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Burger JW, Mafuze B, Brooker J, Patricios JS. Championing mental health: sport and exercise psychiatry for low- and middle-income countries using a model from South Africa. Br J Sports Med 2024; 58:519-521. [PMID: 38599682 DOI: 10.1136/bjsports-2024-108248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/12/2024]
Affiliation(s)
- James W Burger
- Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
- HIV Mental Health Research Group, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Bonginkosi Mafuze
- Department of Psychiatry, School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Janine Brooker
- Department of Psychiatry, School of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Alan J Flisher Centre for Public Mental Health, Cape Town, South Africa
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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2
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Zondi PC, Patricios JS, Hendricks S. South African sport and exercise medicine: shaping health, fostering responsibility. Br J Sports Med 2024; 58:517-518. [PMID: 38569848 DOI: 10.1136/bjsports-2024-108374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Affiliation(s)
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sharief Hendricks
- Human Biology, University of Cape Town, Division of Exercise and Sports Medicine, Cape Town, South Africa
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3
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Davis GA, Schneider KJ, Anderson V, Babl FE, Barlow KM, Blauwet CA, Bressan S, Broglio SP, Emery CA, Echemendia RJ, Gagnon I, Gioia GA, Giza CC, Leddy JJ, Master CL, McCrea M, McNamee MJ, Meehan WP, Purcell L, Putukian M, Moser RS, Takagi M, Yeates KO, Zemek R, Patricios JS. Pediatric Sport-Related Concussion: Recommendations From the Amsterdam Consensus Statement 2023. Pediatrics 2024; 153:e2023063489. [PMID: 38044802 DOI: 10.1542/peds.2023-063489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 12/05/2023] Open
Abstract
The 6th International Consensus Conference on Concussion in Sport, Amsterdam 2022, addressed sport-related concussion (SRC) in adults, adolescents, and children. We highlight the updated evidence-base and recommendations regarding SRC in children (5-12 years) and adolescents (13-18 years). Prevention strategies demonstrate lower SRC rates with mouthguard use, policy disallowing bodychecking in ice hockey, and neuromuscular training in adolescent rugby. The Sport Concussion Assessment Tools (SCAT) demonstrate robustness with the parent and child symptom scales, with the best diagnostic discrimination within the first 72 hours postinjury. Subacute evaluation (>72 hours) requires a multimodal tool incorporating symptom scales, balance measures, cognitive, oculomotor and vestibular, mental health, and sleep assessment, to which end the Sport Concussion Office Assessment Tools (SCOAT6 [13+] and Child SCOAT6 [8-12]) were developed. Rather than strict rest, early return to light physical activity and reduced screen time facilitate recovery. Cervicovestibular rehabilitation is recommended for adolescents with dizziness, neck pain, and/or headaches for greater than 10 days. Active rehabilitation and collaborative care for adolescents with persisting symptoms for more than 30 days may decrease symptoms. No tests and measures other than standardized and validated symptom rating scales are valid for diagnosing persisting symptoms after concussion. Fluid and imaging biomarkers currently have limited clinical utility in diagnosing or assessing recovery from SRC. Improved paradigms for return to school were developed. The variable nature of disability and differences in evaluating para athletes and those of diverse ethnicity, sex, and gender are discussed, as are ethical considerations and future directions in pediatric SRC research.
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Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia
- Neurosurgery, Cabrini Health, Melbourne, Victoria, Australia
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology
- Hotchkiss Brain Institute
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Victoria, Australia
| | - Karen M Barlow
- University of Queensland, Children's Hospital and Health Services,Brisbane, Queensland, Australia
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts
| | | | | | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology
- Hotchkiss Brain Institute
| | - Ruben J Echemendia
- University Orthopedics Concussion Care Clinic, State College, Pennsylvania
- University of Missouri - Kansas City, Kansas City, Missouri
| | - Isabelle Gagnon
- McGill University, Montreal, Quebec, Canada
- Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | | | | | - John J Leddy
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Christina L Master
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | - Laura Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Keith Owen Yeates
- Hotchkiss Brain Institute
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Patricios JS, Davis GA, Ahmed OH, Blauwet C, Schneider GM, Purcell LK, Echemendia RJ, Fremont P, Fuller GW, Herring SA, Harmon KG, Loosemore M, Makdissi M, O'Halloran P, Putukian M, Turner M, Webborn N, Yeates KO, van Ierssel J, Schneider KJ. Introducing the Sport Concussion Office Assessment Tool 6 (SCOAT6). Br J Sports Med 2023; 57:648-650. [PMID: 37316211 DOI: 10.1136/bjsports-2023-106860] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
- School of Sport, Health and Exercise Science, University of Portsmouth, University of Portsmouth, UK
| | - C Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Geoff M Schneider
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Laura K Purcell
- Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Ruben J Echemendia
- Psychology, University of Missouri, Kansas City, Missouri, USA
- University Orthopedics Concussion Care Center, State College Area School District, State College, Pennsylvania, USA
| | - Pierre Fremont
- Rehabilitation, Laval University, Quebec, Quebec City, Canada
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Mike Loosemore
- Institute for Sport Exercise and Health, University Collage Hospital London, London, UK
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- Australian Football League, Melbourne, Victoria, Australia
| | | | - Margot Putukian
- Consultant, Chief Medical Officer, Major League Soccer, New York, New York, USA
| | - Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
- University College London, London, UK
| | - Nick Webborn
- Department of Sport and Exercise Medicine, Loughborough University, Loughborough, UK
- Medical Committee, International Paralympic Committee, Bonn, Germany
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Capgary, Alberta, Canada
| | | | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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5
