Where's your head at? Perceptions and utilisation of concussion prevention and rehabilitation strategies in women's and men's rugby union

G Skudder; P O'Halloran; S McLeod; G Bullock; C A Emery; S W West

doi:10.1016/j.jsams.2025.04.003

Where's your head at? Perceptions and utilisation of concussion prevention and rehabilitation strategies in women's and men's rugby union

J Sci Med Sport. 2025 Apr 15:S1440-2440(25)00100-8. doi: 10.1016/j.jsams.2025.04.003. Online ahead of print.

Authors

G Skudder¹, P O'Halloran², S McLeod³, G Bullock⁴, C A Emery⁵, S W West⁶

Affiliations

¹ Department of Health, University of Bath, UK. Electronic address: https://twitter.com/gemequestphysio.
² Department of Health, University of Bath, UK; Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, UK; UK Collaborating Centre on Injury and Illness Prevention in Sport, University of Bath, UK; UK Sports Institute, Loughborough, UK; Defence Medical Rehabilitation Centre, Stanford Hall, Stanford on Soar, UK. Electronic address: https://twitter.com/PatrickSportMed.
³ Discipline of Physiotherapy, School of Allied Health, Australian Catholic University, Australia. Electronic address: https://twitter.com/SMcLeod_PT.
⁴ Department of Orthopaedic Surgery & Rehabilitation, Wake Forest School of Medicine, USA; Department of Biostatistics and Data Science, Wake Forest School of Medicine, USA; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, UK. Electronic address: https://twitter.com/DrGSBullock.
⁵ Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Canada; Hotchkiss Brain Institute, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Canada; Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada. Electronic address: https://twitter.com/CarolynAEmery.
⁶ Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, UK; UK Collaborating Centre on Injury and Illness Prevention in Sport, University of Bath, UK; Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Canada. Electronic address: sw2124@bath.ac.uk.

PMID: 40340148
DOI: 10.1016/j.jsams.2025.04.003

Abstract

Objectives: Rugby union (rugby) is a popular collision sport with high concussion rates. As such, concussion prevention and rehabilitation strategies are critical to player welfare in the sport. This study aims to identify and analyse the concussion prevention and rehabilitation strategies currently implemented across different rugby contexts.

Design: A cross-sectional study targeting medical professionals and coaches globally through an online survey distributed via email and social media.

Methods: A validated, piloted survey was developed in collaboration with subject-matter experts and delivered using REDCap, with participants (aged 18+) from medical and coaching backgrounds.

Results: A total of 172 respondents (77 medical professionals, 89 coaches, 6 "other") responded. Training strategies and policy changes were perceived as the most important primary prevention strategies, whilst all secondary (education, recognise and remove) and tertiary (return to play processes and rehabilitation) strategies were deemed highly important. Despite this, utilisation varied widely. Perceived importance and utilisation of rehabilitation strategies also varied. The main barriers to implementation were a lack of understanding (47%) and time constraints (45%). There were no significant differences in odds of return-to-play use by level of play or sex; however, there was a significantly lower odds of medical return-to-play sign-off with lower levels of play (odds ratio: 0.77, 95% confidence intervals: 0.61-0.98).

Conclusions: This study underscores the variation in perceived importance and utilisation of prevention and rehabilitation strategies in rugby. It emphasises the necessity for education to help remove barriers with the aim of optimising programme implementation and utility.

Keywords: Concussion; Prevention; Rehabilitation; Return to play; Rugby union.