{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:36:38Z","timestamp":1785173798900,"version":"3.55.0"},"reference-count":101,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T00:00:00Z","timestamp":1719187200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T00:00:00Z","timestamp":1719187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Sports Sci Med Rehabil"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Concussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>More participants showed good overall knowledge of\u2009\u2265\u200975% (<jats:italic>n<\/jats:italic>\u2009=\u200922, 59% vs. <jats:italic>n<\/jats:italic>\u2009=\u200915, 40%), especially those with greater coaching experience (<jats:italic>p<\/jats:italic>\u2009=\u20090.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD\u2009\u00b1\u20090.75, mean 4.68), being adaptable (171,\u2009\u00b1\u20090.86, 4.62), and being completed in the warm-up (167,\u2009\u00b1\u20090.93, 4.51). The biggest perceived barriers were duration (138,\u2009\u00b1\u20091.59, mean 3.73), effort (130,\u2009\u00b1\u20091.56, 3.51), compliance and lack of knowledge (both 127,\u2009\u00b1\u20091.68, 3.43).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>These results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13102-024-00930-5","type":"journal-article","created":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T07:02:13Z","timestamp":1719212533000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["High school rugby coaches\u2019 knowledge and opinions of concussion in KwaZulu Natal province in South Africa: an ecological cross-sectional study"],"prefix":"10.1186","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5669-6121","authenticated-orcid":false,"given":"Daniel","family":"Garnett","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0620-0658","authenticated-orcid":false,"given":"Saul","family":"Cobbing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3548-5509","authenticated-orcid":false,"given":"Carel","family":"Viljoen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6829-4098","authenticated-orcid":false,"given":"Jon","family":"Patricios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,6,24]]},"reference":[{"key":"930_CR1","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1097\/JSM.0000000000000276","volume":"26","author":"S McFie","year":"2016","unstructured":"McFie S, Brown JC, Hendricks S, Posthumus M, Readhead C, Lambert M, et al. Incidence and factors associated with concussion injuries at the 2011 to 2014 South African Rugby Union Youth Week Tournaments. Clin J Sport Med. 2016;26:398\u2013404.","journal-title":"Clin J Sport Med"},{"issue":"16","key":"930_CR2","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1136\/bjsports-2017-098533","volume":"53","author":"D King","year":"2019","unstructured":"King D, Hume PA, Hardaker N, Cummins C, Gissane C, Clark T. Sports-related injuries in New Zealand: National Insurance (Accident Compensation Corporation) claims for five sporting codes from 2012 to 2016. Br J Sports Med. 2019;53(16):1026\u201333.","journal-title":"Br J Sports Med"},{"issue":"3","key":"930_CR3","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1177\/1941738118757178","volume":"10","author":"PL Viviers","year":"2018","unstructured":"Viviers PL, Viljoen JT, Derman W. A Review of a Decade of Rugby Union Injury Epidemiology: 2007\u20132017. Sports Health. 2018;10(3):223\u20137.","journal-title":"Sports Health"},{"issue":"14","key":"930_CR4","doi-asserted-by":"publisher","first-page":"3514","DOI":"10.1177\/0363546519880175","volume":"47","author":"TA McGuine","year":"2019","unstructured":"McGuine TA, Pfaller A, Kliethermes S, Schwarz A, Hetzel S, Hammer E, et al. The effect of sport-related concussion injuries on concussion symptoms and health-related quality of life in male and female adolescent athletes: a prospective study. Am J Sports Med. 2019;47(14):3514\u201320.","journal-title":"Am J Sports Med"},{"issue":"2","key":"930_CR5","doi-asserted-by":"publisher","first-page":"e299","DOI":"10.1542\/peds.2013-2125","volume":"133","author":"NJ Brown","year":"2014","unstructured":"Brown NJ, Mannix RC, O\u2019Brien MJ, Gostine D, Collins MW, Meehan WP. Effect of cognitive activity level on duration of post-concussion symptoms. Pediatrics. 2014;133(2):e299\u2013304.","journal-title":"Pediatrics"},{"issue":"12","key":"930_CR6","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1136\/bjsports-2017-097791","volume":"51","author":"G Manley","year":"2017","unstructured":"Manley G, Gardner AJ, Schneider KJ, Guskiewicz KM, Bailes J, Cantu RC, et al. A systematic review of potential long-term effects of sport-related concussion. Br J Sports Med. 2017;51(12):969\u201377.","journal-title":"Br J Sports Med"},{"issue":"2","key":"930_CR7","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1007\/s40279-017-0810-3","volume":"48","author":"SM Rice","year":"2018","unstructured":"Rice SM, Parker AG, Rosenbaum S, Bailey A, Mawren D, Purcell R. Sport-related concussion and mental health outcomes in elite athletes: a systematic review. Sports Med. 2018;48(2):447\u201365.","journal-title":"Sports Med"},{"key":"930_CR8","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1080\/16501960410023732","volume":"43 Suppl","author":"JD Cassidy","year":"2004","unstructured":"Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, et al. Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on mild traumatic brain injury. J Rehab Med. 2004;43 Suppl:28\u201360.","journal-title":"J Rehab Med"},{"issue":"12","key":"930_CR9","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1136\/bjsports-2020-102967","volume":"55","author":"J van Lerssel","year":"2021","unstructured":"van Lerssel J, Osmond M, Hamid J, Sampson M, Zemek R. What is the risk of recurrent concussion in children and adolescents aged 5\u201318 years? A systematic review and meta-analysis. Br J Sports Med. 2021;55(12):663\u20139.","journal-title":"Br J Sports Med"},{"issue":"11","key":"930_CR10","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1136\/bjsports-2023-106898","volume":"57","author":"JS Patricios","year":"2023","unstructured":"Patricios JS, Schneider KJ, Dvorak J, Ahmed OH, Blauwet C, Cantu RC, et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med. 2023;57(11):695\u2013711.","journal-title":"Br J Sports Med."},{"issue":"12","key":"930_CR11","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/S1474-4422(17)30371-X","volume":"16","author":"AIR Maas","year":"2017","unstructured":"Maas AIR, Adams H, Menon DK, Adelson PD, Andelic N, Bell MJ, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16(12):987\u20131048.","journal-title":"Lancet Neurol"},{"key":"930_CR12","doi-asserted-by":"crossref","unstructured":"Ryu WHA, Feinstein A, Colantonio A, Streiner DL, Dawson DR. Early identification and incidence of mild TBI in Ontario. Can J Neurol Sci. 2009;36(4):429\u201335.","DOI":"10.1017\/S0317167100007745"},{"key":"930_CR13","doi-asserted-by":"publisher","unstructured":"Paul C, Evan F, Tharshini C, Laura L, Catherine WH, George M, et al. The Toronto Concussion Study: a prospective investigation of characteristics in a cohort of adults from the general population seeking care following acute concussion, 2016\u20132020. Front Neurol. 2023; 14. Available from: https:\/\/doi.org\/10.3389\/fneur.2023.1152504.","DOI":"10.3389\/fneur.2023.1152504"},{"issue":"4","key":"930_CR14","first-page":"S3","volume":"1","author":"H Cindy","year":"2016","unstructured":"Cindy H, Michael DC, Chantal V, Alicja M, Brian K, Andrew B, et al. Identification of hidden health utilization services and costs in adults awaiting tertiary care following mild traumatic brain injury in Toronto, Ontario, Canada. Concussion. 2016;1(4):S3\u20137.","journal-title":"Concussion"},{"issue":"1","key":"930_CR15","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1017\/cjn.2022.346","volume":"51","author":"LK Langer","year":"2024","unstructured":"Langer LK, Bayley MT, Levy C, Munce SEP, Lawrence DW, Tam A, et al. Medical care among individuals with a concussion in Ontario: a population-based study. Can J Neurol Sci. 2024;51(1):87\u201397.","journal-title":"Can J Neurol Sci"},{"key":"930_CR16","doi-asserted-by":"publisher","unstructured":"Malakoane B, Heunis JC, Chikobvu P, Kigozi NG, Kruger WH. Public health system challenges in the Free State, South Africa: a situation appraisal to inform health system strengthening. BMC Health Serv Res. 2020; 20(1). Available from: https:\/\/doi.org\/10.1186\/s12913-019-4862-y.","DOI":"10.1186\/s12913-019-4862-y"},{"issue":"1","key":"930_CR17","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.jsams.2018.06.007","volume":"22","author":"N Sewry","year":"2019","unstructured":"Sewry N, Verhagen E, Lambert M, van Mechelen W, Readhead C, Viljoen W, et al. Seasonal time-loss match injury rates and burden in South African under-16 rugby teams. J Sci Med Sport. 2019;22(1):54\u20138.","journal-title":"J Sci Med Sport"},{"issue":"2","key":"930_CR18","doi-asserted-by":"publisher","first-page":"49","DOI":"10.17159\/2078-516X\/2012\/v24i2a345","volume":"24","author":"J Brown","year":"2012","unstructured":"Brown J, Verhagen E, Viljoen W, Readhead C, van Mechelen W, Hendricks S, et al. The incidence and severity of injuries at the 2011 South African Rugby Union (SARU) Youth Week tournaments. S Afr J Sports Med. 2012;24(2):49\u201354.","journal-title":"S Afr J Sports Med"},{"issue":"4","key":"930_CR19","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/j.jsams.2014.06.015","volume":"18","author":"JC Brown","year":"2015","unstructured":"Brown JC, Viljoen W, Lambert MI, Readhead C, Fuller C, Van Mechelen W, et al. The economic burden of time-loss injuries to youth players participating in week-long rugby union tournaments. J Sci Med Sport. 