Doctoral Degrees (Exercise, Sport and Lifestyle Medicine)

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Browsing Doctoral Degrees (Exercise, Sport and Lifestyle Medicine) by browse.metadata.advisor "Brown, James"

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    Head smart: the implementation of a law variation in community rugby union and its effect on head injury rates
    (Stellenbosch : Stellenbosch University, 2024-03) Van Tonder, Riaan; Derman, Wayne; Brown, James; Hendricks, Sharief; Stellenbosch University. Faculty of Medical and Health Sciences. Dept. of Exercise, Sport and Lifestyle Medication.
    ENGLISH ABSTRACT: Background Concussion is a significant concern in contact and collision sports. Emerging evidence indicates potential negative long-term neurological and mental health outcomes associated with exposure to repetitive head impacts and concussion. Concussion is one of the commonest injuries in rugby union (‘rugby’) and most commonly occurs in the tackle. Thus, injury prevention strategies directed at the tackle require investigation. Objectives. The objective of this project was to investigate the implementation of a law variation trial in male amateur community rugby union and its effect on head injury rates, particularly concussion. The primary aim was to evaluate the effectiveness of lowering the maximum legal height of the tackle from shoulder- to armpit-level in reducing concussion incidence. Secondary aims were: 1) To characterise the tackle event and identify factors associated with illegal high tackles. 2) To investigate referee and player behaviour change as measures of successful implementation of the law variation. 3) To qualitatively explore stakeholder perceptions of the tackle law Methods.The study was conducted in Stellenbosch University's ‘Koshuisrugby’ League using a cross-sectional analytical design. Standardised epidemiological injury surveillance and return-to-play data were collected in years one and two of the study, and video footage of all matches in year 2. Covid-19 led to the cancellation of a planned third year of the study and thus no further injury or video surveillance occurred. Data were analysed to compare injury rates and severity between year 1 (2018; control year) and year 2 (2019; intervention year). Video footage was coded and analysed to characterise the tackle, identify factors associated with illegal high tackles, and investigate player and referee behaviour changes across one season. Individual, semi-structured stakeholder interviews were conducted to gain deeper understanding, through qualitative methods, of stakeholder perceptions of the effectiveness of the law variation and factors that influenced the law variation implementation. Results The incidence rate of concussion did not differ significantly between the control and intervention years (rate ratio: 0.69; 95% CI: 0.4 to 1.2; p=0.20). Overall, 108 matches were filmed and >14 000 tackles were coded and characterised. Factors associated with illegal high tackles were lower leagues, on tackles, arm tackles, upright tacklers, and ball carriers in low body positions. Promising positive player and referee behaviour changes were observed. Significantly fewer tacklers were upright in tackles in the last phase of the season and the sanctioning rate of illegal high tackles was significantly higher in the midphase of the season. Despite stakeholders valuing the law variation, many challenges remain to reduce concussion incidence. Ongoing educational campaigns are critical to address knowledge gaps and raise awareness. The prevailing culture in rugby, particularly in this cohort, pits performance against player welfare, mostly prioritising performance. This culture requires change. A multi-factorial, systems-based approach is needed to reduce concussion in rugby.