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Objective The aim of this study was to explore expert opinion to identify the components of sprinting technique they believed to be risk factors for hamstring strain injuries (HSI). Design Mixed-method research design. Methods The Concept Systems groupwisdom™ web platform was used to analyse and collect data. Participants brainstormed, sorted and rated the components of sprinting technique to consider in a HSI prevention strategy. Results Twenty-three experts (academic/researcher, physiotherapist, strength and conditioning coaches and sprint coaches) brainstormed 66 statements that were synthesised and edited to 60 statements. Nineteen participants sorted the statements into clusters and rated them for relative importance and confidence they could be addressed in a hamstring injury prevention program. Multidimensional scaling and cluster analysis identified a 8-cluster solution modified to a 5-cluster solution by the research team: Training prescription (10 statements, mean importance: 3.79 out of 5 and mean confidence: 3.79); Neuromuscular and tendon properties (9, 3.09, 3.08); Kinematics parameters/Technical skills (27, 2.99, 2.98); Kinetics parameters (10, 2.85, 2.92); and Hip mechanics (4, 2.70, 2.63). The statement: “low exposure to maximal sprint running” located in the cluster “Training prescription” received the highest mean importance (4.55) and confidence ratings (4.42) of all statements. Conclusion The five clusters of components of sprinting technique believed to be risk factors for HSIs in order of most to least important were: training prescription, neuromuscular and tendon properties, kinematics parameters/technical drills, kinetics parameters and hip mechanics.

Objectives To engage physiotherapists experienced in female elite sport and athletes to co-create a sport-specific anterior cruciate ligament (ACL) injury risk reduction program. Design Concept Mapping. Methods The Concept Systems Global MAX™ web platform was used to collect and analyse data from 27 context and content experts (22 physiotherapists, 5 athletes). Participants brainstormed statements representing the critical elements that should be included in an ACL injury risk reduction program for women playing elite Australian Football (AF). Results Twenty-two participants brainstormed 56 statements that were synthesised and edited to 62 statements. Statements were sorted into clusters by twenty-three participants and rated on importance and feasibility using six-point scales. Multidimensional scaling and cluster analysis identified a 5-cluster solution as follows: Football-specific preparation (15 statements); Movement skills (17 statements); Strength and conditioning (15 statements); Individual preparation (7 statements); and Education (8 statements). Calculation of mean ratings for each cluster and statement identified the Movement skills cluster as most important (mean = 3.61 out of 5) and the Football-specific preparation cluster as most feasible (3.75 out of 5). By contrast, the Individual preparation cluster was rated the least important (mean = 2.9 out of 5), and the least feasible (3.12 out of 5), to include in the program. Conclusions The five clusters of critical elements to include in an ACL injury risk reduction program for women playing elite AF, in order of most to least importance were: movement skills, football-specific preparation, education, strength and conditioning and individual preparation.

Primary: To gain a system-wide perspective on factors leading to athlete attrition from a high-performance sport system (HPSS). Secondary: To identify what a sample of system-wide stakeholders and past athletes value as the most important and feasible attrition factors to address to retain talented athletes.Mixed-methods.Concept mapping was used for qualitative data collection and quantitative data analysis. Sixty-one participants including: (i) past athletes from an Australian state sporting institute; (ii) their families; and (iii) internal and external stakeholders to a HPSS who supported past athletes.Participants brainstormed 83 unique statements (i.e. attrition factors) that were mapped into 13 clusters of attrition factors following multidimensional scaling and hierarchical cluster analysis performed on the participants sorting data: 'abuse and mismanagement of health'; 'athlete health'; 'limited support/resourcing'; 'coaching'; 'inconsistent processes'; 'financial and career support'; 'pathway structure'; 'organisational dynamics'; 'competitive stress'; 'performance potential'; 'challenges with selection and transition'; 'psychological state'; and 'competing non-sport priorities'. 'Abuse and mismanagement of health' had the highest mean importance (3.76 out of 5) and feasibility (3.31) rating. The 13 clusters were further grouped into four overarching domains: 'sport system policy, structure and processes'; 'pathway structure, transition and support'; 'individual athlete health and capability'; and 'whole-of-life demands and priorities'. The domain 'sport system policy, structure and processes' contained the most important and feasible clusters.Macro (system-level) and micro (intrapersonal and interpersonal) level athlete attrition factors should be considered together. Athlete health was considered the most important athlete retention issue to address.

