Ready for impact? A validity and feasibility study of instrumented mouthguards (iMGs)

Ben Jones; James Tooby; Dan Weaving; Kevin Till; Cameron Owen; Mark Begonia; Keith A Stokes; Steven Rowson; Gemma Phillips; Sharief Hendricks; Éanna Cian Falvey; Marwan Al-Dawoud; Gregory Tierney

doi:10.1136/bjsports-2022-105523

Ready for impact? A validity and feasibility study of instrumented mouthguards (iMGs)

Ben Jones, James Tooby, Dan Weaving, Kevin Till, Cameron Owen, Mark Begonia, Keith A Stokes, Steven Rowson, Gemma Phillips, Sharief Hendricks, Éanna Cian Falvey, Marwan Al-Dawoud, Gregory Tierney

Research output: Contribution to journal › Article › peer-review

55 Citations (Scopus)

31 Downloads (Pure)

Abstract

Objectives: Assess the validity and feasibility of current instrumented mouthguards (iMGs) and associated systems. Methods: Phase I; four iMG systems (Biocore-Football Research Inc (FRI), HitIQ, ORB, Prevent) were compared against dummy headform laboratory criterion standards (25, 50, 75, 100 g). Phase II; four iMG systems were evaluated for on-field validity of iMG-triggered events against video-verification to determine true-positives, false-positives and false-negatives (20±9 player matches per iMG). Phase III; four iMG systems were evaluated by 18 rugby players, for perceptions of fit, comfort and function. Phase IV; three iMG systems (Biocore-FRI, HitIQ, Prevent) were evaluated for practical feasibility (System Usability Scale (SUS)) by four practitioners. Results: Phase I; total concordance correlation coefficients were 0.986, 0.965, 0.525 and 0.984 for Biocore-FRI, HitIQ, ORB and Prevent. Phase II; different on-field kinematics were observed between iMGs. Positive predictive values were 0.98, 0.90, 0.53 and 0.94 for Biocore-FRI, HitIQ, ORB and Prevent. Sensitivity values were 0.51, 0.40, 0.71 and 0.75 for Biocore-FRI, HitIQ, ORB and Prevent. Phase III; player perceptions of fit, comfort and function were 77%, 6/10, 55% for Biocore-FRI, 88%, 8/10, 61% for HitIQ, 65%, 5/10, 43% for ORB and 85%, 8/10, 67% for Prevent. Phase IV; SUS (preparation-management) was 51.3-50.6/100, 71.3-78.8/100 and 83.8-80.0/100 for Biocore-FRI, HitIQ and Prevent. Conclusion: This study shows differences between current iMG systems exist. Sporting organisations can use these findings when evaluating which iMG system is most appropriate to monitor head acceleration events in athletes, supporting player welfare initiatives related to concussion and head acceleration exposure.

Original language	English
Article number	bjsports-2022-105523
Pages (from-to)	1-10
Number of pages	10
Journal	British Journal of Sports Medicine
Volume	56
Early online date	25 Jul 2022
DOIs	https://doi.org/10.1136/bjsports-2022-105523
Publication status	Published online - 25 Jul 2022

Bibliographical note

Funding Information:
The authors would like to thank all players and staff at Hull KR RLFC, Leeds Rhinos RLFC, St Helens RLFC, Wakefield Trinity RLFC, Warrington Wolves RLFC and Wigan Warriors RLFC for participating in the study. The authors would like to acknowledge the funding (dental scans, project expenses and Virginia Tech lab costs) provided by Leeds Beckett University, Carnegie School of Sport. The authors would like to thank all Super League CEOs, Laura Fairbank and Karen Moorhouse (Rugby Football League) for supporting the project. The authors acknowledge Brianna Mulhern and Mily Spiegelhalter for supporting data collection and Matt Halkier for supporting the video analysis. The authors would like to thank Dr Anthony Lovat (OPRO) for reviewing dental scans. Finally, the authors would like to acknowledge their sincere gratitude to Dr Nate Dau and Dr Lee Gabler (Biocore-Football Research Inc (FRI)), Damien Hawes and Tom Laudenbach (HitIQ), Robert Paterson and Thomas Quinn (ORB innovations) and Drew Goodger and Dr Adam Bartsch (Prevent Biometrics) for their support and cooperation during the study.

