1
|
Buckley TA, Passalugo SW, Gallo CA, Bodt B, Evans KM, Munkasy BA. Collegiate student-athletes concussion knowledge and attitudes: what a difference a decade Makes. Brain Inj 2024; 38:288-294. [PMID: 38369869 PMCID: PMC10911450 DOI: 10.1080/02699052.2024.2314549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/31/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE The purpose of this study was to assess changes in concussion knowledge and attitudes amongst incoming intercollegiate student-athletes over the course of a decade (2010-2012 vs 2021-2023). METHODS There were 592 student-athletes from 2 cohorts (2010-2012, 2021-2023) who completed the Rosenbaum Concussion Knowledge and Attitudes Survey (ROCKaS) questionnaire which is comprised of a concussion knowledge index (CKI, 0-24) and attitude index (CAI, 15-75) with higher scores reflecting better performance. A three factor ANOVA (Group, Sex, Concussion History) compared performance on the CKI and CAI. Individual questions were compared between groups with a Chi-Square analysis. RESULTS For the CKI, there was a significant main effect for Group (2010-2012: 18.5 ± 2.6, 2021-2023: 19.4 ± 2.5, p < 0.001, η 2 = 0.032 ) . For the CAI, there was also a significant main effect for group (2010-2012: 52.9 ± 6.0, 2021-2023: 62.2 ± 6.5, p < 0.001, η 2 = 0.359 ) . CONCLUSIONS The results of this study show a modest increase in concussion knowledge; however, large improvements in concussion attitudes were observed between groups. These results suggest a continued improvement in student-athlete concussion awareness and provide specific areas to continue addressing persistent misconceptions.
Collapse
Affiliation(s)
- Thomas A Buckley
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Scott W Passalugo
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Caitlin A Gallo
- Interdisciplinary Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Barry Bodt
- College of Health Sciences, University of Delaware, Newark, Delaware, USA
| | - Kelsey M Evans
- Department of General Surgery, Orlando Health, Orlando, Florida, USA
| | - Barry A Munkasy
- School of Health Sciences and Kinesiology, Georgia Southern University, Statesboro, Georgia, USA
| |
Collapse
|
2
|
Brancaleone MP, Shingles RR, Weber ZA. Effect of Hearing Status on Concussion Knowledge and Attitudes of Collegiate Athletes. J Sport Rehabil 2024:1-8. [PMID: 38253049 DOI: 10.1123/jsr.2023-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
CONTEXT Collegiate athletes who are deaf or hard-of-hearing (D/HoH) are diagnosed with concussions at a similar rate as athletes who are hearing; however, little evidence exists on knowledge and attitudes of athletes who are D/HoH toward concussions. This study aimed to examine differences in knowledge of and attitudes toward concussions between athletes who are D/HoH and athletes who are hearing. DESIGN Cross-sectional research design. METHODS Of the 310 athletes who are D/HoH and 430 athletes who are hearing that were invited to participate, 90 athletes who are D/HoH, and 72 athletes who are hearing completed the survey. The Rosenbaum Concussion Knowledge and Attitudes Survey was used to quantify knowledge of and attitude toward concussions. The Rosenbaum Concussion Knowledge and Attitudes Survey consists of the concussion knowledge index (CKI) and the concussion attitudes index (CAI) subscales. Linear regressions were run to test the association of hearing status with CKI and CAI scores. Pearson correlations were performed to determine relationships between CKI and CAI for athletes who are D/HoH and athletes who are hearing. Alpha level was set a priori at P ≤ .05. RESULTS Athletes who are hearing demonstrated a higher CKI component score (19.58 [2.19]) compared to athletes who are D/HoH (16.14 [3.31]; P < .001). There were no statistical differences in CAI between hearing groups (hearing: 57.18 [8.73], D/HoH: 55.97 [9.92]; P = .41). There was a moderate positive correlation between CKI and CAI (r = .58) for athletes who are D/HoH, while a weak positive correlation (r = .30) for athletes who are hearing was observed. CONCLUSIONS Athletes who are D/HoH have poorer knowledge of concussions but similar attitudes toward concussion as that of athletes who are hearing. Current concussion educational interventions are in written or spoken form which may not be inclusive to athletes who are D/HoH. Health care professionals should consider an athlete's preferred communication mode to improve the efficiency and effectiveness of education.
Collapse
Affiliation(s)
- Matthew P Brancaleone
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
| | - René R Shingles
- School of Rehabilitation and Medical Sciences, Central Michigan University, Mt. Pleasant, MI, USA
| | | |
Collapse
|
3
|
Kossman MK, Kerr ZY, DeFreese JD, Kucera KL, Petschauer MA, Ribisl KM, Register-Mihalik JK. Concussion-Related Decision-Making by Certified Athletic Trainers: Implications for Concussion Prevention and Care. Int J Environ Res Public Health 2024; 21:82. [PMID: 38248545 PMCID: PMC10815082 DOI: 10.3390/ijerph21010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/21/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
Concussions are a common sport-related injury that require appropriate initial care. Athletic trainers, often a primary source of healthcare for student-athletes, are key individuals involved in initial concussion diagnostic and management decisions. Challenges exist within the athletic environment that may hinder the consistency, efficacy, and/or effectiveness of concussion-related decision-making by athletic trainers, thereby impacting secondary concussion prevention and patient health. The purpose of this study was to identify factors that impact the intentions of athletic trainers to make appropriate concussion-related decisions under various circumstances. Overall, 1029 participants completed a survey examining educational precursors (quantity and quality of healthcare communication educational focus), demographic precursors (age, gender, educational degree, and employment setting), theory-based mediators (attitudes, perceived norms, and personal agency), and external mediators (knowledge, salience, and communication/collaboration practices) on appropriate concussion-related decision-making intentions. Data were analyzed using a two-step structural equation modeling approach. Quality of healthcare communication educational focus indirectly impacted appropriate concussion-related decision-making intentions via perceived behavioral control and communication/collaboration practices. Additionally, several factors impacted intentions to make appropriate concussion-related decisions directly including employment setting, self-efficacy, and general attitudes towards decision-making and concussions. Concussion prevention is aided by the initial and appropriate action taken by a healthcare professional to reduce immediate consequences; however, this action may be influenced by stakeholder relationships. These influential factors of decision-making may place athletes at further injury risk and negatively impact overall athlete health. As such, a sound theoretical framework incorporating the complexity of factors that may influence decision-making is needed.
Collapse
Affiliation(s)
- Melissa K. Kossman
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
- Sports Medicine and Community Health Research Lab, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- Center for Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristen L. Kucera
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- National Center for Catastrophic Sport Injury Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Meredith A. Petschauer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
| | - Kurt M. Ribisl
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Johna K. Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- STAR Heel Performance Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| |
Collapse
|
4
|
Black AM, Turcotte K, Fidanova A, Sadler K, Bruin S, Cheng P, Karmali S, Taylor T, Halliday D, Babul S. Development of a tailored concussion education program for athletes: a pragmatic multimethods design and integrated knowledge translation approach from needs assessment to design. BMJ Open 2023; 13:e075080. [PMID: 38030256 PMCID: PMC10689399 DOI: 10.1136/bmjopen-2023-075080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES To understand Canadian university athletic programme concussion management needs, and to describe development and content of a tailored online concussion education tool for Canadian university/college athletes. DESIGN An integrated knowledge translation multiphased, multimethods approach was used. Phases included a needs assessment survey with university representatives and athletes, content selection, mapping behavioural goals to evidenced-based behaviour change techniques, script/storyboard development, engagement interviews with university athletes and tool development using user-centred design techniques. SETTING Canadian U SPORTS universities (n=56). PARTICIPANTS Overall, 64 university representatives (eg, administrators, clinicians) and 27 varsity athletes (52% male, 48% female) completed the needs assessment survey. Five athletes participated in engagement interviews. OUTCOME MEASURES Surveys assessed previous athlete concussion education, recommendations for concussion topics and tool design, concussion management challenges and interest in implementing a new course. RESULTS Institutions used a median (Med) of two (range 1-5) approaches when educating athletes about concussion. Common approaches were classroom-style education (50%), online training (41%) and informational handouts (39%). University representatives rated most important topics as: (1) what is a concussion, (2) how to recognise a concussion and (3) how to report a concussion (Medall=4.8/5). Athletes felt symptom recognition (96%) and effects on the brain (85%) were most important. The majority of athletes preferred learning via computer (81%) and preferred to learn alone (48%) versus group learning (7%). The final resource was designed to influence four behaviours: (1) report symptoms, (2) seek care, (3) encourage teammates to report symptoms and (4) support teammates through concussion recovery. Examples of behaviour change techniques included: knowledge/skills, problem-solving scenarios, verbal persuasion and social comparison. Athletes are guided through different interactions (eg, videos, flip cards, scenarios, testimonials) to maximise engagement (material review takes ~30 min). CONCLUSIONS The Concussion Awareness Training Tool for athletes is the first Canadian education tool designed to address the needs of Canadian university/college athletes.
