SUMMARY: Legislation/regulation is an effective strategy to prevent and manage neurological injuries (including concussion).

The recent article of Gibson and colleagues ¹ in JAMA paediatrics indicates that legislation can be effective in improving concussion management in children. Similarly, Cusimano et al. ² concluded that there is more evidence to support wide-spread mandatory interventions (form of legislation/regulation) than protective equipment for the prevention of rugby-related neurological symptoms. This success could be related to the fact that some form of behaviour change is required if an intervention is to reduce injuries ³. Also, the advantage of legislation is that its effects are not dependent on a specific coach or player ⁴.

In combination, these two articles would suggest that nationwide prevention programmes such as RugbySmart or BokSmart are useful interventions for preventing and managing rugby-related neurological injuries.

References:

1. Gibson TB, Herring SA, Kutcher JS, Broglio SP. Analyzing the Effect of State Legislation on Health Care Utilization for Children With Concussion. JAMA Pediatr. 2014 Dec 22.
2. Cusimano MD, Nassiri F, Chang Y. The Effectiveness of Interventions to Reduce Neurological Injuries in Rugby Union: A Systematic Review. Neurosurgery. 2010 Nov;67(5):1404–18.
3. Gielen AC. Application of Behavior-Change Theories and Methods to Injury Prevention. Epidemiol Rev. 2003 Aug 1;25(1):65–76.
4. Benson BW, MCINTOSH AS, Maddocks D, Herring SA, Raftery M, Dvorák J. What are the most effective risk-reduction strategies in sport concussion? Br J Sports Med. 2013 Apr;47(5):321–6.