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West SW, Shill IJ, Bailey S, Syrydiuk RA, Hayden KA, Palmer D, Black AM, Hagel BE, Stokes KA, Emery CA. Injury Rates, Mechanisms, Risk Factors and Prevention Strategies in Youth Rugby Union: What's All the Ruck-Us About? A Systematic Review and Meta-analysis. Sports Med 2023; 53:1375-1393. [PMID: 37191819 PMCID: PMC10290028 DOI: 10.1007/s40279-023-01826-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Rugby Union is a collision team sport played globally. Despite this, significant concerns have been raised regarding the sport's safety, particularly in youth players. Given this, a review of injury rates, risk factors and prevention strategies is required across different youth age groups as well as in males and females. OBJECTIVE The objective of this systematic review (SR) and meta-analysis was to investigate injury and concussion rates, risk factors and primary prevention strategies in youth rugby. METHODS To be included, studies were required to report either rates, risk factors or prevention strategies in youth rugby and to have a randomised controlled trial, quasi-experimental, cohort, case control, or ecological study design. Exclusion criteria included non-peer-reviewed grey literature, conference abstracts, case studies, previous systematic reviews and studies not written in English. Nine databases were searched. The full search strategy and list of sources are available and pre-registered on PROSPERO (Ref: CRD42020208343). Each study was assessed for risk of bias using the Downs and Black quality assessment tool. Meta-analyses were conducted using a DerSimonian Laird random effect model for each age group and sex. RESULTS Sixty-nine studies were included in this SR. The match injury rates (using a 24-h time-loss definition) were 40.2/1000 match hours (95% CI 13.9-66.5) in males and 69.0/1000 match hours (95% CI 46.8-91.2) in females. Concussion rates were 6.2/1000 player-hours (95% CI 5.0-7.4) for males and 33.9/1000 player-hours (95% CI: 24.1-43.7) for females. The most common injury site was lower extremity (males) and the head/neck (females). The most common injury type was ligament sprain (males) and concussion (females). The tackle was the most common event associated with injury in matches (55% male, 71% females). Median time loss was 21 days for males and 17 days for females. Twenty-three risk factors were reported. The risk factors with the strongest evidence were higher levels of play and increasing age. Primary injury prevention strategies were the focus of only eight studies and included law changes (n = 2), equipment (n = 4), education (n = 1) and training (n = 1). The prevention strategy with the most promising evidence was neuromuscular training. The primary limitations included a broad range of injury definitions (n = 9) and rate denominators (n = 11) used, as well as a limited number of studies which could be included in the meta-analysis for females (n = 2). CONCLUSION A focus on high-quality risk factor and primary prevention evaluation should be considered in future studies. Targeting primary prevention and stakeholder education remain key strategies in the prevention, recognition and management of injuries and concussions in youth rugby.
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Affiliation(s)
- Stephen W West
- Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, Bath, UK.
- UK Collaborating Centre on Injury & Illness Prevention in Sport (UKCCIIS), Edinburgh & Bath, UK.
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada.
- O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.
| | - Isla J Shill
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Stuart Bailey
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Reid A Syrydiuk
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, USA
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Canada
| | - Debbie Palmer
- UK Collaborating Centre on Injury & Illness Prevention in Sport (UKCCIIS), Edinburgh & Bath, UK
- Edinburgh Sports Medicine Research Network, Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, UK
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Amanda M Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Brent E Hagel
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Keith A Stokes
- Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, Bath, UK
- UK Collaborating Centre on Injury & Illness Prevention in Sport (UKCCIIS), Edinburgh & Bath, UK
- Rugby Football Union, Twickenham, London, UK
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- O'Brien Institute of Public Health, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Cunningham J, O'Dowd A, Broglio SP, Newell FN, Kelly Á, Joyce O, Januszewski J, Wilson F. Multisensory perception is not influenced by previous concussion history in retired rugby union players. Brain Inj 2022; 36:1123-1132. [PMID: 35994241 DOI: 10.1080/02699052.2022.2109732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND To assess whether concussion history adversely affects multisensory integration, we compared susceptibility to the Sound-Induced Flash Illusion (SIFI) in retired professional rugby players compared to controls. METHODS Retired professional rugby players ((N = 58) and retired international rowers (N = 26) completed a self-report concussion history questionnaire and the SIFI task. Susceptibility to the SIFI (i.e., perceiving two flashes in response to one flash paired with two beeps) was assessed at three stimulus onset asynchronies (70 ms, 150 ms or 230 ms).Logistic mixed-effects regression modeling was implemented to evaluate how athlete grouping, previous concussion history and total number of years playing sport, impacted the susceptibility to the SIFI task. The statistical significance of a fixed effect of interest was determined by a likelihood ratio test. RESULTS Former rugby players had significantly more self-reported concussions than the rower group (p < 0.001). There was no impact of athlete grouping (i.e., retired professional rugby players and retired international rowers), years participation in elite sport or concussion history on performance in the SIFI. CONCLUSION A career in professional rugby, concussion history or number of years participating in professional rugby was not found to be predictive of performance on the SIFI task.
