Differences In Concussion Knowledge And Attitudes Among American Community Rugby Members

Rugby has one of the highest concussion rates per athletic exposure. Administrators, coaches, referees, and sports medicine staff must do a concussion education course before certification, but players have no such requirement. Consequently, concussion misconceptions and unsafe reporting attitudes may persist among players. Prior research has identified differences in concussion knowledge and attitudes among rugby members, but none have investigated these outcomes in U.S. community-level rugby. PURPOSE: To assess and determine if concussion knowledge and attitudes differ among American community rugby members: Coaches, Sports Medicine Staff (SM), Administrators (Admin), Players, and Referees/Referee Coaches (Refs). METHODS: Participants completed an online survey of the Rosenbaum Concussion Knowledge and Attitude Survey-Student Version (RoCKAS-ST) to calculate two indices: Concussion Knowledge Index (CKI: Range 0-25) and Concussion Attitude Index (CAI: Range 15-75), with higher scores indicating greater knowledge and safer attitudes towards concussion. Krushkal-Wallis tests compared CAI and CKI scores across all five roles, with pairwise comparisons using Dunn's procedure and a Bonferroni correction (α = 0.005). RESULTS: 702 participants (30.0 + 10.4 years, 75.1% Male) represented five groups: Coaches: n = 115; SM: n = 23; Admin: n = 18; Players: n = 472, and Refs: n = 74. Post hoc analyses revealed statistically significant differences in median CKI and CAI between Refs (22.0; 65.5) and SM (13.0; 51.0) and Players (12.0; 50.0) [p < 0.003 for all comparisons]. Refs also had significantly higher CKI than coaches (18.0) [p < 0.001]. Admins (22.0) had significantly higher CKI than players and SM (p < 0.002). Lastly, players had significantly lower CAI than Coaches (61.0) and Admins (65.5) [p < 0.001]. CONCLUSIONS: These findings highlight that concussion knowledge and attitudes vary significantly across member roles in American community rugby. Referees and administrators have the greatest knowledge and safest attitudes. In contrast, players, who are crucial for self-reporting injuries, exhibited the lowest levels of knowledge and least safe attitudes towards concussion, underscoring a critical need for targeted education and interventions among players. Supported by: United States Rugby Foundation Health and Safety Grant (2023-2025)