Explore the vast range of titles available.

ObjectiveTo investigate if a combination of an online and onsite implementation strategy was superior to an online-only strategy in enhancing the use of an injury prevention exercise programme (IPEP) and in reducing the risk of shoulder, knee and ankle injuries in youth community handball players (age 11–17) over a handball season.MethodsIn this 30-week hybrid effectiveness-implementation cluster randomised type 3 study, 20 youth handball clubs were randomly assigned 1:1 to either a combined online and onsite implementation strategy (coach workshop using the health action process approach behaviour change model and health service provider (HSP) support) or an online-only strategy (control group). The primary implementation outcome was coach-reported adherence, measured as the average IPEP exercise usage by the team over 30 weeks. The primary effectiveness outcome was player-reported handball playing time to any new handball-related shoulder, knee and ankle injuries, reported weekly using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems.ResultsWe enrolled 63 coaches (27% women) and 945 players (mean age 14.5 years, 55% girls). Intention-to-treat analyses showed no statistically significant difference between implementation strategies in adherence (between-group difference 1.4, 95% CI −0.5 to 3.4) or in cumulative injury risk (between-group difference 5.5% points, 95% CI −2.2 to 13.1).ConclusionOur findings demonstrate that in youth community handball, a combined online and onsite implementation strategy, including a coach workshop and HSP support, was not superior to an online-only strategy regarding adherence to an IPEP or in reducing shoulder, knee and ankle injury risk.Trial registration numberNCT05294237.

Objective To examine the effect of a comprehensive warm-up programme designed to reduce the risk of injuries in female youth football.Design Cluster randomised controlled trial with clubs as the unit of randomisation.Setting 125 football clubs from the south, east, and middle of Norway (65 clusters in the intervention group; 60 in the control group) followed for one league season (eight months).Participants 1892 female players aged 13-17 (1055 players in the intervention group; 837 players in the control group).Intervention A comprehensive warm-up programme to improve strength, awareness, and neuromuscular control during static and dynamic movements.Main outcome measure Injuries to the lower extremity (foot, ankle, lower leg, knee, thigh, groin, and hip).Results During one season, 264 players had relevant injuries: 121 players in the intervention group and 143 in the control group (rate ratio 0.71, 95% confidence interval 0.49 to 1.03). In the intervention group there was a significantly lower risk of injuries overall (0.68, 0.48 to 0.98), overuse injuries (0.47, 0.26 to 0.85), and severe injuries (0.55, 0.36 to 0.83).Conclusion Though the primary outcome of reduction in lower extremity injury did not reach significance, the risk of severe injuries, overuse injuries, and injuries overall was reduced. This indicates that a structured warm-up programme can prevent injuries in young female football players.Trial registration ISRCTN10306290.

BackgroundShoulder problems are highly prevalent among elite handball players. Reduced glenohumeral rotation, external rotation weakness and scapula dyskinesis have been identified as risk factors.AimEvaluate the effect of an exercise programme designed to reduce the prevalence of shoulder problems in elite handball.Methods45 elite handball teams (22 female teams, 23 male teams, 660 players) were cluster randomised (22 teams, 331 players in the intervention group, 23 teams, 329 players in the control group) and followed for 1 competitive season (7 months). The Oslo Sports Trauma Research Center (OSTRC) Shoulder Injury Prevention Programme, an exercise programme to increase glenohumeral internal rotation, external rotation strength and scapular muscle strength, as well as improve kinetic chain and thoracic mobility, was delivered by coaches and captains 3 times per week as a part of the handball warm-up. The main outcome measures, prevalence of shoulder problems and substantial shoulder problems, were measured monthly.ResultsThe average prevalence of shoulder problems during the season was 17% (95% CI 16% to 19%) in the intervention group and 23% (95% CI 21% to 26%) in the control group (mean difference 6%). The average prevalence of substantial shoulder problems was 5% (95% CI 4% to 6%) in the intervention group and 8% (95% CI 7% to 9%) in the control group (mean difference 3%). Using generalised estimating equation models, a 28% lower risk of shoulder problems (OR 0.72, 95% CI 0.52 to 0.98, p=0.038) and 22% lower risk of substantial shoulder problems (OR 0.78, 95% CI 0.53 to 1.16, p=0.23) were observed in the intervention group compared with the control group.ConclusionsThe OSTRC Shoulder Injury Prevention Programme reduced the prevalence of shoulder problems in elite handball and should be included as a part of the warm-up.Trial registration numberISRCTN96217107.