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Affiliation(s)
- Joice Cunningham
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Alan O'Dowd
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Steven P Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Fiona N Newell
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Áine Kelly
- Department of Physiology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Oisín Joyce
- Department of Physiology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Julia Januszewski
- School of Psychology and Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Fiona Wilson
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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John Taft S, Ennion L. Prevalence of concussion and adherence to return-to-play guidelines amongst male secondary school rugby and hockey players. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1477. [PMID: 33604476 PMCID: PMC7876965 DOI: 10.4102/sajp.v77i1.1477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 10/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background Concussion injuries are common in contact sports. Young players can suffer life-threatening complications if concussion is not recognised and managed. Objectives To determine the prevalence of concussion amongst secondary school rugby and hockey players and describe players’ knowledge and adherence to return-to-play guidelines. Method A mixed-method approach included Phase A, which utilised a questionnaire completed by 221 players (n = 139 rugby; n = 82 hockey) between 13 and 18 years of age, and Phase B, which utilised three focus group discussions of 15 participants who had suffered a concussion. Results The prevalence of concussion (n = 221) was 31.2% (n = 69). Of those, 71% (n = 49) were rugby players. Those who had suffered a concussion were more confident in identifying symptoms of concussion in themselves and others compared with those who did not suffer a concussion (p = 0.001), were more aware of return-to-play guidelines and more confident in their knowledge of concussion (p = 0.001). There were no differences between groups when identifying concussion symptoms. Of those who had a concussion, 30.4% (n = 21) adhered to return-to-play guidelines and followed graded return-to-play after their concussion. Explanations for non-adherence to return-to-play protocols included peer pressure, intrinsic motivation and ignorance. Conclusion Nearly a third had suffered a concussion injury; having suffered a concussion, and awareness of return-to-play guidelines, did not guarantee adherence to return-to-play protocols. Peer pressure and intrinsic factors explained this lack of adherence. Clinical implications Physiotherapists are often involved with the diagnosis and management of concussion injuries among rugby and hockey players. Understanding the prevalence and the reasons why young players do not adhere to the ‘return to play’ guidelines may inform preventative strategies.
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Affiliation(s)
- St John Taft
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Liezel Ennion
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Kung SM, Suksreephaisan TK, Perry BG, Palmer BR, Page RA. The Effects of Anticipation and Visual and Sensory Performance on Concussion Risk in Sport: A Review. SPORTS MEDICINE-OPEN 2020; 6:54. [PMID: 33196878 PMCID: PMC7669979 DOI: 10.1186/s40798-020-00283-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022]
Abstract
Sports-related concussions pose a significant public health concern, and preventative measures are needed to help reduce risk in sport. Vision training could be a suitable prevention strategy for sports-related concussion to help improve athletes’ abilities to scan the visual field for oncoming objects or opponents and thus anticipate head impacts. By accurately anticipating impacts, athletes can prepare for impact or attempt to avoid the collision altogether. The purpose of this review is to explore the relationships between anticipation, visual and sensorimotor performance and head accelerations, as well as to examine the efficacy of vision training programmes in reducing concussion risk in sport. Anticipation of head impacts has been shown to help reduce linear and rotational head accelerations, particularly for mild-to-moderate severity head impacts, but less so for severe head impacts. There is conflicting evidence regarding the influences visual and sensorimotor performance and oculomotor behaviour have on concussion risk. However, preliminary research indicates vision training may help reduce concussion rates in collegiate American Football players. Therefore, this promising area of research warrants further investigation, particularly the role of anticipation and visual and sensory performance on reducing concussion risk in non-helmeted contact sports.
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Affiliation(s)
- Stacey M Kung
- School of Sport, Exercise & Nutrition, Massey University, Wellington, New Zealand
| | | | - Blake G Perry
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Barry R Palmer
- School of Health Sciences, Massey University, Wellington, New Zealand
| | - Rachel A Page
- School of Health Sciences, Massey University, Wellington, New Zealand.
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Abstract
Nowadays, the number of people practising contact sports has increased. In many of them, using head protective equipment is not mandatory, even if the use of headbands could increase the level of safety regarding several types of traumatic brain injuries. Many commercial solutions are currently available, based on plastic-based foams providing a decent level of protection and comfort to the user. This work introduces the use of agglomerated cork as an eco-friendly alternative to synthetic foams but at least keeping safety levels. Cork is a natural cellular material that has been showing excellent crashworthiness properties. In this study, cork agglomerate density is carefully chosen to be incorporated into a protective headband. Results are compared against three other commercial headbands. For each one, the risk of brain injury was analysed for different injury thresholds and impact energies. The results clearly demonstrate that the cork-based apparel may provide comparable, and in some cases, better performances, outlasting the commercial ones.
