Injury Epidemiology and Prevention in Youth Rugby Union

Rugby union is a contact team-sport played by nearly 500,000 school children on a weekly basis in England. The contact nature of the game means there is an inherent risk of injury, and the development and implementation of rugby specific injury prevention strategies is vital to protecting the health of young players. Various strategies have been developed to prevent rugby injuries, including law changes, equipment, and neuromuscular training programmes; however, it was unclear whether the implementation of these interventions has been assessed. The first study of this thesis (chapter two) used the RE-AIM (‘Reach’, ‘Effectiveness’, ‘Adoption’, ‘Implementation’, ‘Maintenance’) Framework to evaluate implementation factors reported in the literature. Intervention ‘Effectiveness’ was the primary focus of most studies, whereas ‘Adoption’, ‘Implementation’, and ‘Maintenance’ were largely not reported despite their influence on ‘Effectiveness’. The Activate injury prevention exercise programme has been shown to lower rugby injury risk. Activate is endorsed and disseminated by the Rugby Football Union (governing body for English rugby union) but assessment of its implementation had not yet been undertaken. As such, chapter three assessed Activate implementation in English schoolboy rugby union. Coaches had good baseline awareness of Activate and reported moderate adoption during the study, but often did not implement Activate as intended, shortening the duration or session frequency. Chapter four assessed how attendance at a coach education workshop could influence behavioural determinants of Activate use. Attendees had significantly greater Activate adoption and adherence during the season, which was associated with greater post-season task self-efficacy. Barriers and facilitators to implementing Activate in English schoolboy rugby union were assessed in a qualitative study (chapter five), with coaches generally holding positive views towards Activate and injury prevention. However, most reported modifying Activate due to lack of time or to maximise player engagement. Coaches reported players often acted as delivery-agents, despite players appearing to lack awareness of Activate (chapter two). Although Activate efficacy was previously established, its effectiveness in the applied setting needed to be assessed. Chapter six describes a quasi-experimental study investigating the injury risk of schoolboy rugby players exposed to Activate versus those who were not. Individuals on teams adopting Activate had lower training and match injury incidence, whilst those using the programme three times per week had a significantly lower match and training than those using the programme