Collapse
Affiliation(s)
- Amanda M Black
- Centre for Healthy Youth Development through Sport, Department of Kinesiology, Faculty of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Kate Turcotte
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Alex Fidanova
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Karen Sadler
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Samantha Bruin
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Phoebe Cheng
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Shazya Karmali
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Taryn Taylor
- Carleton Sport Medicine Clinic, Carleton University, Ottawa, Ontario, Canada
| | - Drew Halliday
- Queen Alexandra Centre for Children's Health, Victoria, British Columbia, Canada
| | - Shelina Babul
- BC Injury Research and Prevention Unit, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Archambault W, Ellemberg D. Hard-Headed Decisions: Intrapersonal Factors Underlying Concussion Reporting in University Athletes. Neurotrauma Rep 2023; 4:533-542. [PMID: 37636338 PMCID: PMC10457645 DOI: 10.1089/neur.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
Most of the research investigating sports concussion (SC) disclosure has been conducted using questionnaires with a pre-determined set of questions. Hence, significant gaps remain in our understanding of which factors weight in the decision-making process underlying SC disclosure and how they contribute to it. This present study aims to fill some of these gaps using qualitative methods to identify intrapersonal determinants of SC disclosure and describe their influence on an athlete's decision-making process. Our results are based on in-depth, semistructured interviews (range, 56-79 min; total = 587 min) with 9 university athletes (5 females, 4 males) from three team sports (soccer, rugby, and cheerleading). Using constant comparative analysis guided by Straussian grounded theory, we identified 13 concepts, across three major intrapersonal categories (i.e., attitudes and behaviors; concussion knowledge; and subjective evaluation of the concussion), contributing to SC disclosure, including novel determinants such as prioritization of athletic versus intellectual activities and maturity level. Our results suggest that a comparison between experiential knowledge and severity of the injury plays a major role in determining an athlete's disclosure behaviors. Athletes with a history of concussion seem to adopt a non-disclosure default strategy and are inclined to disclose their concussion symptoms only if they judge their current concussion to be worse than their previous most severe injury. Other concepts identified appear to contribute to the decisional process by modulating the adoption of this non-disclosure default strategy. Our work highlights the benefits and necessity of using qualitative methods to study the decision-making process underlying concussion disclosure.
Collapse
Affiliation(s)
- William Archambault
- École de Kinésiologie et des science de l'activité physique, Université de Montréal, Montréal, Quebec, Canada
- Ingram School of Nursing, McGill University, Montréal, Quebec, Canada
| | - Dave Ellemberg
- École de Kinésiologie et des science de l'activité physique, Université de Montréal, Montréal, Quebec, Canada
| |
Collapse
|
6
|
Xu MA, Choi J, Capasso A, DiClemente R. Patient-Provider Health Communication Strategies: Enhancing HPV Vaccine Uptake among Adolescents of Color. Healthcare (Basel) 2023; 11:1702. [PMID: 37372820 DOI: 10.3390/healthcare11121702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Cervical cancer remains a public health issue in the United States, particularly among stigmatized racial and ethnic populations. The human papillomavirus (HPV) vaccine has been clinically proven to prevent cervical cancers, and other HPV-associated cancers, among men and women. However, HPV vaccine uptake is suboptimal; only 55% of adolescents complete the two-dose series by age 15. Past research has shown that provider HPV vaccine communication for people of marginalized races/ethnicities is subpar. This article focuses on provider communication strategies to promote HPV vaccine uptake effectively and equitably. The authors reviewed the literature on evidence-based patient-provider HPV vaccine communication techniques to create a set of communication language providers could use and avoid using to enhance HPV vaccine acceptance and uptake among adolescents of marginalized racial and ethnic groups. Evidence has shown that information and the manner of dissemination are critical for influencing HPV vaccine uptake. These communication strategies must be suited to the context of the targeted population, and the message content can be broadly categorized into source, content, and modality. Strategies to improve patient-provider communication among adolescents of color using source, modality, and content include the following: (1) Source: increase provider self-efficacy to provide the recommendation, building rapport between providers and parents; (2) Content: persistent, forceful language with minimal acquiescence should be employed, reframing the conversation focus from sex to cancer; and (3) Modality: use multiple vaccine reminder modalities, and work with the community to culturally adapt the vaccination language. Utilizing effective behavior-change communication adapted for adolescents of color can reduce missed opportunities for HPV prevention, potentially decreasing racial and ethnic disparities in HPV-related morbidity and mortality.
Collapse
Affiliation(s)
- Mia Ann Xu
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | - Jasmin Choi
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| | | | - Ralph DiClemente
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY 10003, USA
| |
Collapse
|
7
|
Abbott A, Ramos T, Smith WAR, Ierulli VK, Mulcahey MK. Concussion Education for Athletes: Symptom Reporting and Safe Return to Sport. JBJS Rev 2023; 11:01874474-202306000-00013. [PMID: 37327353 DOI: 10.2106/jbjs.rvw.23.00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
» Educational programs on concussion have been demonstrated to improve knowledge for athletes, families, athletic trainers, and coaches about concussion, with the goal of reducing concussion incidence, duration, severity, and complications.» Despite the widespread availability and often mandatory concussion education provided to high school and collegiate athletes, there has not been an adequate change in knowledge, attitudes, and self-reporting behavior in this population.» Recently published studies suggest improving concussion education by emphasizing athletes' symptom reporting behavior, to contrast with current emphasis on knowledge-based outcomes.» Future educational programs about concussions for athletes, families, athletic trainers, and coaches should aim to emphasize cultural and behavioral changes that demonstrate outcome changes rather than solely evaluating knowledge improvements to determine effective programming.
Collapse
Affiliation(s)
| | - Tolulope Ramos
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Wyatt A R Smith
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Victoria K Ierulli
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| |
Collapse
|
8
|
Solly H, Badenhorst CE, McCauley M, Slater GJ, Gifford JA, Erueti B, Beck KL. Athlete Preferences for Nutrition Education: Development of and Findings from a Quantitative Survey. Nutrients 2023; 15:nu15112519. [PMID: 37299484 DOI: 10.3390/nu15112519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Nutrition education (NE) is one of several strategies aimed at enhancing the dietary intake of athletes. This study investigated NE preferences of New Zealand and Australian athletes competing nationally and internationally. Athletes (n = 124, 22 (18, 27) years, female 54.8%) from 22 sports completed an online survey, with responses analysed using descriptive statistics. Teaching techniques considered 'extremely effective' were life examples (47.6% of athletes), hands-on activities (30.6%), and discussions with a facilitator (30.6%). Setting personal nutrition goals was important to most athletes (83.9%), along with two-way feedback with a facilitator (75.0%). General nutrition topics considered 'essential' were energy requirements (52.9%), hydration (52.9%), and nutrient deficiencies (43.3%). Performance topics considered 'essential' were recovery (58.1%), pre-exercise nutrition (51.6%), nutrition during exercise (50.0%), and energy requirements for training (49.2%). Athletes preferred a 'combination of in-person group and one-on-one sessions' (25% of athletes), 'one-on one sessions' (19.2%) and 'in-person group sessions' (18.3%), with only 13.3% interested in 'exclusively online delivery'. Sessions of 31-60 min (61.3% of athletes) held monthly (37.5%) and undertaken with athletes of the same sporting calibre (61.3%) were favoured by the participants. The preferred facilitator was a performance dietitian or nutritionist (82.1% of athletes), who had knowledge of the sport (85.5%), experience in sports nutrition (76.6%), and credibility (73.4%). This research provides novel insights into the factors that need to be considered when designing and implementing nutrition education for athletes.
