Recommendations for policy development regarding sport-related concussion prevention and management in Canada Pierre Frémont, 1 Lindsay Bradley, 2 Charles H Tator, 3,4 Jill Skinner, 5 Lisa K Fischer, 6 from the Canadian Concussion Collaborative 1 Department of Rehabilitation, Faculty of Medicine, Laval University, Québec, Canada 2 Carleton University Sport Medicine Centre, Ottawa, Ontario, Canada 3 Division of Neurosurgery, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada 4 Canadian Sports Concussion Project, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada 5 Department of Public Health, Canadian Medical Association, Ottawa, Canada 6 Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada Correspondence to Dr Pierre Frémont, Department of Rehabilitation, Faculty of Medicine, Laval University, 2875 Boulevard Laurier, Québec, Québec, Canada G1V 2M2; pierre.fremont@fmed.ulaval.ca Accepted 17 June 2014 To cite: Frémont P, Bradley L, Tator CH, et al. Br J Sports Med Published Online First: [ please include Day Month Year] doi:10.1136/bjsports-2014- 093961 ABSTRACT The Canadian Concussion Collaborative (CCC) is composed of health-related organisations concerned with the recognition, treatment and management of concussion. Its mission is to create synergy between organisations concerned with concussion to improve education and implementation of best practices for the prevention and management of concussions. Each of the organisations that constitute the CCC has endorsed two recommendations that address the need for relevant authorities to develop policies about concussion management in sports. The recommendations were developed to support advocacy for regulations, policies or legislation to improve concussion prevention and management at all levels of sport. INTRODUCTION Concussion in sport is a recognised public health problem. International experts meet on a periodic basis to update clinical recommendations about concussion management in sports based on the best available evidence. The past two international con- sensus conferences stated that “all athletes, regard- less of the level of participation, should be managed using the same treatment and return to play (RTP) paradigm.” 1 2 However, reaching that objective at the level of mass participation remains a challenge for the sport, academic and healthcare communities in Canada and around the world. The organisations that constitute the Canadian Concussion Collaborative (CCC) 3 support the recommendations of the International Consensus Conference on Concussion in Sport, 2 and therefore the aim of this document is not to review the body of knowledge related to concussion management in sports. Rather, the objective of this document is to make recommendations regarding the need for relevant authorities to develop policies about con- cussion management in sports. The recommenda- tions can be used to advocate for regulations, policies or legislation to improve concussion pre- vention and management at all levels of sport. BARRIERS TO IMPLEMENTATION OF BEST PRACTICES FOR CONCUSSION MANAGEMENT For a number of years, several Canadian organisa- tions invested significant efforts towards the important objective of knowledge translation and dissemination about concussion to diverse target populations including healthcare providers, ath- letes, coaches, teachers, parents and sport organisa- tions. Although such efforts have most likely increased the general awareness, knowledge and attitudes about concussion, successful knowledge implementation requires more than dissemination of knowledge. In other words, improving knowl- edge about concussion is necessary for implementa- tion, but it does not ensure that each individual involved in sport has access to optimal preventive approaches, nor that, in the event of a concussion, they will have access to proper care. The applica- tion of the knowledge-to-action framework to con- cussion 4 tells us that, among a number of characteristics, knowledge transfer should be user- specific, context-specific, impact-oriented and an interdisciplinary process. Accordingly, for the effi- cient implementation of proper concussion preven- tion and management at all levels of participation, user-specific, context-specific and impact-oriented processes (or protocols) should be required when sports or events carry a risk of concussion. RECOMMENDATIONS Recommendation 1: Organisations responsible for operating, regulating or planning sport and sport- ing events with a risk of concussion should be required to develop/adapt and implement a concus- sion management protocol, based on current best practices, that is customised for their context and available resources. Sport-organising bodies including school-based and non-school-based, amateur and professional, should analyse not only the recommendations about concussion management but also how these recommendations can be implemented in their spe- cific context. For example, the implementation of recommendations related to cognitive rest and return to school/learning will need the involvement of academic resources to identify the optimal ways to achieve academic accommodations following a concussion. Likewise, obtaining medical clearance before return to unrestricted (collision or contact) training/practice will raise the issue of timely access to the relevant medical expertise. A required process of protocol development will not only have great implicit educational value for all the relevant organisations, but will also help identify context- specific issues that will lead to innovative and con- textualised solutions for better concussion preven- tion and management. This recommendation implies the development of regulations or legisla- tion by national, provincial and territorial regulat- ing bodies for amateur and professional sport, public health organisations and governments to define these responsibilities. The process for Frémont P, et al. Br J Sports Med 2014;0:1–2. doi:10.1136/bjsports-2014-093961 1 Occasional piece BJSM Online First, published on July 12, 2014 as 10.1136/bjsports-2014-093961 Copyright Article author (or their employer) 2014. 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