{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T13:06:06Z","timestamp":1767791166474,"version":"3.49.0"},"reference-count":29,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T00:00:00Z","timestamp":1759622400000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"PolarCool AB"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Sport Exerc Med"],"accepted":{"date-parts":[[2025,9,14]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>Sports-related concussions (SRCs) typically occur when the brain is hyperthermic. Acute head-and-neck cooling should, therefore, reduce the brain\u2019s metabolic demands, with the potential to improve recovery following an SRC. Elite ice hockey players who underwent head-and-neck cooling after sustaining a concussion (SRC) showed reduced return-to-play times, although further investigation is warranted. This paper aims to describe the methods proposed for investigating the clinical effects and feasibility of acute head-and-neck cooling in elite male rugby union players.<\/jats:p>\n                  <jats:p>A quasi-experimental study will be conducted in two professional male rugby competitions (clusters): the United Rugby Championship \u2018intervention group\u2019 and the PREM Rugby \u2018standard care group\u2019. Both groups will follow World Rugby\u2019s standardised, graduated return-to-play concussion management protocols. In addition to this, within 30\u2009min of the SRC, the intervention group will be offered head-and-neck cooling for 45\u2009min. The quantitative phase of the study will collect return-to-play times and clinical outcomes in both groups (sample size calculated: 100 concussions per cohort). The qualitative phase will explore the experiences of players and medical teams with the intervention. Intention-to-treat and per-protocol analyses, using appropriate regression modelling techniques, will adjust for possible confounders between the two groups, and thematic content analysis will be employed in the analysis of the respective phases.<\/jats:p>\n                  <jats:p>The Clinical Observed Outcomes with Local HEad-neck cooling After Diagnosed concussions study will provide evidence regarding acute head-and-neck cooling as a potential adjunct treatment to current concussion management in elite male rugby union.<\/jats:p>","DOI":"10.1136\/bmjsem-2025-002915","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T06:30:12Z","timestamp":1759732212000},"page":"e002915","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Selective head-and-neck cooling as a treatment method for concussions in elite male rugby union players: the Clinical Observed Outcomes with Local HEad-and-neck cooling After Diagnosed concussions (COOLHEAD) study protocol"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7778-7783","authenticated-orcid":false,"given":"James","family":"Brown","sequence":"first","affiliation":[{"name":"Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Carnegie School of Sport, Leeds, UK"},{"name":"Department of Exercise, Sport and Lifestyle Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Dunlop","sequence":"additional","affiliation":[{"name":"Edinburgh Rugby, Edinburgh, UK"},{"name":"United Rugby Championship, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8443-9173","authenticated-orcid":false,"given":"Marelise","family":"Badenhorst","sequence":"additional","affiliation":[{"name":"Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Carnegie School of Sport, Leeds, UK"},{"name":"SPRINZ, Auckland University of Technology, Auckland, New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cameron","family":"Owen","sequence":"additional","affiliation":[{"name":"Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Carnegie School of Sport, Leeds, UK"},{"name":"Rugby Football League, Manchester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niklas","family":"Marklund","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Neurosurgery, Lund University, Lund, Sweden"},{"name":"Department of Neurosurgery, Sk\u00e5ne University Hospital, Lund, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Andrews","sequence":"additional","affiliation":[{"name":"Department of Centre for Clinical Brain Sciences, University of Edinburgh Western General Hospital, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Hay","sequence":"additional","affiliation":[{"name":"Edinburgh Rugby, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Bazo","sequence":"additional","affiliation":[{"name":"Zebre Parma Rugby Club, Parma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Herman","family":"Rossouw","sequence":"additional","affiliation":[{"name":"Vodacom Blue Bulls, Pretoria, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Hanly","sequence":"additional","affiliation":[{"name":"Connacht Rugby, Galway, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig","family":"Dyson","sequence":"additional","affiliation":[{"name":"Scarlets Rugby, Llanelli, 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UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4274-6236","authenticated-orcid":false,"given":"Ben","family":"Jones","sequence":"additional","affiliation":[{"name":"Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Carnegie School of Sport, Leeds, UK"},{"name":"Rugby Football League, Manchester, UK"},{"name":"PREM Rugby, London, UK"},{"name":"Department of Human Biology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa"},{"name":"School of Behavioural and Health Sciences, Australian Catholic University, Brisbane, Queensland, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,5]]},"reference":[{"key":"2026010700402024000_11.4.e002915.1","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1136\/bjsports-2023-106898","article-title":"Consensus statement on concussion in sport the 6th International Conference on 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