Predictors of concussion management pathway adherence in New Zealand community rugby: A prospective cohort study

There is a need for improved operationalisation of concussion guidelines in community sport. The inclusion of technology may offer a viable solution. This study aimed to evaluate if adherence to a concussion management pathway (CMP) facilitated through the use of technology, improved compliance to concussion guidelines.

This prospective observational study (2020-2022) included 5879 players across four unions in NZ. Healthcare touchpoints, demographics, baseline completion, physiotherapist support, and adherence to stand-down periods (SDP) were captured. Generalised linear mixed models examined factors associated with ideal pathway adherence (logged suspected concussion (SC) → system GP diagnosis → system GP medical clearance) and appropriate SDP.

Across three seasons, 639 SC occurred (n = 550 males, n = 89 females), of which 631 were logged. Of these logged SCs, 82.6% were medically confirmed. The overall SC rate was 16.6 per 1000 match hours. Approximately half (49.9%) adhered to the pathway. The strongest predictor of pathway adherence was completion of a pre-season baseline (OR = 1.90). Physiotherapist support was not significant, but was strongly associated with adherence in one union (OR = 6.15). Pasifika/Other players had lower odds of pathway adherence than NZ European (OR = 0.60). Pathway followers were more likely to adhere to the SDP (79.3% v 45.6%) and RTP that season (85.0% v 57.8%).

Adherence to the pathway was associated with greater compliance to the recommended SDP and increased likelihood of RTP that season. Pre-season baseline was the most consistent predictor of pathway adherence. Integrating digital systems, pre-season assessment and clinical support may strengthen implementation of community concussion guidelines.