6 Supported implementation enhances injury prevention program use in women’s Australian football: a type III hybrid implementation-effectiveness stepped-wedge cluster randomised trial

Introduction Evaluate the effect of supported implementation on injury prevention program (Prep-to-Play) use and injury incidence and evaluate the dose response relationship between adherence and injury incidence.Materials and Methods 165 women’s/girls’ teams (2481 players) were randomly allocated to transition from unsupported to supported implementation at one-of-five sequences 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 outcomes (concussion, anterior cruciate ligament (ACL) injuries) were reported weekly. Weekly Prep-to-Play use was defined as using ≥75% of program elements, ≥two-thirds of sessions. Analyses compared outcomes between supported and unsupported, adjusted for clustering, period, age-group, competition-level, and region.Results Crude Prep-to-Play use 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). Crude 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, which was not statistically significant at this effect size (concussion: 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).Conclusion Supported implementation via in-person workshops and support was associated with greater Prep-to-Play use compared to unsupported implementation, and greater adherence was associated with fewer injuries.