Life after the game: consequences of acute spinal cord injuries in South African rugby union players

There is a well described association between participation in exercise and sport and the positive effects of physical, social and psychological health. 1,2 Rugby union is a popular team sport across many countries.3 As a team sport, rugby shares these positive benefits. However, the physical demands of the game means that it is also associated with a risk of serious injuries, such as spinal cord injuries (SCIs). 4–6 SCIs have profound long-term effects on every aspect of a person’s life, including their overall quality of life (QoL).7–10 As such, a nationwide injury prevention programme called ‘BokSmart’ was launched in South Africa in 2009, with the aim to reduce and ultimately prevent these injuries.11,12 However, implementing an injury prevention programme in a country with vast socio-economic disparities, such as South Africa, is a difficult task.13 Additionally, optimal acute care after the injury, rehabilitation services and ongoing health maintenance are essential in the management of SCIs and may play a determining role in enhancing and maintaining health and functioning, and therefore QoL.14–16 In South Africa, socio-economic disparities also have a profound effect on healthcare access and the subsequent health of the population. 14 Thus, the additional burden of an injury with permanent consequences may be substantial and is an important issue to investigate. This introductory chapter summarises the literature on the incidence and risk factors for rugby-related SCIs, and the immediate management of these injuries. It also summarises the long-term healthcare issues and overall QoL of players who sustain these injuries and identifies how these problems present both globally and in South Africa. This chapter also provides the overall structure of this PhD-thesis

Community perspectives on spinal cord injury in rugby union: Facts and fears

Introduction: The sport of rugby union, henceforth rugby, is associated with a risk of spinal cord injury (SCI). Perceived risks can impact participation. Understanding community perspectives on rugby-related SCI may provide insight for addressing concerns around risk. The aim of this study was to explore community perspectives through social media discussion about SCI in rugby union. Methods: Posts about SCI in rugby union were identified using the advanced search function on Twitter. Data (content as original post, retweet, quote tweet and comments) were included if focused on Rugby Union and written in English. Inclusion dates (July 2018 to June 2019) were chosen to capture a period when several SCI (n = 4) occurred in community rugby in Australia. Data were analysed using a thematic approach. Results: Four themes were derived from the collected data. The ‘pendulum swing’ relates to the disparate views of rugby, from being overly cautious to too dangerous to play. The ‘role of rugby culture’ described engrained behaviours and attitudes on and off-field toward safety. ‘Media influence’ describes the emotive narrative used when reporting rugby-related SCI. ‘After the injury’ looks at expressions of sympathy and inspiration. These findings showed how individuals’ views of SCI were influenced through rugby culture, trust in governing bodies and the news media. Conclusion: By ‘listening in’ to community views, their most pertinent safety concerns can be addressed. Both facts and fears on rugby-related SCI were evident, and these extreme views can be balanced with evidence-based education and sensible risk management. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

What impact have the IOC medical consensus statements made on athlete health? a survey of medical commissions from national olympic/ paralympic committees and international sports federations

Background The International Olympic Committee (IOC) Medical and Scientific Commission has supported collating and sharing evidence globally by developing sports medicine consensus statements (‘Statements’\u27). Publishing the Statements requires substantial resources that must be balanced by use and impact on policy and practice. This study aimed to gain a better understanding of awareness and uptake of the Statements globally through a survey of the National Olympic Committees (NOC), National Paralympic Committees (NPC) and International Federations (IF). Method A cross-sectional survey of medical commission representatives from NOCs/NPCs/IFs. A structured questionnaire was distributed through the IOC head office, informed by prior research. Questions comprised a mix of closed and open-text responses with results presented descriptively by organisation type and total. Results 55 responses were included: 29 (52%) from NOC/ NPC representatives (response rate 14%) and 26 (47%) from IF representatives (response rate 63%). All Statements had been used by at least one respondent, with the Statement addressing concussion ranked highest (used by 33/55). The main barriers to use were financial limitations (n=21), club/sport culture and behaviours (n=19) and lack of understanding from coaches/team sport personnel (n=19). Participants believed the Statements were a successful strategy for improving athlete health (n=39/51 agree or strongly agree). Conclusion There was clear support for the continued development of sports medicine guidance, including in the format of these Statements. To ensure Statements lead to demonstrable health benefits for athletes, input from athletes, coaches and supporting staff is needed, as well as clearer identification of the purpose and audience of each topic developed