Collapse
Affiliation(s)
- Hayley Solly
- School of Sport Exercise and Nutrition, College of Health, Massey University, Private Bag 102904, Auckland 0745, New Zealand
| | - Claire E Badenhorst
- School of Sport Exercise and Nutrition, College of Health, Massey University, Private Bag 102904, Auckland 0745, New Zealand
| | - Matson McCauley
- School of Sport Exercise and Nutrition, College of Health, Massey University, Private Bag 102904, Auckland 0745, New Zealand
| | - Gary J Slater
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
- Australian Institute of Sport, Bruce, ACT 2617, Australia
| | - Janelle A Gifford
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Bevan Erueti
- School of Health Sciences, College of Health, Massey University, Palmerston North 4472, New Zealand
| | - Kathryn L Beck
- School of Sport Exercise and Nutrition, College of Health, Massey University, Private Bag 102904, Auckland 0745, New Zealand
| |
Collapse
|
9
|
Kay MC, Hennink-Kaminski H, Kerr ZY, Gildner P, Ingram BM, Cameron KL, Houston MN, Linnan LA, Marshall SW, Peck KY, Register-Mihalik JK. Factors and expectations influencing concussion disclosure within NCAA Division I athletes: A mixed methodological approach. J Sport Health Sci 2023; 12:388-397. [PMID: 34547482 DOI: 10.1016/j.jshs.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Participation in sports is associated with many benefits to all aspects of health; however, it also comes with the risk of injury, particularly concussions. Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms. Although recent research has explored factors affecting concussion disclosure, use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs. Therefore, the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association (NCAA) athletes that may influence concussion disclosure. METHODS This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports, all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview. Eligible athletes were at least 18 years old and on an NCAA roster. The surveys focused on previous concussion-related disclosure behaviors, knowledge, attitudes, beliefs, norms, and intentions about disclosing concussion. Interviews focused on the athletes' experiences related to concussion disclosure. Survey data were analyzed using descriptive statistics and Mann-Whitney U tests. Interviews were analyzed using a Consensual Qualitative Research tradition. RESULTS Participants had good concussion knowledge (median = 46.0), positive attitudes (median = 38.0), strong beliefs (median = 13.0), and strong intentions to disclose concussion symptoms (median = 7.0). None of the constructs differed by participants' gender. Although quantitative findings were mostly positive, interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult. Educational efforts, sport culture, and medical professional presence were the primary facilitators discussed by participants. Stigma, pressure, and a lack of team support were perceived as disclosure barriers. CONCLUSION The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions. Interventions must prioritize stakeholder- and team-based perspectives on concussion to establish a network supportive to disclosure.
Collapse
Affiliation(s)
- Melissa C Kay
- School of Health Professions, College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Heidi Hennink-Kaminski
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Zachary Y Kerr
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Brittany M Ingram
- Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kenneth L Cameron
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA; Departments of Physical Medicine and Rehabilitation and Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Megan N Houston
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA
| | - Laura A Linnan
- Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karen Y Peck
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA
| | - Johna K Register-Mihalik
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| |
Collapse
|
10
|
Adame BJ, Liu Y, Adame EA, Ruston S, Corman SR. A Randomized Controlled Trial of A Theory-Based Concussion Education Video for NCAA Division I Athletes. Health Commun 2023; 38:1090-1098. [PMID: 34689669 DOI: 10.1080/10410236.2021.1991640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
A large body of research demonstrates that concussions are exceedingly common and extremely difficult to detect. Despite medical efforts to develop sophisticated tools to detect concussions, research continues to demonstrate that proper detection relies on prompt and thorough symptom reporting from the injured athlete. In the context of sports, such reporting requirements are complicated by systems that reward athletic performance. This study seeks to provide student athletes who play NCAA Division I high-contact sports with a theoretically driven intervention to improve their attitudes and behavior toward concussion reporting. Division I student athletes (N = 345) viewed one of three conditions: an NCAA handout consistent with current practices, the experimental video, or a non-treatment control video, then responded to questions regarding attitudes and behaviors toward concussion reporting. Overall, results support the video's effectiveness in changing perceptions of concussion injuries. Nuances of the findings lead to a discussion for practical implications to transform concussion-reporting attitudes and behaviors among athletes.
Collapse
Affiliation(s)
- Bradley J Adame
- Hugh Downs School of Human Communication, Arizona State University
- Center for Strategic Communication, Arizona State University
| | - Yanqin Liu
- Hugh Downs School of Human Communication, Arizona State University
| | - Elissa A Adame
- Hugh Downs School of Human Communication, Arizona State University
- Center for Strategic Communication, Arizona State University
| | - Scott Ruston
- Center for Strategic Communication, Arizona State University
- Center on Narrative, Disinformation, and Strategic Influence, Arizona State University
| | - Steven R Corman
- Hugh Downs School of Human Communication, Arizona State University
- Center for Strategic Communication, Arizona State University
| |
Collapse
|
11
|
Weber Rawlins ML, Valovich McLeod TC. Concussion education perceptions among secondary school athletic trainers. Brain Inj 2023; 37:468-477. [PMID: 36939261 DOI: 10.1080/02699052.2023.2191009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
PURPOSE Describe concussion education perceptions among secondary school athletic trainers and determine the relationship between education program characteristics and perceived effectiveness. METHODS Two hundred and three participants completed at least one survey item (age = 35.2 ± 9.4 years; male = 27.6%). We used descriptive statistics to describe concussion education characteristics and point out biserial correlations to determine if relationships existed between concussion education characteristics and perceived effectiveness. RESULTS The most frequently used mandated concussion education programs were informational handouts created by the state interscholastic association, the Centers for Disease Control and Prevention's (CDC) Heads Up materials, and the National Federation of State High School Athletic Association's materials. The CDC's Heads Up materials, handouts created by the state interscholastic association, and in-person presentations created by respondents were the most frequent concussion educational programs utilized by respondents who indicated no specific program mandated. Educational programs that were engaging increased perceived effectiveness (n = 131, rpb = 0.31,p < 0.001). CONCLUSIONS Our results highlight that materials created by state interscholastic association and the CDC's Heads Up program among others are utilized to satisfy mandates and are perceived to be moderately effective, especially when perceived to be engaging. These results can help guide future studies to examine specific educational tools and administration strategies to determine effectiveness on concussion disclosure.
Collapse
Affiliation(s)
| | - Tamara C Valovich McLeod
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa,AZ, USA.,School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ, USA
| |
Collapse
|
12
|
Younger DS. Mild traumatic brain injury and sports-related concussion. Handb Clin Neurol 2023; 196:475-494. [PMID: 37620086 DOI: 10.1016/b978-0-323-98817-9.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Mild traumatic brain injury (mTBI) and concussion are equivalent terms for the sequela of injury to the head that disrupts brain functioning. Various forces may be causative from seemingly innocuous bumps to the head resulting from sports-related injuries to more severe blows to the head. However, the postconcussive motor, cognitive, emotional, and psychosocial sequelae can be just as devastating and long lasting, leading to loss of independent function and safe performance of activities. Taken together, they pose a significant challenge to recovery, requiring a multifaceted dynamic rehabilitative strategy. The current systems of health care pose challenges to suboptimal management of sports-related concussion (SRC) that goes beyond the acute injury, and into the school setting, failing to be identified by school staff, and inconsistencies in communicating medical information regarding school modifications, follow-up health services, or concussion-related educational services. Children who sustain SRC at different ages face different challenges. Young children face increased vulnerability due to SRC that coincides with periods of brain motor maturation and development.
