Contact Sports And Concussion Research Proposal Sample

1. Introduction: Concussion occurs from traumatic injury to the brain and results in a temporary disruption of brain function or loss/altered consciousness for a short period (Moser, 2012). Concussion is common in contact sports, where there is a collision between players. It is expected to have an adverse cumulative effect on the persons cognitive and mental functioning (Moser, 2012). With course of time, this could adversely affect once athletic career. Identifying incidence of concussion in a particular sport, will help to determine risk and initiate preventive measures.
Rugby is a full body contact sports and there are high chances of players getting concussion injuries in this game. Though the rules of the game help to avoid headlong collision, it is still an aggressive providing opportunities for injuries to happen. The effectiveness of the headgear by the players to protect against concussion is still unconvincing. The purpose of this study will be to identify the incidence of concussion among rugby players and to calculate their relative risk. The hypothesis of the study would be: rugby players are at high risk of developing concussion. Rugby is the independent variable and the incidence of concussion would be the dependent variable. Concussion in this study is defined by the changes like loss of consciousness, loss of memory, altered mental state and neurological deficits that occur following a blunt injury to the head.
Theoretical framework: The study is based on the assumption that collision and aggressive nature of rugby, contributes to concussion injuries (Trewartha, Preatoni, England, & Stokes, 2014). The cranium of the rugby players is exposed to a number of directional and impact forces (Trewartha, Preatoni, England, & Stokes, 2014). Further, the headgear of rugby players, is not hard enough to resist these forces. These biomechanics theories will be used to explain the research findings. We expect that rugby player will show concussion incidences, similar to other contact sports. A biomechanics based theoretical framework is used to explain the incidence of concussion in rugby players. Competitive scrummaging in a component of the rugby. Owing to the highly injurious nature of scrummaging, it is excluded from junior games (Trewartha, Preatoni, England, & Stokes, 2014). During scrummaging, players pack together and produce forceful action to ensure dominance. The force, velocity and acceleration of players while colliding with each other during a ‘scrum’ can result in concussion injuries (Trewartha, Preatoni, England, & Stokes, 2014). The effect of these biomechanical forces in rugby are largely uninvestigated.
2. Review of literature:
Rugby is a physically and mentally demanding game. A rugby team is made of 6 forwards and 6 backwards. According to a study conducted in Australia, very high level of concussion incidence was reported in Australian league players. Higher the frequency of tackles and collisions, higher is the incidence of concussion. Though the game has strict rules to prevent collision, the reason for the higher incidence of concussion in rugby players is largely unknown. The study reported 28 concussions per 1000 players (Savage, Hooke, Orchard, & Parkinson, 2013). Multiple concussions were reported in the same person. This is one of the few studies that has reported highest concussion rate among rugby players. The data for the study was gathered over a period of 15 years and a total 239 players enrolled in the study (Savage, Hooke, Orchard, & Parkinson, 2013). Though this is a large cohort study, considering that there are not many other studies that agree to high incidence of concussion in rugby player; there is a need to repeat such studies in different countries, different teams and different game setting.
Quarrie et al., studied the anthropometric and physical performance of rugby players under different age group categories. The players were enrolled in a program that identifies the type, severity and effects of injuries in different players. There was a significant difference in the anthropometric and physical performance measures of players in the forward and backward position of the team. The players in the backward positions were more agile and scored better in the performance measure. On the other hand, players in the forward positions, had a greater body mass and this enabled them to produce greater momentum. Forward players participate in the components of the game that require extensive body contact and thus, are at higher risk to develop collision injuries. When players with moving in opposite directions collide with each other with an equal force, the change in their velocity will depend on the body mass. Greater the body mass, the greater is the momentum. This offers the player’s advantage in situations like tackles, scrums, rucks and mauls involved in the game. Player who are not physically competitive are at the risk of getting collision injuries. (Quarrie et al., 1995)
Training and age of the players can also influence the rate of injury. Experienced players are likely to suffer less injuries when compared to players who are less conditioned to the toughness of the game (Gabbett, 2006). Players also suffer injuries during the training session. Skill based training resulted in lesser injuries when compared to unskilled training session (Gabbett, 2006). Head on collision and catastrophic head injuries are rare in rugby. Use of head gear is not considered mandatory for the players. This practice, is largely based on the misplaced belief in the safety of the game. Head injuries account for 1/3 to 1/6th of the total injuries reported in Rugby (Hinton-Bayre, Geffen, & Friis, 2004) . Majority of the injuries in the game are related to the musculotendinous system. A considerable difference is seen in the incidence of concussion reported for the game.
