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Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis
ObjectivesTo evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk.DesignThis systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting...
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Published in: | British journal of sports medicine 2023-06, Vol.57 (12), p.749-761 |
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creator | Eliason, Paul H Galarneau, Jean-Michel Kolstad, Ash T Pankow, M Patrick West, Stephen W Bailey, Stuart Miutz, Lauren Black, Amanda Marie Broglio, Steven P Davis, Gavin A Hagel, Brent E Smirl, Jonathan D Stokes, Keith A Takagi, Michael Tucker, Ross Webborn, Nick Zemek, Roger Hayden, Alix Schneider, Kathryn J Emery, Carolyn A |
description | ObjectivesTo evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk.DesignThis systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesEight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review.Eligibility criteriaStudy inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English.ResultsIn total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high (‘++’) or acceptable (‘+’) quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength |
doi_str_mv | 10.1136/bjsports-2022-106656 |
format | article |
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Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English.ResultsIn total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high (‘++’) or acceptable (‘+’) quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies.ConclusionsPolicy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC.PROSPERO registration numberCRD42019152982.</description><identifier>ISSN: 0306-3674</identifier><identifier>EISSN: 1473-0480</identifier><identifier>DOI: 10.1136/bjsports-2022-106656</identifier><identifier>PMID: 37316182</identifier><language>eng</language><publisher>England: BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</publisher><subject>Adolescent ; Age groups ; Brain Concussion ; Brain Concussion - prevention & control ; Child ; Children & youth ; Concussion ; Databases, Factual ; Estimates ; Football ; Gender ; Helmets ; Hockey ; Humans ; Ice hockey ; International conferences ; Meta-analysis ; Prevention ; Preventive Medicine ; Risk factor ; Risk factors ; Rugby ; Sport ; Systematic review ; Teenagers ; Traumatic brain injury ; Warm up (exercise)</subject><ispartof>British journal of sports medicine, 2023-06, Vol.57 (12), p.749-761</ispartof><rights>Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2023 Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b422t-31b015800a5b5abe3b61152a3c3c326ecddd2c0fb849fe1c3ada474cb16efa903</citedby><cites>FETCH-LOGICAL-b422t-31b015800a5b5abe3b61152a3c3c326ecddd2c0fb849fe1c3ada474cb16efa903</cites><orcidid>0000-0002-5951-5899 ; 0000-0002-2282-9325 ; 0000-0001-5800-7000 ; 0000-0001-5668-9706 ; 0000-0001-8293-4496 ; 0000-0002-5530-0639 ; 0000-0002-9499-6691 ; 0000-0001-6985-7043 ; 0000-0001-7807-2459 ; 0000-0002-2994-9880 ; 0000-0003-3636-5557</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://bjsm.bmj.com/content/57/12/749.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://bjsm.bmj.com/content/57/12/749.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>314,780,784,3194,27924,27925,55341,77596,77597</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37316182$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eliason, Paul H</creatorcontrib><creatorcontrib>Galarneau, Jean-Michel</creatorcontrib><creatorcontrib>Kolstad, Ash T</creatorcontrib><creatorcontrib>Pankow, M Patrick</creatorcontrib><creatorcontrib>West, Stephen W</creatorcontrib><creatorcontrib>Bailey, Stuart</creatorcontrib><creatorcontrib>Miutz, Lauren</creatorcontrib><creatorcontrib>Black, Amanda Marie</creatorcontrib><creatorcontrib>Broglio, Steven P</creatorcontrib><creatorcontrib>Davis, Gavin A</creatorcontrib><creatorcontrib>Hagel, Brent E</creatorcontrib><creatorcontrib>Smirl, Jonathan D</creatorcontrib><creatorcontrib>Stokes, Keith A</creatorcontrib><creatorcontrib>Takagi, Michael</creatorcontrib><creatorcontrib>Tucker, Ross</creatorcontrib><creatorcontrib>Webborn, Nick</creatorcontrib><creatorcontrib>Zemek, Roger</creatorcontrib><creatorcontrib>Hayden, Alix</creatorcontrib><creatorcontrib>Schneider, Kathryn