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  1. B Frank1,
  2. J Register-Mihalik2,
  3. S Marshall3,
  4. D Padua1
  1. 1Sports Medicine Research Laboratory; The University of North Carolina at Chapel Hill, Chapel Hill, USA
  2. 2Emergency Services Institute; WakeMed Health & Hospitals, Raleigh, USA
  3. 3Injury Prevention Research Center; The University of North Carolina at Chapel Hill, Chapel Hill, USA


Background There is limited evidence describing methods and challenges for implementing anterior cruciate ligament (ACL) injury prevention programs (IPP) in a “real-world” context.

Objective Evaluate the effects of a ACL IPP workshop on elite-division youth soccer coaches' behavioral determinants to implement a ACL IPP, and describe coaches' subsequent ACL IPP implementation compliance.

Design Descriptive study.

Setting Elite-division youth soccer club.

Participants A convenient sample of 34 soccer coaches (age=34.6±9.1 yrs) of elite-division youth soccer club teams.

Interventions We administered a workshop aimed at increasing coaches' behavioral determinants to implement a ACL IPP. Coaches were provided with instructional materials following the workshop.

Main outcome measurements Coaches' behavioral determinants regarding ACL IPP using pre/post-workshop surveys and coaches' subsequent rate and fidelity of implementation of the ACL IPP during the following soccer season.

Results Wilcoxon signed-rank tests indicated the workshop increased coach attitude toward; conducting a ACL IPP (P=.020), substituting a ACL IPP for a warm-up (P=.007), and improving player cutting and landing technique by implementing a ACL IPP (P=.001). The workshop increased coaches' perceived behavioral control; coaches felt more comfortable in their ability to teach their team a ACL IPP (P=.002) and more confident leading a ACL IPP if given instructions (P=.025). The workshop increased coaches' intent to implement a ACL IPP the next season (P<.001); for 15 minutes (P=.008) and 20 minutes (P=.011) prior to the start of a training session. Only 53% of the club's teams implemented the ACL IPP, with implementers demonstrating high variability in program fidelity.

Conclusions ACL IPP workshops can effectively increase coach attitudes, perceived behavioral control, and intent to implement a ACL IPP. However, amplification of behavioral determinants does not appear to directly translate to high-level implementation compliance. Future research should investigate supplementary strategies to facilitate optimal ACL IPP implementation to improve compliance.

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