Unintended consequences - A qualitative exploration of baseline testing in community rugby concussion management.

OBJECTIVES: Understanding key stakeholders' perceptions around the value of baseline testing, as well as barriers or facilitators experienced as part of the process, may assist with the decision-making process of whether to implement baseline testing in community sport. This study explored coaches', players' and physiotherapists' perceptions of the perceived value, barriers and facilitators of baseline testing as part of New Zealand Rugby's (NZR) community concussion initiative. DESIGN: The study employed a pragmatic, qualitative descriptive design. METHODS: Semi-structured interviews were used to explore participants' perceptions. In total, 73 individual interviews were conducted. The sample consisted of 36 players, 13 coaches and 24 physiotherapists involved in NZR's concussion management pathway. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis. RESULTS: In terms of perceived value, baseline testing was reported to play a role in i) facilitating a positive concussion culture; ii) positive perceptions of rugby and player safety and iii) enhancing concussion management as part of the pathway. Barriers and facilitators of the baseline testing process included i) stakeholder buy-in as critical driver of the process and ii) contextual and operational factors. Although contextual and operational challenges exist, these participants, as key stakeholders in the process, perceived the value of baseline testing to be more important than the barriers experienced. CONCLUSIONS: The value of baseline testing extends beyond concussion assessment and management, by enhancing community concussion awareness, attitudes and player safety. The findings of this study may assist in the decision-making process around inclusion of pre-season baseline testing in community rugby.

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

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.

Time to expand the circle of care - General practitioners' experiences of managing concussion in the community.

New Zealand Rugby (NZR) implemented a concussion management pathway (CMP), aimed at improving management at community level. General Practitioners (GPs) played a large role in the design of this process. The objective of this study was to explore GPs' perceptions of barriers and facilitators of the CMP and rugby-related concussion management in the community. A descriptive qualitative approach using interviews and focus groups was employed. Four themes were derived: i) GPs' existing knowledge and confidence around concussion management; ii) Operational resources: time, remuneration and pathway guidance; iii) Standardising concussion care and iv) Expanding the circle of care - the need for multi-disciplinary healthcare team. These themes described how GP's concussion knowledge, and the efficiency and availability of operational resources affected their experience and ability to fulfil their tasks within the CMP. GPs found NZR's CMP especially valuable, as it provided guidance and structure. Expanding the role of other healthcare providers was seen as critical to reduce the burden on GPs, while also delivering a more holistic experience to improve clinical outcomes. Addressing the identified barriers and expanding the network of care will help to improve the ongoing development of NZR's CMP, while supporting continued engagement with all stakeholders.

Promoting a culture change in junior and youth sport in New Zealand.

This paper provides insight into the evolution of a project designed to address longstanding adult attitudes and behavioural issues in junior and youth sport in New Zealand. The project was funded by Sport New Zealand (Sport NZ) and implemented by Aktive, a charitable trust that works with national and regional partners to fund and deliver community sport in Auckland. Aktive collaborated with a team of junior and youth sport researchers, adopting a pragmatic, mixed methods design-based research (DBR) approach to co-design an educational delivery framework aimed at influencing attitudes and assumptions underpinning coaches, parents, and community sport leaders' behaviours. Transformative learning principles informed the delivery framework with the project reaching 4,222 participants. Research evaluations included multiple case studies, surveys, semi-structured interviews, and focus groups, which confirmed awareness of problematic beliefs. The programme expanded to Regional Sport Organisations (RSOs) and National Sport Organisations (NSOs) culminating in a nationwide rollout. The study highlights the effectiveness of theoretically informed adult behaviour change programmes in junior and youth sport, the benefits of programmes being underpinned by a rigorous pedagogical approach, and the benefits of sport organisations and researchers collaborating to design and deliver sustainable change initiatives that address belief systems underpinning current issues.

The Value of Sport: Wellbeing Benefits of Sport Participation during Adolescence.

Insight into the unique benefits of sport participation above and beyond those associated with participation in other physical activities among adolescents is limited in Aotearoa New Zealand (NZ). The purpose of this study was to examine the association between wellbeing and organised sport participation among adolescents whilst accounting for demographic characteristics and other recreational physical activity. Demographic characteristics (age, gender, ethnicity, deprivation, (dis)ability status), organized sport, recreational physical activity, and wellbeing were assessed in cohorts of NZ adolescents (11-17 years) between 2017 and 2019. After adjusting for demographics, better wellbeing was associated with participation in any recreational physical activity (OR = 2.49, 95%CI = 1.97-3.13), meeting physical activity recommendations (OR = 1.63, 95%CI = 1.47-1.81), and each additional hour of recreational physical activity (OR = 1.03, 95%CI = 1.02-1.04). After adjusting for demographics and overall recreational physical activity participation, better wellbeing was also associated with participation in any organized sport (OR = 1.66, 95%CI = 1.49-1.86), and each additional hour of organized sport (OR = 1.09, 95%CI = 1.07-1.11). Although participation in recreational physical activity appears to be beneficial for wellbeing, organized sport appears to offer unique additional wellbeing benefits. Positive experiences of organized sport participation may offer additional wellbeing value above and beyond other recreational physical activity types in young people who are active.

