Background Persistent post-concussion symptoms (pPCS) affect one-third of individuals following mild traumatic brain injury (mTBI), yet interdisciplinary treatment is difficult to access in non-metropolitan areas of Australia. Telehealth-delivered interdisciplinary concussion care may improve equity of access; however, the feasibility and efficacy of this approach are unknown. Objectives We adapted our previously piloted in-person treatment, Interdisciplinary Rehabilitation for Concussion Recovery (i-RECOVER), for telehealth delivery (i-RECOVER-TH) and aimed to evaluate its feasibility and preliminary efficacy. Methods Thirteen adults completed a non-concurrent multiple-baseline A-B single-case experimental design. The sample was 62% female, with a mean (SD) age of 43 (15.51) years and a mean (SD) post-injury days of 581 (629.19). Participants were randomized to 2-, 3-, or 4-week baselines before receiving a 12-week interdisciplinary neuropsychology, physiotherapy, and medical intervention. The primary outcome was feasibility, assessed through recruitment and retention rates, treatment adherence and fidelity, participant acceptance of the telehealth intervention, and adverse events. Secondary outcomes included changes in pPCS severity, functional improvement, mood, fatigue, sleep, and physical functioning. Data were analyzed descriptively, visually (systematic visual analysis), and statistically (Tau-U non-overlap method). Results i-RECOVER-TH was feasible based on a priori criteria. Over half of participants (7/13) showed statistically meaningful reductions in pPCS from baseline to post-intervention. Most (10/13) achieved at least 1 personalized functional goal. Despite residual pPCS for some, improvements in functional goals and other secondary outcomes were possible. Conclusions As the first global evaluation of interdisciplinary concussion treatment via telehealth, the results support the feasibility of i-RECOVER-TH and its potential efficacy in improving patient-centered outcomes for those with pPCS after mTBI. These preliminary outcomes justify progression to a phase-II randomized controlled trial to more thoroughly evaluate treatment efficacy and to identify sources of variability in treatment response.

The consequences of exposure to head acceleration events (HAEs) in collision sports, including Australian Rules football, are a growing concern. Instrumented mouthguards (iMGs) now enable accurate quantification of HAEs in sport; however, little is known about HAE incidence and mechanisms in Australian Rules football. We aimed to measure HAEs in elite Australian Rules football players, and evaluate the influence of playing position and match event on the incidence and magnitude of HAEs in men and women. iMG data were collected from Australian Football League (AFL) and AFL Women’s (AFLW) players in 2023 utilising the HIT-IQ Nexus Gen III iMG, targeting 500 player-matches per sex. Match footage was synchronised with iMG data for video verification and match play coding. Three hundred and eleven players contributed iMG data in the analyses, including 126 men (median matches per player: 3 (interquartile range [IQR: 2–6]) and 185 women (median: 3 [IQR: 1–4]). Men had a higher mean incidence of HAEs ≥ 8 g per match than women (5.7 [95

Objective:Junior Australian football players with sport-related concussion (SRC) often do not access optimal healthcare. We aimed to evaluate the feasibility of an industry-supported healthcare programme that removed financial and logistical barriers to accessing care for SRC and adherence to the Australian Football League's (AFL) SRC management guidelines. Methods:Junior Australian football players (from a Melbourne-based league of 9852; under 8-18 competitions) who sustained a suspected or diagnosed SRC during the 2023 season were recruited. Players underwent assessment and management for SRC by a sport and exercise medicine registrar, including return to school and play planning in accordance with the AFL guidelines. Outcomes included programme demand, implementation, acceptability and adherence to the AFL's guidelines (median, (range) days for return to school, training and play). Results:From 154 eligible players, 58 (37.7%) participated, resulting in a weekly demand of 4.1 players (95% CI 3.1 to 5.2). 49 players were diagnosed with an SRC, and 9 players were cleared for SRC at their initial appointment. 44 players with SRC (89.8%) adhered to all medical advice and returned to play after receiving a medical clearance. All players returned to school (1 (0-10) days), unrestricted training (16 (2-53) days) and play (21 (7-63) days). Conclusion:The low programme demand indicates financial constraints and/or access to medical practitioners are not the main barriers for players with suspected SRC to formally seek healthcare in a metropolitan context. Those who did participate demonstrated high levels of appointment attendance, acceptability and adherence to AFL guidelines.

