Implementation of concussion guidelines in community Australian Football and Rugby League-The experiences and challenges faced by coaches and sports trainers

Objectives: While guidelines outlining the appropriate management of sport-related concussion have been developed and adapted for use within community sport, it remains unknown how they are experienced by those responsible for implementing them. Design: Longitudinal study. Methods: 111 coaches and sports trainers from community-level Australian Football and Rugby League teams completed pre- and post-season surveys assessing their attitudes towards using concussion guidelines. Participants also provided post-season feedback regarding their experiences in using the guidelines. Results: 71% of participants reported using the guidelines in the preceding season. Post-season attitude was related to pre-season attitude (p = 0.002), football code (p = 0.015), and team role (p = 0.045). An interaction between team role and guideline use (p = 0.012) was also found, with coaches who had used the guidelines, and sports trainers who had not, reporting more positive post-season attitudes towards using the concussion guidelines. Implementation challenges included disputing of decisions about return-to-play by players, parents, and coaches, and a perceived lack of time. Recommendations for improved guideline materials included using larger fonts and providing for witnessing of advice given to players. Conclusions: This is the first study to examine the implementation of concussion guidelines in community sport. Training of coaches/sports trainers needs enhancement. In addition, new education should be developed for parents/players about the importance of the return-to-play advice given to them by those who follow these guidelines. Information provided by those who attempted to use the guidelines will assist the refinement of implementation and dissemination processes around concussion guidelines across sports. (C) 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.