literature review with maxqda

The Practice of Qualitative Data Analysis

Research examples using maxqda.

• Editors: Michael C. Gizzi, Stefan Rädiker
• Released: March 16, 2021
• ISBN: 978-3-948768058
• DOI: 10.36192/978-3-948768058
• About the Book
• About the Editors

Introduction (9–15) Michael C. Gizzi, Stefan Rädiker

1. Using MAXQDA in Ethnographic Research: An Example with Coding, Analyzing, and Writing (17–33) Danielle N. Jacques

2. Using MAXQDA in Qualitative Content Analysis: An Example Comparing Single-Person and Focus Group Interviews (35–53) Natalie Santos, Vera Monteiro, Lourdes Mata

3. Using MAXQDA’s Visual Tools: An Example with Historical Legal Documents (55–70) Andreas W. Müller

4. Using MAXQDA from Literature Review to Analyzing Coded Data: Following a Systematic Process in Student Research (71–88) Michael C. Gizzi, Alena Harm

5. Using MAXQDA for Analyzing Focus Groups: An Example from Healthcare Research (89–106) Matthew H. Loxton

6. Using MAXQDA for Analyzing Documents: An Example of Prioritization Research Design in Urban Development (107–120) Temur Gugushvili, Gvantsa Salukvadze

7. Using MAXQDA for Identifying Frames in Discourse Analysis: Coding and Evaluating Presidential Speeches and Media Samples (121–133) Betsy Leimbigler

8. Using MAXQDA’s Summary Features: Developing Social Types in Migrant Integration Studies (135–147) Aikokul Maksutova

9. Using MAXQDA for Bibliographic Documentary Analysis: Combining Automatic and Manual Procedures Within a Literature Review (149–167) Antoni Casasempere-Satorres, Marisa Vercher-Ferrándiz

10. Using MAXQDA in Teams and Work Groups: An example from Institutional Evaluation and Organizational Data Analysis (169–184) Christian Schmieder, Joel Drevlow, Josset Gauley

This book provides ten case studies with concise real-world examples illustrating how MAXQDA is used in practice. In each research example, the authors present their way of using MAXQDA, addressing a variety of practical questions, such as how the coding system was developed, how coded documents were analyzed, what tools were used, and how those tools informed the results. Embedded in the context of each research example, readers can follow analytical processes step-by-step and gain insights into efficient ways to use MAXQDA.

Readers can benefit from this book in several ways: • Get inspirations and solutions for their own projects • Avoid pitfalls by considering the lessons learned from each author presented at the end of each chapter • Use the examples in teaching

Audience: • All researchers who want to get to learn the potential of qualitative data analysis with MAXQDA • All users of MAXQDA who want to expand their knowledge and skills, no matter if they are novices or experts

Michael C. Gizzi

Dr. Michael C. Gizzi is a professor of criminal justice at Illinois State University, USA. He holds a doctorate in political science, and his research focuses on constitutional criminal procedure and judicial process. He is a professional trainer and consultant for MAXQDA and uses it in research courses, workshops, and webinars.

Stefan Rädiker

Dr. Stefan Rädiker is a consultant and trainer for research methods and evaluation. He holds a doctorate in educational sciences and his research focuses on computer-assisted analysis of qualitative and mixed methods data ( www.methoden-expertise.de ).

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INTERVIEW ANALYSIS WITH MAXQDA

Transcribe your Interviews

Code your Interviews

Create codes first and then assign a code to a text segment via drag and drop . Boost your workflow using the code name suggestions and quickly resize coded segments with the grabbers. Code in-vivo as you are reading your interview transcript, creating codes directly from words or phrases within the interview. For focus group transcripts, use codes and documents created with the automatic speaker recognition to analyze either on a group level or on an individual level.

Deepen your Interview Analysis

Keep track of your ideas, the consideration behind your analyzing steps, and new insights that develop organically through the analysis process using MAXQDA’s Memos functions. Use the  Paraphrasing Tool to summarize specific segments of the text with your own words and condense a large amount of data into an easy-to-read overview with the Paraphrase Matrix. Explore how a word or phrase is used in your interview data in an interactive dashboard of the Word Explorer . Collect relevant insights from your interview data and develop new theories using the new QTT.

Visualize and Publish your Data

Create an overview of both of your data and of your data analysis for yourself and for presentations. Export ready-for-print reports or create powerful visualizations and statistics to illustrate your results and share findings with stakeholders.

LITERATURE ANALYSIS WITH MAXQDA

Build a theoretical framework around your data.

All-in-one Literature Review Software

Use MAXQDA to manage your entire research project.

Easily import data like texts, interviews, focus groups, PDFs, web pages, spreadsheets, articles, e-books, and even tweets. Organize your data into groups, link relevant citations together, and s hare and compare work with your team members. Your project file remains flexible and you can gradually expand and refine your category system to fit your research.

Import & automatic pre-coding

MAXQDA can work with all reference management programs that are able to export their data-bases in RIS-format , containing all collected bibliographic information, such as author, title, links to websites, keywords, abstracts, full texts and other information. During import, the documents are automatically pre-coded to facilitate later search and retrieval.

Idea Storage

When reviewing the literature, good ideas and insightful connections come up often. Record these, such as research questions and goals, in Memos or use them to paraphrase passages into your own words. Especially useful for literature reviews are free Memos you write as you work on the review, from which you can copy and paste passages into the final text.

Search & Retr ieve Functions

With MAXQDA’s Text Search you can search and automatically code interesting keywords, such as important concepts for your literature review. The automatically created document variables can be used with Mixed Methods tools and you can use MAXQDAs powerful Coding Query , which allows you to analyze the combination of codes in different ways.

A look at the Bigger Picture

MAXQDA offers overview tables for almost everything – Memos, coded segments, links, and so on. You can also use summary tables that effectively compare and present condensed summaries of sources. They can easily be integrated into your literature review report .

Quantitative evalu ation of themes

Quantitative aspects can also be relevant in a literature review. For example, sort sources according to document variables and compare values with frequency tables and charts . Don’t miss MAXDictios word frequency functions, which make quantitative analysis of terms and their semantic contexts even easier.

TAKE YOUR QUALITATIVE ANALYSIS TO THE NEXT LEVEL.

Mixed Methods Re search with MAXQDA

Your all-in-one Mixed Methods Software

Use MAXQDA to manage your entire research project . Easily import data from texts, interviews, focus groups, PDFs, web pages, spreadsheets, articles, e-books, and even tweets and YouTube comments.

Enrich your research with quantitative data

MAXQDA is the mixed methods expert! With MAXQDA you can easily combine qualitative and quantitative methods to get an even deeper insight into your data. MAXQDA offers mixed methods tools, quantitative text analysis tools in MAXDictio , the add-on module of MAXQDA Plus, and statistical analysis in the Stats module of MAXQDA Analytics Pro.

Quantitize your qualitative coding information

Import and export quantitative data matrices to and from statistics software packages like SPSS. Turn your codes into variables for a statistical analysis , automatically or manually assign variables to your data , and export any part of your project to a spreadsheet. Analyze your answers to open-ended questions with powerful features and link them with MAXQDA Stats and MAXDictio with one single click.

Create and compare groups

With MAXQDA’s tools you can easily  create and compare the code frequencies of various groups  with each other or  identify and quantify similarity or dissimilarity in code frequency  across your data. Calculate various variables and their percentages for qualitative typologies. Especially useful for mixed methods research are  MAXQDA’s joint displays  that visualize integrated data and/or results.

Visualize your results

With the help of the Statistics module , MAXQDA can create stunning frequency tables and charts which indicate the frequency of subcodes. The colors and captions of your charts are editable, and the result can easily be exported and fits perfectly into your report or presentation.

DEVELOPED BY AND FOR RESEARCHERS.

