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)

Br J Sports Med. 2022 Jul 25:bjsports-2022-105523. doi: 10.1136/bjsports-2022-105523. Online ahead of print.

Authors

Ben Jones^{1

2

3

4

5}, James Tooby⁶, Dan Weaving⁶, Kevin Till^{6

3}, Cameron Owen^{6

2}, Mark Begonia⁷, Keith A Stokes^{8

9}, Steven Rowson⁷, Gemma Phillips^{6

2

10}, Sharief Hendricks^{6

4}, Éanna Cian Falvey^{11

12}, Marwan Al-Dawoud⁶, Gregory Tierney¹³

Affiliations

¹ Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK B.Jones@leedsbeckett.ac.uk.
² England Performance Unit, Rugby Football League, Manchester, UK.
³ Leeds Rhinos, Leeds, UK.
⁴ Human Biology, University of Cape Town, Division of Exercise and Sports Medicine, Cape Town, South Africa.
⁵ School of Science and Technology, University of New England, Armidale, New South Wales, Australia.
⁶ Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University, Leeds, UK.
⁷ Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA.
⁸ Department for Health, University of Bath, Bath, UK.
⁹ Rugby Football Union, Twickenham, UK.
¹⁰ Hull Kingston Rovers, Hull, UK.
¹¹ World Rugby, World Rugby, Dublin, Ireland.
¹² Department of Medicine, University College Cork, Cork, Ireland.
¹³ School of Sport, Ulster University, Belfast, UK.

PMID: 35879022
DOI: 10.1136/bjsports-2022-105523

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.