Concussion education in medical students studying in Scotland: an assessment of knowledge and future needs.

BACKGROUND: Physicians play a key role in ensuring athletes with concussion safely return to sport. Research has shown deficiencies in concussion education amongst physicians and medical students. However, studies have not previously been conducted in UK medical schools. OBJECTIVES: To assess students' concussion knowledge and learning in Scottish Medical Schools. DESIGN: A survey with 23 questions was distributed to Year 3-6 medical students studying in Scotland in October 2020. The survey included the following: (1) demographics, (2) concussion knowledge, e.g. 'What is the role of headgear in preventing concussion?' (3) concussion learning, 'In which part of the curriculum should concussion be taught?.' Frequencies of responses were calculated for each question. RESULTS: 200 students responded (response rate 8%). The average symptoms and management score were 87.3% and 31% respectively. 15% of participants knew that headgear has no role in preventing concussions and one participant identified the minimum "return to sport" timeframes for adults and children. 15% had learnt about concussion at medical school with 92.5% interested in receiving concussion teaching at medical school. CONCLUSION: Knowledge gaps exist in managing and preventing sports-related concussion. There is a discrepancy between levels of concussion teaching and the desire and importance placed on concussion education.

Physical and Technical Demands and Preparatory Strategies in Female Field Collision Sports: A Scoping Review.

Women's participation in field collision sports is growing worldwide. Scoping reviews provide an overview of scientific literature in a developing area to support practitioners, policy, and research priorities. Our aim is to explore published research and synthesise information on the physical and technical demands and preparation strategies of female field collision sports. We searched four databases and identified relevant published studies. Data were extracted to form (1) a numerical analysis and (2) thematic summary. Of 2318 records identified, 43 studies met the inclusion criteria. Physical demands were the most highly investigated (n+=+24), followed by technical demands (n+= 18), tactical considerations (n+=+8) and preparatory strategies (n=1). The key themes embody a holistic model contributing to both performance and injury prevention outcomes in the context of female field collision sports. Findings suggest a gender data gap across all themes and a low evidence base to inform those preparing female athletes for match demands. Given the physical and technical differences in match-demands the review findings do not support the generalisation of male-derived training data to female athletes. To support key stakeholders working within female field collision sports there is a need to increase the visibility of female athletes in the literature.

Rugby Health and Well-Being Study: protocol for a UK-wide survey with health data cross-validation.

INTRODUCTION: Rugby football (Union and League) provides physical activity (PA) with related physical and mental health benefits. However, as a collision sport, rugby research and media coverage predominantly focus on injuries in elite players while the overall impact on health and well-being remains unclear. This study aims to provide a greater understanding of the risks and benefits of rugby participation in a diverse sample of men and women, current and former rugby Union and League players from recreational to the elite level of play. We will explore: (1) joint-specific injuries and concussion; (2) joint pain and osteoarthritis (OA); (3) medical and mental health conditions; (4) PA and sedentary behaviour and (5) well-being (quality of life, flourishing and resilience). METHODS AND ANALYSIS: The Rugby Health and Well-being Study is designed in two phases: (1) a UK-wide cross-sectional survey and (2) cross-validation using health register data from Scotland. Participants will be at least 16 years old, current or former rugby players who have played rugby for at least one season. We will report standardised, level of play-, sex- and age-stratified prevalence of joint injury, concussion, medical conditions and PA. We will describe injury/concussion prevention expectations and protective equipment use. Rugby-related factors associated with injury, pain, OA, PA, health and well-being will be explored in regression models. We will compare joint pain intensity and duration, elements of pain perception and well-being between recreational and elite players and further investigate these associations in regression models while controlling for confounding variables. In the second phase, we will validate self-reported with health register data, and provide further information on healthcare use. ETHICS AND DISSEMINATION: The Yorkshire and the Humber-Leeds East Research Ethics Committee (REC reference: 19/HY/0377) has approved this study (IRAS project ID 269424). The results will be disseminated through scientific publications, conferences and social media.

The relationships between rugby union, and health and well-being: a scoping review.

OBJECTIVE: To scope the relationships between rugby union, and health and well-being. DESIGN: Scoping review. DATA SOURCES: Published and unpublished reports of any age, identified by searching electronic databases, platforms and reference lists. METHODS: A three-step search strategy identified relevant published primary, secondary studies and grey literature, which were screened using a priori inclusion criteria. Data were extracted using a standardised tool, to form (1) a numerical analysis and (2) a thematic summary. RESULTS AND DISCUSSION: 6658 records were identified, and 198 studies met the inclusion criteria. All forms of rugby union can provide health-enhancing physical activity (PA). 'Non-contact' and wheelchair rugby in particular provide a wide range of physical and mental health and well-being benefits. The evidence is either mixed or unclear in relation to 'contact' rugby union and its effects on a range of physical health domains. Injury and concussion incidence rates are high for contact rugby union relative to other sports. CONCLUSIONS: A wide range of stakeholders as well as existing and potential participants can use this information to make a more informed decision about participating in and promoting rugby union as a health-enhancing activity. Industry and policy-makers can use this review to inform policies and strategies that look to increase participation rates and use rugby union as a vehicle to contribute positively to population health. Further research understanding rugby union's contribution to PA as well as to muscle-strengthening and balance is indicated, as well as research examining more health and well-being outcomes across more diverse cohorts.