Funding Information:
GT, JT and DW have received Prevent Biometrics iMGs free of charge for use with Leeds Rhinos RLFC for a research project. BJ, MAD, KT are employed by Leeds Rhinos in a consultancy capacity. GT, JT and ÉCF use Prevent Biometrics iMG for research projects funded by World Rugby. GT submitted a funded research proposal for a different study to Prevent Biometrics during the review process of this article, which was subsequently successful. ÉCF is employed by World Rugby. BJ, JT, DW, KT, CO, KAS, GP, SH, MAD, GT are involved in the Rugby Football League Tackle and Contact Kinematic Load & Exposure (TaCKLE) project. BJ and KT will be involved in the procurement of iMGs for the TaCKLE project. BJ, GP are employed in a consultancy capacity by the Rugby Football League. KAS is employed by the Rugby Football Union. MB and SR lead the Virginia Tech Helmet Lab. Leeds Rhinos, World Rugby and Virginia Tech are research partners of Prevent Biometrics.

Publisher Copyright:
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Funding Information:
The authors would like to thank all players and staff at Hull KR RLFC, Leeds Rhinos RLFC, St Helens RLFC, Wakefield Trinity RLFC, Warrington Wolves RLFC and Wigan Warriors RLFC for participating in the study. The authors would like to acknowledge the funding (dental scans, project expenses and Virginia Tech lab costs) provided by Leeds Beckett University, Carnegie School of Sport. The authors would like to thank all Super League CEOs, Laura Fairbank and Karen Moorhouse (Rugby Football League) for supporting the project. The authors acknowledge Brianna Mulhern and Mily Spiegelhalter for supporting data collection and Matt Halkier for supporting the video analysis. The authors would like to thank Dr Anthony Lovat (OPRO) for reviewing dental scans. Finally, the authors would like to acknowledge their sincere gratitude to Dr Nate Dau and Dr Lee Gabler (Biocore-Football Research Inc (FRI)), Damien Hawes and Tom Laudenbach (HitIQ), Robert Paterson and Thomas Quinn (ORB innovations) and Drew Goodger and Dr Adam Bartsch (Prevent Biometrics) for their support and cooperation during the study.

Funding Information:
GT, JT and DW have received Prevent Biometrics iMGs free of charge for use with Leeds Rhinos RLFC for a research project. BJ, MAD, KT are employed by Leeds Rhinos in a consultancy capacity. GT, JT and ÉCF use Prevent Biometrics iMG for research projects funded by World Rugby. GT submitted a funded research proposal for a different study to Prevent Biometrics during the review process of this article, which was subsequently successful. ÉCF is employed by World Rugby. BJ, JT, DW, KT, CO, KAS, GP, SH, MAD, GT are involved in the Rugby Football League Tackle and Contact Kinematic Load & Exposure (TaCKLE) project. BJ and KT will be involved in the procurement of iMGs for the TaCKLE project. BJ, GP are employed in a consultancy capacity by the Rugby Football League. KAS is employed by the Rugby Football Union. MB and SR lead the Virginia Tech Helmet Lab. Leeds Rhinos, World Rugby and Virginia Tech are research partners of Prevent Biometrics.

Publisher Copyright:
©

Keywords

brain concussion
dentists
rugby
sporting injuries

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1136/bjsports-2022-105523

Ready-for-Impact-BJSM-R3-Clean---JDAuthor Accepted Manuscript, 156 KBLicence: CC BY-NC

Cite this

Jones, B., Tooby, J., Weaving, D., Till, K., Owen, C., Begonia, M., Stokes, K. A., Rowson, S., Phillips, G., Hendricks, S., Falvey, É. C., Al-Dawoud, M., & Tierney, G. (2022). Ready for impact? A validity and feasibility study of instrumented mouthguards (iMGs). British Journal of Sports Medicine, 56, 1-10. Article bjsports-2022-105523. Advance online publication. https://doi.org/10.1136/bjsports-2022-105523