Content Analysis with MAXQDA

All-in-One Content Analysis Software

Use MAXQDA to manage your entire research project. Easily  import data  from text documents, interview transcripts, focus groups, online surveys, web pages, images, audio and video files, spreadsheets, bibliographic data, YouTube data, and even tweets.  Organize your data  in groups, link relevant quotes to each other, and share and compare work with your team members. Your project file remains  flexible  and you can gradually expand and refine your category system to fit your research.

Paraph rasing

Summarize texts in your own words with MAXQDA’s handy  paraphrase mode  and display them directly adjacent to the text. You can also use your paraphrases for inductively forming new categories from your material.

Search keywords in your content

Search for keywords in your data, memos and coded segments and use MAXQDA to automatically code them. Make use of the  extended search functions  that offers you everything you might expect from professional content analysis software – and with the integration of retrieval functions, lemma lists, Boolean operators and wildcards, probably a little more.

Summarize your content

Aggregate your coded data to the next level of analysis by  summarizing  it on the dimensions of code, document, and coded segments in a document. With our summary grids and summary tables, you can keep crate compilations of summaries for determined topics.

Find connections in your data

The activation system for retrieving data segments is surprisingly simple and easy to use. But there’s more that meets the eye: our  Complex Coding Query  gives you a total of 9 further retrieval functions for finding connections in your data.

MAXDictio for Quantitative Content Analysis

Use the tools offered by MAXDictio, our module for quantitative content analysis, for an even deeper analysis. You can display frequencies of individual words or word combinations in tables or visualize them in the  Interactive Word Tree . Use the  Keyword-in-Context  function to transfer the textual contexts of selected words into a clear table.

Whether for your analysis or publication, MAXQDA’s visual tools are tailor-made for qualitative research. Visualize the progression of an interview with the  Codeline  or use the  Code Cloud  to illustrate and explore your categories. Of course, MAXQDA offers many more powerful visualization tools for every purpose.

DEVELOPED AND FOR RESEARCHERS.

Questionnaire Analysis with MAXQDA

Whether your survey contains  standardized or open-ended questions , with MAXQDA you can easily import and analyze both types. Options for a direct import of your data, analysis tools, tailor made for surveys, and the  MAXQDA Stats  module with a large range of tools for statistical analysis, make your questionnaire analysis surprisingly easy.

Direct Import from Survey Monkey, Excel & SPSS

Connect MAXQDA with SurveyMonkey to  import your online survey directly into your MAXQDA project  and analyze the data with MAXQDA’s tools. You can also import Excel spreadsheets and SPSS data. Of course, MAXQDA works with both response types, i.e. open-ended and standardized responses, and offers you numerous tools for analysis.

Organize your data and codes

Organize your data in groups, link relevant quotes to each other, and share and compare work with your team members. Your project file stays flexible and you can  expand and refine  your category system as you go to suit your research.

Categorize Survey Data

MAXQDA helps you analyzing responses to open questions in surveys efficiently and effectively with its interactive table window for  categorizing  survey data. With MAXQDA you can easily  combine qualitative and quantitative methods  to get an even deeper insight in your data. Search for words or phrases in your survey and auto-code search hits, sentences, or paragraphs with  dictionary categories .

Statistical Analysis with MAXQDA Stats

MAXQDA Analytics Pro  equips you with a large range of tools for  statistical analysis . Seamlessly quantify your qualitative data and enrich your analysis with evidence and plausibility. With the integrated  output viewer , you can transfer every table and every chart into your report with a simple copy & paste.

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Reviews of MAXQDA

Capterra offers objective, independent research and verified user reviews. We may earn a referral fee when you visit a vendor through our links. Learn more

Alongside the analysis tool and functions, MAXQDA's user-interface perfectly satisfies the concept of "user friendly.

In particular, it is a nice convenience to extract twitter data. Except that, the variety of language support and the ability to do these in my own language make this program stand out.

Adding memo while coding is also a good practice. At the same time, it is nice that the program includes data collection tools of the qualitative data analysis method.

The creative coding board is good for intuitive 'brain-map' style code diagramming and linkages as well.

Here, there is a problem with dimensions, especially in studies where document analysis is carried out.

I think the program is confusing, especially during analysis. I also think that including quantitative analysis in the qualitative analysis program is not within the scope of the program.

Apart from all these, there are too many freezing programs during the processing of multidimensional data in the program. Saving is also very difficult.

It is undeniable that MaxQDA has a large amount of features, meeting the demand for qualitative data analysis, especially text coding, etc.

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April 30, 2024 | Sarah Al-Arshani

Students Celebrate as Year of Experience Culminates in Long River Review Launch

Dozens of students, faculty, and supporters gathered to celebrate the 27th edition of UConn’s award-winning journal of literature and art

Sophia Ciraldo '24 (CLAS), left, and Mollie Stoffel '24 (CLAS), right, pose for a photo with some props during the launch party for the Long River Review, UConn's literary and arts magazine, at the Barnes & Noble bookstore in downtown Storrs on April 25, 2024. (Sydney Herdle/UConn Photo)

In December 2023, Schuyler Cummings ’25 (CLAS) saw a flyer for the Long River Review featured in a newsletter from her faculty advisor which sparked her interest. Already a copy editor for Nutmeg Publishing, and interested in a career in publishing, Cummings says she decided to apply for a lead copy editor role at the literary publication on “a whim.”  

She landed the role, and in the few short months since, it has become not only a passion project but a meaningful opportunity to gain the experience she needs for a job in the industry.

Cummings joined her fellow student staff members in celebrating the launch of the 27th annual print edition on Thursday, April 25, at Barnes & Noble in Storrs Center.  

A culmination of a yearlong interdisciplinary effort that includes both student staff positions and a course offered in the spring, the award-winning journal of literature and art pulls literary submissions across multiple genres from all over the world and showcases the top content.   

At the event, contributors read their featured work and staff members shared words of gratitude about their time putting the magazine together.  

“The launch party is one of my favorite times in the year because you get to actually hear contributors go up and read the poems or the stories that you’ve loved and cherished and stared at while editing, and you get to hear them talk about it,” says current Editor-in-Chief Allison LeMaster’24 (CLAS), a double major in English and journalism .   

As Long River Review editors, students work together on panels to review submissions and select work to be featured, edit and refine submissions , and designing publish a physical journal and a website.   

For Cummings, it’s been a rewarding and unique opportunity to learn about the publishing industry, a career path she plans to pursue after she graduates.   

“Things don’t always have to do with the writing, the photography, the art, and everything–so much more of it is management, organization, communication, and those kinds of skills,” she says. “It was kind of intimidating at first, but I’ve come to love it because those are the things that help put together a product, like a publication.”  

She added that it’s a wonderful feeling to see the final product of the group’s hard work.   

“I love the satisfaction when I have it in my hands,” says Cummings “ Like today, when we got them, I wanted to cry. It was like ‘Oh my God, we all worked on this, and it all came together and now we have it in our hands.’ It’s such a beautiful moment.”   

The publication has also been a learning opportunity for students who plan to go into other fields.   

“I want to be a journalist, but this has prepared me a lot for editing — I’m a pretty good editor,” LeMaster says.   

LeMaster, who is also an intern at the Connecticut Mirror , covering the legislative session, said working on the literary publication with different narrative and literary styles helped her develop storytelling skills that will help her as she pursues a career in journalism. The experience will help her tell important news stories in a way that helps capture an audience’s attention and connect to them.   

But it’s not just the practical skills LeMaster and Cummings enjoyed about their time with the literary publication. LeMaster, a commuter student who recently transferred from the Hartford campus, says working on the publication allowed her to get acquainted with the campus.  

“What was cool about being the editor-in-chief is that you’re allowed to have your passion project and also help people get involved with it and see how cool it can be working with authors, working with staff, working with people who care about literature,” LeMaster says. Gaining that experience is just so awesome.”  