Objectives To obtain benefits from sports injury prevention programs, players are instructed to perform the exercises as prescribed. We developed an observational checklist to measure the quality of exercise performance by players participating in FootyFirst, a coach-led, exercise-based, lower-limb injury prevention program in community Australian Football (AF). Design Observational. Methods The essential performance criteria for each FootyFirst exercise were described in terms of the technique, volume and intensity required to perform each exercise. An observational checklist was developed to evaluate each criterion through direct visual observation of players at training. The checklist was trialled by two independent raters who observed the same 70 players completing the exercises at eight clubs. Agreement between observers was assessed by Kappa-statistics. Exercise fidelity was defined as the proportion of observed players who performed all aspects of their exercises correctly. Results The raters agreed on 61/70 observations (87%) (Kappa = 0.72, 95% CI: 0.55; 0.89). Of the observations with agreed ratings, 41 (67%) players were judged as performing the exercises as prescribed. Conclusions The observational checklist demonstrated high inter-rater reliability. Many players observed did not perform the exercises as prescribed, raising concern as to whether they would be receiving anticipated program benefits. Where quality of exercise performance is important, evaluation and reporting of program fidelity should include direct observations of participants.

Objectives The “Mayday Safety Procedure” (MSP) is included in the Australian Rugby Union (ARU) Medical and Safety Recommendations and the mandatory SmartRugby training for coaches. Previous research indicates that translating the Mayday Safety Procedure into practice among community rugby coaches is challenging. This study investigated whether Mayday Safety Procedure translation could be enhanced by systematically planning and implementing a range of theory-informed and context-specific diffusion strategies. Design A controlled before-and-after study. Methods Coaches of senior community rugby teams in five zones in New South Wales (Australia) were invited to complete a questionnaire about their Mayday Safety Procedure knowledge and practice at the end of the 2010 and 2011 rugby seasons. During 2011, coaches in the intervention zone were exposed to a range of strategies to promote Mayday Safety Procedure diffusion which were planned by following Step 5 of the Intervention Mapping protocol. Coaches in the other four zones were exposed to usual strategies to promote Mayday Safety Procedure diffusion. Results Using the RE-AIM evaluation framework, statistically significant improvements were found among intervention zone coaches in: knowledge of most Mayday Safety Procedure key criteria; the number of coaches recognising their zone policy requiring them to train players in the Mayday Safety Procedure; frequency of provision of Mayday Safety Procedure training to players; coach perceptions of the quality of Mayday Safety Procedure training for players; and in confidence that referees could implement the Mayday Safety Procedure during a game if required. Conclusions The findings suggest that the translation of injury prevention policy into community practice can be enhanced by developing and implementing a theory-informed, context-specific diffusion plan, undertaken in partnership with key stakeholders.

Objectives Energy-dense, nutrient-poor food and drink (‘junk food’) brands sponsoring sport is a growing public health concern. This study explored sports administrators' perceptions of the barriers to rejecting junk food sponsorship. Study design This study used concept mapping. Methods The Concept Systems Global MAX™ web platform was used to collect and analyse data from 29 sports administrators across all levels of sport in Victoria, Australia. Results Brainstorming generated 33 barriers to rejecting junk food sponsorship. After the barriers were synthesised and edited, participants sorted and rated 32 barriers. Multidimensional scaling and hierarchical cluster analysis identified a four-cluster solution: community attitudes and values (seven barriers); junk food is the easy sell (retail; five barriers); financial viability (16 barriers); and organisational capability (policy and governance; four barriers). The financial viability barriers were rated the most important (mean = 3.65 of 5) and the hardest to overcome (1.42). The organisational capability (policy and governance) barriers were rated the least important (2.14) and the easiest to overcome (3.20). Conclusions Sports administrators clearly perceive that rejecting junk food sponsorship could place significant financial strain on their organisations. There appears to be considerable scope to build the capacity of sporting organisations to rejecting junk food sponsorship. Despite the literature indicating that most parents think junk food companies are not suitable sponsors, sports administrators perceive that there is a broad public acceptance of junk food sponsorship in sport. The fact that sports administrators perceive a link between junk food sponsorship and the lack of healthy options at club canteens and venue food outlets adds an additional, not previously identified, level of complexity to the junk food sponsorship in sport debate.

