There is a growing concern around concussions in rugby union, at all levels of the game. These concerns highlight the need to better manage and care for players. However, consistency around concussion-related responsibilities of stakeholders across the community rugby system remains challenging. Taking a systems thinking approach, this pragmatic, qualitative descriptive study explored key stakeholder groups within New Zealand's community rugby system's perceptions of their own and others' concussion-related responsibilities. Participants included players from schools and clubs, coaches, parents, team leads and representatives from four provincial unions. A total of 155 participants (67 females and 88 males) were included in the study. Focus groups and individual interviews were conducted. Thematic content analysis was used to analyse data. Thirty concussion-related responsibilities were identified. These responsibilities were contained within four themes: (1) policies and support (responsibilities which influence policy, infrastructure, human or financial resources); (2) rugby culture and general management (responsibilities impacting players' welfare and safety, attitudes and behaviour, including education, injury reporting and communication); (3) individual capabilities (responsibilities demonstrating knowledge and confidence managing concussion, leadership or role/task shifting) and (4) intervention following a suspected concussion (immediate responsibilities as a consequence of a suspected concussion). The need for role clarity was a prominent finding across themes. Additionally, injury management initiatives should prioritise communication between stakeholders and consider task-shifting opportunities for stakeholders with multiple responsibilities. How concussions will realistically be managed in a real-world sports setting and by whom needs to be clearly defined and accepted by each stakeholder group. A 'framework of responsibilities' may act as a starting point for discussion within different individual community rugby contexts on how these responsibilities translate to their context and how these responsibilities can be approached and assigned among available stakeholders.
Rugby Union requires annual baseline testing using the Sports Concussion Assessment Tool (SCAT5) as part of its head injury assessment protocols. Scores achieved during baseline testing are used to guide return-to-play decisions at the time of head impact events during matches, and concussion diagnosis during subsequent diagnostic screens. Baseline values must be valid, accurate representations of a player's capability in the various SCAT5 sub-modes, including symptom report, cognitive function and balance. The extent to which prior exercise may affect performance is an important consideration, and the present cross-sectional study aimed to explore how SCAT5 performance differs when assessed at rest (RSCAT) compared to after 30 min of exercise (EXSCAT) in 698 male professional rugby players for whom paired exercise and rest SCAT5 data were available.Symptom endorsement was greater when assessed after exercise than at rest. Fatigue/Low energy was 1.5 times more likely to be reported when assessed during EXSCAT. Orientation score was improved during SCAT5s performed after exercise, but only when rest and exercise SCAT5s were conducted on the same day, suggesting a learning effect. Concentration score was impaired during EXSCAT. No other cognitive sub-modes were affected by exercise. Total errors during Modified Balance Error Scoring System (MBESS) increased during EXSCAT, as a result of increased errors made during single leg balance, irrespective of testing sequence, with 42% of players making more errors in EXSCAT, compared to 28% making more errors in RSCAT.Symptoms, cognitive sub-modes and balance sub-modes are all affected by exercise. These may be the result of learning effects that improve cognitive performance, and the direct effects of exercise on sub-mode performance. The clinical implications of these changes may be assessed in the future through a study of diagnostic screens in players after head impact events, to confirm whether an exercise baseline screen is required annually, or whether specific sub-modes of the SCAT5 should be obtained at rest and after exercise.
Abstract Rugby Sevens (‘Sevens’) is one of the fastest growing sports in the world. This growth was marked by the inclusion of the sport in the Olympic Games in 2016. The most frequently occurring contact events in Sevens are the tackle and ruck. Performing specific techniques during these contact events can reduce the risk of injury and increase the likelihood of success. Therefore, the purpose of this study was to identify the technical determinants associated with tackle and ruck performance outcomes in Sevens. A total of 4799 tackles and 1405 rucks from the 2014/2015 HSBC Sevens World Series were coded for contact, post‐contact, ruck, match contextual variables and outcomes. Relative risk ratio (RR), the ratio of the probability of an outcome occurring when a variable was observed, was determined using multinomial logistic regression. A moderate ball‐carrier leg drive reduced the probability of losing possession by 25% (RR 0.75, 95% CI, 0.58–0.97, p < .05). Conversely, ball‐carriers had a 53% higher likelihood of losing possession when the tackler executed a moderate leg drive (RR 1.53, 95% CI, 1.09–2.14, p ≤ .05). Maintaining possession at the ruck was more likely to occur when committing one attacker compared to two (RR 0.31, 95% CI, 0.19–0.49, p < .001). Active ball‐carrier placement also increased the likelihood of maintaining possession at the ruck (RR 14.67, 95% CI, 9.55–22.56, p < .001). Sevens coaches and trainers can now positively design evidence‐based technical training programmes and emphasise specific tackle techniques in training using data from Sevens video analysis. Also, given that this is the first study to relate tackle technical determinants to an outcome (i.e. the first ‘how’ study) in Sevens, this work provides the foundation for similar Sevens video analysis studies in the future.
South Africa is home to an estimated 53 million people, 400 000 of whom play rugby union (‘rugby’) (www.worldrugby.com). Although rare, rugby can be associated with permanently disabling injuries, which are tragic for the player and their family and also negative for the sport’s image.1 To reduce these injuries, a nationwide injury prevention programme, called ‘BokSmart’ (www.boksmart.com), was launched in South Africa in 2009.
