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Compliance with return-to-play regulations following concussion in Australian schoolboy and community rugby union players
  1. Stephanie J Hollis1,2,
  2. Mark R Stevenson1,3,
  3. Andrew S McIntosh4,
  4. E Arthur Shores5,
  5. Caroline F Finch6
  1. 1Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  2. 2The George Institute for Global Health, Sydney, New South Wales, Australia
  3. 3Accident Research Centre, Monash Injury Research Institute and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4School of Risk and Safety Sciences, The University of New South Wales, Sydney, New South Wales, Australia
  5. 5Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
  6. 6Australian Centre for Research into Injury in Sport and its Prevention, Monash Injury Research Institute, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Stephanie J Hollis, Sydney Medical School, The University of Sydney, 25 Nichols Parade, Mount Riverview, NSW 2774, Australia; shollis{at}


Background There is a risk of concussion when playing rugby union. Appropriate management of concussion includes compliance with the return-to-play regulations of the sports body for reducing the likelihood of premature return-to-play by injured players.

Purpose To describe the proportion of rugby union players who comply with the sports body's regulations on returning to play postconcussion.

Study design Prospective cohort study.

Methods 1958 community rugby union players (aged 15–48 years) in Sydney (Australia) were recruited from schoolboy, grade and suburban competitions and followed over ≥1 playing seasons. Club doctors/physiotherapists/coaches or trained injury recorders who attended the game reported players who sustained a concussion. Concussed players were followed up over a 3-month period and the dates when they returned to play (including either a game or training session) were recorded, as well as any return-to-play advice they received.

Results 187 players sustained ≥1 concussion throughout the follow-up. The median number of days before players returned to play (competition game play or training) following concussion was 3 (range 1–84). Most players (78%) did not receive return-to-play advice postconcussion, and of those who received correct advice, all failed to comply with the 3-week stand-down regulation.

Conclusions The paucity of return-to-play advice received by community rugby union players postconcussion and the high level of non-compliance with return-to-play regulations highlight the need for better dissemination and implementation of the return-to-play regulations and improved understanding of the underlying causes of why players do not adhere to return-to-play practices.

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  • Funding The main funding for the study was provided by the NIH Centres for Disease Prevention and Control, The University of Pittsburgh, Pennsylvania, USA. The primary author received a National Health and Medical Research Council (NHMRC) postgraduate research scholarship during 2 years of PhD candidature, a scholarship from the New South Wales Sporting Injuries Committee and additional financial support from The George Institute for Global Health and the School of Public Health, The University of Sydney, Australia.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Sydney Human Research Ethics Committee (HREC) and the US Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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