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Echemendia RJ, Burma JS, Bruce JM, Davis GA, Giza CC, Guskiewicz KM, Naidu D, Black AM, Broglio S, Kemp S, Patricios JS, Putukian M, Zemek R, Arango-Lasprilla JC, Bailey CM, Brett BL, Didehbani N, Gioia G, Herring SA, Howell D, Master CL, Valovich McLeod TC, Meehan WP, Premji Z, Salmon D, van Ierssel J, Bhathela N, Makdissi M, Walton SR, Kissick J, Pardini J, Schneider KJ. Acute evaluation of sport-related concussion and implications for the Sport Concussion Assessment Tool (SCAT6) for adults, adolescents and children: a systematic review. Br J Sports Med 2023; 57:722-735. [PMID: 37316213 DOI: 10.1136/bjsports-2022-106661] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the acute assessment of sport-related concussion (SRC) and provide recommendations for improving the Sport Concussion Assessment Tool (SCAT6). DATA SOURCES Systematic searches of seven databases from 2001 to 2022 using key words and controlled vocabulary relevant to concussion, sports, SCAT, and acute evaluation. ELIGIBILITY CRITERIA (1) Original research articles, cohort studies, case-control studies, and case series with a sample of >10; (2) ≥80% SRC; and (3) studies using a screening tool/technology to assess SRC acutely (<7 days), and/or studies containing psychometric/normative data for common tools used to assess SRC. DATA EXTRACTION Separate reviews were conducted involving six subdomains: Cognition, Balance/Postural Stability, Oculomotor/Cervical/Vestibular, Emerging Technologies, and Neurological Examination/Autonomic Dysfunction. Paediatric/Child studies were included in each subdomain. Risk of Bias and study quality were rated by coauthors using a modified SIGN (Scottish Intercollegiate Guidelines Network) tool. RESULTS Out of 12 192 articles screened, 612 were included (189 normative data and 423 SRC assessment studies). Of these, 183 focused on cognition, 126 balance/postural stability, 76 oculomotor/cervical/vestibular, 142 emerging technologies, 13 neurological examination/autonomic dysfunction, and 23 paediatric/child SCAT. The SCAT discriminates between concussed and non-concussed athletes within 72 hours of injury with diminishing utility up to 7 days post injury. Ceiling effects were apparent on the 5-word list learning and concentration subtests. More challenging tests, including the 10-word list, were recommended. Test-retest data revealed limitations in temporal stability. Studies primarily originated in North America with scant data on children. CONCLUSION Support exists for using the SCAT within the acute phase of injury. Maximal utility occurs within the first 72 hours and then diminishes up to 7 days after injury. The SCAT has limited utility as a return to play tool beyond 7 days. Empirical data are limited in pre-adolescents, women, sport type, geographical and culturally diverse populations and para athletes. PROSPERO REGISTRATION NUMBER CRD42020154787.
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Affiliation(s)
- Ruben J Echemendia
- Concussion Care Clinic, University Orthopedics, State College, Pennsylvania, USA
- University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Simon Kemp
- Sports Medicine, Rugby Football Union, London, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Christopher M Bailey
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Gerry Gioia
- Depts of Pediatrics and Psychiatry & Behavioral Sciences, Children's National Health System, Washington, District of Columbia, USA
| | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - David Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado, USA
| | | | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | | | - Neil Bhathela
- UCLA Health Steve Tisch BrainSPORT Program, Los Angeles, California, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, School of Medicine, Richmond, Virginia, USA
| | - James Kissick
- Dept of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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6
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Echemendia RJ, Brett BL, Broglio S, Davis GA, Giza CC, Guskiewicz KM, Harmon KG, Herring S, Howell DR, Master C, McCrea M, Naidu D, Patricios JS, Putukian M, Walton SR, Schneider KJ, Burma JS, Bruce JM. Sport concussion assessment tool™ - 6 (SCAT6). Br J Sports Med 2023; 57:622-631. [PMID: 37316203 DOI: 10.1136/bjsports-2023-107036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Miami, Florida, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Sports Medicine Research laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Stanley Herring
- Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - David R Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, University of Colorado, Aurora, Colorado, USA
| | - Christina Master
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Margot Putukian
- Chief Medical Officer, Major League Soccer, New York, New York, USA
- Princeton, New Jersey, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
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7
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Schneider KJ, Patricios JS, Meeuwisse W, Schneider GM, Hayden KA, Premji Z, Ahmed OH, Blauwet C, Broglio S, Cantu RC, Davis GA, Dvorak J, Echemendia RJ, Emery CA, Iverson GL, Leddy JJ, Makdissi M, McCrea M, McNamee M, Putukian M, Yeates KO, Black AM, Burma JS, Critchley M, Eliason PH, Räisänen AM, Tabor JB, Toomey C, Ronksley PE, Cassidy JD. Amsterdam 2022 process: A summary of the methodology for the Amsterdam International Consensus on Concussion in Sport. Br J Sports Med 2023; 57:712-721. [PMID: 37316208 DOI: 10.1136/bjsports-2022-106663] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 06/16/2023]
Abstract
The purpose of this paper is to summarise the consensus methodology that was used to inform the International Consensus Statement on Concussion in Sport (Amsterdam 2022). Building on a Delphi process to inform the questions and outcomes from the 5th International Conference on Concussion in Sport, the Scientific Committee identified key questions, the answers to which would help encapsulate the current science in sport-related concussion and help guide clinical practice. Over 3½ years, delayed by 2 years due to the pandemic, author groups conducted systematic reviews on each selected topic. The 6th International Conference on Concussion in Sport was held in Amsterdam (27-30 October 2022) and consisted of 2 days of systematic review presentations, panel discussions, question and answer engagement with the 600 attendees, and abstract presentations. This was followed by a closed third day of consensus deliberations by an expert panel of 29 with observers in attendance. The fourth day, also closed, was dedicated to a workshop to discuss and refine the sports concussion tools (Concussion Recognition Tool 6 (CRT6), Sport Concussion Assessment Tool 6 (SCAT6), Child SCAT6, Sport Concussion Office Assessment Tool 6 (SCOAT6) and Child SCOAT6). We include a summary of recommendations for methodological improvements for future research that grew out of the systematic reviews.
