Evert Verhagen


The project team is composed of James Brown (PhD Candidate), Evert Verhagen (Associate Professor), Mike Lambert (Professor) and Willem van Mechelen (Professor). This project is funded through the Desmond Tutu Programme; an academic programme of VU University Amsterdam and the National Research Foundation (NRF), South Africa, which aims to strengthen the cooperation between VU University Amsterdam and South African Higher Education Institutions. This project is a joined project between VUmc and the University of Capetown.


Background:There are approximately 500,000 rugby union players in South Africa ranging from junior schoolboys to senior professional players. As with all types of sports involving collision of players at high speed there is always a high risk for (severe) injury, next to the risk of catastrophic injury resulting in either death or permanent damage. Indeed in the last eight years, since records of serious injuries were maintained with reasonable accuracy, there have been an average of 7 catastrophic injuries among schoolboys, and an average of 15 catastrophic injuries among all players. These statistics are conservative as they do not account for those players missed or not detected by the recording system. In an attempt to make the game safer for all players and reduce the risk of catastrophic injuries, the governing body of rugby in South Africa supported the concept of implementing a programme designed to improve safety and reduce the risk of serious injury in rugby. After collaboration with the managers of similar existing programmes in New Zealand (‘Rugbysmart’)1 and Australia (‘Smartrugby’) the Boksmart programme, customised for the needs of rugby in South Africa, was launched in July 2009. 

Objective: This study aims to evaluate the overall effectiveness of the Boksmart programme and recommend improvements that will increase the programme’s effectiveness and reach.

The following sub-studies are addressed:

What is the prevalence and nature of rugby union injuries at the national level?

Doctors at national rugby tournaments (under 13, under 16,  under 18, and Club championship) are required to complete a registration describing the details of each injury incurred during a tournament. The recorded data includes a description of the injury and details on the circumstances of the match, which caused the injury. Data about the playing  field  and environmental conditions at the time of injury are also included. The questionnaires have been prepared in accordance with the recommendations made in the consensus document.

What are the incidence and causes of catastrophic rugby injuries?

Next to data obtained during tournaments. Medical facilities around the country have been instructed to report any catastrophic injury as a result of rugby. Details about these injuries are then recorded. After the injury has stabilised the player is visited by a Serious Case report manager who collects more information about the circumstances of the injury and the long term prognosis.

Is there an overall improvement in knowledge, attitude and behaviour associated with rugby injuries and their prevention during the course of the Boksmart programme?

Data are collected from all Boksmart participants trained around the country, the characteristics of the instructors and the subjective ratings of the quality of the workshop. Furthermore, data are collected on specific aspects of the training and the distribution of safety equipment after training. A random selection of participants who received  the training are contacted by phone after the course and are asked to complete a questionnaire on their coaching, prevention and medical activities at matches and practices.

Does the players’ knowledge, attitude and behaviour associated with rugby injuries and their prevention change during the course of the Boksmart programme?

Players at the annual national under 18 tournament (approximately 450 players) and the National club championships (approximately 400 players) complete a questionnaire which assesses the knowledge, attitude and behaviour about injuries and the prevention and acute management thereof. This questionnaire was completed for the first time in 2008 (i.e. before the BokSmart programme was launched).

Do the injury rates of rugby union related injuries change during the course of the Boksmart programme?

Here the data from subsequent annual tournament registrations will be used. In addition, all the telephone calls concerning rugby-related injuries received by the toll free number during the course of the Boksmart programme are data-logged. Information about the characteristics of the injured player, the details about injury and the response of the emergency services are also logged for each call.