1
|
Salmon D, Badenhorst M, Clark B, Walters S, Sullivan SJ, Sole G. Unintended consequences - A qualitative exploration of baseline testing in community rugby concussion management. J Sci Med Sport 2024:S1440-2440(24)00152-X. [PMID: 38811276 DOI: 10.1016/j.jsams.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Understanding key stakeholders' perceptions around the value of baseline testing, as well as barriers or facilitators experienced as part of the process, may assist with the decision-making process of whether to implement baseline testing in community sport. This study explored coaches', players' and physiotherapists' perceptions of the perceived value, barriers and facilitators of baseline testing as part of New Zealand Rugby's (NZR) community concussion initiative. DESIGN The study employed a pragmatic, qualitative descriptive design. METHODS Semi-structured interviews were used to explore participants' perceptions. In total, 73 individual interviews were conducted. The sample consisted of 36 players, 13 coaches and 24 physiotherapists involved in NZR's concussion management pathway. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. RESULTS In terms of perceived value, baseline testing was reported to play a role in i) facilitating a positive concussion culture; ii) positive perceptions of rugby and player safety and iii) enhancing concussion management as part of the pathway. Barriers and facilitators of the baseline testing process included i) stakeholder buy-in as critical driver of the process and ii) contextual and operational factors. Although contextual and operational challenges exist, these participants, as key stakeholders in the process, perceived the value of baseline testing to be more important than the barriers experienced. CONCLUSIONS The value of baseline testing extends beyond concussion assessment and management, by enhancing community concussion awareness, attitudes and player safety. The findings of this study may assist in the decision-making process around inclusion of pre-season baseline testing in community rugby.
Collapse
Affiliation(s)
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, New Zealand.
| | - Brooke Clark
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, New Zealand
| | | | - Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, New Zealand
| |
Collapse
|
2
|
Salmon DM, Chua J, Brown JC, Clacy A, Kerr ZY, Walters S, Keung S, Sullivan SJ, Register-Mihalik J, Whatman C, Sole G, Badenhorst M. Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System. BMJ Open Sport Exerc Med 2023; 9:e001722. [PMID: 37860152 PMCID: PMC10582854 DOI: 10.1136/bmjsem-2023-001722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Danielle M Salmon
- Safety and Welfare, New Zealand Rugby, Wellington, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Jason Chua
- Safety and Welfare, New Zealand Rugby, Wellington, New Zealand
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - James C Brown
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amanda Clacy
- School of Law & Society, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Simon Walters
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Sierra Keung
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - S John Sullivan
- Safety and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Johna Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Chris Whatman
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Gisela Sole
- School of Physiotherapy, University of Otago - Dunedin Campus, Dunedin, New Zealand
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
3
|
Salmon DM, Badenhorst M, Falvey É, Kerr ZY, Brown J, Walters S, Sole G, Sullivan SJ, Whatman C, Register-Mihalik J, Murphy I. Time to expand the circle of care - General practitioners' experiences of managing concussion in the community. J Sports Sci 2022; 40:2102-2117. [PMID: 36399490 DOI: 10.1080/02640414.2022.2130586] [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: 11/19/2022]
Abstract
New Zealand Rugby (NZR) implemented a concussion management pathway (CMP), aimed at improving management at community level. General Practitioners (GPs) played a large role in the design of this process. The objective of this study was to explore GPs' perceptions of barriers and facilitators of the CMP and rugby-related concussion management in the community. A descriptive qualitative approach using interviews and focus groups was employed. Four themes were derived: i) GPs' existing knowledge and confidence around concussion management; ii) Operational resources: time, remuneration and pathway guidance; iii) Standardising concussion care and iv) Expanding the circle of care - the need for multi-disciplinary healthcare team. These themes described how GP's concussion knowledge, and the efficiency and availability of operational resources affected their experience and ability to fulfil their tasks within the CMP. GPs found NZR's CMP especially valuable, as it provided guidance and structure. Expanding the role of other healthcare providers was seen as critical to reduce the burden on GPs, while also delivering a more holistic experience to improve clinical outcomes. Addressing the identified barriers and expanding the network of care will help to improve the ongoing development of NZR's CMP, while supporting continued engagement with all stakeholders.
