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Controlled ecological evaluation of an implemented exercise training programme to prevent lower limb injuries in sport: differences in implementation activity
  1. Alex Donaldson1,2,
  2. Belinda J Gabbe3,4,
  3. David G Lloyd5,6,
  4. Jill Cook1,7,
  5. Caroline F Finch1
  1. 1 Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Edith Cowan University, Perth, Western Australia, Australia
  2. 2 Centre for Sport and Social Impact, La Trobe University, Melbourne, Victoria, Australia
  3. 3 Prehospital, Emergency and Trauma Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4 Farr Institute, Swansea University Medical School, Swansea University, Swansea, UK
  5. 5 Gold Coast Orthopaedic Research and Education Alliance (GCORE), Menzies Health Institute Queensland, Gold Coast, Queensland, Australia
  6. 6 School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
  7. 7 La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
  1. Correspondence to Professor Caroline F Finch, Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Edith Cowan University, Joondalup, Perth, WA 6027.; c.finch{at}


Objective The public health benefits of injury prevention programmes are maximised when programmes are widely adopted and adhered to. Therefore, these programmes require appropriate implementation support. This study evaluated implementation activity outcomes associated with the implementation of FootyFirst, an exercise training injury prevention programme for community Australian football, both with (FootyFirst+S) and without (FootyFirst+NS) implementation support.

Method An evaluation plan based on the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) Sports Setting Matrix was applied in a controlled ecological evaluation of the implementation of FootyFirst. RE-AIM dimension-specific (range: 0–2) and total RE-AIM scores (range: 0–10) were derived by triangulating data from a number of sources (including surveys, interviews, direct observations and notes) describing FootyFirst implementation activities. The mean dimension-specific and total scores were compared for clubs in regions receiving FootyFirst+S and FootyFirst+NS, through analysis of variance.

Results The mean total RE-AIM score forclubs in the FootyFirst+S regions was 2.4 times higher than for clubs in the FootyFirst+NS region (4.73 vs 1.94; 95% CI for the difference: 1.64 to 3.74). Similarly, all dimension-specific scores were significantly higher for clubs in the FootyFirst+S regions compared with clubs in the FootyFirst+NS region. In all regions, the dimension-specific scores were highest for reach and adoption, and lowest for implementation.

Conclusion Implementing exercise training injury prevention programmes in community sport is challenging. Delivering programme content supported by a context-specific and evidence-informed implementation plan leads to greater implementation activity, which is an important precursor to injury reductions.

  • sports / leisure facility
  • implementation / translation
  • behavior change
  • interventions

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  • Contributors CFF was the lead chief investigator of the NoGAPS project. AD, BJG, DGL and JC were chief investigators on the NoGAPS project, and all authors contributed to the design of FootyFirst and its implementation strategy. CFF and AD designed the evaluation approach reported in this paper. AD coordinated the collection of all evaluation data and its scoring. All authors contributed to the writing and/or editing of the paper before submission and approved its submission.

  • Funding This study was funded by a National Health and Medical Research Council (NHMRC) Partnership Project Grant (ID 565907) with additional support (both cash and in kind) from the project partner agencies: the Australian Football League (AFL); Victorian Health Promotion Foundation (VicHealth); NSW Sporting Injuries Committee (NSWSIC); JLT Sport, a division of Jardine Lloyd Thompson Australia Pty Ltd; the Department of Planning and Community Development, Sport and Recreation Victoria Division (SRV); and Sports Medicine Australia National and Victorian Branches (SMA). CFF was partially supported by an NHMRC Principal Research Fellowship (ID1058737). BJG was supported by an NHMRC Career Development Fellowship (ID1048731). JC was supported by a NHMRC Practitioner Fellowship (ID1058493). The Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) is an International Research Centre for the Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee (IOC).

  • Competing interests None declared.

  • Ethics approval The Federation University Australia and Monash University Human Research Ethics Committees approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are not available.

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