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Effect of nationwide injury prevention programme on serious spinal injuries in New Zealand rugby union: ecological study

BMJ 2007; 334 doi: (Published 31 May 2007) Cite this as: BMJ 2007;334:1150
  1. Kenneth L Quarrie, manager1,
  2. Simon M Gianotti, programme manager2,
  3. Will G Hopkins, chair3,
  4. Patria A Hume, director4
  1. 1Research & Injury Prevention, New Zealand Rugby Union, PO Box 2172, Wellington, New Zealand
  2. 2Sport & Road, Accident Compensation Corporation, Wellington
  3. 3Exercise Science, Institute of Sport & Recreation Research New Zealand, Faculty of Health and Environmental Science, AUT University, Auckland 1020, New Zealand
  4. 4Institute of Sport & Recreation Research New Zealand
  1. Correspondence to: K Quarrie ken.quarrie{at}
  • Accepted 5 April 2007


Objective To investigate the effect of RugbySmart, a nationwide educational injury prevention programme, on the frequency of spinal cord injuries.

Design Ecological study.

Setting New Zealand rugby union.

Participants Population at risk of injury comprised all New Zealand rugby union players.

Intervention From 2001, all New Zealand rugby coaches and referees have been required to complete RugbySmart, which focuses on educating rugby participants about physical conditioning, injury management, and safe techniques in the contact phases of rugby.

Main outcome measures Numbers of all spinal injuries due to participation in rugby union resulting in permanent disablement in 1976-2005, grouped into five year periods; observed compared with predicted number of spinal injuries in 2001-5.

Results Eight spinal injuries occurred in 2001-5, whereas the predicted number was 18.9 (relative rate=0.46, 95% confidence interval 0.19 to 1.14). Only one spinal injury resulted from scrums over the period; the predicted number was 9.0 (relative rate=0.11, 0.02 to 0.74). Corresponding observed and predicted rates for spinal injuries resulting from other phases of play (tackle, ruck, and maul) were 7 and 9.0 (relative rate=0.83, 0.29 to 2.36).

Conclusions The introduction of the RugbySmart programme coincided with a reduction in the rate of disabling spinal injuries arising from scrums in rugby union. This study exemplifies the benefit of educational initiatives in injury prevention and the need for comprehensive injury surveillance systems for evaluating injury prevention initiatives in sport.


  • We acknowledge the assistance of staff from the Accident Compensation Corporation, the New Zealand Rugby Union, and the New Zealand Rugby Foundation in the preparation of this manuscript. We also gratefully recognise the work of provincial union rugby development officers and referee education officers in delivering the RugbySmart programme to coaches and players throughout New Zealand.

  • Contributors: KLQ reviewed the literature, led the writing of the paper, and contributed to the design and analysis. He was responsible for the development and delivery of RugbySmart on behalf of the New Zealand Rugby Union from the inception of the programme. SMG was responsible for extracting and verifying injury data from Accident Compensation Corporation records and writing the section of the methods on the Accident Compensation Corporation system; he contributed to the writing of the remainder of the paper. He was responsible for the development and delivery of RugbySmart on behalf of Accident Compensation Corporation from 2002 onwards. WGH provided statistical advice and contributed to analyses. He provided editorial comment on a draft version of the paper. PAH led the development of the 10 point action for sports injury prevention that was used as a template for RugbySmart. She provided editorial comments on a final draft of the paper. KLQ is the guarantor.

  • Funding: None for the preparation of the manuscript. The RugbySmart programme is funded by the Accident Compensation Corporation and the New Zealand Rugby Union. The employment positions of SMG (Accident Compensation Corporation) and KLQ (New Zealand Rugby Union) are funded by the respective organisations.

  • Competing interests: KLQ and SMG are responsible for the production of the RugbySmart programme on behalf of the New Zealand Rugby Union and Accident Compensation Corporation respectively. WGH and PAH: none declared.

  • Ethical approval: AUT University ethics board.

  • Accepted 5 April 2007
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