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      The ISPA Int Injury Prevention Programme for Youth Competitive Alpine Skiers: A Controlled 12-Month Experimental Study in a Real-World Training Setting

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          Abstract

          Evidence-based injury prevention programmes for youth competitive alpine skiers are widely absent. The aims of this controlled 12-month experimental study were to introduce a novel injury prevention programme targeted to the injury patterns of youth skiers, called ISPA Int , and to compare the differences in injury occurrence between an intervention group (IG) additionally performing the ISPA Int programme and an independent, historical control group (CG) following their regular training routines. None of the skiers of the CG were part of the IG and vice versa. The study was directly conducted within the real-world youth development structures of skiers competing at the under 16 years (U16) level in Switzerland. Seventy-one skiers (aged 14.4 ± 0.3 years) assigned to the IG were compared to 58 age- and gender-matched controls. The IG was offered the ISPA Int programme with the recommendation to perform it at least once per week. Skiers’ adherence to this recommendation was surveyed but not enforced. Injuries were recorded using the Oslo Sports Trauma Research Centre Questionnaire. Primary outcomes were the absolute injury rates (number of injuries/100 athletes per season) and epidemiological incidence proportion (number of injured athletes/100 athletes per season). The secondary outcome was the average 2-weekly prevalence of traumatic knee, knee overuse, and lower back overuse injuries. There were lower absolute rates of all traumatic injuries [rate/risk difference, RD: −57.1 (−98.1, −16.0); rate/risk ratio, RR: 0.665 (0.485, 0.884)] and overuse injuries [RD: −35.9 (−71.0, −0.7); RR: 0.699 (0.493, 0.989)] in the IG than in the CG. Likewise, the epidemiological incidence proportion for all overuse injuries was smaller in the IG [RD: −28.4 (−44.8, −12.0); RR: 0.598 (0.435, 0.822)], while the proportion of skiers suffering from traumatic injuries did not significantly differ between the groups. Notably, the IG particularity differed from the CG in the average 2-weekly prevalence of knee trauma, knee overuse, and lower back overuse complaints, three of the major injury-related hot spots in youth skiers. Based on these promising results, the ISPA Int programme may have great potential to prevent injuries in youth competitive alpine skiers, and the underlying exercises should be considered complementary training content at the U16 level.

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          Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation.

          The first purpose of this review was to assess the impact of implementation on program outcomes, and the second purpose was to identify factors affecting the implementation process. Results from over quantitative 500 studies offered strong empirical support to the conclusion that the level of implementation affects the outcomes obtained in promotion and prevention programs. Findings from 81 additional reports indicate there are at least 23 contextual factors that influence implementation. The implementation process is affected by variables related to communities, providers and innovations, and aspects of the prevention delivery system (i.e., organizational functioning) and the prevention support system (i.e., training and technical assistance). The collection of implementation data is an essential feature of program evaluations, and more information is needed on which and how various factors influence implementation in different community settings.
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            The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change

            Background Despite growth in implementation research, limited scientific attention has focused on understanding and improving sustainability of health interventions. Models of sustainability have been evolving to reflect challenges in the fit between intervention and context. Discussion We examine the development of concepts of sustainability, and respond to two frequent assumptions —'voltage drop,’ whereby interventions are expected to yield lower benefits as they move from efficacy to effectiveness to implementation and sustainability, and 'program drift,’ whereby deviation from manualized protocols is assumed to decrease benefit. We posit that these assumptions limit opportunities to improve care, and instead argue for understanding the changing context of healthcare to continuously refine and improve interventions as they are sustained. Sustainability has evolved from being considered as the endgame of a translational research process to a suggested 'adaptation phase’ that integrates and institutionalizes interventions within local organizational and cultural contexts. These recent approaches locate sustainability in the implementation phase of knowledge transfer, but still do not address intervention improvement as a central theme. We propose a Dynamic Sustainability Framework that involves: continued learning and problem solving, ongoing adaptation of interventions with a primary focus on fit between interventions and multi-level contexts, and expectations for ongoing improvement as opposed to diminishing outcomes over time. Summary A Dynamic Sustainability Framework provides a foundation for research, policy and practice that supports development and testing of falsifiable hypotheses and continued learning to advance the implementation, transportability and impact of health services research.
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              An assessment of maturity from anthropometric measurements.

              The range of variability between individuals of the same chronological age (CA) in somatic and biological maturity is large and especially accentuated around the adolescent growth spurt. Maturity assessment is an important consideration when dealing with adolescents, from both a research perspective and youth sports stratification. A noninvasive, practical method predicting years from peak height velocity (a maturity offset value) by using anthropometric variables is developed in one sample and cross-validated in two different samples. Gender specific multiple regression equations were calculated on a sample of 152 Canadian children aged 8-16 yr (79 boys; 73 girls) who were followed through adolescence from 1991 to 1997. The equations included three somatic dimensions (height, sitting height, and leg length), CA, and their interactions. The equations were cross-validated on a combined sample of Canadian (71 boys, 40 girls measured from 1964 through 1973) and Flemish children (50 boys, 48 girls measured from 1985 through 1999). The coefficient of determination (R2) for the boys' model was 0.92 and for the girls' model 0.91; the SEEs were 0.49 and 0.50, respectively. Mean difference between actual and predicted maturity offset for the verification samples was 0.24 (SD 0.65) yr in boys and 0.001 (SD 0.68) yr in girls. Although the cross-validation meets statistical standards for acceptance, caution is warranted with regard to implementation. It is recommended that maturity offset be considered as a categorical rather than a continuous assessment. Nevertheless, the equations presented are a reliable, noninvasive and a practical solution for the measure of biological maturity for matching adolescent athletes
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                Author and article information

                Contributors
                Journal
                Front Physiol
                Front Physiol
                Front. Physiol.
                Frontiers in Physiology
                Frontiers Media S.A.
                1664-042X
                25 February 2022
                2022
                : 13
                : 826212
                Affiliations
                [1] 1Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich , Zürich, Switzerland
                [2] 2University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich , Zürich, Switzerland
                [3] 3Amsterdam Collaboration on Health and Safety in Sports, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC , Amsterdam, Netherlands
                [4] 4Spine Surgery, Department of Orthopaedics, Balgrist University Hospital, University of Zurich , Zurich, Switzerland
                [5] 5University Spine Centre, Department of Orthopaedics, Balgrist University Hospital, University of Zurich , Zurich, Switzerland
                Author notes

                Edited by: Olaf Prieske, University of Applied Sciences for Sports and Management Potsdam, Germany

                Reviewed by: Marita Harringe, Karolinska Institutet (KI), Sweden; Yasuharu Nagano, Japan Women’s College of Physical Education, Japan

                *Correspondence: Jörg Spörri, joerg.spoerri@ 123456balgrist.ch

                This article was submitted to Exercise Physiology, a section of the journal Frontiers in Physiology

                Article
                10.3389/fphys.2022.826212
                8929391
                35309082
                1e02ddab-168c-4fb8-a5d6-86107ebe1995
                Copyright © 2022 Schoeb, Fröhlich, Frey, Verhagen, Farshad and Spörri.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 30 November 2021
                : 28 January 2022
                Page count
                Figures: 2, Tables: 4, Equations: 0, References: 52, Pages: 11, Words: 8125
                Funding
                Funded by: Balgrist Foundation
                Categories
                Physiology
                Clinical Trial

                Anatomy & Physiology
                athletes,traumatic injuries,overuse injuries,neuromuscular performance,injury prevention,alpine skiing

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