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Implementation of the FIFA 11+ injury prevention program by high school athletic teams did not reduce lower extremity injuries: a cluster randomized controlled trial
Slauterbeck JR, Choquette R, Tourville TW, Krug M, Mandelbaum BR, Vacek P, Beynnon BD
The American Journal of Sports Medicine 2019 Oct;47(12):2844-2852
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Lower extremity injuries are common in high school sports and are costly, and some have poor outcomes. The FIFA 11+ injury prevention program has been shown to decrease injuries in elite athletes by up to 72%. HYPOTHESIS: High schools in which coaches implement the FIFA 11+ injury prevention program in their athletic programs will have a decreased incidence of lower extremity injuries compared with schools using their usual prepractice warm-up. STUDY DESIGN: Randomized controlled trial; level of evidence, 1. METHODS: Fourteen high schools that employed an athletic trainer were randomly assigned to either the FIFA 11+ group or control group (usual warm-up routine). Exposure to sports and injuries were recorded and used to determine the incidence rates of lower extremity injuries per athlete-exposure (AE). The FIFA 11+ program was implemented by coaches and complicance with the program recorded. RESULTS: There were 196 lower extremity injuries among 1,825 athletes in the FIFA 11+ group and 172 injuries among 1,786 athletes in the control group (1.59 and 1.47 injuries per 1,000 AEs, respectively; p = 0.771). The distribution of the types of injury in the 2 groups did not differ, but the body locations where the injuries occurred differed somewhat (p = 0.051). The FIFA 11+ group had larger proportions of thigh and foot injuries, while the control group had higher proportions of knee and ankle injuries. Group differences in injury rates varied with sport (P = 0.041 for interaction), but there were no significant differences in injury rates between the FIFA 11+ and control groups by sport, level of play, and sex. In the FIFA 11+ group, 62% of the coaches reported that their teams completed the full FIFA 11+ program at least once a week, and 32% reported that they completed it at least twice a week. CONCLUSION: This study did not demonstrate a reduction in lower extremity injuries in schools randomized to use the FIFA 11+ program compared with schools using their usual prepractice warm-up program. Coach-reported compliance with performing the FIFA 11+ program at least twice a week was low.

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