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Background Life-space mobility is defined as the size of the area in which a person moves about within a specified period of time. Our study aimed to characterize life-space mobility, identify factors associated with its course, and detect typical trajectories in the first year after ischemic stroke. Methods MOBITEC-Stroke (ISRCTN85999967; 13/08/2020) was a cohort study with assessments performed 3, 6, 9 and 12 months after stroke onset. We applied linear mixed effects models (LMMs) with life-space mobility (Life-Space Assessment; LSA) as outcome and time point, sex, age, pre-stroke mobility limitation, stroke severity (National Institutes of Health Stroke Scale; NIHSS), modified Rankin Scale, comorbidities, neighborhood characteristics, availability of a car, Falls Efficacy Scale-International (FES-I), and lower extremity physical function (log-transformed timed up-and-go; TUG) as independent variables. We elucidated typical trajectories of LSA by latent class growth analysis (LCGA) and performed univariate tests for differences between classes. Results In 59 participants (mean age 71.6, SD 10.0 years; 33.9% women), mean LSA at 3 months was 69.3 (SD 27.3). LMMs revealed evidence (p ≤ 0.05) that pre-stroke mobility limitation, NIHSS, comorbidities, and FES-I were independently associated with the course of LSA; there was no evidence for a significant effect of time point. LCGA revealed three classes: “low stable”, “average stable”, and “high increasing”. Classes differed with regard to LSA starting value, pre-stroke mobility limitation, FES-I, and log-transformed TUG time. Conclusion Routinely assessing LSA starting value, pre-stroke mobility limitation, and FES-I may help clinicians identify patients at increased risk of failure to improve LSA.

Purpose Neuromuscular training (NMT) is effective at reducing football injuries. The purpose of this study was to document the use of NMT to prevent anterior cruciate ligament injuries and lateral ankle sprains in adult amateur football and to identify barriers for using NMT. Methods A preseason and in-season online survey was completed by players and coaches of 164 football teams. The survey contained questions concerning injury history, type and frequency of NMT, and barriers when NMT was not used. Results A total of 2013 players (40% female) and 180 coaches (10% female) completed the preseason survey, whereas 1253 players and 140 coaches completed the in-season survey. Thirty-four percent (preseason) to 21% (in-season) of players used NMT, but only 8% (preseason) to 5% (in-season) performed adequate NMT (i.e. both balance and plyometric exercises, at least twice per week). In the subpopulation of players with an injury history, 12% (preseason) and 7% (in-season) performed adequate NMT. With respect to the coaches, only 5% (preseason) and 2% (in-season) implemented adequate NMT. Most important barriers for using NMT for both players and coaches were a lack of belief in its effectiveness, a lack of knowledge, the belief that stretching is sufficient, and not feeling the need for it. Conclusion Most amateur football teams do not implement essential components of NMT. The results highlight the urgent need for developing strategies to enhance the adequate use of NMT in amateur football. Level of evidence II.

Aim of this study was to test the reliability and validity of the life-space measures and walking speed delivered by the MOBITEC-GP app. Participants underwent several supervised walking speed assessments as well as a 1-week life-space assessment during two assessment sessions 9 days apart. Fifty-seven older adults (47.4% male, mean age= 75.3 (±5.9) years) were included in the study. The MOBITEC-GP app showed moderate to excellent test-retest reliability (ICCs between 0.584 and 0.920) and validity (ICCs between 0.468 and 0.950) of walking speed measurements of 50 meters and above and of most 1-week life-space parameters, including life-space area, time spent out-of-home, and action range. The MOBITEC-GP app for Android is a reliable and valid tool for the assessment of real-life walking speed (at distances of 50 metres and above) and life-space parameters of older adults. Future studies should look into technical issues more systematically in order to avoid invalid measurements., Geriatric Nursing, 48

Football is a contact sport with a significant risk of injury. Although proprioception is well studied in rehabilitation, little is known about the association between proprioception and the occurrence of sport injuries. The purpose of this study was to look into the association between ankle and knee proprioception and lower extremity injuries in young football players. Seventy-three football players from the highest U-21 league in Iran volunteered to participate in this study. Before the start of the 2017–2018 competitive season, joint position sense was measured at 30°, 60° and 90° knee flexion and at 10° and 15° ankle dorsiflexion, and inversion using the Biodex Isokinetic pro 4 system. The teams’ medical staff recorded football-related lower extremity injuries. We used mixed effects Cox regression models to calculate hazard ratios (HRs) with 95% CIs, acknowledging the clustered data structure. Twenty-two players (30.1%) suffered one or more lower extremity injuries during the season. None of the proprioception measures examined was significantly associated with the risk of lower extremity injuries. Based on these results of our sample, joint position sense does not seem to be associated with lower extremity injuries in young male football players.