According to the study conducted by Hinton-Bayre, Geffen, & Friis, the incidence of concussion among Rugby League players in three competitive sessions ranged from 5.9 to 9.8 injuries per 1000 player hours. Head high tackles, accounted for a majority of the concussion injuries. Loss of consciousness associated with concussion, was rare in players. Most cases of concussion exhibited symptoms like amnesia, unsteadiness and headache. The signs of concussion often coexist with other head injuries. The lack of expertise among trainers and physicians to recognize concussion occurring in the field, was also identified through this study. Though high head tackling is forbidden in the game, the dangerous practice still exists in the field. (Hinton-Bayre, Geffen, & Friis, 2004)
According to a study by Brookes et al., contact mechanisms account for 72% of the injuries in the study. Ruck and mauls of the game, during the tackling procedure, accounted for most of the injuries (Brooks et al. 757-766). Though this study, did not conduct a specific investigation into the incidence of concussion; it identifies rugby as a fierce sport that involves mechanical collisions.
Marshal and Spenser, studied the incidence of concussion in two rugby teams, over a period of 3 years. The study looked into the injury rate, severity and the player’s time spend away from game following injury. The studied identified that concussion accounted for 25% of the injuries in these teams (Marshall & Spencer, 2001). The concussion injuries also accounted for 25% of the days lost from game (Marshall & Spencer, 2001). All forms of grade 1, grade 2 and grade 3 level of concussion severity were reported in the study (Marshall & Spencer, 2001).
Poor compliance with wearing protective gears was noticed among players. Due to lack of head on collision, wearing head gears is not mandated for this sport. McIntosh et al, studied the benefits of wearing head gear as protection from head injury in 1493 participants. Interestingly, no positive benefits of wearing head gear were seen in the players. This was a large scale cohort study in which, 82 teams had enrolled their participation (McIntosh et al., 2009). Compliance rate to wearing head gear was limited, nevertheless, wearing padded head gears did not provide any advantage to the players. (McIntosh et al., 2009)
Kirkwood et al, conducted a systematic review to identify the incidence of concussion in children and adolescents participating in competitive rugby league, in the U.K. According to this review, the concussion rate associated with the game in children and adolescent, ranged from 0.2 to 6.9 concussions per 1000 player hours in rugby union. The rate was higher in league games. He used the incidence to work out the probability of the concussion risk. The risk was higher among adolescent when compared to children (Kirkwood, Parekh, Ofori-Asenso, & Pollock, 2015). The probability of getting a concussion was almost 25%, in Rugby league (Kirkwood, Parekh, Ofori-Asenso, & Pollock, 2015).
The above literature, provides evidence for the presence of concussion injuries in rugby. In the light of this review, the research aims to determine incidence of concussion in adult players. There is a need to determine the incidence of concussion in different team setting, practice settings and countries make a conclusive decision. The present study is designed to identify the incidence of concussion among adult league players in U.S. There is a dearth of information about concussion injuries in U.S players. The information from the study can be used to evaluate policies and implement changes that ensure the safety of players.
3. Methodology: A quantitative study design will be used for this project. The study protocol will be presented to institute ethic committee and informed consent will be sought from players participating in the study. Rugby players from union and leagues, will be enrolled into the rugby injury project, during the preseason training. The tentative sample size is set at 400 players. The sample size was decided based on earlier studies. More the sample size, more accurate will be the result.
Publicity of the project will be given to different rugby clubs and teams, so as to promote enrolling their players into the program. The players above 21 years of age will be enrolled into the study. No selective sampling will be done. All active Rugby players who wish to enroll in the study will be accepted. An initial anthropometric measure and health assessment of the players will be done at the time of recruitment into the study. Following recruitment, a health record for each individual player will be maintained. Information on the player’s position like ‘forwards’ and ‘back’ will be recorded.