Physical inactivity (PI), a leading modifiable cause of disease and injury, is endemic in industrialised nations. Although considerable research has been undertaken in this field, we lack a system to synthesise the research literature to inform policy and identify research needs. The aims of this study were to (1) develop a system to classify physical inactivity intervention studies, (2) examine the distribution of PI interventions published in the peer-reviewed health literature using the system, and (3) consider implications for future research. We developed the Physical Inactivity Matrix (PIM), with 12 intervention points, created by the intersection of two dimensions: the intervention target (individual, physical environment and social/cultural environment) and the activity focus (transport, work/school, leisure and consumer). A formal search of the health research literature identified 529 eligible studies and each was classified into one of the 12 cells of the PIM. Most studies were categorised as: individual-leisure (68%), individual-work/school (12%) or social/cultural environment-leisure (13%). Only 4% targeted the physical environment. The findings of this initial application of the PIM support the call for greater investment in policies, interventions and research that focus on the relationship between the environment and PI, and transportation in particular. There would be merit in establishing the inter-rater reliability of the PIM and applying it to a wider variety of studies, including those published in the transportation and urban planning literatures. The PIM could be a useful tool for monitoring trends in research directions and funding levels over time and across countries.

Despite increased national effort directed at sports injury prevention in Australia since the mid 1990s, there is a lack of information available about the sports safety policies and practices of community sports clubs. The aim of this study was to develop a valid and reliable sports safety audit tool (SSAT) to identify these safety policies and practices. A literature review identified issues to be covered by the SSAT. Consultation with "experts" and piloting the SSAT with 19 community sports clubs in metropolitan Sydney established face and content validity. Test-retest reliability was assessed in six clubs. Inter-rater reliability was assessed using twenty-four independent representatives from eight clubs. Face and content validity studies identified issues to include in the SSAT and improvements to language and layout. Test-retest reliability was 91% (range 68-100%). Inter-rater reliability ranged from 40-65% when missing data and 'don't know' answers were included, and from 62-75% when only 'definitive' answers were included. Club presidents and secretaries provided more definitive information than other informants. A preliminary list of safety issues that clubs addressed well or poorly was identified. The SSAT is a useful tool for gathering baseline data, benchmarking and targeting sports safety interventions with community sports clubs. Club presidents and secretaries are the preferred contact point and a face-to-face interview is the best administration mode. A tool to identify safety policies and practices is now available for use by anyone supporting community sports clubs to improve safety.

Methods: Seventy-eight clubs were targeted for implementation of an online injury surveillance system (approximately 4000 athletes) in five community Australian football leagues concurrently enrolled in a larger injury prevention project (National Guidance for Australian Football Partnerships and Safety (NoGAPS)). System implementation was evaluated quantitatively, using the RE-AIM framework, and qualitatively via semi-structured interviews with targeted-users (mainly sports trainers). Results: Across the 78 clubs, there was 69% reach (informed about/trained in use of injury surveillance system), 44% adoption (set up an online account with intention of recording injuries), 23% implementation (used system to record injuries throughout season) and 9% maintenance (used system over two consecutive seasons). Reach and adoption were highest in those leagues receiving concurrent support for the delivery of the NoGAPS injuryprevention trainingprogram(FootyFirst). Interviewees identified several barriers and facilitators to implementation including personal (e.g. belief in the importance of injury surveillance), sociocontextual (e.g. understaffing and athlete underreporting) and systems factors (e.g. the time taken to upload injury data into the online surveillance system). Discussion: The injury surveillance system was implemented andmaintained by only a small proportion of clubs. Outcomeswere best in those leagues receiving concurrent support for the delivery of FootyFirst, suggesting that engagement with club personnel and organisations at all levels can enhance use of injury surveillance systems in community sport. Interview findings suggest that increased implementation could also be achievedby educating club personnel on the importance of recording injuries, asking leagues to create clearer injury surveillance guidelines, increasing club staffing, better remunerating those who conduct surveillance and offering flexible surveillance systems in a range of accessible formats. By increasing the use of surveillance systems, datawill better reflect the target population and increase our understanding of the injury problem in community sport.

Sporting bodies have developed guidelines for managing community-level players with suspected concussion in response to international consensus statements on concussion in sport. The purpose of this study was to examine the factors that influence the intended use of concussion guidelines among community-level coaches and sports trainers from two popular football codes in Australia: Australian football and rugby league.Cross-sectional survey.The survey, based on an extended theory of planned behaviour model, was completed by 183 Australian football coaches, 121 Australian football sports trainers, 171 rugby league coaches, and 142 rugby league sports trainers.Personal norms and self-efficacy were significant predictors of intention to use concussion guidelines, although the relationship between self-efficacy and intention was stronger among Australian football coaches than rugby league coaches. Analysis of the salient beliefs that underpin self-efficacy found that coaches, irrespective of football code, felt less familiar (χ(2)=25.70, p0.001) and less experienced (χ(2)=31.56, p0.001) than sports trainers in using the concussion guidelines. At the same time, Australian football personnel, irrespective of their team role, felt that they had insufficient time (χ(2)=8.04, p0.01) and resources (χ(2)=12.31, p0.001) to implement the concussion guidelines relative to rugby league personnel.Programmes aimed at increasing the intended use of sport concussion guidelines should focus on enhancing self-efficacy and leveraging personal norms. Increasing coaches' familiarity and experience in using the concussion guidelines would also be warranted, as would finding ways to overcome the perceived time and resource constraints identified among Australian football personnel.

