A framework to raise the bar for adherence in sport injury prevention research

We are excited to have been a partner in this important editorial that touches the core of our views and recent approaches to injury prevention (also read this). This editorial highlights the importance of adherence in sport injury prevention research and practice, and provides a framework to raise the bar for sport injury prevention adherence research.

Over the past two decades, sport injury prevention research has developed innovative and proven interventions for injury prevention in athletes. However, most interventions have been developed without the optimal implementation context in mind. Researchers provide evidence of intervention efficacy and as much public advocacy as possible, more like the 'prescribe and educate’ tradition. Unfortunately, the challenge of non-adherence remains palpable.

Currently, very little information is available on adherence in existing sport injury prevention literature, as most studies have been efficacy trials that have focused on compliance. There is a need to advance sport injury prevention research by focusing more on implementation outcomes such as intervention adherence.

To minimise the problem of low and non-adherence, we advise a fair balance between evidence and ongoing consultations with intended users throughout programme development. While this suggestion is fundamental for successful implementation, identifying and modifying determinants of adherence remain a worthwhile research challenge for new and existing interventions.

 Proposed research framework for the development of effective adherence strategies (adapted from the  ‘sequence of prevention’).

Proposed research framework for the development of effective adherence strategies (adapted from the  ‘sequence of prevention’).

Measures of adherence to exercise-based interventions

  • Utilisation frequency: e.g. sessions completed per week.
  • Utilisation fidelity: e.g. components completed of total possible per session.

  • Duration fidelity: e.g. sessions completed in prescribed time of total possible.

  • Exercise fidelity: e.g. proportion of players performing all aspects of exercises correctly.

  • Cumulative utilisation: e.g. sessions completed of total possible.

The full paper can be accessed here (not open access unfortunately)

Owoeye OBA, McKay CD, Verhagen E, et al. Advancing adherence research in sport injury prevention. Br J Sports Med 2018;:bjsports–2017–098272. doi:10.1136/bjsports-2017-098272