Managing concussion in the real world: Stakeholder perspectives of New Zealand Rugby's concussion management pathway

The potential adverse consequences associated with poor concussion management highlights the need to improve the translation of concussion guidelines into consistent use in real-world sport settings. To facilitate this process, New Zealand Rugby developed a community concussion management pathway to support concussion recognition, diagnosis, and management. This study adopted a pragmatic, descriptive qualitative approach to explore key stakeholders’ perceptions of the concussion management pathway, with the aim to inform policy and practice. Interviews were conducted with 123 participants, including players, parents, coaches, healthcare professionals, and school and provincial union representatives. The framework method was used to analyze data. Themes were organized according to the principles of realist process evaluation that considers contextual factors and mechanisms influencing a program's operation to produce specific outcomes. Contextual factors influencing the concussion management pathway's implementation included governing bodies’ support, existing local resources, general concussion attitudes, or concussion severity. The optimal functioning of the concussion management pathway (mechanism) was influenced by (i) pathway resources, (ii) roles and relationships, (iii) buy-in and support towards the concussion management pathway, and (iv) diligence and communication. Outcomes identified included (i) hitting the target (optimally managed and enhanced awareness) or (ii) missing the mark (dissatisfaction or management gaps). Overall, participants found the concussion management pathway valuable. However, the acceptability of certain policy-related aspects and the underlying attitudes associated with these perceptions, are some areas requiring further investigation and support. Tailoring programs according to end-users’ perceptions is crucial in developing context-sensitive interventions appropriate for a specific setting. These findings may act as a foundation for investigations of concussion management in other settings

Evaluating workforce needs : an investigation of healthcare professionals' attitudes, beliefs and preparedness towards the management of para athlete mental health at the Tokyo 2020 and Beijing 2022 Paralympic Games

OBJECTIVES : To examine healthcare professionals (HCPs) attitudes, beliefs and preparedness towards the management of Para athlete mental health during the Tokyo 2020 and Beijing 2022 Paralympic Games. METHODS : A cross-sectional observational study was conducted. National Paralympic Committee’s HCPs (n=857) working at the Tokyo 2020 and Beijing 2022 Paralympic Games were invited to respond to an anonymous online survey regarding the management of Para athlete mental health in their team. Data were analysed using descriptive frequency statistics. RESULTS : The survey was completed by 256 HCPs (30% of respondents). Most HCPs agreed that mental health was a concern in Para athletes (n=210; 82%). However, half (n=122; 48%) agreed that they did not screen Para athletes for mental health symptoms, and half (n=130; 51%) agreed that there was increased stigma around disclosure of mental health symptoms among Para athletes, compared with athletes without disability. Most HCPs (n=221; 86%) agreed they wanted to improve their knowledge and skills surrounding athlete mental healthcare. Culturally sensitivite, non-discriminatory and contextual factors were highlighted as desired areas of education for HCPs and active information dissemination for Para athletes. CONCLUSION : HCPs working at the Paralympic Games considered Para athlete mental healthcare important and reported perceived stigma, yet indicated low rates of mental health screening. Most respondents expressed the need for mental health education. Culturally sensitive training and active education strategies should be implemented to optimally manage Para athlete mental health.The 2021 IOC Medical and Scientific Research Fund and the IOC Research Centre South Africa grant.http://bjsm.bmj.comhj2024Sports MedicineSDG-03:Good heatlh and well-bein

What impact have the IOC medical consensus statements made on athlete health? A survey of medical commissions from National Olympic/ Paralympic Committees and International Sports Federations