ZusammenfassungEs besteht kein Zweifel darüber, dass Sport für Kinder gut ist, gerade angesichts des hohen gesundheitlichen Risikos von Bewegungsmangel. Dass mit dem Sporttreiben auch das Verletzungsrisiko steigt, ist ebenfalls unbestritten. Daher ist es umso erfreulicher, dass das Risiko von Sportverletzungen im Kinder- und Jugendsport mit geeigneten Maßnahmen wirkungsvoll herabgesetzt werden kann. In dem Artikel erfahren Sie, wie das gelingt.

PURPOSE: To assess injury risk in elite-level youth football (soccer) players based on anthropometric, motor coordination and physical performance measures with a machine learning model. METHODS: A total of 734 players in the U10 to U15 age categories (mean age, 11.7 ± 1.7 yr) from seven Belgian youth academies were prospectively followed during one season. Football exposure and occurring injuries were monitored continuously by the academies' coaching and medical staff, respectively. Preseason anthropometric measurements (height, weight, and sitting height) were taken and test batteries to assess motor coordination and physical fitness (strength, flexibility, speed, agility, and endurance) were performed. Extreme gradient boosting algorithms (XGBoost) were used to predict injury based on the preseason test results. Subsequently, the same approach was used to classify injuries as either overuse or acute. RESULTS: During the season, half of the players (n = 368) sustained at least one injury. Of the first occurring injuries, 173 were identified as overuse and 195 as acute injuries. The machine learning algorithm was able to identify the injured players in the hold-out test sample with 85% precision, 85% recall (sensitivity) and 85% accuracy (f1 score). Furthermore, injuries could be classified as overuse or acute with 78% precision, 78% recall, and 78% accuracy. CONCLUSIONS: Our machine learning algorithm was able to predict injury and to distinguish overuse from acute injuries with reasonably high accuracy based on preseason measures. Hence, it is a promising approach to assess injury risk among elite-level youth football players. This new knowledge could be applied in the development and improvement of injury risk management strategies to identify youth players with the highest injury risk.

Objective To identify the causal relation between growth velocity and injury in elite-level youth football players, and to assess the mediating effects of motor performance in this causal pathway. Design Prospective cohort study. Methods We measured the body height of 378 male elite-level football players of the U13 to U15 age categories three to four months before and at the start of the competitive season. At the start of the season, players also performed a motor performance test battery, including motor coordination (Korperkoordinationstest fur Kinder), muscular performance (standing broad jump, counter movement jump), flexibility (sit and reach), and endurance measures (YoYo intermittent recovery test). Injuries were continuously registered by the academies’ medical staff during the first two months of the season. Based on the causal directed acyclic graph (DAG) that identified our assumptions about causal relations between growth velocity (standardized to cm/y), injuries, and motor performance, the causal effect of growth velocity on injury was obtained by conditioning on maturity offset. We determined the natural indirect effects of growth velocity on injury mediated through motor performance. Results In total, 105 players sustained an injury. Odds ratios (OR) showed a 15% increase in injury risk per centimetre/year of growth velocity (1.15, 95%CI: 1.05–1.26). There was no causal effect of growth on injury through the motor performance mediated pathways (all ORs were close to 1.0 with narrow 95%CIs). Conclusions Growth velocity is causally related to injury risk in elite-level youth football players, but motor performance does not mediate this relation.

