Bogardus Rima L, Martin Ryan J, Richman Alice R, Kulas Anthony S
Department of Health Education and Promotion, East Carolina University, Greenville, NC 27858, USA.
J Sport Health Sci. 2019 Jan;8(1):8-16. doi: 10.1016/j.jshs.2017.11.001. Epub 2017 Nov 6.
Preventing anterior cruciate ligament (ACL) injuries is important to avoid long-term adverse health consequences. Identifying barriers to implementation of these prevention programs is crucial to reducing the incidence of these injuries. Our purpose was to identify barriers of implementation for ACL injury prevention programs and suggest mechanisms for reducing the barriers through application of a Socio-Ecological Model (SEM).
Studies investigating ACL prevention program effectiveness were searched in Medline via PubMed and the Cochrane Library, and a subsequent review of the references of the identified articles, yielded 15 articles total. Inclusion criteria encompassed prospective controlled trials, published in English, with ACL injuries as the primary outcome. Studies were independently appraised by 2 reviewers for methodological quality using the PEDro scale. Barriers to implementation were identified when reported in at least 2 separate studies. A SEM was used to suggest ways to reduce the identified barriers.
Five barriers were identified: motivation, time requirements, skill requirements for program facilitators, compliance, and cost. The SEM suggested ways to minimize the barriers at all levels of the model from the individual through policy levels.
Identification of barriers to program implementation and suggesting how to reduce them through the SEM is a critical first step toward enabling ACL prevention programs to be more effective and ultimately reducing the incidence of these injuries.
预防前交叉韧带（ACL）损伤对于避免长期不良健康后果至关重要。识别这些预防计划实施过程中的障碍对于降低此类损伤的发生率至关重要。我们的目的是识别ACL损伤预防计划的实施障碍，并通过应用社会生态模型（SEM）提出减少这些障碍的机制。
通过PubMed和Cochrane图书馆在Medline中检索调查ACL预防计划有效性的研究，随后对已识别文章的参考文献进行回顾，共获得15篇文章。纳入标准包括前瞻性对照试验，以英文发表，以ACL损伤作为主要结局。由2名评审员使用PEDro量表对研究的方法学质量进行独立评估。当至少在2项独立研究中报告时，确定实施障碍。使用SEM提出减少已识别障碍的方法。
确定了五个障碍：动机、时间要求、项目促进者的技能要求、依从性和成本。SEM提出了在模型从个人到政策层面的所有层面上最小化障碍的方法。
识别计划实施的障碍并通过SEM提出如何减少这些障碍，是使ACL预防计划更有效并最终降低此类损伤发生率的关键的第一步。