In an age of digital publication, the students agree that creating something tangible is a special kind of satisfaction.    

“There’s no feeling like getting that magazine in your hand and being like, ‘I helped create this,’” LeMaster says. “It’s such a cool feeling.”  

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Case report article, untypical bilateral breast cancer with peritoneal fibrosis on 18 f-fdg pet/ct: case report and literature review.

• Department of Nuclear Medicine, Peking University First Hospital, Beijing, China

Background: Retroperitoneal fibrosis, a condition of uncertain origin, is rarely linked to 8% of malignant cases, including breast, lung, gastrointestinal, genitourinary, thyroid, and carcinoid. The mechanism leading to peritoneal fibrosis induced by tumors is not well understood, possibly encompassing direct infiltration of neoplastic cells or the initiation of inflammatory responses prompted by cytokines released by tumor cells. We report a case of breast cancer with renal metastasis and retroperitoneal fibrosis detected using 18 F-FDG PET/CT, providing help for clinical diagnosis and treatment.

Case report: A 49-year-old woman was referred to the hospital with elevated creatinine and oliguria for over a month. Abdominal computer tomography (CT) and magnetic resonance imaging (MRI) showed a retroperitoneal fibrosis-induced acute kidney injury (AKI) was suspected. However, a percutaneous biopsy of the kidney lesion confirmed metastasis from breast cancer. The physical examination revealed inverted nipples and an orange peel appearance on the skin of both breasts. Ultrasonography revealed bilateral hyperplasia (BIRADS 4a) of the mammary glands and bilateral neck and axillary lymphadenopathy. Subsequently, 18 F-deoxyglucose positron emission tomography/computer tomography ( 18 F-FDG PET/CT) detected abnormally high uptake (SUVmax) in the bilateral mammary glands and axillary lymph nodes, suggesting bilateral breast cancer. Furthermore, abnormal 18 F-FDG uptake was detected in the kidney, suggesting renal metastasis. In addition, abnormal 18 F-FDG uptake was observed in the vertebrae, accompanied by an elevation in inhomogeneous bone mineral density, raising suspicion of bone metastases. However, the possibility of myelodysplasia cannot be dismissed, and further investigations will be conducted during close follow-ups. There was significant 18 F-FDG uptake in the retroperitoneal position indicating a potential association between retroperitoneal fibrosis and breast cancer. The final pathological diagnosis of the breast tissue confirmed bilateral invasive ductal carcinoma. The patient had been treated with 11 cycles of albumin-bound (nab)-paclitaxel (0.3 mg) and had no significant adverse reaction.

Conclusion: In this case, neither the bilateral breast cancer nor the kidney metastatic lesion showed typical nodules or masses, so breast ultrasound, abdominal CT, and MRI did not suggest malignant lesions. PET/CT played an important role in detecting occult metastases and primary lesions, thereby contributing to more accurate staging, monitoring treatment responses, and prediction of prognosis in breast cancer.

Introduction

Retroperitoneal fibrosis is an uncommon disorder of unclear etiology, with 8% of cases associated with malignancies, among which breast cancer is a relatively common cause. The pathogenesis of peritoneal fibrosis caused by tumors remains unclear, potentially involving direct neoplastic cell infiltration or inflammatory reactions triggered by cytokines secreted by tumor cells. Retroperitoneal fibrosis is characterized by increased fibrotic deposition in the retroperitoneum, frequently leading to ureteral obstruction [1]. Herein, we report a case of breast cancer with retroperitoneal fibrosis and renal insufficiency as the first symptoms. Conventional imaging did not reveal any evidence of breast cancer or distant metastases. However, 18 F-deoxyglucose positron emission tomography/computer tomography ( 18 F-FDG PET/CT) images demonstrated increased 18 F-FDG uptake in the breast and kidney, which was suspicious of bilateral breast cancer (BBC) with diffuse renal metastatic lesions. PET/CT plays a crucial role in detecting primary lesions and metastatic lesions, monitoring relapses, managing treatment, and improving patient prognosis. In addition, we summarized the basic information and clinical details of some cases with tumor-associated retroperitoneal fibrosis in Table 1 .

Table 1 . Literature review of tumor-related retroperitoneal fibrosis.

Case presentation

A 49-year-old woman was referred to the hospital with elevated creatinine and oliguria for over a month. The patient experienced abdominal pain and lower back pain with noticeable pitting edema in both lower extremities, along with decreased urine, without an apparent trigger over a month ago. The patient has no family history of the disease. Laboratory results revealed a serum creatinine level of 1,054 μmol/L and a hemoglobin level of 76 g/L, suggestive of acute kidney injury (AKI). Ultrasonography demonstrated bilateral hydronephrosis with widening of the proximal ureters and moderately low echogenicity around the abdominal aorta, suggesting that retroperitoneal fibrosis might be present. Abdominal CT and magnetic resonance imaging (MRI) ( Figure 1 ) revealed bilateral kidney swelling, dilation of the bilateral kidneys, renal calyces, and upper ureters, accompanied by multiple retroperitoneal and bilateral perirenal exudations, suggestive of retroperitoneal fibrosis. No focal lesions were found in either kidney.

Figure 1 . Computed tomography images and magnetic resonance images. The coronal image shows bilateral hydronephrosis and enlarged kidneys (A,E) . The axial images show diffuse lesions in the renal parenchyma, with no obvious masses detected (B,C,F,G) . The axial image shows retroperitoneal multiple exudation (D,H) .

AKI is likely attributed to post-renal obstruction secondary to retroperitoneal fibrosis. To further define the histological features of renal lesions and exclude the probability of primary kidney disease, a biopsy was performed of the lower pole of the right kidney. The biopsy of the lower pole of the right kidney demonstrated acute renal tubular necrosis and heterotypic cells in the renal tissue. The tumor cells have moderate dysplasia, form adenoid arrangements, and show an invasive growth pattern. Immunohistochemical results showed that P120-, HER2-, PR 90%, ER 90%, E-Cadherin-, GATA (3+), CKpan (3+), and Vimentin-. Combined with the results of immunohistochemistry, it was consistent with breast cancer metastasis. Therefore, the mammary gland of the patient was further examined. A physical examination of the patient revealed an orange peel change on the skin of both breasts and a bilateral inverted nipple. Breast ultrasound showed bilateral hyperplasia (BIRADS 4a) of the mammary glands with a reduced echo. Contrast-enhanced breast MRI was precluded by the patient’s compromised renal function and aimed at averting potential adverse reactions to the gadolinium contrast agent, including those associated with nephrogenic systemic fibrosis. Consequently, whole-body 18 F-deoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) imaging was conducted to pinpoint the most reliable clinical biopsy site. Moreover, 18 F-FDG PET/CT proves valuable in distinguishing between benign and malignant lesions, as well as in determining breast cancer staging, grading, and locating primary and metastatic tumor foci. The anteroposterior 3-dimensional maximum intensity projection (MIP) image demonstrated patchy metabolic elevation on both sides of the mammary glands, along with diffusely uneven metabolic foci in both kidneys ( Figure 2A ). Bilaterally dense mammary glands with a diffuse, mild 18 F-FDG uptake were seen, with a maximum standardized uptake value (SUVmax) of 4.7. Bilateral local thickening of the breast skin with an SUVmax of 2.3 was found, which was higher on the right side. BBC was considered ( Figure 2B ). Enlargement of both kidneys with various degrees of 18 F-FDG uptake is found, with an SUVmax at approximately 8.2 ( Figure 2C ). A patchy soft tissue density lesion is visible around the renal fascia and adjacent to the abdominal aorta, with mild 18 F-FDG uptake, and the SUVmax is approximately 3.3 ( Figure 2D ). Furthermore, diffuse inhomogeneous 18 F-FDG uptake was observed in bone lesions, characterized by an SUVmax of approximately 2.9. Additionally, inhomogeneous hyperintensities in bone mineral density were identified in the cones ( Figures 2E , F ), prompting suspicion of potential bone metastasis. Nevertheless, we cannot definitively exclude the possibility of myelodysplasia, and we will vigilantly monitor this concern during subsequent follow-up assessments. The lesions in the kidneys, bones, and retroperitoneal area were associated with the metastasis of breast cancer.