Objective To assess the association between soft-shell headgear (HG) use and sports-related concussion (SRC). Secondary objectives were to assess the association between HG and superficial head injury and investigate potential increase in injury risk among HG users. Design A systematic search in Ovid MEDLINE, Cochrane Library, Scopus, PsycINFO and SPORTDiscus was conducted in April 2020. Inclusion criteria were youth. Outcome Measures Incidence rates of SRC, superficial head injury or other injuries. Main Results Eight studies were eligible. The majority (n=5) reported no difference in the rate of SRC among HG users versus non-users. One rugby study identified significantly lower risk of SRC for non-HG users (RR 0.63; 95% CI 0.41 to 0.98) compared with HG users, whereas a cross-sectional survey of soccer players indicated higher risk of SRC for non-HG users (RR 2.65; 95% CI 1.23 to 3.12) compared with HG users. Three of the four studies investigating superficial head injury found no significant differences with HG use, though the soccer survey reported reduced risk among HG users (RR 1.86; 95% CI 0.09 to 0.11). Increased incidence of injuries to all body regions for rugby HG users was reported in two studies with adjusted RRs of 1.16 (95% CI 1.04 to 1.29) and 1.23 (95% CI 1.00 to 1.50). Conclusions HG use was not associated with reduced rates of SRC or superficial head injury in youth soccer and rugby. The possibility of increased injury risk to all body regions for rugby HG users was raised. The need for research specific to youth and female athletes was highlighted.

Objective To assess the incidence of, and mechanisms causing concussion in elite male (AFL) and female (AFLW) Australian football, to identify potential targets for risk reduction. Design Retrospective study. Setting/Participants Concussion data was obtained from the AFL medical database, which included all concussions sustained by AFL (male) players from 2015–18 and AFLW (female) players from 2017–19. All concussions were diagnosed by experienced clinicians utilising standardised concussion assessment tools and injury definitions, as well as video review. Interventions Where available, video footage of each incident was obtained and analysed to determine the circumstances in which each concussion occurred, including the mechanism and the contact point of impact. Main Results Overall, 252 concussions (6.72 per 1,000 player hours, 95%CI: 5.89–7.55) were reported in 779 matches in the AFL competition, compared to 44 concussions in 96 matches (14.61 per 1,000 player hours, 95%CI: 10.38–18.85) in the AFLW competition. Video footage was available for 194/252 (77%) concussions in the AFL and 35/44 (80%) concussions in the AFLW. Video analysis determined that players 'being bumped' (23%) and 'being tackled' (20%) were the most prevalent mechanisms in the AFLW, compared with the AFL in which 'marking contests' (multiple players attempting to catch the football, 28%) were most commonly associated with diagnosed concussion. Conclusions These findings confirm that there is a higher incidence of concussion in females compared to males in elite Australian football. The study also suggests that the mechanisms associated with concussion differ across the male and female competitions, potentially requiring individualised injury prevention efforts.