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title = "Ready for impact? A validity and feasibility study of instrumented mouthguards (iMGs)",

abstract = "Objectives: Assess the validity and feasibility of current instrumented mouthguards (iMGs) and associated systems. Methods: Phase I; four iMG systems (Biocore-Football Research Inc (FRI), HitIQ, ORB, Prevent) were compared against dummy headform laboratory criterion standards (25, 50, 75, 100 g). Phase II; four iMG systems were evaluated for on-field validity of iMG-triggered events against video-verification to determine true-positives, false-positives and false-negatives (20±9 player matches per iMG). Phase III; four iMG systems were evaluated by 18 rugby players, for perceptions of fit, comfort and function. Phase IV; three iMG systems (Biocore-FRI, HitIQ, Prevent) were evaluated for practical feasibility (System Usability Scale (SUS)) by four practitioners. Results: Phase I; total concordance correlation coefficients were 0.986, 0.965, 0.525 and 0.984 for Biocore-FRI, HitIQ, ORB and Prevent. Phase II; different on-field kinematics were observed between iMGs. Positive predictive values were 0.98, 0.90, 0.53 and 0.94 for Biocore-FRI, HitIQ, ORB and Prevent. Sensitivity values were 0.51, 0.40, 0.71 and 0.75 for Biocore-FRI, HitIQ, ORB and Prevent. Phase III; player perceptions of fit, comfort and function were 77%, 6/10, 55% for Biocore-FRI, 88%, 8/10, 61% for HitIQ, 65%, 5/10, 43% for ORB and 85%, 8/10, 67% for Prevent. Phase IV; SUS (preparation-management) was 51.3-50.6/100, 71.3-78.8/100 and 83.8-80.0/100 for Biocore-FRI, HitIQ and Prevent. Conclusion: This study shows differences between current iMG systems exist. Sporting organisations can use these findings when evaluating which iMG system is most appropriate to monitor head acceleration events in athletes, supporting player welfare initiatives related to concussion and head acceleration exposure.",

keywords = "brain concussion, dentists, rugby, sporting injuries",

author = "Ben Jones and James Tooby and Dan Weaving and Kevin Till and Cameron Owen and Mark Begonia and Stokes, {Keith A} and Steven Rowson and Gemma Phillips and Sharief Hendricks and Falvey, {{\'E}anna Cian} and Marwan Al-Dawoud and Gregory Tierney",

