Inter-rater Reliability in Assessing Exercise Fidelity for the Injury Prevention Exercise Programme Knee Control in Youth Football Players

Abstract

Background: To receive maximum benefits from injury prevention exercise programmes (IPEP) such as Knee Control, players need to perform the exercises as prescribed. But, exercise fidelity in IPEPs is seldom evaluated. We developed a checklist to assess exercise fidelity in the Knee Control IPEP, and the primary aim was to evaluate its inter-rater reliability. The secondary aim was to study Knee Control exercise fidelity in youth football players and compare sex differences. Methods: This observational study included 11 teams with male and female youth players (11–18 years). On average, the players trained with the Knee Control IPEP for 7 weeks (SD 1.4, range 6–10 weeks). After the training period, two physiotherapists attended a team training session to observe players executing exercises and individually assessed their performance of these exercises as correct or incorrect based on standardised criteria set in the fidelity checklist. Agreement between observers was assessed using Cohen’s kappa coefficient. Results: The observers agreed on 144 out of 160 (90%) observations (Kappa = 0.80, substantial agreement). Both observers agreed on correct exercise performance for 69 out of 144 observations (exercise fidelity 48%). Exercise fidelity was higher in females (56%) than males (40%), but the difference was not statistically significant (p = 0.18). Conclusion: The Knee Control exercise fidelity checklist had high inter-rater reliability with substantial agreement. The exercise fidelity was low, which could hamper the preventive effects of an IPEP. Understanding the reasons for low exercise fidelity is important and more effort should focus on increasing exercise fidelity alongside the implementation of IPEPs.