Coach Education Improves Adherence to Anterior Cruciate Ligament Injury Prevention Programs: A Cluster-Randomized Controlled Trial
Daphne I. Ling, Caroline Boyle, Brandon Schneider, Joseph Janosky, James Kinderknecht, Robert G. Marx
Abstract
OBJECTIVE: To determine the effect of an educational workshop on adherence to neuromuscular training (NMT) among high-school coaches. DESIGN: Cluster-randomized controlled trial. SETTING: High school. PARTICIPANTS: A total of 21 teams in 8 high schools (unit of randomization) were randomized to the intervention or control group. Twelve boys' and 9 girls' teams in a variety of sports were enrolled. INTERVENTION: Coaches in the intervention group participated in a 60-minute education workshop to teach effective implementation of a NMT program and also received print materials. Coaches in the control group received the same print materials. MAIN OUTCOME MEASURES: Eight data collectors were trained to observe each team's practice/game 2 to 3 times a week. They completed a study questionnaire to identify the NMT exercise and whether the coach (1) delivered exercise instructions and (2) provided alignment cues (both yes/no). RESULTS: A total of 399 practices/games were observed over 2 seasons. A greater proportion of coaches in the intervention group provided alignment cues to correct improper technique compared with the control group {difference = 0.04 [95% confidence interval (CI), 0.01-0.07], P = 0.006}. There was a similar proportion of coaches in the intervention and control groups who provided exercise instructions [difference = 0.01 (95% CI, -0.02 to 0.04), P = 0.44]. More coaches in the intervention group completed a full NMT program [OR = 4.62 (1.22, 17.50), P = 0.02]. CONCLUSIONS: Coach education can improve adherence to a NMT program and delivery of alignment cues. Coaches should receive in-person training on NMT and how to deliver alignment cues to their athletes while performing the exercises.