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Holmes G, Clacy A, Salmon PM. Sports-related concussion management as a control problem: using STAMP to examine concussion management in community rugby. ERGONOMICS 2019; 62:1485-1494. [PMID: 31390942 DOI: 10.1080/00140139.2019.1654134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 07/20/2019] [Indexed: 06/10/2023]
Abstract
The effective management of sports-related concussion is an on-going problem in amateur sport due to a number of systemic issues. These factors have often been studied in isolation with minimal consideration for the interactions between them, or the overall system in which they occur. The aim of this research was to model the actors, controls, and feedback mechanisms influencing the management of concussion in community rugby union using the Systems-Theoretic Accident Model and Processes (STAMP) method. Findings show that there are currently many inadequate controls, that are directly and indirectly impacting effective concussion management. The practical implications of these findings are discussed (e.g. improved guideline education, mandatory medical presence, rule amendments). Additionally, the model provides a sound framework similar team sports can use to inform research into injury management and prevention (e.g. rugby league, hockey, AFL). Practitioner Summary: Research shows that concussion management in regional sport is inconsistent due to contextual limitations. Systems-Theoretic Accident Model and Processes was applied to identify the systemic factors currently influencing concussion management practices in community sport. Findings show inadequate controls precipitate concussion management gaps. Practical implications of the findings are discussed.
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Affiliation(s)
- Glenn Holmes
- Sunshine Coast Mind & Neuroscience - Thompson Institute, University of the Sunshine Coast , Sippy Downs , Queensland , Australia
| | - Amanda Clacy
- Sunshine Coast Mind & Neuroscience - Thompson Institute, University of the Sunshine Coast , Sippy Downs , Queensland , Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast , Sippy Downs , Queensland , Australia
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7
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Tierney GJ, Denvir K, Farrell G, Simms CK. Does ball carrier technique influence tackler head injury assessment risk in elite rugby union? J Sports Sci 2018; 37:262-267. [DOI: 10.1080/02640414.2018.1494952] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gregory J Tierney
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
| | | | | | - Ciaran K Simms
- Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
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8
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Cunningham J, Broglio S, Wilson F. Influence of playing rugby on long-term brain health following retirement: a systematic review and narrative synthesis. BMJ Open Sport Exerc Med 2018; 4:e000356. [PMID: 29719729 PMCID: PMC5926651 DOI: 10.1136/bmjsem-2018-000356] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 12/14/2022] Open
Abstract
Objectives The aim of this review was to systematically investigate long-term brain health in retired rugby players. Methods Six databases were systematically searched from inception to January 2018 using Medical Subject Headings and keywords. Two reviewers independently screened studies for inclusion. Cross-sectional studies of living retired male or female rugby players in which at least one cognitive test was used as an outcome measure were included. Data extraction was performed using Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodological quality was assessed independently by two reviewers using the Downs and Black methodological quality tool. Results This review yielded six studies with an overall methodological quality of 'moderate'. A total of 672 male retired rugby players (mean ages of 38-52 years) were included in this review. Three studies investigated neuropsychological functioning in retired rugby players in comparison with controls, with no significant evidence of decreased performance in the majority of tests when compared with controls. Five out of the six studies explored self-reported measures of cognition. Three studies compared retired rugby players to controls, one of which found significantly increased subjective cognitive complaints among retired rugby players. The other two studies found that persistent postconcussion symptoms were associated with a higher number of self-reported concussions. Two studies reported decreased fine motor control in retired rugby players in comparison with controls. Neurometabolites and electrophysiological changes were explored by two studies, with minimal and non-significant findings. Conclusions Overall findings are mixed. Methodological biases reduce the overall study quality and limited the conclusions that can be drawn. Findings of decreased fine motor control in retired athletes may be influenced by lack of controlling for evidence of upper limb musculoskeletal injuries. While some studies show evidence of reduced cognitive function among former athletes, the results are not significantly lower than population norms. Cognitive findings from this review are inconsistent within and across study cohorts and are biased towards positive findings when self-report methods were selected. Current evidence suggests that large gaps remain in the understanding of the cause-and-effect relationships between playing rugby and long-term brain health in retired players.
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Affiliation(s)
- Joice Cunningham
- Department of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Centre for Learning and Development, Trinity Centre, St. James's Hospital, Dublin, Ireland
| | - Steven Broglio
- Departments of Neurology and Physical Medicine and Rehabilitation, University of Michigan in the School of Kinesiology, Ann Arbor, Michigan, USA.,Neuro Trauma Research Laboratory, Ann Arbor, Michigan, USA
| | - Fiona Wilson
- Department of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Centre for Learning and Development, Trinity Centre, St. James's Hospital, Dublin, Ireland
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Fischer JD, Smith GH, Rodrigues RS, Afzal MR, van den Heever DJ, Viviers PL, Viljoen JT. Concussion management application for amateur sports. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2594-2597. [PMID: 29060430 DOI: 10.1109/embc.2017.8037388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Concussion management has become one of the most popular topics in sports medicine. Significant resources are being invested in developing protocols for professional sport associations such as the NFL and FIFA. These protocols are often expensive and require substantial resources to implement. The problem, however, runs much deeper than just professional sports. Currently there exists little infrastructure to effectively manage concussion in amateur settings such as high school, club and university sport. A more holistic approach is required to ensure that the same standard of concussion management is being implemented across the board, regardless of the available medical and financial resources. An application was developed that will allow for easily accessible baseline testing and access to a player's concussion history from anywhere in the world. The application will be used to monitor players from the day they start playing sport until they potentially become professional sport players.
