Omkostningseffektanalyse og implementering af et opvarmningsprogram hos unge fodboldspillere

Abstract

Every year, Denmark spends around 40 million DKK on emergency room visits due to sports injuries. Soccer is the most popular branch of sport and especially the knee is at risk for injuries. It is of interest to prevent injuries in all age groups but especially for adolescents due to the risk of early complications such as osteoarthritis in the knee. Therefore, there is a need for reducing knee injuries in this age group, which can be done effectively through warm-up programs. For example, a study shows a reduction in the number of injuries by 46 % in soccer, handball and basketball combined by implementing a warm-up program. The implementation is not straightforward, and problems occur in the implementation of warm-up programs. The literature suggests that persistence to the program results in a higher reduction. The aim of this project is, therefore, to investigate whether a warm-up program is cost-effective compared to no warm-up program in one year seen from a healthcare sector perspective in adolescent soccer players with acute knee injuries and to investigate how a warm-up program can be implemented. The method used to determine the cost-effectiveness of a warm-up program is a decision tree considering both the costs and effects from the literature. Interviews coupled with classic implementation theory are used to investigate how a warm-up program can be implemented. The results shows that a warm-up program is cost-effective compared to no warmup program with a saving of 310 DKK per player per year and a gain of 0,41 in the International Knee Documentation Committee (IKDC) score. The probabilistic sensitivity analysis shows that the warm-up program will be both less costly and more effective in 79,81% of the cases. Furthermore, it is seen that the healthcare sector can grant up to 16 hours of physiotherapy before the conclusion will change. According to the implementation theory, it is important that the recipients start by seeing the need for change, which can be done by considering the number of injuries in the sports club but it is important to note that it is not all clubs who have the resources to change. Second, the implementation process should include obtaining knowledge of the warm-up program, but it can be difficult to take this knowledge. Furthermore, coaches often do not have the time to take courses in the warm-up techniques. In the second step, the responsibility is placed and overall it is the coach who has the responsibility for using and implementing the warm-up program, but the player and the club also have a part of the responsibility. Third, the future state of the club should be investigated which can be done through strength and weaknesses of a warmup program. Especially, a strength is the reduction of injuries. The recognisability of the program is both a strength and a weakness. Recognisability gives the coaches extra time in warming up, but it can remove the motivation, and 20 minutes is a long time to warm up. It is suggested to vary some of the exercises. Overall it is thought that the strengths can counterbalance the weaknesses. Fourth, it is suggested that the implementation should start on one team and hereafter spread out to the club. At last, it is important to be clear about the goal for having a warm-up program otherwise the motivation from the coach and the players can drop. Whether the costs for a warm-up program should be included can be discussed and studies have not included them, but it is out of the health-care-sector perspective. A strength in the model is that the probability of injury is calculated on the basis of four studies. The probability for the different types of knee injuries is calculated on the basis of one study which can be seen as a weakness and more literature could reduce the uncertainties. The number of interviews and whether it is the right people who have been interviewed can also be discussed. However, it is thought that more interviews would not give another conclusion. Suggestions for implementation of a warm-up program is presented in the project and it can be discussed whether it actually is the coach who has the responsibility. The results from this project should be presented in different ways dependent on the recipient, but overall everybody that works with or is playing soccer can use the knowledge from this project. It can be concluded that a warm-up program is cost-effective compared to no warmup program in one year seen from a healthcare perspective. Several aspects should be considered when implementing a warm-up program, among others who is responsible.

A master thesis from Aalborg University

Omkostningseffektanalyse og implementering af et opvarmningsprogram hos unge fodboldspillere

[Cost-Effectiveness analysis and implementation of a warm-up program among adolescent soccer players]