Return-to-play after concussion: state of knowledge, frequency of use and application barriers of guidelines among decision-makers in rugby

Abstract

Validated strategies and guidelines for a safe and individualized diagnosis and return-to-play (RTP) after concussion in rugby are needed. Little is known about the state of knowledge, frequency of use and application barriers of state-of-the-art guidelines among decision-makers in professional or semi-professional rugby teams. Participants (n = 195) from the coaching team (head coach, assistance coach, athletic coach), the medical team (physiotherapist, physician, rehabilitation therapist, neuropsychologist), or from the officials of a professional or semi-professional rugby team (top three major leagues in Germany), filled in a questionnaire on their knowledge, frequency of use and application barriers of evidence-based guidelines (Graduated RTP protocol and The 5R). Depending on their function in the team and on the league of play, the state of knowledge and application of the diagnostic tools and the RTP guidelines differ. A considerable number are aware of one or both guidelines, but do not apply these guidelines (up to 27% of respondants). The main reasons for the non-usage were not my decision (59%), use of concurrent guidelines (54%), each player must decide by his own (36%), never experienced a concussion in my players (30%), other (19%), the guideline is useless (18%) and a player may play despite a concussion (14%). Raising awareness of the state-of-the-art guidelines is important to educate further the coaching, medical and official team members in identifying symptoms and executing the RTP-process in accordance with evidence-based strategies.

Sport-related concussion practices of medical team staff in elite football in the United Kingdom, a pilot study

“…Awareness of concussion guidance is now much higher than in 2009, when 27.8% of English football doctors were aware of the 2008 Zurich Consensus Statement (Price et al 2012). However, awareness of guidelines did not infer application of guidance, with the majority of English football team medical staff in 2009 not routinely following concussion guidelines (Price et al 2012;Niederer et al 2018). A disconnect between recommendations and implementation has been found in other areas of player care including injury prevention programs (Bahr et al 2015; Bizzini and Dvorak 2015).…”

Sleep/Wake Disorders After Sports Concussion: Risks, Revelations, and Interventions

“…11,65 Emerging data suggest that a symptom-limited activity, including activities of daily living and noncontact aerobic exercise, may begin after a 24 to 48 hours of cognitive and physical relative rest. [66][67][68] Figure 3 shows a graduated return to sport strategy. 66,67 A graduated return to learning is also worthy of consideration including extension of assignment deadlines, rest periods during the school day, postponement or staggering of test, and accommodation for light or noise sensitivity.…”

“…[66][67][68] Figure 3 shows a graduated return to sport strategy. 66,67 A graduated return to learning is also worthy of consideration including extension of assignment deadlines, rest periods during the school day, postponement or staggering of test, and accommodation for light or noise sensitivity. 68…”

More than rugby: A scoping review of coaches in rugby

“…Forty-four of these studies reported male coaches (n = 44), 36,46,50,51,53,56,62,66-68,71,73,76,80,89,92-97, 99-101,103-105,107-110,112,115,117-121,123-126,128 only three (n = 3) studies reported female coaches and 18 studies (n = 18) reported both male and female coaches in their studies. 29,32,35,38,39,55,57,58,60,65,70,72,84,87,90,113,114,130 Most of the studies focused on coaches within rugby union (n = 80, 76%) 18,29-42,44-55,57,58,61,63,69,70,73-80,82-90, 92-95,99-110,112,115-117,119,120,123,124,126-129,131 and rugby league (n = 14, 14%). 43,56,59,60,62,64,[66][67][68]71,81,91,121,125 The remainder of the studies focused on a combination of rugby cohorts (n = 4, 4%), [96][97][98]114 and only one study focused on rugby sevens (n = 1, 1%).…”

“…111 Five studies did not specify the type of rugby (n = 5, 5%). 72,113,118,122,132 Only two studies specifically investigated coaches working in women's rugby (n = 2, 2%). 31,48 Thirty-three percent (n = 35, 33%) of studies were on youth rugby only, 52% (n = 55, 52%) on senior rugby, nine percent (n = 9, 9%) on both youth and senior rugby and the remaining percentage of the studies did not specify.…”