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Martin RK, Hrubeniuk TJ, Witiw CD, MacDonald P, Leiter J. Concussions in Community-Level Rugby: Risk, Knowledge, and Attitudes. Sports Health 2017; 9:312-317. [PMID: 28661825 PMCID: PMC5496701 DOI: 10.1177/1941738117695777] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rugby is a popular collision sport where participants are at risk of sustaining concussions. Most research focuses on elite-level or youth divisions. Comparatively, little is known about adult community rugby. The aim of this research was to estimate the risk of sustaining a concussion during participation in community-level rugby and summarize the collective knowledge and attitudes toward concussions. HYPOTHESIS Concussion symptoms will be reported frequently among community-level rugby players and a substantial proportion will report a willingness to continue participation despite the risk. STUDY DESIGN Cross-sectional analysis. LEVEL OF EVIDENCE Level 3. METHODS An anonymous, voluntary survey was administered to all 464 senior rugby players registered in the province of Manitoba in 2015. Two primary domains were assessed: (1) concussion history from the preceding season including occurrence, symptomatology, and impact on daily activities and (2) knowledge and attitudes toward concussion risks and management. RESULTS In total, 284 (61.2%) rugby players responded. Concussive symptoms were reported by 106 (37.3%). Of those, 87% were formally diagnosed with a concussion and 27% missed school and/or work as a result. The danger of playing while symptomatic was recognized by 93.7% of participants, yet 29% indicated they would continue while symptomatic. Furthermore, 39% felt they were letting others down if they stopped playing due to a concussion. CONCLUSION Concussive symptoms were common among the study cohort and had a notable impact on daily activities. A high proportion of players were willing to continue while experiencing symptoms despite recognizing the danger. The observed discord between knowledge and attitudes implicates a culture of "playing injured." CLINICAL RELEVANCE Understanding the risk of injury may affect an individual's decision to participate in community-level rugby. Moreover, evidence of discord between the knowledge and attitudes of players may direct future research initiatives and league governance.
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Affiliation(s)
- R Kyle Martin
- Pan Am Clinic, Winnipeg, Manitoba, Canada.,Section of Orthopaedics, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Travis J Hrubeniuk
- Pan Am Clinic, Winnipeg, Manitoba, Canada.,Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter MacDonald
- Pan Am Clinic, Winnipeg, Manitoba, Canada.,Section of Orthopaedics, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeff Leiter
- Pan Am Clinic, Winnipeg, Manitoba, Canada.,Section of Orthopaedics, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada
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Watts AD, Shuttleworth-Edwards AB. Neuropsychology in South Africa: confronting the challenges of specialist practice in a culturally diverse developing country. Clin Neuropsychol 2016; 30:1305-1324. [PMID: 27650491 DOI: 10.1080/13854046.2016.1212098] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE This was an invited paper on the history and current status of neuropsychology in South Africa. METHOD Information was gathered from literature searches, personal communication, and the authors' experiences while occupying relevant professional and academic positions for over 30 years. RESULTS Since its origins in the 1950s, the development of neuropsychology in South Africa has faced numerous challenges, against a background of extreme sociocultural and socioeconomic disparity in the country that is on-going. The creation of the South African Clinical Neuropsychological Society in the 1980s, a credentialing and training body, gave impetus to the discipline. In the absence of a neuropsychology category within the South African professional framework, university instruction has been ad hoc with vastly different levels of competency depending on the institution involved. The small number of practitioners and/or academics involved in neuropsychology includes mainly masters, and some doctoral level psychologists registered in clinical, counseling or educational categories. A prime emphasis of neuropsychological research has been local norming of psychometric tests to facilitate valid assessment practices in the country. South Africa is on the cusp of achieving a hard-won neuropsychology professional register. It is anticipated that this development will provide impetus to the discipline by promoting training programs, the creation of neuropsychology posts, wider service delivery, and increased research funding. CONCLUSIONS Despite significant challenges in a culturally diverse, developing country, neuropsychology has evolved sufficiently to warrant the creation of a separate category in the professional framework. This development will facilitate training, research, and services in the country.
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12
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Tierney GJ, Lawler J, Denvir K, McQuilkin K, Simms CK. Risks associated with significant head impact events in elite rugby union. Brain Inj 2016; 30:1350-1361. [PMID: 27715327 DOI: 10.1080/02699052.2016.1193630] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PRIMARY OBJECTIVES To conduct video and statistical analysis on Rugby Union play, focusing mainly on the tackle, to establish the player to player configurations for significant direct head impacts and non-direct head impacts. RESEARCH DESIGN Quantitative, observational cohort study. METHODS AND PROCEDURES Video analysis of 52 significant direct head impacts (31 Tackle, 10 Ruck, 7 Dive and 4 Ground) and 40 non-direct head impact tackles from 2014/15 International Rugby Union matches. Relative risk, 95% CI and p-values were calculated for a range of tackle variables. MAIN OUTCOME AND RESULTS Upper body tackles and lower body tackles accounted for 37% (19) and 23% (12) of cases, respectively, with the tackler as the head impacted player for 97% (30) of cases. The majority (81%) of tackle-related significant direct head impacts occurred in the second half of the game, with 63% of upper body tackle significant direct head impacts occurring in the final quarter. Tackler head placement and high speed tackles had statistical significance for causing tackle related significant direct head impacts as well as foot planting and difference in tackler and ball carrier mass for upper body tackles and ball carrier change in direction for lower body tackles. CONCLUSION Tackle variables that statistically increased the risk of significant direct head impact were identified, which can aid player protection strategies.