Integrating sport and exercise medicine clinics into the National Health Service: a qualitative study.

OBJECTIVES: To explore the services National Health Service (NHS)-based sport and exercise medicine (SEM) clinics can offer, and the barriers to creating and integrating SEM services into the NHS. METHODS: Semi-structured interviews were undertaken to collect data from identified 'stakeholders'. Stakeholders were identified as individuals who had experience and knowledge of the speciality of SEM and the NHS. An inductive thematic analysis approach was taken to analyse the data. RESULTS: N=15 stakeholder interviews. The management of musculoskeletal (MSK) injuries (both acute and chronic) and concussion were highlighted as the two key services that SEM clinics can offer that would most benefit the NHS. MSK ultrasound was also mentioned by all stakeholders as a critical service that SEM clinics should provide. While exercise medicine is an integral part of SEM, SEM clinics should perhaps not have a heavy exercise medicine focus. The key barriers to setting up SEM clinics were stated to be convincing NHS management, conflict with other specialities and a lack of awareness of the speciality. CONCLUSION: The management of acute MSK injuries and concussion should be the cornerstone of SEM services, ideally with the ability to provide MSK ultrasound. Education of others on the speciality of SEM, confirming consistent 'unique selling points' of SEM clinics and promoting how SEM can add value to the NHS is vital. If the successful integration of SEM into the NHS is not widely achieved, we risk the NHS not receiving all the benefits that SEM can provide to the healthcare system.

The relationships between rugby union and health: a scoping review protocol.

INTRODUCTION: Rugby union is played by over eight million people across the world and is considered a form of moderate-to-vigorous physical activity. Consequently, playing rugby may confer health benefits; however, to date, the principal focus of research has been on associated injuries and potential detrimental long-term health sequelae. This protocol outlines the methods behind studying any potential associations between rugby union and both physical and mental health. METHODS AND ANALYSIS: Best practice methodological frameworks (Arksey and O'Malley, Levac et al and the Joanna Briggs Institute) and previously published scoping review protocols in sport informs the methodology of this protocol. This protocol enables us to map the key concepts and evidence available, summarise and share existing research findings, and identify research gaps in the current literature. A three-step search strategy will identify reviews, original research, and published and grey literature. An initial search will identify suitable search terms, followed by a search using keyword and index terms. Two reviewers will independently screen identified studies for final inclusion. DISSEMINATION: When publishing the scoping review, we will map key concepts and evidence both numerically and thematically, as well as identify key research priorities for further studies. The review will subsequently be disseminated to stakeholder groups, practitioners and policymakers through a variety of peer-reviewed and non-peer-reviewed publications, conferences and via multimedia platforms.

Concussion knowledge and experience among Welsh amateur rugby union coaches and referees.

BACKGROUND: Rugby union is a collision sport where participants are at high risk of sustaining a concussion. In settings where there is little qualified medical supervision, certain stakeholders (eg, coaches and officials) should possess sufficient knowledge in regard to the recognition and management of concussion. AIM: The aim of this study was to assess the knowledge and experience of various aspects of concussion among coaches and referees involved in Welsh amateur rugby union. METHODS: A questionnaire was distributed to 1843 coaches and 420 referees. RESULTS: A total of 333 coaches and 283 referees completed the questionnaire (18% and 68% response rates, respectively). Participants exhibited greater knowledge of concussion symptom recognition relative to knowledge of both the consequences of concussion and associated return-to-play protocols, both of which could be considered poor. There were no differences in knowledge levels between coaches and referees or between participants with or without a history of concussion. Two-thirds of participants incorrectly believed that headgear could prevent concussion, and nearly 30% of coaches reported having witnessed other coaches allowing a potentially concussed player to continue playing. CONCLUSIONS: Identification of several misconceptions indicates that concussion management within Welsh amateur rugby union needs to be improved, warranting a multi-faceted educational intervention.

An observational study of spectators' step counts and reasons for attending a professional golf tournament in Scotland.

BACKGROUND: Spectators at several hundred golf tournaments on six continents worldwide may gain health-enhancing physical activity (HEPA) during their time at the event. This study aims to investigate spectators' reasons for attending and assess spectator physical activity (PA) (measured by step count). METHODS: Spectators at the Paul Lawrie Matchplay event in Scotland (August 2016) were invited to take part in this study. They were asked to complete a brief questionnaire with items to assess (1) demographics, (2) reasons for attendance and (3) baseline PA. In addition, participants were requested to wear a pedometer from time of entry to the venue until exit. RESULTS: A total of 339 spectators were recruited to the study and out of which 329 (97.2%) returned step-count data. Spectators took a mean of 11 589 steps (SD 4531). 'Fresh air' (rated median 9 out of 10) then 'watching star players', 'exercise/physical activity', 'time with friends and family' and 'atmosphere' (all median 8 out of 10) were rated the most important reasons for attending. CONCLUSION: This study is the first to assess spectator physical activity while watching golf (measured by step count). Obtaining exercise/PA is rated as an important reason for attending a tournament by many golf spectators. Spectating at a golf tournament can provide HEPA. 82.9% of spectators achieved the recommended daily step count while spectating. Further research directly assessing whether spectating may constitute a 'teachable moment', for increasing physical activity beyond the tournament itself, is merited.

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern.

Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.