When 'just doing it' is not enough: assessing the fidelity of player performance of an injury prevention exercise program

J Sci Med Sport. 2015 May;18(3):272-7. doi: 10.1016/j.jsams.2014.05.001. Epub 2014 May 16.


Objectives: To obtain benefits from sports injury prevention programs, players are instructed to perform the exercises as prescribed. We developed an observational checklist to measure the quality of exercise performance by players participating in FootyFirst, a coach-led, exercise-based, lower-limb injury prevention program in community Australian Football (AF).

Design: Observational.

Methods: The essential performance criteria for each FootyFirst exercise were described in terms of the technique, volume and intensity required to perform each exercise. An observational checklist was developed to evaluate each criterion through direct visual observation of players at training. The checklist was trialled by two independent raters who observed the same 70 players completing the exercises at eight clubs. Agreement between observers was assessed by Kappa-statistics. Exercise fidelity was defined as the proportion of observed players who performed all aspects of their exercises correctly.

Results: The raters agreed on 61/70 observations (87%) (Kappa=0.72, 95% CI: 0.55; 0.89). Of the observations with agreed ratings, 41 (67%) players were judged as performing the exercises as prescribed.

Conclusions: The observational checklist demonstrated high inter-rater reliability. Many players observed did not perform the exercises as prescribed, raising concern as to whether they would be receiving anticipated program benefits. Where quality of exercise performance is important, evaluation and reporting of program fidelity should include direct observations of participants.

Keywords: Athletic injury; Exercise therapy; Football; Injury prevention; Sport.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Checklist*
  • Exercise*
  • Football / injuries*
  • Humans
  • Leg Injuries / prevention & control
  • Lower Extremity / injuries
  • Observer Variation
  • Patient Compliance*
  • Reproducibility of Results
  • Task Performance and Analysis*