Sports-related concussion (SRC) assessment in road cycling: a systematic review and call to action

Background: Sports-related concussion (SRC) is a recognised risk in road cycling and can have serious health consequences. Recent high-profile cases of professional road cyclists continuing to participate in races despite suffering obvious SRC have highlighted the difficulties in assessing SRC within road cycling. Purpose: To undertake a systematic review of the literature on SRC assessment in road cycling. Study design: Systematic review. Methods: Literature describing SRC assessment in road cycling was identified by searching MEDLINE, EMBASE, PsycINFO and Web of Science. Two reviewers independently screened titles and abstracts for eligibility and a qualitative analysis was undertaken of included studies. Results: From 94 studies identified, two were included for review. Gordon et al describe the presentation of a single case of paediatric concussion following a cycling crash. They highlight the utility of SRC evaluation using the Sport Concussion Assessment Tool (SCAT) as well as the importance of a stepwise return-to-play protocol. Greve and Modabber discuss a number of traumatic brain injuries that occurred during the 2011 road cycling season and, as a minimum, call for riders to be withdrawn from competition following loss of consciousness or amnesia. Both studies are at high risk of bias and of low quality. Conclusion: Road cycling poses unique challenges for the assessment of SRC. This review illustrates the lack of published evidence to advise effective means of SRC assessment within road cycling. The Union Cycliste Internationale (UCI) regulations advise the use of SCAT-5 for concussion assessment but this tool is impractical, requiring modification for use in road cycling. We would like to call on the UCI to hold a consensus meeting to establish an evidence-based SRC assessment protocol and return-to-riding protocol for road cycling

Exploring value creation from an ecosystem perspective: A critical examination of social procurement policy

From qualitative research undertaken in Scotland, the authors analyse procurement policy reforms. Utilizing a public service ecosystem framework, barriers to value creation were found, including overly bureaucratic practices, centrally devised rules, and conflicting organizational aims. The authors develop insights into ways policy design and implementation creates (or does not create) value across the many levels of an ecosystem where procurement policy reforms have impact, demonstrating the benefits of using a service ecosystem framework for understanding nuanced impacts and perceptions of policy implementation

Exploring value creation from an ecosystem perspective: A critical examination of social procurement policy

From qualitative research undertaken in Scotland, the authors analyse procurement policy reforms. Utilizing a public service ecosystem framework, barriers to value creation were found, including overly bureaucratic practices, centrally devised rules, and conflicting organizational aims. The authors develop insights into ways policy design and implementation creates (or does not create) value across the many levels of an ecosystem where procurement policy reforms have impact, demonstrating the benefits of using a service ecosystem framework for understanding nuanced impacts and perceptions of policy implementation

What are the critical elements of sideline screening that can be used to establish the diagnosis of concussion? A systematic review

BACKGROUND : Sideline detection is the first and most significant step in recognising a potential concussion and removing an athlete from harm. This systematic review aims to evaluate the critical elements aiding sideline recognition of potential concussions including screening tools, technologies and integrated assessment protocols. DATA SOURCES : Bibliographic databases, grey literature repositories and relevant websites were searched from 1 January 2000 to 30 September 2016. A total of 3562 articles were identified. STUDY SELECTION : Original research studies evaluating a sideline tool, technology or protocol for sports-related concussion were eligible, of which 27 studies were included. DATA EXTRACTION : A standardised form was used to record information. The QUADAS-2 and Newcastle-Ottawa tools were used to rate risk of bias. Strength of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation Working Group system. DATA SYNTHESIS : Studies assessing symptoms, the King-Devick test and multimodal assessments reported high sensitivity and specificity. Evaluations of balance and cognitive tests described lower sensitivity but higher specificity. However, these studies were at high risk of bias and the overall strength of evidence examining sideline screening tools was very low. A strong body of evidence demonstrated that head impact sensors did not provide useful sideline concussion information. Low-strength evidence suggested a multimodal, multitime-based concussion evaluation process incorporating video review was important in the recognition of significant head impact events and delayed onset concussion. CONCLUSION : Conclusion In the absence of definitive evidence confirming the diagnostic accuracy of sideline screening tests, consensus-derived multimodal assessment tools, such as the Sports Concussion Assessment Tool, are recommended. Sideline video review may improve recognition and removal from play of athletes who have sustained significant head impact events. Current evidence does not support the use of impact sensor systems for real-time concussion identification.The National Institute for Health Research and World Rugby.http://bjsm.bmj.comhj2017Sports Medicin

The Concussion Recognition Tool 5th Edition (CRT5): Background and rationale

The Concussion Recognition Tool 5 (CRT5) is the most recent revision of the Pocket Sport Concussion Assessment Tool 2 that was initially introduced by the Concussion in Sport Group in 2005. The CRT5 is designed to assist non-medically trained individuals to recognise the signs and symptoms of possible sport-related concussion and provides guidance for removing an athlete from play/sport and to seek medical attention. This paper presents the development of the CRT5 and highlights the differences between the CRT5 and prior versions of the instrument

Concussion and long-term cognitive function among rugby players-The BRAIN Study.

OBJECTIVE: The BRAIN Study was established to assess the associations between self-reported concussions and cognitive function among retired rugby players. METHODS: Former elite-level male rugby union players (50+ years) in England were recruited. Exposure to rugby-related concussion was collected using the BRAIN-Q tool. The primary outcome measure was the Preclinical Alzheimer Cognitive Composite (PACC). Linear regressions were conducted for the association between concussion and PACC score, adjusting for confounders. RESULTS: A total of 146 participants were recruited. The mean (standard deviation) length of playing career was 15.8 (5.4) years. A total of 79.5% reported rugby-related concussion(s). No association was found between concussion and PACC (β -0.03 [95% confidence interval (CI): -1.31, 0.26]). However, participants aged 80+ years reporting 3+ concussions had worse cognitive function than those without concussion (β -1.04 [95% CI: -1.62, -0.47]). CONCLUSIONS: Overall there was no association between concussion and cognitive function; however, a significant interaction with age revealed an association in older participants

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Survey of emergency medicine doctors in London physical activity characteristics, awareness of guidelines and prescribing behaviours

Objective To determine London emergency medicine (EM) doctors’ physical activity (PA) characteristics, awareness of PA guidelines and PA prescription practice from London emergency departments (EDs).Methods An anonymous online survey of EM doctors working in London over 6 weeks between 27 April 2021 and 12 June 2021. Inclusion criteria included EM doctors of any grade currently working in London EDs. Exclusion criteria were non-EM doctors, other healthcare professionals and those working outside London EDs. The Emergency Medicine Physical Activity Questionnaire created consisted of two parts: part 1, on basic demographic data and the Global Physical Activity Questionnaire and part 2, focused questions around awareness of guidelines and prescribing characteristics.Results 122 participants attempted the survey, of which 75 (61.5%) met the inclusion criteria. 61.3% (n=46) were aware of and 77.3% (n=58) achieved minimum recommended aerobic PA guidelines. However, only 33.3% (n=25) were aware of and 48% (n=36) achieved muscle strengthening (MS) guidelines. The mean sedentary behaviour time/day was 5 hours. 75.3% (n=55) of EM doctors thought it was important to prescribe PA, yet only 41.8% (n=23) prescribed PA.Conclusions Most London EM doctors are aware of and achieve minimum aerobic PA guidelines. Encouraging MS awareness and activities, as well as PA prescribing, should be areas of focus. Larger studies should take place to assess EM doctors’ characteristics in UK regions and data using accelerometers to determine PA more precisely. Further research should also look at patient perceptions of PA