2015;18(4):394\u20139.","journal-title":"J Sci Med Sport"},{"issue":"2","key":"930_CR20","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1177\/0363546516677548","volume":"45","author":"N Burger","year":"2017","unstructured":"Burger N, Lambert MI, Viljoen W, Brown JC, Readhead C, den Hollander S, et al. Mechanisms and factors associated with tackle-related injuries in South African Youth Rugby Union players. Am J Sports Med. 2017;45(2):278\u201385.","journal-title":"Am J Sports Med"},{"issue":"8","key":"930_CR21","doi-asserted-by":"publisher","first-page":"e005556","DOI":"10.1136\/bmjopen-2014-005556","volume":"4","author":"N Burger","year":"2014","unstructured":"Burger N, Lambert MI, Viljoen W, Brown JC, Readhead C, Hendricks S. Tackle-related injury rates and nature of injuries in South African Youth Week tournament rugby union players (under-13 to under-18): an observational cohort study. BMJ Open. 2014;4(8):e005556.","journal-title":"BMJ Open"},{"issue":"15","key":"930_CR22","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1136\/bjsports-2015-095295","volume":"50","author":"N Burger","year":"2016","unstructured":"Burger N, Lambert MI, Viljoen W, Brown JC, Readhead C, Hendricks S. Tackle technique and tackle-related injuries in high-level South African Rugby Union under-18 players: real-match video analysis. Br J Sports Med. 2016;50(15):932\u20138.","journal-title":"Br J Sports Med"},{"issue":"6","key":"930_CR23","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1080\/17461391.2015.1046192","volume":"15","author":"S Hendricks","year":"2015","unstructured":"Hendricks S, O\u2019Connor S, Lambert M, Brown J, Burger N, Mc Fie S, et al. Contact technique and concussions in the South African under-18 Coca-Cola Craven Week Rugby tournament. Eur J Sport Sci. 2015;15(6):557\u201364.","journal-title":"Eur J Sport Sci"},{"key":"930_CR24","unstructured":"SA Rugbymag.co.za. Craven Week dealing with Concussion. 2018. [cited 2023 26 July]. Available from: https:\/\/www.sarugbymag.co.za\/craven-week-dealingwith-concussion\/."},{"key":"930_CR25","unstructured":"World Rugby. Player Welfare\/Medical, c2020. Date unknown [cited 2023 26 July]. Available from: https:\/\/passport.world.rugby\/player-welfare-medical\/."},{"key":"930_CR26","unstructured":"The World Bank. The World Bank in South Africa 2023, c 2023. 2023. [cited 2023 26 July]. Available from: https:\/\/www.worldbank.org\/en\/country\/southafrica\/overview#1."},{"issue":"4","key":"930_CR27","first-page":"1754","volume":"20","author":"C Burnett","year":"2020","unstructured":"Burnett C. From policy to practice for school sport: lessons from South Africa. J Phys Educ Sport. 2020;20(4):1754\u201361.","journal-title":"J Phys Educ Sport"},{"issue":"3","key":"930_CR28","doi-asserted-by":"publisher","first-page":"130","DOI":"10.7196\/SAJCH.2019.v13i3.1640","volume":"13","author":"CE Draper","year":"2019","unstructured":"Draper CE, Micklesfield LK, Harbron J, Tomaz SA, Monyeki A, Kruger HS, et al. Results from the Healthy Active Kids South Africa 2018 Report Card. S Afr J Child Health. 2019;13(3):130\u20136.","journal-title":"S Afr J Child Health"},{"key":"930_CR29","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1136\/bjsports-2012-091278","volume":"46","author":"W Viljoen","year":"2012","unstructured":"Viljoen W, Patricios J. BokSmart \u2013 implementing a National Rugby Safety Programme. Br J Sports Med. 2012;46:492\u20133.","journal-title":"Br J Sports Med"},{"issue":"15","key":"930_CR30","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1136\/bjsports-2016-096757","volume":"52","author":"JC Brown","year":"2018","unstructured":"Brown JC, Gardner-Lubbe S, Lambert MI, van Mechelen W, Verhagen E. Coach-directed education is associated with injury-prevention behaviour in players: an ecological cross-sectional study. Br J Sports Med. 2018;52(15):989\u201393.","journal-title":"Br J Sports Med"},{"issue":"3","key":"930_CR31","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/j.jsams.2008.01.002","volume":"12","author":"SM Gianotti","year":"2009","unstructured":"Gianotti SM, Quarrie KL, Hume PA. Evaluation of RugbySmart: a rugby union community injury prevention programme. J Sci Med Sport. 2009;12(3):371\u20135.","journal-title":"J Sci Med Sport"},{"issue":"2","key":"930_CR32","doi-asserted-by":"publisher","first-page":"e001018","DOI":"10.1136\/bmjsem-2020-001018","volume":"7","author":"C Barden","year":"2021","unstructured":"Barden C, Stokes KA, McKay CD. Implementation of the Activate injury prevention exercise programme in English schoolboy rugby union. BMJ Open Sport Exerc Med. 2021;7(2):e001018.","journal-title":"BMJ Open Sport Exerc Med"},{"issue":"1","key":"930_CR33","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1177\/1747954120961200","volume":"16","author":"DM Salmon","year":"2021","unstructured":"Salmon DM, Romanchuk J, Sullivan J, Walters S, Clacy A, Register-Mihalik J, et al. Concussion knowledge, attitude and reporting intention in rugby coaches and high school rugby players. Int J Sports Sci Coach. 