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Affiliation(s)
- Gregory J Tierney
- a Trinity Centre for Bioengineering , Trinity College Dublin , Ireland
| | - John Lawler
- a Trinity Centre for Bioengineering , Trinity College Dublin , Ireland
| | | | | | - Ciaran K Simms
- a Trinity Centre for Bioengineering , Trinity College Dublin , Ireland
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13
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Lopez V, Ma R, Weinstein MG, Cantu RC, Myers LSD, Nadkar NS, Victoria C, Allen AA. Concussive Injuries in Rugby 7s: An American Experience and Current Review. Med Sci Sports Exerc 2016; 48:1320-30. [PMID: 26829001 DOI: 10.1249/mss.0000000000000892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE There is a comparative lack of concussion incidence data on the new Olympic sport Rugby 7s. This study aimed to determine the incidence (number of concussions per 1000 playing hours [ph]), mean and median severity (days absence), and cause of concussive injuries. METHODS This is a prospective epidemiology study, amateur to elite/national candidate, male (9768) and female (3876) players in USA Rugby sanctioned tournaments, compliant with the international consensus statement for studies in rugby union. RESULTS Concussions in US Rugby 7s were 7.7/1000 ph (n = 67). Women encountered concussions at 8.1/1000 ph, and men at 7.6/1000 ph (risk ratio [RR] = 1.10, P = 0.593). Elite/national-level players encountered concussions at higher rates (18.3/1000 ph) than lower levels (6.4/1000 ph; RR = 5.48, P < 0.001). Nonelite backs had higher concussive injury rates compared with forwards (7.7/1000 ph; 3.6/1000 ph; RR = 1.28, P = 0.024). Women missed 36.7 d absence from play, meanwhile men missed 27.9 d (P = 0.245). Retrospective history recall reflected previous concussive injuries occurred in 43% of the current study's cohort; of these, 57% encountered multiple concussions within 1 yr. The incidence of repetitive concussions was not statistically different between genders (RR = 1.09, P = 0.754). Most concussions occurred from tackles (63%) and collisions (24%) (P = 0.056). CONCLUSIONS Sports-related concussions occurred with frequency among US amateur Rugby 7s players. US Elite tournament players sustained concussions at much higher rates than international male Rugby 7s counterparts. A substantial portion of US players who sustained a concussion had previous concussion injuries. Given the high rate of concussion, including repetitive concussive injuries, US Rugby 7s may benefit from concussion prevention measures similar to other contact sports such as instruction on proper tackling techniques, in-game and postgame medical assessment, and a standardized return-to-play protocol.
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Affiliation(s)
- Victor Lopez
- 1Rugby Research and Injury Prevention Group, New York, NY; 2USA Rugby Empire Geographic Union RFU, New York, NY; 3Rugby Codes Research Group, Sports Performance Research Institute, Auckland University of Technology, Auckland, NEW ZEALAND; 4Northeast Rugby Academy, USOC-Sanctioned Olympic Development Program, New York, NY; 5Comparative Orthopaedic Laboratory, Missouri Orthopaedic Institute, University of Missouri, Columbia, MO; 6Steinhardt School of Culture, Education and Human Development, New York University, New York, NY; 7Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, MA; 8Department of Neurosurgery, Boston University School of Medicine, Boston, MA; 9Department of Neurosurgery, Emerson Hospital, Concord, MA; 10Department of Surgery, Emerson Hospital, Concord, MA; 11Service of Sports Medicine, Emerson Hospital, Concord, MA; 12Neurologic Sports Injury Center, Brigham and Women's Hospital, Boston, MA; 13Concussion Legacy Foundation, Waltham, MA; 14World Rugby, Independent Concussion Group, Dublin, Ireland; 15Advanced Therapeutics Physical Therapy, Inc., Florence, MA; 16Department of Physical Therapy, Seton Hall University, South Orange Village, NJ; 17New York University, Global Institute of Public Health, New York, NY; 18Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY; 19National Basketball Association, New York Knickerbockers New York, NY; and 20USA Basketball, Colorado Springs, CO
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14
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Concussion management in the ED: Beyond GCS. Int Emerg Nurs 2015; 26:47-51. [PMID: 26749207 DOI: 10.1016/j.ienj.2015.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/12/2015] [Accepted: 11/21/2015] [Indexed: 11/20/2022]