Due to its vast socioeconomic disparities, South Africa is a difficult context for the implementation of any health intervention, let alone injury prevention programmes. South Africa ranks as the most inequitable country in the world (www.data.worldbank.org). Moreover, this inequity extends to healthcare: a recent report indicated that the poorest quintile of South Africans receive <10% of the country’s health benefits despite requiring close to 40% of these services, according to their self-reported health (figure 1).2 This disparity is partly due to infrastructure deficiencies in under-resourced communities. For example, rugby coaches in low socioeconomic areas mentioned infrastructure-related barriers to implementing BokSmart that were not mentioned by coaches from high socioeconomic areas.3 The fact that the same programme/strategy is implemented into different …
Though rare, rugby union carries a risk for serious injuries such as acute spinal cord injuries (ASCI), which may result in permanent disability. Various studies have investigated injury mechanisms, prevention programmes and immediate medical management of these injuries. However, relatively scant attention has been placed on the player's experience of such an injury and the importance of context.The aim of this study was to explore the injury experience and its related context, as perceived by the catastrophically injured player.A qualitative approach was followed to explore the immediate, postevent injury experience. Semi-structured interviews were conducted with 48 (n=48) players who had sustained a rugby-related ASCI.Four themes were derived from the data. Participants described the context around the injury incident, which may be valuable to help understand the mechanism of injury and potentially minimise risk. Participants also described certain contributing factors to their injury, which included descriptions of foul play and aggression, unaccustomed playing positions, pressure to perform and unpreparedness. The physical experience included signs and symptoms of ASCI that is important to recognise by first aiders, fellow teammates, coaches and referees. Lastly, participants described the emotional experience which has implications for all ASCI first responders.All rugby stakeholders, including players, first responders, coaches and referees, may gain valuable information from the experiences of players who have sustained these injuries. This information is also relevant for rugby safety initiatives in shaping education and awareness interventions.
Objectives This study assessed whether concussion affects subsequent baseline performance in professional rugby players. Annual baseline screening tests are used to guide return-to-play decisions and concussion diagnosis during subsequent screens. It is important that baseline performances are appropriate and valid for the duration of a season and unaffected by factors unrelated to the current head impact event. One such factor may be a concussion following baseline assessment. Setting The World Rugby concussion management database for global professional Rugby Union. Participants 501 professional rugby players with two baseline Sports Concussion Assessment Tools (SCATs) and an intervening concussion (CONC) were compared with 1190 control players with successive annual SCAT5s and no diagnosed concussion (CONT). Primary and secondary outcome measures Symptom endorsement, cognitive and balance performance during annual SCAT baseline assessments. Results Players with a diagnosed concussion (CONC) endorsed fewer symptoms (change −0.42, 95% CI −0.75 to −0.09), and reported lower symptom severity scores during their second assessment (T2, p<0.001) than non-concussed players (CONT). Concussed players also improved Digits Backward and Final Concentration scores in T2 (p<0.001). Tandem gait time was improved during T2 in CONT. No other sub-mode differences were observed in either group. Conclusions Reduced symptom endorsement and improved cognitive performance after concussion may be the result of differences in the motivation of previously concussed players to avoid exclusion from play, leading to under-reporting of symptoms and greater effort in cognitive tests. Improved cognitive performance may be the result of familiarity with the tests as a result of greater exposure to concussion screening. The changes are small and unlikely to have clinical significance in most cases, though clinicians should be mindful of possible reasons, possibly repeating sub-modes and investigating players whose baseline scores change significantly after concussion. The findings do not necessitate a change in the sport’s concussion management policy.
The high injury rate associated with rugby union is primarily due to the tackle, and poor contact technique has been identified as a risk factor for injury. We aimed to determine whether the tackle technique proficiency scores were different in injurious tackles versus tackles that did not result in injury using real-match scenarios in high-level youth rugby union.Injury surveillance was conducted at the under-18 Craven Week tournaments (2011-2013). Tackle-related injury information was used to identify injury events in the match video footage and non-injury events were identified for the injured player cohort. Injury and non-injury events were scored for technique proficiency and Cohen's effect sizes were calculated and the Student t test (p<0.05) was performed to compare injury versus non-injury scores.The overall mean score for front-on ball-carrier proficiency was 7.17±1.90 and 9.02±2.15 for injury and non-injury tackle events, respectively (effect size=moderate; p<0.05). The overall mean score for side/behind ball-carrier proficiency was 4.09±2.12 and 7.68±1.72 for injury and non-injury tackle events, respectively (effect size=large; p<0.01). The overall mean score for front-on tackler proficiency was 7.00±1.95 and 9.35±2.56 for injury and non-injury tackle events, respectively (effect size=moderate; p<0.05). The overall mean score for side/behind tackler proficiency was 5.47±1.60 and 8.14±1.75 for injury and non-injury tackle events, respectively (effect size=large; p<0.01).Higher overall mean and criterion-specific tackle-related technique scores were associated with a non-injury outcome. The ability to perform well during tackle events may decrease the risk of injury and may manifest in superior performance.
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