The Concussion Management Pathway (CMP)

CMP seeks growth and sustainability while enhancing player support. Qualitative research funded by the NZRF has been crucial for understanding experiences, challenges, and successes since 2019, especially in addressing non-disclosure of concussions among players, influenced by a "warrior mentality" and lack of awareness, particularly among marginalized groups.

Recent data analysis from 2022 indicates positive shifts in player attitudes toward reporting concussions. However, challenges persist, including dissatisfaction with the "If in doubt, sit them out" strategy, leading to hesitancy among some players to disclose symptoms without certainty about their condition. Diverse perspectives exist on the severity of concussion-related issues, influenced by public perception and former players disclosing long-term health consequences. Balancing these perspectives is essential, requiring education to ensure player safety without undue emphasis on risks.

Participants appreciate NZR's support but suggest additional resources for unions to expand CMP effectively. Key recommendations include dedicated roles in each union for concussion management, engaging various stakeholders, improving GP access, and prioritizing concussion education for players, parents, and coaches. Flexibility in mandatory stand periods also warrants discussion.

In summary, this ongoing research has provided valuable insights into CMP effectiveness and challenges, highlighting the need for continued education, resource allocation, and stakeholder engagement to ensure comprehensive concussion management and player welfare.

For further details on the research conducted as part of the CMP, links to the publications are provided (outputs from 2023/4 highlighted in yellow):

  1. Infographic. New Zealand Rugby’s concussion management pathway (2020). British Journal of Sports Medicine, 54(5), 298–299. https://doi.org/10.1136/bjsports-2019-100950
  2. Infographic. New Zealand rugby’s community concussion initiative: Keeping kiwi communities RugbySmart (2020). British Journal of Sports Medicine, 54(5), 300–301. https://doi.org/10.1136/bjsports-2019-100949
  3. What they know and who they are telling: Concussion knowledge and disclosure behaviour in New Zealand adolescent rugby union players (2020). Journal of Sports Sciences, 38(14), 1585–1594. https://doi.org/10.1080/02640414.2020.1749409
  4. Time to customise a concussion assessment tools for primary care: The New Zealand experience? A call for a GP-SCAT (2020). Brain Injury, 34(13–14), 1794–1795. https://doi.org/10.1080/02699052.2020.1831607
  5. Baseline concussion assessment performance of community-based senior rugby players: A cross-sectional study (2021). Brain Injury, 35(11), 1433–1442. https://doi.org/10.1080/02699052.2021.1972452
  6. Time to expand the circle of care–General practitioners’ experiences of managing concussion in the community (2022). Journal of Sports Sciences, 40(19), 2102–2117. https://doi.org/10.1080/02640414.2022.2130586
  7. The rugby tug-of-war: Exploring concussion-related behavioural intentions and behaviours in youth community rugby union in New Zealand (2022). International Journal of Sports Science and Coaching, 17(4), 804–816. https://doi.org/10.1177/17479541211047661
  8. Sport concussion assessment in New Zealand high school rugby players: A collaborative approach to the challenges faced in primary care (2022). Brain Injury, 36(2), 258–270. https://doi.org/10.1080/02699052.2022.2033839
  9. The balancing act—Physiotherapists’ experiences of managing rugby-related concussion in the community (2023) Physiotherapy theory and Practice. https://doi.org/10.1080/09593985.2023.2170195
  10. Concussion education for New Zealand high school rugby players: A mixed method analysis of the impact on concussion knowledge, attitudes, and reporting behaviours (2023). International Journal of Sports Science and Coaching. https://doi.org/10.1177/17479541231156159
  11. Quest for clarity: Investigating concussion-related responsibilities across the New Zealand Rugby Community System | BMJ Open Sport & Exercise Medicine. (2023). https://bmjopensem.bmj.com/content/9/4/e001722.info
  12. Managing concussion in the real world—Stakeholders’ perspectives of New Zealand Rugby’s concussion management pathway (2023). International Journal of Sports Science and Coaching. https://doi.org/10.1177/17479541231218518

The following publications are in progress:

  1. Unintended consequences - A qualitative exploration of baseline testing in community rugby. Under reviewJournal of Science and Medicine in Sport
  2. Navigating concussion - community rugby players’ experiences of a concussion management pathway. Under review – Brain Injury
  3. Utilisation of New Zealand Rugby’s concussion management pathway: a mixed methods investigation. Team review in progress.
  4. Test-retest reliability of baseline scores in community rugby players over two consecutive years using the New Zealand Rugby Concussion Assessment- Individual baselines or Normative Data. Team review in progress.
  5. Quantifying change in SCAT   domains from baseline to return to play in 249 NZ community rugby players (GP assessment NZRCAT). Team review in progress.
  6. Sideline physiotherapy support and pre-season baseline testing are associated with improved compliance to New Zealand Rugby’s community concussion management pathway. Team review in progress.
  7. Recognise and Remove - Logged suspected concussion from 2020-2022. Team review in progress.
  8. CMP touchpoints - 2020-2022. Analysis and Manuscript drafting phase.
  9. Perceptions around risk, prevention, and concussion responsibilities. Analysis and Manuscript drafting phase.
  10. Utilisation of New Zealand Rugby’s concussion management pathway -2022 Mixed methods. Analysis and Manuscript drafting phase.