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Gardner AJ, Iverson GL, Williams WH, Baker S, Stanwell P. A systematic review and meta-analysis of concussion in rugby union. Sports Med 2015; 44:1717-31. [PMID: 25138311 DOI: 10.1007/s40279-014-0233-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Rugby Union, a popular full-contact sport played throughout the world, has one of the highest rates of concussion of all full-contact sports. OBJECTIVE The aim of the current review was to systematically evaluate the available evidence on concussion in Rugby Union and to conduct a meta-analysis of findings regarding the incidence of concussion. METHODS Articles were retrieved via a number of online databases. The current review examined all articles published in English up to May 2014 pertaining to concussion in Rugby Union players. The key search terms included 'Rugby Union', 'rugby', 'union', and 'football', in combination with the injury terms 'athletic injuries', 'concussion', 'sports concussion', 'sports-related concussion', 'brain concussion', 'brain injury', 'brain injuries', 'mild traumatic brain injury', 'mTBI', 'traumatic brain injury', 'TBI', 'craniocerebral trauma', 'head injury', and 'brain damage'. RESULTS The final search outcome following the eligibility screening process resulted in the inclusion of 96 articles for this review. The meta-analysis included a total of 37 studies. The results of the meta-analysis revealed an overall incidence of match-play concussion in men's rugby-15s of 4.73 per 1,000 player match hours. The incidence of concussion during training was 0.07 per 1,000 practice hours. The incidence of concussion in women's rugby-15s was 0.55 per 1,000 player match hours. In men's rugby-7s match-play, concussion incidence was 3.01 per 1,000 player match hours. The incidence of concussion varied considerably between levels of play, with elite level play recording a rate of 0.40 concussions per 1,000 player match hours, schoolboy level 0.62 concussions per 1,000 player match hours, and the community or sub-elite level recording a rate of 2.08 concussions per 1,000 player match hours. The incidence of concussion in men's rugby-15s as a function of playing position (forwards vs. backs) was 4.02 and 4.85 concussions per 1,000 player match hours, respectively. CONCLUSIONS Concussion is a common injury sustained and reported in match play and to a lesser extent during practice by Rugby Union players. Based on the available published data, there appears to be a variation in risk of concussion across level of play, with the sub-elite level having the greatest incidence of injury. Future research focused on studying the acute consequences and best management strategies in current players, and the potential longer term outcomes of concussion in retired players, is needed. A focus on the areas of prevention, injury identification, and medical management, and risk for long-term outcomes will be of benefit to current athletes.
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Affiliation(s)
- Andrew J Gardner
- Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia,
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16
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Alexander DG, Shuttleworth-Edwards AB, Kidd M, Malcolm CM. Mild traumatic brain injuries in early adolescent rugby players: Long-term neurocognitive and academic outcomes. Brain Inj 2015; 29:1113-25. [DOI: 10.3109/02699052.2015.1031699] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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17
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Kirkwood G, Parekh N, Ofori-Asenso R, Pollock AM. Concussion in youth rugby union and rugby league: a systematic review. Br J Sports Med 2015; 49:506-10. [PMID: 25586912 DOI: 10.1136/bjsports-2014-093774] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Children and adolescents who play rugby are at increased risk of concussion and its effects. Competitive rugby union and rugby league feature as major sports in the school sport curriculum in the UK. There is a need for a thorough understanding of the epidemiology of concussion in youth rugby, the mechanisms involved in injuries and predisposing risk factors. DATA SOURCES The publication databases Pubmed, Embase and SportDISCUS were searched in April 2014 for primary research studies of child and adolescent rugby union and rugby league (under 20 years) in English language with data on concussion injuries. The review was conducted within a larger all injury systematic review on rugby union and rugby league where key words used in the search included rugby, injury and concussion with child, adolescent, paediatric and youth. RESULTS There were 25 studies retrieved with data on child or adolescent rugby and concussion, 20 were on rugby union, three on rugby league and in two the code of rugby was unspecified. There was significant heterogeneity in the definitions of injuries and of concussion. The incidence of child and adolescent match concussion ranged from 0.2 to 6.9 concussions per 1000 player-hours for rugby union and was 4.6 and 14.7 concussions per 1000 player-hours for rugby league, equivalent to a probability of between 0.3% and 11.4% for rugby union and of 7.7% and 22.7% for rugby league. CONCLUSIONS There is a significant risk of concussion in children and adolescents playing rugby union and rugby league evident from the studies included in this systematic review. There is a need for reliable data through routine monitoring and reporting in schools and clubs and in hospital emergency departments in order to inform prevention. Concussion protocols should be implemented and tested.
