This review assessed various interventions targeted at preventing sports injuries. The authors concluded that the use of insoles, external joint supports and training programmes were effective in preventing injuries, whereas other prevention methods did not show consistent benefits. Although this was a well-conducted review, the conclusions may be compromised by the overall poor quality of the included studies.

To review interventions targeted at preventing sports injuries.

MEDLINE (from 1966), PubMed, the Cochrane CENTRAL Register, SPORTDiscus, CINAHL (from 1982) and PEDro were searched to December 2005; the search terms were reported. The reference lists of retrieved articles and reviews were screened for additional studies.

Randomised and quasi-randomised controlled trials of any intervention to prevent sports injuries, which reported the injury rate or the number injured as an outcome, were eligible for inclusion. The intervention protocol and outcome measures used in the studies had to be described. The interventions evaluated included insoles, external joint supports, training programmes, stretching and warm-up programmes, mouth guards, modified shoes and videos. The participants were aged from 5 to 68 years, with most in their teens and 20s, and the majority male.

Two reviewers selected the articles, with any disagreements resolved through consensus.

The quality of the studies was assessed on the basis of randomisation, allocation concealment, similarity at baseline, blinding, cointerventions, compliance, drop-outs, timing of the outcome measures and analysis. Study quality was scored between 0 and 11 (best methodological quality).

Two reviewers assessed quality, with any disagreements resolved by consensus or by consultation with three other reviewers.

Odds ratios, with 95% confidence intervals, were calculated using the number of injured individuals or the number of injuries.

Two reviewers independently extracted the data, with any disagreements resolved by consensus or by consultation with three other reviewers if the disagreement was not resolved.

The studies were described narratively. Differences in study characteristics were tabulated and discussed in the text, with results presented for the number of studies that reported a >30% or >50% reduction in risk of injury. Statistical heterogeneity was assessed using the I² statistic.

Thirty-two studies (n=24,931) met the inclusion criteria.

The trials scored 1 to 8 out of 11 for methodological quality: one scored 1, seven scored 2, eight scored 3, six scored 4, five scored 5, two scored 6, two scored 7 and one scored 8.

All 5 studies evaluating insoles (n=2,446) reported a reduction in risk of at least 30%, with four of these reporting a reduction of at least 50%. There was no evidence of statistical heterogeneity.

All 7 studies evaluating external joint supports (n=10,300) reported a reduction in risk of at least 30%, with six of these reporting a reduction of at least 50%. There was no evidence of statistical heterogeneity.

All 6 multi-intervention studies (n=2,809) reported a reduction in the risk of injury of at least 30%, with five of these reporting a reduction of at least 50%. There was no evidence of statistical heterogeneity.

Four studies (n=1,799) assessing balance board training yielded differing results and there was heterogeneity between the studies.

Other interventions were evaluated in few studies and mixed results were reported.

A variety of interventions might prevent sports injuries. The use of insoles, external joint supports and multi-intervention training programmes were associated with a decreased number of sports injuries.

The review addressed a clear question and undertook a comprehensive search for published trials, but did not specifically seek unpublished studies. The restriction to trials published in English might have resulted in the omission of some relevant data. The review process was well conducted with the study selection, quality assessment and data extraction processes undertaken in duplicate, and the quality criteria reported for each study. The authors undertook a thorough quality assessment of the included studies, providing a composite score for the methodological quality of each study. They also undertook a thorough narrative synthesis, opting not to undertake a comprehensive meta-analysis given the diversity of the studies and a number of biases within trials within selected papers. There was no evidence of statistical heterogeneity between the studies. The authors' decision not to perform a comprehensive meta-analysis appears justified. Although this was a well-conducted review, the conclusions may be compromised by the overall poor quality of the included studies.

Practice: The authors did not state any implications for practice.

Research: The authors stated that further research should focus on commonly practised and high-risk sports. Future studies should concentrate on accessing the acceptability, compliance, cost-effectiveness and long-term adherence of preventive measures.

Not externally funded.

This record is a structured abstract written by CRD reviewers. The original has met a set of quality criteria. Since September 1996 abstracts have been sent to authors for comment. Additional factual information is incorporated into the record. Noted as  [A:....].