Objective To assess the effectiveness of the 11+ Kids warm-up programme regarding injury reduction in male high-level children’s football players. Design Cluster-randomised controlled trial. Method Male youth football teams of Iran’s high-level football schools were invited to participate. Inclusion criteria were: teams are competing in the highest league of their province; players are between 7 and 14 years old; regular training takes place at least twice per week. Teams were excluded if they used an injury prevention measure. Participating clubs were randomised to an intervention (INT, N = 20 teams) and a control group (CON, N = 22 teams), stratified by the number of teams and the age group. The groups were blinded against each other. The follow-up period was one season (9 months). INT replaced their warm-up by 11+ Kids. CON performed a standard warm-up programme. The primary outcome was the injury incidence density (injuries per 1000 h of football exposure), compared between groups by incidence rate ratios (RR). Results In total, 64,047 h of football exposure of 962 players (INT = 443 players, 31,934 h of football, CON = 519 players, 32,113 h of football) were recorded. During the study, 90 (INT = 30; CON = 60) injuries occurred. The overall injury incidence density in INT was reduced by 50% compared to CON (RR 0.50; 95%-CI 0.32, 0.78). No injuries occurred during the execution of the intervention exercises. Conclusions The 11+ Kids reduces injuries in high-level children’s football players, thus supporting player health and potentially performance and player development.

Objectives This study investigated anthropometric measures and growth as risk factors for overuse and acute injuries in younger (U10–U12) and older (U13–U15) elite level soccer players. Design Prospective cohort study. Methods Height, weight, and sitting height were measured at the start and the end of the 2016–2017 competitive season and growth velocities were calculated. Throughout the season, injuries were registered continuously by the (para-)medical staff of the included clubs. We analyzed the injury risk using multilevel Poisson regression models, accounting for club and team clustering. Results Of the included 314 players (11.7 ± 1.7 years of age), 160 players sustained 133 overuse and 163 acute injuries (i.e. 106 injuries in 69 players of the younger group, 190 in 91 players of the older group). In the younger group, risk of overuse injuries was associated with an increase in leg length over the season (incidence rate ratio (IRR) 1.620 [95% CI 1.230–2.117]) and risk of acute injuries with relatively younger age (IRR 1.003 [95% CI 1.000–1.006]). In the older group, a higher leg length was associated with an increased risk of overuse injuries (IRR 1.055 [95% CI 1.011–1.108]), and a higher weight and a lower growth rate with an increased risk of acute injuries (IRR 1.043 [95% CI 1.021–1.067] and 0.903 [95% CI 0.831–0.981], respectively). Conclusions Injury risk factors differ by age group and type of injury. The age-specific anthropometric and growth-related risk factors should be monitored and these risk profiles should be considered to manage injury risk effectively.

Background: Equations predicting age at peak height velocity (APHV) are often used to assess somatic maturity and to adjust training load accordingly. However, information on the intra-individual accuracy of APHV in youth athletes is not available. Aim: The purpose of this study is to assess the accuracy of predication equations for the estimation of APHV in individual youth male football players. Subjects and methods: Body dimensions were measured at least every three months in 17 elite youth male football players (11.9 ± 0.8 years at baseline) from the 2008–2009 through the 2011–2012 seasons. APHV was predicted at each observation with four suggested equations. Predicted APHV was compared to the player’s observed APHV using one-sample-t-tests and equivalence-tests. Longitudinal stability was assessed by comparing the linear coefficient of the deviation to zero. Results: Predicted APHV was equivalent to the observed APHV in none of the players. A difference with a large effect size (Cohen’s d > 0.8) was noted in 87% of the predictions. Moreover, predictions were not stable over time in 71% of the cases. Conclusions: None of the evaluated prediction equations is accurate for estimating APHV in individual players nor are predictions stable over time, which limits their utility for adjusting training programmes.