BACKGROUND:After mild traumatic brain injury (mTBI), some patients experience symptoms that persist for weeks to months. Recovery from mTBI is primarily assessed using selfreported symptom questionnaires. Blood biomarkers, including microRNA species, have shown promise to assist diagnosis of mTBI, however, little is known about how blood microRNA measures might predict symptom recovery. OBJECTIVE:The aim of this study was to investigate the variances in plasma microRNAs on the day of injury between individuals with mTBI who report post-concussive symptoms at the 28- day mark and those who do not. METHODS:Patients who presented to an adult, tertiary referral hospital emergency department on the day of the injury and were diagnosed with isolated mTBI (n=35) were followed up for 28 days. Venous blood samples were collected and symptom severity was assessed using the Rivermead Post-Concussion Symptom Questionnaire (RPQ) on the day of injury and at 28 days. Patients who reported ongoing symptoms of total RPQ score ≥10 or at least one symptom severity ≥2, were compared to those with lesser symptom severity or symptom resolution. RESULTS:There were 9 (25.7%; 95%CI: 12.5-43.3) patients who reported persistent symptoms. Day of injury plasma miR-223-3p levels were significantly higher in individuals with ongoing symptoms compared to those without, however, no such differences were observed for miRs 142- 3p, 423-3p, 32-5p, 144-3p, and let-7f-5p. CONCLUSION:Acute plasma miR-223-3p levels appear to detect patients who later have persistent symptoms after mTBI. The results demonstrate the potential utility for such biomarkers to assist in decisions towards early referral for therapy after mTBI.

Objective To assess whether padded headgear (HG) was associated with incidence of suspected sports-related concussion (SRC), non-SRC head injury, and injuries to other body regions in junior Australian football. Design Prospective cohort injury surveillance. Methods There were 400 junior players (42.5% female) enrolled across two seasons. Suspected SRC was defined by detection of observable signs on the field and medical assessment or missed match(es) due to suspected SRC. Non-SRC head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match. Main Results There were 22 teams monitored over 258 matches. 204 players (2,484 player hours) wore mandated HG throughout the season and 196 (2,246 player hours) did not. The incidence rate of suspected SRC was 3.17 (95% CI: 3.04–3.30) per 1000 player-hours and no differences were observed between males and females (RR 1.11; 95% CI: 0.40–3.06). HG use was not associated with suspected SRC (RR 1.09; 95% CI: 0.41–2.97), non-SRC head injury (RR 0.27; 95% CI: 0.06- 1.31), or injuries to other body regions (RR 1.41; 95% CI: 0.79–2.53). Conclusions HG use was not associated with reduced risk of suspected SRC, non-SRC head injury or injuries to other body regions. There was no difference in rate of suspected SRC in female compared to male players, however, rates of non-SRC head injury and injuries to other body regions were higher in male players.

