Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System

Abstract

There is a growing concern around concussions in rugby union, at all levels of the game. These concerns highlight the need to better manage and care for players. However, consistency around concussion-related responsibilities of stakeholders across the community rugby system remains challenging. Taking a systems thinking approach, this pragmatic, qualitative descriptive study explored key stakeholder groups within New Zealand’s community rugby system’s perceptions of their own and others’ concussion-related responsibilities. Participants included players from schools and clubs, coaches, parents, team leads and representatives from four provincial unions. A total of 155 participants (67 females and 88 males) were included in the study. Focus groups and individual interviews were conducted. Thematic content analysis was used to analyse data. Thirty concussion-related responsibilities were identified. These responsibilities were contained within four themes: (1) policies and support (responsibilities which influence policy, infrastructure, human or financial resources); (2) rugby culture and general management (responsibilities impacting players’ welfare and safety, attitudes and behaviour, including education, injury reporting and communication); (3) individual capabilities (responsibilities demonstrating knowledge and confidence managing concussion, leadership or role/task shifting) and (4) intervention following a suspected concussion (immediate responsibilities as a consequence of a suspected concussion). The need for role clarity was a prominent finding across themes. Additionally, injury management initiatives should prioritise communication between stakeholders and consider task-shifting opportunities for stakeholders with multiple responsibilities. How concussions will realistically be managed in a real-world sports setting and by whom needs to be clearly defined and accepted by each stakeholder group. A ‘framework of responsibilities’ may act as a starting point for discussion within different individual community rugby contexts on how these responsibilities translate to their context and how these responsibilities can be approached and assigned among available stakeholders.

An examination of social relations and concussion management via the blue card

“…Rather, downloading the final decision to the match official has provided the opportunity for others (e.g., athletes and coaches) to avoid responsibility. Salmon et al ( 55 ) have similarly identified responsibility concerns in coordinating concussion management. Match officials accepted their role in ensuring the safety of participants, aligning with Clacy et al ( 56 ).…”

Aotearoa New Zealand physiotherapists’ perspectives of potential expanded roles for sports-related concussion management: A qualitative study

“…In reality, physiotherapists are often involved and confident to identify and manage individuals with suspected concussions while waiting for a medical doctor appointment (Frémont et al, 2022;Maxtone et al, 2020;McGrann & Keating, 2012;Salmon, Chua, et al, 2023). To initiate care under the current ACC restrictions, physiotherapists use other read codes that are within their scope, such as neck sprains or head contusions (Kennedy et al, 2017).…”