2021;16(1):54\u201369.","journal-title":"Int J Sports Sci Coach"},{"issue":"13","key":"930_CR34","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1136\/bjsports-2015-094639","volume":"49","author":"CA Emery","year":"2015","unstructured":"Emery CA, Roy TO, Whittaker JL, Nettel-Aguirre A, van Mechelen W. Neuromuscular training injury prevention strategies in youth sport: a systematic review and meta-analysis. Br J Sports Med. 2015;49(13):865\u201370.","journal-title":"Br J Sports Med"},{"issue":"11","key":"930_CR35","doi-asserted-by":"publisher","first-page":"11986","DOI":"10.3390\/ijerph111111986","volume":"11","author":"NC Barengo","year":"2014","unstructured":"Barengo NC, Meneses-Echavez JF, Ramirez-Velez R, Cohen DD, Tovar G, Bautista JE. The impact of the FIFA 11+ training program on injury prevention in football players: a systematic review. Int J Environ Res Public Health. 2014;11(11):11986\u20132000.","journal-title":"Int J Environ Res Public Health"},{"issue":"15","key":"930_CR36","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1136\/bjsports-2016-097434","volume":"51","author":"MD Hislop","year":"2017","unstructured":"Hislop MD, Stokes KA, Williams S, McKay CD, England ME, Kemp SPT, et al. Reducing musculoskeletal injury and concussion risk in schoolboy rugby players with a pre-activity movement control exercise programme: a cluster randomised controlled trial. Br J Sports Med. 2017;51(15):1140\u20136.","journal-title":"Br J Sports Med"},{"issue":"6","key":"930_CR37","doi-asserted-by":"publisher","first-page":"368","DOI":"10.1136\/bjsports-2017-098005","volume":"52","author":"MJ Attwood","year":"2018","unstructured":"Attwood MJ, Roberts SP, Trewartha G, England ME, Stokes KA. Efficacy of a movement control injury prevention programme in adult men\u2019s community rugby union: a cluster randomised controlled trial. Br J Sports Med. 2018;52(6):368\u201374.","journal-title":"Br J Sports Med"},{"issue":"7","key":"930_CR38","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1136\/bjsports-2015-095491","volume":"51","author":"HA Archbold","year":"2017","unstructured":"Archbold HA, Rankin AT, Webb M, Nicholas R, Eames NW, Wilson RK, et al. RISUS study: rugby injury surveillance in ulster schools. Br J Sports Med. 2017;51(7):600\u20136.","journal-title":"Br J Sports Med"},{"key":"930_CR39","unstructured":"New Zealand Rugby. RugbySmart c2023. New Zealand Rugby. Not dated [cited 2023 16 July]. Available from: https:\/\/www.rugbysmart.co.nz\/injuries\/concussion\/."},{"key":"930_CR40","unstructured":"Rugby Football Union. HeadCase. Not dated [cited 2023 26 July]. Available from: https:\/\/www.englandrugby.com\/participation\/playing\/headcase."},{"issue":"2","key":"930_CR41","first-page":"56","volume":"37","author":"D King","year":"2010","unstructured":"King D, Hume PA, Clark T. First-aid and concussion knowledge of rugby league team management, administrators and officials in New Zealand. N Zeal J Sports Med. 2010;37(2):56\u201369.","journal-title":"N Zeal J Sports Med"},{"issue":"26","key":"930_CR42","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1097\/JSM.0000000000000256","volume":"1","author":"P Mathema","year":"2016","unstructured":"Mathema P, Evans D, Moore I, Ranson C, Martin R, Mathema P, Evans D, Moore IS, Ranson C, Martin R. Concussed or not? An assessment of concussion experience and knowledge within elite and semiprofessional rugby union. Clin J Sport Med. 2016;1(26):320\u20135.","journal-title":"Clin J Sport Med"},{"issue":"4","key":"930_CR43","doi-asserted-by":"publisher","first-page":"934","DOI":"10.1177\/1747954121996677","volume":"16","author":"W Kraak","year":"2021","unstructured":"Kraak W, Vuuren HV, Welman K. Post-concussion return-to-play: Perceptions of roles, responsibilities and guideline implementation among community club rugby stakeholders in South Africa. Int J Sports Sci Coach. 2021;16(4):934\u201343.","journal-title":"Int J Sports Sci Coach."},{"key":"930_CR44","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.ptsp.2022.06.004","volume":"57","author":"D Anderson","year":"2022","unstructured":"Anderson D, Cathcart J, Kerr D, Moore I, Hislop M, Wilson I. An investigation of coaches\u2019 awareness of injury in elite adolescent rugby union in Northern Irish schools - a qualitative study. Phys Ther Sport. 2022;57:17\u201325.","journal-title":"Phys Ther Sport"},{"key":"930_CR45","volume-title":"Evidence-based medicine : how to practice and teach EBM","author":"DL Sackett","year":"2000","unstructured":"Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine\u202f: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone; 2000.","edition":"2"},{"issue":"1","key":"930_CR46","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/S0146-0005(97)80013-4","volume":"21","author":"DL Sackett","year":"1997","unstructured":"Sackett DL. Evidence-based medicine. Semin Perinatol. 