Part 1: High-level summary
A high-level summary of key points relating to the primary research projects undertaken by World Rugby is set out in the table below. Further details are available from the detailed summary in Part 2 below.
World Rugby processes all personal data in accordance with its privacy statement and further details on World Rugby’s general data protection policies, practices and procedures, as well as information on how individuals may contact us (and our Data Protection Officer) and exercise their rights under data protection law are set out in that document.
Necessity and proportionality assessment
Third parties involved
Research relating to the frequency and causes of concussions among elite rugby players, aimed at ensuring the effectiveness of the current HIA Protocol and reviewing safety of the laws of the game
The overall aim of the HIA Research Project is to continually evaluate how well the HIA Protocol is working and to identify any areas where detection and management of concussion can be improved
Processing data gathered through administering the HIA protocol is necessary to understand and better managing the risks of concussion, both of which play a key role in advancing and enhancing player welfare. Having regard to the research objectives, for the reasons stated below, the extent of personal data processes pursuant to the HIA study is considered to be proportionate.
HIA is an ongoing study in order to gain insights into concussion in rugby on a continuous basis, so data is retained in accordance with those principles. [Where a player retires, their data can be fully anonymised within the research data (i.e. by removing any unique ID number from the reports relating to that player)]
Team medical staff (who input HIA reports in accordance with the HIA protocol).
CSx Limited, a New Zealand company which provides the technology used in
Institute of Sport and Exercise Medicine, Stellenbosch University, an independent sports research institution which carries out quality assurance on data reported by medics and also supports the WRRU in developing research insights and producing academic papers.
Contractors and other research personnel engaged by World Rugby’s research unit.
Injury Surveillance Studies
Collection and research of data relating to the frequency and circumstances of injuries at World Rugby tournaments, and other selected tournaments and events
The overall aim of the Injury and Illness surveillance programme is to investigate the incidence and nature of injuries and illnesses sustained by players across relevant competitions
Processing data gathered through ISS is necessary to understand and manage injury risks in order to continually improve and enhance player safety .
An archiving process has been established for injury surveillance studies at specific tournaments, whereby, following conclusion of the tournament ISS study report, the database is fully anonymised so that it can be used in longitudinal studies over time.
Team medical staff (who submiit injury reports in accordance with the injury surveillance study methodology into the prescribed ISS application).
Dovetail Technologies Limited, who have been engaged by World Rugby in connection with the development and support of a specific application for the reporting and management of ISS data.
Contractors and other research personnel engaged by World Rugby’s research unit.
Part 2: Detailed Summary
1. Head Injury Assessment Research programme
Concussion is a traumatic brain injury which can result in a range of impairments in neurological function that develop and resolve over varying periods of time. Within sport generally, but particularly contact and collision-orientated sports, concussion has grown prominent as a topic of interest owing to concerns over the short- and long-term health consequences of this injury for players.
World Rugby’s general policy is that everyone involved in Rugby should be able to recognise the signs and symptoms of concussion, and to remove any player displaying the signs or symptoms of concussion from playing or training. This policy is encapsulated in World Rugby’s “Recognise and Remove” principle, which reflects a zero-risk approach to the question of whether any player with clear or suspected symptoms of concussion should be permitted to continue to participate in a rugby match or training.
The Head Injury Assessment (the “HIA”) originated from a World Rugby-administered global trial to a enable temporary substitutions when it is unclear if a player has a suspected concussion. Under this trial, a relevant player could be temporarily substituted to enable medical personnel to carry out a HIA on the player following certain prescribed protocols (the “HIA Protocol”). Where, following certain prescribed protocols, medical personnel treating such player were able to establish that the player had not suffered a concussion, that player would be permitted to return to play. Otherwise, the temporary substitution would become permanent.
Following a successful trial period, temporary substitution for head injury was introduced permanently into Law for elite adult rugby in August 2015. The HIA Protocol is intended to support Law 3.11 of the Laws of the Game and World Rugby Regulation 10, both of which are relevant to temporary replacement for head injury and the management of concussion.
The HIA protocol is supported by a governance system to ensure the highest quality of medical management is provided to players. The HIA protocol for assessing players with a suspected concussion, including components of the off-field screening tool, were formulated following a review of the scientific literature, consideration of position statements, and formal consultation with concussion experts, sports medicine doctors, coaches, players and referees. The HIA protocol is subject to continual review and development by a working group of independent experts advising World Rugby.
