The primary goal of our examine was to guage the effectiveness of the bottom-up developed trainer-based IPPON intervention on the general harm prevalence in contrast with the same old warm-up in leisure judo athletes. The secondary targets had been to guage harm severity, harm incidence, location-specific prevalences, time loss and sudden and gradual onset harm recurrence charges. We hypothesised that the IPPON intervention would scale back the general harm prevalences.

Within the absence of confirmed efficient prevention methods in judo, we developed and printed a judo-specific harm prevention programme utilizing the rules of the Data Switch Scheme (KTS). 15 16 This trainer-based warm-up train programme is targeted on the shoulder, knee and ankle. To develop the Harm Prevention and Efficiency Optimization Netherlands (IPPON) intervention, we used a bottom-up method with the energetic involvement of judo specialists and finish customers. Judo specialists and finish customers participated in all of the professional conferences of the Data Switch Group, individually interviewed and took part in tatami (judo coaching floor) classes.

Harm prevention programmes in different sports activities have been confirmed efficient in decreasing harm charges for elite and leisure athletes. 9–12 In judo, analysis on exercise-based prevention is restricted to the outline of harm prevention programmes, 13 14 however the effectiveness of those programmes has by no means been evaluated.

Judo is a well-liked worldwide fight sport with an estimated 20 million energetic members worldwide. 1 Judo is characterised by the mix of stability, coordination, flexibility, agility, pace and power with the intention to incapacitate their opponent. It’s demanding of the neuromuscular and bodily capability of athletes. Participation in judo entails a considerable danger of harm in each elite and leisure judo. 2 For elite judo athletes, as much as 29% of elite judo athletes will get injured throughout a judo match. 3 An epidemiological examine on leisure judo athletes reported a 3-month harm incidence of 41%. 4 The most typical accidents in judo are sudden onset accidents of the shoulder, knee, ankle and fingers. 2 5 6 The most typical extreme accidents are anterior cruciate ligament rupture and shoulder dislocation. 7 For these accidents, the time-loss burden is 6–9 months, which negatively impacts efficiency. 7 8


Examine design Our examine was a two-armed, cluster randomised managed trial. We adopted the Consolidated Requirements of Reporting Trials Assertion for reporting randomised managed trials.17 The examine protocol was registered within the Dutch trial register (NTR7698). The examine was partly funded by The Dutch Group for Well being and Analysis and Improvement (ZonMw).

Contributors Judo athletes had been eligible in the event that they had been at the very least 12 years of age, keen to carry out an train programme at the very least two occasions per week through the judo coaching and understood the Dutch language. The variety of taking part athletes and their baseline traits are offered within the outcomes part (desk 1). Judo colleges, trainers and athletes had been contacted between Could 2019 and September 2019 by electronic mail, phone, social media (Fb, Instagram and Twitter), newsletters and displays at judo occasions. Detailed data on the examine aim, background, participation necessities, content material and expectations had been shared by electronic mail. The coach registered all judo athletes. On registration, knowledgeable consent was obtained. For members under the age of 16, knowledgeable consent was obtained from mother and father or guardians, as per the Dutch necessities of the moral requirements within the Netherlands. Desk 1 Baseline traits

Trial process Contributors entered the trial from the graduation of the judo season on 1 September 2019. The intervention and management teams had been knowledgeable of their allocation by the coordinating researcher (ALvG). Extra particulars on members’ allocation is described under within the part on ‘information assortment, randomisation and blinding’. The IPPON group was instructed to make use of the trainer-supervised intervention by way of the instruction e book (on-line supplemental appendix A), instruction videos18 and handout picture and outline playing cards (on-line supplemental appendix B). The coordinating researcher (ALvG), who had 23 years of judo expertise, verbally defined the intervention to the trainers and answered any of their questions. The trainers then offered the workout routines to the judo athletes by trainer-supervised coaching classes. To facilitate implementation, the coordinating researcher was accessible all through the trial process to reply questions and supply rationalization as required for the trainers and athletes. Constancy controls to watch the efficiency of the workout routines may not be carried out as a result of COVID-19 induced lockdowns. The management group was instructed to proceed their common judo warm-up and apply. Supplemental materials [bjsports-2022-105869supp001.pdf] Supplemental materials [bjsports-2022-105869supp002.pdf]

