Kathryn J. Schneider

Adolescent girls rugby (ages 10–19) is growing in Canada and globally (World Rugby, 2022). As participation increases, so too does risk of injury, including concussion, which is common and conseque...

Concussion is a common sport injury with serious health implications [1–3]. Managing the return-to-play (RTP) process after concussion is essential, as premature RTP may lead to repeat injury [4–6]...

This investigation assessed the neurovascular coupling response through integrated assessments of neuronal function [electroencephalography (EEG)], microvascular oxygenation concentrations [functional near-infrared spectroscopy (fNIRS)], and arterial responses [transcranial Doppler ultrasound (TCD)]. The NVC response was assessed in 113 participants (86 females, aged 19–40 years) during visual (“Where’s Waldo?”) and motor (finger tapping) tasks. Block-averaged, time–frequency power was computed from the EEG data, while hemodynamic response functions were obtained from the fNIRS and TCD metrics. Granger causality assessed the predictiveness between EEG-fNIRS-TCD waveforms for each participant and was converted into a percentage of individuals displaying a significant value. Linear models were computed to determine the influence of sex, concussion history, young adulthood age, cardiorespiratory fitness, and mental health/learning disabilities on NVC parameters. During the initial 10 s of task onset, unidirectional predictiveness was weak to very strong for EEG-TCD (range: 47–83%) and fNIRS-TCD (44–92%) relationships; however, very weak to weak predictiveness was seen for the E0EG-fNIRS (0–29%) relationship for both tasks. Aside from known sex-, age-, and fitness-based influences on baseline/peak hemodynamic values (p < 0.050), the addition of concussion history and mental health/learning disabilities had minimal influence on NVC responses (p > 0.050). The findings demonstrated a unidirectional feedforward mechanism from the neuronal and microvasculature to the upstream arteries during task onset.

Background: Return-to-play guidelines for concussion recommend a multimodal approach to assess recovery, symptoms, exertion tolerance, and cognition. However, existing assessments do not reflect the speed or complexity of multidomain skill integration in sport. We developed R2Play , a dynamic multidomain return-to-play assessment tool, and previously established proof of concept by demonstrating design objectives alignment. Objective: We aim to (1) assess the feasibility of R2Play according to usability, reliability, practicality, and safety; (2) examine physical exertion levels during R2Play as a preliminary marker of face validity; and (3) understand clinician and youth perspectives on the feasibility, face validity, potential value, and challenges associated with R2Play . Methods: A convergent parallel mixed methods design was used. Rehabilitation clinicians were paired with youth cleared to return-to-play postconcussion to complete R2Play together and provide feedback through semistructured interviews. Feasibility was assessed on predefined criteria for usability (clinician ratings on System Usability Scale), practicality (assessment duration), reliability (technical issues), and safety (adverse events). Face validity was evaluated with a target of youth achieving ≥80% of age-predicted maximal heart rate or rating of perceived exertion ≥7/10. Interviews explored perspectives on feasibility and face validity, analyzed using content analysis. Quantitative and qualitative results were merged via joint display to identify areas of convergence, divergence, and complementarity. Results: Participants included 10 youth (ages 13‐20 y) with a history of concussion and 5 clinicians (n=2 physiotherapists, n=2 occupational therapists, and n=1 kinesiologist). Success criteria were met or approached for all feasibility domains. Clinician-rated usability was good-to-excellent (System Usability Scale=84.00±6.02), and youth reported that instructions were easy to learn. There were no catastrophic technical or user errors interrupting assessments. Configuration was completed in 5.74 (SD 1.09) minutes, and assessments took 26.50±6.02 minutes. There were no safety or symptom exacerbation incidents requiring assessment modification. R2Play elicited vigorous intensity physical exertion (peak heart rate=90.10±5.78% age-predicted maximal heart rate, peak rating of perceived exertion=5.50±1.72), with target exertion criteria met for 9/10 youth. Clinician and youth feedback confirmed that R2Play reflects elements of sport across physical, cognitive, and perceptual domains, making it a valuable tool for assessing readiness to return-to-play and informing rehabilitation planning for unresolved issues. Mixed methods meta-inferences provided enhanced insights regarding how to improve the usability, practicality, safety, and face validity of R2Play . Conclusions: Findings support the potential feasibility and face validity of R2Play , a multidomain assessment tool for youth with concussion, demonstrating excellent usability, vigorous physical exertion demands, and promising feedback regarding its potential to fill gaps in the return-to-play process among this initial sample from a single site. Future work is underway to establish the cross-site feasibility of R2Play and evaluate its content validity by establishing the physical, cognitive, and perceptual loading of assessment levels.

