literature review on planning pdf

Demand Forecasting, Production Planning, and Control: A Systematic Literature Review

First Online: 28 July 2023

Cite this chapter

José Eduardo de Carvalho Lima 6 ,
Paulo Renato Alves Firmino 7 &
Luiz Alberto Oliveira Rocha 8

Part of the book series: Advanced Structured Materials ((STRUCTMAT,volume 171))

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1 Citations

The study of demand is fundamental for organizations in all three sectors. In particular, it marks the production planning and control (PPC) of goods and services, which are fundamental steps for the sustainable development of any business. Thus, there is much research on demand forecasting and PPC. In this sense, using more or less sophisticated mathematical models dedicated to the theme of time series is indispensable. However, some authors warn about these practices’ decline by production managers for two reasons: the shortcomings of the simpler models and the complexity of the best models. Thus, there is no consensus or intense discussion about the best formalism of demand time series modeling to adopt in PPC. This paper presents a systematic review of recent literature on demand forecasting for PPC and the underlying time series formalisms from this proposition. We found 75 articles on the topic, from 2014 to 2022, based on Scopus, ScienceDirect, IEEE, EBSCOhost, Emeraldinsight, Jstor, Taylor & Francis Online, CAPES Journal Portal, and InderScienceOnline. The synthesis of the review was performed from a lexical analysis. As the main findings, the research reveals the literature imbalance, which raises the difficulties of better results in PPC. It should also be noted that few works dedicated to the PPC have resorted to the combination of predictors, one of the most successful time series modeling and forecasting classes, for its simplicity or the quality of its results.

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de Carvalho Lima, J.E., Firmino, P.R.A., Rocha, L.A.O. (2023). Demand Forecasting, Production Planning, and Control: A Systematic Literature Review. In: Öchsner, A., Altenbach, H. (eds) Engineering Design Applications V. Advanced Structured Materials, vol 171. Springer, Cham. https://doi.org/10.1007/978-3-031-26466-5_25

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THE ROLE OF STRATEGIC PLANNING IN SMEs: LITERATURE REVIEW AND IMPLICATIONS

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Writing a Literature Review

Getting Started

Planning the review

Planning the steps in writing a literature review, useful resources.

Melissa Bowles-Terry, Science Librarian
Exploring the Literature
Managing the Review
Organizing and writing the review

Planning the review , the first phases, concerns the preparation of accumulating, managing and organizing literature resources relevant for the review. It is a strategic roadmap that explores the literature with the purpose of identifying relevant sources and evaluating whether the content is appropriate for the review. Planning the review defines the scope in terms of what it will cover; how comprehensive the coverage be,and the timeframe.

The actual steps in writing a literature review requires planning. They are:

Exploring the Literature . The reviewer needs to plan the selection of appropriate databases for finding relevant material, which also requires using strong strategic searching skills.

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Organizing and Writing the Review . This step entails two stages. First, the reviewer needs to prepare a robust outline for the chapter. The second stage encompasses the actual writing process. In compiling the content and in writing the review, requires the ability to plan, organize and synthesize information extracted from the literature.

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Strategic Planning and Management in Transit Agencies (2005)

Chapter: chapter two - literature review.

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4OVERVIEW The literature review revealed that strategic planning is a popular and widespread practice in both the private and pub- lic sectors. It is a leadership and management tool that has been successfully used for decades to help organizations bet- ter prepare for the future and improve long-term performance. There is increased recognition that strategic planning is not enough by itself and that too many good strategic plans have been left to gather dust. Effective leadership is required to both develop and implement strategic plans. This has led to the concept of âstrategic management,â which includes the implementation and ongoing management of strategic plans, not just their development. Another trend has been to make the strategic planning process briefer and more flexible. Part of the problem in the past has been that formal and elaborate planning processes have often led to the development of comprehensive and thor- ough plans that are out of date by the time they are produced. Todayâs more turbulent and uncertain times require that less emphasis be given to the form of the plan and more to the substance and timeliness of the results. Henry Mintzberg has suggested that strategic planning is quite different than âstrategic thinking,â the creative synthe- sis of visionary new business strategies. He goes further by suggesting that strategic planning, essentially analytical in nature, may even be antithetical to strategic thinking. He believes that strategic planning is more appropriately thought of as âstrategic programming.â As such, it may be quite suit- able for relatively stable public transportation systems. Although it began in the military, the early nonmilitary use of strategic planning was primarily in the private sector. How- ever, its use in the public and nonprofit sectors has increased substantially and there are now several good sources of infor- mation on performing strategic planning in these sectors. Sev- eral reports and articles that pertain specifically to public- sector transportation are also reviewed. Effective strategic planning and management requires not only deciding what an organization should do, but also its having the knowledge and skills required to do it. With this in mind, the tools of organization development are discussed as a factor that could increase an organizationâs capability to develop and implement strategic plans. This includes devel- oping and retaining a workforce with the requisite knowledge and skills. Finally, a recent TCRP study about âemerging new para- digmsâ in transit has suggested that fundamental changes will be required if transit is to succeed in a world of increasing social, economic, political, and technological change. If so, it could well be that strategic planning and management will be a crucial tool toward this end. INTRODUCTION As would be expected, there is a significant amount of liter- ature on the subject of strategic planning in general, particu- larly in the private sector. There is also a fair amount written on strategic planning in the public and nonprofit sectors. How- ever, much less has been written specifically about strategic planning in public transportation. This literature review will be selective rather than exhaus- tive. It will cover strategic planning in the private sector; how- ever, it will primarily focus on strategic planning in the public sector and in public transportation. HISTORY Strategic planning has a long history in organizations. Its ori- gins are often thought to have been in the military, where there was a need to develop comprehensive, long-term strate- gies to win a war as opposed to the shorter-term, more limited tactical planning needed to win battles or skirmishes. An early form of strategic planning, the SWOT analysis (strengths, weaknesses, opportunities, and threats), came out of the Har- vard Business School in the 1950s as part of their efforts in regard to business policy development and the analysis of business strategies in relation to an organizationâs internal and external environments. The practice of strategic planning achieved considerable popularity in private-sector organizations in the 1960s and 1970s. In the 1980s, it became more and more prevalent in the public and nonprofit sectors. Unlike other management fads that have quickly disappeared, strategic planning is a management technique or practice that has demonstrated staying power and broad usage across a variety of organiza- tions in both the private and public sectors. STRATEGIC PLANNING IN GENERAL Early on, strategic planning was a relatively formal, elabo- rate, and often lengthy process. In addition, because times CHAPTER TWO LITERATURE REVIEW

5were more stable, a strategic plan was intended to last for several years. More recently, largely in response to these more rapidly changing and turbulent times, there has been a clear trend in the private sector to â¢ Shorten the strategic planning cycle so that the plan is not out of date by the time it is finished. (However, it should also be noted that there has been a countervail- ing trend to open up the process and involve as many participants as feasible, rather than having it be a âtop- downâ plan developed largely by top management and imposed on the organization. The effect of this has been to lengthen the process.) â¢ Make the planning process less formal and more flexible. â¢ Make the process relatively continuous rather than some- thing undertaken only every 2 to 5 years. â¢ Link it to other important business processes such as budgeting and performance measurement. An example of this is found in Strategic Readiness: The Making of the Learning Organization (1) in which the authors suggest a shift from strategic planning to strategic learning through a regular process of â¢ Continuous planningâwherein the organization focuses on questioning and quickly adjusting existing plans; â¢ Improvised implementationâthat is, both experimental and evolving, and that provides good information for learning; and â¢ Deep reflection about original assumptionsâwhat has changed and what has been learned. The authors maintain that âmost organizational change results not from formal plans and fixed programs for change but from a process of learningâand not just from the learning of indi- viduals but, more importantly, from the collective learning of entire organizationsâ (1, p. xi). The 1994 publication of The Rise and Fall of Strategic Planning by Mintzberg (2) presented a very comprehensive, complex, and contrarian view of the practice of strategic plan- ning. His central argument is that strategic planning by its very nature is the antithesis of âstrategic thinking.â He views strategic thinking as a creative act of synthesis, and strategic planning as a process that is essentially one of analysis. (An analogy might be right brain versus left brain thinking, in which the right brain is considered to be more creative and holistic and the left brain is considered to be more linear and logical.) Mintzberg believes that âstrategic planning often spoils strategic thinking, causing managers to confuse real vision with the manipulation of numbersâ (3, p. 107). Mintzberg goes on to argue that âStrategic planning, as it has been practiced, has really been strategic programming, the articulation and elaboration of strategies, or visions, that already existâ (3, p. 107). He asserts that strategic planning does not fail because of such commonly mentioned pitfalls as a lack of commitment from top management or resistance to change, but instead because of its fundamental nature of being too analytical, too formalized, and too detached from the functions and interests of the businessâs line managers. In spite of his belief that strategic planning is not effective at creating business strategies (strategic thinking), he believes that it can play important roles including: â¢ Strategic planning as strategic programmingâInstead of trying to use strategic planning to generate strategies or visions, use it to program them. This can be done through a process of âcodificationâ (expressing the strate- gies in ways that are clear and operational), by âelab- orationâ (breaking strategies down into substrategies and action plans), and âconversionâ (identifying the impacts of the strategies on operations; e.g., on budgets and performance controls). â¢ Strategic plans as tools to communicate and controlâ Plans can be an important way of communicating the organizationâs intentions both internally (helping to ensure that everyone in the organization is pulling in the same direction) and externally. â¢ Strategic planners as analystsâPlanners can use their analytical skills and orientation by performing special studies and by offering new perspectives. â¢ Strategic planners as catalystsâIn this role, planners do not try to enter the âblack boxâ of strategy making, but instead encourage and assist line managers to think in creative ways about the future (3, pp. 112â114). In Mintzbergâs words, âPlanners shouldnât create strategies, but they can supply data, help managers think strategically, and program the visionâ (3, p. 107). Although insightful, Mintzbergâs distinction between strategic thinking and strategic planning may be more rele- vant to the private sector, where the environment tends to be more volatile and where businesses must constantly be on the lookout for new business strategies and opportunities. Gen- erally, in the public sector, and in public transportation more specifically, the situation is usually more constrained. For example, the purpose and geographic jurisdiction of public transportation agencies is usually prescribed by state legisla- tion. For the most part, public transportation agencies are not going to be pursuing business opportunities outside of the area of public transportation. In addition, their financial struc- ture is often defined or controlled in large part by their enabling legislation or funding bodies. It might therefore be argued that strategic planning, when thought of as strategic programming as described by Mintzberg, may be the primary role it should play in public transportation. Mintzberg implies this when he states that âOnly when an organization is sure of the relative stability of