note = "Funding Information: The authors would like to thank all players and staff at Hull KR RLFC, Leeds Rhinos RLFC, St Helens RLFC, Wakefield Trinity RLFC, Warrington Wolves RLFC and Wigan Warriors RLFC for participating in the study. The authors would like to acknowledge the funding (dental scans, project expenses and Virginia Tech lab costs) provided by Leeds Beckett University, Carnegie School of Sport. The authors would like to thank all Super League CEOs, Laura Fairbank and Karen Moorhouse (Rugby Football League) for supporting the project. The authors acknowledge Brianna Mulhern and Mily Spiegelhalter for supporting data collection and Matt Halkier for supporting the video analysis. The authors would like to thank Dr Anthony Lovat (OPRO) for reviewing dental scans. Finally, the authors would like to acknowledge their sincere gratitude to Dr Nate Dau and Dr Lee Gabler (Biocore-Football Research Inc (FRI)), Damien Hawes and Tom Laudenbach (HitIQ), Robert Paterson and Thomas Quinn (ORB innovations) and Drew Goodger and Dr Adam Bartsch (Prevent Biometrics) for their support and cooperation during the study. Funding Information: GT, JT and DW have received Prevent Biometrics iMGs free of charge for use with Leeds Rhinos RLFC for a research project. BJ, MAD, KT are employed by Leeds Rhinos in a consultancy capacity. GT, JT and {\'E}CF use Prevent Biometrics iMG for research projects funded by World Rugby. GT submitted a funded research proposal for a different study to Prevent Biometrics during the review process of this article, which was subsequently successful. {\'E}CF is employed by World Rugby. BJ, JT, DW, KT, CO, KAS, GP, SH, MAD, GT are involved in the Rugby Football League Tackle and Contact Kinematic Load & Exposure (TaCKLE) project. BJ and KT will be involved in the procurement of iMGs for the TaCKLE project. BJ, GP are employed in a consultancy capacity by the Rugby Football League. KAS is employed by the Rugby Football Union. MB and SR lead the Virginia Tech Helmet Lab. Leeds Rhinos, World Rugby and Virginia Tech are research partners of Prevent Biometrics. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ. Funding Information: The authors would like to thank all players and staff at Hull KR RLFC, Leeds Rhinos RLFC, St Helens RLFC, Wakefield Trinity RLFC, Warrington Wolves RLFC and Wigan Warriors RLFC for participating in the study. The authors would like to acknowledge the funding (dental scans, project expenses and Virginia Tech lab costs) provided by Leeds Beckett University, Carnegie School of Sport. The authors would like to thank all Super League CEOs, Laura Fairbank and Karen Moorhouse (Rugby Football League) for supporting the project. The authors acknowledge Brianna Mulhern and Mily Spiegelhalter for supporting data collection and Matt Halkier for supporting the video analysis. The authors would like to thank Dr Anthony Lovat (OPRO) for reviewing dental scans. Finally, the authors would like to acknowledge their sincere gratitude to Dr Nate Dau and Dr Lee Gabler (Biocore-Football Research Inc (FRI)), Damien Hawes and Tom Laudenbach (HitIQ), Robert Paterson and Thomas Quinn (ORB innovations) and Drew Goodger and Dr Adam Bartsch (Prevent Biometrics) for their support and cooperation during the study. Funding Information: GT, JT and DW have received Prevent Biometrics iMGs free of charge for use with Leeds Rhinos RLFC for a research project. BJ, MAD, KT are employed by Leeds Rhinos in a consultancy capacity. GT, JT and {\'E}CF use Prevent Biometrics iMG for research projects funded by World Rugby. GT submitted a funded research proposal for a different study to Prevent Biometrics during the review process of this article, which was subsequently successful. {\'E}CF is employed by World Rugby. BJ, JT, DW, KT, CO, KAS, GP, SH, MAD, GT are involved in the Rugby Football League Tackle and Contact Kinematic Load & Exposure (TaCKLE) project. BJ and KT will be involved in the procurement of iMGs for the TaCKLE project. BJ, GP are employed in a consultancy capacity by the Rugby Football League. KAS is employed by the Rugby Football Union. MB and SR lead the Virginia Tech Helmet Lab. Leeds Rhinos, World Rugby and Virginia Tech are research partners of Prevent Biometrics. Publisher Copyright: {\textcopyright}",

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month = jul,

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doi = "10.1136/bjsports-2022-105523",

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TY - JOUR

T1 - Ready for impact? A validity and feasibility study of instrumented mouthguards (iMGs)

