Research pertaining to the experiences of women in rugby is scarce, which, coupled with the limited visibility of the sport and difficulty accessing resources, suggest that women’s rugby remains undervalued. Indeed, evidence of such gender inequalities remains largely anecdotal, with little rigorous research undertaken to understand the perspectives of women in rugby. This study aimed to explore the experiences of a diverse cohort of rugby players in relation to their participation in the sport and their ability to access resources. Twenty UK-based rugby players (10 men, 9 women and 1 non-binary person aged 29.1 ± 8.3 years) from school, university, club, military, and semi-professional environments, volunteered to participate in semi-structured interviews (36 ± 12 minutes) discussing their rugby experiences in relation to their gender and playing level. Interviews were transcribed verbatim, and a reflexive thematic analysis was undertaken. A widespread under-prioritisation of women in rugby was highlighted. Gender biases were apparent in access to changing rooms, pitches, quality coaches, and playing opportunities, and were reportedly propagated at the managerial level. Irrespective of gender, some amateur players reported difficulty accessing a suitable rugby environment. Insufficient player numbers precluded the formation of second teams, often resulting in inexperienced players competing beyond their ability. Women’s rugby players experienced considerable gender bias. This exploratory study highlights a need to address such issues to protect player welfare. Interventions to change the culture in rugby clubs and increased representation of women in managerial positions in rugby are recommended to enact meaningful change.

Background: Stroke has high mortality. Challenges in providing end-of-life care include uncertainty among healthcare professionals about when to start care. While generic tools and guidelines exist, which outline components of quality end-of life care, they may not fully address stroke’s unpredictable trajectories, complicating care planning. Objective: To enhance understanding of end-of-life care post-stroke. Methods: We undertook an explanatory sequential mixed methods approach, including a cross-sectional survey and semi-structured interviews. All 286 United Kingdom (UK) National Health Service (NHS) hospitals providing inpatient stroke care were approached for participation in an on-line cross-sectional survey. The survey of healthcare professionals from UK stroke units was used to map current stroke end-of-life care and models of care. Fourteen staff who completed the survey and agreed to a future interview were purposively selected. The semi-structured interviews with healthcare professionals involved in delivering end-of-life care post-stroke were conducted and interpreted using the Theoretical Domains Framework. We aimed to enhance our understanding of the experiences, expectations, challenges and barriers in providing end-of-life care post-stroke, including effective clinical decision-making. Results: Across 108 responding survey sites, 317 responses were received. Results showed a lack of structured tools and approaches, an absence of stroke-specific guidance and variable delivery of end-of-life care post-stroke. Thirteen staff (nurses, occupational therapists, medical stroke consultants, and a speech and language therapist) agreed to be interviewed. The data provided a fuller understanding of the context within which end-of-life care post-stroke is delivered. The varied challenges faced include: uncertain prognosis, complex decision-making process, varying skill levels, staffing levels, the hospital environment, emotional strain on both families and staff, inequitable access to specialist palliative care, and difficulties associated with different models of care (stroke service structures and cultural context). Conclusions: Provision of end-of-life care post-stroke is complex, challenging, uncertain, and inconsistent. There is limited evidence or guidance to support healthcare professionals. There is a need for implementation support, which includes education, to better enable quality and more consistent end-of-life care post-stroke. Further research is required to assess interventions that can support end-of-life care post-stroke to aid clinicians in providing quality palliative care for stroke patients.

Numerous concussion-management protocols have been developed in rugby, though little is known about player’s personal experiences of concussion. Specifically, research typically refers to clinical recovery, with social and psychological sequelae post-concussion gaining little attention. This study aimed to explore the experiences of rugby players in relation to being concussed and recovering from concussion. UK-based rugby players (10 men, 9 women and 1 non-binary person) from school, university, club, military and semi-professional teams took part in semi-structured interviews (36 ± 12 minutes). Interviews were transcribed verbatim, and a reflexive thematic analysis was conducted. Players considered pitch-side healthcare a necessity, though amateur players highlighted the difficulty in consistently accessing this resource. In the absence of medical staff, players were reliant on the goodwill of volunteers, but their response to concussion did not always align with current concussion guidance. Players highlighted that concussion recovery could be socially isolating and that current return-to-play programmes did little to restore lost confidence, resulting in retirement from the game in some instances. Participants expressed a desire for more in-person concussion education and for greater coverage of holistic methods to support their recovery. This study highlights a need for further investigation of the post-concussion social and psychological changes that players may experience during their recovery. Greater focus on information relating to concussion recovery and return-to-contact in education programmes would likely benefit player welfare.