J</creatorcontrib><creatorcontrib>Emery, Carolyn A</creatorcontrib><title>Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis</title><title>British journal of sports medicine</title><addtitle>Br J Sports Med</addtitle><addtitle>Br J Sports Med</addtitle><description>ObjectivesTo evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk.DesignThis systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesEight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review.Eligibility criteriaStudy inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English.ResultsIn total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high (‘++’) or acceptable (‘+’) quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies.ConclusionsPolicy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC.PROSPERO registration numberCRD42019152982.</description><subject>Adolescent</subject><subject>Age groups</subject><subject>Brain Concussion</subject><subject>Brain Concussion - prevention & control</subject><subject>Child</subject><subject>Children & youth</subject><subject>Concussion</subject><subject>Databases, Factual</subject><subject>Estimates</subject><subject>Football</subject><subject>Gender</subject><subject>Helmets</subject><subject>Hockey</subject><subject>Humans</subject><subject>Ice hockey</subject><subject>International conferences</subject><subject>Meta-analysis</subject><subject>Prevention</subject><subject>Preventive Medicine</subject><subject>Risk factor</subject><subject>Risk 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strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis</title><author>Eliason, Paul H ; Galarneau, Jean-Michel ; Kolstad, Ash T ; Pankow, M Patrick ; West, Stephen W ; Bailey, Stuart ; Miutz, Lauren ; Black, Amanda Marie ; Broglio, Steven P ; Davis, Gavin A ; Hagel, Brent E ; Smirl, Jonathan D ; Stokes, Keith A ; Takagi, Michael ; Tucker, Ross ; Webborn, Nick ; Zemek, Roger ; Hayden, Alix ; Schneider, Kathryn J ; Emery, Carolyn A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b422t-31b015800a5b5abe3b61152a3c3c326ecddd2c0fb849fe1c3ada474cb16efa903</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adolescent</topic><topic>Age groups</topic><topic>Brain Concussion</topic><topic>Brain Concussion - prevention & control</topic><topic>Child</topic><topic>Children & youth</topic><topic>Concussion</topic><topic>Databases, Factual</topic><topic>Estimates</topic><topic>Football</topic><topic>Gender</topic><topic>Helmets</topic><topic>Hockey</topic><topic>Humans</topic><topic>Ice hockey</topic><topic>International conferences</topic><topic>Meta-analysis</topic><topic>Prevention</topic><topic>Preventive Medicine</topic><topic>Risk factor</topic><topic>Risk factors</topic><topic>Rugby</topic><topic>Sport</topic><topic>Systematic review</topic><topic>Teenagers</topic><topic>Traumatic brain injury</topic><topic>Warm up (exercise)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eliason, Paul H</creatorcontrib><creatorcontrib>Galarneau, Jean-Michel</creatorcontrib><creatorcontrib>Kolstad, Ash T</creatorcontrib><creatorcontrib>Pankow, M Patrick</creatorcontrib><creatorcontrib>West, Stephen W</creatorcontrib><creatorcontrib>Bailey, Stuart</creatorcontrib><creatorcontrib>Miutz, 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medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eliason, Paul H</au><au>Galarneau, Jean-Michel</au><au>Kolstad, Ash T</au><au>Pankow, M Patrick</au><au>West, Stephen W</au><au>Bailey, Stuart</au><au>Miutz, Lauren</au><au>Black, Amanda Marie</au><au>Broglio, Steven P</au><au>Davis, Gavin A</au><au>Hagel, Brent E</au><au>Smirl, Jonathan D</au><au>Stokes, Keith A</au><au>Takagi, Michael</au><au>Tucker, Ross</au><au>Webborn, Nick</au><au>Zemek, Roger</au><au>Hayden, Alix</au><au>Schneider, Kathryn J</au><au>Emery, Carolyn A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis</atitle><jtitle>British journal of sports medicine</jtitle><stitle>Br J Sports Med</stitle><addtitle>Br J Sports Med</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>57</volume><issue>12</issue><spage>749</spage><epage>761</epage><pages>749-761</pages><issn>0306-3674</issn><eissn>1473-0480</eissn><abstract>ObjectivesTo evaluate prevention