Prof Evert Verhagen comments on the need for more implementation research

By Professor Evert Verhagen

In reaction to the guest blog by professor Caroline Finch (May 9th), it is really good to see that the important topic of implementation gets the attention it needs. I’ve heard many times, in relation to van Mechelen’s sequence of prevention [1], that we need more intervention studies. This is whilst most studies focus on the first two steps of the four step prevention sequence; counting injuries and describing causal factors.

However, positive intervention outcomes do not necessarily imply prevention of injuries. In fact, I hardly ever see positive study outcomes being implemented and adopted by associations, coaches or athletes. I have no idea whether it is practice that does not want to bow for the evidence, or whether it is evidence that does not fit practice. My opinion hangs to the latter. Nevertheless, fact remains that we are facing an important gap in our knowledge.

Consider the hierarchy in research questions. Efficacy questions being on the fundamental side, effectiveness questions in the middle, and implementation questions on the practical end of the spectrum. I would argue that just as with the sequence of prevention we are stuck somewhere halfway. The field has a solid foundation with efficacious evidence, but hasn’t progressed past the effectiveness questions.

However, this progression is not easy. Our research group has done a fair bit of implementation research, not only in the field of sports injury prevention, and we continuously face the difficulty in publishing the outcomes of such studies. In relation to effectiveness studies implementation research has no standard approach, study design and methodology. In addition, the outcome measures are different and less objective.

Yes, implementation research is a field in progress and we are still refining our methods. And yes, the outcomes seem a bit fuzzy and cloudy. But…implementation research is needed in order to move our knowledge to practice and really mean something for the athlete.

I hope this short blog by professor Caroline Finch is a sign of things to come.

[1] Van Mechelen W, Hlobil H, Kemper HCG. Incidence, severity, aetiology and prevention of sports injuries. A review of concepts. Sports Med 1992; 14(2): 82-99.

Evert Verhagen is an Assistant Professor at the EMGO Institute for Health and Care Research at the VU University Medical Center, Amsterdam, the Netherlands.  You can follow him on Twitter @EvertVerhagen

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