The Challenges of Concussion Assessment, Management and Education within UK Youth Community Rugby Union

Concussion is widely considered a challenging injury to diagnose, assess and manage. Concussion definitions lack practicality, pitch-side assessments remain inconsistent, and key stakeholder knowledge and attitudes are poorly understood. In turn, risk reduction education strategies have lacked evidence-based foundations. These challenges are magnified within community youth participation where research has been sparse. Unlike professional cohorts, the frequency of concussions within youth community rugby has yet to be fully established. Contact sports such as rugby must address these challenges to ensure participant safety and promote sporting participation. This thesis aims to address these challenges. Collectively, the findings could then shape concussion education risk reduction interventions by governing bodies. Study One first assessed the frequency of reported head injuries in youth community rugby union. It then established the King-Devick tests utility as a tool for community sport-based medical staff and parents to chart cognitive recovery following head injury. A prospective cohort study of 489 players (U9-U18) was conducted at a community level rugby union club over four seasons. The reported head injuries following match play (12.7/1000hrs) were higher than any previously reported. Results indicated that the K-D Test was a practical tool for baseline, post injury and parentally supervised repeated testing within youth community Rugby Union. Study Two implemented the socio-technical systems approach employed by Clacy et al.(1) to identify the demographic of EFA’s within English community youth rugby union and examine their understanding and perceived role/responsibilities of concussion management. A short (3 to 4 minute) audio-recorded survey was conducted on 40 Emergency First Aider’s (EFA’s). Despite limitations in current concussion understanding, the findings suggested EFA’s may be suitable actors within UK youth community Rugby Union to foster improvements in concussion management and return to play (RTP) governance. Study Three utilised the novel Rugby Union Concussion Knowledge and Attitude Survey (RUCKAS-YOUTH) to assess the concussion knowledge and attitude of 515 UK school-based rugby participants. Developed in conjunction with the Rugby Football Union it forms the largest investigation of its kind to date. It is the first study to include a large number of female participants, document perceived completion of the RFU DBaH concussion education programme, and assess differences in state and private school attending participants concussion knowledge and attitude. The study provides a baseline from which to both direct and then evaluate future concussion risk reduction interventions. No broad association was found between participant knowledge and attitudes towards concussion safety in rugby.