BJSM - 2026-05-06 - Journal Article
Supported implementation enhances injury prevention programme (Prep-to-Play) use in women and girls playing Australian Football: a pragmatic type III hybrid implementation-effectiveness stepped wedge cluster randomised trial.
Patterson BE, White NM, Cowan SM, King MG, Donaldson A, Haberfield MJ, Mosler AB, Bruder AM, Barton CJ, McPhail SM, Culvenor AG, Hemming K, Hägglund M, Lannin NA, Ackerman IN, Dowsey MM, Makdissi M, Sundaraj S, Livingstone N, Fitzpatrick J, Crain J, Lampard SJ, Chilman KL, Gracias LJ, Birch E, Bonello C, Crossley KM
Topics
Key Takeaway
Supported implementation (in-person workshops + site visits) increased weekly Prep-to-Play programme use from 13.1% to 29.7% (OR 3.7, 95% CI 2.4–5.7) in women's/girls' Australian Football, and each unit increase in adherence was associated with a 5% reduction in total injury incidence (IRR 0.95).
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Summary
This pragmatic stepped wedge cluster RCT tested whether supported implementation (in-person workshops and support visits) versus unsupported implementation (online resources only) of the Prep-to-Play injury prevention programme improved programme use and reduced concussion and ACL injury incidence in 165 women's/girls' Australian Football teams. Supported implementation nearly tripled weekly programme use (13.1% vs. 29.7%, OR 3.7). The effect of supported implementation on concussion (IRR 1.36, 95% CI 0.74–2.49) and ACL injury incidence (IRR 2.27, 95% CI 0.56–9.12) was statistically unclear, though higher adherence was independently associated with fewer total injuries (IRR 0.95, 95% CI 0.92–0.99).
Key Limitation
Even with supported implementation, weekly programme use reached only 29.7%, leaving the trial critically underpowered to detect statistically significant effects on ACL and concussion incidence—the wide confidence intervals for injury outcomes preclude any clinical conclusions about injury prevention efficacy.
Original Abstract
OBJECTIVES
Evaluate the effect of supported implementation on a co-created injury prevention programme (Prep-to-Play) use and injury incidence and evaluate the dose response relationship between adherence and injury incidence.
METHODS
In this hybrid implementation-effectiveness stepped wedge cluster randomised trial, 165 women's/girls' Australian Football teams (2481 players) were randomly allocated to transition from unsupported to supported implementation at one of five time points during 2021/2022. Supported implementation included in-person workshops and support visits for coaches/team leaders. Unsupported implementation was access to online resources. Prep-to-Play includes warm-up, contact and strength activities. Primary (Prep-to-Play use) and secondary (concussion, anterior cruciate ligament (ACL)) outcomes were reported weekly. Weekly Prep-to-Play use (yes/no) was defined as using ≥75% of programme elements, ≥two-thirds of sessions each week. Analyses compared outcomes between supported and unsupported phases, adjusted for clustering, period, age group, competition level and region.
RESULTS
Average weekly Prep-to-Play use by teams was 13.1% (95% CI 11.5% to 14.9%) in the unsupported and 29.7% (95% CI 27.6% to 31.9%) in supported phase (OR 3.7 95% CI 2.4 to 5.7). The concussion and ACL injury incidence (per 1000 game hours) was 6.80 (95% CI 5.75 to 8.05) and 1.36 (95% CI 0.98 to 1.89) in unsupported, and 3.50 (95% CI 2.72 to 4.52) and 0.69 (95% CI 0.44 to 1.15) in supported, respectively, but the effect of supported implementation on injury incidence was unclear (concussion: incidence rate ratios (IRR) 1.36; 95% CI 0.74 to 2.49;
ACL
IRR 2.27 (0.56 to 9.12). Higher Prep-to-Play adherence was associated with fewer total injuries (IRR: 0.95 95% CI 0.92 to 0.99).
CONCLUSIONS
Supported implementation via in-person workshops and support visits was associated with greater Prep-to-Play use compared with unsupported implementation, and greater adherence was associated with fewer injuries.
TRIAL REGISTRATION NUMBER
NCT04856241.