Is it any wonder that concussion prevention is not working?

Cross Fertilising Injury Prevention (IP) and the British Journal of Sports Medicine (BJSM)

If any topic has to take the top prize for the most talked about sports injury issue globally in 2012, surely that has to be won by concussion, or head injury. Both scientific and public commentary has debated a range of prevention and control strategies including enforcing medical clearances before returning-to-play, changing rules or game play, compulsory pre-participation neuropsychological screening of athletes and the value of helmets. But still these injuries occur.

An international consensus statement on the management of concussion in sport was published in 2008. Two key components were a standardised concussion assessment tool (the SCAT) to help medical personnel diagnose, assess and manage concussions and a concussion “rehabilitation” protocol to facilitate a step-wise graded return-to-play program.

So why then, are we still seeing so many concussions on our playing fields?

Two recent papers in the July 2012 46(9) and August 2012 46(10) issues of the British Journal of Sports Medicine shed some light as to why concussion prevention/management has not been fully effective as it perhaps have could have been.

Ahmed and colleagues undertook a detailed analysis of 43 websites purporting to provide up-to-date information about concussion. When compared to a gold standard concussion checklist (derived from the 2008 international consensus statement), these websites were found to vary in both the quality and completeness of the information they provided. Thus the information being provided to the general and sporting public is not always correct. So there is a knowledge content problem.

Hollis et al surveyed 187 rugby union players post concussion and found that more than three-quarters of them had not receive specific return-to-play advice before resuming play after their injury. Of those who did get return-to-play advice none of them complied with it or were required to comply with it by their clubs. Thus, the information is not being provided to the players who need it, nor is it acted on when given. So, there is a knowledge transfer and subsequent action problem.

It is naive to think that just because there are expert guidelines on concussion management that this will necessarily directly translate to actions by practitioners that impact on injury rates in others. Moreover, how can we realistically expect to make a significant impact on concussion in sport if the information available to professionals and sports participants is not accurate, incomplete, not passed on to the target groups and not acted on even when it is provided?

I am sure this issue is not restricted to concussion in sport nor even only injuries in sport.

As I have argued previously, it is now time for injury prevention researchers to move out of their existing paradigms and to embrace implementation and dissemination science as the basis for their interactions with practitioners, policy makers and other end-users.

If we don’t start to do this now, we will continue to allow our research to have no lasting impact on injury prevention.


Caroline Finch is an injury prevention researcher from the Australian Centre for Research into Injury in Sport and its Prevention (ACRISP) within the Monash Injury Research Centre, Monash University, Australia. She specialises in implementation and dissemination science applications for sports injury prevention as well as sports injury surveillance. 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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