1997;21(1):3\u20135.","journal-title":"Semin Perinatol"},{"issue":"1\u20132","key":"930_CR47","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.jsams.2006.02.009","volume":"9","author":"C Finch","year":"2006","unstructured":"Finch C. A new framework for research leading to sports injury prevention. J Sci Med Sport. 2006;9(1\u20132):3\u20139.","journal-title":"J Sci Med Sport"},{"issue":"4","key":"930_CR48","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1007\/s40279-019-01232-4","volume":"50","author":"JC Tee","year":"2020","unstructured":"Tee JC, McLaren SJ, Jones B. Sports injury prevention is complex: we need to invest in better processes, not singular solutions. Sports Med. 2020;50(4):689\u2013702.","journal-title":"Sports Med"},{"key":"930_CR49","unstructured":"Growing Sports Foundation Trust (GSFT). South Africa must look to history to level the playing fields for school kids: Growing Sports Foundation; 2019. Available from: https:\/\/growingsports.co.za\/2019\/07\/09\/south-africa-must-look-to-history-to-level-the-playing-field-for-school-kids\/."},{"issue":"3","key":"930_CR50","first-page":"43","volume":"30","author":"OE Dodo","year":"2022","unstructured":"Dodo OE, Ntombana L. Social policy paradigms, education and development through sports. Adm Public. 2022;30(3):43\u201362.","journal-title":"Adm Public"},{"issue":"7","key":"930_CR51","first-page":"749","volume":"3","author":"S Gaganpreet","year":"2017","unstructured":"Gaganpreet S. Pros and cons of different sampling techniques. Int J Appl Res. 2017;3(7):749\u201352.","journal-title":"Int J Appl Res"},{"key":"930_CR52","unstructured":"Taherdoost H. What Is the Best Response Scale for Survey and Questionnaire Design; Review of Different Lengths of Rating Scale. Int J Acad Res Man. 2022;8(1):1\u201310."},{"issue":"1","key":"930_CR53","first-page":"33","volume":"43","author":"C Nash","year":"2012","unstructured":"Nash C, Sproule J. Coaches perceptions of their coach education experiences. Int J Sport Psychol. 2012;43(1):33\u201352.","journal-title":"Int J Sport Psychol"},{"issue":"2","key":"930_CR54","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.jclinepi.2010.02.016","volume":"64","author":"AM Garratt","year":"2011","unstructured":"Garratt AM, Helgeland J, Gulbrandsen P. Five-point scales outperform 10-point scales in a randomized comparison of item scaling for the patient experiences questionnaire. J Clin Epidemiol. 2011;64(2):200\u20137.","journal-title":"J Clin Epidemiol"},{"issue":"11","key":"930_CR55","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1136\/bjsports-2017-097699","volume":"51","author":"P McCrory","year":"2017","unstructured":"McCrory P, Meeuwisse W, Dvorak J, Aubry M, Bailes J, Broglio S, et al. Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838\u201347.","journal-title":"Br J Sports Med"},{"key":"930_CR56","unstructured":"SA Rugby. Blue Card. c2023. Not dated [cited 2023 26 July].\u00a0 Available from: https:\/\/www.springboks.rugby\/general\/boksmart-medical-protocolconcussion-blue-card\/."},{"key":"930_CR57","unstructured":"British Journal of Sports Medicine Blog. The blue card in rugby; BJSM; 2023. [cited 2023 Oct 17]. Available from: https:\/\/blogs.bmj.com\/bjsm\/2023\/03\/27\/the-blue-card-in-rugby\/."},{"issue":"13","key":"930_CR58","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1136\/bjsm.2008.056069","volume":"44","author":"CF Finch","year":"2010","unstructured":"Finch CF, Donaldson A. A sports setting matrix for understanding the implementation context for community sport. Br J Sports Med. 2010;44(13):973\u20138.","journal-title":"Br J Sports Med"},{"issue":"2","key":"930_CR59","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1136\/bjsports-2013-092785","volume":"48","author":"PE White","year":"2014","unstructured":"White PE, Newton JD, Makdissi M, Sullivan SJ, Davis G, McCrory P, et al. Knowledge about sports-related concussion: is the message getting through to coaches and trainers? Br J Sports Med. 2014;48(2):119\u201324.","journal-title":"Br J Sports Med"},{"key":"930_CR60","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1016\/j.econedurev.2016.10.003","volume":"55","author":"D Tafreschi","year":"2016","unstructured":"Tafreschi D, Thiemann P. Doing it twice, getting it right? The effects of grade retention and course repetition in higher education. Econ Educ Rev. 2016;55:198\u2013219.","journal-title":"Econ Educ Rev"},{"key":"930_CR61","unstructured":"SA Rugby. BokSmart. c2023. Not dated [cited 2023 25 August]. Available from: https:\/\/www.springboks.rugby\/general\/boksmart-about\/."