RugbyRebels

BJSM wrote:Abstract

Objective We aimed to quantify the female athlete composition of the research data informing the most influential consensus and position statements in treating sports-related concussions.

Design We identified the most influential concussion consensus and position statements through citation and documented clinician use; then, we analysed the percentage of male and female athletes from each statement’s cited research.

...

Results A total of 171 distinct studies with human participants were cited by these three consensus and position papers and included in the female athlete analyses (93 NATA; 13 ICCS; 65 AMSSM). All three statements documented a significant under-representation of female athletes in their cited literature, relying on samples that were overall 80.1% male (NATA: 79.9%, ICCS: 87.8 %, AMSSM: 79.4%). Moreover, 40.4% of these studies include no female participants at all.

Conclusion Female athletes are significantly under-represented in the studies guiding clinical care for sport-related concussion for a broad array of sports and exercise medicine clinicians. We recommend intentional recruitment and funding of gender diverse participants in concussion studies, suggest authorship teams reflect diverse perspectives, and encourage consensus statements note when cited data under-represent non-male athletes.

morepork wrote:These are indeed useful metrics but one cannot help feeling they are designed to triage individuals at prior risk rather than addressing possible increased incidence of dementia as a result of trauma from your day job in pro rugby. Repeat trauma to individuals that have existing risk markers is going to result in a pretty predictable outcome. What we want to know is how increased is the risk for dementia in ostensibly healthy individuals within an age demographic. I'd like to add that any clinical study worth its salt needs to factor in gender, and if the generation of these metrics are not being applied to women also then the results will have an unintentional bias. Women are disproportionately represented in Alzheimer's, for example (women do live longer than men on average, but there is evidence for fundamental sex-specific metabolic factors at play). Most of the real time shear forces that those vids propose to collect data on are known quantities in neurology. Animal studies have absolutely validated this. There needs to be a treatment option for players that get their bell rung, and there needs to be longitudinal data on outcomes following that treatment. I don't have an answer to that but the cataloguing of exposure to risk in the absence of data quantifying the impact of treatment/mitigation of risk is going to become quickly redundant. Rugby needs effective treatment protocols to be coupled with the data collection process. Resveratrol, N-acetyl carnitine...whatever, but on the face of it, getting smashed in the head is bad is all this is going to state.

Which Tyler wrote:https://bjsm.bmj.com/content/early/2022 ... 021-105045

BJSM wrote:Abstract

Objective We aimed to quantify the female athlete composition of the research data informing the most influential consensus and position statements in treating sports-related concussions.

Design We identified the most influential concussion consensus and position statements through citation and documented clinician use; then, we analysed the percentage of male and female athletes from each statement’s cited research.

...

Results A total of 171 distinct studies with human participants were cited by these three consensus and position papers and included in the female athlete analyses (93 NATA; 13 ICCS; 65 AMSSM). All three statements documented a significant under-representation of female athletes in their cited literature, relying on samples that were overall 80.1% male (NATA: 79.9%, ICCS: 87.8 %, AMSSM: 79.4%). Moreover, 40.4% of these studies include no female participants at all.

Conclusion Female athletes are significantly under-represented in the studies guiding clinical care for sport-related concussion for a broad array of sports and exercise medicine clinicians. We recommend intentional recruitment and funding of gender diverse participants in concussion studies, suggest authorship teams reflect diverse perspectives, and encourage consensus statements note when cited data under-represent non-male athletes.

Danno wrote: ↑Tue Oct 04, 2022 11:37 pmhttps://www.theguardian.com/sport/2022/ ... mes-higher

Which Tyler wrote: ↑Wed Oct 05, 2022 8:46 am

Danno wrote: ↑Tue Oct 04, 2022 11:37 pmhttps://www.theguardian.com/sport/2022/ ... mes-higher

https://pubmed.ncbi.nlm.nih.gov/36195436/

me wrote:To my understanding - it kinda sums up the whole "debate"

Instinctively, it would seem like a good idea, and therefore everyone joins the bandwagon.
However, without actual evidence of efficacy, it can do more harm than good, and would open up the Unions to accusations / legal suits, for not being evidence based.
Evidence takes time to acquire, and then it takes time to draft workable responses to the new knowledge, and acquire evidence as to whether the suggested solutions actually help or not.