All injuries that occur to the player during the game and outside game will be documented separately. The time lost from the game, as a result of the injury will be recorded. The database will maintain records for each member of the team individually. The type of injury, its severity and other details will be recorded. Information about team management and clinical recommendations for concussion will be maintained. The investigator will work in close association with the team physicians to get relevant information. Concussion injuries will be graded using the Cantu scale. The investigator will closely monitor concussion injuries and will strive to identify all concussion injuries that occur to the players. The follow up will be done for 3 years. The study can be planned in a retrospective manner if, data on concussion history of players is already available from another project. If there is a no such existing database, then the study will help to create a database by recording injuries in the patient, in a prospective manner.
Concussion injuries will be confirmed using brain imaging. Patients who receive a blow to their upper body region and head, will be suspected for concussion injuries. The presence of symptoms like headache, nausea, dizziness and loss of consciousness, can also help to identify players who suffer a concussion injury. The physician will employ neurological, cognitive and imaging techniques to identify and grade the concussion. At the end of the study period, the incidence rate will be calculated per 100 players. The injury rate will be reported in player hours. The correlation between hours of play and injury rate will be determined.
4. Data analysis: All the statistical analysis will be done using SPSS software. The incidence rate will be compared with incidences published in previous studies, to identify under-reporting or over reporting. The injuries will be examined for each game season as well. The incidence rate of concussion will be calculated at 95% CI. The total number of concussions and the number of concussions under each grade will be recorded individually. The incidence rate of concussion will be compared to the incidence rate of all injuries in the players. The events leading to injury will be reported in an additional table. Histograms will be used to display comparative data. In addition to text information in the results section, a tabular format will be used to represent descriptive information.
5. Applicability to nursing: The knowledge gained through this research will be used to make nursing and healthcare plans for the players. This will also alert the sports authorities and organizations concerned to adopt necessary safety measures. In the event of high concussion rates, the use of protective head gears can be mandated. Prevention strategies can be adopted based on the outcome of the study. It will also enable the creation of a system that maintains a database of the worker’s injury and performance for future reference.
6. References
Brooks, J., Fuller, C., Kemp, S., & Reddin, D. (2005). Epidemiology of injuries in English professional rugby union: part 1 match injuries. British Journal of Sports Medicine, 39(10), 757-766. http://dx.doi.org/10.1136/bjsm.2005.018135
Gabbett, T. (2006). Skill-Based Conditioning Games as an Alternative to Traditional Conditioning for Rugby League Players. J Strength Cond Res, 20(2), 309. http://dx.doi.org/10.1519/r-17655.1
Hinton-Bayre, A., Geffen, G., & Friis, P. (2004). Presentation and mechanisms of concussion in professional Rugby League football. Journal Of Science And Medicine In Sport, 7(3), 400-404. http://dx.doi.org/10.1016/s1440-2440(04)80035-5
Kirkwood, G., Parekh, N., Ofori-Asenso, R., & Pollock, A. (2015). Concussion in youth rugby union and rugby league: a systematic review. British Journal of Sports Medicine, 49(8), 506-510. http://dx.doi.org/10.1136/bjsports-2014-093774
Marshall, S. & Spencer, R. (2001). Concussion in Rugby: The Hidden Epidemic. J Athl Train, 36(3), 334-338.
MCINTOSH, A., MCCRORY, P., FINCH, C., BEST, J., CHALMERS, D., & WOLFE, R. (2009). Does Padded Headgear Prevent Head Injury in Rugby Union Football?. Medicine & Science In Sports & Exercise, 41(2), 306-313. http://dx.doi.org/10.1249/mss.0b013e3181864bee
Moser, R. (2012). Ahead of the game. Hanover, N.H.: Dartmouth College Press.
Quarrie, K., Handcock, P., Waller, A., Chalmers, D., Toomey, M., & Wilson, B. (1995). The New Zealand rugby injury and performance project. III. Anthropometric and physical performance characteristics of players. British Journal Of Sports Medicine, 29(4), 263-270. http://dx.doi.org/10.1136/bjsm.29.4.263
Savage, J., Hooke, C., Orchard, J., & Parkinson, R. (2013). The Incidence of Concussion in a Professional Australian Rugby League Team, 1998–2012. Journal Of Sports Medicine, 2013, 1-7. http://dx.doi.org/10.1155/2013/304576
Trewartha, G., Preatoni, E., England, M., & Stokes, K. (2014). Injury and biomechanical perspectives on the rugby scrum: a review of the literature. British Journal Of Sports Medicine, 49(7), 425-433. http://dx.doi.org/10.1136/bjsports-2013-092972