Refining the recipe or spoiling the broth? Reframing perceptions of programme adaptation in sports injury prevention

Multiple injury prevention exercise programmes have demonstrated efficacy under randomised controlled conditions.1 However, successfully implementing these programmes under real-world conditions poses a significant challenge. It is well documented that football teams modify programmes to better fit their specific context, drawing not only on evidence from randomised controlled trials (RCTs) but also their past experiences, guidelines and individual player screening data.2 Furthermore, evaluation of injury prevention programmes under real-world conditions demonstrates that increased programme adaptability, variation and individualisation can facilitate implementation efforts.2 Modifying efficacious programmes can potentially enhance context-specificity but may also jeopardise fidelity. Replicating the exact protocol from an RCT increases the chances of achieving the desired injury reduction, but failing to consider the intricacies of the specific implementation context and modify the intervention accordingly increases the risk of poor adherence. Balancing these dual aspirations of fidelity and context-specific modifications has been coined the adaptation-fidelity dilemma.3 To evaluate implementation outcomes, sports injury prevention researchers have embraced the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework.4–6 While this has heightened awareness of different implementation factors and common pitfalls, most analyses only consider teams’ use of interventions in their original (RCT) form. But programme modifications are common2 7 and failing to assess and analyse them will paint an incomplete picture of real-world adherence. Taking the example of the Copenhagen Adduction Exercise (CAE), under RCT conditions, the programme reduced the risk of groin problems …