Concussion in sport: new hints about the content of concussion management messages and the timing of interventions

Perhaps the most discussed sports injury issue in the public media over that past 1-2 years has been concussion and its potential for adverse long-term effects. Commentary in this journal earlier this year called for prevention of concussion to be a public health priority.

Two papers published in the Vol 45, Issue 12 (September 2011) of the BJSM reported studies conducted in rugby football in relation to concussion in those sports.

One paper by McLellan and McKinlay, adopted a novel approach that utilised television broadcasts of National Rugby League (NRL) games in Australasia, as being indicative of the sort of information that the public would be regularly exposed to about what happens when a player is concussed. Two independent observers viewed 52 games and recorded every occurrence of injury or impact to a players’ head, as well as the observable disruption to the game. The latter was to give an indication of the management of likely concussion during the game; explicit reference to probable concussion by the game commentators was also noted. Each recorded incident was then classified as probable concussion, or not, by a neuropsychologist and a traumatic brain injury research psychologist. A key finding was that the way that management of concussion injuries was portrayed on the sideline during the broadcasts of these NRL games, was contrary to the common advice given to the public about when to return-to-play, with or without symptoms, after a suspected concussion.

Hollis and colleagues reported a cohort follow-up of 1958 community rugby union players in New South Wales, Australia, with the incidence of concussion monitored for up to three years. Survival analysis was used to estimate the probability of remaining concussion free as a function of the number of game hours played. For every 10 hours of playing time (roughly the length of half a playing season), 7% of players sustained concussion; after 20 hours accumulated game time 14% of players had sustained concussion. In other words, concussion was equally as common in the first and second halves of a playing season. Factors, which were significantly associated with concussion within 20 hours of accumulated play, were prior concussion history, player size and training volume.

It is important that high quality and consistent evidence about how to prevent concussion in sport be disseminated to those most at risk. In addition, to minimise potential adverse consequences of this injury, timely identification and management of this injury should occur. There is clearly a need to do so over all stages of a playing season. It is somewhat concerning that players and their significant others could be receiving most of their information about how and why concussion occurs, and then what the actions should be when it does, from televised broadcast of games where the observed practices are inconsistent with the latest scientific evidence and advice.

This poses a challenge for all of us involved in implementing injury prevention programs in community sport. More research is needed to better understand from where people source their sports injury prevention advice and the relative importance they give to information disseminated through channels such as booklets or websites, compared to the more graphic depictions of what happens to their role models from elite or professional sport.

Caroline Finch is an injury prevention researcher from Monash University, Australia specialising in implementation and dissemination science applications for sports injury prevention.  She is the Senior Associate Editor for Implementation & Dissemination for the British Journal of Sports Medicine and a member of the Editorial Board of Injury Prevention; both journals are published by the BMJ Group.  Caroline can be followed on Twitter @CarolineFinch

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