Figure 2 . 18 F-FDG PET/CT images. The MIP demonstrated patchy metabolic elevation on both sides of the mammary glands, as well as increased volume in both kidneys, accompanied by a diffusely uneven elevated metabolic lesion (A) . The bilateral dense breast tissue shows diffuse mild 18 F-FDG uptake, with an SUVmax of approximately 4.7. There is a local thickening of the skin in both breasts, with an SUVmax of 2.3, more prominent on the right side (B) . The transverse images show inhomogeneous 18 F-FDG uptake in the bilaterally enlarged kidneys, with an SUVmax of approximately 8.2 (C) . The transverse images show right perirenal fascia thickening with a significantly higher uptake of an SUVmax of approximately 3.3 (D) . The sagittal images show the heterogeneous bone density elevation with radioactive distribution, SUVmax of approximately 2.9 (E,F) .

Subsequently, the bilateral mammary glands were examined histologically and immunohistochemically. Pathological examination ( Figure 3 ) revealed grade II invasive lobular carcinoma with ER 90%, PgR 50%, P40-, E-cadherin-, P120++, GATA (3+), Ki67 15%, HER2-, and PD-L1- in both breasts. The clinician diagnosed stage IV invasive breast cancer. The presence of the BRCA1 gene mutation was identified in the germline of the BBC. Renal metastases due to breast cancer were diagnosed on the basis of immunohistochemistry. The patient was ultimately identified as having BBC accompanied by metastases to the bones, kidneys, and retroperitoneal location. Additionally, AKI was observed due to retroperitoneal fibrosis. A week later, after the contraindication of chemotherapy was excluded, the patient was treated with albumin-bound (nab)-paclitaxel (0.3 mg). At present, the chemotherapy has been 11 cycles, and the patient has had no obvious adverse reactions during the course of the chemotherapy. We are still following up.

Figure 3 . Histologic and immunohistochemical features of breast cancer. (A) Hematoxylin–eosin (HE) staining (×400). In immunohistochemical staining, the tumor cells were positive for ER (B) and GATA3 (C) . Moreover, 15% of them were positive for Ki-67 (D) [magnification (B–D)  × 200].

Breast cancer represents 24.5% of all cancer cases in women. In 2022, breast cancer will have the highest incidence and mortality in most countries ( 10 ). BBC is uncommon and accounts for 1.4–12% of all breast cancers ( 11 ). Based on the time interval between the diagnosis of bilateral malignant tumors, BBC can manifest synchronously or asynchronously ( 12 ). The primary risk factors associated with BRCA1-related breast cancer include a family history of breast cancer, younger age (under 40 years old), multifocal cancer, a history of lobular carcinoma, inherited genetic mutations such as those in the BRCA1 and BRCA2 genes, and exposure to radiation ( 13 – 16 ). For BRCA1 mutation carriers, the risk of breast cancer increases substantially between the ages of 30 and 50, while for women with a BRCA2 mutation, the risks are highest between ages 40 and 60 ( 16 ). BRCA-related breast cancer is characterized by a more aggressive phenotype than sporadic breast cancer, with BRCA1-related breast cancer being more frequently high grade and triple negative, and BRCA2-related breast cancer being on average a higher histological grade than sporadic cases ( 17 ). The systematic review and meta-analysis conducted by Baretta et al. ( 17 ) showed that mutation carriers have worse overall survival than BRCA-negative/sporadic cases (hazard ratio, HR 1.30, 95% CI: 1.11–1.52) and worse breast cancer-specific survival than sporadic/BRCA-negative cases among patients with stage I–III breast cancer (HR 1.45, 95% CI: 1.01–2.07). In this particular case, the patient had no other risk factors, and genetic testing revealed a mutation in the BRCA1 gene. BRCA1 mutation carriers with breast cancer may benefit from treatment with cisplatinum ( 18 ) or olaparib ( 19 ) compared to those without a mutation. These data collectively indicate the important role of BRCA mutation status with respect to treatment decisions that may impact outcomes. Genetic mutation detection plays an essential role in the clinical management of breast cancer, as it enables physicians to more accurately identify the molecular characteristics of the disease, formulate personalized treatment plans, and predict the efficacy of therapy and patient prognosis ( 20 , 21 ). Family members can understand their genetic risks through genetic counseling and undergo appropriate screening and management based on the recommendations of healthcare professionals. Moreover, studies have found that the infiltrating ductal type is the most common histology in BBC ( 22 – 24 ). Some studies indicate that the survival rates of patients with unilateral and BBC are comparable ( 25 , 26 ). While routine radiological assessments, including mammography and ultrasonography, are conducted for women presenting with suspicious breast symptoms, these methods have certain limitations in diagnosing BBC ( 27 ). In addition, contrast-enhanced MRI is forbidden for patients with renal failure. In such a situation, PET/CT, in particular, is instrumental in detecting axillary extra-nodal disease and occult metastasis in patients with locally advanced breast cancer. Its role in assessing responses to neoadjuvant or adjuvant chemotherapy is continually evolving. In the detection of suspected recurrences, it proves more effective than traditional imaging modalities ( 28 ).

Retroperitoneal fibrosis is a rare condition of diverse etiology, associated with radiotherapy, aortic aneurysms, infections, and malignancy ( 29 ). Eight percent of cases are associated with malignancies ( 30 ). Common tumors leading to retroperitoneal fibrosis include breast, lung, gastrointestinal, genitourinary, thyroid, lymphoma, sarcoma, and carcinoid ( 31 ). The pathogenic mechanism of peritoneal fibrosis induced by tumors is unknown. It may result from a desmoplastic reaction of the retroperitoneum to malignant cells, an inflammatory reaction, or cytokines secreted by the tumor ( 30 ). We have compiled a subset of cases presenting with tumor-associated retroperitoneal fibrosis, and the basic information and clinical details are summarized in Table 1 . In the literature, several cases of malignant retroperitoneal fibrosis associated with breast cancer have been documented, with the majority of reported cases featuring a history of breast cancer in the patients ( 1 , 2 , 4 ). Obstructive uropathy is typical of retroperitoneal fibrosis, and bilateral flank pain is the most frequent clinical presentation ( 1 , 2 , 4 ). Our patient presented classic symptoms of bilateral flank pain and hydronephrosis. CT reveals a diffusely infiltrative soft tissue mass enveloping retroperitoneal structures, which is a typical radiological manifestation of retroperitoneal fibrosis ( 32 ). 18 F-FDG PET/CT can be a valuable tool in evaluating the disease activity and lesion range of retroperitoneal fibrosis and monitoring the treatment of retroperitoneal fibrosis. Furthermore, as illustrated by our cases, in some patients with malignant tumors present with peritoneal fibrosis as the initial manifestation, PET/CT can assist in identifying the primary lesion and accurately staging and grading the condition.