AU - Jones, Ben

AU - Tooby, James

AU - Weaving, Dan

AU - Till, Kevin

AU - Owen, Cameron

AU - Begonia, Mark

AU - Stokes, Keith A

AU - Rowson, Steven

AU - Phillips, Gemma

AU - Hendricks, Sharief

AU - Falvey, Éanna Cian

AU - Al-Dawoud, Marwan

AU - Tierney, Gregory

N1 - Funding Information: The authors would like to thank all players and staff at Hull KR RLFC, Leeds Rhinos RLFC, St Helens RLFC, Wakefield Trinity RLFC, Warrington Wolves RLFC and Wigan Warriors RLFC for participating in the study. The authors would like to acknowledge the funding (dental scans, project expenses and Virginia Tech lab costs) provided by Leeds Beckett University, Carnegie School of Sport. The authors would like to thank all Super League CEOs, Laura Fairbank and Karen Moorhouse (Rugby Football League) for supporting the project. The authors acknowledge Brianna Mulhern and Mily Spiegelhalter for supporting data collection and Matt Halkier for supporting the video analysis. The authors would like to thank Dr Anthony Lovat (OPRO) for reviewing dental scans. Finally, the authors would like to acknowledge their sincere gratitude to Dr Nate Dau and Dr Lee Gabler (Biocore-Football Research Inc (FRI)), Damien Hawes and Tom Laudenbach (HitIQ), Robert Paterson and Thomas Quinn (ORB innovations) and Drew Goodger and Dr Adam Bartsch (Prevent Biometrics) for their support and cooperation during the study. Funding Information: GT, JT and DW have received Prevent Biometrics iMGs free of charge for use with Leeds Rhinos RLFC for a research project. BJ, MAD, KT are employed by Leeds Rhinos in a consultancy capacity. GT, JT and ÉCF use Prevent Biometrics iMG for research projects funded by World Rugby. GT submitted a funded research proposal for a different study to Prevent Biometrics during the review process of this article, which was subsequently successful. ÉCF is employed by World Rugby. BJ, JT, DW, KT, CO, KAS, GP, SH, MAD, GT are involved in the Rugby Football League Tackle and Contact Kinematic Load & Exposure (TaCKLE) project. BJ and KT will be involved in the procurement of iMGs for the TaCKLE project. BJ, GP are employed in a consultancy capacity by the Rugby Football League. KAS is employed by the Rugby Football Union. MB and SR lead the Virginia Tech Helmet Lab. Leeds Rhinos, World Rugby and Virginia Tech are research partners of Prevent Biometrics. Publisher Copyright: © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ. Funding Information: The authors would like to thank all players and staff at Hull KR RLFC, Leeds Rhinos RLFC, St Helens RLFC, Wakefield Trinity RLFC, Warrington Wolves RLFC and Wigan Warriors RLFC for participating in the study. The authors would like to acknowledge the funding (dental scans, project expenses and Virginia Tech lab costs) provided by Leeds Beckett University, Carnegie School of Sport. The authors would like to thank all Super League CEOs, Laura Fairbank and Karen Moorhouse (Rugby Football League) for supporting the project. The authors acknowledge Brianna Mulhern and Mily Spiegelhalter for supporting data collection and Matt Halkier for supporting the video analysis. The authors would like to thank Dr Anthony Lovat (OPRO) for reviewing dental scans. Finally, the authors would like to acknowledge their sincere gratitude to Dr Nate Dau and Dr Lee Gabler (Biocore-Football Research Inc (FRI)), Damien Hawes and Tom Laudenbach (HitIQ), Robert Paterson and Thomas Quinn (ORB innovations) and Drew Goodger and Dr Adam Bartsch (Prevent Biometrics) for their support and cooperation during the study. Funding Information: GT, JT and DW have received Prevent Biometrics iMGs free of charge for use with Leeds Rhinos RLFC for a research project. BJ, MAD, KT are employed by Leeds Rhinos in a consultancy capacity. GT, JT and ÉCF use Prevent Biometrics iMG for research projects funded by World Rugby. GT submitted a funded research proposal for a different study to Prevent Biometrics during the review process of this article, which was subsequently successful. ÉCF is employed by World Rugby. BJ, JT, DW, KT, CO, KAS, GP, SH, MAD, GT are involved in the Rugby Football League Tackle and Contact Kinematic Load & Exposure (TaCKLE) project. BJ and KT will be involved in the procurement of iMGs for the TaCKLE project. BJ, GP are employed in a consultancy capacity by the Rugby Football League. KAS is employed by the Rugby Football Union. MB and SR lead the Virginia Tech Helmet Lab. Leeds Rhinos, World Rugby and Virginia Tech are research partners of Prevent Biometrics. Publisher Copyright: ©