OBJECTIVE: The objective of this study was to assess the efficacy of a newly developed warm-up programme ('11+ Kids') regarding its potential to reduce injuries in children's football.METHODS: Children's football teams (under 9 years, under 11 years, and under 13 years age groups) from Switzerland, Germany, the Czech Republic and the Netherlands were invited. Clubs were randomised to an intervention group and a control group, and followed for one season. The intervention group replaced their usual warm-up by '11+ Kids', while the control group warmed up as usual. The primary outcome was the overall risk of football-related injuries. Secondary outcomes were the risks of severe and lower extremity injuries. We calculated hazard ratios using extended Cox models, and performed a compliance analysis.RESULTS: In total, 292,749 h of football exposure of 3895 players were recorded. The mean age of players was 10.8 (standard deviation 1.4) years. During the study period, 374 (intervention group = 139; control group = 235) injuries occurred. The overall injury rate in the intervention group was reduced by 48% compared with the control group (hazard ratio 0.52; 95% confidence interval 0.32-0.86). Severe (74% reduction, hazard ratio 0.26; 95% confidence interval 0.10-0.64) and lower extremity injuries (55% reduction, hazard ratio 0.45; 95% confidence interval 0.24-0.84) were also reduced. Injury incidence decreased with increasing compliance.CONCLUSION: '11+ Kids' is efficacious in reducing injuries in children's football. We observed considerable effects for overall, severe and lower extremity injuries. The programme should be performed at least once per week to profit from an injury preventive effect. However, two sessions per week can be recommended to further increase the protective benefit.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02222025.

Injuries—a major concern in a high-intensity contact sport like football—are associated with possible short- and long-term harmful consequences for the individual, the team and club as well as for the whole society. Consequently, there is need for effective injury prevention in football at all levels of play, in all age groups and in both genders. The present review summarizes the current scientific evidence focusing on exercise-based injury prevention and presenting promising prevention strategies in different football populations and settings. There is convincing evidence that multimodal exercise-based injury prevention programs (IPP) can reduce injury incidence by more than 30% in athletes of different age groups and in both genders. Although relevant effects have already been shown for short sessions, increased frequency and regular integration into normal practice may increase efficacy up to an injury reduction of 50%. Most programs last about 15 min and can easily replace traditional warm-up programs. Furthermore, there is increasing evidence that IPP beneficially affect neuromuscular performance parameters and biomechanical movement characteristics, which are associated with injury risk. There remains, however, a major gap between research on the short-term efficacy and long-term intervention strategies. IPP should be implemented continuously and with high fidelity as training effects are transient. It is crucial that future studies report implementation components in detail in order to facilitate the replication of successful interventions.

Football (soccer) is very popular among children. Little is known about risk factors for football injuries in children. The aim was to analyze potential injury risk factors in 7- to 12-year-old players. We collected prospective data in Switzerland and the Czech Republic over two seasons. Coaches reported exposure of players (in hours), absence, and injury data via an Internet-based registration system. We analyzed time-to-injury data with extended Cox models accounting for correlations on team- and intra-person levels. We analyzed injury risk in relation to age, sex, playing position, preferred foot, and regarding age-independent body height, body mass, and BMI. Further, we analyzed injury risk in relation to playing surface. In total, 6038 player seasons with 395 295 hours of football exposure were recorded and 417 injuries occurred. Injury risk increased by 46% (Hazard Ratio 1.46 [1.35; 1.58]; P

ObjectiveTo evaluate a potential reduction in injury related healthcare costs when using the ‘11+ Kids’ injury prevention programme compared with a usual warmup in children’s football.MethodsThis cost effectiveness analysis was based on data collected in a cluster randomised controlled trial over one season from football teams (under-9 to under-13 age groups) in Switzerland. The intervention group (INT) replaced their usual warmup with ‘11+ Kids’, while the control group (CON) warmed up as usual. Injuries, healthcare resource use and football exposure (in hours) were collected prospectively. We calculated the mean injury related costs in Swiss Francs (CHF) per 1000 hours of football. We calculated the cost effectiveness (the direct net healthcare costs divided by the net health effects of the ‘11+ Kids’ intervention) based on the actual data in our study (trial based) and for a countrywide implementation scenario (model based).ResultsCosts per 1000 hours of exposure were CHF228.34 (95% CI 137.45, 335.77) in the INT group and CHF469.00 (95% CI 273.30, 691.11) in the CON group. The cost difference per 1000 hours of exposure was CHF−240.66 (95%CI −406.89, −74.32). A countrywide implementation would reduce healthcare costs in Switzerland by CHF1.48 million per year. 1002 players with a mean age of 10.9 (SD 1.2) years participated. During 76 373 hours of football, 99 injuries occurred.ConclusionThe ‘11+ Kids’ programme reduced the healthcare costs by 51% and was dominant (ie, the INT group had lower costs and a lower injury risk) compared with a usual warmup. This provides a compelling case for widespread implementation.