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Research paper
Long-term health outcomes after exposure to repeated concussion in elite level: rugby union players
  1. T M McMillan1,
  2. P McSkimming2,
  3. J Wainman-Lefley1,
  4. L M Maclean1,
  5. J Hay3,
  6. A McConnachie2,
  7. W Stewart3,4
  1. 1Institute for Health & Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
  2. 2Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
  3. 3Department of Neuropathology, Laboratory Medicine Building, Queen Elizabeth University Hospital, Glasgow, UK
  4. 4Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
  1. Correspondence to Professor TM McMillan, Institute for Health & Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow G120XH, UK; thomas.mcmillan{at}


Background There is continuing concern about effects of concussion in athletes, including risk of the neurodegenerative disease chronic traumatic encephalopathy. However, information on long-term health and wellbeing in former athletes is limited.

Method Outcome after exposure to repeated brain injury was investigated in 52 retired male Scottish international rugby players (RIRP) and 29 male controls who were similar in age and social deprivation. Assessment included history of playing rugby and traumatic brain injury, general and mental health, life stress, concussion symptoms, cognitive function, disability and markers of chronic stress (allostatic load).

Results The estimated number of concussions in RIRP averaged 14 (median=7; IQR 5-40). Performance was poorer in RIRP than controls on a test of verbal learning (p=0.022) and of fine co-ordination of the dominant hand (p=0.038) and not significantly different on other cognitive tests (p>0.05). There were no significant associations between number of concussions and performance on cognitive tests. Other than a higher incidence of cardiovascular disease in controls, no group differences were detected in general or mental health or estimates of allostatic load. In RIRP, persisting symptoms attributed to concussion were more common if reporting more than nine concussions (p=0.028), although these symptoms were not perceived to affect social or work functioning.

Conclusions Despite a high number of concussions in RIRP, differences in mental health, social or work functioning were not found late after injury. Subtle group differences were detected on two cognitive tests, the cause of which is uncertain. Prospective group comparison studies on representative cohorts are required.

Statistics from


  • Contributors TMM was involved in planning the project, the development of the protocol, obtained ethics approval, supervised the research workers, provided the funding, was involved in the analysis, wrote the initial draft manuscript and led the development of the manuscript to submission and acceptance. PM and AM carried out the statistical analysis, were involved in discussions of interpretation of data and commented on drafts of the manuscript. JW-L and LMM were involved in helping to set up the protocol, recruited and consented the participants, carried out all assessments, organised meetings and notes, scored all data and developed and inputted to the database. They commented on drafts of the manuscript and provided insights in relation to their experience in assessing all participants. The data on allostatic load in the paper were gathered as part of JWL's PhD. JH was involved in helping set up the protocol, processing blood, recruiting participants and reviewing the manuscript and attending meetings. WS was involved in planning the project, the development of the protocol and commented on drafts of the manuscript.

  • Funding LMM and JH were partly funded by the Sackler Foundation. JW-L was funded by the Chief Scientist Office (DTF/12/13). WS was supported by an NHS Research Scotland Career Researcher Fellowship.

  • Competing interests None declared.

  • Ethics approval University of Glasgow.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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