Concussion knowledge and attitudes among amateur South African rugby players

Corresponding author: C T Viljoen ([email protected]) Rugby players are exposed to a higher risk of injury than participants in other sports, as players may legitimately be involved in collision incidents.[1] A recent review reported that head injuries, including concussions, are the most frequently reported injuries in professional rugby.[2] Concussion is defined as a ‘traumatically induced transient disturbance of brain function which involves a complex pathophysiological process’.[3] Potentially dangerous long-term side-effects, such as neurological deficits and chronic traumatic encephalopathy, explain why the topic of concussion is covered extensively in medical and lay media.[4] Concussion in rugby is most commonly noted at community/amateur level, with a rate of 2.08 concussions per 1 000 player match-hours.[5] This is followed by schoolboy level and elite level, with respective rates of 0.62 and 0.40 concussions per 1 000 player match-hours.[5] Most of South Africa’s rugby playing population consists of amateur players. Only a limited proportion of amateur clubs and schools offer medical assistance – which is limited to matches – mostly due to a lack of funding.[6] Therefore the focus of the BokSmart programme in South Africa currently leans towards educating coaches and referees to recognise concussion signs and symptoms and to remove concussed players from the field.[6] In a country where medical assistance on the field during a rugby match is scarce, the players themselves can play a pivotal role in reporting possible concussions to their coach or the referee. Only a few studies have researched rugby players’ knowledge of concussion.[7–9,11,12] Less than half of a group of New Zealand high school rugby players knew about concussion, while only 22% of players waited to be medically cleared for return to play (RTP) after being diagnosed with concussion.[7] Research among Italian amateur rugby players showed that 39% of these players had never been informed about concussion.[8] Similar results were noted among 127 subelite South African rugby players, where less than half of the players waited until fully recovered before returning to full participation in rugby.[9] Currently, no rugby safety management programme focuses on concussion education among South African rugby players. Only a single study, to date, has investigated knowledge of concussion and RTP attitudes among South African rugby players and therefore further research in this field of study is warranted.[9] The aim of this study was to evaluate the concussion knowledge and attitudes to RTP of South African amateur rugby players in order to provide information for future concussion education programmes. Based on anecdotal evidence and the study by Walker,[9] it was found that amateur South African rugby players displayed insufficient knowledge concerning concussions.