Effect of neuromuscular injury prevention strategies on injury rates in adolescent males playing sport: a systematic review protocol Franso-Mari Olivier1 � Benita Olivier1,2 � Candice MacMillan1,3 � Sonia Briel4 1Wits Cricket Research Hub for Science, Medicine and Rehabilitation, Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, 2The Wits-JBI Centre for Evidenced-Based Practice: A JBI Affiliated Group, University of Witwatersrand, Johannesburg, South Africa, 3Sport, Exercise Medicine, and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa, and 4Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa A B S T R A C T Objective: This review will assess the effectiveness of neuromuscular injury prevention strategies on injury rates among adolescent males playing sports. Introduction: Adolescent athletes are predisposed to injuries during this period of growth. Growth-related injury risk factors can be mitigated by implementing appropriate neuromuscular injury prevention strategies. This review will include all sporting disciplines in summarizing the components and assessing the effectiveness of injury prevention strategies in the adolescent male population. Inclusion criteria: Randomized controlled trials investigating adolescent males, between the ages of 13 and 18 years, participating in organized sports, in any setting and level of participation, will be included. Studies that evaluate neuromuscular injury prevention strategies (eg, balance, proprioceptive, plyometric, agility, strength, weight, conditioning and sport-specific exercises and training, warm up, cool down, stretches, neuromuscular control) vs no intervention or standard training and competition exposure will be included. The outcomes of interest are injury incidence and prevalence rates. Methods: Databases searched will include MEDLINE (PubMed), CINAHL Complete (EBSCOhost), ClinicalKey, SPORT- Discus (EBSCOhost), Physiotherapy Evidence Database (PEDro), Scopus, ScienceDirect, MasterFILE Premier (EBSCO- host), Academic Search Complete (EBSCOhost), Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Gray literature and unpublished studies will be searched via Health and Medical Complete (ProQuest Dissertations & Theses). Study screening and selection against inclusion criteria will be performed. Data extraction and critical appraisal will be performed using the standardized JBI templates and checklists for qualitative research. All stages will be performed by 2 independent reviewers, with conflicts resolved by a third reviewer. Review registration: PROSPERO CRD42022327047 Keywords: adolescent male; growth spurt; neuromuscular injury prevention; systematic review; youth sport JBI Evid Synth 2024; 22(4):689–699. Introduction A dolescents experience measurable changes in anthropometrics, body composition, or the size of specific regions in the body from age 10 to 20 years.1 Maturation describes the functional and structural system changes contributing to a mature state. Growth and maturation may be used interchangeably, with growth being a constantly evolving process and maturation having a definite end point.2 The 2 processes occur at different rates among individuals.1 The onset and process of adolescence follow dif- ferent paths in male and female bodies. The maximal linear growth tempo is peak height velocity, and is generally observed around 14 years of age in boys and 12 years of age in girls, with annual average gainsDOI: 10.11124/JBIES-22-00448 The authors declare no conflict of interest. Correspondence: Franso-Mari Olivier, fransomari@gmail.com JBI Evidence Synthesis � 2023 JBI 689 © 2023 JBI. Unauthorized reproduction of this article is prohibited. SYSTEMATIC REVIEW PROTOCOL D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024 mailto:fransomari@gmail.com of 9 cm and 8 cm, respectively.3 Body composition (in terms of fat mass, fat-free mass, and body fat distri- bution) also differs between sexes. During early (10 to 13 years of age) and middle adolescence (14 to 16 years of age), both sexes experience increases in fat mass and fat-free mass. Females are also more flexible than their male counterparts. Males experi- ence a decrease in flexibility leading up to mid-ado- lescence, approximately around 14 to 15 years of age; in contrast, females’ flexibility increases slightly and then plateaus, similar to muscle strength.3 Muscle- strength gains amongmales accelerate around the age of 13. Injury rates also differ vastly between sexes, with males reporting rates of injuries nearly twice as high as females (23.8% vs 12.4%).4 Periods of rapid growth (ie, growth spurts) are interspersed with plateaus. Growth spurts are consid- ered a risk factor for sports injuries,5 and adolescent athletes are more susceptible to overuse and growth plate–related injuries.6 Additional factors, such as decreased bone mineral density, increased tensile forces on vulnerable muscle attachments, decreased neuromuscular control, reduced flexibility,7 changes in center of mass, a transient reduction or loss of skill, and rapidly increasing training volumes, further increase risk of injury during this time.8 Consistent adherence to appropriate injury pre- vention programs may protect adolescents from sustaining injuries. These strategies include pre- participation screening, minimizing training errors, technique correction, delaying specialization in a single sport, adequate rest and recovery, avoiding overscheduling, monitoring and modification of training during growth spurts, and appropriate edu- cation for parents and coaches.9 Exercise-based injury prevention programs have successfully modified neuromuscular risk factors and reduced injuries across a wide variety of sports.10 Injury prevention programs among adoles- cent cricket pace bowlers include strength-training regimes, prescription of bowling volume, and mod- ification