Collapse
Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
| |
Collapse
|
13
|
Callahan CE, Kossman MK, Mihalik JP, Marshall SW, Gildner P, Kerr ZY, Cameron KL, Houston MN, Mrazik M, Register-Mihalik JK. Association between Sensation-Seeking Behaviors and Concussion-Related Knowledge, Attitudes, Perceived Norms, and Care-Seeking Behaviors among Collegiate Student-Athletes. J Sports Sci Med 2022; 21:33-42. [PMID: 35250331 PMCID: PMC8851124 DOI: 10.52082/jssm.2022.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/27/2021] [Indexed: 06/14/2023]
Abstract
There are limited data connecting personality and behavioral tendencies and traits related to concussion care-seeking/disclosure behaviors and minimal research exists surrounding the relationship between risky behaviors, sensation-seeking, and concussion-related outcomes. This study examined the association between sensation-seeking and a student-athlete's concussion-related knowledge, attitudes, perceived social norms, and concussion care-seeking/disclosure behaviors (intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury). The current study utilized a retrospective cohort of collegiate student-athletes at a single National Collegiate Athletic Association Division I institution. Separate multivariable linear regression models estimating mean differences (MD) and 95% Confidence Intervals (CI) estimated the association between sensation-seeking and concussion knowledge, concussion attitudes, and perceived social norms. Separate multivariable binomial regression models estimating adjusted prevalence ratios (PR) and 95%CI estimated the association between sensation-seeking and intention to disclose concussion symptoms, perceived control over symptom disclosure, self-removal from play due to concussion symptoms, continued play with concussion symptoms, and disclosure of all concussions at the time of injury. All models were adjusted for sex, sport participation, and concussion history. Higher sensation-seeking was significantly associated with less favorable concussion attitudes (adjusted MD = -1.93; 95%CI = -3.04,-0.83), less favorable perceived social norms surrounding concussion (adjusted MD = -1.39; 95%CI = -2.06,-0.72), and continuing to play while experiencing concussion symptoms (adjusted PR = 1.50; 95%CI = 1.10, 2.06). Student-athletes with increased sensation-seeking could be at risk for failing to disclose a concussion, decreasing athlete safety and resulting in less optimal care post-injury. Results will inform future theory-based concussion education programs which consider behavioral tendencies and traits as well as sport culture to promote concussion care-seeking/disclosure and individualized interventions based on risky behavior engagement.
Collapse
Affiliation(s)
- Christine E Callahan
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina, NC, USA
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
| | - Melissa K Kossman
- School of Health Professions, University of Southern Mississippi, MS, USA
| | - Jason P Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina, NC, USA
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill NC, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, NC, USA
| | - Paula Gildner
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill NC, USA
| | - Zachary Y Kerr
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina, NC, USA
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill NC, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, NY, USA
- Departments of Physical Medicine and Rehabilitation and Surgery, Uniformed Services University of the Health Sciences, MD, USA
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, NY, USA
| | - Martin Mrazik
- Department of Educational Psychology, University of Alberta, AB, Canada
| | - Johna K Register-Mihalik
- Matthew Gfeller Center, Department of Exercise and Sport Science, The University of North Carolina, NC, USA
- Human Movement Science Curriculum, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, NC, USA
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill NC, USA
- STAR Heel Performance Laboratory, The University of North Carolina at Chapel Hill, NC, USA
| |
Collapse
|
14
|
Chandran A, Boltz AJ, Morris SN, Robison HJ, Nedimyer AK, Collins CL, Register-Mihalik JK. Epidemiology of Concussions in National Collegiate Athletic Association (NCAA) Sports: 2014/15-2018/19. Am J Sports Med 2022; 50:526-536. [PMID: 34898299 DOI: 10.1177/03635465211060340] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Updated epidemiology studies examining sports-related concussions (SRCs) are critical in evaluating recent efforts aimed at reducing the incidence of SRCs in National Collegiate Athletic Association (NCAA) sports. PURPOSE To describe the epidemiology of SRCs in 23 NCAA sports during the 2014/15-2018/19 academic years. STUDY DESIGN Descriptive epidemiology study. METHODS SRC and exposure data collected in the NCAA Injury Surveillance Program were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics by sport, event type (practices, competitions), injury mechanism (player contact, surface contact, equipment/apparatus contact), and injury history (new, recurrent). Injury rate ratios (IRRs) were used to examine differential injury rates, and injury proportion ratios (IPRs) were used to examine differential distributions. RESULTS A total of 3497 SRCs from 8,474,400 athlete-exposures (AEs) were reported during the study period (4.13 per 10,000 AEs); the competition-related SRC rate was higher than was the practice-related SRC rate (IRR, 4.12; 95% CI, 3.86-4.41). The highest SRC rates were observed in men's ice hockey (7.35 per 10,000 AEs) and women's soccer (7.15 per 10,000 AEs); rates in women's soccer and volleyball increased during 2015/16-2018/19. Player contact was the most prevalently reported mechanism in men's sports (77.0%), whereas equipment/apparatus contact was the most prevalently reported mechanism in women's sports (39.2%). Sex-related differences were observed in soccer, basketball, softball/baseball, and swimming and diving. Most SRCs reported in men's sports (84.3%) and women's sports (81.1%) were reported as new injuries. CONCLUSION Given the increasing SRC rates observed in women's soccer and volleyball during the latter years of the study, these results indicate the need to direct further attention toward trajectories of SRC incidence in these sports. The prevalence of equipment/apparatus contact SRCs in women's sports also suggests that SRC mechanisms in women's sports warrant further investigation. As most SRCs during the study period were reported as new injuries, the prevalence of recurrent SRCs in men's and women's ice hockey is also noteworthy.
Collapse
Affiliation(s)
- Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Sarah N Morris
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Hannah J Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Aliza K Nedimyer
- Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,STAR Heel Performance Laboratory, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
15
|
Daneshvar DH, Baugh CM, Lama RD, Yutsis M, Pea RD, Goldman S, Grant GA, Cantu RC, Sanders LM, Zafonte RD, Hainline B, Sorcar P. Participating in Two Video Concussion Education Programs Sequentially Improves Concussion-Reporting Intention. Neurotrauma Rep 2022; 2:581-591. [PMID: 35018360 PMCID: PMC8742279 DOI: 10.1089/neur.2021.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Undiagnosed concussions increase the risk of additional concussion and persistent symptoms from concussion. Because there are no reliable objective markers of concussion, self-reporting of subjective and non-visible symptoms are critical to ensuring proper concussion management. For this reason, educational interventions target concussion reporting, but the majority of studies have examined the efficacy of single educational interventions or compared interventions to one another. This randomized crossover study sought to identify whether there was benefit to administering multiple concussion education programs in tandem, back to back. The study randomized 313 male high school football players to first receive CrashCourse concussion education (CC) or Centers for Disease Control and Prevention video concussion education (CDC) followed by crossover with the other education. Athlete concussion-reporting intention, attitudes, subjective norms, perceived behavioral control, and enjoyment of education were assessed at baseline and after each intervention. There were statistically significant improvements across all measures, both after single intervention and crossover (all p < 0.001). Secondary analyses examining differences between education found that athletes reported higher enjoyment of concussion education immediately after participating in CC, as compared to CDC (p < 0.001). These findings demonstrate an additive benefit to implementing CC and CDC education in tandem, without decrement in enjoyment of concussion education after experiencing dual educations; in fact, enjoyment of concussion education improved after receiving education programs back to back. These educational programs appear to complement one another, and the results support the use of multi-modal concussion education to differentially target and maximize concussion reporting.
