The Impact of a Novel Neuromuscular Training Program on Leg Stiffness, Reactive Strength, and Landing Biomechanics in Amateur Female Rugby Players

Round 1

Reviewer 1 Report

The study investigates the effect of 12-week KneeRugbyWomen training program on jump-related biomechanical variables and physical fitness in amateur female rugby sevens players. The authors found that the KneeRugbyWomen training program was effective for improvement of Reactive Strength Index in female players.

This is an interesting study with practical applications of findings. There are, however minor concerns which should be addressed.

 

I would suggest to reformulate the title of the study (it is not necessary to repeate twice „rugby“ and „women“ or „female“).

KneeRugbyWomen program impact on leg stiffness, reactive strength, and landing biomechanics in amateur female rugby players

 

Specify physical fitness varianles.

L12-13: This study aims to assess of 12-weeks of a novel KneeRugbyWomen training program on jump-related biomechanical variables and physical fitness in amateur female rugby sevens players.

 

Specify between-group differences (e.g., significant improvement, significant increase etc.).

L19-22: “…significant differences in the RSI were found between players from EG and CG (p = 0.007, r = 0.55, large effect). LESS scores were significantly different between EG and CG at pre-intervention (p = 0.008, r = 0.55, large effect) and post-intervention (p = 0.003, r = 0.60, large effect).”

 

Specify “partly positive effect”.

L22-24: Results of this study only partly show the positive effect of the KneeRugbyWomen training program on variables associated with increased ACL injury risk in female players.

 

Please, reformulate the conclusion. The relationship between jump-related biomechanical variables and increased ACL injury risk in female rugby players was not investigated in the present study.

L22-24: Results of this study only partly show the positive effect of the KneeRugbyWomen training program on variables associated with increased ACL injury risk in female players.

 

The authors should specify whether the KneeRugby Women training program is an injury prevention program and briefly describe it.

L75-80: Based on our knowledge there is no study exploring effectivity of injury prevention programs in amateur female rugby players. Therefore, our aim was to compare leg stiffness, reactive strength, and LESS scores pre and post 12-week KneeRugby Women training program in a cohort of amateur female rugby players. We hypothesized that our cohort would have increased leg stiffness and reactive strength and decreased LESS scores after prevention program completion.

 

The authors should report whether the power analysis for estimating appropriate sample size was provided.

L89-92: Final sample of 24 players was analysed, 12 in the EG (mean ± SD: age, 20.05 ± 4.43 yrs., height, 166.54 ± 4.46 cm, body mass: 64.65 ± 6.44 kg) and 12 in the CG (mean ± SD: age, 20.04 ± 4.88 yrs., height: 166.83 ± 7.30 cm, body mass: 69.83 ± 12.84 kg).

 

Again, specify post-intervention between-group differences (e.g., significant improvement, significant increase etc.).

L187-191: RSI was not significantly different between EG and CG at pre-intervention (MD = 0.07 [-0.13 to 0.29], p = 0.632, r = 0.11 [0.01 to 0.49]) but a significant difference was found at post-intervention (MD = 0.22 [0.08 to 0.36], p = 0.007, r = 0.55 [0.21 to 0.78]) testing. Post-intervention RSI was significantly different compared to pre-intervention RSI in EG but not in CG (Table 2).

 

Again, specify pre- and post-intervention between-group differences.

L200-202: LESS scores were significantly different between EG and CG at pre-intervention (MD = -1.89 [-3.07 to -0.71] errors, p = 0.008, r = 0.55 [0.19 to 0.81]) and post-intervention (MD = -2.22 [-3.66 to -0.73] errors, p = 0.003, r = 0.60 [0.23 to 0.84]) testing.

 

Please remove the aim of the study from the Discussion part.

L212-214: This study aimed to examine the effect of the 12-week KneeRugbyWomen injury prevention program on leg stiffness, reactive strength, and LESS scores.

 

As the KneeRugbyWomen training program was only effective for improvement of Reactive Strength Index, the authors should suggest recommendations for its improvement and present practical applications of findings with respect to female amateur rugby players.

L214-219: The main finding of this study was that significant effect of the KneeRugbyWomen program was found only in RSI, while leg stiffness indicators and LESS scores showed unclear results. Therefore, observed changes in knee joint neuromuscular control indicators and landing biomechanics only partly support claims about effectiveness of short-term ACL prevention programs and do not support the proposed hypothesis.

 

Please, reformulate the conclusion. It is too verbose. I would suggest to abbreviate both long sentences.

L375-384: The finding of this study suggest that it would be appropriate to verify the KneeRugbyWomen program in a longer time horizon, because only Reactive Strength Index shows positive improvements, but the program does not result in clinically relevant improvements of leg stiffness, and LESS scores if delivered to female amateur rugby players twice a week for 12-weeks. Although, this finding suggests, that such short duration intervention, which takes into account conditions of amateur sport, is not efficient enough to increase SSC capability and decrease the risk factors for ACL injury in female rugby players, the positive effects on RSI indicate improvement in the stretch-reflex contribution and this neuromuscular control improvement can reduce forces in movements typical for rugby.

 

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

Dear authors

Congratulations on your effort in conducting the present research. All research that aims to prevent athletes from getting injured is welcome. I give merit to your writing, stating that it was a pleasure to read it.

I think you did not accomplish the results you were expecting. Even though the statistics used are correct, I suggest checking the 'smallest worthwhile change' approach by Hopkins at:

·         https://www.sportsci.org/jour/04/wghtests.htm

·         https://www.sportsci.org/2017/wghtrend.htm

You probably already know this, but I don't know if you are aware. Sorry for that.