its environment and is in need of the tight coordination of a myriad of intricate operations (as is typically the case of air- lines with their needs for complicated scheduling), does such strategic programming make senseâ (3, p. 112). The more creative strategic thinking described by Mintzberg might be used only infrequently, when there is a need for more trans- formative organizational or institutional change. Another valuable perspective on strategic planning, that appeared in the mid-1990s, was the concept of the âbalanced scorecard,â as developed by Kaplan and Norton in response to their belief that strategic planning and management as practiced in the private sector gave too much weight to financial matters (4). To remedy this, they developed the balanced scorecard idea, an approach that provides a frame- work for helping an organization achieve its long-term strate- gic goals by viewing the organization from four key per- spectives: (1) the customer, (2) internal business processes, (3) learning and growth, and (4) financial performance. The balanced scorecard system involves the development, utilization, and analysis of performance metrics that are devel- oped for each of these perspectives. STRATEGIC PLANNING IN THE PUBLIC SECTOR One of the âbiblesâ of strategic planning in the public (and nonprofit) sector has been John Brysonâs Strategic Planning for Public and Nonprofit Organizations: A Guide to Strength- ening and Sustaining Organizational Achievement (5). This book was first published in 1988, and then substantially revised in 1995. Bryson defines strategic planning as âa disciplined effort to produce fundamental decisions and actions that shape and guide what an organization is, what it does, and why it does itâ (5, pp. 4â5). He offers a generic strategic planning model that has been successfully used by many public and nonprofit agencies. This model consists of 10 steps that he refers to as the Strategy Change Cycle (5, p. 23): 1. Initiate and agree on a strategic planning process (including who should be involved, and their roles and responsibilities). 2. Identify organizational mandates (e.g., enabling legislation). 3. Clarify organizational mission and values (this step should include an analysis of key âstakeholdersâ). 4. Assess the organizationâs external and internal envi- ronments to identify strengths, weaknesses, opportu- nities, and threats (SWOT analysis). 5. Identify the strategic issues facing the organization. 6. Formulate strategies to manage these issues. 7. Review and adopt the strategic plan or plans. 8. Establish an effective organizational vision. 9. Develop an effective implementation process. 10. Reassess strategies and the strategic planning process. 6 Note that Steps 1â8 focus primarily on the planning process, whereas Steps 9 and 10 shift the emphasis from strategic planning to strategic management. There are some lessons to be learned in the revisions the author made to the book in 1995. For example, Steps 7, 9, and 10 were added, reflecting the need to not just produce a plan but to effectively implement it, and also to reassess the planning process as a prelude to another round of planning. The emphasis is on strategic management, not just strategic planning. In addition, the author places more emphasis on the recognition that strategic planning is different than strategic thought and action (a point strongly made by Mintzberg and noted previously). In summary, the 1995 edition makes a more explicit linkage between leadership, strategic planning, and management. Bryson is clearly a strong believer in the benefits of strate- gic planning, including the promotion of strategic thought and action, improved decision making, and enhanced orga- nizational responsiveness and performance (5, p. 7). However, he also recognizes that strategic planning has limitations and should not be considered a panacea for all organizational problems or situations. For example, strategic planning is most likely not an appropriate response to extreme adverse circumstances; if the organization does not have the necessary people, skills, or management commitment to pro- duce a good plan; or if the likelihood of plan implementation is low. Bryson believes that strategic planning is here to stay because it effectively deals with substantive issues and con- cerns as well as the reality of political decision making. In 1993, the U.S. Congress passed the Government Per- formance and Results Act (GPRA). This act requires that federal agencies take a number of steps to operate in a more businesslike manner and that they become more accountable to taxpayers. These steps require agencies to â¢ Define their missions and desired outcomes, use strate- gic planning, involve their stakeholders, assess their environments, and align their activities, core processes, and resources in support of mission-related outcomes; â¢ Measure their performance to ensure that goals are being met; and â¢ Use the performance data to improve organizational processes, identify performance gaps, and set improve- ment goals. Under the GPRA, agencies were instructed to develop mul- tiyear strategic plans, annual performance plans, and annual performance reports. As a result, in 1996, the FTA published its first strategic plan, covering the period from 1997 to 2001. An executive guide for implementing the GPRA, pub- lished by the Government Accounting Office, pointed out that

7the success of the GPRA âdepends on strong leadership prac- tices that devolve decision-making authority with account- ability, create incentives, build expertise, and integrate man- agement reformsâ (6). STRATEGIC PLANNING IN PUBLIC-SECTOR TRANSPORTATION In the mid-1980s, the University Research and Training Program of the Urban Mass Transportation Administration (UMTA) (currently the FTA) funded a project that examined strategic planning in small- and medium-size transit agen- cies (7). The study report included a discussion of strategic planning and its benefits, a survey of 104 transit agencies, and a case study of a small transit system in Missouri (South- east Missouri Transportation Services, Inc.). The author observed that the crux of strategic planning is to create a process that answers three basic questions (7, p. 5): 1. Where are we? 2. Where do we want to go? 3. How can we get there? In the survey of transit properties, the following percent- ages of respondents answered that they conduct a formal strategic planning process: â¢ Small systems (fewer than 50 vehicles) 42% â¢ Medium systems (50â99 vehicles) 68% â¢ Big systems (100â500 vehicles) 62% â¢ Large systems (more than 500 vehicles) 93% The average for the four sizes was 59%. However, when responses were analyzed more closely, it was noted that more than half (57%) were actually referring to long-range service and capital plans as required by the fed- eral UMTA, short-range service plans, or to the annual bud- geting process. In short, there appeared to be a great deal of confusion as to what actually constitutes strategic planning. The study identified the following managerial tools used by transit agencies that might become part of a strategic plan- ning process: â¢ Strategic-type special studies (e.g., performance audits), â¢ Performance indicators, â¢ Management by objectives, and â¢ Strategy retreats. It found that there were a number of obstacles to con- ducting strategic planning in agencies, and that these obsta- cles differed according to the size of the agency. For exam- ple, inadequate staff resources was regarded as a significant obstacle by small agencies, but much less so by large ones. Conversely, a lack of good information was regarded as a serious problem by large agencies, but not so serious by small agencies. Large agencies cited the âfish-bowlâ envi- ronment of public agencies as a problem and also changing state policies. Other obstacles cited by respondents included: â¢ Operating pressures, â¢ A short-term orientation inside and outside the agency (âfire-fightingâ), â¢ The annual budget process, and â¢ An inability to enter new markets or alter the agencyâs external environment. The study also found that small agencies in particular have difficulty in regard to strategic planning. In general, these dif- ficulties had to do with inadequate resources, including staff, expertise, data, and the money needed to hire outside exper- tise. Three key conclusions emerged from the study: 1. The need to reinterpret the concept of strategic planning. 2. The importance of organizational readiness. 3. The need to mold strategic planning to the specific context of the organization. In regard to the need to reinterpret the concept of strate- gic planning, the study noted that conducting a comprehen- sive and formal strategic planning process (the âclassicalâ strategic planning model) may be beyond the capability of most transit agencies. Moreover, it may be more than is nec- essary. Five strategies are suggested in regard to this issue: 1. The formality of the process needs to be de-emphasized. 2. The level of data and analysis should be kept in rea- sonable relationship to the capabilities of the agency. 3. The cost of the process should be kept in some reason- able relationship with the likely benefits. 4. There needs to be a better understanding that long- range planning is not the same as strategic planning. Long-range planning may be necessary and useful; how- ever, it does not fulfill the same purposes. 5. Strategic planning might best be performed by seg- menting it. Rather than implementing a single, rigid process, it might be more effective if it is kept more flex- ible and if it uses various tools for specific purposes (e.g., special strategic studies). The second conclusion was the importance of organiza- tional readiness; some organizations may just not be ready to undertake strategic planning. Key factors in whether an orga- nization is ready include organizational sophistication and stamina, the flexibility and commitment of management, and the skills and expertise of the participants. Finally, in regard to adapting strategic planning to the orga- nizational context, management is encouraged to be realistic about the capabilities of the agency, set priorities and clearly define objectives for the process, design a process that reflects

