease in injury rate, or improved bicycle handling ability and attitudes.

Background Educational resources are important tools in the implementation of sport injury prevention strategies to help foster uptake of information in a community setting; however, there is limited information on how these tools are developed. Objective To develop two injury prevention educational tools targeting children and adolescents for evaluation in school and community settings. Design Qualitative. Setting Schools and ski/snowboard facilities in Calgary, Canada. Participants Key informants, including: 1) Community stakeholders from school and ski/snowboard settings, 2) Students ages 9–14 years, and 3) Ski/snowboard instructors, safety patrols and physical education (PE) specialists. Interventions Semi-structured focus groups and surveys were conducted with key stakeholders to explore pre-understandings, relevant content, delivery methods, and format of the tools. Consultations with community partners, PE specialists and ski/snowboard instructors and patrols helped further inform content and format during the development process. Main Outcome Measurements Videos and posters were developed based on feedback and discussions with key informants. These tools were designed as educational resources for teacher and student evaluation in two injury prevention studies. Results Videos were the main tools developed for the school-based delivery; including content about a neuromuscular training program and ski/snowboard safety strategies targeting injury prevention in youth sport. Focus group participants and informants emphasized the importance of understanding the target audience and adapting content and delivery approaches that increase the likelihood of successful uptake of key messages. This included communicating information in a clear and concise manner and utilizing visual and auditory cues to accommodate multiple learning styles. A health behaviour framework (i.e., Health Action Process Approach) was used to inform tool development. Conclusions Engaging informants supported the development of sport injury prevention educational tools. These tools are being utilized in studies evaluating their effectiveness in increasing knowledge, changing behaviour and reducing the risk of sport-related injury in school and community settings.

Background Obesity, defined as an accumulation of excessive fat mass that impairs health, is associated with lower levels of neuromuscular control including balance and coordination, which may place youth with higher adiposity at greater risk for injury during sport participation. On the opposite end of the spectrum, excessively low fat mass can also pose an injury risk. Objective To determine if adiposity is a risk factor for sport injury in children and adolescents. Design Systematic Review. Methods Ten electronic databases were systematically searched using key words and Medical Sub-Heading terms. Studies selected included: English language; original data; analytic design; adiposity measurement by age- and sex-adjusted body mass index (BMI) or body fat using imaging, impedance or predictive methods and; children, adolescents and young adults ≤20 years who sustained a musculoskeletal injury during sport or recreation participation that resulted in medical attention or time loss from sport or activities. PRISMA guidelines were followed and studies were assessed by two independent raters. Level of evidence was assessed using the Oxford Centre of Evidence-Based Medicine model. Results Of 8029 potentially relevant records, 44 were included in the final review. 75% of these studies were of prospective cohort design (level 2b evidence). Twenty-one studies concluded that a BMI rating of overweight/obese is a significant risk factor for injury; the majority (12/21) of these studies assessed lower extremity injury (e.g. ankle sprain and medial tibial stress syndrome). Nineteen studies showed no association between anthropometric measurement and injury; the majority (14/19) assessed all sport injury. Finally, a BMI rating of underweight (4 studies) was more commonly associated with risk of stress fracture. Conclusions There is consistent level 2b evidence that a rating of overweight/obesity is associated with lower extremity injury. Anthropometric risk of injury appears to be dependent on type and site of injury in youth sport.

Background Dangerous drop-off of student passengers and pedestrian behaviours near schools have not been well described despite the potential for pedestrian motor vehicle collisions (PMVC). Safe environments are required for children around schools. Passenger drop-off and child pedestrian behaviours are described by occurrence of child PMVC and built environment (BE) features in Toronto, Canada. Methods Dangerous passenger drop-off and pedestrian behaviours observations were done in 2015. Child PMVCs from 2000–2013, age 4–12 years, were mapped near 100 schools. Case schools had > 1 collision and control schools had 0. Dangerous driving/parking, unsafe pedestrian crossings, distracted walking and disobeying crossing controls/guards were compared using chi-square statistics by case/control status or BE features: downtown/inner suburbs, school crossing guards and designated car drop-off areas. Results Dangerous drop-off and/or pedestrian behaviours occurred at over 92% of schools. A greater proportion of case schools had children crossing at uncontrolled midblocks (97% vs. 78% controls). A greater proportion of inner suburb schools versus downtown had cars double-parked (52% vs. 28%) and parked blocking crossing controls (25% vs. 4%). A smaller proportion of schools with crossing guards versus without had cars parked blocking crossing controls (10% vs. 25% without) and drivers texting (5% vs. 22%). A smaller proportion of schools with designated drop-off areas versus without, had cars reversing dangerously (76% vs. 55%), parked blocking crossing controls (31% vs. 10%), children crossing at uncontrolled midblocks (78% vs. 95%) and between parked cars (48% vs. 76%). Conclusions Dangerous student drop-off and pedestrian behaviours were pervasive at schools. Occurrence of behaviours was related to the BE; particularly designated car-drop off areas. Adaptations to the BE near schools may defer dangerous behaviours and provide a safer child pedestrian environment.