ImportanceSport-related concussion (SRC), a form of mild traumatic brain injury, is a prevalent occurrence in collision sports. There are no well-established approaches for tracking neurobiologic recovery after SRC.ObjectiveTo examine the levels of serum glial fibrillary acidic protein (GFAP) and neurofilament light (NfL) in Australian football athletes who experience SRC.Design, Setting, and ParticipantsA cohort study recruiting from April 10, 2021, to September 17, 2022, was conducted through the Victorian Amateur Football Association, Melbourne, Australia. Participants included adult Australian football players with or without SRC. Data analysis was performed from May 26, 2023, to March 27, 2024.ExposureSport-related concussion, defined as at least 1 observable sign and/or 2 or more symptoms.Main Outcomes and MeasuresPrimary outcomes were serum GFAP and NfL levels at 24 hours, and 1, 2, 4, 6, 8, 12, and 26 weeks. Secondary outcomes were symptoms, cognitive performance, and return to training times.ResultsEighty-one individuals with SRC (median age, 22.8 [IQR, 21.3-26.0] years; 89% male) and 56 control individuals (median age, 24.6 [IQR, 22.4-27.3] years; 96% male) completed a total of 945 of 1057 eligible testing sessions. Compared with control participants, those with SRC exhibited higher GFAP levels at 24 hours (mean difference [MD] in natural log, pg/mL, 0.66 [95% CI, 0.50-0.82]) and 4 weeks (MD, 0.17 [95% CI, 0.02-0.32]), and NfL from 1 to 12 weeks (1-week MD, 0.31 [95% CI, 0.12-0.51]; 2-week MD, 0.38 [95% CI, 0.19-0.58]; 4-week MD, 0.31 [95% CI, 0.12-0.51]; 6-week MD, 0.27 [95% CI, 0.07-0.47]; 8-week MD, 0.36 [95% CI, 0.15-0.56]; and 12-week MD, 0.25 [95% CI, 0.04-0.46]). Growth mixture modeling identified 2 GFAP subgroups: extreme prolonged (16%) and moderate transient (84%). For NfL, 3 subgroups were identified: extreme prolonged (7%), moderate prolonged (15%), and minimal or no change (78%). Individuals with SRC who reported loss of consciousness (LOC) (33% of SRC cases) had higher GFAP at 24 hours (MD, 1.01 [95% CI, 0.77-1.24]), 1 week (MD, 0.27 [95% CI, 0.06-0.49]), 2 weeks (MD, 0.21 [95% CI, 0.004-0.42]) and 4 weeks (MD, 0.34 [95% CI, 0.13-0.55]), and higher NfL from 1 week to 12 weeks (1-week MD, 0.73 [95% CI, 0.42-1.03]; 2-week MD, 0.91 [95% CI, 0.61-1.21]; 4-week MD, 0.90 [95% CI, 0.59-1.20]; 6-week MD, 0.81 [95% CI, 0.50-1.13]; 8-week MD, 0.73 [95% CI, 0.42-1.04]; and 12-week MD, 0.54 [95% CI, 0.22-0.85]) compared with SRC participants without LOC. Return to training times were longer in the GFAP extreme compared with moderate subgroup (incident rate ratio [IRR], 1.99 [95% CI, 1.69-2.34]; NfL extreme (IRR, 3.24 [95% CI, 2.63-3.97]) and moderate (IRR, 1.43 [95% CI, 1.18-1.72]) subgroups compared with the minimal subgroup, and for individuals with LOC compared with those without LOC (IRR, 1.65 [95% CI, 1.41-1.93]).Conclusions and RelevanceIn this cohort study, a subset of SRC cases, particularly those with LOC, showed heightened and prolonged increases in GFAP and NfL levels, that persisted for at least 4 weeks. These findings suggest that serial biomarker measurement could identify such cases, guiding return to play decisions based on neurobiologic recovery. While further investigation is warranted, the association between prolonged biomarker elevations and LOC may support the use of more conservative return to play timelines for athletes with this clinical feature.

The diagnosis of mild traumatic brain injury (mTBI) and early identification of patients who have persistent symptoms remains challenging. Symptoms are variably reported, and tests for cognitive impairment require specific expertise. The aim of this study was to assess the ability of plasma micro-ribonucleic acid (miRNA) biomarkers to distinguish between patients with mTBI and healthy controls. A secondary aim was to assess whether miRNA biomarker levels on the day of injury could predict persistent symptoms on day 7. Injured patients presented to an adult, tertiary referral hospital emergency department and were diagnosed with isolated mTBI (n = 75). Venous blood samples were collected within 6 h of injury. Symptom severity was assessed using the Rivermead Post-Concussion Symptom Questionnaire (RPQ) on the day of injury and at 7 days post-injury. The comparator group (n = 44) were healthy controls without any injury, who had bloods sampled and symptom severity assessed at the same time-point. Patients after mTBI reported higher symptom severity and had worse cognitive performance than the control group. Plasma miR423-3p levels were significantly higher among mTBI patients acutely post-injury compared to healthy controls and provided moderate discriminative ability (AUROC 0.67; 95 %CI: 0.57-0.77). None of the assessed miRNA biomarkers predicted persistent symptoms at 7 days. Plasma miR423-3p levels measured within 6 h of injury can discriminate for mTBI compared to healthy controls, with potential utility for screening after head injury or as an adjunct to the diagnosis of mTBI. Acute plasma miRNA levels did not predict patients who reported persistent symptoms at 7 days.