Collapse
Affiliation(s)
- Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Boston, Massachusetts, USA; Massachusetts General Hospital; Boston, Massachusetts, USA; Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.,Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christine M Baugh
- Center for Bioethics and Humanities, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA; Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Roberto D Lama
- School of Engineering, Stanford University, Stanford, California, USA
| | - Maya Yutsis
- Department of Neurology, Stanford School of Medicine, Palo Alto, California, USA
| | - Roy D Pea
- Graduate School of Education, Stanford University, Stanford, California, USA
| | - Shelley Goldman
- Graduate School of Education, Stanford University, Stanford, California, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford School of Medicine, Palo Alto, California, USA
| | - Robert C Cantu
- Chronic Traumatic Encephalopathy Center, Boston University School of Medicine, Boston, Massachusetts, USA.,Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Lee M Sanders
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, California, USA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Boston, Massachusetts, USA; Massachusetts General Hospital; Boston, Massachusetts, USA; Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Brian Hainline
- Indiana University School of Medicine, Indianapolis, Indiana, USA; New York University Langone Medical Center, New York, New York, USA
| | - Piya Sorcar
- Stanford Center for Innovation in Global Health, Stanford School of Medicine, Palo Alto, California, USA
| |
Collapse
|
16
|
Ross JD, Cameron KL, Colsant BJ, Houston MN. Leadership Lessons in Concussion Management for Team Physicians. Sports Med Arthrosc Rev 2021; 29:191-199. [PMID: 34730119 DOI: 10.1097/jsa.0000000000000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Over the last decade, with emphasis on concussion awareness and potential long-term deficits, concussions have become a public health concern. Although common, concussions are complex in nature and often require a collaborative treatment approach across multiple disciplines. In an athletic setting, the Team Physician plays a critical leadership role in the organization, management, and provision of care for concussed athletes. However, leadership strategies for the provision of concussion care utilized by the Team Physician have not been adequately described. This manuscript intends to describe advanced planning for concussion management and highlight best practices for the provision of care for the concussed athlete, to assist the Team Physician in coordinating optimal care. Specific emphasis will be placed on outlining a concussion management protocol aligned with evidence-based best practices.
Collapse
|
17
|
Kneavel M, Ernst W. Cognitions That Support Concussion Reporting in Collegiate Athletes: An Analysis of a Worksheet Activity. Health Educ Behav 2021; 49:548-559. [PMID: 34636271 DOI: 10.1177/10901981211046535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sports related concussions continue to be a public health concern and improving reporting behavior a focus of educational programs. While educational programs have addressed changes in knowledge of concussion symptoms, it has been challenging to design educational programs which have lasting effects on reporting behavior. AIMS The current analysis describes an intervention in which thoughts about reporting behavior are actively written down in a worksheet exercise to "pre-arm" athletes with cognitions designed to enhance reporting behavior prior to the injury event. METHOD A total of 503 male and female college athletes participating in collision (football, field hockey, ice hockey, lacrosse, and soccer) and contact sports (baseball, basketball, and softball) from 7 colleges/universities competing across all three NCAA divisions provided data collected during a randomized trial of a peer concussion education program. RESULTS Qualitative analysis revealed 10 themes that would improve reporting including short-term benefits, faster recover, safe and healthy return to play, reporting helps the team, reporting protects the brain, risk aversion, long-term benefits, coach will be supportive, teammates will be supportive and understanding, and academic performance will be affected. DISCUSSION Athletes had awareness of key risks involved in concussions and understood both short- and long-term consequences. CONCLUSION These findings have important implications for understanding how to change athletes' thoughts about reporting concussions.
Collapse
Affiliation(s)
- Meredith Kneavel
- Department of Urban Public Health and Nutrtion, La Salle University, Philadelphia, PA, USA.,Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA, USA
| | - William Ernst
- Department of Professional Psychology, Chestnut Hill College, Philadelphia, PA, USA.,Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA, USA
| |
Collapse
|
18
|
Beidler E, Bogar K, Wallace J, McAllister-Deitrick J, Anderson M, Schatz P. The burden of unsubstantiated messaging: collegiate athletes' chronic traumatic encephalopathy mechanism beliefs. Brain Inj 2021; 35:1259-1266. [PMID: 34499577 DOI: 10.1080/02699052.2021.1972146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate factors associated with collegiate athletes' beliefs regarding chronic traumatic encephalopathy (CTE) mechanism. DESIGN Cross-sectional study. METHODS A total of 838 collegiate athletes (61.9% men) from seven institutions completed a 10-minute survey that captured information relative to demographics, diagnosed concussion history, formal sport-related concussion education, additional sources of concussion information, and beliefs about multiple concussions and premature return-to-play following a head impact as mechanisms for CTE. RESULTS More than half of collegiate athletes believed that multiple concussions (58.2%) and premature return-to-play (59.1%) may cause CTE. Those who reported getting concussion information from sports news had higher odds of believing multiple concussions and premature return-to-play were CTE mechanisms compared to those who did not get information from sports news sources. Additionally, CTE mechanism beliefs were significantly greater in collegiate athletes who were male, had sustained a previous diagnosed concussion, or had acquired concussion information from the NCAA. CONCLUSIONS Sports news' reporting of CTE storylines, which highlight former male athletes with complex brain injury histories, may influence collegiate athletes' beliefs about concussion. Therefore, it is recommended that concussion awareness initiatives incorporate information related specifically to CTE to empower collegiate athletes with evidence-based, patient-oriented information and knowledge regarding this condition.
Collapse
Affiliation(s)
- Erica Beidler
- Department of Athletic Training, Duquesne University, Pittsburgh, Pennsyvania
| | - Kacie Bogar
- Department of Psychology, Saint Joseph's University, Philadelphia, Pa
| | - Jessica Wallace
- Department of Health Science, University of Alabama, Tuscaloosa, AL
| | | | - Morgan Anderson
- Department of Kinesiology, Michigan State University, East Lansing, Michigan
| | - Phillip Schatz
- Department of Psychology, Saint Joseph's University, Philadelphia, Pa
| |
Collapse
|
19
|
Boltz AJ, Nedimyer AK, Chandran A, Robison HJ, Collins CL, Morris SN. Epidemiology of Injuries in National Collegiate Athletic Association Men's Ice Hockey: 2014-2015 Through 2018-2019. J Athl Train 2021; 56:703-710. [PMID: 34280280 DOI: 10.4085/1062-6050-611-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The National Collegiate Athletic Association has supported men's ice hockey, a distinct sport that mandates high-velocity gamesmanship, since 1974. BACKGROUND Injury surveillance systems are designed to identify evolving injury trends and their temporal qualities. Continual monitoring of collegiate men's ice hockey athletes remains essential. METHODS Exposure and injury data collected in the National Collegiate Athletic Association Injury Surveillance Program from 2014-2015 through 2018-2019 were analyzed. Injury counts, rates, and proportions were used to describe injury characteristics, and injury rate ratios (IRR) were used to examine differential injury rates. RESULTS The overall injury rate was 7.65 per 1000 athlete-exposures. Injuries from competition occurred at a rate nearly 7 times that from practice injuries (IRR = 6.54, 95% CI = 6.08, 7.04). The most common specific injury diagnoses were concussions (9.6%), acromioclavicular sprains (7.3%), and medial collateral ligament tears (3.7%). SUMMARY Injury rates by event type and season segment were higher than previously reported. Contusions accounted for nearly a quarter of all injuries, and acromioclavicular sprain rates increased notably across the study period.
Collapse
Affiliation(s)
- Adrian J Boltz
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Aliza K Nedimyer
- Human Movement Science Curriculum and Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill.,Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Hannah J Robison
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Christy L Collins
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Sarah N Morris
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| |
Collapse
|
20
|
Adams SA, Richards H, Sproule J, Hutchinson PJ, Turner AP. A Concussion Education Programme for Motorsport Drivers: A Field-Based Exploratory Pilot Study. Brain Inj 2021; 35:1011-1021. [PMID: 34264789 DOI: 10.1080/02699052.2021.1944669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Concussion education strategies that improve knowledge and attitudes long term are needed. This exploratory study piloted an interactive concussion education program, adopting concepts from the learning sciences and attitude change literature, for the underserved and high-risk population of motorsports. METHOD Forty UK motorsport drivers (ages 16-20 years) participated. The workshop group received a two-phased workshop-based program. The comparison group received a concussion leaflet. Participants completed an adapted version of the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS-ST) at pre-, post- and 2-month follow-up. Within-group analysis for the workshop group explored the differential effect of the individual difference variable, Need for Cognition (NfC), and effectiveness was explored through post-workshop questionnaires and interviews. RESULTS Unlike the comparison group, the workshop group showed a significant improvement in knowledge over time (F(2,58) = 45.49, p < .001, η2p = .61). Qualitative data indicated workshop-program participants developed safer attitudes toward concussion following programming. Preliminary evidence suggested individuals' responses to concussion education aligned with differences in NfC. CONCLUSION This study piloted the first concussion education program for motorsport drivers and explored whether aligning educational provision with the NfC construct may help to improve program effectiveness. Findings are relevant to addressing the public health issue of concussion through educational approaches.