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Affiliation(s)
- Kathryn J Schneider
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Geoff M Schneider
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation, Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Boston, Massachusetts, USA
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert C Cantu
- Centre for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts, USA
- Neurosurgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Jiri Dvorak
- Spine Unit, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Carolyn A Emery
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Grant L Iverson
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, SUNY Buffalo, Buffalo, New York, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael McNamee
- Department of Movement Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
- Swansea University, Swansea, UK
| | - Margot Putukian
- Major League Soccer, Major League Soccer, New York, New York, USA
| | - Keith Owen Yeates
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda M Black
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Anu M Räisänen
- Department of Physical Therapy Education - Oregon, Western University of Health Sciences College of Health Sciences - Northwest, Lebanon, Oregon, USA
| | | | - Clodagh Toomey
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Paul E Ronksley
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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8
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Davis GA, Patricios JS, Purcell LK, Anderson V, Gioia G, Giza CC, Yeates KO, Ahmed OH, Blauwet C, Corwin D, Master CL, Schneider G, van Ierssel J, Echemendia RJ, Fremont P, Fuller GW, Harmon KG, Herring SA, Holte K, Loosemore M, Makdissi M, McCrea M, Meehan WP, O'Halloran P, Premji Z, Putukian M, Shill IJ, Turner M, Vaandering K, Webborn N, Schneider KJ. Child SCOAT6. Br J Sports Med 2023; 57:672-688. [PMID: 37316206 DOI: 10.1136/bjsports-2023-106984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Laura K Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Vicki Anderson
- Child Neuropsychology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Psychology, University of Melbourne, Parkville, Victoria, Australia
| | - Gerry Gioia
- Children's National Health System, Washington, District of Columbia, USA
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics / Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | | | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation/Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Corwin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christina L Master
- Orthopedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Geoff Schneider
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Miami, Florida, USA
| | - Pierre Fremont
- Rehabilitation, Laval University, Quebec, Quebec, Canada
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Mike Loosemore
- Institute for Sport Exercise and Health, University Collage Hospital London, London, UK
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | | | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | - Isla Jordan Shill
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
| | - Kenzie Vaandering
- University of Calgary Faculty of Kinesiology, Calgary, Alberta, Canada
| | | | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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9
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Davis GA, Echemendia RJ, Ahmed OH, Anderson V, Blauwet C, Brett BL, Broglio S, Bruce JM, Burma JS, Gioia G, Giza CC, Guskiewicz KM, Harmon KG, Herring SA, Makdissi M, Master CL, McCrea M, Meehan WP, Naidu D, Patricios JS, Purcell LK, Putukian M, Schneider KJ, Valovich McLeod TC, Walton SR, Yeates KO, Zemek R. Child SCAT6. Br J Sports Med 2023; 57:636-647. [PMID: 37316212 DOI: 10.1136/bjsports-2023-106982] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Port Matilda, Pennsylvania, USA
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
| | - Vicki Anderson
- Child Neuropsychology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Psychology, University of Melbourne, Parkville, Victoria, Australia
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation/Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin L Brett
- Neurosurgery/ Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Gerry Gioia
- Children's National Health System, Washington, District of Columbia, USA
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics / Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Christina L Master
- Orthopedics and Sports Medicine, Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Dhiren Naidu
- Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Laura K Purcell
- The Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Tamara C Valovich McLeod
- Department of Athletic Training and School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, Arizona, USA
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | | | - Roger Zemek
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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10
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Echemendia RJ, Ahmed OH, Bailey CM, Bruce JM, Burma JS, Davis GA, Gioia G, Howell DR, Fuller GW, Master CL, van Ierssel J, Pardini J, Schneider KJ, Walton SR, Zemek R, Patricios JS. The Concussion Recognition Tool 6 (CRT6). Br J Sports Med 2023; 57:692-694. [PMID: 37316201 DOI: 10.1136/bjsports-2023-107021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Port Matilda, Pennsylvania, USA
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, UK
| | - Christopher M Bailey
- University Hospitals, Cleveland, Ohio, USA
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jared M Bruce
- Biomedical and Health Informatics, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Joel S Burma
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Gerry Gioia
- Children's National Health System, Washington, District of Columbia, USA
| | - David R Howell
- Orthopedics, Sports Medicine Center, Children's Hospital Colorado, Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Christina L Master
- Departments of Pediatrics and Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Jamie Pardini