Breast cancer metastasis to the kidneys is rarely seen ( 33 ). In one study, the incidence of metastasis of breast cancer to the kidneys was 12% ( 34 ). The mechanism of breast cancer metastasis to the kidneys can be attributed to the physiological characteristics of the kidneys. Specifically, the substantial proportion of cardiac output dedicated to renal blood flow makes it likely for circulating tumor cells to enter the renal capillaries ( 35 ). Common symptoms of renal metastasis are flank pain and hematuria ( 36 , 37 ). The most common form of metastatic renal carcinomas is multiple bilaterally circumscribed, rounded masses ( 35 ). In patients with known primary tumors, diffuse enlargement of the kidney without a clear mass may suggest renal metastatic disease ( 38 ). In this case, the imaging findings were bilaterally enlarged kidneys without focal lesions. However, PET findings indicated various degrees of 18 F-FDG uptake in the bilateral kidneys with suspicions of breast cancer metastasis to the kidney, which was agreeable with the pathological diagnosis. In PET/CT imaging, renal metastasis may manifest as small, multiple, bilateral, circular lesions with high 18 F-FDG uptake and a diffusely invasive, large, single mass with high 18 F-FDG uptake. By the time the primary lesion was detected by PET/CT at some sites, especially tumors prone to renal metastasis (lymphomas and carcinomas of the lung, breast, stomach, pancreas, and colon), there was a high probability of renal involvement. A biopsy for histological analysis was performed if necessary. Conducting a thorough examination of the renal cortex through 18 F-FDG PET, coupled with a review of anatomical images such as CT and MRI results, plays a pivotal role in the identification of renal tumors.

In conclusion, we present a case study detailing the 18 F-FDG PET/CT imaging manifestations in a BBC patient with retroperitoneal fibrosis and renal metastasis. Compared with conventional imaging, PET can find systemic metastases based on the detection of primary foci, which can be used for disease staging and the evaluation of treatment efficacy.

Data availability statement

The original contributions presented in the study are included in the article/ Supplementary material , further inquiries can be directed to the corresponding author.

Ethics statement

Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. Written informed consent was obtained from the participant/patient(s) for the publication of this case report.

Author contributions

LS: Writing – original draft, Writing – review & editing. YQ: Conceptualization, Writing – original draft. WH: Data curation, Writing – original draft. XS: Investigation, Writing – original draft. QY: Methodology, Writing – original draft. YP: Project administration, Writing – review & editing. LK: Conceptualization, Funding acquisition, Investigation, Project administration, Supervision, Writing – review & editing.

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Natural Science Foundation of China (82171970), the Beijing Science Foundation for Distinguished Young Scholars (JQ21025), the Beijing Municipal Science and Technology Commission (Z221100007422027), and the National High-Level Hospital Clinical Research Funding (Interdisciplinary Research Project of Peking University First Hospital, 2023IR17).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmed.2024.1353822/full#supplementary-material

1. Kava, BR, Russo, P, and Conlon, KC. Laparoscopic diagnosis of malignant retroperitoneal fibrosis. J Endourol . (1996) 10:535–8. doi: 10.1089/end.1996.10.535

PubMed Abstract | Crossref Full Text | Google Scholar

2. MacNeil, JAB, Selegean, S, and Williams, AS. Metastatic lobular carcinoma presenting as retroperitoneal fibrosis: a rare presentation detected using post-mortem cytology. Pathology . (2020) 52:387–90. doi: 10.1016/j.pathol.2019.12.004

3. Kane, AJ, Wang, ZJ, Qayyum, A, Yeh, BM, Webb, EM, and Coakley, FV. Frequency and etiology of unexplained bilateral Hydronephrosis in patients with breast Cancer: results of a longitudinal Ct study. Clin Imaging . (2012) 36:263–6. doi: 10.1016/j.clinimag.2011.10.001

4. Gogas, J, Markopoulos, C, Kouskos, E, Gogas, H, and Kiriakou, V. Metastatic retroperitoneal and mediastinal fibrosis as first sign of recurrence of breast cancer. Eur J Surg . (2001) 167:715–8. doi: 10.1080/11024150152619408

5. Lan, X, Hu, R, Song, T, Gan, L, and Sun, W. A case of follicular lymphoma mimicking idiopathic retroperitoneal fibrosis. Cureus . (2022) 14:e32031. doi: 10.7759/cureus.32031

6. Alvarez Argote, J, Bauer, FA, Posteraro, AF 3rd, and Dasanu, CA. Retroperitoneal fibrosis due to B-cell non-Hodgkin lymphoma: responding to rituximab! J Oncol Pharm Pract . (2016) 22:179–85. doi: 10.1177/1078155214543279

Crossref Full Text | Google Scholar

7. Mori, T, Nabeshima, S, Fujino, S, Imoto, A, Shima, H, Yamamoto, K, et al. A case of acute kidney injury due to secondary retroperitoneal fibrosis caused by direct invasion of esophageal squamous cell carcinoma. CEN Case Rep . (2015) 4:185–9. doi: 10.1007/s13730-014-0164-8

8. Benesch, MGK, and Mathieson, A. Gastric signet-ring-cell adenocarcinoma with delayed retroperitoneal metastasis and fibrosis. Case Rep Oncol . (2022) 15:114–9. doi: 10.1159/000521888

9. Nishiyama, A, Yoshioka, H, Ikeo, S, Morita, M, Sone, N, Ikeda, S, et al. Retroperitoneal metastasis from lung adenocarcinoma mimics retroperitoneal fibrosis. J Thorac Oncol . (2016) 11:266–7. doi: 10.1016/j.jtho.2015.10.023

10. Sung, H, Ferlay, J, Siegel, RL, Laversanne, M, Soerjomataram, I, Jemal, A, et al. Global Cancer statistics 2020: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin . (2021) 71:209–49. doi: 10.3322/caac.21660

11. Hartman, M, Czene, K, Reilly, M, Adolfsson, J, Bergh, J, Adami, HO, et al. Incidence and prognosis of synchronous and Metachronous bilateral breast Cancer. J Clin Oncol . (2007) 25:4210–6. doi: 10.1200/jco.2006.10.5056

12. Mishra, S, Sable, M, Das Majumdar, SK, Mishra, P, Muduly, DK, and Parida, DK. Bilateral breast Cancer-its Clinicopathological profile and management: an experience from a tertiary care center from eastern India. J Cancer Res Ther . (2022) 18:S341–6. doi: 10.4103/jcrt.JCRT_1729_20

13. Mallory, MA, Whiting, K, Park, A, Gönen, M, Gilbert, E, King, TA, et al. Synchronous and Metachronous bilateral breast Cancer among women with a history of lobular carcinoma in situ. Breast Cancer Res Treat . (2022) 194:137–48. doi: 10.1007/s10549-022-06532-4

14. El Hanchi, Z, Berrada, R, Fadli, A, Ferhati, D, Brahmi, R, Baydada, A, et al. Bilateral breast Cancer. Incidence and risk factors. Gynecol Obstet Fertil . (2004) 32:128–34. doi: 10.1016/j.gyobfe.2003.01.002

15. Wang, YA, Jian, JW, Hung, CF, Peng, HP, Yang, CF, Cheng, HS, et al. Germline breast Cancer susceptibility gene mutations and breast Cancer outcomes. BMC Cancer . (2018) 18:315. doi: 10.1186/s12885-018-4229-5

16. Kotsopoulos, J . Brca mutations and breast. Cancer Prev Cancers. (2018) 10:524. doi: 10.3390/cancers10120524

17. Baretta, Z, Mocellin, S, Goldin, E, Olopade, OI, and Huo, D. Effect of Brca germline mutations on breast Cancer prognosis: a systematic review and Meta-analysis. Medicine . (2016) 95:e4975. doi: 10.1097/md.0000000000004975

18. Byrski, T, Gronwald, J, Huzarski, T, Grzybowska, E, Budryk, M, Stawicka, M, et al. Pathologic complete response rates in young women with Brca1-positive breast cancers after neoadjuvant chemotherapy. J Clin Oncol . (2010) 28:375–9. doi: 10.1200/jco.2008.20.7019

