Primary prevention of sports-related injuries in and through physical education teachers: feasibility, effectiveness, and transferability tot the adolescents

Abstract

The large problem of injuries is preventing youngsters from obtaining the health benefits that can be derived from physical activity and sport. Moreover, injuries entail a lot of additional negative consequences for adolescents such as school absences and educational failure. To reach all adolescents, whether being active in a sports club or participating in non-organized sports, the school context was chosen in which injury prevention can be implemented through physical education (PE) teachers in PE lessons. PE teachers are qualified (bachelor/master degree) and capable (e.g. didactical skills) of transferring the injury preventive knowledge and behaviour towards the adolescents. However, their high physical work load (e.g. carrying and lifting heavy loads) and extensive history of sports participation pose them at high risk of sports- and work-related injuries. Moreover, they are often still active in sports during their career and often engage as a sports coach in addition to their regular job. Therefore, the objectives in this dissertation are twofold; on the one hand focusing on the implementation of injury prevention strategies in lives of PE teachers to reduce their injuries and on the other hand changing PE teachers’ preventive behaviour towards adolescents in physical education lessons and towards athletes in sport clubs. First of all, an epidemiologic study in 103 PE teachers, compared to 58 non-PE teachers was designed (Chapter 1). Based on the definition of a sports- or work related injury, PE teachers sustained 0.83 injuries/ teacher/ school year, which was higher than non-PE teachers (0.36). Most injuries in PE teachers were first-time (51%), non-contact (76%) and acute (62%) and the most affected body parts were the back (18.8%) and knees (17.3%). The results of this first study could be used to further shape the content of the existing multifactorial injury prevention intervention, “No Gain With Pain” (NGWP), so that it better fitted the context of the target population of PE teachers. The “adapted NGWP 1.0” program was revised in a next study, in which three cycles of implementation, evaluation and optimization allowed to gradually improve NGWP, so that it optimally fits the needs and wishes of PE teachers (Chapter 2). Appreciation scores improved as a result of the optimizations made, and perceived utility of the strategies, confidence to apply the strategies, and teachers’ knowledge about prevention strategies were found to increase over time. In chapter 3 the effectiveness of the “adapted NGWP 1.0” was evaluated through a randomized-controlled trial in 55 PE teachers and resulted in a reduced injury incidence in the intervention group (0.38 sports- or work related injuries/ PE teacher/ school year) compared to the controls (0.73). Effects were mainly found in the reduction of non-contact injuries. The amount of time performing preventive behavior did not differ between intervention and control groups, however a more balanced use of the strategies was seen in the intervention group. Together chapters 1, 2 & 3 allowed for the optimization of the existing multifactorial injury prevention intervention, NGWP, so that it could be delivered to PE teachers and was effective in increasing teachers’ injury prevention competences and lowering their injuries (aim 1). Then, to reach the second objective in this dissertation, a randomized-controlled trial was designed in 14 PE teachers and 271 pupils (Chapter 4). The “adapted NGWP 2.0” included modules to specifically target transfer through PE teacher to the pupils in the PE lessons. Teachers’ injury prevention knowledge increased after receiving the intervention and they also engaged more frequently in preventive behavior when playing sport themselves and showed an increase in all preventive strategies. Most important to chapter 4, an increased application of preventive strategies in teachers’ PE lessons was reported. There were some disparities in the teacher and students reports on injury prevention in PE lessons, but comparisons are difficult to make because assessments were completed with different rating scales in both groups. Finally, the “adapted NGWP 3.0”, including modules to specifically target transfer to adolescent athletes in a sports club, was delivered to an intervention group in a randomized-controlled trial in 49 PE teachers. Again, improvements in PE teachers’ knowledge were seen. Increased perceived utility of the strategies was reported in teachers’ own sporting activities, in PE lessons, but not in trainings. Most importantly, the study resulted in an increased application of the provided strategies in teachers’ own sporting activities, in their PE lessons, as well as in their trainings. With the latter two studies (chapter 4 and 5), injury prevention in a multi-sport adolescent population was reached by training PE teachers to effectively transfer the prevention strategies in their PE lessons and/or in trainings at club level (aim 2).

Date of Award	21 Dec 2016
Original language	English
Awarding Institution	Ghent University