Prevention strategies and modifiable risk factors for concussion: a systematic review and meta-analysis for the Female, woman and girl Athlete Injury pRevention (FAIR) consensus

Abstract

Objective To examine prevention strategies and potential modifiable risk factors (MRFs) for sport-related concussion (SRC) and head impact/head acceleration event (HAE) outcomes in female, woman and/or girl athletes. Design Systematic review with meta-analyses and Grading of Recommendations, Assessment, Development and Evaluation. Data sources Medline, CINAHL, PsycINfo, SportDiscus, ERIC, CENTRAL and CDSR. Eligibility Primary data studies with comparison group(s) assessing the association of prevention interventions and/or MRFs for SRC or HAE with ≥1 female/woman/girl in each study group. Results Of the 108 included studies, 67 evaluated a SRC prevention strategy (equipment n=25, policy/rule n=21, training n=10, management n=11) and 41 evaluated potential MRFs (34 distinct MRFs across nine categories). In total, 40/108 (37%) studies (prevention 19/67; MRF 21/41) included female/woman/girl-specific estimates. Three meta-analyses were conducted: two SRC prevention strategies (headgear, eyewear) and one MRF (artificial turf vs grass) based on availability of female/woman/girl-only estimates and similar outcomes and exposure. Headgear was associated with 30% lower SRC rates in adolescent female/girl lacrosse and soccer (IRR=0.70, 95% CI 0.50 to 0.99; very-low certainty). Eyewear use was not protective for SRC (IRR=1.08, 95% CI 0.69 to 1.68; very-low certainty). SRC rates did not differ by artificial turf versus grass (IRR=0.95, 95% CI 0.62 to 1.45; very-low certainty). Conclusion We found limited evidence for prevention strategies and MRFs in female/woman/girl athletes except for very-low certainty evidence supporting headgear use in adolescent lacrosse and soccer. Future studies should consider the design, implementation and evaluation of SRC prevention strategies that target MRFs to guide safe practice recommendations specifically for female/woman/girl athletes. Data are available upon reasonable request. Deidentified data can be made available upon reasonable request to the corresponding author. Please email the corresponding author with a written proposal outlining the specific research aims and analysis plan and why these specific data are needed. A formal data-sharing agreement between institutions will be required.