these considerations, and build on what already exists in the agency. In 1985, an article was published about a case study of the development of a strategic management process in the Penn- sylvania Department of Transportation (8). This study made clear the importance of not just developing a strategic plan but of also creating a management process to implement and man- age the plan. There were several factors that distinguished this effort from typical strategic planning processes at the time. For example, several key structural changes were made. A strategic management committee made up of the agencyâs six top managers was formed to direct and manage the change process. Seven substantive subcommittees were also formed to help manage the effort. Organization-wide planning was centralized and program and project planning were decentral- ized. A concept of âbusiness groupsâ was used to create a new way of thinking about the primary products and services pro- vided by the agency (as opposed to the more traditional way of thinking about the functions performed). Four-year plans were developed for each of the agencyâs operating districts. Finally, the strategic planning process was tightly linked to the budget process to ensure that the agencyâs resources were being aligned with the plans. All of these actions served to institutionalize the strategic planning process throughout the agency. In 1988, the same year that Bryson published his book on strategic planning in the public sector, the UMTA published A Guide to Strategic Planning for Transit Properties (9). Considered by some in the transit industry to be a classic text, this report provided an early guide or framework for strate- gic planning in transit. The authors define strategic planning as âthe analysis of environmental change, the formulation of organizational objectives, and the establishment of priorities for resource allocationâ (9, p. 1). The report goes on to describe why it is important to do strategic planning, and presents several case studies as examples of how to do it effectively. (The case studies were AlamedaâContra Costa Transit, NJ Transit, Port Authority of Allegheny County Transit, Seattle Metro, and the Utah Transit Authority.) In addition, the report discusses the following key differences between planning in the public and private sectors (9, pp. 3â4): â¢ The private sector is primarily driven by the financial bottom line, whereas public agencies generally have multiple and often ambiguous goals and a variety of key stakeholders. â¢ Public agencies are more often subject to public scrutiny and political pressures. â¢ Mandates in the public sector are often legislated and are not up to management prerogative. Key conclusions of the study were: 8 â¢ Upper management must be seriously committed to and participate in the strategic planning process. â¢ The development of a mission, goals, and objectives should be based on a careful analysis of the environ- ment (both internal and external) and should emphasize a marketing perspective. Objectives should be stated in ways that are measurable. â¢ There should be linkages between strategic planning, program planning, and budgeting, and between achieve- ment of strategic planning objectives and personnel appraisals and compensation. â¢ Indicators should be developed that measure the effi- ciency and effectiveness of transit services. â¢ Good communication is a crucial ingredient of an effec- tive strategic planning and implementation process. â¢ âStrategy championsâ with appropriate responsibilities and incentives are needed for successful implementation. â¢ Environmental change should be regularly monitored. â¢ The process should be flexible, iterative, and continuous. â¢ Based on the case studies, there are clearly different ways that strategic planning can be conducted in terms of levels of detail and formality, how the process is organized, who participates, and the degree of analysis and documentation. The report ends with a recommended strategic planning framework that includes the following seven steps: 1. Organize management team and planning staff. 2. Undertake an environmental or situation audit. 3. Establish mission, goals, and objectives. 4. Develop broad strategies. 5. Establish programs and budgets. 6. Monitor program resultsâmeasure. 7. Monitor the environment. In 1990, the NCHRP published Strategic Planning and Management Guidelines for Transportation Agencies (10). This study looked at the current environment for strategic planning and management in a variety of publicly funded transportation agencies, provided a definition of strategic man- agement and its components, and recommended guidelines for successfully institutionalizing strategic management. The report distinguished strategic management from other traditional management practices by noting that the tradi- tional practices ask âHow do we keep doing what we are doing, only do it better?â Strategic management focuses instead on an overall vision of where the organization should be heading, i.e., what it plans to accomplish and how it can get it accomplished. It provides for the involvement of the entire organization in managing its people, processes, and products toward successful accomplishment of its goals and objec- tivesâ (10, p. 1). The report went on to delineate the following minimum components of a strategic management process (10, p. 2):

9â¢ Mission statement (including goals and objectives), â¢ Environmental scan, â¢ Strategy development, â¢ Action plan development, â¢ Resource allocation, and â¢ Performance measurement. An environmental scan generally involves an analysis or assessment of both the external and internal issues that are likely to affect an organization. It is sometimes referred to as a âsituation audit.â It concluded that in the various transportation agencies stud- ied, a âstrategic management process and its benefits are pres- ent and understood in less than a dozen state departments of transportationâ and that âmany of the remainderâplus many transit, airport, port authorities, and other publicly funded transportation agenciesâseem to have insufficient interest in, or understanding of, strategic managementâ (10, p. 1). The report included a set of guidelines for instituting strate- gic management comprised of four primary stages: Stage I. Identifying the Need for Strategic Management â¢ Determine the current status of strategic management in the agency. Stage II. Establishment or Enhancement of Key Strategic Management Elements â¢ Define the agencyâs business. â¢ Develop plans for implementing strategic management initiatives. Stage III. Integration of the Key Elements into a Functioning System â¢ Ensure that the agency mission statement and goal structure are in place. â¢ Obtain chief administrative officer and senior management commitment to the strategic management process. â¢ Establish a clearly understood division of responsibility for strategic management implementation, including the selec- tion of implementation managers or facilitators. â¢ Develop an accurate information base and maintain its timeliness. Stage IV. Ongoing Use and Refinement of the Strategic Management System â¢ Monitor the strategic management system. â¢ Develop a reward and recognition program. In a 2003 article, âHow to Develop a Strategic Plan That Wonât Gather Dustâ (11), Richard Simonetta (CEO of Val- ley Metro Rail, Inc., in Phoenix, Arizona) recognized that there is often a significant gap or breakdown between com- pleting a strategic plan and implementing its recommenda- tions. Too often the focus is on the production of a plan doc- ument and not enough emphasis is placed on its execution. He outlined several principles to ensure that the strategic planning effort is successful (11, p. 80): â¢ The process needs to be ongoing, with broad input for development and specific responsibility for effective implementation. â¢ The plan needs to have milestones and performance metrics to measure progress and celebrate achievements. â¢ The plan needs to involve stakeholders in the develop- ment, deployment, and refinement stages. â¢ Finally, a strategic plan must be a living document that evolves over time as the public transit system becomes more successful at achieving its short- and long-range goals. A similar case, that is, that strategic plans often fail to achieve full-scale implementation and significant service improvements, is made in âSegmented Strategic Planning: An Incremental Approach to Transit Planning and Implemen- tationâ (12). The authors propose a segmented approachâ rather than attempting a comprehensive organization-wide strategic planning effort, they recommend a âseries of orches- trated, low-level strategic plansâ (12, p. 1). The report describes such an approach in Knoxville, Tennessee, where only the downtown and university campus trolley service was the focus of a recent strategic planning effort. This segmentation made it much more manageable and helped to avoid many of the obstacles that often arise from a larger-scale planning effort. In December 2001, recognizing the potential of strategic planning to improve the effectiveness of transit systems, APTA produced a Strategic Planning Resource Kit (avail- able on CD) (13). Basically, the kit contains copies of the strategic plans of 28 transit systems. STRATEGIC PLANNING AND PERFORMANCE MEASUREMENT Almost all of the literature on strategic planning and man- agement emphasizes the need for linking the process to per- formance measurement. This is necessary to be able to mon- itor whether plans are being achieved and whether corrective action needs to be taken. There is a great deal of literature on the general subject of performance measurement. An excellent and very compre- hensive study of the issue that pertains directly to transit is the 2003 TCRP Report 88: A Guidebook for Developing a Transit Performance-Measurement System (14). This report provides detailed guidance for developing a system using tra- ditional and nontraditional measures that address both cus- tomer and community issues.

