***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective —To describe the trends in recreational sports injury in Perth , Western Australia . Design —A prospect i ve cohort study of sports injuries during the 1997 winter season ( May to September ) . Setting — Sample of Australian football , field hockey , basketball , and netball players from the Perth metropolitan area , Western Australia . Methods —A cohort of sports participants was followed over the five month winter sports season . Before the season , participants completed a baseline question naire and during the season were interviewed every four weeks by telephone . Results —Overall , 92 % of participants ( n = 1391 ) who completed a baseline question naire completed at least one follow up telephone interview . About half ( 51 % ) of the cohort sustained one or more injuries during the winter season accounting for a total of 1034 injuries . Most injuries were of moderate ( 58 % , n = 598 ) or minor ( 40 % , n = 412 ) severity , with only 3 % ( n = 24 ) requiring emergency department treatment or a hospital stay . The injury incidence rate was greatest for football ( 20.3/1000 hours of participation ) , similar for field hockey and basketball ( 15.2/1000 hours and 15.1/1000 hours respectively ) , and lowest for netball ( 12.1/1000 hours ) . The incidence of injury was greatest in the first four weeks of the season , and participants aged between 26 and 30 years had about a 55 % greater risk of injury than those aged less than 18 years . Conclusions —This is one of the first studies to show that recreational sports are safe . Although the likelihood of injury was greatest in the first month of the season , few injuries required admission to hospital or emergency department treatment . A greater emphasis on prevention in the early part of the season should help to reduce the elevated incidence of injury found at this time Objective To evaluate the effectiveness of neuromuscular training in reducing the rate of acute knee injury  in adolescent female football players . Design Stratified cluster r and omised controlled trial with clubs as the unit of r and omisation . Setting 230 Swedish football clubs ( 121 in the intervention group , 109 in the control group ) were followed for one season ( 2009 , seven months ) . Participants 4564 players aged 12 - 17 years ( 2479 in the intervention group , 2085 in the control group ) completed the study . Intervention 15 minute neuromuscular warm-up programme ( targeting core stability , balance , and proper knee alignment ) to be carried out twice a week throughout the season . Main outcome measures The primary outcome was rate of anterior cruciate ligament injury ; secondary outcomes were rates of severe knee injury ( > 4 weeks ’ absence ) and any acute knee injury . Results Seven players ( 0.28 % ) in the intervention group , and 14 ( 0.67 % ) in the control group had an anterior cruciate ligament injury . By Cox regression analysis according to intention to treat , a 64 % reduction in the rate of anterior cruciate ligament injury was seen in the intervention group ( rate ratio 0.36 , 95 % confidence interval 0.15 to 0.85 ) . The absolute rate difference was −0.07 ( 95 % confidence interval −0.13 to 0.001 ) per 1000 playing hours in favour of the intervention group . No significant rate reductions were seen for secondary outcomes . Conclusions A neuromuscular warm-up programme significantly reduced the rate of anterior cruciate ligament injury in adolescent female football players . However , the absolute rate difference did not reach statistical significance , possibly owing to the small number of events . Trial registration Clinical trials NCT00894595 Background The FIFA 11 + injury prevention program has been shown to decrease the risk of soccer injuries in men and women . The program has also been shown to decrease time loss result ing from injury . However , previous studies have not specifically investigated how the program might impact the rate of anterior cruciate ligament ( ACL ) injury in male soccer players . Questions / purpose sThe purpose of this study was to examine if the FIFA 11 + injury prevention program can ( 1 ) reduce the overall number of ACL injuries in men who play competitive college soccer and whether any potential reduction in rate of ACL injuries differed based on ( 2 ) game versus practice setting ; ( 3 ) player position ; ( 4 ) level of play ( Division I or II ) ; or ( 5 ) field type . Methods This study was a prospect i ve cluster r and omized controlled trial , which was conducted in 61 Division I and Division II National Collegiate Athletic Association men ’s soccer teams over the course of one competitive soccer season . The FIFA 11 + is a 15- to 20-minute on-the-field dynamic warm-up program used before training and games and was utilized as the intervention throughout the entire competitive season . Sixty-five teams were r and omized : 34 to the control group ( 850 players ) and 31 to the intervention group ( 675 players ) . Four intervention teams did not complete the study and did not su bmi t their data , noting insufficient time to complete the program , reducing the number for per- protocol analysis to 61 . Compliance to the FIFA 11 + program , athletic exposures , specific injuries , ACL injuries , and time loss result ing from injury were collected and recorded using a secure Internet-based system . At the end of the season , the data in the injury surveillance system were crosshatched with each individual institution ’s internal data base . At that time , the certified athletic trainer signed off on the injury collection data to confirm their accuracy and completeness . Results A lower proportion of athletes in the intervention group experienced knee injuries ( 25 % [ 34 of 136 ] ) compared with the control group ( 75 % [ 102 of 136 ] ; relative risk [ RR ] , 0.42 ; 95 % confidence interval [ CI ] , 0.29 - 0.61 ; p < 0.001 ) . When the data were stratified for ACL injury , fewer ACL injuries were reported in the intervention group ( 16 % [ three of 19 ] ) compared with the control group ( 84 % [ 16 of 19 ] ) , accounting for a 4.25-fold reduction in the likelihood of incurring ACL injury ( RR , 0.236 ; 95 % CI , 0.193–0.93 ; number needed to treat = 70 ; p < 0.001 ) . With the numbers available , there was no difference between the ACL injury rate within the FIFA 11 + group and the control group with respect to game and practice sessions ( games — intervention : 1.055 % [ three of 15 ] versus control : 1.80 % [ 12 of 15 ] ; RR , 0.31 ; 95 % CI , 0.09–1.11 ; p = 0.073 and practice s — intervention : 0 % [ zero of four ] versus control : 0.60 % [ four of four ] ; RR , 0.14 ; 95 % CI , 0.01–2.59 ; p = 0.186 ) . With the data that were available , there were no differences in incidence rate ( IR ) or injury by player position for forwards ( IR control = 0.339 versus IR intervention = 0 ) , midfielders ( IR control = 0.54 versus IR intervention = 0.227 ) , defenders ( IR control = 0.339 versus IR intervention = 0.085 ) , and goal keepers ( IR control = 0.0 versus IR intervention = 0.0 ) ( p = 0.327 ) . There were no differences in the number of ACL injuries for the Division I intervention group ( 0.70 % [ two of nine ] ) compared with the control group ( 1.05 % [ seven of nine ] ; RR , 0.30 ; CI , 0.06–1.45 ; p = 0.136 ) . However , there were fewer ACL injuries incurred in the Division II intervention group ( 0.35 % [ one of 10 ] ) compared with the control group ( 1.35 % [ nine of 10 ] ; RR , 0.12 ; CI , 0.02–0.93 ; p = 0.042 ) . There was no difference between the number of ACL injuries in the control group versus in the intervention group that occurred on grass versus turf ( Wald chi square [ 1 ] = 0.473 , b = 0.147 , SE = 0.21 , p = 0.492 ) . However , there were more ACL injuries that occurred on artificial turf identified in the control group ( 1.35 % [ nine of 10 ] ) versus the intervention group ( 0.35 % [ one of 10 ] ; RR , 0.14 ; 95 % CI , 0.02–1.10 ; p = 0.049 ) . Conclusions This program , if implemented correctly , has the potential to decrease the rate of ACL injury  in competitive soccer players . In addition , this may also enhance the development and dissemination of injury prevention protocol s and may mitigate risk to athletes who utilize the program consistently . Further studies are necessary to analyze the cost-effectiveness of the program implementation and to analyze the efficacy of the FIFA 11 + in the female collegiate soccer cohort . Level of Evidence Level I , therapeutic study Groin injuries cause major problems in sports and particularly in football . Exercise is effective in treating adductor-related groin pain , but no trials have been published regarding the specific prevention of groin pain or prevention specifically targeting overuse injuries in sport using exercise programs . We performed a cluster-r and omized trial including 55 football clubs representing 1211 players . The clubs were r and omized to an exercise program aim ed at preventing groin injuries ( n=27 ) or to a control group training as usual ( n=28 ) . The intervention program consisted of six exercises including strengthening ( concentric and eccentric ) , coordination , and core stability exercises for the muscles related to the pelvis . Physiotherapists assigned to each club registered all groin injuries . Twenty-two clubs in each group completed the study , represented by 977 players . There was no significant effect of the intervention ( HR=0.69 , 95 % CI 0.40 - 1.19 ) . The risk of a groin injury was reduced by 31 % , but this reduction was not significant . A univariate analysis showed that having had a previous groin injury almost doubles the risk of developing a new groin injury and playing at a higher level almost triples the risk of developing a groin injury Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background : The Fédération Internationale de Football Association ( FIFA ) 11 + program has been shown to be an effective injury prevention program in the female soccer cohort , but there is a paucity of research to demonstrate its efficacy in the male population . Hypothesis : To examine the efficacy of the FIFA 11 + program in men ’s collegiate United States National Collegiate Athletic Association ( NCAA ) Division I and Division II soccer . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Before the commencement of the fall 2012 season , every NCAA Division I and Division II men ’s collegiate soccer team ( N = 396 ) was solicited to participate in this research study . Human ethics review board approval was obtained through Quorum Review IRB . Sixty-five teams were r and omized : 34 to the control group ( CG ; 850 players ) and 31 to the intervention group ( IG ; 675 players ) . Four teams in the IG did not complete the study , reducing the number for analysis to 61 . The FIFA 11 + injury prevention program served as the intervention and was utilized weekly . Athlete-exposures ( AEs ) , compliance , and injury data were recorded using a secure Internet-based system . Results : In the CG , 665 injuries ( mean ± SD , 19.56 ± 11.01 ) were reported for 34 teams , which corresponded to an incidence rate ( IR ) of 15.04 injuries per 1000 AEs . In the IG , 285 injuries ( mean ± SD , 10.56 ± 3.64 ) were reported for 27 teams , which corresponded to an IR of 8.09 injuries per 1000 AEs . Total days missed because of injury were significantly higher for the CG ( mean ± SD , 13.20 ± 26.6 days ) than for the IG ( mean ± SD , 10.08 ± 14.68 days ) ( P = .007 ) . There was no difference for time loss due to injury based on field type ( P = .341 ) . Conclusion : The FIFA 11 + significantly reduced injury rates by 46.1 % and decreased time loss to injury by 28.6 % in the competitive male collegiate soccer player ( rate ratio , 0.54 [ 95 % CI , 0.49 - 0.59 ] ; P < .0001 ) ( number needed to treat = 2.64 ) Background Shoulder problems are highly prevalent among elite h and ball players . Reduced glenohumeral rotation , external rotation weakness and scapula dyskinesis have been identified as risk factors . Aim Evaluate the effect of an exercise programme design ed to reduce the prevalence of shoulder problems in elite h and ball . Methods 45 elite h and ball teams ( 22 female teams , 23 male teams , 660 players ) were cluster r and omised ( 22 teams , 331 players in the intervention group , 23 teams , 329 players in the control group ) and followed for 1 
    Output:
    
The general and mixed programs positively affect injury rates .