A systematic review and network meta-analysis on the effectiveness of exercise-based interventions for reducing the injury incidence in youth team-sport players. Part 2: an analysis by movement patterns

The objectives of this network meta-analysis were: (a) to estimate and compare the pooled effects of some injury prevention programs (IPPs) whose exercise-based components were categorized using a movement pattern-specific taxonomy on reducing overall and some specific body regions (lower extremity, thigh, knee, and ankle) injury incidences in youth team sport athletes and (b) to explore the individual effects of these components on the injury incidence rates (IIRs) previously mentioned. Searches were performed in PubMed, Web of Science, SPORTDiscus, and Cochrane Library. Eligible criteria were: exercise-based interventions comprised of exercises involving athletic motor skill competencies and evaluated against a control group, overall IIRs were reported, and youth (≤19 years old) team sport players. For the current analysis, a taxonomy based on movement patterns was employed for exercise component identification (upper body pushing and pulling; lower body concentric and eccentric; core; mechanics; acceleration; and lower body stability). Pooled effects were calculated by frequentist random effects pairwise and network meta-analyses. Nineteen studies were included. Most of the IPPs exhibit risk reduction when compared to their control groups on overall, lower extremity, and ankle injuries. Interventions comprised of lower body concentric and eccentric, core, mechanics, and lower body stability exercises were the most effective measures for reducing these injuries. None of the IPPs demonstrated to be effective for reducing thigh injuries, and contradictory results were found for knee injuries. Individual analysis at component level revealed that the lower body (bilateral and unilateral, concentric, and eccentric) component was the only one associated with a significant reduction on overall injuries. Indirect evidence suggests that interventions incorporating lower body concentric and eccentric, core, mechanics, and lower body stability exercises might be the most effective for reducing overall, lower extremity, and ankle injuries in youth team sports. The categorization of exercise components based on the movement patterns might, a priori, be considered a criterion more closely associated with the injury phenomenon. Lower body concentric and eccentric, core, mechanics, and lower body stability exercises should be incorporated to any training program aimed at minimizing the risk of injury in youth. The ineffectiveness of interventions on the reduction of thigh injuries reveals the need for reconsideration of injury prevention strategies.本项网络Meta分析（network meta-analysis）的研究目标分为两点：（a）评估并比较若干损伤预防方案（injury prevention programs, IPPs）的合并效应量——此类方案的运动训练组分采用运动模式特异性分类法进行归类，旨在降低青少年团体项目运动员的整体损伤及特定身体部位（下肢、大腿、膝部与踝部）损伤发生率；（b）探究上述运动组分对前述损伤发生率（injury incidence rates, IIRs）的单独效应。研究检索了PubMed、Web of Science、SPORTDiscus及Cochrane Library。纳入标准如下：干预措施为基于运动的训练，训练内容涵盖运动动作技能能力，并设置对照组开展对照研究；需报告整体损伤发生率；研究对象为青少年（≤19岁）团体项目运动员。本分析采用基于运动模式的分类法对训练组分进行识别，具体分为上肢推、拉动作；下肢向心、离心动作；核心区训练；动作力学训练；加速能力训练；以及下肢稳定性训练。合并效应量通过频率学派随机效应配对Meta分析及网络Meta分析计算得到。最终共纳入19项研究。相较于对照组，多数损伤预防方案可降低受试者的整体、下肢及踝部损伤风险。包含下肢向心与离心训练、核心区训练、动作力学训练及下肢稳定性训练的干预措施，是降低此类损伤的最优手段。现有损伤预防方案均未被证实可有效降低大腿损伤发生率，而针对膝部损伤的预防效果则存在矛盾结果。组分水平的单独分析显示，下肢（双侧与单侧、向心及离心）训练组分是唯一与整体损伤发生率显著降低相关的因素。间接证据表明，纳入下肢向心与离心训练、核心区训练、动作力学训练及下肢稳定性训练的干预措施，或许是降低青少年团体项目运动员整体、下肢及踝部损伤风险的最优方案。基于运动模式对训练组分进行分类，在事前层面可被认为是与损伤发生机制更为契合的分类标准。针对旨在降低青少年运动员损伤风险的训练计划，应纳入下肢向心与离心训练、核心区训练、动作力学训练及下肢稳定性训练内容。现有干预方案无法有效降低大腿损伤的结果，提示亟需重新审视当前的损伤预防策略。