strategies, their unintended consequences and modifiable risk factors for sport-related concussion (SRC) and/or head impact risk.DesignThis systematic review and meta-analysis was registered on PROSPERO (CRD42019152982) and conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesEight databases (MEDLINE, CINAHL, APA PsycINFO, Cochrane (Systematic Review and Controlled Trails Registry), SPORTDiscus, EMBASE, ERIC0 were searched in October 2019 and updated in March 2022, and references searched from any identified systematic review.Eligibility criteriaStudy inclusion criteria were as follows: (1) original data human research studies, (2) investigated SRC or head impacts, (3) evaluated an SRC prevention intervention, unintended consequence or modifiable risk factor, (4) participants competing in any sport, (5) analytic study design, (6) systematic reviews and meta-analyses were included to identify original data manuscripts in reference search and (7) peer-reviewed. Exclusion criteria were as follows: (1) review articles, pre-experimental, ecological, case series or case studies and (2) not written in English.ResultsIn total, 220 studies were eligible for inclusion and 192 studies were included in the results based on methodological criteria as assessed through the Scottish Intercollegiate Guidelines Network high (‘++’) or acceptable (‘+’) quality. Evidence was available examining protective gear (eg, helmets, headgear, mouthguards) (n=39), policy and rule changes (n=38), training strategies (n=34), SRC management strategies (n=12), unintended consequences (n=5) and modifiable risk factors (n=64). Meta-analyses demonstrated a protective effect of mouthguards in collision sports (incidence rate ratio, IRR 0.74; 95% CI 0.64 to 0.89). Policy disallowing bodychecking in child and adolescent ice hockey was associated with a 58% lower concussion rate compared with bodychecking leagues (IRR 0.42; 95% CI 0.33 to 0.53), and evidence supports no unintended injury consequences of policy disallowing bodychecking. In American football, strategies limiting contact in practices were associated with a 64% lower practice-related concussion rate (IRR 0.36; 95% CI 0.16 to 0.80). Some evidence also supports up to 60% lower concussion rates with implementation of a neuromuscular training warm-up programme in rugby. More research examining potentially modifiable risk factors (eg, neck strength, optimal tackle technique) are needed to inform concussion prevention strategies.ConclusionsPolicy and rule modifications, personal protective equipment, and neuromuscular training strategies may help to prevent SRC.PROSPERO registration numberCRD42019152982.</abstract><cop>England</cop><pub>BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine</pub><pmid>37316182</pmid><doi>10.1136/bjsports-2022-106656</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-5951-5899</orcidid><orcidid>https://orcid.org/0000-0002-2282-9325</orcidid><orcidid>https://orcid.org/0000-0001-5800-7000</orcidid><orcidid>https://orcid.org/0000-0001-5668-9706</orcidid><orcidid>https://orcid.org/0000-0001-8293-4496</orcidid><orcidid>https://orcid.org/0000-0002-5530-0639</orcidid><orcidid>https://orcid.org/0000-0002-9499-6691</orcidid><orcidid>https://orcid.org/0000-0001-6985-7043</orcidid><orcidid>https://orcid.org/0000-0001-7807-2459</orcidid><orcidid>https://orcid.org/0000-0002-2994-9880</orcidid><orcidid>https://orcid.org/0000-0003-3636-5557</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0306-3674 |
ispartof | British journal of sports medicine, 2023-06, Vol.57 (12), p.749-761 |
issn | 0306-3674 1473-0480 |
language | eng |
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source | BMJ Publishing |
subjects | Adolescent Age groups Brain Concussion Brain Concussion - prevention & control Child Children & youth Concussion Databases, Factual Estimates Football Gender Helmets Hockey Humans Ice hockey International conferences Meta-analysis Prevention Preventive Medicine Risk factor Risk factors Rugby Sport Systematic review Teenagers Traumatic brain injury Warm up (exercise) |
title | Prevention strategies and modifiable risk factors for sport-related concussions and head impacts: a systematic review and meta-analysis |
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