ARTICLE IN PRESS JSHS317_proof ■ 4 August 2016 ■ 1/8 HOSTED BY Available online at www.sciencedirect.com Available online at www.sciencedirect.com ScienceDirect ScienceDirect Journal of Sport and Health Science xx (2016) 1–8 Production and hosting by Elsevier www.jshs.org.cn 1bs_bs_query Q1 Original Article 2bs_bs_query 3bs_bs_query Scientific evidence is just the starting point: A generalizable process for 4bs_bs_query 5bs_bs_query developing sports injury prevention interventions 6bs_bs_query a, b c a,d a,e 7bs_bs_query Alex Donaldson *, David G. Lloyd , Belinda J. Gabbe , Jill Cook , Warren Young , a a 8bs_bs_query Peta White , Caroline F. Finch a 9bs_bs_query Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria 3353, Australia b 10bs_bs_query Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Queensland 9726, Australia c 11 bs_bs_query Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria 3181, Australia d 12bs_bs_query La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria 3083, Australia e 13bs_bs_query School of Health Sciences, Federation University Australia, Ballarat, Victoria 3353, Australia 14bs_bs_query Received 12 February 2016; revised 13 May 2016; accepted 23 May 2016 15bs_bs_query Available online 16bs_bs_query 17bs_bs_query Abstract 18bs_bs_query 19bs_bs_query Background: The 2 most cited sports injury prevention research frameworks incorporate intervention development, yet little guidance is available 20bs_bs_query in the sports science literature on how to undertake this complex process. This paper presents a generalizable process for developing implementable 21bs_bs_query sports injury prevention interventions, including a case study applying the process to develop a lower limb injury prevention exercise training 22bs_bs_query program (FootyFirst) for community Australian football. 23bs_bs_query Methods: The intervention development process is underpinned by 2 complementary premises: (1) that evidence-based practice integrates the best 24bs_bs_query available scientific evidence with practitioner expertise and end-user values and (2) that research evidence alone is insufficient to develop 25bs_bs_query implementable interventions. 26bs_bs_query Results: The generalizable 6-step intervention development process involves (1) compiling research evidence, clinical experience, and knowledge 27bs_bs_query of the implementation context; (2) consulting with experts; (3) engaging with end users; (4) testing the intervention; (5) using theory; and (6) 28bs_bs_query obtaining feedback from early implementers. Following each step, intervention content and presentation should be revised to ensure that the final 29bs_bs_query intervention includes evidence-informed content that is likely to be adopted, properly implemented, and sustained over time by the targeted 30bs_bs_query intervention deliverers. For FootyFirst, this process involved establishing a multidisciplinary intervention development group, conducting 2 31bs_bs_query targeted literature reviews, undertaking an online expert consensus process, conducting focus groups with program end users, testing the program 32bs_bs_query multiple times in different contexts, and obtaining feedback from early implementers of the program. 33bs_bs_query Conclusions: This systematic yet pragmatic and iterative intervention development process is potentially applicable to any injury prevention topic 34bs_bs_query across all sports settings and levels. It will guide researchers wishing to undertake intervention development. 35bs_bs_query © 2016 Production and hosting by Elsevier B.V.on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND 36bs_bs_query license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 37bs_bs_query 38bs_bs_query Keywords: Australian football; Intervention development; Lower limb injuries; Sports injury prevention; Implementation; Research-to-practice; Translation 39bs_bs_query 40bs_bs_query 1. Introduction Both the Translating Research into Injury Prevention Practice 53bs_bs_query 4 7 41bs_bs_query framework and the Sequence of Prevention model require prac- 54bs_bs_query 42bs_bs_query Evidence-based sports injury prevention interventions are 1-3 titioners and researchers to identify potential injury prevention 55bs_bs_query 43bs_bs_query not well implemented in real-world settings, often because solutions and develop appropriate prevention measures guided by 56bs_bs_query 44bs_bs_query the interventions are not directly relevant to specific implemen- 4,5 high-quality epidemiologic and etiologic studies. Most research 57bs_bs_query 45bs_bs_query tation contexts. Interventions should be informed by research 8,9 remains in the early stages of these models and frameworks, and 58bs_bs_query 46bs_bs_query evidence and be widely adopted, properly implemented, and 4,6 this limits the potential for injuries to be prevented. In practice, 59bs_bs_query 47bs_bs_query sustained over time. preventive measures are often based on anecdotal experience or 60bs_bs_query 48bs_bs_query 4 current practice, and the scientific literature rarely provides 61bs_bs_query 49bs_bs_query insights into the complex process of intervention development in 62bs_bs_query 50bs_bs_query Peer review under responsibility of Shanghai University of Sport. 