I say this as someone who was calling for fMRI scans every season for professional players about 10 years ago. I'm not anymore though, as we've learned more about the harms associated with routine/regular imaging - I currently suspect they'd be useful, but can no longer claim that it would be harm-free, therefore, we need actual evidence that it would show what we need it to show, before having a conversation about the risks vs rewards of the process, and making a decision.

As someone who was long critical of rugby's response to concussion, I'm far more forgiving these days than I was 10-15 years ago. Back then, we weren't really doing anything about it, and the macho "man up" culture persisted, players were applauded for refusing to admit the injury, and would actively block physio.s from reaching a concussed player. Equally, CTE wasn't a known thing, and the link between repeat concussion and early onset dementia was barely understood (known, but not understood), the link between sub-concussive mTBIs and dementia not even made yet.
The only options we had to deal with things were based on instinct, not evidence - and I called for those options (mostly due to the known risk of second impact syndrome).
Since then, rugby has been very open about the risks as they became more clear, massive headway has been made on educating players, coaches, medical staff and parents, at all levels of the game, further research has been funded, and a never-ending program of regulations and innovations attempting to address the issue has been followed.

For me, World Rugby, and the Unions, have done pretty-much everything they could, and in a timely fashion. The problem has been when the regulations haven't been followed (eg the only people not seeing that G North was unconscious being the Welsh medical and coaching teams).



Going forward, I hope the massed class-action suit against WR and RFU fails - not because those players don't deserve compensation, but because it sends the message that you are responsible for knowing things that nobody knew at the time - medically speaking - that's a hell of a dangerous precedent to set.
Action absolutely can be taken against those who ignored, or bypassed the regulations, and should have known better.
Going forwards, and IMO, rugby's authorities should make the game as safe as it reasonably can be made, with regulations aimed at addressing the issue, but ultimately, it comes down to informed consent. If they players know the risks, and are happy to take the field in full knowledge, then that's on them.

Peej wrote: ↑Thu Oct 06, 2022 10:24 am It was engrossing but also terrifying. Particularly the point he made about care homes not taking men below a certain age, which is an additional layer of shit.

His comment was also revealing about those sessions after a poor defensive performance in a game; 'You were rubbish in defence at the weekend, so we're just going to smash into each other.'

Danno wrote: ↑Tue Oct 04, 2022 11:37 pm Crumbs

https://www.theguardian.com/sport/2022/ ... mes-higher

Peej wrote: ↑Thu Oct 06, 2022 10:24 am It was engrossing but also terrifying. Particularly the point he made about care homes not taking men below a certain age, which is an additional layer of shit.

padprop wrote: ↑Thu Oct 06, 2022 6:49 pm

Danno wrote: ↑Tue Oct 04, 2022 11:37 pm Crumbs

https://www.theguardian.com/sport/2022/ ... mes-higher

Did a bit of a deep dive into the paper itself. As you can imagine the title is a bit sensationalised.

Essentially they had 412 of former Scottish International rugby players and a control group of 1200 people matched for year of birth and socieconomic status.

No one in the control group developed MND, which is rare as lifetime prevalence is approx 1 in 350. They added 1 case to the control for the sake of the paper so stated 1/1200 cases in the control group.

They did not state the amount of individual players who developed mnd but gave a hazard ratio of x15.0 (The stat making the rounds on the news), which likely means there was around 4-5 cases in the elite rugby group.

We already have studies that show elite sportsmen are more likely to develop mnd, both in contact and non-contact sports, although admittedly higher in contact sports.

So yes another bad trend in rugby news, but nothing particularly new imo