19. Lee, JM, Ledermann, JA, and Kohn, EC. Parp inhibitors for Brca1/2 mutation-associated and Brca-like malignancies. Ann Oncol . (2014) 25:32–40. doi: 10.1093/annonc/mdt384

20. Kuchenbaecker, KB, Hopper, JL, Barnes, DR, Phillips, KA, Mooij, TM, Roos-Blom, MJ, et al. Risks of breast, ovarian, and contralateral breast Cancer for Brca1 and Brca2 mutation carriers. JAMA . (2017) 317:2402–16. doi: 10.1001/jama.2017.7112

21. Desai, NV, and Tung, NM. Medical Management of Newly Diagnosed Breast Cancer in a Brca1/2 mutation carrier. Breast J . (2020) 26:1506–12. doi: 10.1111/tbj.13972

22. Li, B, Xu, W, Cao, J, Guo, D, Tao, Z, Jin, J, et al. A study of clinical and molecular characteristics in bilateral primary breast Cancer. Cancer Med . (2023) 12:15881–92. doi: 10.1002/cam4.6226

23. Vuoto, HD, García, AM, Candás, GB, Zimmermann, AG, Uriburu, JL, Isetta, JA, et al. Bilateral breast carcinoma: clinical characteristics and its impact on survival. Breast J . (2010) 16:625–32. doi: 10.1111/j.1524-4741.2010.00976.x

24. Li, CI, Malone, KE, Porter, PL, and Daling, JR. Epidemiologic and molecular risk factors for contralateral breast Cancer among young women. Br J Cancer . (2003) 89:513–8. doi: 10.1038/sj.bjc.6601042

25. Nichol, AM, Yerushalmi, R, Tyldesley, S, Lesperance, M, Bajdik, CD, Speers, C, et al. A case-match study comparing unilateral with synchronous bilateral breast Cancer outcomes. J Clin Oncol . (2011) 29:4763–8. doi: 10.1200/jco.2011.35.0165

26. Irvine, T, Allen, DS, Gillett, C, Hamed, H, and Fentiman, IS. Prognosis of synchronous bilateral breast Cancer. Br J Surg . (2009) 96:376–80. doi: 10.1002/bjs.6553

27. Johnson, L, Pinder, S, and Douek, M. Multiple foci of invasive breast Cancer: can breast Mri influence surgical management? Breast Cancer Res Treat . (2011) 128:1–5. doi: 10.1007/s10549-011-1491-5

28. Hegarty, C, and Collins, CD. PET/CT and breast cancer. Cancer Imaging . (2010) 10:S59–62. doi: 10.1102/1470-7330.2010.9031

29. Carloss, H, and Saab, G. Breast Cancer and retroperitoneal metastasis. South Med J . (1980) 73:1570–1. doi: 10.1097/00007611-198012000-00009

30. Vega, J, Ceriani, A, and Jensen, D. Retroperitoneal fibrosis associated with malignancies: report of eight cases. Rev Med Chile . (2014) 142:791–8. doi: 10.4067/s0034-98872014000600015

31. Monev, S . Idiopathic retroperitoneal fibrosis: prompt diagnosis preserves organ function. Cleve Clin J Med . (2002) 69:160–6. doi: 10.3949/ccjm.69.2.160

32. Kim, J, Hwang, JH, Nam, BD, Park, YW, and Jeen, YM. Mediastinal and retroperitoneal fibrosis as a manifestation of breast Cancer metastasis: a case report and literature review. Medicine (Baltimore) . (2018) 97:e11842. doi: 10.1097/md.0000000000011842

33. Huo, Z, Gao, Y, Yu, Z, Zuo, W, and Zhang, Y. Metastasis of breast cancer to renal cancer: report of a rare case. Int J Clin Exp Pathol . (2015) 8:15417–21.

PubMed Abstract | Google Scholar

34. Abrams, HL, Spiro, R, and Goldstein, N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer . (1950) 3:74–85. doi: 10.1002/1097-0142(1950)3:1<74::aid-cncr2820030111>3.0.co;2-7

35. Ahmed, Y, Aynaou, M, El Houmaidi, A, Mhanna, T, Tombet, C, and Barki, A. Breast Cancer metastatic to the kidney: case report. Urol Case Rep . (2020) 33:101302. doi: 10.1016/j.eucr.2020.101302

36. Cazacu, SM, LD, SĂ, Mitroi, G, Neagoe, DC, Streba, C, and Albulescu, DM. Metastases to the kidney: a case report and review of the literature. Curr Health Sci J . (2020) 46:80–9. doi: 10.12865/chsj.46.01.11

37. Zhou, C, Urbauer, DL, Fellman, BM, Tamboli, P, Zhang, M, Matin, SF, et al. Metastases to the kidney: a comprehensive analysis of 151 patients from a tertiary referral Centre. BJU Int . (2016) 117:775–82. doi: 10.1111/bju.13194

38. Srisung, W, Mankongpaisarnrung, C, Warraich, I, Sotello, D, Yarbrough, S, and Laski, M. Carcinoma of the lungs causing enlarged kidneys. Proc (Baylor Univ Med Cent) . (2015) 28:221–3. doi: 10.1080/08998280.2015.11929235

Keywords: bilateral breast cancer , peritoneal fibrosis , renal metastasis , 18 F-FDG PET/CT , case report

Citation: Song L, Qiu Y, Huang W, Sun X, Yang Q, Peng Y and Kang L (2024) Untypical bilateral breast cancer with peritoneal fibrosis on 18 F-FDG PET/CT: case report and literature review. Front. Med . 11:1353822. doi: 10.3389/fmed.2024.1353822

Received: 11 December 2023; Accepted: 08 April 2024; Published: 29 April 2024.

Reviewed by:

Copyright © 2024 Song, Qiu, Huang, Sun, Yang, Peng and Kang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Lei Kang, [email protected]

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Case Reports in PET Imaging 2023

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• Best practices for the dissemination and implementation of neuromuscular training injury prevention warm-ups in youth team sport: a systematic review
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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.

• View inline

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.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

