Concussion recovery time, return-to-play protocols, and mandated sit-out periods among adult amateur contact field sports: A systematic review.

BACKGROUND

Field-based contact sports, including American football and rugby are among those with the highest sport-related concussion (SRC) rates. Regarding SRC treatment, gradual return-to-play (RTP) protocols are commonly used, however variability in RTP protocols between sporting bodies and scholastic institutions makes accurately interpreting published SRC severity data difficult.

AIMS: Compare SRC recovery times, RTP protocols, and mandated sit-out period duration among adult amateur contact field sports.

METHODS

MEDLINE, CINAHL Complete, SPORTDiscus, APA PsycInfo, and APA PsycArticles were searched on May 13th, 2024. Eligibility criteria included (1) published in English in a peer-reviewed journal from 2015 to 2024, (2) adult population, (3) amateur, field-based contact sport athlete population, (4) diagnosed and/or suspected SRC, and (5) recovery time (days/weeks) data available.

RESULTS

19/6085 (< 1%) studies comprising 58 datasets met all inclusion criteria. The studies comprised American football (10/19, 52.6%), field-hockey (5/19, 26.3%), lacrosse (9/19, 47.4%), ladies gaelic football (1/19, 5.3%), rugby (8/19, 42.1%), soccer (10/19, 52.6%), and sprint football (1/19, 5.2%). Mandated sit-out periods ranged from 0 to 21 days across sports, and RTP protocol durations ranged from 5 to 21 days. The most common RTP protocol duration was 7 days (n = 31/58), and mandated sit-out period was no same-day return (n = 25/58). Field hockey had the longest reported SRC recovery duration (34 days), and rugby had the longest mandated sit-out period (21 days).

CONCLUSION

Recovery time following concussion in contact sports should be interpreted in light of sport type, mandated sit-out policies, and RTP protocols. Empirical evidence should drive decisions in RTP protocols and sit-out periods, which are currently inconsistent between sports.