DATA AVAILABITY STATEMENT: All data relevant to the study are included in the article or uploaded as supplementary information.BACKGROUND: The International Olympic Committee (IOC) Medical and Scientific Commission has supported collating and sharing evidence globally by developing sports medicine consensus statements (‘Statements’'). Publishing the Statements requires substantial resources that must be balanced by use and impact on policy and practice. This study aimed to gain a better understanding of awareness and uptake of the Statements globally through a survey of the National Olympic Committees (NOC), National Paralympic Committees (NPC) and International Federations (IF). METHOD: A cross-sectional survey of medical commission representatives from NOCs/NPCs/IFs. A structured questionnaire was distributed through the IOC head office, informed by prior research. Questions comprised a mix of closed and open-text responses with results presented descriptively by organisation type and total. RESULTS: 55 responses were included: 29 (52%) from NOC/ NPC representatives (response rate 14%) and 26 (47%) from IF representatives (response rate 63%). All Statements had been used by at least one respondent, with the Statement addressing concussion ranked highest (used by 33/55). The main barriers to use were financial limitations (n=21), club/sport culture and behaviours (n=19) and lack of understanding from coaches/team sport personnel (n=19). Participants believed the Statements were a successful strategy for improving athlete health (n=39/51 agree or strongly agree). CONCLUSION: There was clear support for the continued development of sports medicine guidance, including in the format of these Statements. To ensure Statements lead to demonstrable health benefits for athletes, input from athletes, coaches and supporting staff is needed, as well as clearer identification of the purpose and audience of each topic developed.The International Olympic Committee Medical and Scientific Commission.https://bmjopensem.bmj.com/Sports MedicineSDG-03:Good heatlh and well-beingSDG-17:Partnerships for the goal

Are we levelling the playing field? A qualitative case study of the awareness, uptake and relevance of the IOC consensus statements in two countries

DATA AVAILAVBILITY STATEMENT : No data are available. All data are published, and therefore there are no additional data available. The authors will consider request to access to the raw data, within the constraints of privacy and consent.OBJECTIVES : Research evidence is commonly compiled into expert-informed consensus guidelines intended to consolidate and distribute sports medicine knowledge. Between 2003 and 2018, 27 International Olympic Committee (IOC) consensus statements were produced. This study explored the policy and practice impact of the IOC Statements on athlete health and medical team management in two economically and contextually diverse countries. METHODS : A qualitative case study design was adopted. Fourteen face-to- face interviews were conducted with purposively selected interviewees, seven participants from Australia (higher economic equality) and seven from South Africa (lower economic equality), representing their national medical commissions (doctors and physiotherapists of Olympic, Paralympic and Youth teams). A framework method was used to analyse interview transcripts and identify key themes. RESULTS : Differences across resource settings were found, particularly in the perceived usefulness of the IOC Statements and their accessibility. Both settings were unsure about the purpose of the IOC Statements and their intended audience. However, both valued the existence of evidence-informed guidelines. In the Australian setting, there was less reliance on the resources developed by the IOC, preferring to use locally contextualised documents that are readily available. CONCLUSION : The IOC Statements are valuable evidence-informed resources that support translation of knowledge into clinical sports medicine practice. However, to be fully effective, they must be perceived as useful and relevant and should reach their target audiences with ready access. This study showed different contexts require different resources, levels of support and dissemination approaches. Future development and dissemination of IOC Statements should consider the perspectives and the diversity of contexts they are intended for.https://bjsm.bmj.comam2024Sports MedicineSDG-03:Good heatlh and well-bein

Developing a Complex Understanding of Physical Activity in Cardiometabolic Disease from Low-to-Middle-Income Countries—A Qualitative Systematic Review with Meta-Synthesis

