Primary Prevention of Sport-Related Concussion in Youth Ice Hockey: A Pilot Randomized Controlled Trial
K. J. Schneider, PT, PhD,*,†,‡,§,¶ P. Eliason, MSc,*,†,‡ C. van Rassel, MKin,* C. Hilson,* S. Sick, BSc, CAT(C),*,§ L. Miutz, MS,* and C. A. Emery PT, PhD*,†,‡
Affiliations: *Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; †Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada; ‡Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; §Acute Sport Concussion Clinic, Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; and ¶Evidence Sport and Spinal Therapy, Calgary, AB, Canada.
Objective: (1) To evaluate the feasibility of a concussion prevention training program in youth ice hockey players; and (2) evaluate the efficacy of a concussion prevention program in decreasing the risk of concussion.
Study Design: Pilot randomized controlled trial (RCT).
Subjects: Youth ice hockey players (ages 13-17) from Calgary, Alberta.
Intervention: A study physiotherapist visited teams weekly for six weeks and both teams received standard concussion education and identification. Players on control teams completed their typical warm-up and practice, and were observed by the study physiotherapist. Players on intervention teams completed a progressive training program (10-20 minutes per session) including neuromuscular and sensorimotor training, balance, adaptation, cervical spine strength and dividing attention, both on-and off-ice. A series of exploratory measures including symptoms, vestibulo-ocular reflex, dynamic balance, divided attention, cervical spine, oculomotor and Hockey Canada Skills Testing were completed before and after the intervention.
Outcome Measures: Recruitment rates, completion rates, retention rates, time to complete and safety were used to evaluate feasibility. Diagnosis of sport-related concussion was defined as per the fifth Consensus Statement on Concussion in Sport.
Results: A total of 118 players [83 males; 35 females; median age: 14 (range, 13-18 years)] from 8 teams consented to participate in this study. All control teams and 3/4 of the intervention teams completed all 6 sessions over a median of 85 days (range, 42-102 days). Timing of training sessions (eg, too close to finishing school) and lack of space to complete the intervention or control resulted in a longer duration of the protocol. No adverse events were reported. There were 6 concussions in the intervention group (n = 65) and 4 in the control group (n = 53). Exploratory univariate Poisson regression analysis adjusted for cluster by team revealed no difference in concussion risk between groups [Incidence proportion (IP) = 0.99 (95% CI, 0.28-3.48)].
Conclusions: The implementation of a neuromuscular and sensorimotor training program with youth ice hockey teams appears safe and feasible. Future evaluation in a larger sample powered to understand the effects of intrinsic training strategies on the risk of concussion in youth ice hockey players, including consideration of sex and age group, is warranted.
Acknowledgments: We acknowledge funding from Hotchkiss Brain Institute/Department of Clinical Neurosciences Pilot Research Fund Program (PFUN), University of Calgary; Alberta Children's Hospital Foundation, Alberta Children's Hospital Research Institute, and Canadian Institutes of Health Research (CIHR). Thank you to Hockey Calgary for supporting this project. We acknowledge and would like to thank all the research coordinators: Cody van Rassel, Stacy Sick, and Shane Virani. This research would not have been possible without the hard work of the study therapists, study physicians, team therapists, team designates, coaches, players and parents. The Sport Injury Prevention Research Centre is one of the International Olympic Committee Research Centers for the Prevention of Injury and Protection of Athlete Health.
A School-Based Neuromuscular Training Warm-up Program Is Effective in Preventing All Injuries: The Isprint Cluster-Randomized Controlled Trial
Carolyn Emery,*,†,‡ Carla van den Berg,* Sarah A. Richmond,*,§ Luz Palacios-Derflingher,*,† Alberto Nettel-Aguirre,*,†,‡ Megan McKinlay,¶ Patricia Doyle-Baker,* and Brent Hagel*,†,‡
Affiliations: *Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada; †Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; ‡Department of Pediatrics, Cumming School of Medicine, University of Calgary; §Public Health Ontario, Toronto, Ontario, Canada; and ¶Ever Active Schools, Calgary, Alberta, Canada.
Objective: To evaluate the effect of iSPRINT, a neuromuscular training (NMT) warm-up program implemented in physical education (PE) classes, on preventing sport and recreational (S&R) injuries in junior high school students.
Study Design: Cluster-randomized controlled trial.
Subjects: 1065 grade 7 to 9 students (53.7% female) from 12 junior high schools in Calgary and surrounding area between 2014 and 2017.
Intervention: iSPRINT (“Implementing a School Prevention program to Reduce Injuries through Neuromuscular Training”) is a NMT warm-up including aerobic, agility, strength, and balance exercises. Teachers in intervention schools (n = 6) implemented iSPRINT at the beginning of PE classes over a 12-week period; control schools (n = 6) used a standard-of-practice warm-up including aerobic exercises and static and dynamic stretching. All teachers participated in a pre-program workshop; only intervention schools participated in NMT components, receiving training resources including a NMT video and posters.
Outcome Measures: Included injuries were those sustained during a sport or recreational (S&R) activity that resulted in the inability to complete a session, time loss and/or medical attention. Injuries were assessed weekly and recorded by a Certified Athletic Therapist who was blinded from study group allocation. Incidence rate ratios (IRR) were estimated based on multivariable Poisson regression analyses (adjusting for sex, previous injury and clustering by class, offset by S&R participation hours) for all injuries, lower extremity injuries and medically-treated injuries.
Results: Students in the iSPRINT intervention schools demonstrated a 38% lower rate of all injuries [adjusted IRR (aIRR) = 0.62; 95% CI, 0.39-0.98], a 62% lower rate of lower extremity injuries (aIRR = 0.38; 95% CI, 0.22-0.66), and a 63% lower rate of medically-treated injuries (aIRR = 0.37; 95% CI, 0.20-0.67) compared with students in the control schools. The incidence rate of all injuries was significantly higher in females compared to males (1.58, 95% CI, 1.12-2.22) and in participants with a previous injury compared to no previous injury (IRR = 2.14; 95% CI, 1.40-3.24).
Conclusions: The iSPRINT program was effective in preventing all injuries, lower extremity injuries, and medically-treated injuries in junior high school students. Teachers should include NMT warm-ups in their PE programming for injury prevention and to support continued physical activity participation.
Acknowledgments: The University of Calgary Sport Injury Prevention Research Centre is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee. We acknowledge participation from the students and teachers in the Calgary Board of Education and Calgary Catholic School District.