"Balance Is Better": The Wellbeing Benefits of Participating in a Breadth of Sports across a Variety of Settings during Adolescence.

The purpose of this study was to examine how wellbeing is associated with the setting in which sport participation takes place and the breadth of sport participation. Demographic characteristics (age, gender, ethnicity, deprivation, (dis)ability status), recreational physical activity, and wellbeing were assessed in cohorts of adolescents (11-17 years) between 2017 and 2019 in Aotearoa, New Zealand. Better wellbeing was associated with participation in any sport vs. none (OR = 1.57, 95% CI = 1.30-1.90). Better wellbeing was also associated with participating in any coached sport training (OR = 1.48, 95% CI = 1.33-1.66), competitive sport (OR = 1.33, 95% CI = 1.18-1.49), social sport (OR = 1.33, 95% CI = 1.18-1.49), and uncoached sport training (OR = 1.16, 95% CI = 1.03-1.31) compared to non-participation in the given setting. Wellbeing was not associated with participation in physical education or solo sport. Participating in sport in three to five different settings (3 settings: OR = 1.21, 95% CI = 1.01-1.44; 4 settings: OR = 1.33, 95% CI = 1.09-1.62; 5 settings: OR = 1.37, 95% CI = 1.07-1.75) or sports (3 sports: OR = 1.25, 95% CI = 1.04-1.51; 4 sports: OR = 1.31, 95% CI = 1.06-1.61; 5 sports: OR = 1.33, 95% CI = 1.05-1.69) was associated with better wellbeing compared to participation in a single setting or sport, respectively. A balanced approach to participating across a variety of sport settings and sports that are facilitated by quality coaches may offer the largest additional wellbeing value.

Sport concussion assessment in New Zealand high school rugby players: a collaborative approach to the challenges faced in primary care.

PRIMARY OBJECTIVE: To describe the collaborative development of a New Zealand Rugby Concussion Assessment (NZRCA) for primary care and to provide normative baseline data from a representative group of high school rugby players. METHODS: This study, conducted over the 2018 and 2019 community rugby season where players were baseline tested during the pre- or start of season period. RESULTS: Data were collected from 1428 players (males n = 1121, females n = 307) with a mean age of 15.9 ± 1.4 years. The mean ± SD symptom severity score was 11.3 ± 8.6, the mean number of endorsed symptoms was 8.5 ± 5.3 and the percentage feeling "normal" was 80.2 ± 15.3%. Only 5.3% of players reported no symptoms at baseline. The most common reported were: 'distracted easily' (72.5%), 'forgetful' (68.5%), and 'often tired' (62.6%). None of the participants achieved a perfect score for the SAC50. The majority of participants (89.7%) passed the tandem gait test with a time of 12.2 ± 1.7 seconds. Age, gender, and ethnicity were associated with NZRCA performance; albeit weakly. CONCLUSION: This study provides normative reference values for high-school rugby players. These data will aid healthcare providers in their identification of suspected concussion in the absence of individualized baselines.

Baseline concussion assessment performance of community-based senior rugby players: a cross-sectional study.

OBJECTIVE: To report pre-season baseline concussion assessment performance among senior rugby players and explore associations between assessment performance and player demographics. DESIGN: A cross-sectional study using the New Zealand Rugby Concussion Assessments (NZRCA), comprising symptom, cognitive and dynamic coordination assessments was conducted in the 2018-2019 season. METHODS: Players' baseline assessments were characterised using descriptive statistics; effect sizes (ES) and t-tests were used to explore associations between player demographic characteristics and NZRCA performance. RESULTS: A total of 733 players (11.4% female) aged between 16 and 52 years completed the NZRCA. The median (range) value for symptom severity, endorsed symptoms and "percentage normal" was respectively, 5 (0-40), 5 (0-21) and 90% (30-100%). A perfect standardised assessment of concussion score was achieved by one participant; seven achieved ≥27/30 for immediate recall, and 22 achieved a perfect delayed recall score. Most participants (n = 674, 92%) passed the tandem gait test. Associations between NZRCA performance and gender, concussion history, and Pasifika ethnicity were observed with effect sizes ranging from small (0.18) to large (0.70). Six hundred and twenty-three (85%) participants reported at least one symptom. CONCLUSIONS: The results from this study could help support decision-making by clinicians, improving the management of concussions in the community setting.

What they know and who they are telling: Concussion knowledge and disclosure behaviour in New Zealand adolescent rugby union players.

