Injury Prevention in Youth Male and Female Floorball Players : Effects, Compliance, and Experiences of the Knee Control Programme

Abstract

Background: Floorball is one of the most popular team ball sports in Northern Europe, particularly among youths. The injury incidence is high, as is the case in other pivoting youth team ball sports, such as football. The injury prevention exercise programme (IPEP) Knee Control is developed to reduce injuries in team ball sports. Though, programme effects and implementation factors in floorball has not been evaluated.The overall aim of this thesis was to evaluate the effects of the Knee Control IPEP and explore players' and coaches' experiences of using Knee Control in youth floorball. Methods:Study A was a cluster-randomised controlled trial (RCT) evaluating the effects of Knee Control in reducing floorball injuries. The RCT comprised of 48 clusters (clubs) with male and female floorball players (12-17 years) on the community level who were randomised into either an intervention or control group. Seventeen clusters (31 teams with 301 players) in the intervention group and 12 clusters (16 teams with 170 players) in the control group were included for analyses. During a pre-season implementation workshop, the intervention group coaches were instructed to use Knee Control and a standard running warm-up before every training session during the season. Control teams continued usual training. Teams were followed during a competitive season (26 weeks). Player exposure to floorball and occurrence of acute and gradual onset injuries were reported weekly via a web-based player survey using the Oslo Sports Trauma Research Centre overuse injury questionnaire. Team and player compliance to Knee Control was reported monthly by coaches. Players were divided into three compliance groups based on their average weekly number of Knee Control sessions: high (≥2 sessions), intermediate (≥1 to <2 sessions), and low dose (<1 session). Additionally, players and coaches in the intervention group answered a post-season survey on experiences using Knee Control.Study B was a qualitative study exploring facilitators and barriers of Knee Control use and how to overcome the barriers. Semi-structured focus group discussions, six with players (11-17 years old, n =42), and two with coaches (n =12) were conducted. Results:In Study A, the intervention group had a 35% lower incidence rate of injuries overall (adjusted incidence rate ratio (IRR), 0.65; 95% confidence interval (CI), 0.52-0.81) and 45% lower incidence of acute injuries (adjusted IRR, 0.55; 95% CI, 0.37-0.83) than the control group. There was no difference in the prevalence of gradual onset injuries. Male players in the high dose group had consistently lower injury incidence and prevalence compared to the low dose group, while no differences between the three compliance groups were seen in female players. Common facilitators of Knee Control use among coaches were support and education for coaches and high player motivation, and common barriers were that injury prevention training was time-consuming, a lack of space to execute the exercises, and a lack of player motivation. Players and ...