Concussion knowledge and practice among role players in primary school rugby in the North West Province
Jansen van Rensburg, Magrietha
MetadataShow full item record
Background: Concussion is a common medical problem which can have devastating complications, particularly in young adults and children. Due to the nature of rugby, concussions are frequently sustained by the players engaging in this contact sport. Since children are more susceptible to sustain a concussion, medical personnel such as doctors or paramedics should theoretically be the role players responsible for medical decision making next to the school rugby field. Coaches, who are often teachers, are often the primary source of medical support next to school sports field. Since failure to recognise or mismanagement of a concussion may lead to serious medical complications and delayed recovery, all role players involved with a potentially concussed child should be knowledgeable on the factors influencing medical decision making. These factors include knowledge on the prevention, recognition and management of a concussion, knowledge on the consequences of a sustained concussion and when to clear a child to Return to Play (RTP). Aims: This study aimed to report on the general and essential knowledge to be able to recognise a concussion of role players potentially involved with a concussed primary school rugby player and knowledge of role players regarding the prevention and consequences of concussion. In addition, knowledge and practices of role players regarding the management of a suspected or confirmed concussion, as well as knowledge and practices of role players regarding Return to Play (RTP) decision making following a concussion were assessed. Methods: A self-administered questionnaire was developed according to guidelines from literature to assess the child-specific concussion knowledge and practices of role players. These questionnaires were completed by primary school rugby coaches (n=51), paramedics (n = 39) and doctors (n = 20) in the Klerksdorp, Orkney, Stilfontein and Hartbeesfontein (KOSH) area in the North West Province. The outcome measures consisted of scores (out of a potential 100% if all the correct answers were given) on the prevention, management, recognition, RTP and consequences of a concussion. In addition, the knowledge regarded by literature as being essential to the safe practice of doctors were also assessed among all role players. Results: It was found that coaches and paramedics were generally the most senior persons responsible for medical decision making next to the rugby field. A substantial proportion of coaches (60.8%) were not BokSmart certified at the time of data collection and therefore not adhering to this requirement set out by SA Rugby. There was no relationship between the time since the coaches received their last concussion-related information and their concussion knowledge. There was also no relationship between the coaches’ concussion knowledge and whether they attended a recognised concussion training programme such as BokSmart. The only variable to show a relationship (p = 0.001) with the coaches’ overall essential knowledge needed for safe practice was the amount of years they have been coaching rugby. The coaches, who were also teachers, displayed a general lack in knowledge on the effect of a concussion on a child’s school work and the need for cognitive rest following a concussion. The paramedics displayed a widespread weakness in their knowledge pertaining to the cognitive aspects associated with a concussion. There was general consensus that the decision to clear a child to Return to Play (RTP) should rest with a doctor. However, the results from this study indicates that a considerable proportion of doctors (30.0%) were unaware of the fact that a child should be free from concussion symptoms not only during physical activity, but also at rest, which may result in premature RTP. The role players displayed a less than adequate knowledge on sport-related concussion with the coaches scoring 71.44 ± 12.03%, the paramedics scoring 67.01 ± 12.29% and the doctors scoring 76.67 ± 6.56% on the overall essential knowledge needed for safe practice Conclusions: Despite the fact that the doctors scored significantly better compared to the coaches and paramedics on their overall essential knowledge score (all of the essential knowledge items combined), very few doctors did not present with considerable gaps in their essential knowledge needed for safe practice when dealing with a concussed child. By implication the findings from this study indicates that children suffering from a concussion may be at risk for receiving inappropriate or insufficient medical care when sustaining a concussion. These findings should be communicated to sport governing bodies such as SA Rugby and further research undertaken to address the lack in knowledge among role players potentially dealing with concussed athletes as a matter of urgency.