STRATEGIC PLANNING AND ORGANIZATION DEVELOPMENT One of the strengths of strategic management is that it recog- nizes that strategic planning by itself often does little to change an organizationâs direction, because it does not deal with the significant structural, political, and behavioral forces that tend to resist change. This point is made in two articles that argue for the blending or âmarriageâ of strategic planning and management and âOrganization Developmentâ (15, 16). Organization development (OD) seeks to develop and implement planned change strategies aimed at improving an organizationâs effectiveness. It uses many tools or techniques to ensure that an organization has the internal capability to effectively achieve its goals and objectives. These include such activities as goal setting, leadership development, team building, employee feedback surveys, education and train- ing, organizational design, process consultation, coaching and counseling, and development of appropriate reward and recog- nition programs. In âFor Successful Strategic Change: Blend OD Practices with Strategic Managementâ (15, p. 43), Buller suggests that OD tools can be helpful in the following phases of a typical strategic planning process: â¢ Assessing and developing the organizationâs readiness for change, â¢ Facilitating the strategic planning process, â¢ Helping with strategy implementation, and â¢ Developing leadership skills. A similar point is made by Eadie and Steinbacher in âStrategic Agenda Management: A Marriage of Organiza- tional Development and Strategic Planningâ; that is, that tra- ditional strategic planning too often results in âunimple- mentable strategiesâ (16, p. 424). In this article, the authors describe a case study of a large and complex public-sector organization in Ohio. They argue that strategic management can be one of the tools in the larger strategy of OD. More specifically they describe a concept of âstrategic agenda management.â Strategic agenda management basically involves the âcol- lective management of a strategic agenda, which changes as an organizationâs problems and opportunities change.â The authors state that âeffective strategic agenda management requires intensive, continuous, and collective involvement of senior management,â and that a strategic agenda must be highly selective if it is not to overtax the organizationâs abil- ity to manage strategic issues (16, p. 425). The important point is that strategic planning and man- agement must pay close attention to not only the development of strategic initiatives but also to the organizationâs capabil- ity to implement the initiatives. OD tools can be an important resource for developing or enhancing this capability. 10 NEW PARADIGMS IN PUBLIC TRANSPORTATION In the late 1990s, a group of transit industry leaders gathered under the aegis of the TCRP. The reason for this gathering was a shared concern that unless fundamental changes were made, the future of the transit industry was in jeopardy, owing to the significant changes taking place in the world and the inability of the transit industry to adapt to them (e.g., fundamental social and economic changes in this country, an emerging global economy, and the increasing significance of rapid advances in information technology). In 1997, a âfuture search conferenceâ was organized by TCRP and the Eno Foundation to explore this issue. The con- ference included approximately 80 individuals representing transit managers, riders, drivers, labor leaders, political lead- ers, community residents and other important public trans- portation stakeholders. The effort led to a TCRP project that in 2003 culminated in a report that described emerging ânew paradigmsâ that might affect the industry and that outlined a number of suggested responses (17). Many of the responses are such that strategic planning and management would be a key tool for developing and implementing them. The report points out that the transit industry has not changed its basic business model for more than 40 years. It also notes that although in recent years transit ridership has reached post-World War II highs, its market share of trips remains quite small. Moreover, increasing levels of automo- bile traffic are far outpacing the capacity of the street and highway system, thus leading to severe congestion and grid- lock in many areas. The project studied transportation in three key arenas else- where in transportation industries in search of lessons, or new models, for transit. 1. The âlogistics revolutionâ in intermodal freight. 2. The rise of airline âalliances.â 3. New models for organizing and managing transit in Europe. In the freight arena, companies are finding ways to inte- grate their operations to better serve the door-to-door needs of their customers, encourage customer loyalty, and increase efficiency. This involves use of a logistics manager, who coordinates the movement of items from start to finish, and the use of powerful information technologies that allow uni- fied dispatching and tracking. Airlines have followed a very similar strategy, forming alliances with other carriers so that passengers can book trips through a single airline and so that the quality of service can be better tracked. Information tech- nology again plays a key role. Much the same is occurring in European transit. For exam- ple, even though there are a variety of operators that provide service in metropolitan London, London Transport has been empowered to set broad policy on fares, service coverage, and

11 service quality. It tracks efficiency and quality from the cus- tomerâs viewpoint. More recently, organizational changes are being made that give multimodal responsibility (buses, taxis, rail systems, ferries, and traffic control) to a new agencyâ Transport for London. The report goes on to identify four key elements of âthe emerging paradigmâ: 1. Emphasis on monitoring service quality and customer satisfaction across the entire network is replacing the previous emphasis on the operation of a particular agencyâs vehicles and facilities. 2. New collaborative relationships or alliances are replac- ing independent agency operations and head-to-head competition. 3. Traditional assets such as vehicles, passenger terminals, and maintenance facilities are being jointly managed. 4. State-of-the-art information technology is being used to better manage operations, evaluate service quality, and provide customer information. A key theme of the emerging paradigm is that of âmobil- ity management,â the function of meeting the door-to-door travel needs of the customer no matter whose transportation assets are being used. This concept should be a central focus of the strategic planning efforts of transportation agencies. One of the new paradigm project reports includes as an appendix a guide that organizations can use for managing the change process (18). This includes strategies for â¢ Recognizing the need for change, â¢ Leading and planning change, â¢ Making change happen, and â¢ Institutionalizing new approaches. Most of the strategies described would be excellent com- ponents of an effective strategic planning and management process. The final report points out that transit agencies cannot do this alone, and that public policy decisions and public invest- ment must be coordinated in other key areas such as land use strategies, other public infrastructure investments (water, sew- ers, parking facilities, etc.), environmental measures (clean air and energy conservation), and other public policies such as tax incentives and economic development strategies. Because transit agencies have little or no control over these areas, they must work indirectly to encourage such coordination.

TRB’s Transit Cooperative Research Program (TCRP) Synthesis 59: Strategic Planning and Management in Transit Agencies examines the value and benefits of strategic planning and management in transit agencies. The report also provides case studies from five transit agencies based on the comprehensiveness of process or presence of innovative or noteworthy practices.

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http://orcid.org/0009-0005-0529-0398 Destiny Lutz 1 ,
http://orcid.org/0000-0001-6429-4333 Carla van den Berg 1 ,
http://orcid.org/0000-0003-3056-8169 Anu M Räisänen 1 , 2 ,
Isla J Shill 1 , 3 ,
Jemma Kim 4 , 5 ,
Kenzie Vaandering 1 ,
Alix Hayden 6 ,
http://orcid.org/0000-0002-0427-2877 Kati Pasanen 1 , 7 , 8 , 9 ,
http://orcid.org/0000-0002-5951-5899 Kathryn J Schneider 1 , 3 , 8 , 9 , 10 ,
http://orcid.org/0000-0002-9499-6691 Carolyn A Emery 1 , 3 , 8 , 9 , 11 , 12 , 13 ,
http://orcid.org/0000-0002-5984-9821 Oluwatoyosi B A Owoeye 1 , 4
1 Sport Injury Prevention Research Centre, Faculty of Kinesiology , University of Calgary , Calgary , Alberta , Canada
2 Department of Physical Therapy Education - Oregon , Western University of Health Sciences College of Health Sciences - Northwest , Lebanon , Oregon , USA
3 Hotchkiss Brain Institute , University of Calgary , Calgary , Alberta , Canada
4 Department of Physical Therapy & Athletic Training , Doisy College of Health Sciences, Saint Louis University , Saint Louis , Missouri , USA
5 Interdisciplinary Program in Biomechanics and Movement Science , University of Delaware College of Health Sciences , Newark , Delaware , USA
6 Libraries and Cultural Resources , University of Calgary , Calgary , Alberta , Canada
7 Tampere Research Center for Sports Medicine , Ukk Instituutti , Tampere , Finland
8 McCaig Institute for Bone and Joint Health , University of Calgary , Calgary , Alberta , Canada
9 Alberta Chilrden's Hopsital Research Institute , University of Calgary , Calgary , Alberta , Canada
10 Sport Medicine Centre , University of Calgary , Calgary , Alberta , Canada
11 O'Brien Institute for Public Health , University of Calgary , Calgary , Alberta , Canada
12 Department of Community Health Sciences , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada
13 Department of Paediatrics , Cumming School of Medicine, University of Calgary , Calgary , Alberta , Canada
Correspondence to Ms Destiny Lutz, Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada; destiny.lutz{at}ucalgary.ca

Objective To evaluate best practices for neuromuscular training (NMT) injury prevention warm-up programme dissemination and implementation (D&I) in youth team sports, including characteristics, contextual predictors and D&I strategy effectiveness.

Design Systematic review.

Data sources Seven databases were searched.

Eligibility The literature search followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria: participation in a team sport, ≥70% youth participants (<19 years), D&I outcomes with/without NMT-related D&I strategies. The risk of bias was assessed using the Downs & Black checklist.

Results Of 8334 identified papers, 68 were included. Sport participants included boys, girls and coaches. Top sports were soccer, basketball and rugby. Study designs included randomised controlled trials (RCTs) (29.4%), cross-sectional (23.5%) and quasi-experimental studies (13.2%). The median Downs & Black score was 14/33. Injury prevention effectiveness (vs efficacy) was rarely (8.3%) prioritised across the RCTs evaluating NMT programmes. Two RCTs (2.9%) used Type 2/3 hybrid approaches to investigate D&I strategies. 19 studies (31.6%) used D&I frameworks/models. Top barriers were time restrictions, lack of buy-in/support and limited benefit awareness. Top facilitators were comprehensive workshops and resource accessibility. Common D&I strategies included Workshops with supplementary Resources (WR; n=24) and Workshops with Resources plus in-season Personnel support (WRP; n=14). WR (70%) and WRP (64%) were similar in potential D&I effect. WR and WRP had similar injury reduction (36–72%) with higher adherence showing greater effectiveness.

Conclusions Workshops including supplementary resources supported the success of NMT programme implementation, however, few studies examined effectiveness. High-quality D&I studies are needed to optimise the translation of NMT programmes into routine practice in youth sport.

