Return-to-play after concussion: state of knowledge, frequency of use and application barriers of guidelines among...

Validated strategies and guidelines for a safe and individualized diagnosis and return-to-play (RTP) after concussion in rugby are needed. Little is known about the state of knowledge, frequency of use and application barriers of state-of-the-art guidelines among decision-makers in professional or semi-professional rugby teams. Participants (n = 195) from the coaching team (head coach, assistance coach, athletic coach), the medical team (physiotherapist, physician, rehabilitation therapist, neuropsychologist), or from the officials of a professional or semi-professional rugby team (top three major leagues in Germany), filled in a questionnaire on their knowledge, frequency of use and application barriers of evidence-based guidelines (Graduated RTP protocol and The 5R). Depending on their function in the team and on the league of play, the state of knowledge and application of the diagnostic tools and the RTP guidelines differ. A considerable number are aware of one or both guidelines, but do not apply these guidelines (up to 27% of respondants). The main reasons for the non-usage were not my decision (59%), use of concurrent guidelines (54%), each player must decide by his own (36%), never experienced a concussion in my players (30%), other (19%), the guideline is useless (18%) and a player may play despite a concussion (14%). Raising awareness of the state-of-the-art guidelines is important to educate further the coaching, medical and official team members in identifying symptoms and executing the RTP-process in accordance with evidence-based strategies.