From MDPI via Jisc Publications RouterHistory: accepted 2021-11-06, pub-electronic 2021-11-15Publication status: PublishedPhysical activity behaviour is complex, particularly in low-resource settings, while existing behavioural models of physical activity behaviour are often linear and deterministic. The objective of this review was to (i) synthesise the wide scope of factors that affect physical activity and thereby (ii) underpin the complexity of physical activity in low-resource settings through a qualitative meta-synthesis of studies conducted among patients with cardiometabolic disease living in low-to-middle income countries (LMIC). A total of 41 studies were included from 1200 unique citations (up to 15 March 2021). Using a hybrid form of content analysis, unique factors (n = 208) that inform physical activity were identified, and, through qualitative meta-synthesis, these codes were aggregated into categories (n = 61) and synthesised findings (n = 26). An additional five findings were added through deliberation within the review team. Collectively, the 31 synthesised findings highlight the complexity of physical activity behaviour, and the connectedness between person, social context, healthcare system, and built and natural environment. Existing behavioural and ecological models are inadequate in fully understanding physical activity participation in patients with cardiometabolic disease living in LMIC. Future research, building on complexity science and systems thinking, is needed to identify key mechanisms of action applicable to the local context

Risk factors associated with acute respiratory illnesses in athletes : a systematic review by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'

OBJECTIVE : To review risk factors associated with acute respiratory illness (ARill) in athletes, including non-infectious ARill and suspected or confirmed acute respiratory infections (ARinf). DESIGN : Systematic review. DATA SOURCES : Electronic databases: PubMed-Medline, EbscoHost and Web of Science. ELIGIBILITY CRITERIA : Original research articles published between January 1990 and July 2020 in English were searched for prospective and retrospective full text studies that reported quantitative data on risk factors associated with ARill/ARinf in athletes, at any level of performance (elite/non-elite), aged 15–65 years. RESULTS : 48 studies (n=19 390 athletes) were included in the study. Risk factors associated with ARill/ARinf were: increased training monotony, endurance training programmes, lack of tapering, training during winter or at altitude, international travel and vitamin D deficits. Low tear-(SIgA) and salivary-(IgA) were immune biomarkers associated with ARill/ARinf. CONCLUSIONS : Modifiable training and environmental risk factors could be considered by sports coaches and athletes to reduce the risk of ARill/ARinf. Clinicians working with athletes can consider assessing and treating specific nutritional deficiencies such as vitamin D. More research regarding the role and clinical application of measuring immune biomarkers in athletes at high risk of ARill/ARinf is warranted.http://bjsm.bmj.comhj2023Sports Medicin

Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'

OBJECTIVE : To determine the incidence of acute respiratory illness (ARill) in athletes and by method of diagnosis, anatomical classification, ages, levels of performance and seasons. DESIGN : Systematic review and meta-analysis. DATA SOURCES : Electronic databases: PubMed-Medline, EbscoHost and Web of Science. ELIGIBILITY CRITERIA : Original research articles published between January 1990 and July 2020 in English reporting the incidence of ARill in athletes, at any level of performance (elite/non-elite), aged 15–65 years. RESULTS : Across all 124 studies (n=1 28 360 athletes), the incidence of ARill, estimated by dividing the number of cases by the total number of athlete days, was 4.7 (95% CI 3.9 to 5.7) per 1000 athlete days. In studies reporting acute respiratory infections (ARinf; suspected and confirmed) the incidence was 4.9 (95% CI 4.0 to 6.0), which was similar in studies reporting undiagnosed ARill (3.7; 95% CI 2.1 to 6.7). Incidences of 5.9 (95% CI 4.8 to 7.2) and 2.8 (95% CI 1.8 to 4.5) were found for studies reporting upper ARinf and general ARinf (upper or lower), respectively. The incidence of ARinf was similar across the different methods to diagnose ARinf. A higher incidence of ARinf was found in non-elite (8.7; 95% CI 6.1 to 12.5) vs elite athletes (4.2; 95% CI 3.3 to 5.3). SUMMARY/CONCLUSIONS : These findings suggest: (1) the incidence of ARill equates to approximately 4.7 per athlete per year; (2) the incidence of upper ARinf was significantly higher than general (upper/lower) ARinf; (3) elite athletes have a lower incidence of ARinf than non-elite athletes; (4) if pathogen identification is not available, physicians can confidently use validated questionnaires and checklists to screen athletes for suspected ARinf. For future studies, we recommend that a clear diagnosis of ARill is reported. PROSPERO registration number CRD42020160472.https://bjsm.bmj.comhj2023Sports Medicin