QATAR ORTOPAEDIC AND SPORTS MEDICINE HOSPITAL: Aspetar experts emphasise the role of healthcare providers in managing concussion for athletes on and off the pitch

Source: Qatar Orthopaedic and Sports Medicine Hospital

Qatar Orthopaedic and Sports Medicine Hospital issued the following announcement on May 8.

Last week several leading healthcare providers from around the country met at Aspetar, Qatar’s orthopaedic and sports medicine hospital, for a workshop to discuss the challenges they face and recommended approaches when identifying and treating concussion injuries among players in various sports, particularly football, handball and athletics.

When dealing with a concussion injury during a match or event, healthcare providers can sometimes face pressure and even scrutiny from team managers and athletes themselves, if they request that a star player be taken off a match or if they prevent an athlete who is yet to make full recovery from returning to play in time for an important event.

Realising the severity of concussion injuries and the potential short and long-term consequences, organisations, federations and leagues such as the National Football League (NFL) in the United States have put in place legal protocols and procedures that enable healthcare providers to take a player off the pitch immediately if they have major concerns. As the result of such steps, it is now a criminal offence in the US should a coach or doctor in the NFL not follow the League’s concussion policy.

Yet that is not the case in all sports. In Association Football for example, the guidelines are less clear-cut. There is no unified approach to take when a member of the medical staff spots a concussion injury. Sometimes coaches or players themselves can interfere and refuse to stop playing. Argentinian football player Javier Mascherano for example refused to be taken off and was allowed to return immediately to the game, despite sustaining an apparent head injury during the 2014 World Cup Brazil™ semi-finals, sparking controversy.

The workshop drew on the expertise of Aspetar’s staff in the field of sports medicine in covering a range of concussion-related topics and the implications for athletes in Qatar specifically, as well as around the world. Most of the approaches and protocols discussed related to those developed at the Fifth International Conference on Concussion in Sport held in Berlin in 2016. Discussion focused on players’ autonomy, shared decision making, the effects of match schedules on players’ recovery as well as the ethical and legal issues surrounding the treatment of concussion.

Speaking on the side-lines of the workshops, Dr. Louis Holtzhausen, a Sports Medicine Physician at Aspetar with more than 25 years of experience treating players in athletics, rugby, cricket, hockey and the South African Olympic team, said: “First of all, concussion is a brain injury with potentially very serious short and long term implications. It is sometimes called the ‘hidden injury’ because patients don’t bleed or limp, so we can’t physically see the symptoms, making it very difficult to diagnose even for a doctor. That’s why a very important part of this concussion programme is to make people aware and educate them about recognising concussion symptoms more generally. This includes the general public.”

“Concussion also affects performance, which is something players and coaches need to be aware of. A team’s star player will not be a star player on the day if he’s concussed. They will be off balance or their reaction time might be slower, and that might mean the difference between winning and losing a match. Everyone fights to get them back on the field, but if we get them back on the field and they’re not ready, they will be useless.”

It’s understandable, no player wants to be taken off. He feels a little bit shaken but he thinks he’s okay and he doesn’t really know that he’s off balance. So that is why the key thing is to educate them about the seriousness of a concussion injury. At the end of the day, the doctor is trying to protect them.”

“Of course, there should also be support from the relevant sports federations as well. As far as I’m concerned, if there’s not a policy in place, none of this would work.”

Commenting on Aspetar’s second concussion workshop, Dr. Holtzhausen added:

“This second workshop builds on the knowledge we developed during the first workshop we organised which took place back in November 2017. After the first workshop, we had discussions with team doctors and various parties, and identified a few gaps in knowledge and recommended approaches to assist them. So today we came and presented an updated concussion programme that is specially customised to Qatar for them to use.”

Our first target audience was from the medical staff at Aspetar’s National Sports Medicine Programme (NSMP) and ambulance staff because they play a crucial role and are very often the first ones on the pitch in the event of an injury. This time, we increased our target pool and invited sports physicians, physiotherapists, medical consultants and doctors from Hamad Medical Corporation (HMC) because we refer to them. So, if they can follow the same protocol as us, then patient care generally will be better.”

“Once we’ve covered all team doctors from Aspetar and other hospitals in Qatar, our next step is to roll out a public awareness campaign that is suitable for general practitioners, physiotherapists in the chiropractic field as well as public health practitioners.

“Then we will also start developing specialised lectures and workshops like advanced concussion care where we will include neurologists, neurosurgeons, radiologists and advanced neuropsychology.”

One of the most important aims of this programme is to prepare for the 2022 FIFA World Cup Qatar™, because that will make up an essential part of the medical care so we don’t encounter the same issues as in previous tournaments.”

As far as we know, there isn’t any sports-related concussion programme anywhere in the GCC or the Middle East. So one of the most important contributions we’ll make at Aspetar will be in the field of intercultural concussion management. Currently, we are working with language experts from Qatar University and Weill Cornell Medicine-Qatar (WCM-Q) to culturally adapt the existing protocols and translate them into Arabic. Then we need to validate the translation scientifically by the relevant scientific and medical entities so it becomes a valid tool. Once we have it, it will be the first Arabic translation of the concussion management tool, making a massive contribution to sports science.

“Furthermore, we’re also looking at how different cultures perceive various symptoms. There has only been one study done in Canada that looks at this aspect, which compares baseline health scores of people from different backgrounds in Africa, Europe and the Middle East. This identified significant differences in how people interpret these symptoms and why.”

“If the healthcare provider administering this test doesn’t understand the cultural boundaries, they might get the symptoms totally wrong. Thanks to Qatar’s wonderfully diverse population, we are planning to recreate the study here and see how healthy people interpret concussion symptoms to provide some guidance on how to interpret results better. Findings from that study will also be unprecedented so it’ll also make a valuable contribution to the scientific field of concussion management.”

The workshop was organised by the Aspetar Sport Related Concussion Programme – a comprehensive concussion management programme offering evidence-based concussion care for athletes everywhere, particularly locally. Aspetar collaborates with the Concussion in Sport Group (CiSG), the authors of the consensus statement and the Sport Concussion Assessment Tool (SCAT), as well as with UK-based Elite Sport Concussion Multi-Disciplinary Team (MDT) Clinic at the Institute for Sport, Exercise and Health (ISEH), and Weill-Cornell Medical College in Qatar.

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Qatar Orthopaedic and Sports Medicine Hospital

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