The systematic development of a tennis injury prevention programme - a great example of our Knowledge Transfer Scheme in practice

Tennis is one of the most practised individual sports in the world. Estimates show that approximately 75 million people practise tennis worldwide. Playing tennis has proven cardiovascular health benefits and is even associated with decreased all-cause mortality. The downside is the injury rate of up to 3.0/1000 hours of tennis. These injuries have an important (economic) impact. A recent Dutch report showed that 43% of the injuries among tennis players were treated (para)medically, leading to an emergency room treatment cost of €3.6 million Indirect costs due to loss of work were estimated at €8.3 million. Extrapolating these numbers, the worldwide impact of tennis-related injuries can be considered significant and prevention, as such, is necessary. 

Exercise-based injury prevention strategies in sports have been frequently evaluated.  A meta-analysis of 36 randomised controlled trials has shown that most of these interventions are effective in reducing the number of injuries. The majority of trials have been conducted in team sports, such as basketball, volleyball, football (soccer) and tackle collision ball sports (eg, rugby union). For individual sports, the literature is limited to running athletes. Only three randomised controlled trials for exercise-based prevention in runners have been published, which all showed no significant reduction in injury rates. Given the global individual sports participation exceeds team participation, the lack of evidence-based prevention intervention is a call for action.

Previously, intervention mapping (IM) was commonly applied for the development of this type of interventions. However, a novel programme, the Knowledge Transfer Scheme (KTS), was recently published. The KTS is a practical five-step tool for developing intervention strategies in sports. The fundament of the KTS is the direct translation of evidence into practice. Prospected users are involved throughout the KTS process; however, the resulting intervention is based on findings from literature reviews. The KTS can thus lead to a more evidence-based and user-friendly product or programme. Using KTS, in this project an e-health intervention was developed for recreational tennis players in the Netherlands.

Flow chart of the development process.

Flow chart of the development process.

  • During step 1, a problem statement among targeted users was carried out. 475 (partially) completed surveys and group interviews (n=8) revealed a preference for an app-based prevention intervention of 10–15 min.
  • As step 2, a systematic review was performed to identify prevention strategies in tennis. None were found.
  • In step 3, during two expert group meetings (n=18), the findings of the first two steps were discussed and goals were formulated. Relevant and potential exercises for the programme were discussed.
  • A subgroup of a total of six physical therapists, physicians and trainers developed the content of the programme in step 4.
  • Step 5 included an evaluation of the exercises in 33 recreational tennis players. Participants evaluated the exercises during training sessions with trainers involved in the programme’s development or their colleagues. Participants evaluated the programme through standardised surveys or group interviews. Based on this evaluation, the programme was adjusted by altering exercises and frequencies, and it was evaluated in a second target group (n=27). The second evaluation did not result in any major changes to the final prevention programme.

Through a five-step approach guided by the Knowledge Transfer Scheme, this project developed an e-health tennis-specific prevention programme for adult tennis players. This 10 min intervention will require testing in a randomised controlled setting which is currently undergoing.

The full article can be accessed here (open access)

Pas HIMFL, Bodde S, Kerkhoffs GMMJ, et al. Systematic development of a tennis injury prevention programme. BMJ Open Sport & Exercise Medicine 2018;4:e000350–7. doi:10.1136/bmjsem-2018-000350