Are Irish Sporting Organisations Neglecting the Safety of Their Athletes? A Narrative Review on Concussion Return-to-Play Protocols

Introduction: Concussion can vary in presentation and requires an individualised clinical assessment and so, it is imperative that the appropriate return to play (RTP) protocols are administered to facilitate the safe recovery of an athlete prior to their return to sport. A 2014 report by the Houses of the Oireachtas (Parliament) Joint Committee on Health and Children (JCHC) proposed several recommendations to tackle issues with current concussion management policies in Ireland. Aims: The aim of this narrative review is to provide an in depth comparative analysis of Irish sporting organisations’ concussion RTP protocols and to assess their compliance with the JCHC’s recommended RTP proposals. Materials & Methods: Fifteen organisations were eligible for review under the inclusion criteria. Information on their RTP protocols was gathered from their official websites and through direct communication with relevant representatives from each organisation. Results: Whilst the majority of the RTP protocols bear resemblance to recent international consensus guidelines, there is a lack of consistency, clarity and detail across the approaches. Key areas in the RTP management of an athlete appear neglected; essential domains are underdeveloped for athletes, coaches and parents such as instructions pertaining to cognitive rest, return-to-learn (RTL), return-to-work (RTW) accommodations and the impact of concussion modifiers. Conclusion: The findings of this review weigh heavily in favour of the establishment of a specialised national “Sports related Concussion (SRC) Taskforce” to regulate the management of concussion in Ireland. Further research needs to be undertaken to evaluate the efficacy of an educational intervention in the graded return-to-play (GRTP) of an athlete.