b) Research Objectives
The overall aim of the HIA Research Project is to continually evaluate how well the HIA Protocol is working and to identify any areas where detection and management of concussion can be improved. For example, the data collected pursuant to this research programme are used to:
- define normative reference values for delineating normal and abnormal baseline and post-injury HIA performance by players;
- investigate the influence of factors that may modify HIA performance (e.g. familiarisation effects of multiple baseline tests, effect of previous concussion(s) on subsequent baseline performance, comparing baseline assessments conducted at rest and after exercise)
- examine the diagnostic accuracy of the HIA Assessment process in detecting concussion;
- evaluate the diagnostic accuracy of individual sub-modes of the HIA in detecting concussion;
- compare the accuracy of new and evolving test modes and/or technologies with the existing HIA protocol;
The overall intended effect of the HIA Research Project is to enhance player safety over time by ensuring that the HIA Protocol ensures best practice for the detection and management of concussion in elite adult rugby.
c) Assessment of necessity and proportionality
Processing data gathered through administering the HIA protocol is necessary to understand and better managing the risks of concussion, both of which play a key role in advancing and enhancing player welfare.
The HIA research programme is essential to ensuring that the HIA Protocol remains effective and can continue to achieve its overall purpose of improving player safety. It is unlikely that the same outcomes could be achieved without collecting a significant body of data detailing the incidence and causes for head injuries, and the outcomes of HIA assessments.
HIA Data is accessed only by a dedicated research unit in World Rugby and at the Institute of Sport and Exercise Medicine, Stellenbosch University, who are experienced in handling sensitive research data. The mandate for using HIA Data, as approved by the World Rugby Research Ethics Committee, is player welfare and there is no prospect of data being used for other purposes.
The accuracy and completeness of the data collected for the HIA Research programme is, to a certain extent, dependent on the accuracy and quality of the information collected by the relevant doctors and medics through paper based and/or electronic HIA Forms. It is the responsibility of such doctors and medics to ensure that the HIA Forms are completed correctly and that the data submitted via the online platform is accurate. As a condition of using the HIA Protocol, competition organisers are required to have a HIA review process to ensure that the HIA Protocol is implemented correctly and that data has been collected properly and accurately.
The HIA Data is stored on Amazon Web Service servers located in Dublin, Ireland. Third-party technology support personnel, who are based in New Zealand, have access to the data for the purposes of providing reporting and analysis services to World Rugby and for maintenance and development purposes. To allow for the possibility of HIA Data being transferred to locations outside of the EEA or New Zealand (for example in the context of a tournament taking place outside of such jurisdictions), World Rugby has implemented appropriate safeguards in relation to such potential transfers.
To reduce the extent to which players may be identified from the HIA Data used in the HIA Research programme, the use of pseudonymised player reference numbers instead of player names has been adopted. It is appropriate to retain other information which may serve to enable players to be identified (e.g. team represented, date of match, etc) as this data is necessary to enable data collected at various stages of the HIA protocol to be linked to the same incident or player, and cross-reference relevant match footage to review the accuracy of data and obtain a better understanding of the cause and/or circumstances of a particular injury.
World Rugby takes a number of steps to ensure that players whose data may be collected during the course of the HIA Research Project are informed about and understand the uses that will be made of their data in connection with such research. These steps include:
- World Rugby has developed and disseminated concussion education modules, which cover the essential information outlined in the HIA Protocol document and appendices, as well as the required standards for concussion management, immediate care in rugby and medical protocols for match-day medical staff. Players participating in tournaments and matches approved for the use of HIA Protocol are required to undertake these modules.
- In respect of tournaments organised and controlled by World Rugby, World Rugby ensures that the Participation Agreement which all players participating in such tournaments are asked to sign, includes notification that HIA Data relating to such players may be collected and used for research purposes;
- In relation to tournaments not organised by World Rugby, but in respect of which World Rugby has provided approval for the use of temporary replacements in accordance with the HIA Protocol, one of the conditions of World Rugby’s approval is that all team staff are provided with the explanation set out in the HIA Protocol document (at Appendix 3) in relation to the HIA Protocol and the HIA Research Project.
Information regarding player’s rights with respect to their HIA Data is included in the Player information notices included in the Participation Agreement for World Rugby tournaments. The research explanation letter included in the HIA Protocol document also provides players with information in relation to their rights.
2. Injury and Illness Surveillance at World Rugby Competitions
Injury and illness are an unfortunate but inherent possibility when playing sport. Managing the risk of injury or illness to acceptable levels is a key feature of protecting player health. Studying the patterns and associated effects of injuries and illnesses in defined populations is a crucial underpinning in risk management, and can help to answer a number of key questions, such as:
- What are the most prominent types of injury or illness, in terms of incidence or severity?
- Has the frequency or severity of overall or specific types of injury or illness changed over time?
- Which factors may influence the likelihood of individual(s) becoming injured or ill?
- Has the introduction of a certain preventive measure been met with a reduction in injury or illness frequency or severity?
