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Previous injuries and joint health identify soccer players at greater risk of injury
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March 2013
Previous injuries and joint health identify soccer players at greater risk of injury
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
Prevention of Injuries Among Male Soccer Players- A Prospective, Randomized Intervention Study Targeting Players With Previous Injuries or Reduced Function
Am J Sports Med. 2008 Jun;36(6):1052-60. Epub 2008 Apr 3Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
508 male soccer players were classified as high or low risk (LR) for injury using a number of questionnaires assessing previous injuries and health status. High risk (HR) patients were randomized to control or targeted training to assess its effect on injury occurrence throughout the season. LR patients had the lowest incidence of injury, while there were no differences between the two HR groups, which may have been due to the low compliance with targeted training.
Publication Funding Details
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Funding:
Non-Industry funded
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
2/4
Randomization
3/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/5
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Injuries are a common occurrence in competitive sport and some individuals may be at greater risk than others due to previous injuries and health status. Identification of high risk individuals may allow for prevention of injuries by using target specific training to strengthen weakened areas. This study attempted to identify patients at greater risk of injury and assess if target training can reduce the incidence of injury.
What was the principal research question?
Does a targeted exercise program for soccer players at high risk of injury reduce injury rates during the course of one season?
Study Characteristics
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Population:
508 male soccer players representing 31 teams were administered the identification questionnaire
Intervention:
HR intervention: Players identified in the high risk group using a questionnaire who underwent targeted exercise programs. Programs were targeted to the knee, ankle, hamstring, or groin, depending on the area of highest risk (n=193)
Comparison:
HR control: Players identified as high risk that did not undergo targeted exercises (n=195)
LR: Players identified as low risk who did not undergo targeted exercises (n=120)
Outcomes:
Foot and ankle outcome scores, knee osteoarthritis outcome score, hamstring outcome score, groin outcome score, total number of injuries and sum of the risk for an injury
Methods:
RCT: Multiple Centers
Time:
One soccer season
What were the important findings?
- No difference in mean player exposure to match play was found between the HR intervention group and the controls (p>0.05).
- There were a total of 505 injuries reported during the course of the study sustained by 283 of the players
- There were 82 injuries in the LR 216 in the HR control and 207 in the HR intervention group. No difference was found between the HR intervention and control group and HR control in terms of incidence of injury (RR: 0.94 (95% CI: 0.77 to 1.13); p=0.90).
- Injury Incidence rate was lower in the LR control group when compared to both HR groups (p=0.029)
- 45.8% of LR control and 58.5% of HR control were injured throughout the season (p=0.029)
- Injury rates per 1000 playing hours were 1.3 for LR, 2.8 for HR control, and 2.6 for HR intervention. A significantly lower injury rate was found for patients in the LR control group than either of the HR groups (p<0.05).
What should I remember most?
Patients who were classified as high risk based on pre randomization questionnaires were at a greater risk of injury than those classified as low risk. This finding indicated the successful identification of players at greater risk of injury using the questionnaires. There were no difference between the HR control and intervention groups; however minimal compliance with targeted training might have been a confounding factor.
How will this affect the care of my patients?
Players at greater risk of injury can be identified using specific questionnaires dealing with previous injuries. Further studies with greater compliance are required to investigate the effect of targeted training on injury incidence among those at high risk.
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