Background: Despite clinical guidelines recommending an interdisciplinary approach to persisting post-con-cussion symptom (PPCS) management, evaluations of interdisciplinary interventions remain scant. Objectives: This pilot study aimed to explore the feasibility and preliminary efficacy of an interdisciplinary intervention for PPCSs. Method: A single-case experimental design with randomisation to multiple baselines (2, 4, or 6 weeks) was repeated across 15 participants (53% female) with mild traumatic brain injury (mean age 38.3 years, SD 15.7). The 12-week treatment incorporated psychology, physiotherapy, and medical interventions. Feasibility out -comes included recruitment and retention rates, adverse events, treatment adherence and fidelity. Patient-cen-tred secondary outcomes included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), assessed 3 times per week during the baseline and treatment phases, and at the 1-and 3-month follow-ups. Other sec-ondary outcomes included measures of mood, sleep and fatigue, physical functioning, health-related quality of life, illness perceptions, and goal attainment. Changes in PPCSs were evaluated using systematic visual analysis and Tau -U. Clinically significant changes in secondary outcomes were explored descriptively. Results: 16/26 individuals assessed for eligibility were enroled (61% recruitment rate); 15 completed the post-treatment follow-ups, and 13 completed the 1-and 3-month follow-up assessments (81% retention rate). High treatment adherence and competence in delivering treatments was observed. Moderate-large effect sizes for reducing PPCSs were observed in 12/15 cases, with 7/15 reaching statistical significance. Improvements were maintained at the 1-and 3-month follow-ups and were accompanied by reductions in fatigue, sleep difficulties, and mood symptoms, and changes in illness perceptions. All participants had clini-cally significant improvements in at least 1 outcome, with 81% of individual therapy goals achieved. Conclusions: This pilot study provided preliminary support for a subsequent randomised controlled trial (RCT), with satisfactory recruitment, retention, treatment compliance, and treatment fidelity. Improvement was evident on participant outcomes including symptom reduction and goal attainment, suggesting that pro-gressing to a phase-II RCT is worthwhile. Findings highlight the potential benefit of individualized interdisci-plinary treatments. (c) 2023 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

The objective of this systematic scoping review is to understand the extent and scope of evidence regarding neurodiversity in elite sport. This systematic scoping review considered epidemiological studies, commentary and viewpoints papers, systematic review and meta-analyses, and any intervention or clinical treatment, management and practice studies in relation to neurodiversity in elite sport. Case studies and grey literature were ineligible for review. Neurodivergence included neurodevelopmental disorders such as autism spectrum disorder, attention-deficit hyperactivity disorder (ADHD) and specific learning disorders. Elite sport was defined as Olympic, Paralympic, national, international, professional and semiprofessional sport. The final 23 studies included in this review comprised 10 observational studies, 4 systematic/narrative reviews, 6 commentary/position statements and 3 qualitative studies. The literature reflected a major focus on ADHD as a risk factor for concussion and prognosis for postconcussion recovery. Further, there was a focus on the medical management of ADHD, regarding adherence to sporting antidoping regulations. One study focused on the experience of autism in athletes in elite sport settings through qualitative interviews. One study focused on anxiety disorders in elite athletes, with ADHD emerging as a major risk factor. There is a strong rationale for future research to build on the evidence for neurodiversity in elite sport to foster supportive and inclusive elite sporting environments.

Aim: To explore soft-shell padded headgear (HG) use, player behavior and injuries associated with HG in junior Australian football. Methods: Prospective case-crossover with head impact measurement, injury surveillance and video review. Results: 40 players (mean age: 12.43 years, standard deviation: 1.36) across 15 matches were observed. Frequency of head/neck (p = 0.916) or body (p = 0.883) contact events, and match incidents were similar between HG and no HG conditions. Without HG, females had higher frequency of body contacts compared with males (p = 0.015). Males sustained more body contacts with HG than without HG (p = 0.013). Conclusion: Use of HG in junior football was not associated with injury or head contact rate. Associations between HG use and body contact may differ across sexes. (ID: ACTRN12619001165178).