- Departments of Internal Medicine and Neurology, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Banner - University Medical Center Phoenix, Phoenix, Arizona, USA
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Roger Zemek
- Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
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11
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Patricios JS, Schneider GM, van Ierssel J, Purcell LK, Davis GA, Echemendia RJ, Fremont P, Fuller GW, Herring SA, Harmon KG, Holte K, Loosemore M, Makdissi M, McCrea M, Meehan WP, O'Halloran P, Premji Z, Putukian M, Shill IJ, Turner M, Vaandering K, Webborn N, Yeates KO, Schneider KJ. Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children. Br J Sports Med 2023; 57:737-748. [PMID: 37316204 DOI: 10.1136/bjsports-2023-106897] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To systematically review the scientific literature regarding the assessment of sport-related concussion (SRC) in the subacute phase (3-30 days) and provide recommendations for developing a Sport Concussion Office Assessment Tool (SCOAT6). DATA SOURCES MEDLINE, Embase, PsycINFO, Cochrane CENTRAL, CINAHL, SPORTDiscus and Web of Science searched from 2001 to 2022. Data extracted included study design, population, definition of SRC diagnosis, outcome measure(s) and results. ELIGIBILITY CRITERIA (1) Original research, cohort studies, case-control studies, diagnostic accuracy and case series with samples >10; (2) SRC; (3) screening/technology that assessed SRC in the subacute period and (4) low risk of bias (ROB). ROB was performed using adapted Scottish Intercollegiate Guidelines Network criteria. Quality of evidence was evaluated using the Strength of Recommendation Taxonomy classification. RESULTS Of 9913 studies screened, 127 met inclusion, assessing 12 overlapping domains. Results were summarised narratively. Studies of acceptable (81) or high (2) quality were used to inform the SCOAT6, finding sufficient evidence for including the assessment of autonomic function, dual gait, vestibular ocular motor screening (VOMS) and mental health screening. CONCLUSION Current SRC tools have limited utility beyond 72 hours. Incorporation of a multimodal clinical assessment in the subacute phase of SRC may include symptom evaluation, orthostatic hypotension screen, verbal neurocognitive tests, cervical spine evaluation, neurological screen, Modified Balance Error Scoring System, single/dual task tandem gait, modified VOMS and provocative exercise tests. Screens for sleep disturbance, anxiety and depression are recommended. Studies to evaluate the psychometric properties, clinical feasibility in different environments and time frames are needed. PROSPERO REGISTRATION NUMBER CRD42020154787.
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Affiliation(s)
- Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Geoff M Schneider
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Laura K Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ruben J Echemendia
- Psychology, University of Missouri, Kansas City, Missouri, USA
- University Orthopedics Concussion Care Clinic, State College Area School District, State College, Pennsylvania, USA
| | - Pierre Fremont
- Rehabilitation, Laval University, Quebec, Quebec, Canada
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stanley A Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | | | - Mike Loosemore
- Institute for Sport Exercise and Health, University Collage Hospital London, London, UK
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Patrick O'Halloran
- Neurotrauma and Ophthalmology Research Group, University of Birmingham, Birmingham, UK
- Health Education England West Midlands, Edgbaston, UK
| | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | - Isla Jordan Shill
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
- University College London, London, UK
| | - Kenzie Vaandering
- University of Calgary Faculty of Kinesiology, Calgary, Alberta, Canada
| | - Nick Webborn
- Medical Committee, International Paralympic Committee, Bonn, Germany
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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12
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Iverson GL, Castellani RJ, Cassidy JD, Schneider GM, Schneider KJ, Echemendia RJ, Bailes JE, Hayden KA, Koerte IK, Manley GT, McNamee M, Patricios JS, Tator CH, Cantu RC, Dvorak J. Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies. Br J Sports Med 2023; 57:810-821. [PMID: 37316187 DOI: 10.1136/bjsports-2023-106890] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Concern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health effects associated with sport-related concussion, or exposure to repetitive head impacts, in former athletes. DESIGN Systematic review. DATA SOURCES Search of MEDLINE, Embase, Cochrane, CINAHL Plus and SPORTDiscus in October 2019 and updated in March 2022. ELIGIBILITY CRITERIA Studies measuring future risk (cohort studies) or approximating that risk (case-control studies). RESULTS Ten studies of former amateur athletes and 18 studies of former professional athletes were included. No postmortem neuropathology studies or neuroimaging studies met criteria for inclusion. Depression was examined in five studies in former amateur athletes, none identifying an increased risk. Nine studies examined suicidality or suicide as a manner of death, and none found an association with increased risk. Some studies comparing professional athletes with the general population reported associations between sports participation and dementia or amyotrophic lateral sclerosis (ALS) as a cause of death. Most did not control for potential confounding factors (eg, genetic, demographic, health-related or environmental), were ecological in design and had high risk of bias. CONCLUSION Evidence does not support an increased risk of mental health or neurological diseases in former amateur athletes with exposure to repetitive head impacts. Some studies in former professional athletes suggest an increased risk of neurological disorders such as ALS and dementia; these findings need to be confirmed in higher quality studies with better control of confounding factors. PROSPERO REGISTRATION NUMBER CRD42022159486.
