Impact case study database

Injury surveillance research conducted by Moore and Ranson for the International Cricket Council (ICC), World Rugby (WR), England and Wales Cricket Board (ECB) and Welsh Rugby Union (WRU) has had significant impact on the identification and prevention of head injuries in cricket and rugby union, nationally and internationally. In relation to cricket, injury surveillance research by Ranson that revealed deficiencies in helmet design resulted in the ICC commissioning a helmet safety project. Led by Ranson, the project involved the ECB, player associations, helmet manufacturers, standards testing houses and academic institutions [E1]. Based on Ranson’s research and the project findings, a British Standards Institute panel published a new British Standard for Head Protectors in Cricket (BS7928:2013) [E2]. The deficits identified in the underpinning research were used to create the new testing protocol for cricket helmets, which includes a facial contact projectile test to ensure helmets must be able to withstand a cricket ball being directed at specific areas. The new British Standard came into effect on July 1^st 2014. The ECB and Professional Cricketers Association began producing helmets that met the new British Standard in 2014 [E3]. On February 1^st 2017 the ICC’s Helmets/Head Protectors Rules and Regulations were revised, stipulating that all helmets worn during any format of international cricket matches played by all member and associate nations (n=104) must comply with the new British Standards [E3]. All major helmet manufactures now make helmets that meet the new standard (with a full list of compliant models available on the ICC’s website [E3]) and all international cricketers who wear helmets are now required to wear the new standard helmet. Cricket Australia have updated their equipment regulations to state that the new British Standard must be worn by all individuals playing cricket in Australia (n=~1.65 million), from junior and community levels through to professional and international levels [E4]. To date, no fatal head injuries associated with wearing new standard helmets have been recorded, with the last death recorded in 2014 before the British Standard was adopted by the ICC [E5].

The head injury research also resulted in funding from the ICC and ECB to revise their respective injury surveillance programmes, and the Injury Surveillance consensus methods to include a medical attention definition and updated calculations. This revised definition is currently being used to identify injury problems that were previously unreported, such as throwing arm pain. Further funding was provided by the ECB, in addition to a fully funded PhD project (2015) to evaluate reported injury rates, usage of the Injury Surveillance system and implementation of the revised methods. The associated research also contributed to the first International Olympic Committee consensus statement on conducting injury epidemiology in sports [E6].

As a direct result of Ranson’s surveillance research in cricket, the first injury surveillance programme in Welsh rugby union was fully implemented in late 2013 at National (men’s senior, men’s sevens, men’s U20s, women’s senior and women’s sevens) and Club (all 4 professional teams in Wales) level (n= **~**350 players)[E7]. The system was also adopted by the British and Irish Lions at the end of 2013. The findings of subsequent research led to the development of the WRU Concussion Education Programme, which aims to safeguard the on-field identification and subsequent management of head injuries in rugby [E8]. Since the inception of the programme, which has been mandatory for players, coaches, referees and medical practitioners since 2014, reported concussion rates have risen by 65% from 12.9 to 21.3 injuries per 1000 match hours [R5] and the management of all reported concussions has adhered to the WRU’s graduated concussion return to play protocol. To date, over 550 players, coaches, team managers and referees have attended one of the courses that have been delivered by medical practitioners within Wales over the last 6 years. Over 150 European club and International level games, including the Rugby World Cup Final in 2015 and Semi-final in 2019, were officiated by referees educated through the concussion education programme.

In 2015, Ranson and Moore received £90K from the WRU to evaluate the impact of the Concussion Education Programme and concussion risk factors (e.g., cervical and shoulder strength, and playing surface) on reported concussions in professional Welsh rugby. As a result of this evaluation and continued investment (£130K; 2018), the courses and programme have been regularly updated to reflect emerging research evidence. National press coverage of Moore’s work has also increased the awareness of concussion across key stakeholders (players, coaches, medical staff) [E9]. In 2015, £38K from World Rugby and a Data Science Award from Microsoft Azure ($20K US), enabled Moore and Ranson to provide normative injury rates for international rugby and assess subsequent injury risk following concussion, which led to the development of a free, online bespoke software tool that can be accessed by any sport to predict concussion and quantify subsequent injury risk following concussion (released 2020). Finally, as a result of the injury surveillance research and work with Welsh rugby, Moore has been commissioned by the Guinness PRO14 Rugby Union league to develop the first multi-continent injury surveillance system in rugby union (2019; £45k funding received) [E7]. In sum, collectively the research in rugby has had a direct impact on player welfare by improving coach, medical staff, referee and player concussion management knowledge.