Contributors to negative biopsychosocial health or performance outcomes in rugby players (CoNBO): a systematic review and Delphi study protocol.

The importance of contributors that can result in negative player outcomes in sport and the feasibility and barriers to modifying these to optimise player health and well-being have yet to be established. Within rugby codes (rugby league, rugby union and rugby sevens), within male and female cohorts across playing levels (full-time senior, part-time senior, age grade), this project aims to develop a consensus on contributors to negative biopsychosocial outcomes in rugby players (known as the CoNBO study) and establish stakeholder perceived importance of the identified contributors and barriers to their management. This project will consist of three parts; part 1: a systematic review, part 2: a three-round expert Delphi study and part 3: stakeholder rating of feasibility and barriers to management. Within part 1, systematic searches of electronic databases (PubMed, Scopus, MEDLINE, SPORTDiscus, CINAHL) will be performed. The systematic review protocol is registered with PROSPERO. Studies will be searched to identify physical, psychological and/or social factors resulting in negative player outcomes in rugby. Part 2 will consist of a three-round expert Delphi consensus study to establish additional physical, psychological and/or social factors that result in negative player outcomes in rugby and their importance. In part 3, stakeholders (eg, coaches, chief executive officers and players) will provide perceptions of the feasibility and barriers to modifying the identified factors within their setting. On completion, several manuscripts will be submitted for publication in peer-reviewed journals. The findings of this project have worldwide relevance for stakeholders in the rugby codes. PROSPERO registration number CRD42022346751.

Injury risk factors and barriers to their mitigation for women playing rugby league: a Delphi study.

This study aimed to 1) develop a consensus (≥70% agreement between experts) on injury risk factors specific to women playing rugby league, 2) establish the importance of the identified injury risk factors and the feasibility of mitigating these risk factors and 3) establish context specific barriers to injury risk management. Aim 1: A Delphi panel, consisting of 12 experts in rugby league and injury (e.g., physiotherapists, research scientists) were asked to identify injury risk factors specific to women playing rugby league. Aim 2: seven coaches of women's rugby league teams were asked to rate each risk factor that achieved consensus by their importance and feasibility to manage. Aim 3: Coaches reported barriers which restrict injury risk factor mitigation. Of the 53 injury risk factors which achieved consensus, the five injury risk factors with the highest combination of importance and feasibility ratings were: "poor tackle technique", "a lack of pre-season intensity", "training session are too short", "the current medical standards", and "limited access to physiotherapists". Following the identification of injury risk factors, their feasibility to manage and context specific barriers, this study proposes three constraint driven, integrated solutions which may reduce the barriers which limit injury risk factor management.

The anthropometric and physical qualities of women's rugby league Super League and international players; identifying differences in playing position and level.

Participation in women's rugby league has been growing since the foundation of the English women's rugby league Super League in 2017. However, the evidence base to inform women's rugby league remains sparse. This study provides the largest quantification of anthropometric and physical qualities of women's rugby league players to date, identifying differences between positions (forwards & backs) and playing level (Women's Super League [WSL] vs. International). The height, weight, body composition, lower body strength, jump height, speed and aerobic capacity of 207 players were quantified during the pre-season period. Linear mixed models and effects sizes were used to determine differences between positions and levels. Forwards were significantly (p < 0.05) heavier (forwards: 82.5 ± 14.8kg; backs: 67.7 ± 9.2kg) and have a greater body fat % (forwards: 37.7 ± 6.9%; backs: 30.4 ± 6.3%) than backs. Backs had significantly greater lower body power measured via jump height (forwards: 23.5 ± 4.4cm; backs: 27.6 ± 4.9cm), speed over 10m (forwards: 2.12 ± 0.14s; backs: 1.98 ± 0.11s), 20m (forwards: 3.71 ± 0.27s; backs: 3.46 ± 0.20s), 30m (forwards: 5.29 ± 0.41s; backs: 4.90 ± 0.33s), 40m (forwards: 6.91 ± 0.61s; backs: 6.33 ± 0.46s) and aerobic capacity (forwards: 453.4 ± 258.8m; backs: 665.0 ± 298.2m) than forwards. Additionally, international players were found to have greater anthropometric and physical qualities in comparison to their WSL counterparts. This study adds to the limited evidence base surrounding the anthropometric and physical qualities of elite women's rugby league players. Comparative values for anthropometric and physical qualities are provided which practitioners may use to evaluate the strengths and weaknesses of players, informing training programs to prepare players for the demands of women's rugby league.

Optimising long-term athletic development: An investigation of practitioners' knowledge, adherence, practices and challenges.