},{"issue":"3","key":"930_CR62","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1249\/JSR.0000000000000049","volume":"13","author":"J Patricios","year":"2014","unstructured":"Patricios J. BokSmart\u2014South African rugby\u2019s national rugby safety and injury prevention program. Curr Sports Med Rep. 2014;13(3):142\u20134.","journal-title":"Curr Sports Med Rep"},{"key":"930_CR63","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1136\/bjsports-2019-101885","volume":"55","author":"M Raftery","year":"2021","unstructured":"Raftery M, Tucker R, Falvey \u00c9C. Getting tough on concussion: how welfare-driven law change may improve player safety\u2014a Rugby Union experience. Br J Sports Med. 2021;55:527\u20139.","journal-title":"Br J Sports Med"},{"issue":"3","key":"930_CR64","doi-asserted-by":"publisher","first-page":"428","DOI":"10.1177\/0363546504268407","volume":"33","author":"TJ Gabbett","year":"2005","unstructured":"Gabbett TJ, Domrow N. Risk factors for injury in subelite rugby league players. Am J Sports Med. 2005;33(3):428\u201334.","journal-title":"Am J Sports Med"},{"issue":"8","key":"930_CR65","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1016\/j.jsams.2022.04.001","volume":"25","author":"S Nutt","year":"2022","unstructured":"Nutt S, McKay MJ, Gillies L, Peek K. Neck strength and concussion prevalence in football and rugby athletes. J Sci Med Sport. 2022;25(8):632\u20138.","journal-title":"J Sci Med Sport"},{"issue":"5","key":"930_CR66","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1007\/s10935-014-0355-2","volume":"35","author":"CL Collins","year":"2014","unstructured":"Collins CL, Fletcher EN, Fields SK, Kluchurosky L, Rohrkemper MK, Comstock RD, et al. Neck strength: a protective factor reducing risk for concussion in high school sports. J Prim Prev. 2014;35(5):309\u201319.","journal-title":"J Prim Prev"},{"issue":"11","key":"930_CR67","doi-asserted-by":"publisher","first-page":"2373","DOI":"10.1007\/s40279-021-01501-1","volume":"51","author":"J Elliott","year":"2021","unstructured":"Elliott J, Heron N, Versteegh T, Gilchrist IA, Webb M, Archbold P, et al. Injury reduction programs for reducing the incidence of sport-related head and neck injuries including concussion: a systematic review. Sports Med. 2021;51(11):2373\u201388.","journal-title":"Sports Med"},{"issue":"1","key":"930_CR68","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1093\/ije\/dyh346","volume":"34","author":"SW Marshall","year":"2005","unstructured":"Marshall SW, Loomis DP, Waller AE, Chalmers DJ, Bird YN, Quarrie KL, et al. Evaluation of protective equipment for prevention of injuries in rugby union. Int J Epidemiol. 2005;34(1):113\u20138.","journal-title":"Int J Epidemiol"},{"issue":"6","key":"930_CR69","doi-asserted-by":"publisher","first-page":"e044320","DOI":"10.1136\/bmjopen-2020-044320","volume":"11","author":"JM Knight","year":"2021","unstructured":"Knight JM, Nguyen JVK, Mitra B, Willmott C. Soft-shell headgear, concussion and injury prevention in youth team collision sports: a systematic review. BMJ Open. 2021;11(6):e044320.","journal-title":"BMJ Open"},{"issue":"2","key":"930_CR70","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1177\/0956797615620784","volume":"27","author":"T Gamble","year":"2016","unstructured":"Gamble T, Walker I. Wearing a bicycle helmet can increase risk taking and sensation seeking in adults. Psychol Sci. 2016;27(2):289\u201394.","journal-title":"Psychol Sci"},{"key":"930_CR71","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1503\/cmaj.150124","volume":"188","author":"M Ellis","year":"2016","unstructured":"Ellis M, Wenneberg R. Convulsions in a 17-year-old boy after a head injury sustained while playing hockey. CMAJ. 2016;188:443\u20135.","journal-title":"CMAJ"},{"key":"930_CR72","unstructured":"SA Rugby. BokSmart Concussion Guide. c2023. Not dated [cited 2023 25 August]. Available from: https:\/\/www.springboks.rugby\/media\/i0qnf4fg\/boksmartconcussion-guide-cropped.pdf."},{"key":"930_CR73","unstructured":"World Rugby. Fits and Seizures, c2020. Date unknown [cited 2023 26 July]. Available from: https:\/\/passport.world.rugby\/player-welfare-medical\/first-aid-inrugby\/chapter-3-head-injuries-in-rugby-union\/fits-and-seizures\/."},{"issue":"11","key":"930_CR74","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1136\/bjsports-2023-106851","volume":"57","author":"RJ Echemendia","year":"2023","unstructured":"Echemendia RJ, Ahmed OH, Bailey CM, Bruce JM, Burma JS, Davis GA, et al. The Concussion Recognition Tool 6 (CRT6). Br J Sports Med. 2023;57(11):692\u20134.","journal-title":"Br J Sports Med"},{"issue":"11","key":"930_CR75","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1136\/bjsports-2023-106982","volume":"57","author":"GA Davis","year":"2023","unstructured":"Davis GA, Echemendia RJ, Ahmed OH, Anderson V, Blauwet C, Brett BL, et al. Child SCAT6. Br J Sports Med. 2023;57(11):636\u201347.","journal-title":"Br J Sports Med"},{"issue":"11","key":"930_CR76","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1136\/bjsports-2023-106849","volume":"57","author":"RJ Echemendia","year":"2023","unstructured":"Echemendia RJ, Brett BL, Broglio S, Davis GA, Giza CC, Guskiewicz KM, et al. Sport concussion assessment tool\u2122\u20136 (SCAT6). Br J Sports Med. 2023;57(11):622\u201331.","journal-title":"Br J Sports Med"},{"issue":"11","key":"930_CR77","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1136\/bjsports-2023-106851","volume":"57","author":"RJ Echemendia","year":"2023","unstructured":"Echemendia RJ, Ahmed OH, Bailey CM, Bruce JM, Burma JS, Davis GA, et al. Introducing the Concussion Recognition Tool 6 (CRT6). Br J Sports Med. 2023;57(11):689\u201391.","journal-title":"Br J Sports Med"},{"key":"930_CR78","unstructured":"World Rugby. Recognise and Remove, c2020. Date unknown [cited 2023 26 July]. Available from: https:\/\/www.world.rugby\/the-game\/playerwelfare\/medical\/concussion\/recognise-and-remove."