Collapse
Affiliation(s)
- Danielle M Salmon
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Éanna Falvey
- World Rugby House, Pembroke Street Lower, Dublin.,College of Medicine & Health, University College Cork, Cork, Ireland
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Newzeland
| | - S John Sullivan
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Chris Whatman
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Johna Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ian Murphy
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| |
Collapse
|
4
|
Salmon DM, Chua J, Sullivan SJ, Whatman C, Brown J, Register-Mihalik J, Murphy I, Walters S, Clacy A, Sole G, Kerr ZY, Rasmussen K, England M. Sport concussion assessment in New Zealand high school rugby players: a collaborative approach to the challenges faced in primary care. Brain Inj 2022; 36:258-270. [PMID: 35143350 DOI: 10.1080/02699052.2022.2033839] [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
PRIMARY OBJECTIVE To describe the collaborative development of a New Zealand Rugby Concussion Assessment (NZRCA) for primary care and to provide normative baseline data from a representative group of high school rugby players. METHODS This study, conducted over the 2018 and 2019 community rugby season where players were baseline tested during the pre- or start of season period. RESULTS Data were collected from 1428 players (males n = 1121, females n = 307) with a mean age of 15.9 ± 1.4 years. The mean ± SD symptom severity score was 11.3 ± 8.6, the mean number of endorsed symptoms was 8.5 ± 5.3 and the percentage feeling "normal" was 80.2 ± 15.3%. Only 5.3% of players reported no symptoms at baseline. The most common reported were: 'distracted easily' (72.5%), 'forgetful' (68.5%), and 'often tired' (62.6%). None of the participants achieved a perfect score for the SAC50. The majority of participants (89.7%) passed the tandem gait test with a time of 12.2 ± 1.7 seconds. Age, gender, and ethnicity were associated with NZRCA performance; albeit weakly. CONCLUSION This study provides normative reference values for high-school rugby players. These data will aid healthcare providers in their identification of suspected concussion in the absence of individualized baselines.
Collapse
Affiliation(s)
| | - Jason Chua
- New Zealand Rugby, Wellington, New Zealand
| | | | - Chris Whatman
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ian Murphy
- New Zealand Rugby, Wellington, New Zealand
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Amanda Clacy
- School of Law & Society, University of the Sunshine Coast, Maroochydore, Australia
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | |
Collapse
|
5
|
Salmon DM, Chua J, Sullivan SJ, Whatman C, Brown J, Register-Mihalik J, Murphy I, Walters S, Clacy A, Sole G, Kerr ZY, Rasmussen K, England M. Baseline concussion assessment performance of community-based senior rugby players: a cross-sectional study. Brain Inj 2021; 35:1433-1442. [PMID: 34658272 DOI: 10.1080/02699052.2021.1972452] [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: 10/20/2022]
Abstract
OBJECTIVE To report pre-season baseline concussion assessment performance among senior rugby players and explore associations between assessment performance and player demographics. DESIGN A cross-sectional study using the New Zealand Rugby Concussion Assessments (NZRCA), comprising symptom, cognitive and dynamic coordination assessments was conducted in the 2018-2019 season. METHODS Players' baseline assessments were characterised using descriptive statistics; effect sizes (ES) and t-tests were used to explore associations between player demographic characteristics and NZRCA performance. RESULTS A total of 733 players (11.4% female) aged between 16 and 52 years completed the NZRCA. The median (range) value for symptom severity, endorsed symptoms and "percentage normal" was respectively, 5 (0-40), 5 (0-21) and 90% (30-100%). A perfect standardised assessment of concussion score was achieved by one participant; seven achieved ≥27/30 for immediate recall, and 22 achieved a perfect delayed recall score. Most participants (n = 674, 92%) passed the tandem gait test. Associations between NZRCA performance and gender, concussion history, and Pasifika ethnicity were observed with effect sizes ranging from small (0.18) to large (0.70). Six hundred and twenty-three (85%) participants reported at least one symptom. CONCLUSIONS The results from this study could help support decision-making by clinicians, improving the management of concussions in the community setting.
Collapse
Affiliation(s)
- Danielle M Salmon
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Jason Chua
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - S John Sullivan
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Chris Whatman
- School of Sport and Recreation, Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center and Rehab University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina U.S.A
| | - Ian Murphy
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Simon Walters
- School of Sport and Recreation, Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Amanda Clacy
- Vitality Village, Wearebe, Kensington, Queensland, Australia
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center and Rehab University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina U.S.A
| | - Karen Rasmussen
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Mike England
- Injury Prevention and Welfare, New Zealand Rugby, Wellington, New Zealand
| |
Collapse
|