Safer rugby through BokSmart? Evaluation of a nationwide injury prevention programme for rugby union in South Africa
Doctoral Thesis
2014
Permanent link to this Item
Authors
Journal Title
Link to Journal
Journal ISSN
Volume Title
Publisher
Publisher
University of Cape Town
Department
Faculty
License
Series
Abstract
Introduction and objectives: Rugby union ('rugby') is a popular sport that has a high risk of injury. The sport has particular popularity in South Africa with about 500,000 players. Based on concerns about the number of rugby-related catastrophic injuries, the BokSmart nationwide injury prevention programme was launched in July 2009 by South African Rugby Union (SARU). This programme educates coaches and referees on safe techniques during a Rugby Safety Workshop (RSW). To assess real-world injury prevention efforts, researchers have suggested using the six Translating Research into Injury Prevention Practice (TRIPP) stages. Stage 1 and 2 investigate the incidence, severity and aetiology of injuries. Stage 2 investigates the aetiology of injuries. Stage 3 is the introduction of an intervention. Stage 4 is an investigation of the effectiveness of the intervention under ideal conditions. Stages 5 and 6 investigate the real-world implementation of the intervention. Thus, the objective of this thesis is to comprehensively evaluate the BokSmart programme using the TRIPP framework. Methods: TRIPP stages 1 and 2 are investigated in Chapters 2, 3, 4 and 5. Chapter 2 investigates the incidence, severity and aetiology of injuries at four competitive youth tournaments. Chapter 3 used Chapter 2's data to investigate the economic burden of these injuries. Chapter 4 investigates the incidence and severity of catastrophic injuries. Chapter 5 investigates the risk of both general and catastrophic injury specific to the scrum phase of play using the data from Chapters 2 and 4. TRIPP stages 3 and 4 were conducted by SARU and are thus outside the scope of this thesis. TRIPP stages 5 and 6 are investigated in Chapters 6, 7 and 8. Chapter 6 evaluates the effect of BokSmart in on catastrophic injury rates. Chapter 7 evaluates the effect of BokSmart on targeted player behaviours. Chapter 8 uses qualitative methods to investigate coaches and referees' perceptions of BokSmart. Results: Through TRIPP Stages 1 and 2 it was established that South Africa has comparable general and catastrophic injury rates to other countries. Senior players were at significantly (p<0.05) greater risk of suffering a catastrophic injury than younger players. The economic investigation indicated that injury rehabilitation was affected by whether the player had medical insurance or not – this may be unique to South Africa. Through TRIPP stages 5 and 6 BokSmart was associated with a reduction in catastrophic injuries in junior, but not senior players. BokSmart was also associated with a significant improvement in targeted player behaviours. Coaches' perceptions of the programme varied by socioeconomic status (SES). All coaches and referees agreed that the programme was capable of reducing catastrophic injuries in players. However, high SES coaches described difficulties in changing coach and player behaviour, while low SES coaches mentioned their lack of necessary infrastructure as barriers to adoption. There was also negativity about the delivery of BokSmart: coaches and referees felt the course was not practical enough, was too long and should not be compulsory. Conclusions: From BokSmart's perspective, the lack of effectiveness of the programme in senior players should be of concern, considering this age group's greater risk of catastrophic injury. This greater effect in juniors could be explained either by the higher number of players, or greater adoption in this age group. Future research should attempt to elucidate this reason. The barriers and suggestions described by low and high SES coaches and referees should be addressed to optimise the programme's impact. The programme should continue to be evaluated to assess the impact of these suggestions.
Description
Includes bibliographical references.
Reference:
Brown, J. 2014. Safer rugby through BokSmart? Evaluation of a nationwide injury prevention programme for rugby union in South Africa. University of Cape Town.