Need of clearer guidelines at an organizational level with improved collaboration and improved management of handball players with a head injury - The SWEdish CONcussion study in elite handball

BACKGROUND: Handball is a contact sport, and a head-injury is one of many possible injuries. The diagnosis concussion has been reported as one of the more complex sports injuries, both regarding the diagnostic procedure and the sports medical management and rehabilitation. Hereby a handball-related head-injury is expected to be challenging both for the players and for the medical-team and there is a need to explore how medical team professionals’ reason regarding management and return to play. OBJECTIVES: The aim of the study was to explore how the medical team in Swedish elite handball, medical doctors and physiotherapists, reason regarding principals of managing a handball related head-injury and return to sport decisions. METHODS: A Qualitative individual interview study with a semi-structured interview guide was performed. Data was analyzed with content analysis and an inductive approach. Study participants were eight medical doctors and twelve physiotherapist supporting Swedish elite handball team during the season of 2019/2020. RESULTS: The participants descriptions and reasoning regarding management and return to play principals emerged into the following three main categories; “Organization and working routine”; “Experienced complicating factors and feeling insufficient and scarce”; “Management strategies”. Together with nine subcategories the analysis exposed a variety of principals, challenges and expressed needs related to the process of medical decisions and management for handball players sustaining a head injury. CONCLUSION: The results reveal a need for clearer guidelines, enhanced collaboration, and improved management of head-injuries. There is also an expressed need for sharpened handball rules and regulations as well as a need of clarified health-care pathways for players with more complex post-concussion symptoms. The medical team members expressed an uncertainty regarding symptoms due to the concussion, so being acquainted with the player is hereby very important.