OBJECTIVES:To investigate beliefs and factors associated with padded headgear (HG) use in junior (<13 years) and youth (≥13 years) Australian football.DESIGN:Online survey.SETTING:Junior and youth athletes in Australia.PARTICIPANTS:Australian football players aged U8 to U18.ASSESSMENT OF VARIABLES:Survey questions regarding demographics, HG use, concussion history, beliefs about HG, and risk-taking propensity.MAIN OUTCOME MEASURES:Rates of padded HG use, and beliefs associated with HG use.RESULTS:A total of 735 players (including 190, 25.9% female) representing 206 clubs participated. Headgear was worn by 315 players (42.9%; 95% CI: 39.3-46.4). Most (59.5%) HG users wore it for games only and wore it voluntarily (59.7%), as opposed to being mandated to do so. Junior players were more likely than youth players to agree to feeling safer ( P < 0.001) and being able to play harder while wearing HG ( P < 0.001). Median responses were "disagree" on preferring to risk an injury than wear HG, and on experienced players not needing to wear HG. Beliefs did not differ between males and females. Headgear use was associated with players belonging to a club where HG was mandated for other age groups (OR 16.10; 95% CI: 7.71-33.62, P < 0.001), youth players (OR 2.79; 95% CI: 1.93-3.93, P < 0.001), and female players (OR 1.57; 95% CI: 1.07-2.30, P = 0.019).CONCLUSIONS:Club HG culture, older age and being female were prominent variables associated with voluntary HG use. Players reported believing that HG offers protection. The rate of voluntary and mandated HG use identified is at odds with current scientific evidence that does not support HG as effective concussion prevention.

PURPOSE Many factors contribute to persisting post-concussion symptoms (PPCSs), necessitating multi-modal treatment. Quantitative investigations have shown the potential of interdisciplinary intervention to reduce the burden of PPCSs and facilitate return to activities. There are often varied responses to intervention, warranting further investigation of potential factors underlying treatment response. This study aimed to explore participant experiences of i-RECOveR, an interdisciplinary intervention for PPCSs and its impact on symptoms, daily function, and concussion beliefs. MATERIALS AND METHOD Semi-structured interviews were conducted 1-month post-treatment via videoconferencing with 13 individuals (61% female) with mild traumatic brain injury (Mage=39.77 years, SD = 16.27) who participated in i-RECOveR. Interview transcripts were analysed thematically. RESULTS Three themes reflected participants' treatment journeys from concussion to life after treatment: (1) Dissatisfaction with Previous Consultations, reflected personal experiences prior to commencing treatment; (2) Perceived Active Ingredients of Intervention, reflected participant experiences of i-RECOveR; and (3) Impact of Interdisciplinary Intervention, reflected a range of positive changes after completing i-RECOveR. CONCLUSIONS Findings highlight current gaps in the acute management of concussion and provide end-user insights into the facilitators and barriers of treatment engagement and response. Responses also highlight the potential positive impact of interdisciplinary treatments. Clinician perspectives should be explored in future research.