Collapse
Affiliation(s)
- Stephanie A Adams
- Institute for Sport, PE & Health Sciences Moray House School of Education, University of Edinburgh, Edinburgh, Scotland
| | - Hugh Richards
- Institute for Sport, PE & Health Sciences Moray House School of Education, University of Edinburgh, Edinburgh, Scotland
| | - John Sproule
- Institute for Sport, PE & Health Sciences Moray House School of Education, University of Edinburgh, Edinburgh, Scotland
| | - Peter J Hutchinson
- Academic Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Anthony P Turner
- Institute for Sport, PE & Health Sciences Moray House School of Education, University of Edinburgh, Edinburgh, Scotland
| |
Collapse
|
21
|
Beidler E, Eagle S, Wallace J, Anderson M, Schmitt AJ, O'Connor S, Kontos AP. Anxiety-related concussion perceptions of collegiate athletes. J Sci Med Sport 2021:S1440-2440(21)00161-4. [PMID: 34272167 DOI: 10.1016/j.jsams.2021.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 04/01/2021] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The purpose of this study was to identify collegiate athletes' anxiety-related concussion perceptions and examine factors that may be related to increased anxiety injury beliefs. DESIGN Cross-sectional study. METHODS Male and female Division I, II and III NCAA collegiate athletes (n = 482) completed a 10- to 15-minute survey examining their demographics, diagnosed concussion history, concussion knowledge, and public media sources they have previously acquired concussion information from. The survey also included the Perceptions of Concussion Inventory for Athletes (PCI-A) which results in six outcome variables (anxiety, effects, control, clarity, treatment, and symptom variability). Univariable and a backward stepwise multivariable logistic regression model were utilized to identify variables that were associated with greater (above median) negative anxiety-related concussion perception scores. RESULTS Collegiate athletes displayed moderate anxiety-related concussion perceptions (12.8 ± 3.2; scores ranged from 4 - low anxiety to 20 - high anxiety). The majority of participants reported that concussions are upsetting to them (60.7%), with a sizable proportion being worried (46.7%), fearful (40.7%), or anxious (25.0%) about sustaining a concussion. In the multivariable regression, higher perception that concussions have long-term effects (OR = 2.72; 95% CI: 1.79-4.12), greater beliefs of internal control to influence concussion outcomes (OR = 1.78; 95% CI: 1.15-2.75), and female sex (OR = 1.77; 95% CI: 1.15-2.71) were associated with higher anxiety beliefs. CONCLUSIONS This study for the first time establishes that negative, anxiety-related perceptions about concussions are prevalent in a collegiate athlete population. Addressing these perceptions through evidence-based, educational and management initiatives, such as highlighting that concussions are treatable and most do not result in long-term negative consequences with early diagnosis and proper management, are critical to improve emotions surrounding concussion. This may be particularly important for female athletes in this population.
Collapse
|
22
|
Kneavel M, Ernst W, Brandsma L. Collegiate athletes' perceptions of the culture of concussion reporting. J Am Coll Health 2021; 69:435-443. [PMID: 31662115 DOI: 10.1080/07448481.2019.1679816] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/13/2019] [Accepted: 10/06/2019] [Indexed: 06/10/2023]
Abstract
The current study was designed to understand the culture of concussion among college student-athletes. Participants: Eight men's lacrosse and seven women's soccer players. Methods: A focus group was conducted to understand thoughts, barriers, team culture, and what was needed to feel safe reporting symptoms. Thematic analysis was conducted to identify key themes. Results: Themes included concerns about being taken out, pushing through, wanting to play, severity influencing reporting, changes about concussion reporting, uncertainty about symptoms, concussion have changed the game, reporting a teammate, wanting someone else to make the call, desire to raise awareness, deception, wanting professors to have more understanding, circumstances influencing reporting, helmets specific for concussion, malingering, and the return to play protocol being too long. Conclusion: Factors ranging from intrinsic to more distal cultural and environmental factors appear to influence reporting concussions. Student-athletes identified factors unique to the college athlete environment.
Collapse
Affiliation(s)
- Meredith Kneavel
- Department of Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - William Ernst
- Department of Professional Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| | - Lynn Brandsma
- Department of Psychology, Chestnut Hill College, Philadelphia, Pennsylvania, USA
| |
Collapse
|
23
|
Callahan CE, Kay MC, Kerr ZY, Hinson MT, Linnan LA, Hennink-Kaminski H, Gildner P, Marshall SW, Houston MN, Cameron KL, Register-Mihalik J. Association Between Previous Concussion Education and Concussion Care-Seeking Outcomes Among National Collegiate Athletic Association Division I Student-Athletes. J Athl Train 2021; 56:461578. [PMID: 33618368 PMCID: PMC8010936 DOI: 10.4085/1062-6050-0211.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Limited data exist concerning differences in concussion-education exposure and how education exposures relate to care seeking and symptom disclosure, specifically by National Collegiate Athletic Association Division I student-athletes. OBJECTIVE To investigate demographic characteristics associated with concussion-education exposure and examine whether overall education exposure (yes versus no) and education-source exposure number (multiple sources versus a single source) affect concussion care-seeking and disclosure factors in Division I student-athletes. DESIGN Cross-sectional study. SETTING Classroom or online survey. PATIENTS OR OTHER PARTICIPANTS Division I student-athletes (n = 341). MAIN OUTCOME MEASURE(S) Frequencies and proportions were computed for sex, race, school year, sport, and concussion history across concussion-education groups. Prevalence ratios (PRs) and 95% CIs were calculated to quantify the associations between student-athlete characteristics and (1) overall concussion-education exposure and (2) source-exposure number. Separate multivariable linear regression models estimated adjusted mean differences (MDs) and 95% CIs, which allowed us to assess differences in concussion knowledge, attitudes, and perceived social norms relative to concussion-education exposure and exposure to multiple sources. Separate multivariable binomial regression models were performed to estimate adjusted PRs and 95% CIs in order to evaluate associations of intention, perceived control, and care-seeking or disclosure behaviors and overall concussion-education exposure and exposure to multiple sources. All models controlled for sex, sport, and concussion history. RESULTS Overall, 276 (80.9%) participants reported previous concussion education, with 179 (64.9%) being exposed to multiple sources. Student-athletes who participated in a contact sport (adjusted PR = 1.24; 95% CI = 1.06, 1.44) and those who had a concussion history (adjusted PR = 1.19; 95% CI = 1.09, 1.31) had higher prevalences of concussion-education exposure. Females had a lower prevalence of reporting multiple sources (adjusted PR = 0.82; 95% CI = 0.68, 0.99). Overall concussion-education exposure was significantly associated with more favorable perceived social norms surrounding concussion care seeking (adjusted MD = 1.37; 95% CI = 0.13, 2.61). CONCLUSIONS These findings highlighted the potential differences in overall concussion-education exposure and provide clinicians with information on groups who may benefit from additional targeted education.
