{
  "abstract": "Objectives Evaluate the effect of supported implementation on a co-created injury prevention programme (Prep-to-Play) use and injury incidence and evaluate the dose response relationship between adherence and injury incidence.Methods In this hybrid implementation-effectiveness stepped wedge cluster randomised trial, 165 women’s/girls’ Australian Football teams (2481 players) were randomly allocated to transition from unsupported to supported implementation at one of five time points 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 (concussion, anterior cruciate ligament (ACL)) outcomes were reported weekly. Weekly Prep-to-Play use (yes/no) was defined as using ≥75% of programme elements, ≥two-thirds of sessions each week. Analyses compared outcomes between supported and unsupported phases, adjusted for clustering, period, age group, competition level and region.Results Average weekly Prep-to-Play use by teams 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). The 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, but the effect of supported implementation on injury incidence was unclear (concussion: incidence rate ratios (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).Conclusions Supported implementation via in-person workshops and support visits was associated with greater Prep-to-Play use compared with unsupported implementation, and greater adherence was associated with fewer injuries.Trial registration number NCT04856241.",
  "authors": [
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Brooke E Patterson"
    },
    {
      "affiliations": [
        "Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia"
      ],
      "name": "Nicole M White"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Sallie M Cowan"
    },
    {
      "affiliations": [
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia",
        "Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Matthew G King"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "Centre for Sport and Social Impact, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Alex Donaldson"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Melissa J Haberfield"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Andrea B Mosler"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia",
        "Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Andrea M Bruder"
    },
    {
      "affiliations": [
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia",
        "Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Christian J Barton"
    },
    {
      "affiliations": [
        "Australian Centre for Health Services Innovation & Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia",
        "Digital Health and Informatics Directorate, Metro South Health, Woolloongabba, Queensland, Australia"
      ],
      "name": "Steven M McPhail"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Adam G Culvenor"
    },
    {
      "affiliations": [
        "Applied Health Research, University of Birmingham, Birmingham, UK"
      ],
      "name": "Karla Hemming"
    },
    {
      "affiliations": [
        "Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden"
      ],
      "name": "Martin Hägglund"
    },
    {
      "affiliations": [
        "Department of Neuroscience, Monash University, Melbourne, Victoria, Australia",
        "Bayside Health, Melbourne, Victoria, Australia"
      ],
      "name": "Natasha A Lannin"
    },
    {
      "affiliations": [
        "School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Ilana N Ackerman"
    },
    {
      "affiliations": [
        "Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Michelle M Dowsey"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia",
        "Australian Football League, Melbourne, Victoria, Australia"
      ],
      "name": "Michael Makdissi"
    },
    {
      "affiliations": [
        "Medibank Better Health Research Hub, Medibank Better Health Foundation, Melbourne, Victoria, Australia"
      ],
      "name": "Shona Sundaraj"
    },
    {
      "affiliations": [
        "Australian Football League, Melbourne, Victoria, Australia"
      ],
      "name": "Nicole Livingstone"
    },
    {
      "affiliations": [
        "Research Committee, Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia"
      ],
      "name": "Jane Fitzpatrick"
    },
    {
      "affiliations": [
        "Sports Medicine Australia, Albert Park, Victoria, Australia"
      ],
      "name": "Jamie Crain"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Sarah J Lampard"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Eliza A Roughead"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Karina L Chilman"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Libby J Gracias"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Elizabeth Birch"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Christian Bonello"
    },
    {
      "affiliations": [
        "Australian IOC Research Centre, La Trobe University Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia",
        "La Trobe University Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Kay M Crossley"
    }
  ],
  "title": "Supported implementation enhances injury prevention programme (Prep-to-Play) use in women and girls playing Australian Football: a pragmatic type III hybrid implementation-effectiveness stepped wedge cluster randomised trial",
  "uid": "c9e7f090-ea10-5058-b87f-e7d756718740"
}