The purpose of this study was to survey high school rugby players from a range of ethnic, geographic and socioeconomic backgrounds in New Zealand (NZ) to gain an understanding of concussion knowledge, awareness of NZ Rugby's (NZR) guidelines and attitudes towards reporting behaviours. Male and female high school rugby players (n= 416) from across NZ were surveyed. The findings indicated that 69% of players had sustained a suspected concussion, and 31% had received a medical diagnosis of concussion. 63% of players indicated they were aware of NZR's guidelines. Maori and Pasifika players were less likely to be aware of the guidelines compared to NZ European, Adjusted OR 0.5, p = 0.03. Guideline awareness was significantly higher for those from high decile schools when compared to low (Unadjusted OR 1.63, p = 0.04); however, when ethnicity and school locations were controlled for this became non-significant (Adjusted OR= 1.3, p=0.37). The coach was the key individual for the provision of concussion information and disclosure of symptoms for players. The findings of this study will inform the development and delivery of NZR's community concussion initiative and how these examined factors influence a high school player's concussion knowledge and reporting behaviour.

The Process of Magnetizing FeNbYHfB Bulk Amorphous Alloys in Strong Magnetic Fields.

The structure of amorphous alloys still has not been described satisfactorily due to the lack of direct methods for observing structural defects. The magnetizing process of amorphous alloys is closely related to its disordered structure. The sensitivity of the magnetization vector to any heterogeneity allows indirect assessment of the structure of amorphous ferromagnetic alloys. In strong magnetic fields, the magnetization process involves the rotation of a magnetization vector around point and line defects. Based on analysis of primary magnetization curves, it is possible to identify the type of these defects. This paper presents the results of research into the magnetization process of amorphous alloys that are based on iron, in the areas called the approach to ferromagnetic saturation and the Holstein-Primakoff para-process. The structure of a range of specially produced materials was examined using X-ray diffraction. Primary magnetization curves were measured over the range of 0 to 2 T. The process of magnetizing all of the tested alloys was associated with the presence of linear defects, satisfying the relationship Ddi p < 1H. It was found that the addition of yttrium, at the expense of hafnium, impedes the magnetization process. The alloy with an atomic content of Y = 10% was characterized by the highest saturation magnetization value and the lowest value of the Dspf parameter, which may indicate the occurrence of antiferromagnetic ordering in certain regions of this alloy sample.

The associations of early specialisation and sport volume with musculoskeletal injury in New Zealand children.

OBJECTIVE: To investigate associations of early specialisation (highly specialised before age 13 years) and sport participation volume with injury history in New Zealand children. DESIGN: Cross-sectional survey study. METHODS: Children attending a national sports competition were invited to complete a questionnaire capturing specialisation level (high, moderate or low), participation volume and injury history. Multiple logistic regression was used to investigate associations between variables. RESULTS: Nine hundred and fourteen children (538 female) completed the questionnaire. After adjusting for age, sex and hours of weekly sport participation, the odds of reporting an injury history were not significantly higher for early specialised children compared to children categorised as low specialisation (OR=0.88; CI=0.59-1.31; p=0.53). Participating in more hours of sport per week than age in years (OR=2.42; CI=1.27-4.62; p=0.02), playing one sport for more than 8 months of the year (OR=1.60; CI=1.07-2.36; p=0.02), or exceeding a 2:1 weekly ratio of organised sport to recreational free-play hours (OR=1.52; CI=1.08-2.15; p=0.02), increased the odds of reporting a 'gradual onset injury'. CONCLUSION: Early specialisation in one sport did not increase the odds of reporting a history of injury. Exceeding currently recommended sport participation volumes was associated with increased odds of reporting a history of gradual onset injury.

Coach and player attitudes to injury in youth sport.

OBJECTIVES: To investigate coach and player attitudes to injury in New Zealand (NZ) secondary school sport. DESIGN: Cross-sectional survey SETTING: Secondary school sport. PARTICIPANTS: Secondary school coaches and players. MAIN OUTCOME MEASURES: Responses to a survey of injury attitudes. The survey was distributed in electronic and paper-based form to secondary school coaches and players across three sporting organisations. Coaches' uptake of injury prevention training and whether they had first aid qualifications was also elicited. RESULTS: 117 coaches and 226 players from netball, football and basketball participated. The majority of coaches surveyed (n = 82, 70%) reported having a coaching qualification and 72 (62%) had completed a sport related first aid/injury prevention programme. Overall, 196 players (87%) reported hiding an injury to continue playing, and 102 coaches (87%) and 205 players (91%) had witnessed injured players play on. Approximately 50% of players and coaches had seen players put under pressure to play when injured. A lack of knowledge, the desire to win, and not letting the team down were key reasons given for the behaviour reported. CONCLUSIONS: The observed prevalence of players playing on when injured and associated attitudes to secondary school sport injuries demands further investigation.

Someone is watching you: the ethics of covert observation to explore adult behaviour at children's sporting events.

Concerns have been expressed about adult behaviour at children's sporting events in New Zealand. As a consequence, covert observation was identified as the optimal research method to be used in studies designed to record the nature and prevalence of adult sideline behaviour at children's team sporting events. This paper explores whether the concerns raised by the ethics committee about the use of this controversial method, particularly in relation to the lack of informed consent, the use of deception, and researcher safety, were effectively managed. This is achieved by reflecting on the conduct and findings of the research and by drawing on the perspectives of research assistants who carried out the covert observation. The authors argue that in the context of these studies, the ends have justified the means and with careful attention to the design of the study the complex ethical tensions arising from the use of this method can be managed.