Objectives: To assess whether padded headgear was associated with incidence of suspected sports-related concussion, non-sports-related concussion head injury, and injuries to other body regions in junior Australian football. Design: Prospective cohort injury surveillance. Methods: There were 400 junior players (42.5% female) enrolled across two seasons. Suspected sports-related concussion was defined by detection of observable signs on the field and medical assessment or missed match (es) due to suspected sports-related concussion. Non-sports-related concussion head injury and injuries to other body regions were defined as those that received medical assessment or resulted in a missed match. Results: There were 20 teams monitored over 258 matches. 204 players (2484 player hours) wore mandated headgear throughout the season and 196 (2246 player hours) did not. The incidence rate of suspected sports-related concussion was 3.17 (95% confidence interval: 3.04-3.30) per 1000 player-hours and no differences were observed between males and females (risk ratio 1.11; 95% confidence interval: 0.40-3.06). Headgear use was not associated with suspected sports-related concussion (risk ratio 1.09; 95% confidence interval: 0.41-2.97), non-sports-related concussion head injury (risk ratio 0.27; 95% confidence interval: 0.06-1.31), or injuries to other body regions (risk ratio 1.41; 95% confidence interval: 0.79-2.53). Conclusions: Headgear use was not associated with reduced risk of suspected sports-related concussion, non-sports-related concussion head injury or injuries to other body regions. There was no difference in the rate of suspected sports-related concussion in female compared to male players, however, rates of non-sports-related concussion head injury and injuries to other body regions were higher in male players. (c) 2021 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Video surveillance and detection of players with visible signs of concussion by experienced medical staff facilitates rapid on-field screening of suspected concussion in professional sports. This method, however has not been validated in community sports where video footage is unavailable. This study aimed to explore the utility of visible signs of concussion to identify players with decrements in performance on concussion screening measures. In this observational prospective cohort study, personnel with basic training observed live matches across a season (60 matches) of community male and female Australian football for signs of concussion outlined in the community-based Head Injury Assessment form (HIAf). Players identified to have positive signs of concussion (CoSign+) following an impact were compared with players without signs (CoSign-). Outcome measures, the Sport Concussion Assessment Tool (SCAT3) and Cogstate, were administered at baseline and post-match. CoSign+ (n = 22) and CoSign- (n = 61) groups were similar with respect to age, sex, education, baseline mood, and medical history. CoSign+ players exhibited worse orientation, concentration, and recall, and slower reaction time in attention and working memory tasks. Comparing individual change from baseline to post-match assessment revealed 100% (95% confidence interval [CI]: 84-100%) of CoSign+ players demonstrated clinically significant deficits on SCAT3 or Cogstate tasks, compared with 59% (95% CI: 46-71%) of CoSign- players. All CoSign+ players observed to have a blank/vacant look demonstrated clinically significant decline on the Standardized Assessment of Concussion (SAC). Detection of visible signs of concussion represents a rapid, real-time method for screening players suspected of concussion in community sports where video technology and medical personnel are rarely present. Consistent with community guidelines, it is recommended that all CoSign+ players be immediately removed from play for further concussion screening.

Up to 25% of concussed individuals experience persistent post-concussion symptoms (PPCSs) which may interfere with the return to pre-injury activities and cause significant stress. Given that multiple etiological factors are thought to contribute to PPCSs, an interdisciplinary approach is recommended. This pilot study aims to primarily investigate the feasibility of a novel interdisciplinary treatment for PPCSs. Given this intervention is novel, uncertainty exists in terms of potential recruitment and retention rates, adverse events, and treatment adherence and fidelity. These factors will be explored to inform the feasibility of a phase-2 randomised controlled trial. Preliminary efficacy of this intervention will also be explored. Fifteen individuals with mild traumatic brain injury and PPCSs will receive up to 12 weeks of interdisciplinary treatments including psychology, physiotherapy, and medical interventions. Primary feasibility outcomes including data on recruitment and retention rates and treatment adherence will be explored descriptively. The cognitive therapy rating scale will be used to assess treatment fidelity. A single-case series with multiple baseline design will be used to explore preliminary efficacy. Participants will be randomly assigned to baseline phases of 2, 4, or 6 weeks. Regarding patient-centred secondary outcomes, the Rivermead Post-Concussion Symptoms Questionnaire will be assessed three times a week during baseline and treatment phases. Secondary outcomes also include measures of mood, sleep and fatigue, physical functioning, return to activity, and health-related quality of life. Patient-centred outcomes will be assessed at baseline, pretreatment, post-treatment, and one- and three-month follow-up. Thematic analysis of participant experiences will be explored through qualitative interviews. Results from this trial will inform the feasibility and preliminary efficacy of this interdisciplinary concussion intervention and whether proceeding to a future definitive phase-2 randomised controlled trial is worthwhile. Understanding the end-user perspective of the treatment will also enable modifications to the treatment protocol for future trials to best suit the needs of individuals with PPCSs after mTBI. Outcomes from this trial can be directly translated into community rehabilitation programmes. ANZCTR, ACTRN12620001111965. Registered 27 October 2020, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379118