Wearables in rugby union: A protocol for multimodal digital sports-related concussion assessment

Abstract

Background Pragmatic challenges remain in the monitoring and return to play (RTP) decisions following suspected Sports Related Concussion (SRC). Reliance on traditional approaches (pen and paper) means players readiness for RTP is often based on self-reported symptom recognition as a marker for full physiological recovery. Non-digital approaches also limit opportunity for robust data analysis which may hinder understanding of the interconnected nature and relationships in deficit recovery. Digital approaches may provide more objectivity to measure and monitor impairments in SRC. Crucially, there is dearth of protocols for SRC assessment and digital devices have yet to be tested concurrently (multimodal) in SRC rugby union assessment. Here we propose a multimodal protocol for digital assessment in SRC, which could be used to enhance traditional sports concussion assessment approaches. Methods We aim to use a repeated measures observational study utilising a battery of multimodal assessment tools (symptom, cognitive, visual, motor). We aim to recruit 200 rugby players (male n≈100 and female n≈100) from University Rugby Union teams and local amateur rugby clubs in the North East of England. The multimodal battery assessment used in this study will compare metrics between digital methods and against traditional assessment. Conclusion This paper outlines a protocol for a multimodal approach for the use of digital technologies to augment traditional approaches to SRC, which may better inform RTP in rugby union. Findings may shed light on new ways of working with digital tools in SRC. Multimodal approaches may enhance understanding of the interconnected nature of impairments and provide insightful, more objective assessment and RTP in SRC. Clinical trial registration NCT04938570. https://clinicaltrials.gov/ct2/results?cond=NCT04938570&term=&cntry=&state=&city=&dist=

Diagnostic tools for return-to-play decisions in sports-related concussion

“…The limited evidence base suggests that more powerful and standardised studies are needed to improve our knowledge. A holistic impression is provided by the protocol of Powell et al 41 in a repeated measures observational study using a range of multimodal assessment tools (symptom, cognitive, visual, and motor). Morris et al 37 protocol, using the push-and-release test, attempts to examine reactive postural responses to balance restoration in athletes.…”

“…Preventing this could be via a combination of different approaches. Using, for example, Powell's et al 41 protocol, may enhance sensitivity and objectivity of measures used to make activity removal-decisions, support diagnose SRC, and make RTP decisions.…”

A deep learning-based approach to diagnose mild traumatic brain injury using audio classification

“…Athletes were subsequently diagnosed with an mTBI by a medical doctor or physiotherapist through SCAT5 administration (within 8.2 ± 6.4 days of head impact). The inclusion and exclusion criteria for this study are from a multi-modal mTBI assessment protocol [ 35 ], Table 1 .…”

Considerations for integrating wearables into the everyday healthcare practice

“…The conclusion and insights from that perspective reflected that advancements in wearable technology are facilitating data capture trends greater than just superficial activity monitoring. More interestingly, data capture on disease monitoring and progression is becoming feasible with previous research demonstrating the wide utility wearables can have in a variety of health conditions from Parkinson’s disease to mild traumatic brain injury, with new opportunities afforded during remote assessment 8 – 12 . Taking the leap of routinely using wearables (of any description) in everyday clinical life across the spectrum of the medical profession is still premature but methodologies to enable transition from research playthings to care solutions are being proposed 13 – 15 .…”