EXPLORING USABILITY IN EXERCISE INTERVENTIONS: FROM CONCEPTUALIZATION TO MEASUREMENT AND APPLICATION

Exercise interventions hold promise for preventing and treating numerous conditions, diseases, and injuries. However, these interventions will only be effective if they are being used. Unfortunately, uptake and adherence to prescribed exercise and physical activity guidelines are insufficient. Some reasons for this include lack of knowledge, resources, flexibility, and enjoyment. Exercise program developers need to not only consider the effectiveness of the program during the development phase, but also involve end-users and receive feedback on program usability to determine likelihood of uptake and adoption. Usability testing can be used to detect barriers to use and implementation likelihood but has not yet been utilized within the domain of exercise-based interventions. The goal of this research was to better characterize and quantify exercise program usability to promote the design of more usable exercise programs. In the first study, a modified usability scale was used to assess and identify important program characteristics and their relationship to female handball players’ intention to use a newly developed anterior cruciate ligament (ACL) injury prevention program (IPP). Study 2 involved a mixed methods approach to gain deeper insight into factors affecting use of an IPP and the relationship between perceived program characteristics and effectiveness of the program utilizing interviews with coaches and players, and surveys. From study 1 and 2, results indicated that perceived effectiveness, enjoyability, efficiency and flexibility affected players’ and coaches’ intention and willingness to continue using the IPP. Building on these findings, the Intervention Usability Scale for Exercise (IUSE) was developed and validated in study 3. Exercise intervention stakeholders and target users of an exercise program contributed to item generation and content validation. Subsequently, a large sample of target users used the full scale to assess the usability of an exercise program. Following an extensive data analysis process, the 8-item IUSE indicated good psychometrics properties. Collectively, this research sought to improve exercise program usability by developing a tool exercise intervention developers can utilize as part of their program development and assessment process. Future studies should evaluate the predictive utility of the scale on actual uptake and adherence to an exercise intervention

I spy with my little eye … a knee about to go \u27pop\u27? Can coaches and sports medicine professionals predict who is at greater risk of ACL rupture?

BACKGROUND: The vertical drop jump (VDJ) test is widely used for clinical assessment of ACL injury risk, but it is not clear whether such assessments are valid. AIM: To examine if sports medicine professionals and coaches are able to identify players at risk of sustaining an ACL injury by visually assessing player performance during a VDJ test. METHODS: 102 video clips of elite female handball and football players performing a baseline VDJ test were randomly extracted from a 738-person prospective cohort study that tracked ACL injuries. Of the sample, 20 of 102 went on to suffer an ACL injury. These 102 videos were uploaded to an online survey. Sports medicine professionals and coaches were invited to assess athlete performance and rate each clip with a number between 1 and 10 (1 representing low risk of sustaining an ACL injury and 10 representing high risk). Receiver operating characteristic analyses were used to assess classification accuracy and between-group differences were analysed using one-way analysis of variance. RESULTS: 237 assessors completed the survey. Area under the curve values ranged from 0.36 to 0.60, with a mean score of 0.47, which is similar to random guessing. There were no significant differences in classification accuracy between groups (physicians, coaches, certified athletic trainers, researchers or physical therapists). CONCLUSION: Assessors have poor predictive ability (no better than chance), indicating that visual assessment of a VDJ test is a poor test for assessing ACL injury risk in elite female handball and football players

The effect of a brief, web-based animated video for improving comprehension and implementation feasibility for reducing anterior cruciate ligament injury: A three-arm randomized controlled trial

