Facts and values: on the acceptability of risks in children's sport using the example of rugby - a narrative review.

A clash of values has been identified between those who assert that:1. all childhood injuries, regardless of origin, are inherently undesirable and should be prevented and;2. those who believe that some measure of injury to children is an acceptable compromise for the physical benefits associated with physical activity and the development of abilities to appraise and deal with risks.A debate regarding whether the tackles and collisions permitted in schools' rugby represent acceptable risks, and what steps should be taken if they do not, exemplifies the issue.Questions regarding the magnitude of injury risks in sport are issues of fact and can be quantified via the results of injury surveillance studies. Risks are neither high nor low in isolation; they are relatively high or low with reference to other activities or across groups participating in an activity. Issues of the acceptability of a given degree of risk are value dependent. Research regarding perceptions of risk reveals wide variations in the degree of risk people view as acceptable. Factors impacting on risk perception include whether the risks are well known and understood, whether they are 'dread' risks and the degree to which people undertake the risks voluntarily and feel they have control over them.Based on the evidence currently available, the risks to children playing rugby do not appear to be inordinately high compared with those in a range of other childhood sports and activities, but better comparative information is urgently needed. Further evidence, however, should not necessarily be expected to result in the resolution of acceptable risk debates-pre-existing values shape our perspectives on whether new evidence is relevant, valid and reliable.
Competing Interests: Competing interests: Dr Ken Quarrie is employed by New Zealand Rugby, in the role of Senior Scientist; is a member of World Rugby’s Medical, Science and Research Working Group, a member of World Rugby’s Scientific Committee, and a member of World Rugby’s Scrum Steering Group. He is aware of, and complies with, the professional standards expected of scientists as stated in the Royal Society of New Zealand’s Code of Professional Standards in Ethics in Science, Technology and the Humanities. Professor Patria Hume specialises in sports injury prevention research, specifically sports injury biomechanics, sports injury epidemiology and sports kinanthropometry. She is aware of, and complies with, the professional standards expected of scientists stated in the Royal Society of New Zealand’s Code of Professional Standards in Ethics in Science, Technology and the Humanities. She was commissioned by World Rugby and New Zealand Rugby to lead the WR/NZR/AUT Rugby Health study in New Zealand, for which AUT received financial contribution towards her salary and other co-researchers’ salaries and study costs. Professor Hume was a co-supervisor for Ken Quarrie’s PhD. Nicholas Burger is a doctoral student at the University of Cape Town (UCT) specialising in the field of tackle-related injury epidemiology and tackle performance in youth rugby union players. He has previously worked as a researcher for the South African Rugby Union (SA Rugby) and the BokSmart National Rugby Safety Programme, and was granted access to the SA Rugby injury and video databases for use in his thesis. He attests that his research is in accordance with the guidelines and SOPs established by the UCT Human Research Ethics Committee and all his studies have received ethical approval. Dr John Brooks was formerly employed by the Rugby Football Union as a researcher examining the epidemiology of rugby among professional players in the United Kingdom. He is currently practising medicine. Dr Steve Jackson has no relevant conflicts of interest.
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