Opinion, Research
by PESS

The Implementation of an Injury Surveillance web-based system into School Rugby – Therese Leahy

Unfortunately, 2020 was not the year for sport! However, as I reflect on my last 3 years as a PhD researcher on the Irish Rugby Injury Surveillance (IRIS) project, I would like to share some thoughts and lessons I have learned while implementing IRISweb into the Irish school Rugby setting.  IRISweb is a web based injury surveillance system designed by my IRIS PhD predecessor Dr. Caithriona Yeomans and the IRIS research team. This system was developed in line with the World Rugby consensus guidelines on injury surveillance3 for the amateur Rugby game to collect longitudinal injury data using a standardised approach. One of my roles as a PhD researcher with IRIS was to modify and implement a version of IRISweb suitable for the school Rugby setting to facilitate the longitudinal collection of injury data. School Rugby has attracted unfavourable media attention in the past due to the contact nature of the game and the proposed injury risk. However, when you dig into the data, the actual injury risk to these players becomes less clear. A systematic review4 I undertook in year 1 highlighted a number of methodology pitfalls associated with previous research in youth Rugby;

  1. Vast inconsistencies in study methodologies implemented across all studies
  2. Large range of injury definitions utilised making study comparison difficult
  3. Inclusion criteria not specific to one age grade or level of play with some studies inclusive of players aged 9-21years
  4. Injury data not always collected prospectively with some studies relying on player recall raising questions of reliability
  5. Lack of consistency in which injury specific data were reported (e.g. mechanism, location, occurrence, position) making it difficult to compare with the professional/amateur game.

In order to implement a successful and reliable injury surveillance system into a school based setting it is imperative that these pitfalls are addressed. There are many challenges when carrying out research with schools as I’m sure my colleagues in PESS will agree with! It is important that for any system like this to be successful, it must be sensitive to the environment in which it is being implemented. This is really key for community research across all fields! It was crucial that we really understood the resources and staffing available in these schools so that we could adapt the IRISweb system around this environment. To explore this further, I undertook a national based survey of Rugby coaches across Irish Rugby schools5 from which we learned:

  1. The availability of medical professionals for matches/trainings across Rugby schools is limited and varies considerable across schools.
  2. Large inconsistencies in injury data that is already collected by schools for school records, especially limited data on return to play, diagnosis and mechanism.
  3. Strength and Conditioning practices varied considerably across schools. Where schools did implement S&C, it was directed towards the Senior or Junior Cup teams.

Three key texts which also fed into the implementation of IRIS into the school setting were the World Rugby Consensus Statement3, the IOC consensus statement1 and Brown’s paper on injury surveillance in the community setting2. IRISweb has now successfully collected two full seasons of injury data across Senior Cup teams and one full season across Junior Cup teams with the third season being halted due to COVID-19. The main things we have learned and specific features of IRISweb which have been integral to successful implementation in this setting are:

  1. Establishing a rapport with the team coach/physiotherapist/S&C coach, education of the importance of injury monitoring to achieve ‘buy in’.
  2. Providing each school with a visual/inphographic injury report each month for their own team helps facilitate ‘buy in’!
  3. Demonstrating that the project visually has support from the sport’s governing body (IRFU) by offering incentives, running workshops and competitions (especially med-end of season) helps compliance.
  4. Identification and nomination of an appropriate injury recorder who will take responsibility for injury monitoring – coaches/S&C’s/physiotherapists work well as they have invested interests in injury monitoring.
  5. Easy to use web-based system which takes approximately 2minutes to complete injury reports each week – this is key!
  6. All injuries are recorded at occurrence regardless of suspected diagnosis/time absent – injuries are only ‘cleared’ when the player returns to play so they system automatically captures severity data. (This takes away the ‘guessing’ for non-medical professionals for minor injuries and ensures that all data are captured).
  7. A system which enables important injury specific data such as nature, location, mechanism, playing position, occurrence, playing surface and diagnosis to be collected. (Think about what you want/need to analyse to identify trends!)
  8. Capturing of school specific data such as days absent from school due to a Rugby injury helps calculate injury burden (don’t forget about the social burden!)
  9. The system is designed for use by non-medical personnel increasing feasibility across all Rugby schools regardless of resource/staffing availability – Imperative for the community setting!
  10. In-built functions allow suspected diagnoses to be recorded at time of injury and only verified on return to play once the player has attended their treating health care professional – improving accuracy of diagnoses data and removing the ‘guessing’ by non-medical staff.
  11. Standardised methods are utilised so that data can be confidently compared to the professional/community/school game across the world
  12. Treatment data such as ‘Attendance at A&E, referral to GP or Physiotherapist’ also collected to help establish degree of involvement of other medical professionals in school Rugby injuries.

References

  1. Bahr R, Clarsen B, Derman W, et al. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)). British Journal of Sports Medicine. 2020;54(7):372.
  2. Brown JC, Cross M, England M, et al. Guidelines for community-based injury surveillance in rugby union. Journal of Science and Medicine in Sport. 2019.
  3. Fuller CW, Molloy MG, Bagate C, et al. Consensus statement on injury definitions and data collection procedures for studies of injuries in rugby union. British Journal of Sports Medicine. 2007;41(5):328-331.
  4. Leahy TM, Kenny IC, Campbell MJ, et al. Injury surveillance in school Rugby: A systematic review of injury epidemiology & surveillance practices. Physical Therapy in Sport. 2019;38:170-178.
  5. Leahy TM, Kenny IC, Campbell MJ, et al. Injury surveillance and prevention practices across Rugby schools in Ireland. Phys Ther Sport. 2020;43:134-142.
Image Source: https://unsplash.com/photos/5jhbUdG8nlM

 

Therese Leahy is a postgraduate research in the Department of Physical Education and Sport Sciences at the University of Limerick.   Therese’s current research interests include injury surveillance, injury prevention, player welfare and injury rehabilitation.  You can contact Therese on twitter @ThereseMLeahy or via email at Therese.Leahy@ul.ie or view her research profile on Researchgate

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