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Affiliation(s)
- Grant L Iverson
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Rudolph J Castellani
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - J David Cassidy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Geoff M Schneider
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Ruben J Echemendia
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
- University Orthopedic Centre, Concussion Care Clinic, State College, Pennsylvania, USA
| | - Julian E Bailes
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatic, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Mass General Brigham, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Geoffrey T Manley
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Michael McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles H Tator
- Department of Surgery and Division of Neurosurgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Canadian Concussion Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Robert C Cantu
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Robert C. Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Jiri Dvorak
- Schulthess Clinic Zurich, Zurich, Switzerland
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13
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Davis GA, Patricios JS, Purcell LK, Anderson V, Gioia GA, Giza CC, Yeates KO, Ahmed OH, Blauwet C, Corwin D, Master CL, Schneider GM, van Ierssel J, Echemendia RJ, Fremont P, Fuller GW, Herring S, Harmon KG, Holte K, Loosemore M, Makdissi M, McCrea M, Meehan WP, O'Halloran P, Premji Z, Putukian M, Shill IJ, Turner M, Vaandering K, Webborn N, Schneider KJ. Introducing the Child Sport Concussion Office Assessment Tool 6 (Child SCOAT6). Br J Sports Med 2023; 57:668-671. [PMID: 37316205 DOI: 10.1136/bjsports-2023-106858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Neurosurgery, Cabrini Health, Malvern, Victoria, Australia
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | | | - Vicki Anderson
- Psychology, University of Melbourne, Parkville, Victoria, Australia
- Brain and Mind, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Gerard A Gioia
- Children's National Health System, Washington, District of Columbia, USA
- School of Medicine, George Washington University, Washington, DC, USA
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | | | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, Staffordshire, UK
- School of Sport Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Corwin
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina L Master
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Geoff M Schneider
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Miami, Florida, USA
| | - Pierre Fremont
- Rehabilitation, Laval University, Quebec City, Quebec, Canada
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stanley Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | | | - Mike Loosemore
- Institute for Sport Exercise and Health, University Collage Hospital London, London, UK
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - William P Meehan
- Sports Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
- Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA
| | | | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | | | - Isla Jordan Shill
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada
| | - Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
| | - Kenzie Vaandering
- University of Calgary Faculty of Kinesiology, Calgary, Alberta, Canada
| | | | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
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14
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Patricios JS, Schneider KJ, Dvorak J, Ahmed OH, Blauwet C, Cantu RC, Davis GA, Echemendia RJ, Makdissi M, McNamee M, Broglio S, Emery CA, Feddermann-Demont N, Fuller GW, Giza CC, Guskiewicz KM, Hainline B, Iverson GL, Kutcher JS, Leddy JJ, Maddocks D, Manley G, McCrea M, Purcell LK, Putukian M, Sato H, Tuominen MP, Turner M, Yeates KO, Herring SA, Meeuwisse W. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. Br J Sports Med 2023; 57:695-711. [PMID: 37316210 DOI: 10.1136/bjsports-2023-106898] [Citation(s) in RCA: 98] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/16/2023]
Abstract
For over two decades, the Concussion in Sport Group has held meetings and developed five international statements on concussion in sport. This 6th statement summarises the processes and outcomes of the 6th International Conference on Concussion in Sport held in Amsterdam on 27-30 October 2022 and should be read in conjunction with the (1) methodology paper that outlines the consensus process in detail and (2) 10 systematic reviews that informed the conference outcomes. Over 3½ years, author groups conducted systematic reviews of predetermined priority topics relevant to concussion in sport. The format of the conference, expert panel meetings and workshops to revise or develop new clinical assessment tools, as described in the methodology paper, evolved from previous consensus meetings with several new components. Apart from this consensus statement, the conference process yielded revised tools including the Concussion Recognition Tool-6 (CRT6) and Sport Concussion Assessment Tool-6 (SCAT6, Child SCAT6), as well as a new tool, the Sport Concussion Office Assessment Tool-6 (SCOAT6, Child SCOAT6). This consensus process also integrated new features including a focus on the para athlete, the athlete's perspective, concussion-specific medical ethics and matters related to both athlete retirement and the potential long-term effects of SRC, including neurodegenerative disease. This statement summarises evidence-informed principles of concussion prevention, assessment and management, and emphasises those areas requiring more research.
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Affiliation(s)
- Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jiri Dvorak
- Spine Unit, Schulthess Clinic Human Performance Lab, Zurich, Switzerland
| | - Osman Hassan Ahmed
- Physiotherapy Department, University Hospitals Dorset NHS Foundation Trust, Poole, UK
- The FA Centre for Para Football Research, The Football Association, Burton-Upon-Trent, Staffordshire, UK
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation/Harvard Medical School, Boston, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation, Boston, Massachusetts, USA
| | - Robert C Cantu
- CTE Center, Boston University School of Medicine, Boston, Massachusetts, USA
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Ruben J Echemendia
- Psychology, University of Missouri Kansas City, Kansas City, Missouri, USA
- Psychological and Neurobehavioral Associates, Inc, Miami, Florida, USA
| | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Michael McNamee
- Department of Movement Sciences, KU Leuven, Leuven, Belgium
- School of Sport and Exercise Medicine, Swansea University, Swansea, UK
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Nina Feddermann-Demont
- University Hospital Zurich, Zurich, Switzerland
- Sports Neuroscience, University of Zurich, Zurich, Switzerland
| | - Gordon Ward Fuller
- School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Christopher C Giza
- Neurosurgery, UCLA Steve Tisch BrainSPORT Program, Los Angeles, California, USA