of bowling mechanics.11 Traditionally, stretching (passive, static, ballistic, isometric, and proprioceptive neuromuscular facilitation) has been included in warm-up and cool-down routines to improve athletes’ flexibility and reduce injury risk; however, findings regarding the efficacy of stretch- ing are inconclusive.12 Neuromuscular training is widely supported as an effective intervention strat- egy for reducing injury risk.13 A preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis was conducted, and no current or in-progress systematic reviews were identified that investigate neuromuscular injury pre- vention strategies for adolescent males playing sport. A systematic review was published in 2007,14 but limits on language (English) and sporting discipline were applied, excluding “minority sports” and “ex- treme sport.” Other reviews focused only on a single intervention, such as exercise.10 This study will include all languages, sports, and neuromuscular training as injury prevention strategies. The objective of this review is to assess the effec- tiveness of neuromuscular training strategies to mit- igate injury rates among adolescent male athletes. This review will summarize the components of cur- rent neuromuscular training strategies (eg, balance, proprioceptive, plyometric, agility, strength, weight, conditioning and sport-specific exercises and train- ing, warm up, cool down, stretches and neuro- muscular control) utilized as injury prevention pro- grams in adolescent sport and the methods used for evaluating the programs’ effectiveness. These results can be used to inform stakeholders (eg, coaches, players) about best current practices (or lack thereof) aimed at addressing injury risk among adolescent male athletes (see Appendix I for definitions). Review question What is the effectiveness of neuromuscular injury prevention strategies vs standard training on the number of injuries in adolescent males playing sport? Inclusion criteria Participants This review will include studies on adolescent males between 13 and 18 years of age, of all body mass index (BMI) percentiles and categories (under- weight, normal weight, overweight), participating in all sporting disciplines from recreational to elite levels. Youth sport includes activities designed and/ or organized for children or youth. Sport will be defined according to PubMed’s Medical Subject Headings (MeSH) description: “activities or games, usually involving physical effort or skill. Reasons for engagement in sports include pleasure, competition or financial reward.” SYSTEMATIC REVIEW PROTOCOL F-M. Olivier et al. JBI Evidence Synthesis � 2023 JBI 690 © 2023 JBI. Unauthorized reproduction of this article is prohibited. D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024 Studies reporting on participants with growth abnormalities or diseases, such as endocrine disor- ders (growth hormone deficiency, hypothyroidism, and hypoparathyroidism) or severe childhood con- ditions (cystic fibrosis, Crohn’s disease, and cancer), reducing bone mass and increasing risk of fractures or abnormal skeletal growth, will be excluded. Con- sidering the influence of sex-related anthropometric differences on injury risk and sports performance, females will be excluded in this study. Intervention Studies that evaluate neuromuscular injury preven- tion strategies for adolescent males participating in sport will be included. These programs are typically multifaceted. Strategies will include, but not be lim- ited to, balance, proprioceptive, plyometric, agility, strength, weight, conditioning and sport-specific ex- ercises and training, warm up, cool down, stretches, and neuromuscular control.15 All eligible studies will be included, regardless of intervention frequency, dosage, or method of delivery. Interventions deliv- ered by any sports trainers, physiotherapists, re- searchers, or research assistants will be considered. The following interventions will be excluded: nutri- tion, strapping, bracing, protective gear (eg, helmets, shin guards, mouth guards), virtual reality exercises, orthotics, training and competition volume manage- ment, technique modification, education, rest and recovery, screening, injury surveillance, and delayed specialization. Comparator This review will consider studies that compare neu- romuscular training interventions to age-matched control groups receiving no intervention or stan- dard, routine training and competition exposure. Standard training and competition exposure refers to no intervention, no change to the training, or practice that the group would typically be receiving. If the group implementing standard training consists of elements similar to those in the intervention, those elements will be treated as standard strategy, and only the elements not part of the standard training will be measured for the effectiveness of preventing injury. Outcomes The primary outcome measures of interest are the injury incidence (per 1000 athlete hours) and prev- alence rates (proportion of athletes per time period). A sports injury involves tissue damage or other derangements of normal physical function due to participation in sports, resulting from rapid or repetitive transfer of kinetic energy.16 Secondary outcome measures may include the type (measured as categorical data) of injuries (acute and chronic) obtained after the intervention, as well as the severity. This systematic review will adopt the following definitions. An acute injury is obtained during a sin- gle, identifiable traumatic event where tissue is stressed and strained by a force greater than what the tissue can withstand.17 Overuse or chronic inju- ries are obtained during repetitive stress and cumula- tive trauma.18 Severity of sports injuries will be described as slight (0 days absent, able to participate fully in next match or training), minor (absent from match or training 1 to 7 days), moderate (absent from match or training 8 to 21 days), or major (absent from match or training more than 21 days).19 Types of studies This review will only include randomized controlled trials. Methods The proposed systematic review will be conducted according to the JBI methodology for systematic re- view of effectiveness20 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.21 This protocol has been regis- tered in PROSPERO (CRD42022327047). Any devi- ations from the protocol will be explained in the final review. Search strategy A 3-step search strategy will be conducted to find published and unpublished studies. Firstly, an initial search was conducted in MEDLINE via PubMed. The search strategy was trialed to refine it by remov- ing duplicate or inadequate search terms and retest- ing as necessary to ensure that it was sufficiently sensitive to identify all relevant studies. Secondly, the search strategy will then be adapted for each database searched. Keywords will be searched in titles and abstracts, index terms, and, where possi- ble, MeSH terms (see Appendix II for a sample search strategy for MEDLINE via PubMed). Thirdly, a search will be performed on the reference SYSTEMATIC REVIEW PROTOCOL F-M. Olivier et al. JBI Evidence Synthesis � 2023 JBI 691 © 2023 JBI. Unauthorized reproduction of this article is prohibited. D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024 lists of the included studies to identify any additional studies to be included in the review. No language filters will be applied. Google Trans- late will be used for studies in languages other than English to assess them for inclusion based on title, abstract, and full text. A professional translator will translate the full text to ensure accurate extraction of data. The following databases will be searched from inception to the present with a human: MEDLINE (PubMed), CINAHL Complete (EBSCOhost), Clin- icalKey, SPORTDiscus (EBSCOhost), Physiotherapy Evidence Database (PEDro), Scopus, ScienceDirect, MasterFILE Premier (EBSCOhost), Health and Medical Complete (ProQuest), Academic Search Complete (EBSCOhost), Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials. gov, ProQuest Dissertations and Theses, MedNar, OpenGrey (SIGLE), Worldwidescience.org, Google Scholar, and WorldCat. Due to the large volume of results provided by Google Scholar, and the limited ability to narrow results down when using the advanced search function, the reviewers will con- sider the first 1000 results. Theses and dissertations found in gray literature databases will be included in the review. Further, known experts will be contacted to identify any additional publications. Study selection All identified citations will be collated and uploaded to EndNote v.20 (Clarivate Analytics, PA, USA) and duplicates removed. Two or more independent re- viewers will screen titles and abstracts against the inclusion criteria for the review. A pilot will be undertaken to familiarize the reviewers with the process and criteria. Potentially relevant studies will be retrieved in full, and their details imported into the JBI System for the Unified Management, Assess- ment and Review of Information (JBI SUMARI; JBI, Adelaide, Australia).22 Two independent reviewers will then screen full-text articles against the inclusion criteria. Full-text articles that do not meet the inclu- sion criteria will be excluded, and reasons for exclu- sion will be reported in the systematic review. Any disagreements between the reviewers will be resolved through discussion or with a third reviewer. The search results and the study inclusion process will be reported in full in the final systematic review and presented in a PRISMA flow diagram.21 Assessment of methodological quality Two independent reviewers will independently assess eligible studies for methodological quality using the JBI critical appraisal tool for experimental studies (randomized controlled trials). Any disagree- ments will be discussed with a third reviewer.20,22 This standardized critical appraisal tool consists of 13 items, each requiring a dichotomous yes/no response. A “yes” response is allocated 1 point, and a “no” response 0 points. An “unclear/not applicable” will not be allocated any points and the total number of points will be adapted to account for the “unclear/not applicable” options. Methodological quality for randomized controlled trails will be assigned as follows: studies scoring 1–5 (low quality), 6–10 (moderate quality), and 11–13 (high quality). All studies, irrespective of method- ological quality, will be included. The results of critical appraisal will be reported in a table with accompanying narrative, and methodological qual- ity will be considered when conclusions are drawn. Data extraction The standardized JBI SUMARI data extraction tool20,23 will be used to extract data from the eligible studies by 2 independent reviewers. Extracted data will be presented in a table, including details about authors and articles (names, article title, year of publication, and source); participants (number of participants, level of sport participation, country, sport discipline, ages of participants); study methods (randomized controlled trials); neuromuscular injury prevention interventions (intervention type, content, timing, nature of implementation [ie, number of training sessions, frequency of program, dosages, duration of a program]); compliance (ie, percentage attended, sessions attended, role of the person delivering the sessions); outcomes (injury rates/ incidence, severity of injury, acute vs chronic); and critical appraisal rating. Two reviewers will pilot data extraction to famil- iarize themselves with the tool, evaluate appropri- ateness thereof, and minimize data extraction errors; data will then be extracted