To assess the effectiveness of exercise-based injury-prevention programs in preventing sports injuries in team handball players. Scopus, PubMed, Web of Science, SPORTDiscus, and CINAHL from inception until April 2023. Studies were included if they were randomized controlled trials or prospective cohort studies, contained a population of competitive team handball players, included an intervention designed specifically to prevent or reduce the risk of team handball injuries, and reported injury incidence rates specific to team handball players. Two researchers independently evaluated studies for inclusion and assessed their methodological quality. Study design, intervention details, participant characteristics, and the number of injuries in each group were extracted from each study by 2 independent researchers. The outcome of interest was the incidence rate of injury. Injury data were classified into 5 groups: shoulder injuries, lower extremity injuries, knee injuries, anterior cruciate ligament injuries, and ankle injuries. Extracted data were analyzed using a random-effects model to compute the overall effect estimates of injury-prevention programs in reducing the risk of injuries. Odds ratios (ORs) with 95% CIs were calculated based on the number of injuries in each group. Meta-analyses were conducted independently for each injury classification. Results indicated that prevention programs reduced the risk of shoulder injuries (OR = 0.60; 95% CI = 0.42, 0.85; P = .004), lower extremity injuries (OR = 0.59; 95% CI = 0.37, 0.95; P = .03), knee injuries (OR = 0.53; 95% CI = 0.35, 0.78; P = .002), anterior cruciate ligament injuries (OR = 0.66; 95% CI = 0.45, 0.96; P = .03), and ankle injuries (OR = 0.57; 95% CI = 0.40, 0.81; P = .002) in team handball players. In team handball players, injury-prevention programs appear to effectively reduce the risk of shoulder, lower extremity, knee, ankle, and anterior cruciate ligament injuries.

Research questionDoes the Nordic hamstring exercise (NHE) prevent hamstring injuries when included as part of an injury prevention intervention?DesignSystematic review and meta-analysis.Eligibility criteria for selecting studiesWe considered the population to be any athletes participating in any sporting activity, the intervention to be the NHE, the comparison to be usual training or other prevention programmes, which did not include the NHE, and the outcome to be the incidence or rate of hamstring injuries.AnalysisThe effect of including the NHE in injury prevention programmes compared with controls on hamstring injuries was assessed in 15 studies that reported the incidence across different sports and age groups in both women and men.Data sourcesMEDLINE via PubMed, CINAHL via Ebsco, and OpenGrey.ResultsThere is a reduction in the overall injury risk ratio of 0.49 (95% CI 0.32 to 0.74, p=0.0008) in favour of programmes including the NHE. Secondary analyses when pooling the eight randomised control studies demonstrated a small increase in the overall injury risk ratio 0.52 (95% CI 0.32 to 0.85, p=0.0008), still in favour of the NHE. Additionally, when studies with a high risk of bias were removed (n=8), there is an increase of 0.06 in the risk ratio to 0.55 (95% CI 0.34 to 0.89, p=0.006).ConclusionsProgrammes that include the NHE reduce hamstring injuries by up to 51%. The NHE essentially halves the rate of hamstring injuries across multiple sports in different athletes.Trial registration numberPROSPERO CRD42018106150.

Acute kidney injury (AKI) is a common and important complication of major surgery, yet recommended preventive care is rarely administered. We used urinary biomarkers to identify patients at high risk of AKI and implemented a preventive care strategy to reduce AKI within 72 h after major surgery. BigpAK-2 was a multicentre randomised clinical trial done in 34 hospitals in Europe. Patients (aged ≥18 years) undergoing major surgery at high risk for AKI identified by predefined clinical risk factors and tubular stress biomarkers were randomly assigned to usual care or a preventive care strategy as per recommendations by the Kidney Disease Improving Global Outcome guidelines: advanced hemodynamic monitoring, optimisation of volume status and haemodynamics, avoidance of nephrotoxic drugs and radiocontrast agents, and prevention of hyperglycaemia. The primary outcome was the occurrence of moderate or severe AKI within 72 h after surgery, assessed in the intention-to-treat population. Safety was assessed by comparing rates of adverse events between groups. This trial is registered with ClinicalTrials.gov, NCT04647396. From Nov 25, 2020, to June 21, 2024, 7873 patients were screened and 1180 (15·0%) were randomly assigned (589 [49·9%] to the intervention group and 591 [50·1%] to the control group). Among the 1176 patients available for the primary endpoint analysis, moderate or severe AKI occurred in 84 (14·4%) patients in the intervention group and in 131 (22·3%) patients in the control group (odds ratio 0·57 [95% CI 0·40–0·79; p=0·0002; number needed to treat 12 [7–33]). There were no differences in adverse events. The most common adverse events were atrial fibrillation (50 [8·8%] in the intervention group vs 56 (9·7%) in the control group), hemodynamically relevant arrhythmias (41 [7·2%] in the intervention group vs 50 [8·6%] in the control group), significant bleeding or haemorrhage (34 [6·0%] in the intervention group vs 31 [5·3%] in the control group), and unplanned return to the operating room (29 [5·1%] in the intervention vs 38 [6·5%] in the control group). Among adults at high risk for AKI undergoing major surgery, a preventive care strategy consisting of supportive measures and avoidance of nephrotoxins significantly reduced the occurrence of moderate or severe AKI without increasing adverse events. BioMérieux.