Long-term athletic development practices have been recommended for the past two decades. However, limited research exists exploring the knowledge and skills required by practitioners to optimise long-term athletic development. Therefore, this study aimed to evaluate the knowledge, adherence, practices, and challenges of practitioners responsible for delivering long-term athletic development. A mixed methods survey was completed by 236 practitioners (e.g., sport coaches, physical education teachers) consisting of four parts; 1) demographics, 2) knowledge, 3) adherence, and 4) practices and challenges. Quantitative and qualitative data were analysed by Friedman's analysis of variance and thematic analyses, respectively. Quantitative findings showed practitioners 1) recognised their responsibility for delivering long-term athletic development, 2) have a familiarity with existing developmental models, and 3) had high adherence, focused upon health and wellbeing, to delivering long-term athletic development. However, practices associated with growth and maturity, monitoring and assessment, and the systematic progression and individualisation of training had lower adherence. Qualitative analysis indicated that practitioner's perceived definitions of athleticism and long-term athletic development were inconsistent, especially according to the psychological components (i.e., confidence). Practitioners' descriptions of their long-term athletic development practices identified two higher order themes; 1) goals, in which long-term athletic development "is for life" and the importance of "an individual centered journey" highlighted as sub-themes; and 2) realities of delivering long-term athletic development, whereby variety in programme delivery, monitoring development and practical challenges were noted as key priorities. Eight practical challenges were identified including governance and priorities, resources, education, early specialization, high training volumes, staff communication, parents and youth motivation. This mixed method survey highlighted a multitude of knowledge, adherence, practices and challenges towards long-term athletic development. These novel findings can help inform policy to optimise long-term athletic development and to support the complex problem of developing a healthier, fitter and more physically active youth population.

Coaches' Assessment of Players Physical Performance: Subjective and Objective Measures are needed when Profiling Players.

This mixed methods study aimed to assess the agreement between coaches ranking of youth rugby league players compared against objective physical performance data and gather coaches' subjective descriptions of their players performance. Five hundred and eight male rugby league players (U16 n = 255, U18 n = 253) completed a fitness testing battery of anthropometric and physical performance measures. Subsequently, 22 rugby (n = 11) and strength and conditioning (S&C) coaches (n = 11) ranked each player's physical qualities using a 4-point Likert scale (1 - top 25%; 2-25-50%; 3-50-75%; and 4 - bottom 25%) and described their performance. U16 S&C coaches displayed fair agreement when assessing players body mass (39.3%, κ = 0.20). U18 rugby coaches demonstrated fair agreement for strength and size (42.5%, κ = 0.23) and body mass (48.7%, κ = 0.31) whilst both U18 rugby and S&C coaches showed fair agreement levels for endurance (39.8%, κ = 0.25, 44.3%, κ = 0.29), respectively. Three higher-order themes were identified from coaches' descriptions of players including physical, rugby and attitude characteristics when evaluating performance. Overall, coaches cannot accurately assess players physical performance against fitness testing data. Though, findings suggest coaches adopt a multidimensional approach when evaluating players performance. Practitioners within talent development systems should utilise both objective and subjective assessments when making decisions regarding players performance.HighlightsRugby and S&C coaches cannot accurately assess all aspects of players physical performance.The greatest assessment agreement was for body mass, strength and size, and endurance, while the poorest were for strength, acceleration, and maximum speed.Rugby and S&C coaches considered rugby, physical and attitude attributes when evaluating players.Findings highlight the complex nature of physical profiling. Subjective and objective measures are required to provide an accurate description of players physical performance.

Using Principal Component Analysis to Compare the Physical Qualities Between Academy and International Youth Rugby League Players.

PURPOSE: To compare the physical qualities between academy and international youth rugby league (RL) players using principal component analysis. METHODS: Six hundred fifty-four males (age = 16.7 [1.4] y; height = 178.4 [13.3] cm; body mass = 82.2 [14.5] kg) from 11 English RL academies participated in this study. Participants completed anthropometric, power (countermovement jump), strength (isometric midthigh pull; IMTP), speed (10 and 40 m speed), and aerobic endurance (prone Yo-Yo IR1) assessments. Principal component analysis was conducted on all physical quality measures. A 1-way analysis of variance with effect sizes was performed on 2 principal components (PCs) to identify differences between academy and international backs, forwards, and pivots at under 16 and 18 age groups. RESULTS: Physical quality measures were reduced to 2 PCs explaining 69.4% of variance. The first PC (35.3%) was influenced by maximum and 10-m momentum, absolute IMTP, and body mass. Ten and forty-meter speed, body mass and fat, prone Yo-Yo, IMTP relative, maximum speed, and countermovement jump contributed to PC2 (34.1%). Significant differences (P < .05, effect size = -1.83) were identified between U18 academy and international backs within PC1. CONCLUSION: Running momentum, absolute IMTP, and body mass contributed to PC1, while numerous qualities influenced PC2. The physical qualities of academy and international youth RL players are similar, excluding U18 backs. Principal component analysis can reduce the dimensionality of a data set and help identify overall differences between playing levels. Findings suggest that RL practitioners should measure multiple physical qualities when assessing physical performance.