- Pediatrics/Pediatric Neurology, Mattel Children's Hospital UCLA, Los Angeles, California, USA
| | - Kevin M Guskiewicz
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - Grant L Iverson
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Sports Concussion Program, MassGeneral Hospital for Children, Boston, Massachusetts, USA
| | | | - John J Leddy
- UBMD Orthopaedics and Sports Medicne, SUNY Buffalo, Buffalo, New York, USA
| | - David Maddocks
- Melbourne Neuropsychology Services & Perry Maddocks Trollope Lawyers, Melbourne, Victoria, Australia
| | - Geoff Manley
- Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael McCrea
- Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura K Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Haruhiko Sato
- Neurosurgery, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | | | - Michael Turner
- International Concussion and Head Injury Research Foundation, London, UK
- University College London, London, UK
| | | | - Stanley A Herring
- Department of Rehabilitation Medicine, Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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15
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Schneider KJ, Critchley ML, Anderson V, Davis GA, Debert CT, Feddermann-Demont N, Gagnon I, Guskiewicz KM, Hayden KA, Herring S, Johnstone C, Makdissi M, Master CL, Moser RS, Patricios JS, Register-Mihalik JK, Ronksley PE, Silverberg ND, Yeates KO. Targeted interventions and their effect on recovery in children, adolescents and adults who have sustained a sport-related concussion: a systematic review. Br J Sports Med 2023; 57:771-779. [PMID: 37316188 DOI: 10.1136/bjsports-2022-106685] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVES We evaluated interventions to facilitate recovery in children, adolescents and adults with a sport-related concussion (SRC). DESIGN Systematic review including risk of bias (modified Scottish Intercollegiate Guidelines Network tool). DATA SOURCES MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase, APA PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL Plus with Full Text, SPORTDiscus and Scopus searched until March 2022. STUDY ELIGIBILITY CRITERIA (1) Original research including randomised controlled trials (RCTs), quasi-experimental designs, cohort, comparative effectiveness studies; (2) focus on SRC; (3) English; (4) peer-reviewed and (5) evaluated treatment. RESULTS 6533 studies were screened, 154 full texts reviewed and 13 met inclusion (10 RCTs, 1 quasi-experimental and 2 cohort studies; 1 high-quality study, 7 acceptable and 5 at high risk of bias). Interventions, comparisons, timing and outcomes varied, precluding meta-analysis. For adolescents and adults with dizziness, neck pain and/or headaches >10 days following concussion, individualised cervicovestibular rehabilitation may decrease time to return to sport compared with rest followed by gradual exertion (HR 3.91 (95% CI 1.34 to 11.34)) and when compared with a subtherapeutic intervention (HR 2.91 (95% CI 1.01 to 8.43)). For adolescents with vestibular symptoms/impairments, vestibular rehabilitation may decrease time to medical clearance (vestibular rehab group 50.2 days (95% CI 39.9 to 60.4) compared with control 58.4 (95% CI 41.7 to 75.3) days). For adolescents with persisting symptoms >30 days, active rehabilitation and collaborative care may decrease symptoms. CONCLUSIONS Cervicovestibular rehabilitation is recommended for adolescents and adults with dizziness, neck pain and/or headaches for >10 days. Vestibular rehabilitation (for adolescents with dizziness/vestibular impairments >5 days) and active rehabilitation and/or collaborative care (for adolescents with persisting symptoms >30 days) may be of benefit.
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Affiliation(s)
- Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Vicki Anderson
- Child Neuropsychology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Psychology, University of Melbourne, Parkville, Victoria, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Cabrini Health, Malvern, Victoria, Australia
| | - Chantel T Debert
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Nina Feddermann-Demont
- Department of Neurology, University Hospital Zurich, Zurich Switzerland Sports Neuroscience, University of Zurich, Zurich, Switzerland
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Kevin M Guskiewicz
- Sports Medicine Research Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Stanley Herring
- Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Michael Makdissi
- Florey Institute of Neuroscience and Mental Health - Austin Campus, Heidelberg, Victoria, Australia
- Australian Football League, Melbourne, Victoria, Australia
| | - Christina L Master
- Pediatrics and Sports Medicine, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Johna K Register-Mihalik
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul E Ronksley
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Keith Owen Yeates
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Psychology, University of Calgary, Calgary, Alberta, Canada
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16
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Hall TM, Basson PJ, Patricios JS. South African professional Super Rugby players' lived experiences of career-related traumatic injuries: A descriptive phenomenological analysis. S Afr J Sports Med 2020; 32:v32i1a8622. [PMID: 36818987 PMCID: PMC9924589 DOI: 10.17159/2078-516x/2020/v32i1a8622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Historically, non-career-ending traumatic rugby injury (TRI) has been viewed from a predominantly biological perspective. However, dimensional perspectives, such as the biopsychosocial model, have highlighted the need to incorporate psychosocial understandings of TRI into treatment plans. Aim To describe the lived experiences of a cohort of traumatically injured South African Super Rugby players in order to add to the body of literature on the subject of TRI experience. Methods The employment of a qualitative, descriptive phenomenological method was used to achieve the research outcome. Discussion Common descriptive themes indicated that TRI seems to exist within three stages: the initial, emotional and subsequent reactions to the traumatic injury. Sub-themes described within each stage included attempts at remaining positive and appraising the severity of the injury during onset, fear responses and concomitant feelings of loss related to foregone career opportunities during the emotional reactions stage, the employment of coping mechanisms, and relying on specific support structures during subsequent reactions. Two novel experiences revealed within this study and not reported in the international literature included the injured players' reliance on compartmentalisation and positive religious belief structures as coping strategies. All themes were reduced to descriptive phenomenological essences that describe a lifeworld or biopsychosocial experience of TRI. Conclusion Themes drawn from this study can be applied in the future design and implementation of expanded studies and psychological interventions aimed at assisting traumatically injured rugby players during their recovery process. The identified themes affirm aspects from the international literature while highlighting some uniquely South African outcomes.
