Injury Rates, Mechanisms, Risk Factors and Prevention Strategies in Youth Rugby Union: What’s All the Ruck-Us About? A Systematic Review and Meta-analysis,Sports Medicine

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Injury Rates, Mechanisms, Risk Factors and Prevention Strategies in Youth Rugby Union: What’s All the Ruck-Us About? A Systematic Review and Meta-analysis
Sports Medicine ( IF 9.3 ) Pub Date : 2023-05-16 , DOI: 10.1007/s40279-023-01826-z
Stephen W West _{1,

2,

3,

4} , Isla J Shill _{3,

5} , Stuart Bailey ₆ , Reid A Syrydiuk _{3,

7,

8} , K Alix Hayden ₉ , Debbie Palmer _{2,

10,

11} , Amanda M Black _{3,

4,

5,

7} , Brent E Hagel _{3,

4,

7,

12,

13} , Keith A Stokes _{1,

2,

14} , Carolyn A Emery _{3,

4,

5,

7,

12,

13,

15}

Affiliation

Centre for Health, and Injury and Illness Prevention in Sport, University of Bath, Bath, UK.
UK Collaborating Centre on Injury & Illness Prevention in Sport (UKCCIIS), Edinburgh & Bath, UK.
Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada.
O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.
Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK.
Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
Michigan Concussion Center, School of Kinesiology, University of Michigan, Ann Arbor, USA.
Libraries and Cultural Resources, University of Calgary, Calgary, Canada.
Edinburgh Sports Medicine Research Network, Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, UK.
Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.
Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Rugby Football Union, Twickenham, London, UK.
Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.

Background

Rugby Union is a collision team sport played globally. Despite this, significant concerns have been raised regarding the sport’s safety, particularly in youth players. Given this, a review of injury rates, risk factors and prevention strategies is required across different youth age groups as well as in males and females.

Objective

The objective of this systematic review (SR) and meta-analysis was to investigate injury and concussion rates, risk factors and primary prevention strategies in youth rugby.

Methods

To be included, studies were required to report either rates, risk factors or prevention strategies in youth rugby and to have a randomised controlled trial, quasi-experimental, cohort, case control, or ecological study design. Exclusion criteria included non-peer-reviewed grey literature, conference abstracts, case studies, previous systematic reviews and studies not written in English. Nine databases were searched. The full search strategy and list of sources are available and pre-registered on PROSPERO (Ref: CRD42020208343). Each study was assessed for risk of bias using the Downs and Black quality assessment tool. Meta-analyses were conducted using a DerSimonian Laird random effect model for each age group and sex.

Results

Sixty-nine studies were included in this SR. The match injury rates (using a 24-h time-loss definition) were 40.2/1000 match hours (95% CI 13.9–66.5) in males and 69.0/1000 match hours (95% CI 46.8–91.2) in females. Concussion rates were 6.2/1000 player-hours (95% CI 5.0–7.4) for males and 33.9/1000 player-hours (95% CI: 24.1–43.7) for females. The most common injury site was lower extremity (males) and the head/neck (females). The most common injury type was ligament sprain (males) and concussion (females). The tackle was the most common event associated with injury in matches (55% male, 71% females). Median time loss was 21 days for males and 17 days for females. Twenty-three risk factors were reported. The risk factors with the strongest evidence were higher levels of play and increasing age. Primary injury prevention strategies were the focus of only eight studies and included law changes (n = 2), equipment (n = 4), education (n = 1) and training (n = 1). The prevention strategy with the most promising evidence was neuromuscular training. The primary limitations included a broad range of injury definitions (n = 9) and rate denominators (n = 11) used, as well as a limited number of studies which could be included in the meta-analysis for females (n = 2).

Conclusion

A focus on high-quality risk factor and primary prevention evaluation should be considered in future studies. Targeting primary prevention and stakeholder education remain key strategies in the prevention, recognition and management of injuries and concussions in youth rugby.

中文翻译：

青少年橄榄球联盟的受伤率、机制、危险因素和预防策略：Ruck-Us 到底是怎么回事？系统回顾和荟萃分析

背景

橄榄球是一项全球性的碰撞团队运动。尽管如此，人们对这项运动的安全性，特别是青少年运动员的安全性，还是产生了极大的担忧。鉴于此，需要对不同青年年龄组以及男性和女性的伤害率、危险因素和预防策略进行审查。

客观的

本次系统评价（SR）和荟萃分析的目的是调查青少年橄榄球运动中的损伤和脑震荡发生率、危险因素和一级预防策略。

方法

要纳入其中，研究必须报告青少年橄榄球的发生率、风险因素或预防策略，并进行随机对照试验、准实验、队列、病例对照或生态研究设计。排除标准包括未经同行评审的灰色文献、会议摘要、案例研究、以前的系统评价和非英文撰写的研究。检索了九个数据库。完整的搜索策略和来源列表已在 PROSPERO 上提供并预先注册（参考号：CRD42020208343）。使用 Downs 和 Black 质量评估工具评估每项研究的偏倚风险。使用 DerSimonian Laird 随机效应模型对每个年龄组和性别进行荟萃分析。

结果

本 SR 中包含 69 项研究。男性比赛受伤率（使用 24 小时损失时间定义）为 40.2/1000 比赛小时（95% CI 13.9–66.5），女性为 69.0/1000 比赛小时（95% CI 46.8–91.2）。男性脑震荡发生率为 6.2/1000 小时（95% CI 5.0–7.4），女性为 33.9/1000 小时（95% CI：24.1–43.7）。最常见的损伤部位是下肢（男性）和头/颈部（女性）。最常见的损伤类型是韧带扭伤（男性）和脑震荡（女性）。铲断是比赛中最常见的与受伤相关的事件（55% 男性，71% 女性）。男性平均损失时间为 21 天，女性平均损失时间为 17 天。报告了二十三个风险因素。最有力的证据表明，危险因素是更高水平的玩耍和年龄的增长。初级伤害预防策略是仅有八项研究的重点，包括法律变更 ( n = 2)、设备 ( n = 4)、教育 ( n = 1) 和培训 ( n = 1)。最有希望证据的预防策略是神经肌肉训练。主要局限性包括使用的伤害定义范围广泛（n = 9）和比率分母（n = 11），以及可纳入女性荟萃分析的研究数量有限（n = 2）。