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Implementing a junior high school-based programme to reduce sports injuries through neuromuscular training (iSPRINT): a cluster randomised controlled trial (RCT)
  1. Carolyn A Emery1,2,
  2. Carla van den Berg1,
  3. Sarah Ann Richmond3,4,
  4. Luz Palacios-Derflingher1,5,
  5. Carly D McKay6,
  6. Patricia K Doyle-Baker7,
  7. Megan McKinlay8,
  8. Clodagh M Toomey1,
  9. Alberto Nettel-Aguirre2,
  10. Evert Verhagen9,
  11. Kathy Belton10,
  12. Alison Macpherson11,
  13. Brent E Hagel2
  1. 1 Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  2. 2 Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3 Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
  4. 4 Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  5. 5 Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  6. 6 Department for Health, University of Bath, Bath, UK
  7. 7 Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  8. 8 Ever Active Schools, Calgary, Alberta, Canada
  9. 9 Department of Public and Occupational Health, Amsterdam Collaboration for Health and Safety in Sports, Amsterdam University Medical Center, Amsterdam, The Netherlands
  10. 10 School of Public Health, University of Alberta, Edmonton, Alberta, Canada
  11. 11 Faculty of Health, York University, Toronto, Ontario, Canada
  1. Correspondence to Dr Carolyn A Emery, Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; caemery{at}


Objective To evaluate the effectiveness of a junior high school-based sports injury prevention programme to reduce injuries through neuromuscular training (NMT).

Methods This was a cluster randomised controlled trial. Students were recruited from 12 Calgary junior high schools (2014–2017). iSPRINT is a 15 min NMT warm-up including aerobic, agility, strength and balance exercises. Following a workshop, teachers delivered a 12-week iSPRINT NMT (six schools) or a standard-of-practice warm-up (six schools) in physical education classes. The definition of all recorded injuries included injuries that resulted in participants being unable to complete a sport and recreation (S&R) session, lost time from sport and/or seek medical attention. Incidence rate ratios (IRRs) were estimated based on multiple multilevel Poisson regression analyses (adjusting for sex (considering effect modification) and previous injury, offset by S&R participation hours, and school-level and class-level random effects were examined) for intent-to-treat analyses.

Results 1067 students (aged 11–16) were recruited across 12 schools (6 intervention schools (22 classes), 6 control schools (27 classes); 53.7% female, 46.3% male). The iSPRINT programme was protective of all recorded S&R injuries for girls (IRR=0.543, 95% CI 0.295 to 0.998), but not for boys (IRR=0.866, 95% CI 0.425 to 1.766). The iSPRINT programme was also protective of each of lower extremity injuries (IRR=0.357, 95% CI 0.159 to 0.799) and medical attention injuries (IRR=0.289, 95% CI 0.135 to 0.619) for girls, but not for boys (IRR=1.055, 95% CI 0.404 to 2.753 and IRR=0.639, 95% CI 0.266 to 1.532, respectively).

Conclusion The iSPRINT NMT warm-up was effective in preventing each of all recorded injuries, lower extremity injuries and medically treated S&R injuries in female junior high school students.

Trial registration number NCT03312504

  • adolescent
  • injury prevention
  • injuries
  • randomised controlled trial

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  • Twitter @CarolynAEmery, @clo2me

  • Contributors CE, SAR, LP-D, CDM, PKD-B, AN-A, EV, KB, AM and BEH contributed to the study proposal development. CvdB and LP-D contributed to data collection, entry and data cleaning. CE, CvdB, LP-D, AN-A and BEH contributed to data analysis and interpretation of study results. CE, SAR, LP-D, CDM, PKD-B, AN-A, EV, AM and BEH contributed to acquisition of funding and study design. CE and BEH led all aspects of the cohort. All authors critically reviewed and edited the manuscript before submission.

  • Funding This study was funded by Alberta Innovates Health Solutions (Collaborative Research and Innovation Opportunities Program Grant 3685). CE is funded through a Chair in Pediatric Rehabilitation (Alberta Children’s Hospital Foundation).

  • Competing interests None declared.

  • Patient and public involvement statement Ever Active Schools was involved as the knowledge broker community partner, contributing to approval of study design, study recruitment, injury surveillance methods, development of intervention and control group programmes, support of school-based therapist role, and dissemination of research findings within the school community. The research questions and outcome measures were developed and informed by the priorities, experience and preferences of Ever Active Schools, Calgary Board of Education and Calgary Catholic School Board. Junior high school students, parents, teachers and administrators in the Calgary Board of Education and Calgary Catholic School Board were dedicated to the collection of weekly exposure data, identification of a student with a suspected injury and supporting communication with the research team for injury follow-up. A knowledge broker from Ever Active Schools (MM) informed the methods and time commitment for study participation by students and parents and teachers. Partners from Ever Active Schools, Calgary Board of Education and Calgary Catholic School Board have received an executive report of the study findings based on preliminary results and abstract presented at the Canadian Academy of Sport and Exercise Medicine (2018) and will inform dissemination of final study results in the school community once the final manuscript results are published. The Injury Prevention Centre and the Sport Injury Prevention Research Centre will contribute to evidence-informed safety guideline updates for Alberta schools.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was received from the University of Calgary Conjoint Health Research Ethics Board (Ethics ID REB14-0470) and both school boards prior to commencing recruitment.

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

  • Data availability statement No data are available.