Knowledge assortment, randomisation and blinding Knowledge was collected by a web based survey and information administration programme (CastorEDC, CastorEDC, CIWIT B.V., Amsterdam, The Netherlands). All eligible athletes had been registered on this information administration programme (CastorEDC). Cluster randomisation was carried out by a computer-generated permuted 1:1 block scheme (CastorEDC) with random block sizes of two or 4. The definition of a cluster was one judo college. Blinding of the members was not doable as a result of nature of the intervention. The coordinating researcher (ALvG) was unblinded to group allocation and organised all correspondence to the members. All different examine personnel had been blinded for group allocation.

Baseline measurements The baseline survey (on-line supplemental appendix C) was despatched in the beginning of the examine. Baseline traits included; gender, age, physique mass, top, belt color (kyu or dan diploma), judo expertise (years), coaching publicity (hours of coaching per week), competitors participation (sure/no) and former accidents. Supplemental materials [bjsports-2022-105869supp003.pdf]

Harm definition and registration The harm survey was despatched each fortnight to register accidents regularly with out inundating members with surveys.19 The harm survey registered all accidents together with element on; areas, kind and time loss by the Oslo Sports activities and Trauma Analysis Centre (OSTRC) Questionnaire20 21 (on-line supplemental appendix D). The OSTRC Questionnaire has beforehand been validated and translated to the Dutch language.21 An harm was outlined as any reply above the minimal worth on one of many first 4 questions of the OSTRC Questionnaire and when it didn’t concern an sickness.22 Time loss was outlined because the variety of days that athletes had been unable to take part in judo actions within the earlier 14 days with the belief that they need to prepare judo every single day. A extreme harm was outlined as an harm that led to average or extreme discount of coaching (OSTRC query 2) or lack of ability to coach (OSTRC query 3). Time to return to play was outlined because the time from harm onset till return to full and unrestricted judo coaching. Supplemental materials [bjsports-2022-105869supp004.pdf]

Intervention The IPPON intervention is an harm prevention programme designed particularly to scale back accidents in judo athletes.16 The KTS15 was used for the systematic growth of the programme. The 5 steps of the bottom-up growth course of have been described in full element before16 and summarised in on-line supplemental appendix E. The intervention was accessible by tutorial movies,18 and an instruction e book with photographs and rationalization of all workout routines together with key factors of appropriate efficiency of the workout routines. There have been additionally hand-held picture playing cards with descriptions for the trainers to make use of on the tatami (judo coaching floor). The trainer-supervised IPPON intervention primarily focuses on stopping musculoskeletal accidents of the shoulder, knee and ankle. That is based mostly on earlier epidemiological studies2 and follows the steps of the Van Mechelen23 and Translating Analysis into Harm Prevention Apply (TRIPP) fashions.24 The IPPON intervention consists of 36 workout routines divided into (1) flexibility and agility, (2) stability and coordination and (3) power and stability. Every class consisted of 12 workout routines with 3 ranges of issue. Athletes carried out 4 workout routines per class and thus 12 workout routines in the beginning of the coaching at the very least two occasions per week. Previous to the intervention workout routines, athletes accomplished working workout routines and falling methods. Athletes within the management group had been instructed to proceed their regular warm-up and common judo apply as warm-up previous to coaching or competitors is commonplace routine in judo. The period of the IPPON intervention was aligned with the common period of the same old warm-up within the management teams. Though, not measured within the examine process, the approximate period of warm-up was 15 min in each teams. Supplemental materials [bjsports-2022-105869supp005.pdf]