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Affiliation(s)
- Graham Kirkwood
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - Richard Ofori-Asenso
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Allyson M Pollock
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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18
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Freitag A, Kirkwood G, Scharer S, Ofori-Asenso R, Pollock AM. Systematic review of rugby injuries in children and adolescents under 21 years. Br J Sports Med 2015; 49:511-9. [DOI: 10.1136/bjsports-2014-093684] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fraas MR, Coughlan GF, Hart EC, McCarthy C. Concussion knowledge and management practices among coaches and medical staff in Irish professional rugby teams. Ir J Med Sci 2014; 184:425-30. [DOI: 10.1007/s11845-014-1137-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
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20
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Epidemiology of concussion in sport: a literature review. J Chiropr Med 2014; 12:230-51. [PMID: 24396326 DOI: 10.1016/j.jcm.2012.11.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/19/2012] [Accepted: 11/30/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to summarize sport concussion incidence data, identify sports that present higher injury frequency, reveal the degree of risk in some lesser-known sports, and outline specific details within the sports literature that raise additional concerns, such as helmet-to-helmet contact and player positions that experience frequent impact. METHODS A systematic literature review of Pub Med using keyword search on injury, concussion, and sports was performed through May 2012. Abstracts were identified, selections were made based upon inclusion criteria, and full-length articles were obtained. Additional articles were considered following review of reference sections. Articles were reviewed and tabulated according to sport. RESULTS Two hundred eighty-nine articles were screened, and 62 articles were reviewed. The overall incidence of concussion in sport ranged from 0.1 to 21.5 per 1000 athletic exposures. The lowest incidence was reported in swimming and diving. Concussion incidence was highest in Canadian junior ice hockey, but elevated incidence in American football remains a concern because of the large number of participants. CONCLUSIONS The literature reviewed included incidence of concussion on the field of play under real-world conditions and influenced by the current culture of sport. The studies examined in this article show that there is risk of concussion in nearly every sport. Some sports have higher concussion frequency than others, which may depend upon the forces and roles of the positions played in these sports. Younger athletes have a higher incidence of concussion, and female incidence is greater than male in many comparable sports. Headgear may reduce concussion in some sports but may also give athletes a false sense of protection.
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Fraas MR, Coughlan GF, Hart EC, McCarthy C. Concussion history and reporting rates in elite Irish rugby union players. Phys Ther Sport 2013; 15:136-42. [PMID: 24035483 DOI: 10.1016/j.ptsp.2013.08.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/31/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the self-reported, seasonal rates of concussion and the reporting practices among Irish rugby union players. DESIGN Descriptive epidemiology study. SETTING The study was conducted at the training grounds of four professional Irish rugby union clubs. PARTICIPANTS One hundred seventy-two players (24.97 ± 4.11 years of age, 13.49 ± 5.79 years playing experience) gave consent to participate. MAIN OUTCOME MEASURES Number of concussions reported during the 2010-2011 season, reasons for not reporting, and positions of concussed players. RESULTS Forty-five percent of players reported at least one concussion during the 2010-2011 season, but only 46.6% of these presented to medical staff. The reasons for not reporting their concussions included, not thinking the injury was serious enough, and not wanting to be removed from the game. The relative proportion of concussions was higher for backs than forwards; however, the severity of injury was greater for forwards. Scrum-halves (12.0%) and flankers (10.9%) accounted for the majority of concussions reported. CONCLUSIONS The self-reported rate of concussion in elite rugby union players in Ireland is higher than reported in other countries or other sports. Many concussions remain unreported and, therefore, unmanaged. However, recent changes in concussion management guidelines by the International Rugby Board may impact future reporting practices of players.
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Affiliation(s)
- Michael R Fraas
- Department of Communication Sciences and Disorders, Western Washington University, 516 High Street, Bellingham, WA 98225-9171, USA; Department of Communication Arts and Sciences, Elmhurst College, Chicago, USA.
| | | | - Emily C Hart
- Department of Communication Arts and Sciences, Elmhurst College, Chicago, USA; Department of Psychology, The Chicago School, Chicago, IL, USA
| | - Conor McCarthy
- Medical Department, Irish Rugby Football Union, Dublin, Ireland
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Shuttleworth-Edwards AB, Radloff SE, Whitefield-Alexander VJ, Smith IP, Horsman M. Practice effects reveal visuomotor vulnerability in school and university rugby players. Arch Clin Neuropsychol 2013; 29:86-99. [PMID: 23917347 DOI: 10.1093/arclin/act061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article reports on three pre- versus post-season prospective studies in which male university and high school contact sport players predominantly of Rugby Union (hereafter rugby) were compared with age, education, and IQ equivalent non-contact sport controls on the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) test. All analyses revealed a relative absence of practice effects on the Visual Motor Speed (VMS) composite for contact sport groups compared with controls. The VMS data for rugby players from each study were pooled and subjected to additional analysis (Rugby, n = 145; Controls, n = 106). Controls revealed significant improvement over the season (p < .001), whereas no learning effect was in evidence for rugby players whose performance remained the same (interaction effect, p = .028). It is apparent that practice effects have diagnostic potential in this context, implicating vulnerability on speeded visuomotor processing in association with participation in rugby. Pointers for further research and concussion management in the individual case are explored.
