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Post-concussion return-to-play: Perceptions of roles, responsibilities and guideline implementation among community club rugby stakeholders in South Africa

Concussions are an inherent part of rugby; however, subsequent concussions can be decreased by following the appropriate post-concussion return-to-play (RTP) protocols. The aim of this study was to compare stakeholders’ perceptions regarding their roles and responsibilities in terms of the implementation of post-concussion RTP in community club rugby in the Western Cape, South Africa. The results of a post-concussion RTP implementation questionnaire revealed limited knowledge of the recommended 6-stage BokSmart™ RTP protocol among players. Although not essential that players have knowledge of this protocol, this can be indicative of coaches’ disregard of the importance of communicating concussion knowledge. Coaches were identified as having a major role to play in post-concussion RTP, being responsible for monitoring matches and training sessions for concussion. They were also considered the most knowledgeable stakeholders on post-concussion return-to-play guidelines. Yet, coaches and administrative staff demonstrated a relatively low ability to advise on when to safely return to play. Only two thirds of coaches and a third of administrative staff were found to implement the recommended protocol, while less than half of medical staff and only a third of coaches demonstrated the ability to implement the protocol correctly, revealing inadequate knowledge. Hence, the study underscored the significance of education focusing on the practical implementation of post-concussion RTP protocols within community club rugby.