Background Sport injuries are a significant burden, and while there are studies demonstrating the effectiveness of injury prevention programs, there is less guidance on how they are adopted and implemented successfully. The aim of this project was to conduct a process and formative evaluation of an injury prevention program implemented in a school setting. Methods This study proposes two frameworks [RE-AIM and the Consolidated Framework for Implementation Research (CFIR)] to evaluate the implementation of a neuromuscular training program (iSPRINT) to reduce sport injury and improve health-related measures in a junior high school population. The five dimensions of the RE-AIM and CIFR frameworks will be used. Results A total of 245/320 students were willing to participate in the program (68% reach). There was a lower risk of injury in intervention schools (n = 2) compared to controls (n = 2) [RR = 0.52 (95% CI: 0.33–0.81)]. 76% of students and 83% of teachers reported positive attitudes towards the program, 60% of students reported they believed the program could reduce the risk of injury, and 74% reported the program could improve fitness. 14% of the schools approached agreed to participate in the program (adoption). For students, the most frequently reported reason for participating was the belief that the program would reduce injury and increase fitness. Factors related to successful implementation of the program in schools included clear explanation and demonstration of the program, and barriers included difficulty in executing certain program components. Finally, 88% of teachers reported interest in maintaining the program. Ongoing formative evaluation will be collected via focus groups using CFIR constructs (2015–2016). Conclusions Teachers were able and keen to continue to use the iSPRINT program. We will provide further discussion on the dimensions of REAIM, and report the specific constructs that facilitated and impeded implementation of the iSPRINT program.

Background Injuries are a serious but preventable health concern in Canada and a growing field of research, attracting a large number of graduate students and other trainees across Canada to identify injury prevention as their field of study. In 2009, the Canadian Institute for Health Research funded a team in Child and Youth (C&Y) Injury Prevention. With this support, the team was able to develop a model of practice involving researchers, stakeholders, knowledge users, and trainees as part of a multidisciplinary approach to reducing the burden of injury in youth. The C&Y team was successful at supporting and highlighting the work of over 40 team trainees. The efforts of this trainee team have resulted in the formation of the Canadian Injury Prevention Trainee Network (CIPTN). Objective The CIPTN aims to build a network of trainees interested in the science and practice of injury prevention (IP) from a multi-disciplinary perspective. Specifically, the goals include increasing opportunities for collaboration, professional development, mentorship and networking. Results The CIPTN has worked to develop a list of learning and research oriented catalyst activities for trainee members. The CIPTN has successfully collaborated with IP experts and organisations from across Canada in the development of a comprehensive IP resource, as well as updating the Canadian Injury Prevention Curriculum, a course for IP practitioners across Canada. Further, an executive board and governance structure has facilitated the identification of future collaborative activities (e.g., bi-monthly seminars, grant writing, and evaluating an injury methods workshop). Conclusions The CIPTN increases opportunities for junior researchers and trainees to work within a network of colleagues to share research, build collaborative projects, expand capacity, and provide training opportunities. This in turn, will develop the quantity and quality of IP science and practice across Canada for future generations.

