Monday, July 8, 2013

Using The Dynamic Movement Assessment ™ to Prevent Injuries and Improve Performance With Division 1 Soccer - Part II

Last week we presented the first part of a business case using the Dynamic Movement Assessment™ in D1 Soccer.  This article, we will review the methods and both the impact on injuries as well as financial cost to the university.

Methods:
Subject pool consisted of female soccer players playing at the Division 1 level.  There were 102 female sophomore, junior and senior soccer players ranging in age from 18-24 years old.  Average years of play for all the athletes was 6.5 years.  Average number of seasonal non-contact ACL injuries for the intervention group ranged from 2-4 per season for the last 8 seasons.  As part of the standard procedure, each student athlete was put through an annual pre-participation physical and orthopedic examination by the team physician.  Consent to participate in the DMA™ was received from each athlete.  Each athlete then participated in a DMA™ and Fatigue DMA™.  The DMA™ and Fatigue DMA™ consisted of 6 essential movements which were filmed and scored using Dartfish™ video technology.  The DMA™ consisted of:

·         8 min warm-up on bike
·         Performing the DMA™

Three days after performing the DMA™ participants then performed the Fatigue DMA™.  The Fatigue DMA™ consisted of:

·         8 min warm-up on bike
·         Performing the Functional Agility Short Term Fatigue Protocol (FAST-FP)
·         Performing the DMA™

Results:
Analysis of the initial data in comparison of the DMA™ with the Fatigue DMA™, showed the following trends:
·         N = 102
 
·         Average perceived rating of exertion for the DMA™ was:
  • Range of 5-7/10
  • Average 6/10

·         Average perceived rating of exertion for the Fatigue DMA™ was:
  • Range 7-9/10
  • Average 8/10

·         Rating players pre fatigue resulted in:
  • 25% of athletes categorized at risk
  • 2% of athletes categorized high risk

·         Rating players post fatigue resulted in:
  • 5% of athletes categorized at risk
  • 36% of athletes categorized high risk

 Of the athlete’s tested, 48 were provided with an intervention over a 2 year period.  The results were as follows: 
·         N = 48

·         Injuries:
  • 100% reduction of non-contact ACL injuries over 2 years – prior 8 seasons averaged 2-4 ACLs per season
  • 58.2% reduction non-contact musculoskeletal injuries in comparison to prior 8 seasons

·         Performance impact
  • 2 best seasonal performances in comparison to the last 5 years. 
  • Coaches and ATCs correlate this to the ability to keep key players on the field and off the DL

·         $200K health care cost savings over 2 years with just one sport
  • Savings related to both ACL injury and other non-contact musculoskeletal injury reduction
  • If continue 1 more year with reductions will result in university having decrease in premiums for 1st time in 10 years.

Although the rate of reduction is not statistically significant (prevented 4 of potential 8), the cost savings is.  As the study continues, the statistical significance will be more evident.


Use of DMA™ and Impact on Injuries & Health Care Costs for Universities
Research indicates that identifying those with movement dysfunction or pathokinematics can have a dramatic impact on injury rates, individual performance and team performance.  The preliminary data collected in this current business case appears to support previous findings.  Although not statistically significant due to the low sample size and previous seasons ACL injuries, as time goes on, the investigators suspect the current trends will become more significant over time. 

However, there are no studies currently in the literature that look at the health care savings associated with these injury prevention initiatives.  With rising health care costs associated with injuries for the university, the athlete and primary policy holder, closer attention to the impact these initiatives can have on overall health care cost and future premiums paid by the university as well as policy holders will become more imperative.  With budgetary restraints and high costs associated with athletic programs and small profit margins, many universities and professional teams are looking at proactive measures to contain and control these costs.  Knowing that ACL injuries are one of the most costly lower extremity athletic injuries (average $25,000 to $50,000 per injury) and which have causative factors (pathokinematics) that also lead to other non-contact injuries, many teams are focusing efforts on initiatives that impact these specific injuries.  By doing this, the thought is that there will also be a downstream impact on reducing other non-contact lower extremity injuries.  The current business case highlights that.

In the current business case, in just 2 years, with one university and one sport (women’s soccer), the total health care savings for the intervention group was >$200K compared to previous years.  This reduced cost is associated with both the reduction in ACL injuries (MD visits, MR, surgery, rehabilitation, etc.) as well as a 58.2% reduction in other non-contact lower extremity injuries.  If expanded to other high risk sports (football, volleyball, basketball) the annual savings could be much greater.

With the cost of this assessment at $5000 per team or $10,000 over 2 seasons, the total ROI was a $190K in measurable cost savings to the university.  When considering the total ROI, one must also consider the human capital savings (long term health to the athlete), team capital (keeping key players in longer resulting in better seasonal performance with enhanced revenue) as well as overall health care savings.  Although collectively this is not as quantifiable, most agree it is just as valuable in the overall ROI analysis.

Conclusion

The current business case highlights the importance of injury prevention initiatives at the collegiate and professional level.  When looking at the rising health care costs, the fiscal impact to the department or team is growing exponentially.  When looking at factors that are not as easy to quantify financially (insurance premiums, paid time on the DL, fiscal impact to seasonal performance with key players lost) as well as the human toll, it becomes apparent that proactive management is imperative.  Although there are many systems out there that are used, the following business case highlights the impact of the Dynamic Movement Assessment™ on health care costs, injury prevention and performance improvement. 

Several key factors that lead to the current results are:

·         Engagement of the coaching staff, strength & conditioning team, athletic trainers, team physician and athletic director – due to the training of the key stakeholders in the movements, pathokinematics and impact on performance/injury prevention all were engaged in the program’s success.

·         Engagement and compliance of the athletes with the program – due to the training of the team on their individual results and importance of preventing pathokinematics during activities the players became engaged in helping their team mates be successful with the training.

·         Flexibility of the DMA™ and it’s integration into existing practice and strength & conditioning schedules by the developers of the DMA™, this allowed them to adapt to the needs of the team and university while maintaining the integrity of the program.

Based on the results with the intervention group, the university will be expanding use of the DMA™ to additional high risk and high health care dollar per athlete sports.  These include football, volleyball and basketball with the anticipation that one additional year of reduced health care spending will result in a decrease in their annual health care premiums.
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