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Effectiveness of online tailored advice to prevent running-related injuries and promote preventive behaviour in Dutch trail runners: a pragmatic randomised controlled trial
  1. Luiz Carlos Hespanhol Jr1,2,
  2. Willem van Mechelen1,3,4,5,
  3. Evert Verhagen1,4,6
  1. 1 Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
  2. 2 Department of Physiotherapy, Universidade Cidade de São Paulo, São Paulo, Brazil
  3. 3 Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia
  4. 4 Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  5. 5 School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Dublin, Ireland
  6. 6 Australian Centre for Research into Injury in Sport and Its Prevention, Federation University Australia, Ballarat, Victoria, Australia
  1. Correspondence to Luiz Carlos Hespanhol Jr, Department of Public and Occupational Health and the Amsterdam Public Health research institute, VU University Medical Center Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; l.hespanhol{at}


Background Trail running is popular worldwide, but there is no preventive intervention for running-related injury (RRI).

Aim To evaluate the effectiveness of adding online tailored advice (TrailS6 ) to general advice on (1) the prevention of RRIs and (2) the determinants and actual preventive behaviour in Dutch trail runners.

Methods Two-arm randomised controlled trial over 6 months. 232 trail runners were randomly assigned to an intervention or control group. All participants received online general advice on RRI prevention 1 week after baseline. Every 2 weeks, participants in the intervention group received specific advice tailored to their RRI status. The control group received no further intervention. Bayesian mixed models were used to analyse the data.

Results Trail runners in the intervention group sustained 13% fewer RRIs compared with those in the control group after 6 months of follow-up (absolute risk difference −13.1%, 95% Bayesian highest posterior credible interval (95% BCI) −23.3 to −3.1). A preventive benefit was observed in one out of eight trail runners who had received the online tailored advice for 6 months (number needed to treat 8, 95% BCI 3 to 22). No significant between-group difference was observed on the determinants and actual preventive behaviours.

Conclusions Online tailored advice prevented RRIs among Dutch trail runners. Therefore, online tailored advice may be used as a preventive component in multicomponent RRI prevention programmes. No effect was observed on determinants and actual preventive behaviours.

Trial registration number The Netherlands National Trial Register (NTR5431).

  • evidence-based practice
  • health behavior
  • risk reduction behavior
  • sports injuries
  • comparative effectiveness research

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  • Contributors All authors were involved in the conceptualisation, design and conduction of the study. LCH cleaned, analysed and interpreted the data. All authors were involved in the drafting and revision of the manuscript for intellectual content, and all approved the final version of the article. All authors had full access to the data (including statistical reports and tables) and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding LCH was granted with a CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior) PhD scholarship, process number 0763/12-8, Ministry of Education of Brazil.

  • Competing interests WvM is a director-share holder of VU University Medical Center Amsterdam spin-off company Evalua Nederland ( and non-executive board member of Arbo Unie ( Both companies operate on the Dutch occupational healthcare market, and they have no relationship with the TrailS6 intervention.

  • Ethics approval This study was approved by the medical ethics committee of the VU University Medical Center Amsterdam, the Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.