Background Approximately half of all children will sustain a fracture during childhood and adolescence. Understanding the factors that place a child at increased risk of fracture is necessary to inform effective injury prevention strategies. Methods A case-control study design with 128 cases and 426 frequency-matched controls (age and sex) was used to examine the risk of fracture (radiologist diagnosed fracture) in children ages 3–6 years. Cases were recruited from the Hospital for Sick Children Fracture Clinic and controls from the TARGet Kids primary care paediatric network. The Childhood Behaviour Questionnaire (CBQ), a 36-item caregiver response questionnaire was used to assess three temperament factors: surgency (i.e. impulsivity, high activity level); negative affect (i.e. anger, fear, discomfort); and effortful control (i.e. inhibitory control, attentional focusing) as the exposure. Results Unadjusted logistic models demonstrated no association between children with a fracture and higher scores of surgency (unadjusted OR = 1.06, 95% CI: 0.84, 1.34), negative affect (unadjusted OR = 1.15, 95% CI: 0.93, 1.42) or effortful control (unadjusted OR = 0.80, 95% CI: 0.63, 1.03). Models adjusted for covariates (waist circumference, maternal education, history of fracture, attendance in daycare, amount of time spent in unstructured playtime outdoors, having been breastfed, daily milk and soda consumption), also demonstrated no significant association with surgency (OR = 1.00, 95% CI: 0.78, 1.29), negative affect (OR = 1.09, 95% CI: 0.86, 1.37) and effortful control (OR = 0.80, 95% CI: 0.61, 1.05). Conclusions Children who are more extraverted, impulsive, aggressive or easily distracted as measured by the CBQ, are not at greater odds of experiencing a fracture, compared to their peers.

Background Walking to school is a way to increase daily physical activity; however the risk of injury must also be considered so that walking does not lead to an increase in pedestrian injuries. Risk factors associated with the environment around schools with high child pedestrian motor vehicle collision (PMVC) rates were examined. Methods Child PMVCs from 2000–2013, ages 4–12 years, were mapped within elementary school attendance boundaries in Toronto, Canada. Case and control schools were defined as those with the highest and lowest quartile of PMVC rates, calculated using census data. Potential risk factors included built and non-built environment variables obtained from municipal data sources as well as via direct observational counts done in the spring, 2015, to measure the proportion of children walking to school. Logistic regression was used to compare case versus control schools stratified by geographic location (downtown vs inner suburbs). Results The mean PMVC rate in case schools (n = 50) was 13.4/10,000/year and in controls (n = 50) was 1.75/10,000/year. Walking was not associated with high PMVC rates after adjustment for the built environment and school social disadvantage. Overall, lower residential (OR 0.56, 95% CI: 0.37, 0.86) and higher one-way street densities (OR 4.00, 95% CI: 1.76, 9.08), school crossing guards (OR 3.65, 95% CI: 1.10, 12.20) and higher social disadvantage (OR 1.37, 95% CI: 1.11, 1.70) were associated with high PMVC schools, Similar associations of high PMVC schools with built environment features were found in the inner suburbs; however, there was a stronger association with school social disadvantage downtown. Conclusions Walking to school was unrelated to high PMVC rates after controlling for the built environment. The built environment and school disadvantage were associated with higher PMVC rates with possible differences by geographic location.

Background Intentional and unintentional injuries are a significant and preventable health concern in Canada with 4.27 million Canadians ages 12 or older suffering an activity limiting injury. Knowledge translation and education among researchers, practitioners and policy makers as well as the continual development of trainees in the area of injury prevention, is paramount for the future health of Canadians. Methods The Canadian Injury Prevention Curriculum (CIPC) was designed to provide practitioners the understanding of the theory and practice of injury prevention along with the tools needed to develop and implement effective injury prevention programs. The CIPC is targeted toward adult learners (researchers, practitioners and/or policy makers) who develop, implement and/or evaluate programs aimed at reducing the frequency and severity of both intentional and unintentional injury. The last update of this curriculum was in 2010. This project aimed to update the CIPC, using an integrated knowledge translation approach to reflect an evidence-informed approach to injury prevention. Results The revision occurred over a series of phases: PHASE 1 – Update to the current curriculum to reflect an evidence-informed approach to injury prevention (what is injury prevention and defining the problem, risk and protective factors and key determinants of injury, designing/selecting an intervention, implementation and evaluation) in consultation with an adult learning expert; PHASE 2 – Modules were developed for practitioners to further knowledge and application of core knowledge; PHASE 3 – The updated curriculum was made available across Canada to researchers, practitioners and policy makers interested in preventing injury in Canada. Conclusions The CIPC was updated using an integrated knowledge translation approach. The result was an education tool using an evidence-informed approach to the prevention of injury, applicable for researchers, practitioners, policy makers, and junior trainees.