independently. The reviewers will resolve any disagreements through discussion or arbitration by a third reviewer. Confounding factors (age, BMI, socioeconomic sta- tus, comorbidities, growth spurt status, additional sports participation, or different definitions used for injury outcomes) reported by the included studies SYSTEMATIC REVIEW PROTOCOL F-M. Olivier et al. JBI Evidence Synthesis � 2023 JBI 692 © 2023 JBI. Unauthorized reproduction of this article is prohibited. D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024 will also be extracted and accounted for. Where required, missing or additional data will be re- quested from the authors of papers. In cases where no response is obtained from an author, a reminder email will be sent 10 days after the initial email. Data synthesis A statistical meta-analysis, using JBI SUMARI, will pool quantitative data, if possible. A narrative method, using tables and graphs, may be utilized to represent data if pooling is not possible. Propor- tion-based effect sizes will be expressed as relative risk, odds ratios, or weighted, and prevalence will be calculated using a random or fixed effects model and mean differences for continuous data (injury incidence and prevalence rates).24 For the analysis of effect sizes, the 95% CI will be calculated. Cate- gorical data (type of injury and severity) will be analyzed using χ² probability distribution. A sensitivity analysis will be performed to investi- gate the robustness of the results and the variance in study design, statistical methods, and methodology. Subgroup analyses will be performed to test the dif- ferent cluster adjustment methods, performing syn- thesis using various statistical models, methods, and effect measures. The inclusion of the methodological quality of studies will also be assessed. Similarity regarding the effect magnitude and direction will be ascertained by this testing and illustrated in a forest plot. Statistical heterogeneity will be identified by the standard Cochran’s Q and its P value, together with the χ2 statistical assessments. The heterogeneity will be quantified by the I² and T² statistical tests. The thresholds for heterogeneity will be classified as unimportant (0 to 40%), moderate (30% to 60%), substantial (50% to 90%), and considerable (75% to 100%). The significance of the clinical heterogeneity will be indicated by a lower P value, bearing in mind that the P value’s significance is set at 0.1, due to the statistical test’s low power.25 Sufficient data could allow for subgroup analyses, including different com- ponents of neuromuscular injury prevention pro- grams; different sporting disciplines; acute vs chronic injuries; and confounding factors, such as BMI, as discussed in data extraction. Subgroups will enable the comparison of the effect and effectiveness of the different components, between different sporting dis- ciplines; acute and chronic injuries; and elite vs recre- ational levels of sport. A funnel plot will be generated using the statistical program IBM SPSS Statistics 28.0.1 (Armonk, NY: IBMCorp), and statistical tests for asymmetry (Egger test, Begg test, Harbord test) will be performed, where appropriate.24 Assessing certainty in the findings The Grading of Recommendations, Assessment, De- velopment and Evaluation (GRADE) approach for grading the certainty of evidence will be followed.26 A Summary of Findings (SoF) will be created using GRADEpro GDT (McMaster University, ON, Can- ada).27 Two independent reviewers will compile this, and disagreements will be resolved through discus- sion or with a third reviewer. The SoF will present the following information, where appropriate: esti- mates of relative risk, a ranking of the quality of the evidence based on the risk of bias, directness, het- erogeneity, precision, and risk of publication bias of the review results. The outcomes reported in the SoF will be injury incidence (per 1000 athlete hours), prevalence rates (proportion of athletes per time period), and severity of injury (time lost). Acknowledgments This review will contribute toward a doctorate in philosophy through the University of the Witwaters- rand for FO. Funding Funding was received by FO from the South African Society of Physiotherapy. The funders will have no role in the review process. Author contributions FO, BO, CM contributed to the review design. FO and SB will perform the literature screening, appraisal, and data extraction. FO will perform the analysis and writing of the manuscript. BO and CM contributed to the manuscript as supervisors. References 1. Brown KA, Patel DR, Darmawan D. Participation in sports in relation to adolescent growth and development. Transl Pediatr 2017;6(3):150. 2. Beunen G, Malina R. The young athlete: relevance to ath- letic performanceIn: Hebestreit H, editor. Encyclopaedia of Sports Medicine. Blackwell Publishing; 2008:3–17. 3. Kreipe RE. Textbook of Adolescent Medicine. W B Saunders; 1994:24. SYSTEMATIC REVIEW PROTOCOL F-M. Olivier et al. JBI Evidence Synthesis � 2023 JBI 693 © 2023 JBI. Unauthorized reproduction of this article is prohibited. D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024 4. LeBrun DG, Del Rosario J, Kelly JD, Wren SM, Spiegel DA, Mkandawire N, et al. An estimation of the burden of sports injuries among African adolescents. J Epidemiol Glob Health 2018;8(3-4):171. 5. Johnson DM, Williams S, Bradley B, Sayer S, Murray Fisher J, Cumming S. Growing pains: maturity associated variation in injury risk in academy football. Eur J Sport Sci 2020;20(4): 544–52. 6. Jayanthi N, Schley S, Cumming SP, Myer GD, Saffel H, Hartwig T, et al. 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Munn Z, Aromataris E, Tufanaru C, Stern C, Porritt K, Farrow J, et al. The development of software to support multiple systematic review types: the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Int J Evid Based Healthc 2019;17 (1):36–43. 