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Bleakley C, Tully M, O'Connor S. Epidemiology of adolescent rugby injuries: a systematic review. J Athl Train 2013; 46:555-65. [PMID: 22488143 DOI: 10.4085/1062-6050-46.5.555] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite recent increases in the volume of research in professional rugby union, there is little consensus on the epidemiology of injury in adolescent players. We undertook a systematic review to determine the incidence, severity, and nature of injury in adolescent rugby union players. DATA SOURCES In April 2009, we performed a computerized literature search on PubMed, Embase, and Cochrane Controlled Trials Register (via Ovid). Population-specific and patient-specific search terms were combined in the form of MEDLINE subject headings and key words (wound$ and injur$, rugby, adolescent$). These were supplemented with related-citation searches on PubMed and bibliographic tracking of primary and review articles. STUDY SELECTION Prospective epidemiologic studies in adolescent rugby union players. DATA SYNTHESIS A total of 15 studies were included, and the data were analyzed descriptively. Two independent reviewers extracted key study characteristics regarding the incidence, severity, and nature of injuries and the methodologic design. CONCLUSIONS Wide variations existed in the injury definitions and data collection procedures. The incidence of injury necessitating medical attention varied with the definition, from 27.5 to 129.8 injuries per 1000 match hours. The incidence of time-loss injury (>7 days) ranged from 0.96 to 1.6 per 1000 playing hours and from 11.4/1000 match hours (>1 day) to 12-22/1000 match hours (missed games). The highest incidence of concussion was 3.3/1000 playing hours. No catastrophic injuries were reported. The head and neck, upper limb, and lower limb were all common sites of injury, and trends were noted toward greater time loss due to upper limb fractures or dislocations and knee ligament injuries. Increasing age, the early part of the playing season, and the tackle situation were most closely associated with injury. Future injury-surveillance studies in rugby union must follow consensus guidelines to facilitate interstudy comparisons and provide further clarification as to where injury-prevention strategies should be focused.
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Affiliation(s)
- Christopher Bleakley
- University of Ulster, Health and Rehabilitation Research Institute, Shore Road, Newtownabbey, County Antrim BT37 0QB, UK.
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The effect of footwear and sports-surface on dynamic neurological screening for sport-related concussion. J Sci Med Sport 2010; 13:382-6. [DOI: 10.1016/j.jsams.2010.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 01/07/2010] [Accepted: 01/18/2010] [Indexed: 11/19/2022]
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Sabini RC, Reddy CC. Concussion management and treatment considerations in the adolescent population. PHYSICIAN SPORTSMED 2010; 38:139-46. [PMID: 20424411 DOI: 10.3810/psm.2010.04.1771] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Over the past decade, significant advances have been made in understanding concussions. Information regarding proper identification, pathophysiology, risks, outcomes, and management protocols has shifted the treatment paradigm from a generalized grading system to an individualized approach. Early identification and timely management of a concussion is necessary to ensure that patients minimize persistent post-concussive symptoms affecting the physical, behavioral, emotional, and cognitive domains. Adolescents are particularly vulnerable to concussions, having greater susceptibility and more prolonged recovery after sustaining an injury. This article aims to inform clinicians on how to improve symptom relief and functional outcomes for adolescent patients with concussion via immediate intervention, neuropsychological management, and pharmacological treatment.
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Affiliation(s)
- Rosanna C Sabini
- University of Pittsburgh Medical Center, Pittsburgh, PA 15219, USA.
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Shuttleworth-Edwards AB, Whitefield-Alexander VJ, Radloff SE, Taylor AM, Lovell MR. Computerized neuropsychological profiles of South African versus US athletes: a basis for commentary on cross-cultural norming issues in the sports concussion arena. PHYSICIAN SPORTSMED 2009; 37:45-52. [PMID: 20048540 DOI: 10.3810/psm.2009.12.1741] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Computerized programs are widely used as part of the overall medical management of concussion in order to monitor recovery and facilitate safe return-to-play decisions. Typically, neurocognitive profiles of concussed athletes are compared with baseline and/or normative data in the absence of baseline scores. However, the cultural equivalence of performance on neuropsychological tests cannot be assumed and has not been sufficiently researched. The purpose of this study was to investigate the neuropsychological test profiles of the ImPACT (Immediate Postconcussion Assessment and Cognitive Testing) on age-matched South African (SA) rugby and US football players. Participants included 11 257 English-speaking, predominantly white male athletes from multiple SA and US schools and sports organizations in 3 age groups: 11 to 13 years (SA, n = 301; US, n = 775); 14 to 16 years (SA, n = 997; US, n = 4081); and 17 to 21 years (SA, n = 319; US, n = 4784). ImPACT neurocognitive composite scores (verbal and visual memory, visual motor speed, reaction time, impulse control) and the ImPACT total symptom score, derived from the initial baseline testing, were used for comparison purposes between the targeted groups. Independent t-test comparisons revealed overall equivalence between the SA and US athletes on the neurocognitive measures, but they also revealed consistently higher symptom scores for SA athletes in association with clinically relevant effect sizes. It was concluded that US neurocognitive normative data on the ImPACT test are appropriate for use on South African athletes whose first language is English, whereas culture-specific sensitivity for symptom reporting on this same population should be taken into consideration for management purposes. It is argued that neurocognitive equivalence is less likely to apply in educationally disadvantaged populations. The use of registered psychologists is deemed necessary to provide contextualized interpretations of computerized test scores, thereby protecting against misdiagnosis that may occur within the concussion management arena via actuarial approaches that fail to take sociocultural complexities into account.
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