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Affiliation(s)
- T M Hall
- Counselling Psychologist, Private Practice, Sea Point, Western Cape,
South Africa
| | - P J Basson
- Counselling Psychologist, Lecturer, Department of Psychology, University of Johannesburg, Auckland Park, Johannesburg
| | - J S Patricios
- Sport and Exercise Medicine Physician, Wits Sport and Health (WISH), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
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17
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Hall TM, Botha JA, Patricios JS. Addressing negative psychosocial factors linked to severe injury in professional rugby players: An introduction to a group psychotherapy approach. S Afr J Sports Med 2020; 32:v32i1a8505. [PMID: 36818988 PMCID: PMC9924593 DOI: 10.17159/2078-516x/2020/v32i1a8505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Negative psychosocial sequelae of severe rugby injury (SRI) in professional rugby players are well documented. Unaddressed, these issues can leave players vulnerable to persistent common mental disorders (CMD) and negatively affect injury recovery processes. Objective To introduce a psychotherapeutic group intervention aimed at addressing negative psychosocial sequelae linked to SRI in professional rugby player cohorts. Methods Literature aimed at clarifying the potential efficacy of an integrative group therapy model, the Recovery Mastery Group (RMG), is discussed after which component parts of the intervention are presented. Case illustration A case illustration is presented comprising examples of how the RMG framework addressed psychosocial recovery issues in a professional South African rugby team during 2019. Conclusion The proposed Recovery Mastery Group (RMG) is presented as a cost- and time- effective psychotherapeutic intervention that integrates well-researched psychotherapeutic techniques. The RMG appears able to address multiple facets of psychosocial injury recovery, while possibly offering protection from the onset of CMD. This introduction to the RMG can be a forerunner of similar research across larger cohorts, in different team sports, to determine wider therapeutic intervention efficacy.
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Affiliation(s)
- T M Hall
- Counselling Psychologist, Private Practice, Kenilworth, Western Cape,
South Africa
| | - J A Botha
- Clinical Psychologist, Private Practice, Netcare Waterfalls, Johannesburg,
South Africa
| | - J S Patricios
- Sport and Exercise Medicine Physician, Wits Sport and Health (WiSH), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
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18
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Patricios JS, Ardern CL, Hislop MD, Aubry M, Bloomfield P, Broderick C, Clifton P, Echemendia RJ, Ellenbogen RG, Falvey ÉC, Fuller GW, Grand J, Hack D, Harcourt PR, Hughes D, McGuirk N, Meeuwisse W, Miller J, Parsons JT, Richiger S, Sills A, Moran KB, Shute J, Raftery M. Implementation of the 2017 Berlin Concussion in Sport Group Consensus Statement in contact and collision sports: a joint position statement from 11 national and international sports organisations. Br J Sports Med 2018; 52:635-641. [PMID: 29500252 PMCID: PMC5931244 DOI: 10.1136/bjsports-2018-099079] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2018] [Indexed: 01/25/2023]
Abstract
The 2017 Berlin Concussion in Sport Group Consensus Statement provides a global summary of best practice in concussion prevention, diagnosis and management, underpinned by systematic reviews and expert consensus. Due to their different settings and rules, individual sports need to adapt concussion guidelines according to their specific regulatory environment. At the same time, consistent application of the Berlin Consensus Statement's themes across sporting codes is likely to facilitate superior and uniform diagnosis and management, improve concussion education and highlight collaborative research opportunities. This document summarises the approaches discussed by medical representatives from the governing bodies of 10 different contact and collision sports in Dublin, Ireland in July 2017. Those sports are: American football, Australian football, basketball, cricket, equestrian sports, football/soccer, ice hockey, rugby league, rugby union and skiing. This document had been endorsed by 11 sport governing bodies/national federations at the time of being published.
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Affiliation(s)
- Jon S Patricios
- University of Pretoria, Section of Sports Medicine, Faculty of Health Sciences, Johannesburg, South Africa
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare L Ardern
- Department of Physiotherapy, Linköping University, Linköping, Sweden
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | | | - Mark Aubry
- International Ice Hockey Federation, Zurich, Switzerland
| | | | | | - Patrick Clifton
- Australian Football League, Melbourne, Victoria, Australia
- Australian Institute of Sport, Canberra, Australia
| | - Ruben J Echemendia
- National Hockey League, New York, USA
- University Orthopedic Center, Concussion Care Clinic, State College, Pennsylvania, USA
- University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Richard G Ellenbogen
- National Football League, New York, USA
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Gordon Ward Fuller
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Dallas Hack
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | | | - David Hughes
- Australian Football League, Melbourne, Victoria, Australia
- Australian Institute of Sport, Canberra, Australia
| | - Nathan McGuirk
- National Rugby League, Sydney, New South Wales, Australia
| | | | | | - John T Parsons
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | | | - Allen Sills
- National Football League, New York, USA
- Fédération Equestre Internationale, Lausanne, Switzerland
| | | | - Jenny Shute
- Fédération Internationale de Ski, Oberhofen and Thunersee, Switzerland
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19
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Stovitz SD, Weseman JD, Hooks MC, Schmidt RJ, Koffel JB, Patricios JS. What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review. Curr Sports Med Rep 2017; 16:50-55. [PMID: 28067742 DOI: 10.1249/jsr.0000000000000326] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Concern about what has been termed, "second impact syndrome" (SIS) is a major factor determining return-to-play decisions after concussion. However, definitions of SIS vary. We used Scopus to conduct a systematic review and categorize the definitions used to describe SIS. Of the 91 sources identified, 79 (87%) clearly specified that SIS involved either cerebral edema or death after a concussion when a prior concussion had not resolved. Twelve articles (13%) could be interpreted as merely the events of two consecutive concussions. Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was "high" (e.g., 50% to 100%). Our review found that most articles define SIS as a syndrome requiring catastrophic brain injury after consecutive concussive episodes. Given that it is unclear how common it is to have a second concussion while not fully recovered from a first concussion, the actual mortality rate of SIS is unknown.