Collapse
Affiliation(s)
- Christine E. Callahan
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
| | - Melissa C. Kay
- School of Health Professions, University of Southern Mississippi, Hattiesburg
| | - Zachary Y. Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
| | - Madison T. Hinson
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
| | - Laura A. Linnan
- Department of Health Behavior, Gillings School of Global Public Health
| | | | - Paula Gildner
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill
| | - Stephen W. Marshall
- Injury Prevention Research Center, The University of North Carolina at Chapel Hill
| | | | | | - Johna Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science
| |
Collapse
|
24
|
Daneshvar DH, Yutsis M, Baugh CM, Pea RD, Goldman S, Grant GA, Ghajar J, Sanders LM, Chen C, Tenekedjieva LT, Gurrapu S, Zafonte RD, Sorcar P. Evaluating the Effect of Concussion Education Programs on Intent to Report Concussion in High School Football. J Athl Train 2021; 56:1197-1208. [PMID: 33428746 DOI: 10.4085/509-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Concussion underreporting leads to delays in diagnosis and treatment, prolonging recovery time. Athletes' self-report of concussion symptoms therefore reduces risk. OBJECTIVE Evaluate the efficacy of three concussion education programs in improving concussion-reporting intention. DESIGN Randomized controlled clinical trial with assessment immediately and one-month after education. SETTING Three high schools in California. PATIENTS OR OTHER PARTICIPANTS 118 male football players were randomly assigned to receive concussion education via: CrashCourse (CC), Centers for Disease Control (CDC) video educational materials (Vi), or CDC written educational materials (Wr). MAIN OUTCOME MEASURES Concussion-reporting intention was assessed at baseline, immediately after education, and at one-month follow-up. Secondary outcomes included concussion knowledge, attitudes, perceived reporting norms, and perceived behavioral control. RESULTS Athletes across all educational formats had significant improvement in concussion-reporting intention immediately following education and at one-month follow-up (mean improvement 6.8% and 11.4%, respectively; p<0.001). Similar findings were observed across all education formats in secondary analyses examining knowledge, attitudes, and perceived behavioral control. However, there were significant differences by education and time (p=0.03). On post-hoc analysis, athletes who received CC had increased concussion-reporting intention immediately and at one-month (baseline=4.7, immediate=6.1, one-month=6.0; p=0.007 compared to significant increases only at one-month for CDC-Vi (baseline=4.3, immediate=5.2, one-month=5.8; p=0.001), and no significant improvement for CDC-Wr (p=0.10). Secondary analyses indicated significant differences between CC and both CDC interventions, in concussion knowledge and attitudes, immediately after education and at one-month. There were no significant differences in perceived behavioral control between-interventions or in perceived concussion-reporting norms across or between interventions. CONCLUSION All athletes exhibited improved intent to report concussions, increased concussion knowledge, better concussion attitudes, and more perceived behavioral control, both immediately after education and at one-month follow-up. However, athletes randomized to CC reported greater intent to report concussion, more knowledge, and improved concussion-reporting attitudes, when compared to CDC-Vi and CDC-Wr. TRIAL REGISTRY ClinicalTrials.gov trial ID number is XXX.
Collapse
Affiliation(s)
- Daniel H Daneshvar
- Active Staff, Harvard Medical School, Department of Physical Medicine and Rehabilitation; Boston University, Chronic Traumatic Encephalopathy Center. e-mail:
| | - Maya Yutsis
- Assistant Professor, Stanford University, Department of Neurology. e-mail:
| | - Christine M Baugh
- Assistant Professor, Center for Bioethics and Humanities, University of Colorado Denver Anschutz Medical Campus. e-mail:
| | - Roy D Pea
- David Jacks Professor of Learning Sciences and Education, Stanford University, Graduate School of Education. e-mail:
| | - Shelley Goldman
- Associate Dean for Faculty Affairs and for Student Affairs and Professor of Education, Stanford University, Graduate School of Education. e-mail:
| | - Gerald A Grant
- Endowed Professor in Pediatric Neurosurgery and Professor, by courtesy, of Neurology, Stanford University, Department of Neurosurgery. e-mail:
| | - Jamshid Ghajar
- Clinical Professor of Neurosurgery, Moghadam Family Director of the Stanford Brain Performance Center, Stanford, University, Stanford Concussion and Brain Performance Center, Department of Neurosurgery. e-mail:
| | - Lee M Sanders
- Associate Professor, Stanford University, Department of Pediatrics. e-mail:
| | - Christine Chen
- Medical Student, University of Texas Southwestern Medical Center.
| | | | - Shravya Gurrapu
- Student, Stanford University, School of Humanities and Sciences, School of Engineering. e-mail:
| | - Ross D Zafonte
- Earle P. and Ida S. Charlton Professor and Chairman of the Department of Physical Medicine and Rehabilitation, Harvard Medical School, Department of Physical Medicine and Rehabilitation. e-mail:
| | - Piya Sorcar
- Lecturer and Adjunct Affiliate, Stanford University, School of Education.
| |
Collapse
|
25
|
Beakey M, Keenan B, Tiernan S, Collins K. Is It Time to Give Athletes a Voice in the Dissemination Strategies of Concussion-Related Information? Exploratory Examination of 2444 Adolescent Athletes. Clin J Sport Med 2020; 30:562-7. [PMID: 30119086 DOI: 10.1097/JSM.0000000000000653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of the research was to screen male and female adolescent athletes on their concussion educational histories and preferred future methods of education in terms of educational messenger, modality, and concussion-related areas of interest. DESIGN Cross-sectional survey. SETTING Examination setting within the classroom. PARTICIPANTS Adolescent male (n = 1854) and female (n = 590) athletes aged 12 to 18 years. MAIN OUTCOME MEASURES To explore the concussion educational histories and preferred future methods of education in Irish male and female adolescent athletes. RESULTS 19.7% (n = 482) of the sample received education in the past 12 months. Male athletes had a significantly higher rate of previous education than female athletes (41% vs 17%). The methods used in previous educational interventions are failing to match the interests of the athletes. Sex played a significant role in the preferred educational methods, as male and female athletes had significant differences in their choice of educational messenger, modality, and concussion-related areas of interest. CONCLUSIONS The current disparity in previous concussion education rates between male and female adolescent athletes should be addressed. Forthcoming research should explore the efficacy of tailoring knowledge translation strategies to match the specific needs of the recipient.
Collapse
|
26
|
Abstract
Context
Concussion-symptom education remains the primary approach used by athletic trainers to address underreporting of possible sport-related concussions. Social marketing represents an untapped approach to promote concussion reporting by communicating the benefits or consequences of reporting or not reporting, respectively.
Objective
To apply expectancy value theory and identify how marketing the possible consequences of concealing concussion symptoms influenced young adults' concussion-reporting beliefs to increase the likelihood of reporting.
Design
Randomized controlled clinical trial.
Setting
Laboratory.
Patients or Other Participants
A total of 468 competitive collegiate club sport athletes at a large US university who engaged in 1 of 46 sports with various levels of concussion risk.
Intervention(s)
Participants were randomly assigned by team to 1 of 3 conditions. The treatment condition was a social-marketing program focused on the possible consequences of the reporting decision. The control condition was traditional concussion-symptom education based on the National Collegiate Athletic Association's publication, “Concussion: A Fact Sheet for Student-Athletes.” An additional condition mirrored the traditional symptom education but included a less clinical delivery.
Main Outcome Measure(s)
Positive and negative beliefs regarding concussion reporting were assessed. We applied expectancy value theory, which posits that changing beliefs in the short term will produce greater reporting intentions in the long term.
Results
Club sport athletes exposed to consequence-based social marketing showed higher levels of positive reporting beliefs and lower levels of negative reporting beliefs than athletes exposed to traditional or revised symptom education. We observed no differences between the traditional and revised symptom-education programs. Exposure to consequence-based marketing decreased negative beliefs about reporting (B = −0.165, P = .01) and increased positive beliefs about reporting (B = 0.165, P = .01).
Conclusions
Social marketing offers athletic trainers another strategic tool for motivating athletes to report concussion symptoms by translating scientific findings into marketable statements and then communicating the benefits of reporting or the negative consequences of concealing concussion symptoms.
