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Original research
Health And Performance Promotion in Youth (HAPPY) hybrid effectiveness-implementation cluster randomised trial: comparison of two strategies to implement an injury prevention exercise programme in Danish youth handball
  1. Merete Møller1,2,
  2. Lotte Nygaard Andersen3,
  3. Sören Möller4,5,
  4. Alice Kongsted6,
  5. Carsten B Juhl1,7,
  6. Ewa M Roos1
  1. 1 The Faculty of Health Sciences, Department of Sports Science and Clinical Biomechanics, Research Unit of Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Odense, Denmark
  2. 2 Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  3. 3 Faculty of Health Sciences, Department of Sports Science and Clinical Biomechanics, Research Unit of Physical Activity and Health in Working life, University of Southern Denmark, Odense, Denmark
  4. 4 Department of Clinical Research, Research Unit of Open, University of Southern Denmark, Odense, Denmark
  5. 5 Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
  6. 6 The Faculty of Health Sciences, Department of Sports Science and Clinical Biomechanics, Research Unit of Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  7. 7 Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
  1. Correspondence to Dr Merete Møller; memoller{at}health.sdu.dk

Abstract

Objective To investigate if a combination of an online and onsite implementation strategy was superior to an online-only strategy in enhancing the use of an injury prevention exercise programme (IPEP) and in reducing the risk of shoulder, knee and ankle injuries in youth community handball players (age 11–17) over a handball season.

Methods In this 30-week hybrid effectiveness-implementation cluster randomised type 3 study, 20 youth handball clubs were randomly assigned 1:1 to either a combined online and onsite implementation strategy (coach workshop using the health action process approach behaviour change model and health service provider (HSP) support) or an online-only strategy (control group). The primary implementation outcome was coach-reported adherence, measured as the average IPEP exercise usage by the team over 30 weeks. The primary effectiveness outcome was player-reported handball playing time to any new handball-related shoulder, knee and ankle injuries, reported weekly using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems.

Results We enrolled 63 coaches (27% women) and 945 players (mean age 14.5 years, 55% girls). Intention-to-treat analyses showed no statistically significant difference between implementation strategies in adherence (between-group difference 1.4, 95% CI −0.5 to 3.4) or in cumulative injury risk (between-group difference 5.5% points, 95% CI −2.2 to 13.1).

Conclusion Our findings demonstrate that in youth community handball, a combined online and onsite implementation strategy, including a coach workshop and HSP support, was not superior to an online-only strategy regarding adherence to an IPEP or in reducing shoulder, knee and ankle injury risk.

Trial registration number NCT05294237.

  • Knowledge translation
  • Implementation
  • Behaviour
  • Child Health
  • Exercise training

Data availability statement

Data are available on reasonable request. All personally identifiable information will be deleted or anonymised before data transfer.

https://doi.org/10.1136/bjsports-2023-107880

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    Data availability statement

    Data are available on reasonable request. All personally identifiable information will be deleted or anonymised before data transfer.

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    Footnotes

    • X @Merete_Moller, @ewa_roos

    • Contributors All authors contributed to the manuscript preparation. MM, LNA, EMR and AK contributed to the planning of the study. SM and MM performed the analyses. MM was responsible for the data collection. MM is responsible for the overall content (guarantor).

    • Funding University of Southern Denmark, the Danish Handball Federation, Team Denmark, Danish Gymnastics and Sports Associations, Minestry of Culture in Denmark research funding (grant number FPK.2018-0067), Østifterne (grant number 2020-0277), The Foundation for Advancement of Chiropractic Research and Postgraduate Education (grant number A3488).

    • Competing interests MM is associate editor for the British Journal of Sports Medicine.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.