Outcomes of epidemiological studies into injury and illness can assist with identifying priority injury or illness types to target for prevention, identifying factors that protect or predispose to injury or illness, and determining the efficacy of preventive measures.
World Rugby is committed to implementing injury and illness surveillance studies (ISS) at all major World Rugby Tournaments. All ISS are conducted by selected research consultants in accordance with the definitions and protocols described in the World Rugby approved International Consensus Statement on definitions and procedures for injury surveillance studies in Rugby . Findings from ISS are reported back to relevant parties within World Rugby and are made accessible to members of the public through World Rugby Player Welfare webpage.
b) Research Objectives
The overall aim of the Injury and Illness surveillance programme is to investigate the nature of injuries and illnesses sustained by players across World Rugby competitions. For example, the data collected during the course of the research programme are used to:
- identify injuries or illnesses that are prominent in their frequency, or that carry the highest severity in terms of time lost from subsequent participation;
- assess trends in injury or illness patterns over time (e.g. across the HSBC Sevens World Series);
- identify factors that may predispose or protect players from injury or illness;
- evaluate the efficacy of preventive measures (e.g. introducing a law change to lower the legal height of the tackle)
The overall intended effect of the Injury and Illness surveillance programme is to enhance player safety over time by ensuring that the risk of injury and illness that players are exposed to remain acceptable.
c) Assessment of necessity and proportionality
Processing data gathered through ISS is necessary to manage injury risks and in the general interests of enhancing player welfare.
As the risk of injury and illness can fluctuate over time in response to various factors, there is scope to continually improve and enhance player safety. The ISS programme is essential to ensuring that World Rugby can continue to achieve its aim of improving player welfare by enabling monitoring and evaluating injury risk management initiatives.
Without understanding the issues that dominate rugby from an injury frequency and severity perspective, it would be impossible for World Rugby to implement evidence-based player welfare initiatives and/or changes to the laws of the game or other regulatory requirements in order to improve player safety. In support of this, World Rugby’s attempts to enhance the detection and management of concussion across rugby partly originated from the findings of ISS that pointed towards a high proportion of players continuing to play rugby despite having suffered a concussion. Furthermore, the efficacy of preventive measures targeting head injuries across rugby is heavily reliant on the findings of IISS.
World Rugby has been identified across the sports governance world as having taken a leadership role across all sports in injury risk management and the World Rugby ISS reflects and helps to drive best practice across all sports from an injury analysis perspective.
Data is accessed only by a dedicated research unit within World Rugby who are experienced in handling sensitive research data. The mandate for using this data has been approved by the Ethics Committee and is restricted in its use to player welfare. The independence of the ISS Consultant, who has access to the full dataset of each ISS, ensures that the data collected pursuant to the ISS cannot be used by World Rugby for other functions or purposes.
World Rugby and Dovetail staff who have access to the full data set of each ISS have such access for administrative and support purposes only and to ensure that appropriate access controls are in place and adhered to.
The quality of the data collected by World Rugby pursuant to each ISS Project is dependent on the accuracy and quality of the information collected by the relevant doctors and medics supporting each team. It is the responsibility of such doctors and medics to ensure that the data are completed correctly and that the data submitted to World Rugby are accurate. However, the ISS Consultants responsible for implementing World Rugby ISS Projects actively follow up with each team involved in a competition to ensure that the data are complete.
In order to reduce the extent to which players may be identified from the ISS Data used in the ISS programme, the use of pseudonymised player reference numbers instead of player names has been adopted. It is necessary, however, to retain information which may in some way enable players to be identified (e.g. team represented, playing position) as these data are necessary to provide insight into injury risk factors.
World Rugby takes a number of steps to ensure that players whose data may be collected pursuant to the ISS Project are informed about and understand the uses that will be made of their data in connection with such research. These steps include:
- In respect of tournaments organised and controlled by World Rugby, World Rugby’s Participation Agreement, which all participating players sign, includes notification that ISS data may be collected and used for player welfare research purposes;
- Implementation of an ISS at every relevant World Rugby Tournament is a condition of the Terms of Participation of each such tournament and players sign up to the Terms of Participation which sets out the requirement for an ISS. Separately to the players signing up to the relevant Tournament Terms of Participation, they are also provided with an opportunity to request to be excluded from the study. This is on the basis that it is considered appropriate and wholly consistent with player rights and player welfare that a player’s data be included in the ISS Project, only where that player is happy for such data to be so included.
Information regarding player’s rights with respect to their ISS Data is included in the Player information notices included in the Participation Agreement for World Rugby tournaments.
Data will be submitted by and made available to Participating Unions from around the world in connection with the ISS. All Member Unions of World Rugby have signed the World Rugby Data Protection Framework Agreement which implements a number of safeguards in respect of personal data which is transferred to jurisdictions outside of the EEA.
 Fuller et al., 2007