Evaluation of an Injury Prevention Program (Prep-to-play) in 2713 Women and Girls Playing Community Australian Football: a Hybrid Implementation-Effectiveness, Stepped-Wedge Cluster Randomised Controlled Trial

Introduction: Prep-to-Play, an injury prevention program for community women’s football, was co-designed with the Australian Football League, adapted from effective programs in women’s soccer. Prep-to-Play online resources were distributed to all coaches in 2019, but coaches reported low confidence and limited support to use it. We aimed to compare Prep-to-Play use and injury rates between unsupported (online resources) and supported implementation in women’s community Australian Football. Methods: This hybrid implementation-effectiveness stepped-wedge, cluster randomised trial (NHMRC-funded, NCT04856241) included 169 teams [U16 to senior women] throughout Victoria. Ten geographically-separated clusters (each ≥14 teams) began the unsupported phase before being randomised to one of five dates to transition to the supported phase during two football seasons. Prep-to-Play includes (i) eight warm-up activities, (ii) three contact football skills, (iii) three strength exercises, and (iv) education. Teams in the unsupported phase continued usual practice with access to Prep-to-Play online resources. In the supported phase, we trained 56 physiotherapists to support teams to use Prep-to-Play—including a workshop for coaches/team leaders, hardcopy posters, and two training visits. Outcomes were evaluated throughout 2021 and 2022 seasons (April-Sept). A team representative reported Prep-to-Play use, knee and head injuries, at each training/game. Teams were categorised as ‘using’ Prep-to-Play each week (yes/no), if they used ≥75% of the program elements (≥6/8 warm-up, ≥1/3 skills, ≥2/3 strength), ≥two-thirds of the time. All knee- and head-injured players who provided consent were called by the research team to confirm diagnosis of anterior cruciate ligament (ACL) rupture, or concussion, respectively. Rates of Prep-to-Play use and ACL and concussion injuries were compared between the supported and unsupported phase (relative risk, 95%CI) *, using a generalised linear mixed model adjusting for cluster, time, age group, and competition-level. *Preliminary rates are reported descriptively for this abstract. Results: All 169 teams were randomised in pre-season 2021, and 2713 players consented for follow-up injury calls. No teams withdrew, but 22 teams (13%) didn’t provide data in 2022 as they could not field a team. 145 teams (86%) received the workshop, and 142 (84%) and 134 (79%) received one and two support visits, respectively. Prep-to-Play use was 12.9% (201/1565 weekly periods) and 38.2% (712/1864 weekly periods) in the unsupported and supported phases. The balance and contact (e.g., falling) warm-up activities, and hamstring strength activities had the lowest uptake. 180 knee injuries were reported, 161 completed the follow-up call, and 43% (69/161) were ACL injuries. 716 head injuries were reported, 581 (81%) completed the follow-up call, and 28% (162/581) were concussion. Discussion: Extensive support to coaches/players, and organisational endorsement, led to 38.2% meeting our threshold for program use Prep-to-Play after receiving support. Our lower uptake may reflect our ambitious weekly criteria (75% completion) compared to other implementation trials (>60% use) who typically ask coaches (yes/no) if they “used” the program. Impact/Application to the field: This study will help practitioners improve uptake of injury prevention programs in community sport, and guide researchers evaluating prevention programs. Implementation strategies must continue to consider social behaviour change theories, socioecological systems and innovative delivery models to optimise uptake. Declaration: My co-authors and I acknowledge that we have no conflict of interest of relevance to the submission of this abstract.