Effect of adherence to exercise-based injury prevention programmes on the risk of sports injuries: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND: Adherence may affect the effectiveness of injury prevention programmes (IPPs), yet no previous meta-analyses have examined the pooled impact of adherence to exercise-based IPPs across multiple injury types. The objective of the systematic review and meta-analysis was to investigate the effect of exercise-based IPP adherence on the risk of sports injuries.

METHODS: Six databases (PubMed, EMBASE, SPORTDiscus, PEDro, Cochrane Central Register of Controlled Trials and Web of Science) were searched from inception to the end of May 2023. Randomised, quasi-randomised controlled trials and cluster-randomised controlled trials investigating exercise-based sports injury prevention interventions and providing data on adherence were included in the systematic review. Studies included in the meta-analysis were divided into top (≥84%), middle (74%-83%) and bottom (<74%) adherence tertiles according to the percentage of completed intervention sessions with equal distribution in each tertile. Of 2647 identified reports, 52 studies were included in the systematic review and 35 of these were included in the meta-analysis.

RESULTS: The top-adherence group had a 47% lower injury rate than the control group (rate ratio (RR)=0.53, 95% CI 0.42 to 0.67, p<0.001). In the middle and bottom-adherence groups, injury rates were RR=0.50 (95% CI 0.39 to 0.64, p<0.001) and RR=0.87 (95% CI 0.75 to 1.02, p=0.08), respectively. Meta-regression analysis confirmed the results of the primary meta-analysis showing that adherence level significantly moderates the sports injury rate (β=-0.013, p<0.001).

CONCLUSIONS: Higher adherence to IPPs resulted in reduced injury rates. When the adherence level was lower, the rate of injuries was not significantly reduced.

PROSPERO REGISTRATION NUMBER: CRD42023429370.