Behavioural factors and beliefs are important determinants of the adoption of sports injury interventions. This study aimed to understand behavioural factors associated with junior community netball players' intentions to learn correct landing technique during coach-led training sessions, proposed as a means of reducing their risk of lower limb injury.Cross-sectional survey.287 female players from 58 junior netball teams in the 2007/2008-summer competition completed a 13-item questionnaire developed from the Theory of Planned Behaviour (TPB). This assessed players' attitudes (four items), subjective norms (four), perceived behavioural control (four) and intentions (one) around the safety behaviour of learning correct landing technique at netball training. All items were rated on a seven-point bipolar scale. Cluster-adjusted logistic regression was used to assess which TPB constructs were most associated with strong intentions.Players had positive intentions and attitudes towards learning safe landing technique and perceived positive social pressure from significant others. They also perceived themselves to have considerable control over engaging (or not) in this behaviour. Players' attitudes (p0.001) and subjective norms (p0.001), but not perceived behavioural control (p=0.49), were associated with strong intentions to learn correct landing technique at training.Injury prevention implementation strategies aimed at maximising junior players' participation in correct landing training programs should emphasise the benefits of learning correct landing technique (i.e. change attitudes) and involve significant others and role models whom junior players admire (i.e. capitalise on social norms) in the promotion of such programs.

This talk will describe the rationale behind the conduct of the NoGAPS implementation trial and provide the rationale for the design of its evaluation plan as a three-arm observational trial. Results: There have been very few true implementation effectiveness trials conducted in any context and so there is limited guidance available on how to design and conduct such studies. Using the ecological version of the RE-AIM for sports delivery settings as the evaluation framework in a three-arm controlled study design over 3 years, the NoGAPS study is comparing the real-world uptake and sustainability of two intervention delivery modes (the FootyFirst programwith fully supported or limited-support implementation delivery) compared to usual implementation practice as a control. The evaluationplan reflects the fact that the project is just as much about understanding the process of program implementation as it is about assessing if FootyFirst works. Discussion: In order to deliver effective sports safety programs, it is necessary to understand the key barriers and facilitators to sustainable program implementation in community sport. The NoGAPS project is the first large scale implementation study for sports injury prevention, with a focus on better understanding the uptake of exercise-training programs in community sport. Importantly, NoGAPS also examines if the players attain the training-principles of the exercises that are supposed to be imparted by the implementation program. This study is funded by an NHMRC Partnerships Project Grant.

Methods: Seventy-eight clubs were targeted for implementation of an online injury surveillance system (approximately 4000 athletes) in five community Australian football leagues concurrently enrolled in a larger injury prevention project (National Guidance for Australian Football Partnerships and Safety (NoGAPS)). System implementation was evaluated quantitatively, using the RE-AIM framework, and qualitatively via semi-structured interviews with targeted-users (mainly sports trainers). Results: Across the 78 clubs, there was 69% reach (informed about/trained in use of injury surveillance system), 44% adoption (set up an online account with intention of recording injuries), 23% implementation (used system to record injuries throughout season) and 9% maintenance (used system over two consecutive seasons). Reach and adoption were highest in those leagues receiving concurrent support for the delivery of the NoGAPS injuryprevention trainingprogram(FootyFirst). Interviewees identified several barriers and facilitators to implementation including personal (e.g. belief in the importance of injury surveillance), sociocontextual (e.g. understaffing and athlete underreporting) and systems factors (e.g. the time taken to upload injury data into the online surveillance system). Discussion: The injury surveillance system was implemented andmaintained by only a small proportion of clubs. Outcomeswere best in those leagues receiving concurrent support for the delivery of FootyFirst, suggesting that engagement with club personnel and organisations at all levels can enhance use of injury surveillance systems in community sport. Interview findings suggest that increased implementation could also be achievedby educating club personnel on the importance of recording injuries, asking leagues to create clearer injury surveillance guidelines, increasing club staffing, better remunerating those who conduct surveillance and offering flexible surveillance systems in a range of accessible formats. By increasing the use of surveillance systems, datawill better reflect the target population and increase our understanding of the injury problem in community sport.