23. Munn Z, Tufanaru C, Aromataris E. JBI’s systematic reviews: data extraction and synthesis. Am J Nurs 2014;114(7):6. 24. Tufanaru C, Munn Z, Stephenson M, Aromataris E. Fixed or random effects meta-analysis? Common methodological issues in systematic reviews of effectiveness. Int J Evid Based Healthc 2015;13(3):196–207. 25. Fletcher J. What is heterogeneity and is it important? BMJ 2007;334(7584):94–6. 26. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence pro- files and summary of findings tables. J Clin Epidemiol 2011; 64(4):383–94. 27. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommenda- tions. BMJ 2008;336(7650):924–6. SYSTEMATIC REVIEW PROTOCOL F-M. Olivier et al. JBI Evidence Synthesis � 2023 JBI 694 © 2023 JBI. Unauthorized reproduction of this article is prohibited. D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024 https://synthesismanual.jbi.global Appendix I: Definitions of terms to be used in the systematic review Participants Adolescents Any person between 10 and 19 years of age is referred to as an adolescent by the World Health Organization (https://www.who.int/health-topics/adolescent-health) Definitions Athlete An athlete is an individual who is formally registered with a sport federation – in this case a club or school – attempting to improve skill, performance, and results by being actively engaged in sports training to compete. Training and competition are the main physical activities and several hours are devoted to it. Sport Sport will be defined as an activity or game where physical effort and skill is required. Participation in sport could be for pleasure, to compete, or for financial gain. Organized sport Organized sport is defined by the degree of structure in organizations, surrounding and influencing sport. This will determine whether it is an activity or ‘organized sport. Interventions: included Agility training Agility is the body’s ability to rapidly change direction, accelerate, or decelerate. It is influenced by balance, strength, coordination, and skill level. Balance Balance control is the ability to maintain the body’s center of mass within the limits of the supporting base. Cool down A low- to moderate-intensity exercise or movement performed within 1 hour after training and competition Neuromuscular injury prevention strategies Balance, proprioceptive, plyometric, agility, strength, weight training, conditioning and sport- specific exercises and training, warm up, cool down, stretches, massage, manual therapy and neuromuscular core control Plyometric training The stretch reflex is increased by muscles repeatedly and rapidly stretching, followed by shortening, concentric contraction (eg, jumping and rebounding). Proprioception Proprioceptive receptors in joints, tendons, muscles, and the inner ear transduce stimuli into neural impulses to the central nervous system. Proprioception is the sense of stationary positions and movements of body parts and is important in maintaining kinesthesia and postural balance. Sport-specific exercises Sport-specific exercises are fitness and performance training designed specifically for athletic performance enhancement. Strength and weight training Strength training (also known as resistance exercise) increases muscle strength by making muscles work against a weight or force and is a form of anaerobic exercise. Stretches Exercises that stretch the muscle fibers to increase muscle-tendon flexibility, improve range of motion or musculoskeletal function, and prevent injuries. Types of stretching techniques include active, passive (relaxed), static, dynamic (gentle), ballistic (forced) and isometric. Warm up Warm up is a period of preparatory exercise to enhance subsequent competition or training performance. Interventions: excluded Nutrition, pre-participation screening, delayed specialization, protective measures (strapping and bracing) and equipment (helmets, mouth guards, shin guards, padding), virtual reality exercises, orthotics, training and competition volume management, technique modification, education, rest and recovery, injury surveillance SYSTEMATIC REVIEW PROTOCOL F-M. Olivier et al. JBI Evidence Synthesis � 2023 JBI 695 © 2023 JBI. Unauthorized reproduction of this article is prohibited. D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024 https://www.who.int/health-topics/adolescent-health Comparators Standard competition exposure Standard competition exposure refers to no change in the standard/normal/routine amount/level of competition, hence, taking part in the usual amount or type of competition. Standard training Standard training refers to no intervention, no change to the training or practice that group would normally be receiving. Outcomes Injury A sports injury involves tissue damage or other derangements of normal physical function due to participation in sports, resulting from rapid or repetitive transfer of kinetic energy. Acute injury An acute injury is obtained during a single, identifiable traumatic event where tissue is stressed and strained by a force greater than what the tissue can withstand. Chronic injury Overuse or chronic injuries are obtained during repetitive stress and cumulative trauma. Severity of injury (categorical data: slight, minor, moderate, major; continuous data: time lost) Severity of sports injuries will be described as: slight (0 days absent, able to participate fully in next match or training), minor (absent from match or training 1-7 days), moderate (absent from match or training 8-21 days), and major (absent from match or training more than 21 days). Injury incidence Incidence is an expression of risk. Incidence rates describe the number of new injuries that occur in a population at risk over a specific period of time, or the number of new injuries during a period divided