Data availability statement

Data are available in a public, open access repository. Not Applicable.

https://doi.org/10.1136/bjsports-2023-106906

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WHAT IS ALREADY KNOWN ON THE TOPIC

Neuromuscular training (NMT) injury prevention warm-up programmes are effective at preventing injury rates in youth sports. However, for proper dissemination and implementation (D&I) by multiple stakeholders, barriers such as low adoption, adherence and lack of time must be addressed.

WHAT THIS STUDY ADDS

There are limited high-quality research studies to facilitate the widespread adoption of, and improved adherence to, NMT programmes. Few studies used D&I theories, frameworks or models. Programme flexibility is a common barrier to implementation; adaptation of NMT programmes to fit local contexts is imperative. Comprehensive workshops and supplementary resources currently support the success of NMT programme implementation.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Promotion of NMT programmes as the standard of practice is essential to increase practical D&I of these programmes, and thus reduce the burden of youth sport injuries. This work provides some directions for stakeholders, including researchers, implementation support practitioners and youth sport policymakers, on current best practices for the delivery of NMT programmes in local youth sport settings. This work also provides the evidence base for more translational research efforts in youth sport injury prevention, a much-needed next step to optimise NMT programmes into youth sport practice.

Introduction

Youth (<19 years) sport participation provides numerous benefits, positively impacting physical and mental health. 1 Youth sport participation rates are high, with up to 90% of youth participating in sport globally. 2–5 However, with increased sport participation comes increased injury risk. One-in-three youth sustain a sport-related injury each year, leading to a significant public health burden with high healthcare costs. 3 6–8 Sport-related injuries may also result in long-term health consequences (eg, poor mental health, reduced physical activity, post-traumatic osteoarthritis). 7–9 Implementing injury prevention strategies is critical to mitigate the injury risk associated with youth sport participation.

Neuromuscular training (NMT) injury prevention warm-up programmes in youth team sport are effective in reducing injury rates by up to 60% and decreasing costs associated with injury based on randomised controlled trials (RCT) and systematic reviews. 10–21 NMT programmes include exercises that can be categorised across aerobic, balance, strength and agility components 22 23 and typically take 10–15 min. 24 25 Originally implemented with the intention of reducing non-contact lower extremity injury risk, 26–28 the effectiveness of NMT programmes has since been evaluated across numerous sports, age groups and levels of play and are associated with lower extremity and overall injury rates compared with standard of practice warm-ups. 12 20 21 25 In youth team sports, a protective effect has been demonstrated in soccer, handball, basketball, netball, rugby and floorball. 11 16 29–31 The International Olympic Committee Consensus Statement on Youth Athletic Development recommends multifaceted NMT warm-up programmes in youth sport. 32

Despite being a primary injury prevention strategy across youth sports, NMT programme adoption remains low. 33–38 For evidence-informed interventions to be successful and have a practical impact, pragmatic approaches derived from dissemination and implementation (D&I) science are necessary across multiple socioecological levels including organisation, coach and player. 36 Dissemination is defined as ‘the active process of spreading evidence-based interventions to a target population through determined channels and using planned strategies’. Implementation is ‘the active process of using strategies across multiple levels of change to translate evidence-based interventions into practice and prompt corresponding behaviour change in a target population’. 36

The aim of this systematic review was to evaluate current best practices for the D&I of NMT programmes in a youth team sport. The specific objectives of this systematic review were to: (1) describe the characteristics of identified D&I-related studies (studies with at least one D&I outcome directly or indirectly assessed as primary, secondary or tertiary outcome); (2) evaluate factors associated with the D&I of NMT warm-up programme across socioecological levels, including barriers and facilitators; (3) examine the effect of D&I strategies in delivering NMT warm-ups across multiple socioecological levels; and (4) examine the influence of D&I strategies on injury rates. Our protocol was registered in PROSPERO (CRD42021271734), and the review is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines ( supplemental appendix S1 ).

Supplemental material

Search strategy and data sources.

A comprehensive search was developed with a librarian (KAH) in MEDLINE, incorporating four main concepts: child/youth, injury prevention, implementation/compliance/adherence and sports. The author team reviewed the final search strategy which was then piloted against the known key studies to ensure that the search was capturing relevant studies. Finally, the MEDLINE search was translated to the other databases. Searches were conducted 25 August 2021 (updated 16–18 August 2022; 5 September 2023). Search strategies are available in Supplemental Appendix S2 . Studies were identified by searching seven databases: MEDLINE(R) and EPUB Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Embase, Cochrane Central Register of Controlled Trials, Cochrane database of Systematic Reviews (all Ovid); CINAHL Plus with Full Text, SPORTDiscus with Full Text (EBSCO) and ProQuest Dissertations & Thesis Global.

Study selection and eligibility

All database search results were uploaded and duplicates were removed in Covidence (Veritas Health Innovation, Melbourne, Australia). Records were independently reviewed by authors in pairs (DL/IJS, CV/JK, KV/DL), starting with a screening of 50 randomly selected citations to assess inter-rater agreement with a threshold set at 90%. Each pair of reviewers performed title/abstract screening and full-text screening independently, providing reasons for exclusion at full-text stage ( figure 1 ). Any disagreements for exclusion, where a consensus could not be reached within pairs, were resolved by a senior author (OBAO). A secondary evaluation of included manuscripts was performed by senior authors (OBAO and CAE) to ensure appropriate inclusion. Study inclusion criteria were: (1) Participation in a team sport (male and female); (2) a minimum of 70% of participants as a youth (<19 years) or coaches of these youth teams; (3) reported dissemination and/or implementation outcomes (eg, self-efficacy, adherence, intention); (4) reported D&I strategies related to NMT warm-up programmes (ie, NMT delivery strategies, where applicable eg, in RCTs). Exclusion criteria were: (1) Studies evaluating rehabilitation programmes, non-team-based or physical education programmes; (2) non-peer-reviewed; (3) not English. The screening process was reported using the PRISMA flow diagram. 39

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Study identification Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Risk of bias

To assess the risk of bias, three sets of paired reviewers independently used the Downs & Black (D&B) quality assessment tool. 40 The tool consists of a 27-item checklist (total score/33). A third senior reviewer (OBAO or CAE or AMR) resolved any disagreements. The rating of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. 41–43

Frameworks/models

The proportion of studies that used D&I research theories/frameworks/models, including behaviour change frameworks/models, was examined to identify commonly used frameworks/models.

Efficacy-effectiveness orientation in RCTs

We assessed the components of 12 RCTs using the Rating Included Trials on the Efficacy-Effectiveness Spectrum (RITES) tool, as adapted by Maddox et al 44 RITES scores RCTs in systematic reviews based on a continuum of efficacy-effectiveness across four domains: Participant characteristics, trial setting, flexibility of intervention(s) and clinical relevance of experimental and comparison intervention(s) ( online supplemental table S1 ). 45 We modified the Likert grading system to classify studies depending on whether their emphasis was more on efficacy or effectiveness or balanced for both. Given that different aspects of each trial may fall in different places along the efficacy-effectiveness continuum, each RITES domain is scored independently and a composite score is not applicable. To minimise subjectivity, the RITES evaluation for included RCTs was completed by two reviewers (AMR and OBAO). Any disagreements were resolved through discussion to reach a consensus.

Study typologies and assessment of study relevance to D&I

The level of relevance of individual studies (RCTs and quasi-experiments) to D&I was determined based on the implementation-effectiveness hybrid taxonomy: Type 1 (primarily focused on clinical/intervention outcomes), Type 2 (balance focused on both clinical/intervention outcomes and D&I outcomes) and Type 3 (primarily or ‘fully’ (our adaptation) focused on D&I outcomes) studies. 36 46 For ease of interpretation of results, studies were rated considering three broad traditional research design categories (ie, hierarchy of evidence): RCTs, quasi-experimental and observational studies, including cohort, cross-sectional, pre-experimental, qualitative, mixed-methods and ecological studies. Observational studies were categorised as ‘fully focused’ observational-implementation (if only D&I outcomes were evaluated) or ‘partially focused’ observational-implementation (if a combination of clinical and D&I outcomes were evaluated’ D&I studies. 47 RCTs and quasi-experimental studies with Type 2 or Type 3 hybrid approaches were indicated as ‘highly relevant’ towards informing D&I best practices. Furthermore, observational-implementation studies that are fully focused on D&I were also indicated as ‘highly relevant’.

Data extraction

The extracted data included: study design, author, journal, year, population (eg, 13–17 years old female soccer players), participant demographics, D&I intervention strategies (eg, workshops, supplementary resources), D&I framework/model, control group strategies, D&I outcomes (eg, adoption, adherence, intention, fidelity, self-efficacy) and injury outcomes. Study design classification was completed based on data extracted and the process taken by authors, 48 which may have differed from the original classification. Furthermore, prospective, and retrospective cohort studies were consolidated into ‘cohort’ to improve ease of readability. D&I outcomes indicated as compliance were included in the appropriate adherence category as defined in Owoeye et al and described as ‘adherence-related’ outcomes, to maintain unified language across results; the full list is provided in online supplemental table S2 . 36 49–51 Based on the dose-response thresholds reported for NMT programmes within current literature, measures of adherence were used to indicate potential D&I effect ( online supplemental table S5 ). 24 36 52–54 Studies with cumulative utilisation (sessions completed/total possible) of ≥70%, utilisation frequency of ≥1.5 sessions/week or a significant association between D&I exposures and outcomes were defined as moderate-to-highly relevant and identified as having a potential D&I effect (ie, yes). Studies presenting cumulative utilisation <70%, utilisation frequency <1.5 sessions/week or no association between D&I exposures and outcomes were defined as low-to-no relevance (ie, no). Studies reporting both frequency utilisation and cumulative utilisation must both reach the established dose-response thresholds to be considered as having a potential D&I effect. D&I barriers and facilitators, factors influencing injury prevention implementation success and the identification of any frameworks used were also extracted and categorised into themes. Measures of potential effect for these results were summarised using OR, proportions and mean differences in D&I outcomes (eg, adoption, adherence). Injury-specific results were reported as incidence rate ratios, risk ratios, ORs or prevalence. D&I strategies were classified into various categories, including workshops, supplementary resources, personnel support, supervision and combinations of these strategies.

