| Course | D634 Health Sciences Capstone |
|---|---|
| Task | Task 2 |
| Paper type | Literature review with annotated bibliography |
| Length | About 1,000 words, 3 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | BS Health Science |
| Updated | September 2026 |
Free sample paper for D634 Task 2
Programs Work When Athletes Do Them: A Literature Review and Annotated Bibliography on Neuromuscular Training to Prevent Anterior Cruciate Ligament Injuries in Female High School Athletes
Student Name
Leavitt School of Health, Western Governors University
D634: Health Sciences Capstone, Task 2
Course Instructor
Month Day, Year
Programs Work When Athletes Do Them: A Literature Review and Annotated Bibliography on Neuromuscular Training to Prevent Anterior Cruciate Ligament Injuries in Female High School Athletes
Purpose and Search Approach
This review examines the research on the capstone question: whether coach-delivered neuromuscular training reduces anterior cruciate ligament injuries for girls who play soccer and basketball in high school, and what determines whether such programs are used consistently. PubMed, CINAHL and SPORTDiscus were searched using combinations of anterior cruciate ligament, injury prevention, neuromuscular training, female athletes, adolescent and adherence or compliance. Sources were limited to peer-reviewed studies in English, with priority given to meta-analyses and randomized trials. Older landmark studies were included when later research depends on them. Six sources were selected for the annotated bibliography; together they address how large the risk is, whether prevention works and why it often fails in practice.
Theme One: The Size and Consequences of the Risk
The literature agrees that female athletes in sports with cutting and landing face higher risk than male athletes. A meta-analysis of incidence studies found that female athletes in contact sports, including soccer and basketball, had three times the injury rate of male athletes per exposure (Montalvo et al., 2019). The consequences are long lasting: a cohort of female soccer players had radiographic knee osteoarthritis in half of injured knees 12 years later, at a mean age of 31 (Lohmander et al., 2004). These studies justify prevention but have limits; incidence estimates depend on how exposures were counted, and the osteoarthritis cohort was Swedish and small.
Theme Two: Whether Prevention Works
Evidence that neuromuscular training reduces injury is strong and consistent. Webster and Hewett's (2018) combination of eight meta-analyses found a 50% reduction in all anterior cruciate ligament injuries and a 67% reduction in noncontact injuries among female athletes, with low variation between meta-analyses. The largest single randomized trial in the population of interest, a cluster randomized trial of 1,892 female soccer players aged 13 to 17, found that a structured warm-up lowered the risk of overall, overuse and severe injuries, although its primary outcome, all lower extremity injuries, did not reach statistical significance (Soligard et al., 2008). Together, these sources show that the programs are effective, particularly for noncontact injuries in girls, though evidence for boys is limited.
Theme Three: Why Programs Fail in Practice
The most important finding for this capstone is that effectiveness depends on use. A meta-analysis of six studies found that injury rates were substantially lower in studies with high compliance than in those with low compliance, suggesting a dose-response relationship (Sugimoto et al., 2012). Coaches determine compliance. In a cluster randomized trial in eight high schools, coaches who attended a 60-minute workshop were more likely to complete the full program and to correct athletes' technique than coaches who received only printed materials (Ling et al., 2022). The trial was small, with 21 teams, and measured adherence rather than injuries, but it identifies a practical lever: training coaches in person.
Quality of the Evidence and Gaps
The evidence for effectiveness is high quality, drawn from randomized trials and repeated meta-analyses. The evidence on implementation is thinner, drawn from smaller trials and observational studies. Gaps remain: few studies follow athletes over several seasons, most trials took place in soccer rather than basketball, few examine schools without athletic trainers, and little research measures cost. These gaps suggest that any solution should include measurement of compliance and injuries over time.
Annotated Bibliography
Each entry below states the study's purpose and method, its main findings, its strengths and limits, and how it bears on the capstone question.
Ling et al. (2022). In this cluster randomized trial, 21 high school teams in eight schools were assigned to a coach education workshop plus printed materials or printed materials alone. Across 399 observed sessions over two seasons, workshop coaches were more likely to complete the full program and gave more alignment cues. Strengths include randomization by school and direct observation; limits include the small sample and the lack of injury outcomes. It directly informs how the proposed solution should train coaches. It also suggests that printed materials alone, the approach most districts take now, are not enough.
Lohmander et al. (2004). This cohort study examined female soccer players 12 years after injury. Of 67 who underwent radiography, 51% had radiographic osteoarthritis, and most reported symptoms affecting quality of life, regardless of surgery. The sample was small and from one country, but the findings establish the long-term stakes and strengthen the case for prevention over treatment.
Montalvo et al. (2019). This systematic review and meta-analysis compared injury incidence by sex and sport type. Female athletes in contact sports had three times the rate of male athletes. It is the strongest source on relative risk, though pooled rates vary with how studies counted exposures. It supports the choice of population.
Soligard et al. (2008). This cluster randomized trial of 125 youth soccer clubs tested a structured warm-up among 1,892 girls. Severe and overall injuries fell, although the primary outcome was not significant. It is a well-designed trial in the target age group, and its warm-up is freely available, making it a practical model for Cedar Valley.
Sugimoto et al. (2012). This meta-analysis of six studies compared injury incidence by compliance with neuromuscular training and found much lower injury rates with high compliance. The number of studies is small and compliance was defined differently across them, but the finding is central to designing a solution that people will actually use.
