Predictors of concussion management pathway adherence in New Zealand community rugby: A prospective cohort study

Background There is a need for improved operationalisation of concussion guidelines in community sport. The inclusion of technology may offer a viable solution. This study aimed to evaluate if adherence to a concussion management pathway (CMP) facilitated through the use of technology, improved compliance to concussion guidelines. Methods This prospective observational study (2020–2022) included 5879 players across four unions in NZ. Healthcare touchpoints, demographics, baseline completion, physiotherapist support, and adherence to stand-down periods (SDP) were captured. Generalised linear mixed models examined factors associated with ideal pathway adherence (logged suspected concussion (SC) → system GP diagnosis → system GP medical clearance) and appropriate SDP. Results Across three seasons, 639 SC occurred (n = 550 males, n = 89 females), of which 631 were logged. Of these logged SCs, 82.6% were medically confirmed. The overall SC rate was 16.6 per 1000 match hours. Approximately half (49.9%) adhered to the pathway. The strongest predictor of pathway adherence was completion of a pre-season baseline (OR = 1.90). Physiotherapist support was not significant, but was strongly associated with adherence in one union (OR = 6.15). Pasifika/Other players had lower odds of pathway adherence than NZ European (OR = 0.60). Pathway followers were more likely to adhere to the SDP (79.3% v 45.6%) and RTP that season (85.0% v 57.8%). Conclusion Adherence to the pathway was associated with greater compliance to the recommended SDP and increased likelihood of RTP that season. Pre-season baseline was the most consistent predictor of pathway adherence. Integrating digital systems, pre-season assessment and clinical support may strengthen implementation of community concussion guidelines.