Female, woman and/or girl athletes’ sport participation rates are rising and associated with high injury rates and burden. Using best-practice consensus methodology, we developed recommendations to guide injury prevention for female/woman/girl athletes. The Female/woman/girl Athlete Injury pRevention ( FAIR ) International Olympic Committee Consensus meeting was held from 31 March to 2 April 2025 (Lausanne, Switzerland). The FAIR Consensus followed an eight-step hybrid method. 109 authors from six continents conducted: (1) systematic reviews synthesising evidence on injury prevention strategies and modifiable risk factors for lower-extremity and upper-extremity injuries, concussions and spine/chest/abdominal/pelvic injuries/pain, (2) a scoping review synthesising dissemination and implementation (D&I) approaches; and (3) a concept mapping project generating knowledge on gender/sex-related factors for injury prevention. These projects underpinned draft recommendations subsequently voted on by a steering committee (n=24) and an external advisory committee chair over two anonymous survey rounds. Recommendations, Round 1 voting results and suggestions/dissenting comments were discussed between Round 1 and 2 voting. Consensus was defined as ‘critical to include’ (≥70% scored recommendation as 7–9 (9-point Likert scale, 1=not important; 9=critically important) AND ≤15% scored recommendation as 1–3). The 56 FAIR recommendations address: primary injury prevention (n=16) (policy/rules/laws=6; personal protective equipment=8; training=2); secondary injury prevention (n=4); modifiable risk factors (n=12); approaches to D&I (n=14); and promoting gender/sex-supportive environments (n=10). The FAIR Consensus informs evidence-based best practices and policy for injury prevention, approaches to implementation and creation of supportive environments for female/woman/girl athletes. Every person at all levels of sport can, and should, take responsibility for actions that positively influence female/woman/girl athlete health and safety.

Objective To examine prevention strategies and potential modifiable risk factors (MRFs) for sport-related concussion (SRC) and head impact/head acceleration event (HAE) outcomes in female, woman and/or girl athletes. Design Systematic review with meta-analyses and Grading of Recommendations, Assessment, Development and Evaluation. Data sources Medline, CINAHL, PsycINfo, SportDiscus, ERIC, CENTRAL and CDSR. Eligibility Primary data studies with comparison group(s) assessing the association of prevention interventions and/or MRFs for SRC or HAE with ≥1 female/woman/girl in each study group. Results Of the 108 included studies, 67 evaluated a SRC prevention strategy (equipment n=25, policy/rule n=21, training n=10, management n=11) and 41 evaluated potential MRFs (34 distinct MRFs across nine categories). In total, 40/108 (37%) studies (prevention 19/67; MRF 21/41) included female/woman/girl-specific estimates. Three meta-analyses were conducted: two SRC prevention strategies (headgear, eyewear) and one MRF (artificial turf vs grass) based on availability of female/woman/girl-only estimates and similar outcomes and exposure. Headgear was associated with 30% lower SRC rates in adolescent female/girl lacrosse and soccer (IRR=0.70, 95% CI 0.50 to 0.99; very-low certainty). Eyewear use was not protective for SRC (IRR=1.08, 95% CI 0.69 to 1.68; very-low certainty). SRC rates did not differ by artificial turf versus grass (IRR=0.95, 95% CI 0.62 to 1.45; very-low certainty). Conclusion We found limited evidence for prevention strategies and MRFs in female/woman/girl athletes except for very-low certainty evidence supporting headgear use in adolescent lacrosse and soccer. Future studies should consider the design, implementation and evaluation of SRC prevention strategies that target MRFs to guide safe practice recommendations specifically for female/woman/girl athletes.

Objective: Investigate prevention interventions and potential modifiable risk factors (MRFs) for female/woman/girl athletes’ spine, chest, abdominal or pelvic injury and/or pain. Design: Systematic review with meta-analyses, semiquantitative analyses and Grading of Recommendations Assessment, Development and Evaluation. Data sources: MEDLINE, CINAHL, APA PsycINFO, CDSR, CENTRAL, SPORTDiscus, EMBASE, ERIC. Eligibility: Primary data studies with comparison group(s) assessing the association of prevention interventions and/or MRFs for spine, chest, abdominal and/or pelvic injury/pain with ≥1 female/woman/girl athlete in each study group. Results: Across 105 studies (n=11 interventions, n=92 MRFs, n=2 both, n=35 female/woman/girl-specific estimates) including 59 833 participants (23.7% females/women/girls) 9 injury/pain outcomes were assessed (n=74 low-back, n=14 back, n=13 neck, n=5 pelvis, n=3 thoracic, n=3 abdominal, n=3 trunk, n=2 rib, n=1 breast). Three prevention strategies (exercise, equipment, rule-change) and 22 MRFs were identified. High risk of confounding bias (Downs and Black quality assessment tool) was present in 92% and 63% of intervention and MRF studies, respectively. Considering female/woman/girl estimates, we performed meta-analyses (standardised mean-difference) on 4 MRFs (body mass, body mass index (BMI), weekly training hours, spinal flexion) for low-back pain (LBP) and semiquantitative analyses for one intervention (exercise), and 3 MRFs (yearly training load, hip motion, hip strength) for LBP. Very low-certainty evidence suggests no difference in body mass (g=0.28, 95% CI −0.06 to 0.62; I ² =67.7%), BMI (g=0.22, 95% CI −0.25 to 0.69; I ² =68.2%), weekly training hours (g=0.15, 95% CI −0.29 to 0.58; I ² =45.6%) or spinal flexion (g=0.27, 95% CI −0.23 to 0.76; I ² =40.4%) between female/women/girls athletes with and without LBP. Conclusions: There is limited knowledge about prevention interventions or MRFs for female/women/girl athletes’ spine, chest, abdominal and/or pelvic injury/pain. PROSPERO registration number: CRD42024479654.