Equity, diversity and inclusion statement

Our author team is comprised of student and senior researchers across various disciplines with representation from low-to-middle-income countries. A variety of demographic, socioeconomic and cultural backgrounds were included in our study populations.

PRISMA flow, characteristics of included studies and risk of bias assessment

A total of 68 relevant studies were included from our initial and updated search yield of 9021 studies ( figure 1 ). Across included studies, 13 included only male youth participants, 13 included only female youth participants, 26 included both and 16 reported coach-focused findings. Sports represented were soccer (n=33), rugby (n=8), basketball (n=7), multisport (n=7), handball (n=5), floorball (n=3), field hockey (n=3), volleyball (n=1) and futsal (n=1).

Details of study characteristics and risk of bias are presented in online supplemental table S3 . D&B scores ranged from 4/33 to 24/33 (median=14/33) from a variety of study designs, including 20 RCTs, 16 cross-sectional, 9 quasi-experimental, 8 cohort, 6 qualitative, 3 ecological, 3 mixed-methods and 3 pre-experimental. The D&B scores for the two top D&I-related relevant studies—an RCT Type 2 study (n=1) was 21/33 and an RCT Type 3 hybrid study (n=1) was 17/33. Using the GRADE guidelines for the process of rating the quality of evidence available and interpreting the quality assessment, the strength of recommendations was ‘low’ given the multiplicity of designs. 42 43

Characteristics of current D&I-related studies

23 studies (33.8%) reported using a D&I /behaviour change framework/model. D&I frameworks included Reach, Effectiveness, Adoption, Implementation and Maintentance (RE-AIM) Framework (n=7), Consolidation Framework for Implementation Research (n=1), Precede-Proceed Model (n=1), Translating Research into Injury Prevention Practice (n=1) and Promoting Action on Research Implementation of Health Sciences (n=1) and the Adherence Optimisation Framework (n=1). Behaviour change models included the Health Action Process Approach (HAPA) (n=8), Theory of Planned Behaviour (n=1) and the Health Belief Model (n=1).

Assessment of study relevance to D&I

Two RCTs of 68 included D&I-related studies (2.9%) were identified as highly relevant to D&I best practices (ie, Type 2 or 3 hybrid approach). 55 56 18 (27.9%) RCTs reported a secondary analysis of D&I strategies 12 16 19 30 53 57–69 ; classified as Type 1 hybrids. Five (8.3%) quasi-experimental studies used Type 2 or Type 3 hybrid approach 22 70–73 ; the remaining studies (n=4; 5%) were classified as quasi-experimental Type 1 hybrids. 74–77 Many observational studies (n=17; 26.7%), 78–94 were highly relevant based on being fully-focused observational-implementation studies; 5 (6.7%) were partially-focused observational-implementation studies. 52 95–98 The remaining observational studies (n=17; 23.3%) were observational-implementation studies, 35 99–114 reporting D&I outcomes from a qualitative lens using interviews and surveys.

The RITES scores for the 14 D&I-related RCTs that examined injuries as primary outcome and D&I outcomes as secondary (Type 1 hybrid approach) are presented in table 1 . Almost all (13 of 14; 92.9%) of the RCTs focused mainly on intervention efficacy (as opposed to effectiveness) regarding the flexibility of NMT warm-up programmes. Cumulatively, effectiveness was rarely (7.1%) prioritised as a primary focus across all the 56 possible ratings of the RITES domains for all 14 studies. 50% of the domain ratings demonstrated efficacy as a priority and 42.9% of the ratings were indicated for a balance between efficacy and effectiveness.

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RITES domain scores for included trials

Contextual predictors of NMT warm-up programme implementation

50 (73.5% of total) studies identified ≥1 barrier or facilitator within their findings, with 10 (14.7% of total) specifically examining barriers/facilitators as their main objectives. Full list is provided in online supplemental table S4 . The most common barriers identified were time restrictions (n=30), 30 35 59 62 69 70 73 74 78 79 81 82 84 87–91 93 96 98 101 102 105 107 108 112 114 reduced buy-in/support (n=8) 62 75 84 87 105 110–112 and limited awareness of preventative effects of programmes (n=8). 74 84 103 104 107 109 113 Facilitators included comprehensive workshops from trained instructors (n=11), 53 71 78–80 84 90 96 99 100 112 accessibility of supplementary resources (n=10) 82 84 87 89 90 105 114 and uptake/support from multiple stakeholders (n=7). 56 67 84 101 103 105 112 Moreover, suggestions from multiple socioecological levels indicated that increasing programme education and support, increased sport-specific activities and improved awareness of preventive effects, influence NMT implementation success. 36 88 89 115 116 Figure 2 , adapted from Basow et al 117 illustrates the contextual factors reported in the literature. 117 This evidence-informed model shows the important barriers and facilitators that influence the end-user implementation of NMT warm-up programmes across the three key socioecological levels of change.

Contextual predictors of NMT implementation across multiple socioecological levels. (Adapted from Basow et al (2021)).(116). Notes. SE, self-efficacy. NMT, neuromuscular training. Bold represents top barrier(s)/facilitator(s).

51 (75%) studies used implementation strategies for NMT warm-up programmes. The most frequently used strategies were Workshops with supplementary Resources (WR; n=24), followed by Workshops with supplementary Resources, plus in-season Personnel support (WRP; n=14). Three studies employed both WR and WRP strategies. Other methods for implementation included only workshops (n=9), only supplementary resources (n=4), supplementary resources and personnel support (n=2), workshops with personnel support (n=1) and supervision (n=1). Note, some studies are duplicated throughout the table when multiple D&I strategies are compared. 22 53 56 86

The key D&I concepts that were reported within the included studies were adherence or adherence-related (eg, self-efficacy, translation and perception). Specific outcomes within these concepts were further examined from the individual study results. We did not have enough evidence to present a meta-analysis of the effect of D&I strategies on D&I outcomes. Therefore, online supplemental table S5 presents a qualitative summary of the relationships between reported D&I exposure and D&I outcomes. 40 studies reported adherence-related outcomes, of which 32 (80%) were indicated to have potential D&I effect. Studies using WRP (n=14) reported completing between 1.4 and 2.6 sessions/week and cumulative utilisation of 39–85.6%; 9 of these 14 studies have potential D&I effect. Studies using WR (n=24) presented utilisation frequency ranging from 0.8 to 3.2 sessions/week and cumulative utilisation of 55–98% of sessions; 16 of these 24 have potential D&I effect. In studies evaluating workshops only (n=9; 22%), frequency utilisation was reported between 1 and 2 sessions/week across eight of the nine studies and one study had 52% cumulative utilisation; two have potential D&I effect.

Effects of D&I strategies on injury outcomes

Three RCTs specifically examined the effects of the D&I strategies used to deliver NMT programmes on injury outcomes ( table 2 ). Two studies that compared both WR and WRP to supplementary resource only found no significant differences between strategies, 53 56 they reported reduced injury rates in the highest adherence groups by 56% and 72%, respectively. Another study comparing WR and WRP to a standard of practice warm-up found a 36% reduction of ankle and knee injuries when using WR and a 38% reduction in ankle and knee injuries without supervision. 22 There were no significant differences in injury rates between groups.

Injury Outcomes by D&I strategies and adherence

This study evaluated current literature to inform evidence-based best practices for the D&I of NMT programmes in youth team sport. To our knowledge, this is the first systematic review evaluating the D&I of NMT programmes in youth sport. To improve the practical implementation of NMT warm-ups, factors associated with implementation success and current best practices for delivering context-specific NMT programmes are required to be evaluated. 118 In this review, we found few D&I-related studies use D&I or behaviour change frameworks, theories or models to guide their research questions. We discovered the number of RCTs examining the effectiveness of D&I strategies for NMT programme delivery is limited. Common barriers to NMT implementation include programme flexibility and time restrictions; and the use of coach workshops and supplementary resources are currently the primary strategy in NMT programme D&I facilitation.

One-third of the included studies used a D&I framework or behaviour change model in their research work. The HAPA and RE-AIM models were the most frequently used. These models are a conceptual and organised combination of theories required to direct the design, evaluation and translation of evidence-based interventions (NMT programmes) and the context in which they are being implemented. 36 71 119 It is imperative for D&I studies to use these frameworks/models to fully understand specific implementation processes and contexts. Future D&I studies should consider using appropriate frameworks or models, including adaptations and combination of models to guide their specific aims.

