The effectiveness of the nationwide BokSmart rugby injury prevention program on catastrophic injury rates

Scand J Med Sci Sports. 2016 Feb;26(2):221-5. doi: 10.1111/sms.12414. Epub 2015 Jan 31.


Rugby Union ("rugby") participants have a higher than average risk of injury compared with participants of other popular team sports. BokSmart, a nationwide injury prevention program was launched in South Africa in mid-2009, with the goal of reducing catastrophic head/neck (serious) injuries in players. The program provides injury prevention information to coaches and referees. This study investigated if BokSmart has been associated with a reduction in these injuries. The BokSmart program collected data on all South African rugby-related serious injuries since 2008. Using a Poisson regression, injury numbers were compared pre-BokSmart (2008-2009) to the years post-implementation (2010-2013). Player numbers were assumed to be constant throughout this evaluation: junior = 529,483; senior = 121,663. In junior players, the "post-BokSmart" period had 2.5 less annual serious injuries than "pre-BokSmart" (incidence rate ratio: 0.6, 95% confidence interval: 0.5-0.7, P < 0.000). In contrast, there was no significant difference in these periods in seniors. The absence of effect in seniors may be a result of fewer players or of differences in effectiveness of BokSmart in this group--future studies should investigate these questions.

Keywords: Primary prevention; football; program evaluation; spinal injuries; wounds and injuries/prevention and control.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Athletic Injuries / epidemiology
  • Athletic Injuries / prevention & control
  • Craniocerebral Trauma / epidemiology*
  • Craniocerebral Trauma / prevention & control*
  • Football / injuries*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Incidence
  • Neck Injuries / epidemiology
  • Neck Injuries / prevention & control
  • Program Evaluation
  • South Africa
  • Spinal Cord Injuries / epidemiology*
  • Spinal Cord Injuries / prevention & control*