Neuromuscular injury prevention training (IPT) has been shown to reduce anterior cruciate ligament (ACL) injury risk by approximately 50%, but the implementation rate is low. One of the most important modifiable barriers for implementation is coaches’ comprehension of risk and intervention strategies. This study aimed to evaluate the effect of a brief, web-based, animated video on ACL injury prevention comprehension and IPT implementation feasibility. Coaches in landing and cutting sports were recruited and randomized into three groups. (1) Intervention: brief multimedia animated video about ACL injury and prevention. (2) Active control: commonly accessed, text-based web resource about ACL injury and prevention. (3) Placebo control: brief multimedia video about concussions. Overall ACL comprehension—composed of basic ACL knowledge, risk knowledge, prevention knowledge, and severity knowledge—as well as implementation feasibility were all measured prior to and immediately following the interventions. Overall ACL comprehension improved the most in the animated video group (Cohen’s d = 0.86) and, to a lesser degree, in the active control web-based article group (Cohen’s d = 0.39). Both video and web-based article groups had greater implementation feasibility compared to the control group (p = 0.01). Overall, these initial results suggest that a brief, web-based, animated video has the potential to be a superior method for informing stakeholders in order to reduce traumatic injuries in sport

Usefulness of Current Patient-Reported Outcome Scales for ACL Injury: A Mixed-Methods Evaluation of Stakeholder-Perceived Utility of Specific Constructs and Items Across the Rehabilitation Timeline

BACKGROUND: Numerous patient-reported outcome measures (PROMs) have been used in patients with anterior cruciate ligament reconstruction (ACLR), often with overlapping constructs of interest and limited content validity. Inefficient scale application increases burden and diminishes overall usefulness for both the patient and practitioner. PURPOSE: To isolate specific PROM items across a diverse set of constructs that patients and practitioners perceive as having the greatest value at various stages of recovery and return to sport (RTS) in patients after ACLR. STUDY DESIGN: Cross-sectional study. METHODS: A combined 77 stakeholders participated in this 2-phase mixed-methods investigation. In phase 1, a total of 27 patients and 21 practitioners selected individual PROM items from various constructs that had the greatest utility or importance. In phase 2, the highest rated items were further tested in a head-to-head comparison with 29 stakeholders who attended the 2022 ACL Injury Research Retreat. In addition to the utility assessment, practitioners answered other questions related to importance and timing of PROM assessments. RESULTS: In phase 1, both patients and practitioners shared the same top item in 6 of the 8 (75%) constructs assessed. In phase 2, the construct of psychological burden was rated as extremely important by 59% of respondents, followed by physical function (54%), symptoms (35%), and donor site issues (10%). The PROM items of confidence, perceived likelihood of reinjury, and difficulty stopping quickly were rated by a respective 93%, 89%, and 86% of the sample as either very useful or extremely useful. All constructs except donor site issues were rated by most stakeholders to be absolutely necessary to evaluate treatment progress and RTS readiness at the 6-month postoperative time and at RTS. CONCLUSION: Overall, psychological burden, with specific items related to confidence and reinjury likelihood, were rated as most important and useful by both patients and practitioners. The second most important and useful PROM item was related to higher intensity function (eg, decelerating or jumping/landing activities during sports)

I spy with my little eye … a knee about to go ‘pop’? Can coaches and sports medicine professionals predict who is at greater risk of ACL rupture?

Background: The vertical drop jump (VDJ) test is widely used for clinical assessment of ACL injury risk, but it is not clear whether such assessments are valid. Aim: To examine if sports medicine professionals and coaches are able to identify players at risk of sustaining an ACL injury by visually assessing player performance during a VDJ test. Methods: 102 video clips of elite female handball and football players performing a baseline VDJ test were randomly extracted from a 738-person prospective cohort study that tracked ACL injuries. Of the sample, 20 of 102 went on to suffer an ACL injury. These 102 videos were uploaded to an online survey. Sports medicine professionals and coaches were invited to assess athlete performance and rate each clip with a number between 1 and 10 (1 representing low risk of sustaining an ACL injury and 10 representing high risk). Receiver operating characteristic analyses were used to assess classification accuracy and between-group differences were analysed using one-way analysis of variance. Results: 237 assessors completed the survey. Area under the curve values ranged from 0.36 to 0.60, with a mean score of 0.47, which is similar to random guessing. There were no significant differences in classification accuracy between groups (physicians, coaches, certified athletic trainers, researchers or physical therapists). Conclusion: Assessors have poor predictive ability (no better than chance), indicating that visual assessment of a VDJ test is a poor test for assessing ACL injury risk in elite female handball and football players