Injury Prevention for Female Lacrosse Athletes
Condition: Lower Extremity Problem
Study type: Interventional

Summary: 
      In this pilot study the investigators are testing whether an injury prevention program will
      help improve quality of movement and decrease number of injuries in collegiate women's
      lacrosse athletes. The primary purpose is to determine whether an injury prevention program
      including individualized movement instruction along with an educational program is better
      than an educational program alone for improving movements that can increase risk of injury
      and decreasing number of injuries. The investigators will recruit women's lacrosse athletes
      from the San Diego State University women's lacrosse team. Enrolled participants will be
      divided up into two groups of 10 individuals. Both groups will participate in an injury
      prevention educational program including a lecture component with pictures and videos, and a
      practice component in which athletes will be provided with group instruction on how to
      perform the activities and then will have an opportunity to practice all activities. In
      addition to the educational program, athletes in the individualized movement instruction
      group will be provided individualized feedback on their movements when performing activities
      from the injury prevention program during 3 sessions throughout the season. The primary
      outcomes that will be evaluated include lower body movement during a jumping and balance task
      as measured using a 3D motion capture system. The investigators hypothesize that participants
      who receive the individualized feedback in addition to the education program will display
      greater improvements in movements that increase injury risk when compare to the education
      only intervention group.
    

Detailed description: 
      The purpose of this pilot study is to determine whether augmenting an injury prevention
      program (IPP) with individualized video, verbal, and tactile feedback is more effective than
      implementation of an IPP with general education alone in female collegiate lacrosse players.

      The investigators will recruit a purposive sample of 20 women from the SDSU Women's NCAA
      Division I Lacrosse team to conduct a quasi-experimental pilot study. To ensure adequate
      exposure to injury risk during matches, players who regularly participate in matches will be
      identified by athletics staff and offered the opportunity to participate in the study.
      Athletes who participate will be assigned (non-random) to one of two groups, control
      (education only) or education with individualized feedback, which will be balanced based on
      position, playing time, and history of injury.

      All athletes and medical staff for the women's lacrosse team will attend a pre-season
      educational program focused on the purpose and benefits of IPPs, the importance of adherence
      to the IPP, and proper form when performing movements in the IPP to maximize injury
      prevention benefits. The program includes demonstration and practice of proper form,
      identification and correction of common errors and compensations. Videos and written
      documentation of the program will be shared with athletes, coaches and medical staff for
      reference. The athletes and staff will be encouraged to provide feedback to one another, to
      detect and correct errors and compensations, and help each other perform the program most
      optimally. This education program is scheduled to be implemented with all women's lacrosse
      athletes, regardless of whether the athletes participate in this research, as a joint effort
      between the principal investigator of the study and athletics staff, to address injury
      prevention for these athletes. The 10 participants assigned to the education with
      individualized feedback group will receive 3 additional sessions in which they receive
      individualized feedback on their movement when performing the IPP with one of 6 DPT students
      (supervised by PI Gombatto, licensed Physical Therapist). Individual feedback sessions will
      be 45-60 minutes and consist of a video review of athlete performance of the IPP, real-time
      feedback using a mirror, a combination of verbal and tactile feedback, and integration of
      peer feedback with a partner who is also receiving individualized feedback.

      All participants (N=20) will complete pre-intervention (pre-season) and post-intervention
      (post-season) testing including a 3D biomechanics analysis, anthropometric and body
      composition measures, and questionnaires to identify other known risk factors for injury. The
      3D biomechanical analysis will include an evaluation of lower extremity movement and forces
      with the Drop Vertical Jump (DVJ) and three directions of the Star Excursion Balance Test
      (SEBT). Injury history and incidence of injuries during the 2022 and 2023 season will be
      gathered from the athlete's electronic health records and via athlete self-report.
      Participant questionnaires will include questions about position, footwear, orthotic use, and
      taping. Adherence surveys will be administered weekly (15-16 weeks) via personalized text
      links or phone call (for non-responders) to record how often athletes are engaging in the
      IPP, self-correction, and peer feedback.

      The primary outcomes of this study will be biomechanical risk factors associated with knee
      injury, including dynamic knee valgus during the DVJ and asymmetry in lower extremity reach
      distance during the SEBT. Secondary outcomes will include lower extremity injuries during the
      Spring 2023 season, examined between treatment groups, and for all participants between the
      Spring 2022 and Spring 2023 seasons. The primary outcome was selected because the
      intervention is proposed to change movements that place athletes at risk for injury, and
      injury is the secondary outcome because reduced injuries are the intended effect of the IPP
      but the sample size may not be sufficient to measure change in injuries during a single
      season with this pilot study.

      Summary statistics for all outcomes will be examined for each treatment group. Analysis of
      variance (ANOVA) will be conducted to determine whether change in biomechanical risk factors
      is different between athletes in the education vs. education with individualized feedback
      groups (group x time interaction effect). Fisher's exact test will be used to test for
      differences in incidence of injury between groups. Number of lower extremity injuries across
      all participants will be quantitatively compared for the 2022 vs. 2023 season. Effect sizes
      (Cohen's d) will be calculated for each outcome. A power analysis will be performed to
      determine the number of subjects needed to detect significant effects in a larger sample.
    

Intervention name(s): Education Program on Injury Prevention; Individualized Feedback + Education Program on Injury Prevention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The didactic component of the injury prevention education program includes information on prevalence of injuries in female athletes, biomechanical risk factors for injury, and effectiveness of injury prevention programs (IPP) for mitigation of injury risk. Examples of different activities from the IPP, including proper and improper movement strategies will be provided. Athletes will be instructed as a group on how to properly perform of each activity of the IPP, and will be given an opportunity to practice. Athletes, coaches, and staff will be provided with links to written instructions and videos of proper performance for each activity. The IPP will be performed at least 3 times/week prior to practice. Coaches, staff, and athletes will be encouraged to provide supervision and feedback on performance of the IPP throughout the season.; In addition to the education program, participants in this group will receive individualized feedback on performance of the IPP. The participant will be videotaped while performing the IPP, and movement errors and compensations will be identified to provide a basis for feedback sessions to correct movement. The session will include different forms of feedback including showing the athlete their video, identifying the error or compensation, and providing verbal, tactile, and visual feedback to correct the error or compensation. Common errors and compensations, along with verbal cues and corrections, have been identified and manualized for the study. Two additional feedback sessions will be scheduled at regular intervals during the season to provide feedback on performance throughout the season. Participants in this group will be encouraged to provide peer feedback to one another.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: The pilot study model is a single site, 2-arm parallel quasi-experimental intervention study. After completing the baseline testing, enrolled participants will be purposively assigned (non-random) to one of two intervention groups, control (education only) or education with individualized feedback, which will be balanced based on position, playing time, and history of injury.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: injury prevention program; biomechanics; education; feedback; female; lacrosse; athletes