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Effectiveness of an e-health tennis-specific injury prevention programme: randomised controlled trial in adult recreational tennis players
  1. Haiko Ivo Maria Franciscus Lodewijk Pas1,2,3,4,
  2. Babette M Pluim3,5,6,
  3. Ozgur Kilic1,2,3,
  4. Evert Verhagen3,7,
  5. Vincent Gouttebarge1,2,3,8,9,
  6. Rebecca Holman10,
  7. Maarten H Moen1,11,12,
  8. Gino M Kerkhoffs1,2,3,
  9. Johannes L Tol2,3,13
  1. 1 Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  2. 2 Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  3. 3 Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam UMC IOC Research Center of Excellence, Amsterdam, The Netherlands
  4. 4 Northwest Hospital group location Alkmaar, Department of Pulmonary Medicine, Alkmaar, The Netherlands
  5. 5 Royal Netherlands Lawn Tennis Association, Amstelveen, The Netherlands
  6. 6 Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Hatfield, South Africa
  7. 7 Department of Public and Occupational Health, Amsterdam UMC, VU University, Amsterdam Movement Sciences, Amsterdam, The Netherlands
  8. 8 Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
  9. 9 Dutch Consumer Safety Institute, Amsterdam, The Netherlands
  10. 10 Clinical Research Unit, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
  11. 11 Department of Sports Medicine, Bergman Clinics, Naarden, The Netherlands
  12. 12 The Sports Physician Group, Onze Lieve Vrouwe Gasthuis West, Amsterdam, The Netherlands
  13. 13 Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  1. Correspondence to Dr Johannes L Tol, Sports Medicine, Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar; j.l.tol{at}


Background Despite reported injury rates of up to 3 per 1000 hours exposure, there are no evidence-based prevention programmes in tennis.

Purpose To evaluate the effectiveness of an e-health prevention programme for reducing tennis injury prevalence.

Study design Two-arm, researcher-blinded randomised controlled trial.

Methods Adult tennis players of all playing levels were randomised in an unsupervised programme lasting 12 weeks (TennisReady group or control group). The primary outcome was the overall injury prevalence over a 16-week period, measured at 2 weekly intervals with the Oslo Sports and Trauma Research Centre questionnaire. Estimates for the primary outcome and associated 95% CIs were obtained using generalised estimating equation models. Secondary outcome scores included prevalence of substantial injuries, overall incidence, adherence and time-loss injuries.

Results A total of 579 (83%) (TennisReady n=286, control n=293) participants were included in the primary analysis. The mean injury prevalence was 37% (95% CI 33% to 42%) in the TennisReady vs 38% (95% CI 34% to 42%) in the control group (adjusted p-value 0.93). The prevalence of substantial injuries was 11% (95% CI 9% to 14%) in the TennisReady vs 12% (95% CI 9% to 15%) in the control group (p value of 0.79). Analysis of the secondary outcome scores showed no difference between groups. The mean prevalence rates between high (8%) and low (92%) adherent groups were 32% (95% CI 23% to 44%) and 37% (95% CI 33% to 42%), respectively (p value 0.36).

Conclusion Providing an unsupervised e-health tennis-specific exercise programme did not reduce the injury rates and should not be implemented.

Trial registration number NTR6443.

  • tennis
  • Injury prevention
  • Exercise
  • App
  • Randomised controlled trial

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  • Twitter @docpluim, @Evertverhagen, @vgouttebarge

  • Contributors HIMFLP, JLT, VG, EV and BMP were involved in the design of the trial. HIMFLP, JLT, BMP and OK were involved in the recruitment. HIMFLP and OK were involved in the data collection. RH designed the statistical plan and performed the statistical analysis. HIMFLP was responsible for drafting the manuscript. All authors reviewed and agreed on the manuscript.

  • Funding The study was partly funded by a grant (grant number 50-53600-98-015) from the Netherlands Organization for Health Research and Development, a governmental institution that finances research to improve healthcare in the Netherlands.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The medical ethics committee of the Academic Medical Center Amsterdam gave permission for the study with an exempt status (qualified as non-WMO obliged research, W16_321 17.066). The study protocol was registered in the Dutch trial register (NTR6443).

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. -