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Lower reinjury rate with a coach-controlled rehabilitation program in amateur male soccer: a randomized controlled trial |
Hagglund M, Walden M, Ekstrand J |
The American Journal of Sports Medicine 2007 Sep;35(9):1433-1442 |
clinical trial |
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; 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: Soccer injuries are common, and athletes returning to play after injury are especially at risk. Few studies have investigated how to prevent reinjury. HYPOTHESIS: The rate of reinjury is reduced using a coach-controlled rehabilitation program. STUDY DESIGN: Randomized controlled trial; level of evidence, 1. METHODS: Twenty-four male amateur soccer teams were randomized into an intervention (n = 282) and control group (n = 300). The intervention was implemented by team coaches and consisted of information about risk factors for reinjury, rehabilitation principles, and a 10-step progressive rehabilitation program including return to play criteria. During the 2003 season, coaches reported individual exposure and all time loss injuries were evaluated by a doctor and a physiotherapist. Four teams (n = 100) withdrew from the study after randomization, leaving 10 teams with 241 players for analysis in both groups. RESULTS: There were 90 injured players (132 injuries) in the intervention group, and 10 of these (11%) suffered 14 reinjuries during the season. In the control group, 23 of 79 injured players (29%) had 40 recurrences (134 injuries). A Cox regression analysis showed a 66% reinjury risk reduction in the intervention group for all injury locations (hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.16 to 0.72, p = 0.0047) and 75% for lower limb injuries (HR 0.25, 95% CI 0.11 to 0.57, p < 0.001). The preventive effect was greatest within the first week of return to play. Injured players in the intervention group complied with the intervention for 90 of 132 injuries (68%). CONCLUSION: The reinjury rate in amateur male soccer players was reduced after a controlled rehabilitation program implemented by coaches.
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