Cervical muscle strength has been demonstrated to reduce concussion risk in high school athletes, and interventions to improve this in male rugby players have elicited strength improvements. However, the feasibility of introducing neck-strengthening interventions into women's rugby has not been investigated. This study sought to pilot a neck-strength intervention in university-level women's rugby players. A fixed-frame dynamometer was used to assess the multi-directional isometric neck-strength of 14 university women's rugby players (20.3 +/- 1.0 years). Between baseline and end-of-season testing, a neck-strengthening program was completed. Interviews were conducted with six players and two coaches to understand program engagement. Interviews were transcribed verbatim and processed via inductive content analysis. Increases in absolute neck-strength post-intervention in left and right lateral flexion (left 85.4 +/- 29.7 N to 108.2 +/- 41.6 N, p = 0.02, right 87.4 +/- 33.3 N to 110.5 +/- 40.3 N, p = 0.01) and flexion (128.4 +/- 28.8 N to 147.9 +/- 30.5 N, p = 0.01) were perceived positively by the players although there were suggestions that greater adaptability according to training age and more variety was required. Participants initially demonstrated limited awareness of neck-strength training but engaged well with the exercises once the potential benefits were understood. This intervention shows promise as an effective, palatable strategy to improve neck-strength in university women's rugby players. Further research is needed to establish whether such improvements in neck-strength are associated with meaningful reductions in head impact occurrence. Neck-strength training has proved an effective strategy for reducing concussion incidence in high-school and elite male populations but is yet to be investigated in females. A neck-strengthening intervention was introduced in a team of university women's rugby players, who were later interviewed to understand their experiences of the intervention. Multi-directional neck-strength was tested via an Isometric Neck-Strength Testing Apparatus, purpose-built to mimic the scrum position associated with rugby. Improvements to neck-strength reached significance in flexion and lateral flexion strength, and the intervention was received positively by players and coaches.

Women are increasingly participating in rugby, a full-contact team sport. This contact acts as a source of exposure to repeated head-acceleration events and concussion, yet strategies to reduce this exposure, or improve concussion management are often developed from male/men’s data. This is despite the numerous sex-and-gender differences that limit the generalisability of male/men’s data and resultantly, the efficacy of subsequently developed interventions. Therefore, this thesis explored the biomechanical, and sociological factors that may influence how women’s rugby players are exposed to head-acceleration events, and how concussions are managed. Study One analysed video footage of two playing levels of university women’s rugby to identify relationships between tackle technique and exposure to head-impact events (HIEs). Players who did not maintain neck positioning during landing, or landed supine were significantly more likely to experience a head-to-ground HIE, or HIE, respectively. Studies Two and Three contextualised the findings of Study One, through the qualitative investigation of player’s concussion history, resource access, and rugby-playing experience. Concussion misconceptions were identified and players expressed a desire for further information pertaining to concussion recovery. Women were less able to access resources than men and were negatively impacted by preconceptions of their playing ability and belonging in the sport. Study Four investigated the feasibility of introducing a neck-strengthening intervention to a university women’s rugby team. Neck-strength improvements were elicited, and stakeholder interviews provided feedback from which future interventions could be improved. This thesis has contributed novel findings to the literature, providing insights that can inform future strategies to minimise head-acceleration event exposure and improve concussion management. Strategies to reduce head-to-ground HIE and address the endemic sexism in rugby should be considered an area of research priority to protect player welfare.

INPLASY202570003 Visual Search Post-Stroke: a Protocol for the Scoping Review of Associated Research Foci and Gaps Keywords: Haemorrhagic Stroke; Intra-cerebral Haemorrhage; Visual neglect; Visual …