This does not preclude any judgement I'm making on your manuscript.

I'm uploading the revised manuscript with my annotations (only to assure it has been read).

Anyhow, I wish you the best of success in your future research.

 

 

Abstract

The abstract contextualises the topic, summarising the main points. All information matches that in the body of the text. For the specific topic, the abstract will capture the reader's attention.

 

Introduction

 

The authors present a clear framework on their topic, citing relevant research and ending with a clear objective.

 

 

Methods

 

The manuscript presents a robust research design with a longitudinal approach and controls. All procedures are detailed, permitting others to replicate them.

The statistics are correct; nonetheless, check my suggestion mentioned above (Hopkins).

 

 

Results

The results match the proposed procedures and objectives.

 

Comment

 

The discussion is relevant. I rarely revise discussion sections like this one, where the authors discuss their findings in the context of existing research.

Moreover, the authors point out the limitations and weaknesses of the study.

 

Conclusion

The conclusion is succinct and supported by data.

 

Table

 

The information in the table is easy to interpret and detailed enough to stand on their own, matching the data information in the text.

 

References

 

References are relevant and updated.

Comments for author File: Comments.pdf

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

Thanks to the authors for submitting this manuscript and the editors for the opportunity to review this work. The title of the study is “KneeRugbyWomen program impact on leg stiffness, reactive strength, and landing biomechanics in amateur female rugby players”.

The study aimed to compare leg stiffness, reactive strength, and LESS scores pre and post 12-week Knee Rugby Women training program in a cohort of amateur female rugby players.

Overall, you had a good and interesting manuscript. Your introduction and methods were sounded good. The results section is well organized, and the strongest parts are the discussion and the indication of study limitations as a guide for the future work.

There are several minor comments:

1-      KneeRugbyWomen used as a connected word, is it correct or Knee Rugby Women?

2-      Line 176: Microsoft 365 MSO (version 2019), right!

 

3-      Lines 363-373: It might be better to move it to the end of the discussion section under the subsection name “Limitations”.

 

Author Response

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Author Response File: Author Response.docx

Reviewer 4 Report

Dear authors

Thank you for the opportunity to review your prominent research. In the analyzed paper, you have focused on assessing 12 weeks of a novel KneeRugbyWomen training program on jump-related biomechanical variables and physical fitness in amateur female rugby seven players. According to this reviewer, significant modifications or new data are required although the originality, scientific potential, and empirical application. In opposition, the results of the research are very well discussed by the authors. Congratulations.

The manuscript “applsci-2129362” needs major and minor adjustments for further consideration. All criticism points are presented in sequence according to this comment.

MAJOR COMMENTS:
I. The study's aim presented in the abstract differs from the one reported in the last paragraph of the introduction. Line 12 reports “… assess of 12-weeks of a novel KneeRugbyWomen training program on jump-related biomechanical variables and physical fitness in amateur female rugby sevens players.” Line 76 reports “…compare leg stiffness, reactive strength, and LESS scores pre and post 12-week KneeRugbyWomen training program in a cohort of amateur female rugby players”. What is the correct research objective?

II. In the same way, lines 78 and 79 inform the reader “… in a cohort of amateur female rugby players …” and “… our cohort would have increased …”. In opposition, lines 86 and 87 report “The players were divided by block randomization procedure into experimental group (EG, n = 16) and control group (CG, n = 15)”. This is an analytical comparative study, but you reported it as a cohort. Also, the groups were described as a case-control study. Please indicate the experimental design of the study. If it is a cohort or case-control study, use the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Checklist for cohort studies or STROBE Checklist for case-control studies.

III. Some relevant information is missing according to the STROBE Checklist. Especially regarding the participants and procedures sections.
III.1. What were the reasons for not including the seven absent players in the final analysis? Please provide this information.
III.2. Please provide the study flow chart.
III.3. What was the reason for the use of block randomization? Players from one team were selected for the experimental group? Players from the second team were selected as control? Please provide this information in full.
III.4. Please provide the baseline information for the sample and groups.

IV. The statistical procedures need adjustments. The authors report the mean differences, but present the results comparing ranks. The use of two different statistical tests to compare groups over time may have resulted in both types I and II errors.
IV.1. The use of two-way analysis of variance (ANOVA) with one repetition factor was not possible? The interaction value is recommended in a small group analysis.
IV.2. Is Spearman's linear correlation coefficient the r value presented in the paper? R is the correlation coefficient of two variables in a data set.
IV.3. Between lines 184 and 185 the interpretation of the magnitude of effect size is reported using reference 49. This reference is applied to using the SPSS program. But the authors used Microsoft Excel and RStudio. What is the reason?
IV.4. In trend with small sample sizes, has been recommended the use of the Cohen effect size. Please calculate and report this indicator or an indicator like non-parametric tests. There are other formulas for calculating effect sizes on samples smaller than twenty subjects with non-parametric data. Analyze this possibility.

V. According to the authors, “The LESS is a clinical assessment tool that is often used in research to explore effectiveness of injury prevention programs on presence of landing movement “errors” that have been linked to non-contact ACL injury” (lines 291 to 293). In this sense, the statistical differences between the Experimental and Control groups in the baseline is not a limitation? If yes, this is not discussed. Also, the randomization process should have provided statistical equality between the groups. What happened?

MINOR COMMENT:
A) Moderate editing of the English language and style is mandatory.

Author Response

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Author Response File: Author Response.docx

Round 2

Reviewer 4 Report

Congratulations to the authors for the great work.

I have no further requests or comments.