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Coach-directed education is associated with injury-prevention behaviour in players: an ecological cross-sectional study
  1. James C Brown1,2,
  2. Sugnet Gardner-Lubbe3,
  3. Michael Ian Lambert1,2,
  4. Willem van Mechelen1,2,4,
  5. Evert Verhagen1,2,4,5
  1. 1 Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  2. 2 Department of Public and Occupational Health EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  3. 3 Faculty of Science, Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
  4. 4 Amsterdam Collaboration on Health and Safety in Sports, IOC Research Centre for Prevention of Injury and Protection of Athlete Health, VUmc/AMC, Amsterdam, The Netherlands
  5. 5 Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
  1. Correspondence to Dr James C Brown; jamesbrown06{at}


Background/aim Rugby union (‘rugby’) presents an above-average risk of injury to participants. BokSmart is a South African nationwide intervention that aims to reduce rugby-related injuries in players. This is achieved by educating coaches and referees to improve injury behaviour of players. Thus, the aim of this study was to assess if the receipt of injury-prevention education was associated with player behaviour.

Methods Junior (n=2279) and senior (n=1642) players, who attended merit-based South African Rugby tournaments (2008–2012), completed an anonymous questionnaire. Logistic regressions investigated if player injury-prevention behaviours were associated with the receipt of education on the same topic. Additionally, players' preferred sources of education were explored through frequency and χ2 analyses.

Results Of the 16 injury-prevention behaviours, 12 (75%) were associated with receiving education on that topic. The four behaviours not associated with education were: warming-up (before training and matches), and avoiding heat and massage post injury. Of the seven possible sources of this education, the majority of players chose either coaches or physiotherapists as their preferred media. In comparison with junior players, more senior players chose physiotherapists instead of coaches for warming-up and cooling-down education.

Conclusions The results of this study support, to a large degree, the strategy of BokSmart—influence of player behaviour through coach education. However, these findings also suggest that BokSmart could target team physiotherapists in addition to coaches and referees with their safety education. Also, players might have different preferences for this education depending on their age.

  • Cohort study
  • Intervention effectiveness
  • Behaviour
  • Football

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  • Twitter Follow James Brown @jamesbrown06, Michael Lambert @MikeLambert01 and Evert Verhagen @Evertverhagen

  • Contributors JCB conceived and planned the analyses and wrote the article. SG-L performed the initial analyses. JCB revised the analyses after input from other authors (MIL, WVM and EV). All authors revised and checked final version of the manuscript.

  • Funding JCB received PhD funding from the SAVUSA/NRF Desmond Tutu Doctoral Programmes to complete this study. Furthermore, JCB is now a Postdoctoral Research Fellow paid by the BokSmart programme and Chris Burger/Petro Jackson Players' Fund.

  • Competing interests None declared.

  • Ethics approval Human Research Ethics Committee of the University of Cape Town.

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

  • Data sharing statement The data that were analysed are owned by SA Rugby, but are available for sharing should SA Rugby agree.