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Peer-reviewedCC BY 4.0Biology of Sport

What evidence supports primary prevention strategies for sport-related concussion? An umbrella review

  • Khaled Trabelsi1,2
  • Omar Boukhris3,4
  • Souhail Chebbi5
  • Waqar Husain6
  • Achraf Ammar7,8,9
  • Louis Holtzhausen10,11
  • Hamdi Chtourou12,13
  • Karim Chamari14,15
  • Haitham Jahrami16,17
17 affiliations
  1. 1Research laboratory Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education of Sfax, University of Sfax, Tunisia
  2. 2Department of Movement Sciences and Sports Training, School of Sport Science, The University of Jordan, Amman, Jordan
  3. 3Sport, Performance, and Nutrition Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
  4. 4SIESTA Research Group, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
  5. 5Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
  6. 6Department of Humanities, COMSATS University Islamabad, Islamabad Campus, Park Road, Islamabad, Pakistan
  7. 7Department of Training and Movement Science, Institute of Sport Science, Johannes Gutenberg-University Mainz, Mainz, Germany
  8. 8Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine of Sfax, University of Sfax, Sfax 3000, Tunisia
  9. 9Nutrition and Food Technology Department, School of Agriculture, the University of Jordan, Amman, Jordan
  10. 10Section Sports Medicine, University of Pretoria, South Africa
  11. 11Department of Exercise and Sport Sciences, University of the Free State, South Africa
  12. 12High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
  13. 13Research Unit Physical Activity, Sport and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia
  14. 14Naufar Center, Doha, Qatar
  15. 15Higher institute of Sport and Physical Education, ISSEP Ksar Saïd, Manouba University, Tunis, Tunisia
  16. 16Department of Psychiatry, College of Medicine and Health Sciences, Arabian Gulf University, Manama, Bahrain
  17. 17Government Hospitals, Manama, Bahrain
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Abstract

This umbrella review aimed to systematically evaluate and synthesize evidence from published systematic reviews on the effectiveness of primary prevention strategies for sport-related concussion (SRC) in athletes, and to identify areas of uncertainty relevant to policy and practice. A comprehensive search of the Cochrane Database of Systematic Reviews, Epistemonikos, ERIC, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science was conducted from 2001 to April 2025, with an updated search in November 2025. Peerreviewed systematic reviews, with or without meta-analyses, assessing primary prevention strategies to reduce SRC incidence in competitive athletes of any age or sex were eligible. Interventions included rule or policy changes, protective equipment, educational programs and training-based strategies. Twenty-five systematic reviews were included, eight of which contained meta-analyses; all were rated as critically low quality using the AMSTAR-2 tool. Rule and policy changes, particularly the disallowance of body checking in youth ice hockey, demonstrated the most consistent evidence for reducing SRC incidence. Meta-analyses evaluating mouthguards and headgear showed substantial overlap of primary studies and inconsistent effects. Educational interventions and training-based programs, including structured warm-up programs such as FIFA 11+ Kids, produced inconclusive findings. Evidence specific to female athletes was limited and insufficient to support any particular prevention strategy. Overall, rule and policy changes that reduce exposure to high-risk contact currently have the strongest supporting evidence for SRC prevention, whereas evidence for equipment, education and training remains mixed. Given the critically low methodological quality of existing reviews, higher-quality evidence syntheses and robust primary studies are urgently needed.

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Cite

BibTeXRIS
BibTeX
@article{trabelsi2026what,
  title = {{What evidence supports primary prevention strategies for sport-related concussion? An umbrella review}},
  author = {Khaled Trabelsi and Omar Boukhris and Souhail Chebbi and Waqar Husain and Achraf Ammar and Louis Holtzhausen and Hamdi Chtourou and Karim Chamari and Haitham Jahrami},
  journal = {Biology of Sport},
  year = {2026},
  month = jul,
  doi = {10.5114/biolsport.2026.161108},
  url = {https://doi.org/10.5114/biolsport.2026.161108},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - What evidence supports primary prevention strategies for sport-related concussion? An umbrella review
AU  - Khaled Trabelsi
AU  - Omar Boukhris
AU  - Souhail Chebbi
AU  - Waqar Husain
AU  - Achraf Ammar
AU  - Louis Holtzhausen
AU  - Hamdi Chtourou
AU  - Karim Chamari
AU  - Haitham Jahrami
PY  - 2026
DA  - 2026/07/13
JO  - Biology of Sport
DO  - 10.5114/biolsport.2026.161108
UR  - https://doi.org/10.5114/biolsport.2026.161108
AB  - This umbrella review aimed to systematically evaluate and synthesize evidence from published systematic reviews on the effectiveness of primary prevention strategies for sport-related concussion (SRC) in athletes, and to identify areas of uncertainty relevant to policy and practice. A comprehensive search of the Cochrane Database of Systematic Reviews, Epistemonikos, ERIC, PsycINFO, PubMed, Scopus, SPORTDiscus, and Web of Science was conducted from 2001 to April 2025, with an updated search in November 2025. Peerreviewed systematic reviews, with or without meta-analyses, assessing primary prevention strategies to reduce SRC incidence in competitive athletes of any age or sex were eligible. Interventions included rule or policy changes, protective equipment, educational programs and training-based strategies. Twenty-five systematic reviews were included, eight of which contained meta-analyses; all were rated as critically low quality using the AMSTAR-2 tool. Rule and policy changes, particularly the disallowance of body checking in youth ice hockey, demonstrated the most consistent evidence for reducing SRC incidence. Meta-analyses evaluating mouthguards and headgear showed substantial overlap of primary studies and inconsistent effects. Educational interventions and training-based programs, including structured warm-up programs such as FIFA 11+ Kids, produced inconclusive findings. Evidence specific to female athletes was limited and insufficient to support any particular prevention strategy. Overall, rule and policy changes that reduce exposure to high-risk contact currently have the strongest supporting evidence for SRC prevention, whereas evidence for equipment, education and training remains mixed. Given the critically low methodological quality of existing reviews, higher-quality evidence syntheses and robust primary studies are urgently needed.
SN  - 0860-021X
SN  - 2083-1862
ER  -