Conference Abstracts:

IOC World Conference on Prevention of Injury and Illness in Sport, Monaco, 29 Feb – 2 Mar 2024

  1. The under-appreciated value of concussion baseline testing: Its role in education and positive concussion-related behaviours (Accepted)
  2. Is an ounce of prevention worth a pound of cure? Community rugby union players’ beliefs around concussion-related risk and prevention (Accepted)
  3. Sideline physiotherapy support and pre-season baseline testing are associated with improved compliance with New Zealand Rugby’s community concussion management pathway (Accepted)
  4. Navigating multiple role: how physiotherapists’ experience supporting concussions in New Zealand Rugby Concussion Management Pathway

15th Injury Prevention & Safety Promotion Conference, Rotorua, New Zealand, 11-13 March, 2024

Supporting diverse communities: Lesson learnt from Concussion Management in New Zealand rugby union

  1. Kumanu Tāngata: The AfterMatch Project - Unravelling the Health Effects of High-Level Rugby
  2. Rugby is a sport played by millions, and followed by many millions more, yet its long-term health impacts remain largely unknown. Kumanu Tāngata, the AfterMatch Project, is seeking to shed light the impacts of the sport on players’ health beyond the final whistle.

    The name itself tells a tale. It comes from the Māori phrase ““He Tukutuku Raraunga he kumanu tāngata”, which blends the concept of cherishing something special (our people!), with weaving together the multiple statistics that mark an individual’s journey through their life. It's about more than just the physical and mental; it's about the social fabric, the camaraderie that binds players and communities together.

    The Kumanu Tāngata project involves researchers from New Zealand, Australia, and the Netherlands, who together bring a mix of expertise across sports injuries, clinical medicine, and public health. The project is funded by World Rugby and the New Zealand Rugby Foundation, with the project being managed by Dr Ken Quarrie of NZ Rugby and Dr Stephanie D’Souza of the University of Auckland.

    Injuries in rugby are no secret, but the true extent of the risks associated with playing the sport, especially in later life, remains unclear. We know that there is concern about concussions and their potential links to depression, anxiety, and even dementia. But how big are the issues? And what about the broader picture? Does playing rugby extend or shorten lives? Does it enhance or diminish quality of life? These are the questions driving our research.

    Our method? A retrospective cohort study, a fancy term for using data that have already been collected to look back at the health outcomes of groups of people over time. We're digging into the New Zealand Rugby Register compiled by Clive Akers and health records housed in New Zealand’s Integrated Data Infrastructure to compare the health outcomes of former high-level rugby players with a matched general population group. The players’ careers fell between 1950 and 2000, with follow-up for health conditions spanning the period from 1988 to 2018.

    We have already published one paper from the study, with the second well through peer-review process. The first, the protocol paper, outlines the study's rationale and methodology, focusing on comparing health outcomes of 12861 first-class male rugby players with 2,385,300 individuals from the general population, matched for age, ethnicity, and birthplace. Cox proportional hazards models are used to assess risks of neurodegenerative diseases, musculoskeletal conditions, chronic physical conditions, and mental health outcomes.

    The second paper, focussed on neurodegenerative diseases, reports a small to moderate increase in neurodegenerative disease risk among rugby players compared to the general population. By the end of the follow-up period, 3.9% of the general population, and 4.7% of players, had developed or died from neurodegenerative diseases. Put another way, around 20 of the former players per year are being identified as having or dying from a neurodegenerative disease. Given the rate in the general population we would be expecting to see about 17 per year. The paper also notes that there was little difference in the median age of onset of neurodegenerative conditions between rugby players and the general population, with no indication that players from the period studied have higher rates of early onset dementia.

    We know, though, that rugby in the professional era from 1996 onwards represents a very different sport to that played in the 1950s through to the 1980s, so we have been urging a precautionary approach to reduce the number of high-speed collisions and head impacts that occur in the sport.

    While we can't predict the future, we're working to ensure that the risks of playing rugby are as well-understood as possible and managed based on solid evidence. With your support, we're one step closer to ensuring the health and well-being of rugby players, today and in the future.

  3. https://www.auckland.ac.nz/en/arts/our-research/research-institutes-centres-groups/compass/whole-population-data-analysis/kumanu-t_ngata--the-aftermatch-project.html

  4. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4638307