Background Child fatalities due to motor vehicle collisions (MVCs) are a significant burden in Canada. Data specific to these deaths are often referenced, yet few Canadian jurisdictions systematically collect comprehensive details of all child occupant and pedestrian MV fatalities reducing the effectiveness of informing and setting targets for injury prevention initiatives. Methods This project had two objectives; 1): To document the details of injuries and specific crash circumstances of all fatally injured child and youth (0–18 years) occupants and pedestrians through review of two provincial coroner case files (2004–2012). 2): To introduce recommendations toward standardised data collection procedures for use by coroners, specific to child and youth occupants and pedestrians involved in fatal MVC to: a) support revision of procedures, processes, and practices to facilitate detailed data capture by coroners; and b) to improve information transfer to inform prevention initiatives. Results Phase 1: Review of death investigation files (n = 317) did not allow ascertainment of suitable detail about injuries (56.5%, n = 160), restraint status (38.1%, n = 121) and crash type (7.3%, n = 23). Data obtained in the retrospective review revealed 43% (95% CI: 36.3, 50.0) of cases were side impact collisions, and 40.0% (95% CI: 33.0, 48.0) of the fatalities were reported improperly or unrestrained. Phase 2: A standardised form was developed and provided to each provincial coroner service to facilitate consistent and detailed data collection. Prospective data collection reduced missing data to 0%. Conclusions Review of data obtained from review of child and youth fatalities demonstrated a significant proportion of deaths followed side impact collisions without use of restraint systems; however, detailed information about MVC circumstances and injury details were not present in the investigation files. Stakeholder involvement plays a pivotal role in attaining data that are imperative to the development of effective injury prevention products, policies and practices.

Background Declines in child pedestrian motor vehicle collisions have occurred over the past 20 years possibly due to the simulaneous decline in children walking to school. Active school transportation (AST) is a form of physical activity that should be encouraged as all children make the daily school commute. Little is known about AST in kindergarten students (4–5 years). Young children may travel to school by sedentary means such as by car, stroller or wagon, due to parental concerns regarding traffic safety; however, recent recommendations by several professional associations have discouraged stroller use due to concerns their use may lead to reduced physical activity. Methods School transportation modes for kindergarten students were compared to those of students of all ages. Observational transportation mode counts were conducted in two samples in May-June 2015 at kindergarten-grade 6 schools in Toronto, Canada: 1) outside of schools with separate kindergarten entrances (n = 26 schools); 2) at optimal viewing locations for all-age students (n = 100 schools). Proportions of children arriving by different modes were compared between samples using Chi–square statistics. Results The use of active modes was significantly lower in the kindergarten sample (n = 26 schools) compared to those in the all-age sample (n = 100 schools); 60% versus 74%, Chi-square = 91.37, p Conclusions Strollers and wagons were not generally used for school travel by kindergarten students. Observed AST was significantly lower in kindergarten students compared to all ages. The overuse of cars for school travel for young children requires further examination to reduce sedentary behaviour and to decrease vehicle traffic around schools which puts all child pedestrians at increased risk for injury.

Background Neuromuscular training programs have shown to decrease injury rates in sport specific domains; however, there is limited research in non-sport populations. Objective Examine the effectiveness of reducing sport injury through a high intensity, neuromuscular training program aimed at school youth. Design Pilot, randomised controlled trial. Participants were randomised by school, to either intervention or control programs in year one. Year two, the intervention program was implemented in the control school. Setting Physical education (PE) classes. Participants 725 (year one) and 314 (year two) consenting participants aged 11–15. Intervention Intervention group completed a 15 min, high intensity, neuromuscular training warm-up, three times per week for 12 weeks. The control group warm-up was the same duration, with standard of care components. Main outcome measurements Sport injury, defined as any sport injury that required medical attention, and/or cessation of the activity, and/or time loss from sport. Secondary outcomes; aerobic fitness (VO 2 maximum (ml/kg/min), vertical jump (cm) and balance (s). Results Incidence rate ratios (IRR), adjusted for clustering by class, previous injury and exposure hours, estimated the intervention program was protective of all sport injury (IRR=0.29 (95% CI 0.18 to 0.46)), lower extremity injury (IRR=0.30 (95% CI 0.17 to 0.53)), and time loss injury (IRR=0.43 (95% CI 0.20 to 0.94)). The intervention group showed greater improvement in aerobic fitness (2.14 ml/kg/min (95% CI 1.17 to 2.59)) (t=-3.86, p=0.0001) and vertical jump (4.16 cm (95% CI 3.65 to 4.66)) (t=-3.67, p=0.0003) compared to the control group. No statistical differences were detected in balance measures. Conclusions A neuromuscular training program implemented in PE classes was protective of all sport injury, lower extremity injury and time loss injury. Results pertaining to year two will be determined and presented.