Relevance to D&I

Across the relevant literature, a variety of designs and levels of evidence were included.

Of 68 studies, 7 (10.3%) were found to be ‘highly relevant’ toward informing D&I best practice (2 (2.9%) RCTs, 5 (7.4%) quasi-experimental). Other ‘relevant’ studies evaluated implementation as secondary objectives (Type 1 hybrid designs) and/or were of lower level of evidence. 33 observational studies were ‘highly relevant’ to D&I, assessing D&I outcomes and barriers and facilitators from a qualitative lens. While these studies are important for understanding D&I context, more high-quality and highly relevant studies such as RCTs and quasi-experimental designs using the Type 3 hybrid approach, or non-hybrid approach focused on solely evaluating the effectiveness of D&I strategies, are needed to advance the widespread adoption and continued use of NMT programmes in youth team sport.

Effectiveness versus efficacy

Effectiveness is indicative of an evidence-informed intervention’s readiness for practical implementation. 36 Findings from our RITES scores evaluation indicate that the majority of the RCTs had a primary focus on efficacy and not effectiveness. Although many RCT studies had a fair balance between efficacy and effectiveness for participant characteristics, trial settings and clinical relevance domains (≥50% of RCTs), there is a lack of flexibility in the development and evaluation of the evidence supporting current NMT warm-up programmes. These disparities regarding practical implementation have implications for D&I research and practice in this field. Current NMT programmes may need to be modified or adapted to the local context and evaluated further to improve implementation in youth sport settings.

Contextual considerations

In our Adapted Socioecological Model ( figure 2 ), we demonstrate that the utilisation of NMT programmes by individual players within youth team sport can depend on their coach adopting and implementing the warm-up, which may also be dependent on larger organisational systems. Barriers related to end-users’ success in wide-spread adoption and long-term maintenance can be moderated; however, researchers and implementers have to be intentional about tackling these recognised barriers and associated challenges 25 87 104 115 ; integrating the facilitators of successful implementation intending to reduce and address these obstacles is essential. The barriers and facilitators identified in this systematic review provide insight into the combination of D&I strategies that should be formulated and tested by D&I researchers in the sports injury prevention field.

Within the current review, lack of time, whether it be learning, instructing and/or practicing the programme, is a common barrier that plays a significant role in implementation. A recent narrative review focused solely on the barriers and facilitators associated with exercise-based warm-up programmes showed similar conclusions regarding time restrictions. 115 Collective themes within this literature for players, coaches and organisations found that reduced buy-in and support at different levels impacted the adoption of NMT warm-up programmes. The lack of awareness and knowledge of the injury prevention benefits of NMT warm-up programmes also presented major barriers to buy-in, leading to reduced implementation success. Future interventions should ensure that education about evidence-informed injury prevention outcomes associated with programme adherence is integrated within their D&I strategies.

D&I science is a growing field of study. A variety of D&I outcomes were identified such as self-efficacy, intention, reach, outcome expectancy and most commonly, adherence or adherence-related outcomes. These outcomes were evaluated using different D&I strategies for NMT warm-up programmes. The most commonly reported strategies were Workshops with supplementary Resources with/without in-season Personnel support. Evaluation of D&I outcomes showed that adherence or adherence-related outcomes were most frequently reported across studies. Various measures of adherence as defined by Owoeye et al (2020) were identified, including cumulative utilisation, utilisation frequency, utilisation fidelity, duration fidelity and exercise fidelity. 36

Adherence remains the most common D&I outcome in the sport injury prevention literature. 36 120 In this review, we defined adherence and adherence-related thresholds for a moderate-to-high dose-response to be ≥70% cumulative utilisation and/or ≥1.5 session/week to achieve the desired protective effects. This was done with consideration of pragmatism and a practical balance between programme efficacy and effectiveness given the existing literature. 24 91 32 of 40 studies (80%) from those with adherence or adherence-related outcomes had a potential D&I effect based on a moderate-to-high adherence or adherence-related outcome level. The use of WR and WRP was the most common D&I strategies for delivering NMT warm-up programmes. While there are several areas for improvement for the practical D&I of NMT warm-up programmes in youth sport settings, the use of comprehensive workshops and supplementary resources at various levels, particularly with coaches, appears to be the optimal best practice. However, only two ‘highly relevant’ D&I studies (RCTs) from the current systematic review presented conclusions based on the effectiveness of D&I strategies and outcomes specifically.

Many studies (n=26/68; 38.2%) included both male and female participants; however, no sex-differences were described. When examining D&I outcomes, only 7/26 (26.9%) had moderate-to-high adherence when looking at both male and female youth players. In total, 84.6% of the female-only (11/13) and 72.7% of the male-only studies (8/11) reported moderate-to-high adherence levels. These findings suggest greater attention and efforts for adherence and implementation of NMT programmes in the male youth team sport setting may need further consideration compared with the female youth sport context.

Of the preliminary evidence for Type 2 and 3 hybrid designs, the literature highlighted in the synthesis of this data that WR are effective strategies in injury prevention and showed more moderate-to-high adherence levels. Given that most studies are doing some form of WR, adding in-season personnel support does not increase the protective effect and may be less sustainable given that resources, time and support are significant barriers to the D&I of these programmes.

Additionally, greater implementation and programme buy-in were found in studies where uptake of these NMT programmes was supported across multiple stakeholders, particularly at the organisation level. 19 67 90 103 112 Catering to programme deliverers (coaches, organisations, parents) and evaluating their awareness, perception and self-efficacy may help further inform our understanding of D&I and how we can best work to promote programme uptake further.

D&I strategies and injury outcomes

The findings from this systematic review suggest that while various D&I intervention strategies are effective at reducing injuries in youth team sports, the ranges of injury rate ratios are similar across studies employing different strategies (32–88% lower injury rates across WR strategy studies and 41–77% lower injury rates across WRP strategy studies). 22 53 56 Although this was not the proposed evaluation of these studies, our findings demonstrate that the use of workshops may influence D&I success and the availability of supplementary resources alone may not be efficacious. Future evaluation of the influence of delivery strategies should be considered.

Future directions

Using facilitators to reduce barrier burden.

Regarding NMT strategy evaluation, our findings show that most of the current programmes focus on efficacy over effectiveness, particularly in the aspect of intervention flexibility; this suggests a need for the adaptation of NMT programmes to fit local contexts. NMT programme developers should consider more enjoyable and user-friendly exercises that include sport-specific activities (eg, ball work, partner drills, tags). Increasing variations also improves player buy-in and increases intrinsic motivation. At a coaching level, workshops on NMT programmes should include evidence-informed education on the injury prevention benefits and should incorporate content addressing coach self-efficacy to enhance implementation quality. 16 100 121 An ongoing pragmatic evaluation of NMT programme effectiveness is warranted as they undergo adaptation to local contexts.

Organisations have expressed limited knowledge and education for implementation as a significant barrier to successful NMT programme use. 90 99 101 105 112 115 122 Implementers should look to provide accessible resources and encourage further support from multiple stakeholders, including the governing bodies. This could lead to policy changes within the club and result in greater uptake of these programmes long-term. Collaborations among stakeholders (researchers, youth sport administrators, coaches and players) in programme development, evaluation, D&I are necessary to improve efforts for impactful practical translation of programmes.

Research recommendations

The support for NMT programmes within youth sport is extensive. 28 Although these programmes have been shown to be effective for injury prevention in many sports, 10 11 sport representation across D&I studies in our review was limited. Scaling up of NMT programmes and supporting continued research into other sports is vital for increased context-specific D&I of these programmes to reduce the overall burden of youth sport injuries.

Compliance and adherence were often used interchangeably, despite having distinct definitions. Although their mathematical calculations are similar, these two constructs are contextually different. Compliance refers to individuals conforming to prescribed recommendations in controlled intervention settings, 123 while adherence refers to the agreement of an individual’s behaviour to recommended evidence-based interventions in uncontrolled settings. 36 Standardised definitions should be considered more frequently by researchers to build on current knowledge and inform future D&I research.

Using D&I frameworks/models can improve NMT programme implementation success in a practical setting. 71 124 Application of D&I frameworks/models, including behaviour change models, 124 is limited in injury prevention and this is reflected in the current systematic review. Future studies should use D&I frameworks/models to help guide the implementation of these NMT programmes. In doing so, researchers can gain a better understanding of the contextual and behaviour change aspects related to youth sport injury prevention. 115

Limitations

Given the broad nature of our research question, specific results were required for inclusion. Despite being specific to our objectives, our limitations set for participant age range, team sport settings and English language studies only, may have resulted in missing other studies that evaluated D&I interventions and outcomes related to NMT programmes.

Due to the heterogeneous nature of studies, meta-analysis was not possible for any of our objectives. Inclusion of various study designs, although comprehensive, impeded this process and resulted in inconsistent injury and adherence definitions across our population of interest. Furthermore, the subjective nature of many qualitative studies included may have resulted in variability within the data extracted. With the varied definitions used for each specific outcome and design, we looked to consolidate the terminology used into more succinct and unified language and we encourage this to be employed by researchers.

