Rugby players from Aviva Premiership Rugby and Greene King IPA Championship are to take part in a major study led by the University of Birmingham as part of its work to develop a ground-breaking pitch-side test to diagnose concussion and brain injury.
The study, being carried out in collaboration with the Rugby Football Union (RFU), Premiership Rugby and the Rugby Players’ Association, will run throughout the 2017/18 rugby season and is the biggest of its kind to take place in the history of UK sport. It is a key element in the University of Birmingham’s research programme to create a test that can be performed rapidly pitch-side and will determine whether a player has been concussed. The study is part of the University of Birmingham’s REpetitive COncussion in Sport (RECOS) project.
The test also has the potential to assist in return to play decisions and could be used across sports, from grassroots to professional level. It is hoped it could also be used more widely by frontline medics in the NHS and military to improve diagnosis and treatment within the first critical hour after brain trauma.
The team at the University’s College of Medical and Dental Sciences, led by neurosurgeon Professor Tony Belli, has spent the last nine years carrying out research which has led to the development of a test that measures biomarkers present in the saliva and urine of players. The test, if validated, could be done on a hand-held device, which is currently under development.
Professor Belli said: “Early and accurate diagnosis of concussion is one of the biggest challenges we face clinically and is particularly a major concern in the sporting world.
“The University of Birmingham recently made a significant breakthrough after identifying molecules, which can be found in saliva and act as biomarkers to indicate whether the brain has suffered injury.
“In this exciting next study with the RFU, Premiership Rugby and the Rugby Players' Association, we will collect players’ saliva and urine pre and post-injury, which we will then test in the laboratory in order to assess the reliability of these biomarkers.
“If these biomarkers are found reliable, we can continue our work with industrial partners with the hope to have a device available within the next two years that will instantaneously diagnose concussion on the pitch-side with the same accuracy as in the laboratory - a major step forward for both sport and medicine.”
Dr Simon Kemp, RFU Chief Medical Officer, explained: “This is an important addition to the breadth of research we are undertaking into concussion and player welfare more broadly. There is currently no reliable or proven biomarker or objective test for the diagnosis of concussion and this lack of objectivity is the biggest challenge facing medical professionals in dealing with this type of injury.
“While very much an exploratory piece of research, this is a project that has the potential to make a very significant impact on the diagnosis and management of players following concussion.”
Premiership Rugby Head of Elite Performance and Player Development Corin Palmer said: “Premiership Rugby is committed to putting our clubs and players at the front and centre of what we do, and player welfare is our number one priority. This research has the potential to impact positively on the way in which we assess and manage concussion and as such we are keen to give it our full support.
“All Premiership Rugby clubs and players are already taking part in the preparatory stages of the research ahead of the new season, and we look forward to seeing the results of Professor Belli’s work.”
The Rugby Players’ Association’s Rugby Director Richard Bryan said: “The RPA Players’ Board has given its full support to this vital research study which we hope will be a significant development for the future of concussion diagnosis.
“This forms part of the RPA’s ongoing commitment to work collaboratively with the RFU and Premiership Rugby to ensure that the game continues to make advances in concussion education, research and management for the wellbeing of all players.”
Players participating in the study will provide saliva and urine samples to act as a base-line benchmark. During a match, players with confirmed or suspected concussion will provide saliva samples immediately following injury. Players will also provide follow-up saliva samples, as well as urine samples, as they go through the return to play protocol. These will be compared to the baseline benchmarks, plus those from players from the same game who did not suffer head injury, and those who had other injuries. If there are no Head Injury Assessments (HIAs) or confirmed concussions in a match, then no samples will be collected.
The study will be carried out during all Aviva Premiership and Greene King IPA Championship club competitions where the HIA is in operation and will run alongside the existing HIA off field screen that will be for a fixed period of ten minutes. This study replaces the King-Devick research project that was conducted last season. The King-Devick results are currently being analysed and the aim is to publish the findings following scientific peer review.
For further information please contact:
- Additional information about the study: Each time a player is identified with a possible, suspected or confirmed concussion during a match, he will be asked to provide samples at the following time points:
- At point of HIA 1 – during match (2ml saliva prior to being removed/returning to field of play)
- At point of HIA 2 – post match (2ml saliva and a urine sample)
- At point of HIA 3 – 36-48hrs post-match (2ml saliva and a urine sample)
- Finish graduated return to play protocol (final 2ml saliva and urine sample)
- The study is being funded by the British Medical Association, National Institute for Health Research, the Ministry of Defence, the Medical Research Council and the Rugby Football Union.
- Research by the University of Birmingham, published in July 2017 in the Journal of Neurotrauma, identified biomarkers, known as microRNAs, as novel early biomarkers of Traumatic Brain Injury (TBI). (Di Pietro et al. (2017). ‘MicroRNAs as Novel Biomarkers for the Diagnosis and Prognosis of Mild and Severe Traumatic Brain Injury’.) Read the paper here.
- About the University of Birmingham: The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 5,000 international students from over 150 countries.
- About the Rugby Football Union: The Rugby Football Union is the National Governing Body for rugby union in England and supports participants and fans from the grassroots to the national team. For more information, visit www.englandrugby.com
- About Premiership Rugby Limited: Premiership Rugby is the organisation which manages the top league in English club rugby – Aviva Premiership Rugby. It acts for its shareholder clubs in all major commercial and strategic negotiations with media and sponsorship partners of the league, as well as with other rugby governing bodies. Premiership Rugby is also responsible for key areas of governance of the top flight competitions, including the Salary Cap Framework, Minimum Standards Criteria and Code of Conduct, as well as managing the Aviva Premiership Rugby competition, the Singha Premiership Rugby 7s and the Anglo-Welsh Cup, all of which are televised live exclusively by BT Sport.
- About the Rugby Players’ Association: The Rugby Players' Association looks after the collective welfare interest of the 700 current male and female RPA members in England, as well as over 400 former players.