by the total number of sportspeople at that period. Injury prevalence Prevalence refers to the proportion of individuals in a population who have an injury at a particular time. SYSTEMATIC REVIEW PROTOCOL F-M. Olivier et al. JBI Evidence Synthesis � 2023 JBI 696 © 2023 JBI. Unauthorized reproduction of this article is prohibited. D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024 Appendix II: Search strategy MEDLINE (PubMed) Search conducted: October 24, 2023 Total records retrieved: 770 Search Query Records retrieved #1 adolescent [mh] OR “adolescent development” [mh] OR teen [tw] OR teenager [tw] OR Adolescents [tw] OR teens [tw] OR youth [tw] OR youths [tw] OR adolescence[All Fields] OR adolescent [All Fields] OR teenager [All Fields] OR teenagers[All Fields] OR teen [tw] Filter: Human (“adolescent”[MeSH Terms] OR “adolescent development”[MeSH Terms] OR “teen”[Text Word] OR “teenager”[Text Word] OR “Adolescents”[Text Word] OR “teens”[Text Word] OR “youth”[Text Word] OR “youths”[Text Word] OR “adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “Adolescents”[All Fields] OR “adolescent s”[All Fields] OR “adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “Adolescents”[All Fields] OR “adolescent s”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “teenage”[All Fields] OR “teenager”[All Fields] OR “teenagers”[All Fields] OR “teenaged”[All Fields] OR “teenager s”[All Fields] OR “teenages”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “teenage”[All Fields] OR “teenager”[All Fields] OR “teenagers”[All Fields] OR “teenaged”[All Fields] OR “teenager s”[All Fields] OR “teenages”[All Fields] OR “teen”[Text Word]) AND (humans[Filter]) Translations adolescent [mh]: “adolescent”[MeSH Terms] adolescence[All Fields]: “adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent’s”[All Fields] adolescent [All Fields]: “adolescences”[All Fields] OR “adolescency”[All Fields] OR “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “adolescence”[All Fields] OR “adolescents”[All Fields] OR “adolescent’s”[All Fields] teenager [All Fields]: “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “teenage”[All Fields] OR “teenager”[All Fields] OR “teenagers”[All Fields] OR “teenaged”[All Fields] OR “teenager’s”[All Fields] OR “teenages”[All Fields] teenagers[All Fields]: “adolescent”[MeSH Terms] OR “adolescent”[All Fields] OR “teenage”[All Fields] OR “teenager”[All Fields] OR “teenagers”[All Fields] OR “teenaged”[All Fields] OR “teenager’s”[All Fields] OR “teenages”[All Fields] 2,297,378 #2 sports [mh] OR Athletic Performance [mh] OR baseball [mh] OR basketball [mh] OR bicycling [mh] OR boxing [mh] OR Boxing [mh] OR cricket sport [mh] OR cricket sport [mh] OR Cricket Sport [tw] OR football [mh] OR Football [tw] OR golf [mh] OR Golf [tw] OR gymnastics [mh] OR Gymnastics [tw] OR hockey [mh] OR Hockey [tw] OR martial arts [mh] OR Martial Arts [tw] OR “tai ji” [mh] OR “Tai Ji“ [tw] OR Mountaineering [tw] OR “racquet sports”[mh] OR Racquet Sports [tw] OR “tennis”[mh] OR Tennis [tw] OR “return to sport” [mh] OR “Return to Sport” [tw] OR “rugby”[mh] OR Rugby [tw] OR running [mh] OR Running [tw] OR jogging [mh] OR Jogging [tw] OR “marathon running” [mh] OR “Marathon Running” [tw] OR skating [mh] OR Skating [tw] OR “snow sports” [mh] OR “Snow Sports” [tw] OR skiing [mh] OR Skiing [tw] OR soccer [mh] OR Soccer [tw] OR “team sports”[mh] OR Team Sports [tw] OR “track and field” [mh] OR “Track and Field” [tw] OR “volleyball” [mh] OR Volleyball [tw] OR walking [mh] OR Walking [tw] OR “nordic walking” [mh] OR “Nordic Walking” [tw] OR “water sports” [mh] OR “Water Sports” [tw] OR swimming [mh] OR Swimming [tw] OR “weight lifting” [mh] OR “Weight Lifting” [tw] OR wrestling [mh] OR Wrestling [tw] OR “youth sports” [mh] OR “Youth sports“ [tw] OR “diving”[mh] OR diving[tw] Filter: Human (“Sports”[MeSH Terms] OR “athletic performance”[MeSH Terms] OR “baseball”[MeSH Terms] OR “basketball”[MeSH Terms] OR “bicycling”[MeSH Terms] OR “boxing”[MeSH Terms] OR “boxing”[MeSH Terms] OR “cricket sport”[MeSH Terms] OR “cricket sport”[MeSH Terms] OR “cricket sport”[Text Word] OR “Football”[MeSH Terms] OR “Football”[Text Word] OR “Golf”[MeSH Terms] OR “Golf”[Text Word] OR “Gymnastics”[MeSH Terms] OR “Gymnastics”[Text Word] OR “Hockey”[MeSH Terms] OR “Hockey”[Text Word] OR “martial arts”[MeSH Terms] OR “martial arts”[Text Word] OR “Tai Ji”[MeSH Terms] OR “Tai Ji”[Text Word] OR “Mountaineering”[Text Word] OR “racquet sports”[MeSH Terms] OR “racquet sports”[Text Word] OR “Tennis”[MeSH Terms] OR “Tennis”[Text Word] OR “Return to Sport”[MeSH Terms] OR “Return to Sport”[Text Word] OR “Rugby”[MeSH Terms] OR “Rugby”[Text Word] OR “Running”[MeSH Terms] OR “Running”[Text Word] OR “Jogging”[MeSH Terms] OR “Jogging”[Text Word] OR “Marathon Running”[MeSH Terms] OR “Marathon Running”[Text Word] OR “Skating”[MeSH Terms] OR “Skating”[Text Word] OR “Snow Sports”[MeSH Terms] OR “Snow Sports”[Text Word] OR “Skiing”[MeSH Terms] OR “Skiing”[Text Word] OR “Soccer”[MeSH Terms] OR “Soccer”[Text Word] OR “team sports”[MeSH Terms] OR “team sports”[Text Word] OR “Track and Field”[MeSH Terms] OR “Track and Field”[Text Word] OR “Volleyball”[MeSH Terms] OR “Volleyball”[Text Word] OR “Walking”[MeSH Terms] OR “Walking”[Text Word] OR “Nordic Walking”[MeSH Terms] OR “Nordic Walking”[Text Word] OR “Water Sports”[MeSH Terms] OR “Water Sports”[Text Word] OR “Swimming”[MeSH Terms] OR “Swimming”[Text Word] OR “Weight Lifting”[MeSH Terms] OR “Weight Lifting”[Text Word] OR “Wrestling”[MeSH Terms] OR “Wrestling”[Text Word] OR “Youth sports”[MeSH Terms] OR “Youth sports”[Text Word] OR “diving”[MeSH Terms] OR “diving”[Text Word]) AND (humans [Filter]) Translations sports [mh]: “sports”[MeSH Terms] Athletic Performance [mh]: “athletic performance”[MeSH Terms] 282,182 SYSTEMATIC REVIEW PROTOCOL F-M. Olivier et al. JBI Evidence Synthesis � 2023 JBI 697 © 2023 