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Affiliation(s)
- Steven D Stovitz
- 1Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; 2University of Minnesota Medical School, Minneapolis, MN; 3Bio-Medical Library, University of Minnesota, Minneapolis, MN; 4Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; and 5Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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20
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Abstract
Rugby Union (rugby) is a sport that evolved from and resembles other forms of football but is unique in many respects and presents distinctive clinical challenges. This article discusses those aspects of rugby that are different from other sports and those injuries that have specific significance to the game as a result of it being a global collision sport with an increasing focus on serious injury prevention. Injury screening and intervention programs, neck injuries, rugby's contribution to evolving concussion protocols, contact and travel-related illnesses, and rugby's drug intervention protocols are discussed.
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Affiliation(s)
- Jon S Patricios
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa, Department of Emergency Medicine, and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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21
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Affiliation(s)
- Jon S Patricios
- Section of Sports Medicine, Faculty of Health Sciences, University of Pretoria, , Pretoria, Johannesburg, South Africa
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22
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Affiliation(s)
- RM Collins
- Section Sports Medicine, University of Pretoria, Golden Lions Rugby Union
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23
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24
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Affiliation(s)
- Jon S Patricios
- South African Rugby Union (SARU), Newlands, , Cape Town, South Africa
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25
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Patricios JS. Why some Africans stand out in a crowd: BokSmart for injury prevention and other SASMA-related jewels. Br J Sports Med 2012. [DOI: 10.1136/bjsports-2012-091306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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26
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27
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Patricios JS. The Sports Concussion Note: Should SCAT Become SCOAT? Med Sci Sports Exerc 2011. [DOI: 10.1249/01.mss.0000403060.54001.a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Guidelines for returning a concussed player to sport had been somewhat controversial and nebulous until the emergence of a series of international consensus meetings and statements initiated in 2001. The Vienna (2001), Prague (2004) and Zurich (2009 statements as well as the American National Athletic Trainers Association (2004) and the American College of Sports Medicine (2005) position stands have given all clinicians better guidance that is more evidence-based than the somewhat subjective guidelines of the latter 20th century. Some impetus to research and the re-evaluation of assessment and management guidelines has been provided by the emergence of computerised neuropsychological test batteries as a useful barometer of cognitive recovery. However, the clinical evaluation of a concussed player remains the cornerstone of management and should incorporate a thorough symptom analysis, general, cognitive and neurological examination, and balance testing. The Sports Concussion Assessment Tool (SCAT) 2 card is a clinical evaluation tool intended to summarise the most significant aspects of clinical assessment. In addition, and as an essential ‘final stress’ test, the athlete must be subjected to a series of graded exercise sessions, increasing in severity, before being returned to contact or collision sport. A structured clinical evaluation is particularly important in the South African context, where computerised testing may not be accessible to many. This article serves to collate and highlight the evidence-based and consensus data available for management of the concussed rugby player in 2010.
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Collins RM, Janse van Rensburg DC, Grant CC, Patricios JS, Veller M, Ramagole DA. Effort thrombosis: A case study and discussion. S Afr j sports med 2010. [DOI: 10.17159/2078-516x/2010/v22i4a306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Paget-Schroetter syndrome or effort thrombosis is a rare condition with potentially severe consequences, affecting young and otherwise healthy athletes. Its classic clinical presentation should be rapidly identified to promote early diagnosis and treatment. This prevents recurrences and long-term complications such as persistent swelling of the affected arm. In a 1-year period we saw two young male athletes with this condition. One was treated conservatively and the other surgically, with vastly different outcomes. We therefore present their cases as well as a review of relevant literature to emphasise treatment of this rare condition.
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Patricios JS, Collins RM. BokSmart: Pre-participation screening of rugby players by coaches based on internationally accepted medical standards. S Afr j sports med 2010. [DOI: 10.17159/2078-516x/2010/v22i3a311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A comprehensive medical history forms a significant part of any medical assessment or screening. In the athlete, pre-participation screening is aimed at determining those aspects of personal and family history that place the participant at greater risk of sudden death, serious illness or musculoskeletal injury. In rugby union, where the incidence of head and neck injuries is higher than in other sports, emphasis needs to be placed on screening for potential risk factors for neurological injury. In a South African rugby environment, pre-season medical screening is not standard and indeed rarely practised. In most club and school settings, the rugby coach may well be the person most in contact with players and therefore in the best position to conduct an initial screening. This article reviews the relevant literature pertinent to such a guideline.
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31
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Patricios JS, Ferguson MC, Schwellnus M. Chronic Exertional Compartment Syndrome - Accurate Diagnosis and Effective Surgical Management. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-01268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Munshi IR, Patricios JS, Levy RD, Saadia R. Uterine actinomycosis associated with an enterocutaneous fistula. A case report. S AFR J SURG 1994; 32:13-4. [PMID: 11218434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
A postmenopausal woman with suppurative actinomycotic uterine infection complicated by an enterocutaneous fistula is reported. It occurred against a background of prolonged use of an intra-uterine contraceptive device.
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Affiliation(s)
- I R Munshi
- Department of Surgery, University of the Witwatersrand and Baragwanath Hospital, Johannesburg
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33
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Patricios JS, Munshi IR, Levy RD, Saadia R. 'Tropical' pyomyositis. A case report. S AFR J SURG 1993; 31:142-3. [PMID: 8122180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J S Patricios
- Department of Surgery, Baragwanath Hospital, Johannesburg
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