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These InfoPOEMs® are selected by JNMA InfoPOEMS Editor Gregory E. Gilbert, MSPH, (Gregory.E.Gilbert@ and Associate InfoPOEMS Editor Amy H. Wahlquist, MS, from InfoPOEMs®
are created by experts who continuously survey medical journals worldwide. They identify and summa-
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    STUDY LEVELS OF EVIDENCE (LOE)                                                            domized (concealed allocation) by
    From the Centre for Evidence-Based                Specialized Training                    team to receive the specific training
    Medicine, Oxford. For the most up-to-             Decreases Injuries                      or no intervention. One or 2 team
    date levels of evidence, see www.cebm.
    net/levels_of_evidence.asp)                       in Elite Athletes                       members were educated in the exer-
                                                                                              cise program and were provided an
    Therapy/Prevention/Etiology/Harm:                 Clinical Question                       instruction booklet, balance boards,
    1a: Systematic reviews of randomized                 Can a specific warm-up exercise      balance pads and other materials.
         controlled trials                            program decrease injuries in elite      The 30-minute program consisted
    1b: Individual randomized controlled              athletes?                               of 5–7 minutes of running exercise,
    1c: All or none randomized controlled
                                                                                              balance and body control exercises,
         trials                                       Bottom Line                             plyometrics (jumping, hopping and
    2a: Systematic reviews of cohort studies              Injuries can be reduced by          other explosive movements), core
    2b: Individual cohort study or low-               incorporating exercises specifically    and lower-limb strengthening exer-
         quality randomized controlled
                                                      aimed at improving proprioception,      cises, and stretching. The exercises
    2c: “Outcomes” research, ecological
         studies                                      strength and balance. A 30-minute       were performed 2–3 times per week
                                                      exercise program performed 2–3          before the season and during a break,
    Diagnosis:                                        times per week reduced the number       and once weekly during the season.
    1a: Systematic review of level-1                  of noncontact leg injuries by 66%       After adjusting for the number of
         diagnostic studies                           (LOE = 1b)                              scheduled hours of training and play,
    1b: Independent blind comparison
         of an appropriate spectrum
                                                                                              there were significantly fewer non-
         of consecutive patients, all of              Study Design                            contact injuries, defined as an injury
         whom have undergone both the                    Randomized controlled trial          requiring ≥1 day missed of practice
         diagnostic test and the reference
         standard, or a clinical decision rule
                                                      (nonblinded)                            or play, in the trained group: 20 in
         not validated on a second set of                                                     the trained group versus 52 in the
         patients                                     Funding                                 control group (P<0.001). This differ-
    1c: Absolute SpPins and SnNouts                     Government                            ence remained when all injuries were
    2a: Systematic review of level >2                                                         considered. Similar effectiveness has
    2b: Independent blind or objective
         comparison, study confined
                                                      Allocation                              been shown in adolescents who play
         to a narrow spectrum of study                   Concealed                            handball (BMJ. 2005;330:449-452).
         individuals, or a diagnostic clinical
         rule not validated in a test set
                                                      Setting                                 REFERENCE
                                                         Outpatient (primary care)            Pasanen K, Parkkari J, Pasanen M, et al. Neu-
    Prognosis:                                                                                romuscular training and the risk of leg injuries
    1a: Systematic review of inception                                                        in female floorball players: cluster rando
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