"It's Important, but It's Not Everything": Practitioners' Use, Analysis and Perceptions of Fitness Testing in Academy Rugby League.

A plethora of research exists examining the physical qualities of rugby league players. However, no research has investigated practitioners' insights into the use, analysis and perceptions of such fitness testing data that is vital for applying research into practice. Therefore, this study aimed to examine practitioners' (coaches and strength & conditioning [S&C] coaches) perceptions and challenges of using fitness testing and the development of physical qualities. Twenty-four rugby league practitioners were purposefully sampled and completed a semi-structured interview. Interviews were transcribed and thematically analysed identifying five themes (it's important, but it's not everything; monitoring; evaluation and decision making; motivation; and other external challenges). The theme of "it's important, but it's not everything" emerged as a fundamental issue with regard fitness testing and the use of such data and that physical data alone does not inform coaches decisions. There appears conflicts between coaches and S&C coaches' perceptions and use of fitness data, identifying complexities of supporting players in multidisciplinary teams. Collectively, the findings highlight the multifaceted nature of academy rugby league and suggest that practitioners should utilise fitness testing to inform player evaluations, positively influence training and assist with decision making. Moreover, practitioners should understand the combination of factors that influence fitness testing and work collaboratively to enhance talent development strategies.

Diagnostic Accuracy of Imaging Modalities in the Evaluation of Vascular Invasion in Pancreatic Adenocarcinoma: A Meta-Analysis.

BACKGROUND: The extent of vascular invasion is a key factor determining the resectability of non-metastatic pancreatic adenocarcinoma. The purpose of this study is to determine the diagnostic accuracy of computed tomography (CT), endoscopic ultrasound (EUS), and magnetic resonance imaging (MRI) in the pre-operative evaluation of vascular invasion in pancreatic adenocarcinoma, with surgery as the reference standard. METHODS: A search of the MEDLINE database for relevant articles in the English language published between January 2000 and February 2009 was performed. From each study, 2 × 2 tables were obtained, and pooled sensitivity, specificity, positive likelihood ratios, negative likelihood ratios and diagnostic odds ratios were calculated for each modality, along with a summary receiver operating characteristics (SROC) curve. RESULTS: 16 studies with a total of 797 patients who had surgical assessment of vascular invasion were included in the analysis. Several studies evaluated more than one imaging modality, allowing 24 datasets to be obtained in total. Sensitivity was highest for CT (0.73, 95% CI 0.67 - 0.79), followed by EUS (0.66, 95% CI 0.56 - 0.75) and MRI (0.63, 95% CI 0.48 - 0.77). The specificity for all three imaging modalities was comparable. The diagnostic odds ratios for CT, EUS and MRI were 45.9 (95% CI 18.0 - 117.4), 23.0 (95%CI 9.4 - 56.6), 23.9 (95% CI 5.4 - 105.1) respectively. CONCLUSION: CT was more accurate than EUS and MRI in the evaluation of vascular invasion in pancreatic adenocarcinoma and should be the first line investigation in pre-operative staging.

MRI of the vestibular nerve after selective vestibular neurectomy.

CONCLUSION: In patients with Ménière's disease and persisting vertigo attacks after vestibular neurectomy (VNx) MRI of the vestibulocochlear nerve can identify residual vestibular nerve fibres that could be responsible for the vertigo attacks. OBJECTIVE: To test if MRI of the vestibulocochlear nerve can corroborate the presence of residual vestibular nerve fibres in patients with persisting vertigo attacks and residual vestibular function after VNx. MATERIALS AND METHODS: Vestibulocochlear nerve bundles of seven post-VNx unilateral Ménière's patients were imaged using 1.5 Tesla MRI with steady state free precession (SSFP) sequences. Reformatted MR images orthogonal to the vestibulocochlear nerve axis in internal auditory canal were compared on the VNx and intact sides. Vestibular function was assessed with caloric tests, three-dimensional head impulse tests and vestibular evoked myogenic potentials. Of the seven patients only one was asymptomatic (totally free of vertigo); six had continued to experience vertigo attacks, albeit not as long or as severe as before VNx. RESULTS: On the VNx side, MRI showed intact facial and cochlear nerves in all seven patients. In the six symptomatic patients, although superior and inferior vestibular nerve bulk and signal were reduced, residual bulk suggestive of inferior vestibular nerve was evident, correlating with evidence of residual posterior canal function on impulsive testing in all six symptomatic patients. In the asymptomatic patient, superior and inferior vestibular nerves were absent on MRI and impulsive testing revealed no residual posterior canal function.