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Abstract
Objectives This study assessed whether concussion affects subsequent baseline performance in professional rugby players. Annual baseline screening tests are used to guide return-to-play decisions and concussion diagnosis during subsequent screens. It is important that baseline performances are appropriate and valid for the duration of a season and unaffected by factors unrelated to the current head impact event. One such factor may be a concussion following baseline assessment.
Setting The World Rugby concussion management database for global professional Rugby Union.
Participants 501 professional rugby players with two baseline Sports Concussion Assessment Tools (SCATs) and an intervening concussion (CONC) were compared with 1190 control players with successive annual SCAT5s and no diagnosed concussion (CONT).
Primary and secondary outcome measures Symptom endorsement, cognitive and balance performance during annual SCAT baseline assessments.
Results Players with a diagnosed concussion (CONC) endorsed fewer symptoms (change −0.42, 95% CI −0.75 to −0.09), and reported lower symptom severity scores during their second assessment (T2, p<0.001) than non-concussed players (CONT). Concussed players also improved Digits Backward and Final Concentration scores in T2 (p<0.001). Tandem gait time was improved during T2 in CONT. No other sub-mode differences were observed in either group.
Conclusions Reduced symptom endorsement and improved cognitive performance after concussion may be the result of differences in the motivation of previously concussed players to avoid exclusion from play, leading to under-reporting of symptoms and greater effort in cognitive tests. Improved cognitive performance may be the result of familiarity with the tests as a result of greater exposure to concussion screening. The changes are small and unlikely to have clinical significance in most cases, though clinicians should be mindful of possible reasons, possibly repeating sub-modes and investigating players whose baseline scores change significantly after concussion. The findings do not necessitate a change in the sport’s concussion management policy.
- sports medicine
- neurological injury
- physiology
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Footnotes
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Contributors MR conceived the study. MR, RT and EF designed the study. RT and JB performed the analyses. All authors (RT, EF, JB and GF) made substantial contributions to the study design, data processing and interpretation. RT drafted the article and all other authors revised it critically for important intellectual content. RT is the guarantor. All authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Funding There was no specific funding for the research study, though the research was supported by World Rugby, which employs some of the author group, as described in Competing Interests.
Competing interests Two of the authors (RT and EF) are employed full-time and part-time by World Rugby in roles of research and medicine. GF has served as an independent advisor on a working group on concussion administered by World Rugby, for which expenses are covered.
Patient consent for publication Not required.
Ethics approval The research plan for this study was approved by the World Rugby Institutional Ethics committee (REF 19007). Players had provided written informed consent for all data gathered as part of the World Rugby Concussion management programme to be used for research in a de-identified manner.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Original participant data belongs to the players and the clubs/unions that generate such data. This may be provided upon request to third parties. World Rugby (the corresponding author) may facilitate the provision of that data, in terms of permissions and contacts, though there is not a single point of contact, since the data are generated globally from multiple teams and Unions.