- Title
- The identification of sport related concussion in the National Rugby League Women’s Premiership
- Creator
- McLeod, Shreya
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2025
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Rugby league is a popular, high intensity, collision sport. The tackle is the in-game event associated with the highest risk of injury, in particular, concussion. The majority of the published research in rugby league has been conducted on men. To date, very few studies have explored the mechanisms of head impacts and the identification of concussion in women’s rugby league. Purpose: This body of research aimed at identifying the head injury mechanisms and initial management of concussion in the National Rugby League Women’s (NRLW) Premiership. In the first study, video analysis was utilised to determine the tackle related risk factors and head impact characteristics in NRLW players. Second, the one-year test-retest reliability of the baseline Sport Concussion Assessment Tool-5th Edition (SCAT5) subcomponents were examined, in order to develop reliable change indices for professional women’s rugby league players. Third, video signs of concussion were examined in players removed for a Head Injury Assessment and the in-game medical evaluations were compared between concussed and uninjured players, to understand return to play parameters in the NRLW Premiership. Methods: At the time of data collection, the NRLW Premiership consisted of four teams competing over four rounds, with 154 unique players participating in at least one NRLW match. In study one, the first three seasons of the National Rugby League Women’s Premiership (2018-2020) were retrospectively coded using a predefined video analysis matrix exploring 36 categorical variables. This study focused on the tackle height, body position of the tackler and ball carrier, and location of head contact during the tackle. The event risk or propensity was reported as head impact events (HIEs) per 1,000 tackles. The incidence of HIEs was determined as the number of HIEs per 1,000 player match hours. In the second study, uninjured NRLW players who completed baseline SCAT5 assessments over a one-year period (2018-2019 and 2019-2020) were eligible to participate. Team medical staff administered the SCAT5 prior to the first game of each season. Team doctors administered the SCAT5 during the pre-season. Descriptive statistics (mean, Median, Standard Deviation, Interquartile range, skewness and kurtosis) were determined for each season. Normality was assessed using the Shapiro-Wilk test. Non-parametric correlation coefficients (Spearman’s rho and Kendall’s tau-b) were used to calculate between season differences. Intra-class correlation coefficients(ICCs) were calculated to determine test-retest reliability of each SCAT5 subcomponent. The natural distribution of test-retest change scores and reliable change estimates were used to aid clinicians determine cutoffs for NRLW players who demonstrated worsening in function, compared to their baseline values. In the third study, video signs of all NRLW players from the 2018-2020 seasons were reviewed. Medical personnel and sideline operators tagged head impact events requiring further medical evaluation. If players were suspected of sustaining a concussion, they were removed from the field for a HIA, which included the SCAT5. Two experienced video analysts retrospectively reviewed all HIA events using the NRLW Category I and II signs and symptoms, together with the six International Consensus video signs of concussion. The observed signs and symptoms, and game-day medical evaluation findings were examined descriptively. Results were compared between concussed and uninjured athletes. Inter-rater reliability analyses using both the absolute percentage agreement and Cohen’s kappa statistics were used to determine consistency between the two analysts, for the overall rating of all concussion signs, and each of the individual signs. Non-parametric Mann-Whitney U tests were used to determine differences in SCAT5 subcomponent scores for NRLW players, with and without a medical diagnosis of concussion. Due to the small sample, Cohen’s d effect size statistics were included in group comparisons. Results: Study one was a case-controlled, retrospective analysis of 6,401 tackles, from the first three seasons of the NRLW Premiership, with 83 tackles (cases) resulting in a HIE and the remaining 6,318 tackles forming the control cohort. Head impact events (n=83) were chosen as they were sufficient in number to power the statistical analysis. A subset of these head impact events resulted in a head injury assessment (n=18) and medically diagnosed concussions (n=6). In this study, the propensity for tacklers to sustain an HIE was 6.6 per 1,000 tackles (95%CI: 4.87-8.92), similar to that of the ball carrier, at 6.13 per 1,000 tackles (95% CI: 4.48-8.38), with the greatest risk to both players occurring when head proximity was above the sternum (21.66 per 1,000 tackles; 95%CI: 16.55-28.35), with an incidence of 13 per 1,000 match hours. The incidence of HIAs and concussions equated to 33 per 1,000 match hours and 11 per 1,000 match hours, respectively. The preliminary results indicate that in the NRLW, the tackler and ball carrier are at equal risk of a head impact event, differing from the men’s NRL competition where the tackler is more at risk. Second, head-to-head proximity and tackles above the sternum are associated with the highest propensity for HIEs. Therefore, injury prevention initiatives in the women’s game could consider tackle technique and proficiency, both in terms of the tackler’s execution and ball carrier’s evasion methods. In study two, 69 NRLW players had complete baseline SCAT5 data across the one-year period. Test-retest reliability of all baseline SCAT5 metrics were low to moderate, with ICCs of 0.28-0.57. Compared to previously established NRLW baseline norms, most women in this cohort (64-82%) performed within the broadly normal category for all SCAT5 subcomponents. Reliable change estimates using the widest confidence intervals (70%) were created to assist clinicians interpret change on the SCAT5, as follows: a worsening of ≥5 total symptoms, ≥11 on the symptom severity scale, worsening of ≥3 on the Standardised Assessment of Concussion and an increase in total errors by ≥3 on the modified Balance Error Scoring System. In study three, 24 players were removed from the field for a HIA. Video signs were rated consistently between the two independent analysts, with less than 20% of players demonstrating consensus video signs. Concussed players reported more symptoms (M=4.6 vs.1.4, p=0.07, d=0.98), with greater severity (M=9.71 vs. 1.50, p=0.02, d=0.93) and performed significantly worse on the Standardised Assessment of concussion (M=21.8 vs. 27.8, p=0.01, d=1.62), compared with uninjured players. Concussed players also made more balance errors, with a moderate effect size (M=3.14 vs. 1.88, p=.46, d=0.59), but these results did not reach statistical significance. Due to the limited sample size and related power considerations in all three studies, caution must be exercised when interpreting findings. Conclusion: In summary, rugby league is a sport characterised by intense physical demands and frequent collisions, carrying an inherent of concussive injury. The current series of studies provide a preliminary point of reference for concussions in women’s professional rugby League players and can be used to guide acute clinical decision making and target future injury prevention strategies, specific to the women’s game. Further studies with larger sample sizes are needed to better understand head injury kinematics, in combination with instrumented mouthguard technology and clinical biomarkers, to evaluate the in-game detection and clinical outcomes of professional women’s rugby league players.
- Subject
- sport related concussion; rugby; rugby league; women athletes; diagnosis; tackle related risk factors; injury; head impact events; SCAT5; video analysis
- Identifier
- http://hdl.handle.net/1959.13/1517819
- Identifier
- uon:57185
- Rights
- Copyright 2025 Shreya McLeod
- Language
- eng
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