Methodological flaws existed in the included studies that may warrant caution about the interpretation of our conclusions. For example, many of the included studies did not include power calculations or reported low power, increasing the chance of Type 2 error. Further, many studies did not consider confounding or effect modification in their analyses or failed to report the validity of measurement tools used for injury data collection. We also acknowledge that publication bias may have favoured the inclusion of studies demonstrating significant findings (eg, effectiveness, efficacy). By considering quality assessment as an objective, we aimed to account for these limitations.

There was limited evidence supporting the effect of D&I strategies on D&I-specific outcomes. There were only two high-level evidence (RCTs) studies in this review that directly discussed the matter of D&I strategies on D&I outcomes. 55 56 D&I-related outcomes were evaluated as secondary objectives in other high-level evidence studies, therefore, we could only examine the relationship between D&I strategy and outcome to assess if the strategy used resulted in moderate-to-high adherence levels, given our pre-established thresholds.

Conclusions

This systematic review demonstrates that: (1) Few D&I-related studies are based on D&I or behaviour change theories, frameworks or models; (2) few RCTs have examined the effectiveness of D&I strategies for delivering NMT programmes; (3) programme flexibility and time restrictions are the most common barriers to implementation and; (4) a combination of coach workshops and supplementary resources are currently the primary strategy facilitating NMT programme D&I; however their effectiveness is only evaluated in a few studies. This systematic review provides foundational evidence to facilitate evidence-informed knowledge translation practices in youth sport injury prevention. Transitioning to more high-quality D&I research RCTs and quasi-experimental designs that leverage current knowledge of barriers and facilitators, incorporates Type 2 or Type 3 hybrid approaches and uses behaviour change frameworks are important next steps to optimise the translation of NMT programmes into routine practice in youth team sport settings.

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Patient consent for publication.

Not applicable.

Ethics approval

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Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Data supplement 1
Data supplement 2

X @carlavdb_, @amraisanen, @KatiPasanen, @Kat_Schneider7, @CarolynAEmery, @owoeye_oba

Contributors DL, CE and OBAO contributed to development of study proposal and design. DL, CvdB, AMR, IJS, KV, JK, AH, CE and OBAO conducted search, study selection and screening, data extraction and synthesis and quality assessment. DL led the writing of the manuscript and was the guarantor for the project. All authors contributed to drafting and revising the final manuscript. All authors approved the submitted version of the manuscript.

Funding This study was funded by Canadian Institutes for Health Research Foundation Grant Program (PI CAE).

Competing interests OBAO is a Deputy Editor for the British Journal of Sports Medicine. CE, KJS and KP are Associate Editors for the British Journal of Sports Medicine.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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http://orcid.org/0000-0002-5111-7861 Amit K Dutta 1 ,
http://orcid.org/0000-0003-2472-3409 Vishal Sharma 2 ,
Abhinav Jain 3 ,
Anshuman Elhence 4 ,
Manas K Panigrahi 5 ,
Srikant Mohta 6 ,
Richard Kirubakaran 7 ,
Mathew Philip 8 ,
http://orcid.org/0000-0003-1700-7543 Mahesh Goenka 9 ,
Shobna Bhatia 10 ,
http://orcid.org/0000-0002-9435-3557 Usha Dutta 2 ,
D Nageshwar Reddy 11 ,
Rakesh Kochhar 12 ,
http://orcid.org/0000-0002-1305-189X Govind K Makharia 4
1 Gastroenterology , Christian Medical College and Hospital Vellore , Vellore , India
2 Gastroenterology , Post Graduate Institute of Medical Education and Research , Chandigarh , India
3 Gastroenterology , Gastro 1 Hospital , Ahmedabad , India
4 Gastroenterology and Human Nutrition , All India Institute of Medical Sciences , New Delhi , India
5 Gastroenterology , All India Institute of Medical Sciences - Bhubaneswar , Bhubaneswar , India
6 Department of Gastroenterology , Narayana Superspeciality Hospital , Kolkata , India
7 Center of Biostatistics and Evidence Based Medicine , Vellore , India
8 Lisie Hospital , Cochin , India
9 Apollo Gleneagles Hospital , Kolkata , India
10 Gastroenterology , National Institute of Medical Science , Jaipur , India
11 Asian Institute of Gastroenterology , Hyderabad , India
12 Gastroenterology , Paras Hospitals, Panchkula , Chandigarh , India
Correspondence to Dr Amit K Dutta, Gastroenterology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India; akdutta1995{at}gmail.com

https://doi.org/10.1136/gutjnl-2024-332154

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PROTON PUMP INHIBITION
META-ANALYSIS

We read with interest the population-based cohort studies by Abrahami et al on proton pump inhibitors (PPI) and the risk of gastric and colon cancers. 1 2 PPI are used at all levels of healthcare and across different subspecialties for various indications. 3 4 A recent systematic review on the global trends and practices of PPI recognised 28 million PPI users from 23 countries, suggesting that 23.4% of the adults were using PPI. 5 Inappropriate use of PPI appears to be frequent, although there is a lack of compiled information on the prevalence of inappropriate overuse of PPI. Hence, we conducted a systematic review and meta-analysis on the inappropriate overuse of PPI globally.

Supplemental material

Overall, 79 studies, including 20 050 patients, reported on the inappropriate overuse of PPI and were included in this meta-analysis. The pooled proportion of inappropriate overuse of PPI was 0.60 (95% CI 0.55 to 0.65, I 2 97%, figure 1 ). The proportion of inappropriate overuse by dose was 0.17 (0.08 to 0.33) and by duration of use was 0.17 (0.07 to 0.35). Subgroup analysis was done to assess for heterogeneity ( figure 2A ). No significant differences in the pooled proportion of inappropriate overuse were noted based on the study design, setting (inpatient or outpatient), data source, human development index of the country, indication for use, sample size estimation, year of publication and study quality. However, regional differences were noted (p<0.01): Australia—40%, North America—56%, Europe—61%, Asia—62% and Africa—91% ( figure 2B ). The quality of studies was good in 27.8%, fair in 62.03% and low in 10.12%. 6

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Forest plot showing inappropriate overuse of proton pump inhibitors.

(A) Subgroup analysis of inappropriate overuse of proton pump inhibitors (PPI). (B) Prevalence of inappropriate overuse of PPI across different countries of the world. NA, data not available.

This is the first systematic review and meta-analysis on global prescribing inappropriateness of PPI. The results of this meta-analysis are concerning and suggest that about 60% of PPI prescriptions in clinical practice do not have a valid indication. The overuse of PPI appears to be a global problem and across all age groups including geriatric subjects (63%). Overprescription increases the patient’s cost, pill burden and risk of adverse effects. 7–9 The heterogeneity in the outcome data persisted after subgroup analysis. Hence, this may be inherent to the practice of PPI use rather than related to factors such as study design, setting or study quality.

Several factors (both physician and patient-related) may contribute to the high magnitude of PPI overuse. These include a long list of indications for use, availability of the drug ‘over the counter’, an exaggerated sense of safety, and lack of awareness about the correct indications, dose and duration of therapy. A recently published guideline makes detailed recommendations on the accepted indications for the use of PPI, including the dose and duration, and further such documents may help to promote its rational use. 3 Overall, there is a need for urgent adoption of PPI stewardship practices, as is done for antibiotics. Apart from avoiding prescription when there is no indication, effective deprescription strategies are also required. 10 We hope the result of the present systematic review and meta-analysis will create awareness about the current situation and translate into a change in clinical practice globally.

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Patient consent for publication.

Not applicable.

Ethics approval

Abrahami D ,
McDonald EG ,
Schnitzer ME , et al
Jearth V , et al
Malfertheiner P ,
Megraud F ,
Rokkas T , et al
Shanika LGT ,
Reynolds A ,
Pattison S , et al
O’Connell D , et al
Choudhury A ,
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Lees JS , et al
Paynter S , et al
Targownik LE ,
Fisher DA ,

Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Data supplement 1

X @drvishal82

Contributors AKD: concept, study design, data acquisition and interpretation, drafting the manuscript and approval of the manuscript. VS: study design, data acquisition, analysis and interpretation, drafting the manuscript and approval of the manuscript. AJ, AE, MKP, SM: data acquisition and interpretation, critical revision of the manuscript, and approval of the manuscript. RK: study design, data analysis and interpretation, critical revision of the manuscript and approval of the manuscript. MP, MG, SB, UD, DNR, RK: data interpretation, critical revision of the manuscript and approval of the manuscript. GKM: concept, study design, data interpretation, drafting the manuscript, critical revision and approval of the manuscript.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; internally peer reviewed.

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WHAT IS ALREADY KNOWN ON THE TOPIC

WHAT THIS STUDY ADDS

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Introduction

Supplemental material

Study selection and eligibility

Risk of bias

Frameworks/models

Efficacy-effectiveness orientation in RCTs

Study typologies and assessment of study relevance to D&I

Data extraction

Equity, diversity and inclusion statement

PRISMA flow, characteristics of included studies and risk of bias assessment

Characteristics of current D&I-related studies

Assessment of study relevance to D&I

Contextual predictors of NMT warm-up programme implementation

Effects of D&I strategies on injury outcomes

Relevance to D&I

Effectiveness versus efficacy

Contextual considerations

D&I strategies and injury outcomes

Future directions

Research recommendations

Limitations

Conclusions

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