Virtual Neuromuscular Training: Preliminary Findings Using an Injury Prevention Program for Physically Active Adults.

Context: Neuromuscular training (NMT) is an effective injury prevention strategy but may have barriers to in-person delivery. Our objective was to examine injury incidence in the year following NMT intervention delivered virtually and to identify functional test performance associated with subsequent injuries.

Design: Secondary analysis of randomized controlled trial.

Methods: We recruited 40 physically active adults aged 18-40 years. Functional testing included simple (stimulus-response) and clinical (drop stick) reaction time (RT), single- and dual-task tandem gait, vestibular/oculomotor function, and cervical spine proprioception (head repositioning accuracy). Participants were randomized to virtual NMT or control groups. Virtual NMT was an 8-week program delivered via smartphone application, consisting of 3 self-guided sessions/wk. The main outcome was subsequent injuries sustained in the year following study completion.

Results: Forty participants were randomized to intervention (n = 20) or control (n = 20). Thirty-five (87.5%) completed the intervention period. Twenty-four (69%) completed the 1-year follow-up injury survey (age = 26.0 [3.4] y, 71% female; n = 11 intervention and n = 13 control). Five participants reported a subsequent injury, and 19 did not. There was no proportional difference in subsequent injuries between the intervention (27.3%) and control groups (15.4%; P = .63). However, those who sustained subsequent injuries demonstrated significantly slower clinical RT (260.2 [18.7] vs 238.4 [17.3] ms, P = .02, Hedge g = 1.2) and greater head repositioning accuracy error (4.9 [1.8] vs 3.4 [0.8] degrees, P = .007, Hedge g = 1.5). Although not statistically significant, those who sustained injuries demonstrated slower tandem gait (single task: 17.0 [4.2] vs 14.7 [2.4] s, P = .12; dual task: 20.8 [6.2] vs 17.5 [4.1] s, P = .17) and more positive vestibular/oculomotor tests (2.0 [2.3] vs 0.7 [0.95], P = .06) compared to those who did not. Simple RT was similar between groups (467 [64.7] vs 457 [53.5] ms, P = 0.78).

Conclusions: We did not observe a proportional difference in subsequent injuries between virtual NMT and control groups among uninjured adults. However, slower clinical RT and worse cervical spine proprioception may help identify individuals with an increased risk of injuries.