},{"key":"930_CR79","unstructured":"World Rugby. Graduated Return to Play Poster, c2020. Date unknown [cited 2023 29 August]. Available from: https:\/\/resources.world.rugby\/worldrugby\/document\/2021\/04\/20\/9bebff3e-4d7b-43b6-994830281126cb46\/GRTP_Poster_EN-2-.pdf."},{"issue":"9","key":"930_CR80","doi-asserted-by":"publisher","first-page":"2263","DOI":"10.1177\/0363546518778251","volume":"46","author":"AC Bretzin","year":"2018","unstructured":"Bretzin AC, Covassin T, Fox ME, Petit KM, Savage JL, Walker LF, et al. Sex differences in the clinical incidence of concussions, missed school days, and time loss in high school student-athletes: part 1. Am J Sports Med. 2018;46(9):2263\u20139.","journal-title":"Am J Sports Med"},{"issue":"4","key":"930_CR81","doi-asserted-by":"publisher","first-page":"e218191","DOI":"10.1001\/jamanetworkopen.2021.8191","volume":"4","author":"AC Bretzin","year":"2021","unstructured":"Bretzin AC, Covassin T, Wiebe DJ, Stewart W. Association of sex with adolescent soccer concussion incidence and characteristics. JAMA Netw Open. 2021;4(4):e218191.","journal-title":"JAMA Netw Open"},{"issue":"8","key":"930_CR82","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1136\/bjsports-2014-093774","volume":"49","author":"G Kirkwood","year":"2015","unstructured":"Kirkwood G, Parekh N, Ofori-Asenso R, Pollock AM. Concussion in youth rugby union and rugby league: a systematic review. Br J Sports Med. 2015;49(8):506\u201310.","journal-title":"Br J Sports Med"},{"issue":"8","key":"930_CR83","doi-asserted-by":"publisher","first-page":"1751","DOI":"10.1007\/s40279-022-01645-8","volume":"52","author":"DA King","year":"2022","unstructured":"King DA, Hume PA, Hind K, Clark TN, Hardaker N. The incidence, cost, and burden of concussion in women\u2019s rugby league and rugby union: a systematic review and pooled analysis. Sports Med. 2022;52(8):1751\u201364.","journal-title":"Sports Med"},{"key":"930_CR84","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1007\/s40279-014-0233-3","volume":"44","author":"AJ Gardner","year":"2014","unstructured":"Gardner AJ, Iverson GL, Williams WH, Baker S, Stanwell P. A systematic review and meta-analysis of concussion in rugby union. Sports Med. 2014;44:1717\u201331.","journal-title":"Sports Med"},{"issue":"4","key":"930_CR85","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1177\/0363546511435626","volume":"40","author":"M Marar","year":"2012","unstructured":"Marar M, McIlvain NM, Fields SK, Comstock RD. Epidemiology of concussions among United States high school athletes in 20 sports. Am J Sports Med. 2012;40(4):747\u201355.","journal-title":"Am J Sports Med"},{"key":"930_CR86","unstructured":"World Rugby. Women's Rugby 2023. Date unknown [cited 2023 29 August]. Available from: https:\/\/www.world.rugby\/organisation\/about-us\/womens."},{"key":"930_CR87","unstructured":"SA School Sports. School Rugby First XV Rankings:24\/04\/2023. 2023. [cited 2023 August 29]. Available from: https:\/\/saschoolsports.co.za\/school-rugby\/."},{"key":"930_CR88","unstructured":"Michaelhouse. Sport: The grassroots of greatness. c2023. Date unknown [cited 2023 29 August]. Available from: https:\/\/www.michaelhouse.org\/about\/sport\/."},{"key":"930_CR89","unstructured":"Roux J. SARU Safety Regulations and Medical Requirements Process 2016. 2016. Available from: http:\/\/bullscoaches.co.za\/wp-content\/uploads\/2017\/02\/SARU-Safety-Regulations-and-Medical-Requirements-Process-Flow-2016.pdf."},{"issue":"12","key":"930_CR90","doi-asserted-by":"publisher","first-page":"1314","DOI":"10.1016\/j.jsams.2019.08.006","volume":"22","author":"JC Brown","year":"2019","unstructured":"Brown JC, Cross M, England M, Finch CF, Fuller GW, Kemp SPT, et al. Guidelines for community-based injury surveillance in rugby union. J Sci Med Sport. 2019;22(12):1314\u20138.","journal-title":"J Sci Med Sport"},{"key":"930_CR91","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.ptsp.2018.11.010","volume":"35","author":"M Cosgrave","year":"2019","unstructured":"Cosgrave M, Williams S. The epidemiology of concussion in professional rugby union in Ireland. Phys Ther Sport. 