Experiences with the Enhanced Return to Play Guidelines in Rugby Union - are they being Successfully Implemented Across Levels of the Game and are they Protecting Players?

Background
Rugby union has now seen 61 players retire due to ongoing concussion issues. In 2014 the Rugby football union (RFU) bought in the enhanced return to play guidelines (ERTP) to protect players from the cumulative effects of concussion and to ensure the correct recovery period for players was followed. However, previous studies have found that player education and the implementation of the guidelines is lacking, in particular at the amateur level.

 Methods
An interview study of 16 participants, including coaches, players and medical staff at both professional and amateur level either face to face or over Skype, with set consistent stem questions that guided the interviewer.

Results
This study found that the guidelines, in most cases, are being implemented across all levels of the game but the effectiveness is dependent on player education, which appears to be variable at the amateur level.

Key messages

This study has shown that while implementation of the guidelines has improved, further education about the long-term effects of concussion is needed at all levels. Headcase, the RFU initiative brought in for the amateur level, is failing to penetrate with many amateurs having never heard of it. One novel finding of this study, was the idea that the ERTP guidelines are not aligned with the professional player’s working week, requiring contact training on the last day before a match. Further work needs to be done by the RFU to encourage player education and more research is needed on the longer-term impact of concussion.