Improving the Design and Implementation of New Zealand’s NetballSmart Injury Prevention Programme
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Netball is the most popular female sport played in New Zealand and has a high incidence of lower extremity injuries. Knee injuries are common, often keeping players from participating for substantial periods of time. A collaborative approach between the Accident Compensation Corporation (ACC) (a no-fault national insurance system), Netball New Zealand (NNZ) and respected members of the netball community led to the development of the NetballSmart Injury Prevention Program (NIPP). This collaborative group identified key areas of focus for the programme, with two priority areas being ‘Smart movement’ and ‘Smart Warm-up”. Unfortunately, many national injury prevention programmes (IPPs) have failed to be effectively implemented amongst their community, leading to poor adoption and subsequent ineffective change. Therefore, the aim of this thesis, was to improve the design and implementation of New Zealand’s NIPP. The thesis is comprised of eight chapters, with chapters two through seven written in a manuscript style. The narrative of the thesis somewhat follows the four steps of the injury prevention model “sequence of prevention stages” (van Mechelen, Hlobil & Kemper, 1992). The thesis aim was achieved by taking a pragmatic approach to undertaking research in a real-world setting, starting with a narrative review of the literature on IPP implementation. The review clearly identified common themes for barriers and facilitating factors that affect implementation of an IPP. The four themes identified were: The importance of stakeholders; The importance of collaboration; Relevant content; Implementation. From these themes a suggested 6-step practical guideline for effective real-world dissemination of the NIPP over the next three -years was developed. The practical guideline highlighted the need to better understand common netball injuries age groups most at risk of injury and seasonal injury patterns. This improved the focus of NIPP resource and educational workshop content design and guided the dissemination plan. Ankle and knee injuries were identified as the most prevalent injury body sites and a ten-year review of the ACC injury data for these two body areas was evaluated. Key findings were that ankle and knee injuries had increased the most in 10-19-year-olds (ankle 37-84% increase and knee 49-133% increase), but that injuries in 20-24-year-olds still represent the highest cost and continued at a higher rate than in younger players. Spikes in injury were seen and are likely associated with intense periods of trialling and tournament play. As Anterior Cruciate ligament (ACL) injuries remain a serious problem within netball and are a key focus in the NIPP. An investigation of injury mechanism specific to ACL injury was also undertaken. Twenty-one ACL injuries videoed during games were analysed by a group of experts, who identified new insights into the mechanism and player behaviours associated with ACL injury in netball. Firstly, many of the injured players were receiving the ball high in the air and opting to bring the ball low (at/or below pelvis level), which could theoretically subject the knee to increased abduction and rotation moments. Secondly, that the players were turning their head 45-90o away from the injured limb, looking for their next pass rather than bringing their whole body around for the pass before completing their landing. This likely created some action-reaction rotational torque through segments of the body increasing knee injury risk. The findings of this study led to the introduction of new practical coaching tips in the NIPP for reducing injury-risk in players. The thesis then investigated the effects of two key NIPP neuromuscular training resources, the NetballSmart Dynamic Warm-up and the adapted Power Warm-up, on physical performance measures and landing ability in youth netball players. A 12-week cluster randomised control trial, involving 12 secondary school netball teams, with pre-and post-physical outcome measure was undertaken. The key finding of this study was that both warm-ups improved all landing technique outcomes and several of the performance measures (strength and balance) and neither warm-up was better than the other. Evidence of performance enhancement increased the legitimacy of the warm-up programmes within the netball community and facilitated uptake, whilst offering suggestions for further training exercises to potentially reduce injury risk and increase performance. Finally, commentary was made on how the research of this thesis was practically applied to the real-world design and implementation of the NIPP over the first three-years of the programme. All the studies add to our knowledge regarding the nature of netball injury and how guided research can improve the design and implementation of a national IPP. Future research building upon the ideas presented in this thesis is recommended to further develop the design and adoption of the NIPP in the forthcoming years and leverage the programmes early success.