JBI. Unauthorized reproduction of this article is prohibited. D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024 (Continued ) Search Query Records retrieved baseball [mh]: “baseball”[MeSH Terms] basketball [mh]: “basketball”[MeSH Terms] bicycling [mh]: “bicycling”[MeSH Terms] boxing [mh]: “boxing”[MeSH Terms] Boxing [mh]: “boxing”[MeSH Terms] cricket sport [mh]: “cricket sport”[MeSH Terms] cricket sport [mh]: “cricket sport”[MeSH Terms] football [mh]: “football”[MeSH Terms] golf [mh]: “golf”[MeSH Terms] gymnastics [mh]: “gymnastics”[MeSH Terms] hockey [mh]: “hockey”[MeSH Terms] martial arts [mh]: “martial arts”[MeSH Terms] running [mh]: “running”[MeSH Terms] jogging [mh]: “jogging”[MeSH Terms] skating [mh]: “skating”[MeSH Terms] skiing [mh]: “skiing”[MeSH Terms] soccer [mh]: “soccer”[MeSH Terms] walking [mh]: “walking”[MeSH Terms] swimming [mh]: “swimming”[MeSH Terms] wrestling [mh]: “wrestling”[MeSH Terms] #3 “injury prevention training”[All Fields] OR “strength training activities” [All Fields] OR “neuromuscular training intervention” [All Fields] OR “neuromuscular exercises” [All Fields] OR “stretching”[All Fields] OR “proprioception” [All Fields] OR “conditioning”[All Fields] OR “plyometric activity” [All Fields] OR balance [All Fields] OR “resistance training” [mh] OR “strength training” [tw] OR “weight lifting” [mh] OR sports [mh] OR sport [tw] AND exercise [mh] OR “exercise therapy” [mh] OR exercises [tw] OR “warm-up exercise” [mh] OR “warm- up exercise” [tw] OR cool [All Fields] AND down[All Fields] OR neuromuscular [All Fields] AND “prevention and control” [sh] OR “control groups” [mh] OR control [tw] OR “Muscle Stretching Exercises”[Mesh] OR “proprioception”[MeSH] OR “plyometric”[All Fields] OR “Circuit-Based Exercise”[Mesh] OR “Postural Balance”[Mesh] OR “core stability”[MeSH] OR core stability[Text Word] OR “Abdominal Core”[Mesh] OR “prevention and control” [Subheading] OR “massage”[MeSH] OR massage[Text Word] OR mobilize[All Fields] OR “risk reduction”[All Fields] OR “manual movement”[All Fields] OR “manual therapy”[All Fields] OR “manual therapies”[Text Word] OR “manual therapy”[Text Word] OR “muskuloskeletal”[All Fields] Filter: Human “injury prevention training”[All Fields] OR “strength training activities”[All Fields] OR “neuromuscular training intervention”[All Fields] OR “neuromuscular exercises”[All Fields] OR “stretching”[All Fields] OR “proprioception”[All Fields] OR “conditioning”[All Fields] OR “plyometric activity”[All Fields] OR “stretching”[All Fields] OR “proprioception”[All Fields] OR “conditioning”[All Fields] OR (“balance”[All Fields] OR “balanced”[All Fields] OR “balances”[All Fields] OR “balancing”[All Fields]) OR “resistance training”[MeSH Terms] OR “strength training”[Text Word] OR “weight lifting”[MeSH Terms] OR “sports”[MeSH Terms] OR “sport”[Text Word]) AND “exercise”[MeSH Terms]) OR “exercise therapy”[MeSH Terms] OR “exercises”[Text Word] OR “warm-up exercise”[MeSH Terms] OR “warm-up exercise”[Text Word] OR “cool”[All Fields]) AND “down”[All Fields]) OR “neuromuscular”[All Fields]) AND “prevention and control”[MeSH Subheading]) OR “control groups”[MeSH Terms] OR “control”[Text Word] OR “Muscle Stretching Exercises”[MeSH Terms] OR “proprioception”[MeSH Terms] OR “plyometric”[All Fields] OR “Circuit-Based Exercise”[MeSH Terms] OR “balance”[All Fields] OR “Postural Balance”[MeSH Terms] OR “core stability”[MeSH Terms] OR “core stability”[Text Word] OR “Abdominal Core”[MeSH Terms] OR “prevention and control”[MeSH Subheading] OR “massage”[MeSH Terms] OR “massage”[Text Word] OR (“mobilisation”[All Fields] OR “mobilisations”[All Fields] OR “mobilise”[All Fields] OR “mobilised”[All Fields] OR “mobiliser”[All Fields] OR “mobilisers”[All Fields] OR “mobilises”[All Fields] OR “mobilising”[All Fields] OR “mobilization”[All Fields] OR “mobilizations”[All Fields] OR “mobilize”[All Fields] OR “mobilized”[All Fields] OR “mobilizer”[All Fields] OR “mobilizers”[All Fields] OR “mobilizes”[All Fields] OR “mobilizing”[All Fields]) OR “risk reduction”[All Fields] OR “manual movement”[All Fields] OR “manual therapy”[All Fields] OR “manual therapies”[Text Word] OR “manual therapy”[Text Word] OR “muskuloskeletal”[All Fields]) AND (humans[Filter]) Translations balance [All Fields]: “balance”[All Fields] OR “balanced”[All Fields] OR “balances”[All Fields] OR “balancing”[All Fields] sports [mh]: “sports”[MeSH Terms] exercise [mh]: “exercise”[MeSH Terms] mobilize[All Fields]: “mobilisation”[All Fields] OR “mobilisations”[All Fields] OR “mobilise”[All Fields] OR “mobilised”[All Fields] OR “mobiliser”[All Fields] OR “mobilisers”[All Fields] OR “mobilises”[All Fields] OR “mobilising”[All Fields] OR “mobilization”[All Fields] OR “mobilizations”[All Fields] OR “mobilize”[All Fields] OR “mobilized”[All Fields] OR “mobilizer”[All Fields] OR “mobilizers”[All Fields] OR “mobilizes”[All Fields] OR “mobilizing”[All Fields] 2,980,524 SYSTEMATIC REVIEW PROTOCOL F-M. Olivier et al. JBI Evidence Synthesis � 2023 JBI 698 © 2023 JBI. Unauthorized reproduction of this article is prohibited. D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024 (Continued ) Search Query Records retrieved #4 injured[All Fields] OR injuries[All Fields] OR injuring[All Fields] OR injurious[All Fields] OR injury[All Fields] OR “Wounds and Injuries”[Mesh] OR acute[All Fields] OR Chronic[All Fields] OR Overuse[All Fields] Filters: Humans (“injure”[All Fields] OR “injured”[All Fields] OR “injures”[All Fields] OR “injuring”[All Fields] OR (“injurie”[All Fields] OR “injuried”[All Fields] OR “injuries”[MeSH Subheading] OR “injuries”[All Fields] OR “Wounds and Injuries”[MeSH Terms] OR (“wounds”[All Fields] AND “injuries”[All Fields]) OR “Wounds and Injuries”[All Fields] OR “injurious”[All Fields] OR “injury s”[All Fields] OR “injuryed”[All Fields] OR “injurys”[All Fields] OR “injury”[All Fields]) OR (“injurie”[All Fields] OR “injuried”[All Fields] OR “injuries”[MeSH Subheading] OR “injuries”[All Fields] OR “Wounds and Injuries”[MeSH Terms] OR (“wounds”[All Fields] AND “injuries”[All Fields]) OR “Wounds and Injuries”[All Fields] OR “injurious”[All Fields] OR “injury s”[All Fields] OR “injuryed”[All Fields] OR “injurys”[All Fields] OR “injury”[All Fields]) OR (“injure”[All Fields] OR “injured”[All Fields] OR “injures”[All Fields] OR “injuring”[All Fields]) OR (“injure”[All Fields] OR “injured”[All Fields] OR “injures”[All Fields] OR “injuring”[All Fields]) OR (“injurie”[All Fields] OR “injuried”[All Fields] OR “injuries”[MeSH Subheading] OR “injuries”[All Fields] OR “Wounds and Injuries”[MeSH Terms] OR (“wounds”[All Fields] AND “injuries”[All Fields]) OR “Wounds and Injuries”[All Fields] OR “injurious”[All Fields] OR “injury s”[All Fields] OR “injuryed”[All Fields] OR “injurys”[All Fields] OR “injury”[All Fields]) OR (“injurie”[All Fields] OR “injuried”[All Fields] OR “injuries”[MeSH Subheading] OR “injuries”[All Fields] OR “Wounds and Injuries”[MeSH Terms] OR (“wounds”[All Fields] AND “injuries”[All Fields]) OR “Wounds and Injuries”[All Fields] OR “injurious”[All Fields] OR “injury s”[All Fields] OR “injuryed”[All Fields] OR “injurys”[All Fields] OR “injury”[All Fields]) OR “Wounds and Injuries”[MeSH Terms] OR (“acute”[All Fields] OR “acutely”[All Fields] OR “acutes”[All Fields]) OR (“chronic”[All Fields] OR “chronical”[All Fields] OR “chronically”[All Fields] OR “chronicities”[All Fields] OR “chronicity”[All Fields] OR “chronicization”[All Fields] OR “chronics”[All Fields]) OR (“overuse”[All Fields] OR “overused”[All Fields] OR “overuser”[All Fields] OR “overusers”[All Fields] OR “overuses”[All Fields] OR “overusing”[All Fields])) AND (humans[Filter]) Translations injured[All Fields]: “injure”[All Fields] OR “injured”[All Fields] OR “injures”[All Fields] OR “injuring”[All Fields] injuries[All Fields]: “injurie”[All Fields] OR “injuried”[All Fields] OR “injuries”[Subheading] OR “injuries”[All Fields] OR “wounds and injuries”[MeSH Terms] OR (“wounds”[All Fields] AND “injuries”[All Fields]) OR “wounds and injuries”[All Fields] OR “injurious”[All Fields] OR “injury’s”[All Fields] OR “injuryed”[All Fields] OR “injurys”[All Fields] OR “injury”[All Fields] injuries[All Fields]: “injurie”[All Fields] OR “injuried”[All Fields] OR “injuries”[Subheading] OR “injuries”[All Fields] OR “wounds and injuries”[MeSH Terms] OR (“wounds”[All Fields] AND “injuries”[All Fields]) OR “wounds and injuries”[All Fields] OR “injurious”[All Fields] OR “injury’s”[All Fields] OR “injuryed”[All Fields] OR “injurys”[All Fields] OR “injury”[All Fields] injuring[All Fields]: “injure”[All Fields] OR “injured”[All Fields] OR “injures”[All Fields] OR “injuring”[All Fields] injuring[All Fields]: “injure”[All Fields] OR “injured”[All Fields] OR “injures”[All Fields] OR “injuring”[All Fields] injurious[All Fields]: “injurie”[All Fields] OR “injuried”[All Fields] OR “injuries”[Subheading] OR “injuries”[All Fields] OR “wounds and injuries”[MeSH Terms] OR (“wounds”[All Fields] AND “injuries”[All Fields]) OR “wounds and injuries”[All Fields] OR “injurious”[All Fields] OR “injury’s”[All Fields] OR “injuryed”[All Fields] OR “injurys”[All Fields] OR “injury”[All Fields] injury[All Fields]: “injurie”[All Fields] OR “injuried”[All Fields] OR “injuries”[Subheading] OR “injuries”[All Fields] OR “wounds and injuries”[MeSH Terms] OR (“wounds”[All Fields] AND “injuries”[All Fields]) OR “wounds and injuries”[All Fields] OR “injurious”[All Fields] OR “injury’s”[All Fields] OR “injuryed”[All Fields] OR “injurys”[All Fields] OR “injury”[All Fields] acute[All Fields]: “acute”[All Fields] OR “acutely”[All Fields] OR “acutes”[All Fields] Chronic[All Fields]: “chronic”[All Fields] OR “chronical”[All Fields] OR “chronically”[All Fields] OR “chronicities”[All Fields] OR “chronicity”[All Fields] OR “chronicization”[All Fields] OR “chronics”[All Fields] Overuse[All Fields]: “overuse”[All Fields] OR “overused”[All Fields] OR “overuser”[All Fields] OR “overusers”[All Fields] OR “overuses”[All Fields] OR “overusing”[All Fields] 3,335,953 #5 Experimental [All Fields] AND study [All Fields] OR “randomized controlled trial”[Publication Type] OR “randomized controlled trials as topic”[mh] OR “randomized controlled trial”[All Fields] OR “randomized control trial” OR “randomized control trials”[All Fields] OR “randomised control trial”[All Fields] OR “randomised control trials”[All Fields] OR “randomised controlled trial”[All Fields] OR “randomised controlled trials”[All Fields] OR “rct”[All Fields] Filters: Humans (((“experimental”[All Fields] OR “experimentally”[All Fields] OR “experimentals”[All Fields] OR “experimentation”[All Fields] OR “experimentations”[All Fields] OR “experimenter”[All Fields] OR “experimenter s”[All Fields] OR “experimenters”[All Fields]) AND (“studies”[All Fields] OR “study”[All Fields] OR “study s”[All Fields] OR “studying”[All Fields] OR “studys”[All Fields])) OR “randomized controlled trial”[Publication Type] OR “randomized controlled trials as topic”[MeSH Terms] OR “randomized controlled trial”[All Fields] OR “randomized control trial”[All Fields] OR “randomized control trials”[All Fields] OR “randomised control trial”[All Fields] OR “randomised control trials”[All Fields] OR “randomised controlled trial”[All Fields] OR “randomised controlled trials”[All Fields] OR “rct”[All Fields]) AND (humans[Filter]) 1,178,202 #6 #1 AND #2 AND #3 AND #4 AND #5 770 SYSTEMATIC REVIEW PROTOCOL F-M. Olivier et al. JBI Evidence Synthesis � 2023 JBI 699 © 2023 JBI. Unauthorized reproduction of this article is prohibited. D ow nloaded from http://journals.lw w .com /jbisrir by B hD M f5eP H K av1zE oum 1tQ fN 4a+ kJLhE Z gbsIH o4X M i0hC yw C X 1A W nY Q p/IlQ rH D 3i3D 0O dR yi7T vS F l4C f3V C 1y0abggQ Z X dgG j2M w lZ LeI= on 07/29/2024