End result measures Major consequence The first consequence was the general harm prevalence (%) over 16–26 weeks of follow-up, measured with the OSTRC Questionnaire at 2 weekly intervals. The general harm prevalence (%) and related 95% CIs had been calculated as the whole variety of athletes reporting an harm divided by the whole variety of returned surveys over 16 to 26 weeks of follow-up.25 Secondary outcomes Secondary outcomes had been: (1) the prevalence of extreme accidents; () incidence fee outlined as the whole variety of new accidents per 1000 hours of coaching and competitors publicity throughout follow-up; (3) location-specific harm prevalence (% of complete accidents); (4) time loss; (5) sudden and gradual onset harm recurrence charges had been calculated and outlined as accidents of the identical kind and on the identical aspect sustained inside 2 months after full and unrestricted return to judo coaching. All major and secondary consequence measures had been corrected for potential confounders: earlier accidents inside 6 months, participation in competitors, judo expertise in years, age, physique mass and top. These confounders had been included as per professional opinion (judo specialists from the Data Switch Group, fashioned for the event of the IPPON intervention) as no danger components have beforehand been recognized (on-line supplemental appendix F). Supplemental materials [bjsports-2022-105869supp006.pdf] Publicity, adherence and expertise Publicity, self-reported adherence and expertise analysis had been monitored by on-line questionnaires despatched with CastorEDC (on-line supplemental appendices G and H). Publicity was recorded on the particular person athlete degree in each the IPPON and management teams. The IPPON group athletes and trainers additionally recorded weekly adherence to the programme. We calculated the adherence share by dividing the general variety of reported IPPON classes by the whole variety of prescribed IPPON classes (two classes per week). Trainers and athletes recorded their expertise by a standardised questionnaire on the finish of the intervention interval. Trainers and athletes within the intervention group had been requested in the event that they had been happy with the IPPON intervention utilizing a five-level Likert scale: disagree totally, disagree, impartial, agree and agree totally). Supplemental materials [bjsports-2022-105869supp007.pdf] Supplemental materials [bjsports-2022-105869supp008.pdf]

Pattern measurement For the pattern measurement calculation, we thought of a discount of 40% in harm prevalence as clinically related.26 For this 40% discount within the prevalence from 0.414 to 0.25, with an α of 0.05 and β of 0.80 and adjustment for cluster correlations (estimated intraclass correlation of 0.05), a pattern of 15 clusters was wanted assuming 15 athletes per cluster. Correcting for an estimated dropout fee of 30%, the minimal pattern measurement was set at 20 clusters. This corresponded to an approximate complete of 300 athletes divided throughout the examine teams.

COVID-19 pandemic adjustment Because of the COVID-19 pandemic, all indoor and group sports activities participation was cancelled through the lockdown interval from 16 March to 1 July 2020. The lockdown influenced the examine in two methods. First, the members couldn’t proceed with the IPPON intervention or warm-up as regular. Second, members weren’t uncovered to judo coaching or competitors. Subsequently, judo colleges began with the intervention at totally different time factors. There was a various interval till the lockdown wherein the athletes carried out the intervention and had been uncovered to judo (on-line supplemental appendix I). Subsequently, we modified the result evaluation by making an allowance for the variance in publicity by together with all athletes for so long as that they had entry to indoor judo coaching till 16 March 2020. Moreover, we added two sensitivity evaluation eventualities, one over 16 weeks and the second evaluation over 26 weeks. Supplemental materials [bjsports-2022-105869supp009.pdf]

Statistical evaluation Modified intention-to-treat rules had been carried out to analyse the first and secondary consequence measures. Contributors had been thought of accessible for the first consequence evaluation if the baseline survey and at the very least one follow-up survey had been accomplished. Estimates for the harm prevalence over the entire interval had been obtained utilizing generalised linear mixed-effect fashions with the intervention interval as a covariate variable to check each teams. Further mixed-effect mannequin analyses had been carried out to appropriate for potential confounders. Statistical significance was set at p<0.05. All analyses had been carried out utilizing SPSS software program V.26.0. The statistical evaluation has been described intimately in on-line supplemental appendix J. The statistical evaluation and presentation are according to the Guidelines for statistical Evaluation of Medical Papers (CHAMP) assertion.27 Supplemental materials [bjsports-2022-105869supp010.pdf]