{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T11:59:03Z","timestamp":1773230343174,"version":"3.50.1"},"reference-count":182,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"unspecified","delay-in-days":68,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Sport Exerc Med"],"accepted":{"date-parts":[[2026,1,14]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This review aimed to establish the contributors to negative biopsychosocial outcomes in rugby, defined as unexpected adverse changes in players\u2019 physical, psychological, social or health status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>PubMed, Scopus, MEDLINE, SPORTDiscus and CINAHL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>Studies were eligible if they investigated a physical, psychological or social factor which results in a negative biopsychosocial outcome in men\u2019s or women\u2019s rugby union, league or sevens. Studies were excluded if they did not differentiate outcome measures between rugby and other sports or did not differentiate outcome measures (ie, positive or negative) between physical\/psychological\/social factors and other factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>9165 studies were identified in the initial search and two studies were identified from reference lists, 151 of which met the inclusion criteria (104 rugby union, 46 rugby league, 6 rugby sevens; 141 men, 16 women; 37 youth populations). 29 contributor groups and eight negative biopsychosocial outcome groups were identified. Previous injury (n=26), physical characteristics (n=32), training and match load (n=30) and factors within the contact event (n=22) were the most identified contributor groups. The negative biopsychosocial outcome of injury was investigated by 84% of studies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Overall, the systematic review summarises the contributors to negative biopsychosocial outcomes within the current evidence base. There is a focus on previous injury, physical characteristics, training and match load and factors within the contact event as contributors to negative biopsychosocial outcomes. Eight studies investigated women\u2019s cohorts independently from men; this underrepresentation within the literature could lead to the potential omittance of women-specific contributors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Prospero registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42022346751\">https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42022346751<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsem-2025-002549","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T15:00:42Z","timestamp":1773154842000},"page":"e002549","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Contributors to 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