708 EP015 – Navigating multiples roles: how physiotherapists’ experience supporting concussions in community rugby using New Zealand rugby concussion management pathway

Background As a collision-based sport, rugby participation has a relatively high risk of concussion. In response, New Zealand Rugby (NZR) implemented a concussion management pathway (CMP). In the context of the CMP, physiotherapists are often responsible for pre-season baseline testing, education, prevention, recognising suspected concussions, removing players from play and guiding them through the graduated return-to-play. Objective To examine physiotherapists' experiences in the management of rugby-related concussions as part of the CMP. Design A descriptive, pragmatic qualitative approach was adopted. Setting Community rugby environment in NZ encompassing high school and club level rugby. Participants Twenty-four physiotherapists who were involved in the CMP. Intervention Semi-structured interviews and focus groups were used to explore participant's perceptions. Reflexive thematic analysis drove the data analysis. Results Four themes represented physiotherapists' experiences. Navigating between player welfare and performance; describes the balancing act between stakeholders' different attitudes and priorities, and the stabilising influence of the CMP. Empowering physiotherapists; described the influence of physiotherapists' authority within the team and concussion management responsibilities. They described a need for a level of authority and support to make decisions, the weight of this authority and how the CMP acted as a tool to support their role. Multi-directional communication; described the role of communication between multiple stakeholders, and how shared info rmation affected both their own role within the CMP and how players would progress through the CMP. The influence of context; encompassed the severity of the concussion, knowledge of the physiotherapists and team, resource support for the physiotherapist, and access to a doctor. Conclusion Physiotherapists had positive attitudes towards the CMP and are well-positioned to play an active role in the pathway. Priorities of other stakeholders, authority of the physiotherapist and the communication flow influences physiotherapists' ability to optimally manage players with concussion.