PY - 2022/7/25

Y1 - 2022/7/25

N2 - Objectives: Assess the validity and feasibility of current instrumented mouthguards (iMGs) and associated systems. Methods: Phase I; four iMG systems (Biocore-Football Research Inc (FRI), HitIQ, ORB, Prevent) were compared against dummy headform laboratory criterion standards (25, 50, 75, 100 g). Phase II; four iMG systems were evaluated for on-field validity of iMG-triggered events against video-verification to determine true-positives, false-positives and false-negatives (20±9 player matches per iMG). Phase III; four iMG systems were evaluated by 18 rugby players, for perceptions of fit, comfort and function. Phase IV; three iMG systems (Biocore-FRI, HitIQ, Prevent) were evaluated for practical feasibility (System Usability Scale (SUS)) by four practitioners. Results: Phase I; total concordance correlation coefficients were 0.986, 0.965, 0.525 and 0.984 for Biocore-FRI, HitIQ, ORB and Prevent. Phase II; different on-field kinematics were observed between iMGs. Positive predictive values were 0.98, 0.90, 0.53 and 0.94 for Biocore-FRI, HitIQ, ORB and Prevent. Sensitivity values were 0.51, 0.40, 0.71 and 0.75 for Biocore-FRI, HitIQ, ORB and Prevent. Phase III; player perceptions of fit, comfort and function were 77%, 6/10, 55% for Biocore-FRI, 88%, 8/10, 61% for HitIQ, 65%, 5/10, 43% for ORB and 85%, 8/10, 67% for Prevent. Phase IV; SUS (preparation-management) was 51.3-50.6/100, 71.3-78.8/100 and 83.8-80.0/100 for Biocore-FRI, HitIQ and Prevent. Conclusion: This study shows differences between current iMG systems exist. Sporting organisations can use these findings when evaluating which iMG system is most appropriate to monitor head acceleration events in athletes, supporting player welfare initiatives related to concussion and head acceleration exposure.

AB - Objectives: Assess the validity and feasibility of current instrumented mouthguards (iMGs) and associated systems. Methods: Phase I; four iMG systems (Biocore-Football Research Inc (FRI), HitIQ, ORB, Prevent) were compared against dummy headform laboratory criterion standards (25, 50, 75, 100 g). Phase II; four iMG systems were evaluated for on-field validity of iMG-triggered events against video-verification to determine true-positives, false-positives and false-negatives (20±9 player matches per iMG). Phase III; four iMG systems were evaluated by 18 rugby players, for perceptions of fit, comfort and function. Phase IV; three iMG systems (Biocore-FRI, HitIQ, Prevent) were evaluated for practical feasibility (System Usability Scale (SUS)) by four practitioners. Results: Phase I; total concordance correlation coefficients were 0.986, 0.965, 0.525 and 0.984 for Biocore-FRI, HitIQ, ORB and Prevent. Phase II; different on-field kinematics were observed between iMGs. Positive predictive values were 0.98, 0.90, 0.53 and 0.94 for Biocore-FRI, HitIQ, ORB and Prevent. Sensitivity values were 0.51, 0.40, 0.71 and 0.75 for Biocore-FRI, HitIQ, ORB and Prevent. Phase III; player perceptions of fit, comfort and function were 77%, 6/10, 55% for Biocore-FRI, 88%, 8/10, 61% for HitIQ, 65%, 5/10, 43% for ORB and 85%, 8/10, 67% for Prevent. Phase IV; SUS (preparation-management) was 51.3-50.6/100, 71.3-78.8/100 and 83.8-80.0/100 for Biocore-FRI, HitIQ and Prevent. Conclusion: This study shows differences between current iMG systems exist. Sporting organisations can use these findings when evaluating which iMG system is most appropriate to monitor head acceleration events in athletes, supporting player welfare initiatives related to concussion and head acceleration exposure.

KW - brain concussion

KW - dentists

KW - rugby

KW - sporting injuries

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UR - https://bjsm.bmj.com/content/early/2022/07/25/bjsports-2022-105523

U2 - 10.1136/bjsports-2022-105523

DO - 10.1136/bjsports-2022-105523

M3 - Article

C2 - 35879022

SN - 0306-3674

VL - 56

SP - 1

EP - 10

JO - British Journal of Sports Medicine

JF - British Journal of Sports Medicine

M1 - bjsports-2022-105523

ER -

Ready for impact? A validity and feasibility study of instrumented mouthguards (iMGs)

Abstract

Bibliographical note

Keywords

UN SDGs

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