Webster and Hewett (2018). This summary of eight meta-analyses found that prevention programs halve all anterior cruciate ligament injuries and reduce noncontact injuries in females by two-thirds. Overlap among included studies is a limitation, but the consistency of results makes it the strongest evidence on effectiveness and the foundation for the proposal.
Conclusion
The literature answers the first part of the research question clearly: neuromuscular training reduces anterior cruciate ligament injuries in female athletes. It answers the second part in a way that shapes the solution: programs work when athletes complete them consistently, and coaches who receive in-person training deliver them more completely. The proposal in the final task will therefore focus as much on coach training and compliance as on the exercises themselves.
References
Ling, D. I., Boyle, C., Schneider, B., Janosky, J., Kinderknecht, J., & Marx, R. G. (2022). Coach education improves adherence to anterior cruciate ligament injury prevention programs: A cluster-randomized controlled trial. Clinical Journal of Sport Medicine, 32(4), 348-354. https://doi.org/10.1097/JSM.0000000000000936
Lohmander, L. S., Östenberg, A., Englund, M., & Roos, H. (2004). High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis & Rheumatism, 50(10), 3145-3152. https://doi.org/10.1002/art.20589
Montalvo, A. M., Schneider, D. K., Webster, K. E., Yut, L., Galloway, M. T., Heidt, R. S., Kaeding, C. C., Kremcheck, T. E., Magnussen, R. A., Parikh, S. N., Stanfield, D. T., Wall, E. J., & Myer, G. D. (2019). Anterior cruciate ligament injury risk in sport: A systematic review and meta-analysis of injury incidence by sex and sport classification. Journal of Athletic Training, 54(5), 472-482. https://doi.org/10.4085/1062-6050-407-16
Soligard, T., Myklebust, G., Steffen, K., Holme, I., Silvers, H., Bizzini, M., Junge, A., Dvorak, J., Bahr, R., & Andersen, T. E. (2008). Comprehensive warm-up programme to prevent injuries in young female footballers: Cluster randomised controlled trial. BMJ, 337, a2469. https://doi.org/10.1136/bmj.a2469
Sugimoto, D., Myer, G. D., Bush, H. M., Klugman, M. F., McKeon, J. M. M., & Hewett, T. E. (2012). Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes: A meta-analysis. Journal of Athletic Training, 47(6), 714-723. https://doi.org/10.4085/1062-6050-47.6.10
Webster, K. E., & Hewett, T. E. (2018). Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of Orthopaedic Research, 36(10), 2696-2708. https://doi.org/10.1002/jor.24043
What the D634 Task 2 instructions ask
The second D634 task asks you to review the literature on your capstone question. Most versions ask for a description of how sources were found, a synthesis of the literature organized by themes, an assessment of the quality of the evidence and gaps, and an annotated bibliography. Sources should be credible and mostly peer-reviewed. Evaluators look for synthesis, where sources are compared and combined around themes, rather than summaries of one source after another. They also look for an honest assessment of how strong each finding is and what remains unknown, since that will shape the solution in Task 3. Some versions set a minimum number of sources.
How this D634 Task 2 example is built
The review begins with its search approach, naming databases and terms. Each theme has its own section that draws several sources together and states what they agree on. The first theme establishes risk and consequences, the second summarizes trials and meta-analyses on prevention, and the third explains why compliance matters, which becomes the key finding for the capstone. The quality section weighs designs and notes gaps. The annotated bibliography follows, with each entry structured the same way so the reader can compare sources. The conclusion answers the first part of the research question and names the gap the solution must address.
Where the D634 Task 2 rubric puts the marks
D634 Task 2 aspects are rated competent, approaching competence or not evident. A search aspect checks that the approach is described. A synthesis aspect rewards themes that combine sources. A quality aspect asks for evidence strength and gaps assessed. An annotation aspect looks for entries that summarize and evaluate each source. A relevance aspect wants the review connected to the research question. Evaluators notice when the review identifies the finding that shapes the solution, and they check APA formatting of references and annotations. Evaluators also look for the review to identify the gap that the solution will address, since that is how the capstone's three tasks connect. Reviews that weigh study designs, rather than treating all sources as equal, earn the quality aspect more easily.
D634 Task 2 help: what sends it back
Literature reviews come back most often when they summarize sources one by one. Organize by themes and compare studies within each. Second, the search is not described. Name databases, terms and criteria. Third, quality is not assessed. Say which designs support which conclusions. Fourth, annotations only summarize. Add strengths, limits and relevance. Finally, keep the capstone question in view. A review that wanders into related topics weakens the link to the solution you will propose next. Group your notes by theme before you start writing, not by source. Keep a table of each study's design and sample size so the quality section is easy to write, and cite every claim in the themes to at least one source.
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D634 Task 2 questions, answered
What goes in a D634 annotation?
The study's purpose and method, main findings, strengths and limits, and how it bears on your capstone question. The sample uses the same structure for every entry.
Should D634 Task 2 use meta-analyses?
Yes, where they exist, because they summarize many studies. The sample relies on meta-analyses for effectiveness and on individual studies for implementation and compliance. Note each one's included studies and date range.
Can D634 sources be older?
Older landmark studies can appear when they remain important, but most sources should be recent. The sample pairs recent reviews with a long-term study of knee outcomes.
How is D634 Task 2 organized?
By themes that answer parts of the research question, followed by an annotated bibliography. The sample uses three themes: risk, effectiveness and compliance. Each theme answers part of the question.
Where can I find a free D634 Task 2 sample paper?
The literature review and annotated bibliography are on this page with notes. Send your D634 task and research question for a first tailored review at no charge.