• Cumming SP ,
• Australian Sports Commission
• Meeuwisse DW ,
• Eliason PH , et al
• Child and Adolescent Health Measurement Initiative
• Emmonds S ,
• Weaving D ,
• Lara-Bercial S , et al
• Merkel DL ,
• Raysmith BP ,
• Charlton PC
• Brunner R ,
• Friesenbichler B ,
• Casartelli NC , et al
• Whittaker JL , et al
• Meeuwisse WH
• Gianotti S ,
• Jacquet C ,
• Verhagen E , et al
• Marshall DA ,
• Lopatina E ,
• Lacny S , et al
• Owoeye OBA ,
• Akinbo SRA ,
• Tella BA , et al
• Palacios-Derflingher LM ,
• Pasanen K ,
• Parkkari J ,
• Pasanen M , et al
• Soligard T ,
• Myklebust G ,
• Steffen K , et al
• Thorborg K ,
• Krommes KK ,
• Esteve E , et al
• Webster KE ,
• Räisänen AM , et al
• Räisänen AM ,
• van den Berg C ,
• Owoeye OBA , et al
• Pfeifer K , et al
• Richmond SA ,
• Doyle-Baker PK , et al
• Barengo N ,
• Meneses-Echávez J ,
• Ramírez-Vélez R , et al
• Bizzini M ,
• Sadigursky D ,
• De Lira DNL , et al
• Åkerlund I ,
• Sonesson S , et al
• Hislop MD ,
• Stokes KA ,
• Williams S , et al
• Hopper AJ ,
• Joyce C , et al
• Bergeron MF ,
• Mountjoy M ,
• Armstrong N , et al
• De Ste Croix M ,
• Sanchez SH , et al
• Creech MJ ,
• Peterson DC , et al
• Rauvola RS ,
• Brownson RC
• Owoeye OB ,
• Olawale OA , et al
• Niederer D ,
• Vogt L , et al
• Ardern CL ,
• Büttner F ,
• Andrade R , et al
• Guyatt GH ,
• Vist GE , et al
• Kunz R , et al
• Siemieniuk R ,
• Maddox CD ,
• Subialka JA ,
• Young JL , et al
• Wieland LS ,
• Berman BM ,
• Altman DG , et al
• Landes SJ ,
• McBain SA ,
• Schwartz S ,
• Duncan DT , et al
• Ranganathan P
• Proctor E ,
• Silmere H ,
• Raghavan R , et al
• Schwarzer R
• Hägglund M ,
• Atroshi I ,
• Wagner P , et al
• Steffen K ,
• Romiti M , et al
• Sugimoto D ,
• Barber Foss KD , et al
• Schneider B , et al
• Meeuwisse WH ,
• Al Attar WSA ,
• Alzahrani H , et al
• Alizadeh MH ,
• Shahrbanian S , et al
• Waldén M , et al
• Akasaka K ,
• Otsudo T , et al
• Leppänen M ,
• Vasankari T , et al
• LaBella CR ,
• Huxford MR ,
• Grissom J , et al
• Loppini M ,
• Berton A , et al
• Parsons JL ,
• Carswell J ,
• Nwoba IM , et al
• Rössler R ,
• Bizzini M , et al
• Slauterbeck JR ,
• Choquette R ,
• Tourville TW , et al
• Olsen OE , et al
• Mattacola CG ,
• Bush HM , et al
• Hancock MV ,
• Stokes KA , et al
• RÄisÄnen AM , et al
• Barboza SD ,
• Emery C , et al
• Hellquist E ,
• Ahlqvist K , et al
• Tomsovsky L ,
• Whatman C , et al
• Verhagen E ,
• Gouttebarge V , et al
• Celebrini RG ,
• Miller WC , et al
• Franchina M ,
• Tercier S , et al
• Register-Mihalik J ,
• Choquette R , et al
• Lindblom H ,
• Carlfjord S ,
• Ljunggren G ,
• Perera NKP ,
• Merrett CK ,
• Linnéll J , et al
• Myklebust G , et al
• O’Brien J ,
• Santner E ,
• Befus K , et al
• Räisänen A ,
• Black AM , et al
• Sonesson S ,
• Lindblom H , et al
• Nilstad A ,
• Thein-Nissenbaum J ,
• Ageberg E ,
• Lucander K , et al
• Brodin EM ,
• Watkins R ,
• Cornelissen MH ,
• Baan A , et al
• Donaldson A ,
• Callaghan A ,
• Taylor JR ,
• Novak MA , et al
• MacFarlane AJ ,
• Weiss-Laxer NS , et al
• McGuine TA ,
• Pennuto A , et al
• Munoz-Plaza C ,
• Davis A , et al
• Norcross MF ,
• Johnson ST ,
• Bovbjerg VE , et al
• Jimenez P ,
• Oliver JL , et al
• Denegar CR , et al
• Lambert M , et al
• Withall AL , et al
• Minnig MC ,
• Hawkinson L ,
• Root HJ , et al
• Macpherson A , et al
• Fenelon D , et al
• Bruinsma A , et al
• Verhagen EALM , et al
• Brown JC , et al
• Bogardus RL ,
• Martin RJ ,
• Richman AR , et al

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.

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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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By A.O. Scott

One of the most talked-about novels of the year so far is “ James ,” by Percival Everett. Last year, everyone seemed to be buzzing about Barbara Kingsolver’s “ Demon Copperhead ,” which won a Pulitzer Prize for fiction . These are very different books with one big thing in common: Each reimagines a beloved 19th-century masterwork, a coming-of-age story that had been a staple of youthful reading for generations.

“Demon Copperhead” takes “David Copperfield,” Charles Dickens’s 1850 chronicle of a young boy’s adventures amid the cruelty and poverty of Victorian England, and transplants it to the rocky soil of modern Appalachia, where poverty and cruelty continue to flourish, along with opioids, environmental degradation and corruption. “James” retells Mark Twain’s “Adventures of Huckleberry Finn,” first published in 1884, from the point of view of Huck’s enslaved companion, Jim — now James.

The rewriting of old books is hardly a new practice, though it’s one that critics often like to complain about. Doesn’t anyone have an original idea ? Can’t we just leave the classics alone?

Of course not. Without imitation, our literature would be threadbare. The modern canon is unimaginable without such acts of appropriation as James Joyce’s “Ulysses,” which deposited the “Odyssey” in 1904 Dublin, and Jean Rhys’s “Wide Sargasso Sea,” an audacious postcolonial prequel to “Jane Eyre.” More recently, Zadie Smith refashioned E.M. Forster’s “Howards End” into “ On Beauty ” and tackled Dickens in “ The Fraud, ” while Kamel Daoud answered Albert Camus’s “The Stranger” with “ The Meursault Investigation .”

Shakespeare ransacked Holinshed’s “Chronicles” for his histories and whatever Latin and Italian plays he could grab hold of for his comedies and tragedies. A great many of those would be ripped off, too — reinvented, transposed, updated — by ambitious artists of later generations. Tom Stoppard and John Updike twisted “Hamlet” into “Rosencrantz and Guildenstern Are Dead” and “Gertrude and Claudius.” “Romeo and Juliet” blossomed into “West Side Story.” The best modern versions of “Macbeth” and “King Lear” are samurai movies directed by Akira Kurosawa .

As for Dickens and Twain, it’s hard to think of two more energetic self-imitators. Their collected writings are thick with sequels, reboots and spinoffs. Literary brands in their own right, they were among the most successful IP-driven franchise entertainers of their respective generations, belonging as much to popular culture as to the world of letters.

“David Copperfield,” drawing on incidents in Dickens’s early life and coming in the wake of blockbusters like “The Pickwick Papers” and “Oliver Twist,” functions as an autobiographical superhero origin story. David, emerging from a childhood that is the definition of “Dickensian,” discovers his powers as a writer and ascends toward the celebrity his creator enjoyed.

Twain was already famous when he published “Huckleberry Finn,” which revived the characters and setting of an earlier success. The very first sentence gestures toward a larger novelistic universe: “You don’t know about me without you have read a book by the name of ‘The Adventures of Tom Sawyer’; but that ain’t no matter.” (Classic sequelism: a welcome back to the established fans while ushering in the newbies.) Tom, who very nearly ruins Huck’s book when he shows up at the end, is the heart of the franchise: Tony Stark to Huck’s Ant-Man, the principal hero in an open-ended series of adventures, including a handful that Twain left unfinished .

“James” and “Demon Copperhead,” then, might fairly be described as fan fiction. Not just because of the affection Everett and Kingsolver show for their predecessors — in his acknowledgments, Everett imagines a “long-awaited lunch with Mark Twain” in the afterlife; in hers, Kingsolver refers to Dickens as her “genius friend” — but because of the liberties their love allows them to take. “Huckleberry Finn” and “David Copperfield” may be especially susceptible to revision because they are both profoundly imperfect books, with flaws that their most devoted readers have not so much overlooked as patiently endured.

I’m not talking primarily about matters of language that scrape against modern sensibilities — about Victorian sexual mores in Dickens or racial slurs in Twain. As the critic and novelist David Gates suggests in his introduction to the Modern Library edition of “David Copperfield,” “sophisticated readers correct for the merely antiquated.” I’m referring to failures of stylistic and narrative quality control.

As Gates puts it, Dickens’s novel “goes squishy and unctuous” when he “stops following his storytelling instincts and starts listening to extra-literary imperatives.” Preachiness and piety are his most evident vices. Twain’s much noted misjudgment goes in other directions, as he abandons the powerful story of Huck and Jim’s friendship — and the ethical awakening at its heart — to revert to strenuous boys-adventure Tom Sawyerism. The half-dozen final chapters postpone Jim’s freedom so that Tom — and possibly Twain as well — can show off his familiarity with the swashbuckling tropes of popular fiction and insulate “Huckleberry Finn” from the charge of taking itself too seriously.

