Implementation Strategies and Their Effects on ACL Injury Prevention in Amateur Youth Soccer: A Prospective Study

Meg Darmofal, Tzu-Chieh Liao, William Suits, Olivia Roe
Purpose:

The purpose of this study was to evaluate ACL-IPP implementation rates and ACL injury risk in youth soccer across two different implementation strategies. 

Methods:

This was a prospective cohort study which followed 671 youth female soccer players (15.72 ± 1.78 years) over the course of a single competitive soccer season. Players were members of teams where their coaches received either a knowledge translation intervention guided by the knowledge-to-action(KTA) framework (n=400) or an educational handout (n=271) regarding ACL-IPP implementation. The KTA framework intervention included options between evidence-based ACL-IPPs, discussions regarding strategies for implementation relevant to the local context, and on-site training for coaches. The educational handout consisted of the coaches receiving a handout with information regarding strategies for and benefits of an evidence-based ACL-IPP. A chi-squared test was used to compare the implementation rates and cox-hazard proportional regressions were used to examine the effect of different strategies on risk of ACL injury.

Results:

Implementation of an evidence-based ACL-IPP at least two times per week from either strategy was associated with a lower risk of ACL injury (hazard ratio [HR] = 0.15, 95% CI = 0.03, 0.73; p=0.01). The KTA framework intervention yielded higher ACL-IPP implementation (X2 (1, n=671) = 25.87, p 0.01) compared to the educational handout. 

Conclusion(s):

ACL-IPP implementation was associated with reduced ACL injury risk, regardless of the implementation strategy employed. However, ACL-IPP implementation was significantly higher in the KTA framework intervention compared to the educational handout. 

Implications:

Implementation of ACL-IPPs were associated with reduced ACL injury risk, and implementation of ACL-IPP was greater in the KTA framework intervention. This suggests that a KTA framework intervention may be more useful for promoting real-world change compared to an educational handout. Further research, including randomized implementation trials along with evaluation of cost-effectiveness and sustainability will be beneficial to determine the utility of such interventions. 

Funding acknowledgements:
This research project was partially supported by the Community Foundation of Greater Flint.
Keywords:
knowledge translation
female athlete
risk reduction
Primary topic:
Research methodology, knowledge translation and implementation science
Second topic:
Sport and sports injuries
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
This study protocol was approved by the University of Michigan Institutional Review Board (#HUM00214282).
Provide the ethics approval number:
#HUM00214282
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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