Where's your head at? Perceptions and utilisation of concussion prevention and rehabilitation strategies in women's and men's rugby union.

Objectives: Rugby union (rugby) is a popular collision sport with high concussion rates. As such, concussion prevention and rehabilitation strategies are critical to player welfare in the sport. This study aims to identify and analyse the concussion prevention and rehabilitation strategies currently implemented across different rugby contexts.

Design: A cross-sectional study targeting medical professionals and coaches globally through an online survey distributed via email and social media.

Methods: A validated, piloted survey was developed in collaboration with subject-matter experts and delivered using REDCap, with participants (aged 18+) from medical and coaching backgrounds.

Results: A total of 172 respondents (77 medical professionals, 89 coaches, 6 "other") responded. Training strategies and policy changes were perceived as the most important primary prevention strategies, whilst all secondary (education, recognise and remove) and tertiary (return to play processes and rehabilitation) strategies were deemed highly important. Despite this, utilisation varied widely. Perceived importance and utilisation of rehabilitation strategies also varied. The main barriers to implementation were a lack of understanding (47%) and time constraints (45%). There were no significant differences in odds of return-to-play use by level of play or sex; however, there was a significantly lower odds of medical return-to-play sign-off with lower levels of play (odds ratio: 0.77, 95% confidence intervals: 0.61-0.98).

Conclusions: This study underscores the variation in perceived importance and utilisation of prevention and rehabilitation strategies in rugby. It emphasises the necessity for education to help remove barriers with the aim of optimising programme implementation and utility.