2019;35:99\u2013105.","journal-title":"Phys Ther Sport"},{"key":"930_CR92","unstructured":"World Rugby. First Aid in Rugby, c2020. Date unknown [cited 2023 August 29]. Available from: https:\/\/passport.world.rugby\/player-welfare-medical\/first-aidin-rugby\/."},{"key":"930_CR93","unstructured":"Rugby Football Union. HeadCase. Not dated [cited 2023 July 26]. Available from: https:\/\/www.englandrugby.com\/participation\/playing\/player-welfare-rugbysafe\/courses."},{"issue":"3","key":"930_CR94","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1249\/JSR.0000000000000049","volume":"13","author":"J Patricios","year":"2014","unstructured":"Patricios J. BokSmart \u2014 South African rugby\u2019s national rugby safety and injury prevention program. Curr Sports Med Rep. 2014;13(3):142\u20134.","journal-title":"Curr Sports Med Rep"},{"issue":"3","key":"930_CR95","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1177\/1941738113476850","volume":"5","author":"A Esquivel","year":"2013","unstructured":"Esquivel A, Haque S, Keating P, Marsh S, Lemos S. Concussion management, education, and return-to-play policies in high schools: a survey of athletic directors, athletic trainers, and coaches. Sports Health. 2013;5(3):258\u201362.","journal-title":"Sports Health"},{"key":"930_CR96","unstructured":"Accident Compensation Corporation (ACC) New Zealand Government. Managing concussion is everyone\u2019s responsibility. 2022. [cited 2023 July 26]. Available from: https:\/\/www.acc.co.nz\/newsroom\/stories\/managing-concussion-is-everyones-responsibility\/."},{"key":"930_CR97","unstructured":"UK Government GOV.UK. Landmark concussion guidance for grassroots sport published. 2023. [cited 2023 July 26]. Available from: https:\/\/www.gov.uk\/government\/news\/landmark-concussion-guidance-for-grassroots-sportpublished."},{"key":"930_CR98","unstructured":"U.S. Department of Health & Human Services Centers for Disease Control and Prevention. Get the facts about TBI. 2023. [cited 2023 July 26]. Available from: https:\/\/www.cdc.gov\/traumaticbraininjury\/get_the_facts.html."},{"issue":"4","key":"930_CR99","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1038\/s41415-021-2654-3","volume":"230","author":"A Shelley","year":"2021","unstructured":"Shelley A, Horner K. Questionnaire surveys - sources of error and implications for design, reporting and appraisal. Br Dent J. 2021;230(4):251\u20138.","journal-title":"Br Dent J"},{"issue":"12","key":"930_CR100","doi-asserted-by":"crossref","first-page":"232596712211414","DOI":"10.1177\/23259671221141442","volume":"10","author":"MF Beaudry","year":"2022","unstructured":"Beaudry MF, Beaudry AG, Benzinger BC, Gilliam BD, Haynes DE. Knowledge and perceptions of ulnar collateral ligament injuries in baseball players: a survey of NCAA head baseball coaches. Orthop J Sports Med. 2022;10(12):23259671221141440.","journal-title":"Orthop J Sports Med."},{"issue":"2","key":"930_CR101","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1093\/her\/8.2.181","volume":"8","author":"MA Diefenbach","year":"1933","unstructured":"Diefenbach MA, Weinstein ND, O\u2019Reilly J. Scales for assessing perceptions of health hazard susceptibility. Health Educ Res. 1933;8(2):181\u201392.","journal-title":"Health Educ Res"}],"container-title":["BMC Sports Science, Medicine and Rehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13102-024-00930-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13102-024-00930-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13102-024-00930-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,28]],"date-time":"2024-06-28T13:10:32Z","timestamp":1719580232000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsportsscimedrehabil.biomedcentral.com\/articles\/10.1186\/s13102-024-00930-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,24]]},"references-count":101,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["930"],"URL":"https:\/\/doi.org\/10.1186\/s13102-024-00930-5","relation":{},"ISSN":["2052-1847"],"issn-type":[{"value":"2052-1847","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,24]]},"assertion":[{"value":"22 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 June 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 June 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 June 2024","order":4,"name":"change_date","label":"Change Date","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Update","order":5,"name":"change_type","label":"Change Type","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"There was a typographical error in the article title in the original publication. The article has been updated to correct Kwa-Zulu to KwaZulu.","order":6,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Permission to conduct the research study was granted by the UKZN Ethics committee BREC 00000961\/2020. Study information was provided and informed consent was obtained from all participating subjects, who were adults.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"139"}}