10 real-world settings. Although systematic reviews and meta- 63bs_bs_query 51bs_bs_query * Corresponding author. 52bs_bs_query E-mail address: [email protected] (A. Donaldson). analyses can identify promising interventions, their conclusions 64bs_bs_query http://dx.doi.org/10.1016/j.jshs.2016.08.003 2095-2546/© 2016 Production and hosting by Elsevier B.V. on behalf of Shanghai University of Sport. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Alex Donaldson, et al., Scientific evidence is just the starting point: A generalizable process for developing sports injury prevention interventions, Journal of Sport and Health Science (2016), doi: 10.1016/j.jshs.2016.08.003 ARTICLE IN PRESS JSHS317_proof ■ 4 August 2016 ■ 2/8 2 A. Donaldson et al. 1 65bs_bs_query Table 1 66bs_bs_query Summary of the primary methods used to develop FootyFirst. 67bs_bs_query Evidence-based practice Aims Contribution to the development of FootyFirst 68bs_bs_query element 69bs_bs_query Compilation and quality To ensure that the best available research • Compilation of published and previously unpublished community AF injury 12 70bs_bs_query assessment of research evidence relevant to the specific problem data (Fig. 1, step 1) 71bs_bs_query evidence was identified and applied in the • Review of the scientific literature to systematically evaluate the evidence about 72bs_bs_query development of the intervention the benefits of lower limb injury prevention protocols aimed at reducing the 20 73bs_bs_query most common, severe lower limb injuries in community AF (Fig. 1, step 1). 74bs_bs_query Incorporation of clinical To fill in the gaps where there was limited • Application of health promotion, implementation science, physiotherapy, 75bs_bs_query expertise and practitioner information in the literature or where no biomechanical, and sports science clinical and research expertise to develop 76bs_bs_query knowledge and views successful intervention for a specific injury the exercise training program (Fig. 1, step 1) 77bs_bs_query was identified • Delphi consultation to achieve expert consensus on the specific content of the 21 78bs_bs_query To fit the available evidence to the specific exercise training program (step 2) 79bs_bs_query circumstances, populations, and needs 34 80bs_bs_query Consideration of end user To ensure that the intervention is • Focus groups, following standard focus group methods, with community AF 81bs_bs_query preference, capacity, and appropriate for, and reflects the capacity of, senior coaches, strength and conditioning/fitness/high-performance coaches, 82bs_bs_query values the implementation context players, sports trainers, and administrators (Fig. 1, step 3) 83bs_bs_query • Testing of the exercise training program with delivery agent representatives 84bs_bs_query and conducting a “train-the-trainer” session (Fig. 1, step 4) 85bs_bs_query • Evaluation of the program against the attributes of innovations from the 25 86bs_bs_query diffusion of innovations theory (Fig. 1, step 5) 87bs_bs_query • Feedback from early implementers on the content and presentation of the 88bs_bs_query program (Fig. 1, step 6) = 89bs_bs_query Abbreviation: AF Australian football. 90bs_bs_query 91bs_bs_query are rarely directly applicable to specific real-world settings, and considers the implementation context, the end user’s perspectives, 126bs_bs_query 11 92bs_bs_query translation into effective practice is challenging. and long-term sustainability, injury prevention programs are 127bs_bs_query 4,5 93bs_bs_query Australian football (AF) is a popular sport at the community unlikely to be widely used and will therefore have limited impact. 128bs_bs_query 94bs_bs_query level in Australia. It is a dynamic sport that incorporates running, Three methods underpinned the application of the interven- 129bs_bs_query 95bs_bs_query rapid acceleration and deceleration, changing direction, jumping tion development process to FootyFirst: (1) literature