Injury knowledge and beliefs influence uptake of prevention programmes, but the relationship between knowledge, beliefs and adherence remains unclear. To describe injury knowledge and beliefs among youth female soccer coaches and players, and to identify the relationship between these factors, different delivery strategies of the FIFA 11+ programme and adherence. A subcohort analysis from a cluster-randomised controlled trial of 31 female soccer teams (coaches n=29, players (ages 13-18) n=258). Preseason and postseason questionnaires were used to assess knowledge and beliefs. Teams recorded FIFA 11+ adherence during the season. At baseline, 62.8% (95% CI 48.4% to 77.3%) of coaches and 75.8% (95% CI 71.5% to 80.1%) of players considered 'inadequate warm-up' a risk factor for injury. There was no effect of delivery method (OR=1.1; 95% CI 0.8 to 1.5) or adherence (OR=1.0; 95% CI 0.9 to 1.1) on this belief. At baseline, 13.8% (95% CI 1.3% to 26.4%) of coaches believed a warm-up could prevent muscle injuries, but none believed it could prevent knee and ankle injuries. For players, 9.7% (95% CI 6.1% to 13.3%), 4.7% (95% CI 2.1% to 7.3%) and 4.7% (95% CI 2.1% to 7.3%) believed a warm-up would prevent muscle, knee and ankle injuries, respectively. Years of playing experience were negatively associated with high adherence for coaches (OR=0.93; 0.88 to 0.99) and players (OR=0.92; 0.85 to 0.98). There were gaps in injury knowledge and beliefs, which differed for coaches and players. Beliefs did not significantly affect adherence to the FIFA 11+, suggesting additional motivational factors should be considered.

BackgroundGroin injuries represent a considerable problem in male football. Previous groin-specific prevention programmes have not shown a significant reduction in groin injury rates. An exercise programme using the Copenhagen Adduction exercise increases hip adduction strength, a key risk factor for groin injuries. However, its preventive effect is yet to be tested.AimTo evaluate the effect of a single-exercise approach, based on the Copenhagen Adduction exercise, on the prevalence of groin problems in male football players.Methods35 semiprofessional Norwegian football teams were cluster-randomised into an intervention group (18 teams, 339 players) and a control group (17 teams, 313 players). The intervention group performed an Adductor Strengthening Programme using one exercise, with three progression levels, three times per week during the preseason (6–8 weeks), and once per week during the competitive season (28 weeks). The control group were instructed to train as normal. The prevalence of groin problems was measured weekly in both groups during the competitive season using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire.ResultsThe average prevalence of groin problems during the season was 13.5% (95% CI 12.3% to 14.7%) in the intervention group and 21.3% (95% CI 20.0% to 22.6%) in the control group. The risk of reporting groin problems was 41% lower in the intervention group (OR 0.59, 95% CI 0.40 to 0.86, p=0.008).ConclusionThe simple Adductor Strengthening Programme substantially reduced the self-reported prevalence and risk of groin problems in male football players.Trial registration number ISRCTN98514933.

Background Both acute and overuse injuries are common among recreational volleyball players, especially finger/wrist, ankle, shoulder and knee injuries. Consequently, an intervention (‘VolleyVeilig’) was developed to prevent or reduce the occurrence of finger/wrist, shoulder, knee and ankle injuries among recreational volleyball players. This article describes the design of a study evaluating the effectiveness of the developed intervention on the one-season occurrence of finger/wrist, shoulder, knee and ankle injuries among recreational adult volleyball players. Methods A randomized prospective controlled trial with a follow-up period of one volleyball season will be conducted. Participants will be healthy recreational adult volleyball players (18 years of age or older) practicing volleyball (training and/or match) at least twice a week. The intervention (‘VolleyVeilig’) consists of a warm-up program based on more than 50 distinct exercises (with different variations and levels). The effect of the intervention programme on the occurrence of injuries will be compared to volleyball as usual. Outcome measures will be incidence of acute injury (expressed as number of injuries per 1000 h of play) and prevalence of overuse injuries (expressed as percentage). Discussion This study will be one of the first randomized prospective controlled trials evaluating the effectiveness of an intervention on the occurrence of both acute and overuse injuries among recreational adult volleyball players. Outcome of this study could possibly lead to the nationwide implementation of the intervention in all volleyball clubs in The Netherlands, ultimately resulting in less injuries. Trial registration Dutch Trial Registration NTR6202 , registered February 1st 2017. Protocol: Version 3, February 2017.

Acute kidney injury (AKI) is a common, heterogeneous, multifactorial condition, which is part of the overarching syndrome of acute kidney diseases and disorders. This condition's incidence highest in low-income and middle-income countries. In the short term, AKI is associated with increased mortality, an increased risk of complications, extended stays in hospital, and high health-care costs. Long-term complications include chronic kidney disease, kidney failure, cardiovascular morbidity, and an increased risk of death. Several strategies are available to prevent and treat AKI in specific clinical contexts. Otherwise, AKI care is primarily supportive, focused on treatment of the underlying cause, prevention of further injury, management of complications, and short-term renal replacement therapy in case of refractory complications. Evidence confirming that AKI subphenotyping is necessary to identify precision-oriented interventions is growing. Long-term follow-up of individuals recovered from AKI is recommended but the most effective models of care remain unclear.