“Persons attempting to find a moral in it will be banished,” Twain warned in a prefatory note. But “Huckleberry Finn” and “David Copperfield” are both essentially comic — sometimes outright hilarious — novels rooted in hatred of injustice. It’s impossible to tease those impulses apart, or to separate what’s most appealing about the books from what’s frustrating.

That tension, I think, is what opens the door to Kingsolver’s and Everett’s reimaginings. For Kingsolver, “David Copperfield” is an “impassioned critique of institutional poverty and its damaging effects on children in his society. Those problems are still with us.” (“You’d think he was from around here,” her protagonist says when he reads Dickens for the first time.)

One way Kingsolver insulates “Demon Copperhead” from Dickensian sentimentality is by giving her protagonist a voice likely to remind many readers of Huckleberry Finn himself. Huck, after all, is the North American archetype of the resourceful, marginal, backwoods man-child. Though she doesn’t push as far into regional dialect as Twain did, the tang and salt of what used to be called southwestern humor season her pages.

Dialect figures in Dickens and Twain as a mark of authenticity and a source of laughter. In “James,” Everett weaves it into the novel’s critique of power. He replicates Jim’s speech patterns from “Huckleberry Finn,” but here they represent the language enslaved Black characters use in front of white people, part of a performance of servility and simple-mindedness that is vital to surviving in a climate of pervasive racial terror. Among themselves, James and the other slaves are witty and philosophical, attributes that also characterize James’s first-person narration. “Never had a situation felt so absurd, surreal and ridiculous,” he muses after he has been conscripted into a traveling minstrel show. “And I had spent my life as a slave.”

In “Huckleberry Finn,” Jim is Huck’s traveling companion and protector, the butt of his pranks and the agent of his redemption. Early in their journey downriver, Huck is stricken with guilt at the “sin” of helping Jim escape. His gradual understanding of the error of this thinking — of the essential corruption of a society built on human chattel — is the narrative heart of Twain’s book. Against what he has been taught, against the precepts of the “sivilized” world, he comes to see Jim as a person.

For Everett’s James, his own humanity is not in doubt, but under perpetual assault. His relationship with Huck takes on a new complexity. How far can he trust this outcast white boy? How much should he risk in caring for him? To answer those questions would be to spoil some of Everett’s boldest and most brilliant twists on Twain’s tale.

Which, in Everett’s hands, becomes, like “David Copperfield,” the story of a writer. James, who has surreptitiously learned how to read, comes into possession of a pencil stub — a treasure whose acquisition exacts a horrific cost. It represents the freedom of self-representation, the hope, implicitly realized by the novel itself, that James might someday tell his own story.

James’s version is not something Twain could have conceived, but it is nonetheless a latent possibility in the pages of “Huckleberry Finn,” much as the terrible logic of dispossession, addiction and violence in 21st-century America can be read between the lines of Dickens. Everett and Kingsolver are able to see that. This is what originality looks like.

A.O. Scott is a critic at large for The Times’s Book Review, writing about literature and ideas. He joined The Times in 2000 and was a film critic until early 2023. More about A.O. Scott

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Tuesday, April 23, 2024

Release 24.3 (April 23rd, 2024)

• AI Chat with One Document
• The AI-powered “Chat with One Document” allows users to chat with a single document directly within MAXQDA’s interface.
• Users can inquire about the most relevant topics discussed in an interview or seek insights into an interviewee’s opinions on a specific topic.
• Users can ask follow-up questions, reset conversations anytime, and click on the references to review the cited section in the Document Browser.
• Exclude Areas from PDF Documents
• This feature allows users to exclude a PDF’s header and footer sections from all MAXQDA analyses, such as Word Frequencies and MAXDictio-based analyses.
• Easily exclude repetitive text information, such as journal names, page numbers, and header titles.
• Excluded areas can be set up for all pages of a PDF document at once.
• Automatic Transcription
• Ignore disfluencies: you now have the flexibility to exclude verbal fillers (such as “uhm,” “err,” and “hm”) in your English transcripts for enhanced readability or include them for detailed analysis.
• The progress indicator now displays the number of ongoing transcription processes, so you can easily track how many transcriptions are in process.
• Hebrew has been added as a language option.
• True Page Numbers for PDF documents
• MAXQDA now detects if a PDF file contains information about “true” page numbering, the numbers on the actual document.
• “True” PDF page numbers are now displayed alongside MAXQDA’s native file numbering for easy navigation and are used as source information for copied segments.
• PDF Documents
• Relink a missing PDF document easily by dragging and dropping it into the corresponding area in the document properties.
• Blank characters and hyphens at the end of the line are ignored in analyses using the Smart Coding Tool, Categorize Survey Data, and Categorize Paraphrases functions.
• Improved zooming capabilities with Apple trackpads.
• New, modern and easily recognizable icons for our AI Assist features.
• The Smart Coding Tool, Categorize Survey Data, and Categorize Paraphrases windows are now non-modal, allowing you to use other MAXQDA functions while these windows remain open.
• MAXQDA windows on MacOS remain in focus while switching to another app.
• Autocode with Dictionary: We added the code and memo options to the dialogue, so you can use the same code options when using the Autocode with Dictionary tool as you are used to.
• Long Dictionary Descriptions: When hovering over the name of a long dictionary or list, the entire description is displayed in the tooltip.
• Undo: You can now use the “Undo” functionality in Dictionaries and Go/Stop Word Lists to undo the previous action easily.
• Keyword in Context: The Keyword in Context feature now supports the Japanese language.
• More improvements
• Activation: You can now activate all codes that have been assigned to a document via the document context menu in the Document System.
• Focus Group Transcripts: Focus Group Speakers can now be removed via the Document and Code System to easily clean up Focus Group Transcripts.
• Focus Group Transcripts: The import dialogue for Focus Group Transcripts is now scrollable, enabling you to easily view all the imported speakers regardless of how many there are.
• Color Choices : Tooltips with the color names have been added to color choices in the Document and Code System.
• Interface : Several smaller interface adjustmens and improvements.
• Fixes an issue while linking a transcript to an already imported media file where MAXQDA did not link the .dat file from the external files folder correctly.
• Fixes an issue while importing web pages with the Web Collector where certain files could not be imported.
• Fixes an issue while exporting sentiments of survey responses where the sentiment column was empty.
• Fixes an issue while using AI Assist functions for long documents where the action could not be performed immediately.
• Fixes an issue while opening an automatcally created transcript via the notifications dropdown menu where the document was not focussed in the Document Browser.
• Fixes an issue while exporting coded segments from the overview of coded segments window where the chosen options were not applied correctly.
• Fixes an issue while saving a PDF document as a text document where MAXQDA quit unexpectedly.
• Fixes an issue while zooming a map in MAXMaps where duplicate zoom icons were displayed.
• Fixes an issue while exporting a QTT worksheet where only elements from the selected tab were exported.
• Fixes an issue while using MAXQDA Transcription where the transcript was not correctly created for files that had apostrophes in the file name.
• Fixes an issue while creating an in-document memo in a PDF document where the memo was attached to the coded segments of this document.
• Fixes an issue while navigating between multiple memos in PDF documents where the next memo was not displayed.
• Fixes an issue while importing web pages via URL where web pages with redirections in the link could not be imported properly.
• Fixes an issue where the keyboard shortcut “ALT+N” did not work to create a new code for a text selection.
• Fixes an issue while exporting all memos from a project file via the Memo Manager where unnumbered lists were exported as bullet points.
• Fixes several minor interface issues.

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