title: Preventive Neuromuscular Training for Young Female Athletes: Comparison of Coach and Athlete Compliance Rates.
abstract: BACKGROUND
  Fewer athletic injuries and lower anterior cruciate ligament injury incidence rates were noted in studies of neuromuscular-training (NMT) interventions that had high compliance rates. However, several groups have demonstrated that preventive NMT interventions were limited by low compliance rates.
  
  
  OBJECTIVE
  To descriptively analyze coach and athlete compliance with preventive NMT and compare the compliance between study arms as well as among school levels and sports.
  
  
  METHODS
  Randomized, controlled clinical trial.
  
  
  METHODS
  Middle and high school athletic programs. Participants or Other Participants: A total of 52 teams, comprising 547 female athletes, were randomly assigned to the experimental or control group and followed for 1 athletic season.
  
  
  METHODS
  The experimental group (n = 30 teams [301 athletes]: 12 basketball teams [125 athletes], 6 soccer teams [74 athletes], and 12 volleyball teams [102 athletes]) participated in an NMT program aimed at reducing traumatic knee injuries through a trunk-stabilization and hip-strengthening program. The control group (n = 22 teams [246 athletes]: 11 basketball teams [116 athletes], 5 soccer teams [68 athletes], and 6 volleyball teams [62 athletes]) performed a resistive rubber-band running program.
  
  
  METHODS
  Compliance with the assigned intervention protocols (3 times per week during the preseason [mean = 3.4 weeks] and 2 times per week in-season [mean = 11.9 weeks] of coaches [coach compliance] and athletes [athlete compliance]) was measured descriptively. Using an independent t test, we compared coach and athlete compliance between the study arms. A 2-way analysis of variance was calculated to compare differences between coach and athlete compliance by school level (middle and high schools) and sport (basketball, soccer, and volleyball).
  
  
  RESULTS
  The protocols were completed at a mean rate of 1.3 ± 1.1 times per week during the preseason and 1.2 ± 0.5 times per week in-season. A total of 88.4% of athletes completed 2/3 of the intervention sessions. Coach compliance was greater in the experimental group than in the control group (P = .014). Coach compliance did not differ by sport but was greater at the high school than the middle school (P = .001) level. Athlete compliance did not differ by study arm, sport, or school level.
  
  
  CONCLUSIONS
  Athletes received instruction in about 50% of each protocol. Nearly 90% of athletes performed more than 2/3 of the assigned NMT interventions. The assigned intervention was performed more often in the experimental arm compared with the control arm. Coaches at the high school level complied with the given protocol more than middle school coaches did. Athletes complied well with the protocol, but coaches did not, especially at the middle school level.
authors.affiliation: The Micheli Center for Sports Injury Prevention, Waltham, MA.|Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, MA.
authors.forename: Dai
authors.initials: D
authors.lastname: Sugimoto
authors.affiliation: Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington.
authors.forename: Carl G
authors.initials: CG
authors.lastname: Mattacola
authors.affiliation: Department of Biostatistics, College of Public Health, University of Kentucky, Lexington.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Bush
authors.affiliation: The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, OH.
authors.forename: Staci M
authors.initials: SM
authors.lastname: Thomas
authors.affiliation: The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, OH.
authors.forename: Kim D Barber
authors.initials: KD
authors.lastname: Foss
authors.affiliation: The Micheli Center for Sports Injury Prevention, Waltham, MA.|The SPORT Center, Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, OH.|Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, OH.|Department of Orthopaedics, University of Pennsylvania, Philadelphia.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Myer
authors.affiliation: Mayo Clinic Biomechanics Laboratories and Sports Medicine Center, Departments of Orthopedics, Physical Medicine and Rehabilitation and Physiology & Biomedical Engineering, Mayo Clinic, Rochester and Minneapolis, MN.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Hewett
mesh_terms: D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries / Q000517:prevention & control; D056352:Athletes / Q000706:statistics & numerical data; D001265:Athletic Injuries / Q000517:prevention & control*; D001490:Basketball / Q000293:injuries; D002648:Child; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000517:prevention & control*; D010349:Patient Compliance; D011446:Prospective Studies; D012572:School Health Services; D012574:Schools / Q000706:statistics & numerical data; D012916:Soccer / Q000293:injuries; D013178:Sports Medicine / Q000706:statistics & numerical data; D054798:Volleyball / Q000293:injuries
keywords: anterior cruciate ligament; athletic injuries; high school; knee; middle school