Collapse
Affiliation(s)
- Dee Warmath
- Department of Financial Planning, Housing, and Consumer Economics, College of Family and Consumer Sciences, University of Georgia, Athens
| | | |
Collapse
|
27
|
Kroshus E, Cameron KL, Coatsworth JD, D'Lauro C, Kim E, Lee K, Register-Mihalik JK, Milroy JJ, Roetert EP, Schmidt JD, Silverman RD, Warmath D, Wayment HA, Hainline B. Improving concussion education: consensus from the NCAA-Department of Defense Mind Matters Research & Education Grand Challenge. Br J Sports Med 2020; 54:1314-1320. [PMID: 32912847 DOI: 10.1136/bjsports-2020-102185] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Abstract
Early disclosure of possible concussive symptoms has the potential to improve concussion-related clinical outcomes. The objective of the present consensus process was to provide useful and feasible recommendations for collegiate athletic departments and military service academy leaders about how to increase concussion symptom disclosure in their setting. Consensus was obtained using a modified Delphi process. Participants in the consensus process were grant awardees from the National Collegiate Athletic Association and Department of Defense Mind Matters Research & Education Grand Challenge and a multidisciplinary group of stakeholders from collegiate athletics and military service academies. The process included a combination of in-person meetings and anonymous online voting on iteratively modified recommendations for approaches to improve concussion symptom disclosure. Recommendations were rated in terms of their utility and feasibility in collegiate athletic and military service academy settings with a priori thresholds for retaining, discarding and revising statements. A total of 17 recommendations met thresholds for utility and feasibility and are grouped for discussion in five domains: (1) content of concussion education for athletes and military service academy cadets, (2) dissemination and implementation of concussion education for athletes and military service academy cadets, (3) other stakeholder concussion education, (4) team and unit-level processes and (5) organisational processes. Collectively, these recommendations provide a path forward for athletics departments and military service academies in terms of the behavioural health supports and institutional processes that are needed to increase early and honest disclosure of concussion symptoms and ultimately to improve clinical care outcomes.
Collapse
Affiliation(s)
- Emily Kroshus
- Department of Pediatrics, University of Washington, Seattle, Washington, USA .,Department of Pediatrics, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kenneth L Cameron
- Orthopaedics, Keller Army Community Hospital, West Point, New York, USA
| | - J Douglas Coatsworth
- Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, USA
| | - Christopher D'Lauro
- Behavioral Science and Leadership, US Air Force Academy, Colorado Springs, Colorado, USA
| | | | - Katherine Lee
- Health Readiness and Policy Oversight, Health Affairs, Department of Defense, Falls Church, Virginia, USA
| | - Johna K Register-Mihalik
- Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffery J Milroy
- Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - E Paul Roetert
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| | | | - Ross D Silverman
- Richard M Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Dee Warmath
- Family and Consumer Sciences, University of Georgia, Athens, Georgia, USA
| | - Heidi A Wayment
- Psychological Sciences, Northern Arizona University, Flagstaff, Arizona, USA
| | - Brian Hainline
- National Collegiate Athletic Association, Indianapolis, Indiana, USA
| |
Collapse
|
28
|
Beidler E, Welch Bacon CE, Hattrup N, Powers C, Saitz L, McLeod TV. Going Beyond the State Law: Investigating High School Sport-Related Concussion Protocols. J Athl Train 2020; 57:466508. [PMID: 34129675 PMCID: PMC8775288 DOI: 10.4085/1062-6050-0505.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT State laws provide general guidelines for sport-related concussion (SRC) management, but do not comprehensively address the multiple layers of management for this complex injury. While high schools are encouraged to develop a SRC protocol that includes both state law tenets and additional management practices, the execution of this warrants examination. OBJECTIVE To investigate state law compliance and practice components included in high school SRC protocols, and determine whether the degree of sports medicine coverage influenced protocol quality. DESIGN Qualitative document analysis. SETTING High school athletics. PARTICIPANTS In total, 184 Pennsylvania high schools [24.3% of schools statewide; full-time athletic trainer=149, part-time athletic trainer=13, missing=21] voluntarily provided copies of their protocol from the 2018-2019 academic year. MAIN OUTCOME MEASURES Four athletic trainers conducted document analyses using a 67-item component analysis guide. Frequencies were computed for included protocol components related to the state law, preparticipation and prevention, recognition and assessment, and management. The difference in the total number of included components (max 60) by sports medicine coverage was assessed using a Mann-Whitney U test. RESULTS There was heterogeneity in components included in the submitted protocols. Only 23.4% included all mandatory state law tenets. Immediate removal from play was noted in 67.4% of protocols, while only 1.6% contained prevention strategies. Return-to-play was addressed more frequently than return-to-learn (74.5% versus 32.6%). The sample had a mean of 15.5±9.7 total components per protocol. Schools with full-time sports medicine coverage had significantly more protocol components than those with part-time athletic trainers (15 [8.5-22.5] versus 6 [3-10.5] median components; U = 377.5, p < .001) Conclusions: School-level written SRC protocols were often missing components of the state law and additional best practice recommendations. Full-time sports medicine coverage in high schools is recommended to increase SRC protocol and healthcare quality.
Collapse
Affiliation(s)
| | - Cailee E Welch Bacon
- A.T. Still University, Athletic Training Programs, School of Osteopathic Medicine in Arizona, 5850 E Still Circle, Mesa, AZ 85206, United States,
| | - Nicholas Hattrup
- Boston University, Athletic Training Services, 285 Babcock Street, Boston, Massachusetts 02215, United States,
| | - Cassidy Powers
- Duquesne University, Department of Athletic Training, 600 Forbes Avenue, Pittsburgh, Pennsylvania 15282, United States,
| | - Lilly Saitz
- Mount Holyoke College, Department of Environmental Studies, 50 College Street, South Hadley, Massachusetts 01075, United States,
| | - Tamara Valovich McLeod
- A.T. Still University, Athletic Training Programs, School of Osteopathic Medicine in Arizona, 5850 E Still Circle, Mesa, Arizona 85206, United States,
| |
Collapse
|
29
|
Affiliation(s)
- Christine M Baugh
- Division of General Internal Medicine, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
30
|
Schmidt JD, Suggs DW, Rawlins MLW, Bierema L, Miller LS, Courson R, Reifsteck F. Coach, sports medicine, and parent influence on concussion care seeking intentions and behaviors in collegiate student-athletes. J Clin Transl Res 2020; 5:215-226. [PMID: 32671281 PMCID: PMC7357618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/13/2020] [Accepted: 04/28/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Sport is a socio-ecological framework where student-athletes are part of a larger community of stakeholders, including coaches, sports medicine professionals (SMPs), and parents. This framework may hold influence over whether student-athletes seek care for a concussion. AIM We aimed to describe, compare, and determine the influence of stakeholder concussion knowledge, attitudes, and concussion scenario responses. MATERIALS AND METHODS We recruited a sample of 477 student-athletes and their 27 coaches (response rate=46.6%), 24 SMPs (48.7%), and 31 parents/guardians (4.8%). Stakeholder surveys assessed their concussion knowledge, attitudes toward care seeking, and concussion scenario responses. Surveys administered to student-athletes assessed their concussion care seeking intentions and behaviors. Kruskal-Wallis tests were used to compare responses between stakeholder groups and to determine the differences in student-athlete intentions and behaviors (alpha=0.05). RESULTS SMPs had significantly better knowledge (p<0.001) and concussion scenario responses (p<0.001) compared to both coaches and parents. SMPs also had significantly better attitudes compared to parents, but not coaches (p=0.038). Coach concussion scenario responses (p=0.044) and SMP knowledge positively influenced student-athletes' concussion care seeking intentions (p=0.049). Parent responses were not associated with their child's concussion care seeking intentions and behaviors. CONCLUSIONS The gap in coach and parent concussion knowledge and concussion scenario response relative to SMPs is a preliminary target for stakeholder concussion education and supports the current sports medicine model where SMPs primarily disseminate concussion education. Stakeholders, specifically coaches and SMPs, do hold influence over collegiate athlete concussion care seeking intentions and behaviors. RELEVANCE FOR PATIENTS Stakeholders should be addressed within educational efforts aimed at student-athletes and should also complete stakeholder-specific concussion education.
Collapse
Affiliation(s)
- Julianne D. Schmidt
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
- UGA Concussion Research Laboratory, University of Georgia, Athens, Georgia, USA
| | - David Welch Suggs
- Grady College of Journalism and Mass Communication, University of Georgia, Athens, Georgia, USA
| | | | - Laura Bierema
- Department of Lifelong Education, Administration, and Policy, University of Georgia, Athens, Georgia, USA
| | | | - Ron Courson
- Athletic Association, University of Georgia, Athens, Georgia, USA
| | - Fred Reifsteck
- Athletic Association, University of Georgia, Athens, Georgia, USA
- University Health Center, University of Georgia, Athens, Georgia, USA
| |
Collapse
|
31
|
Abstract
CONTEXT The National Collegiate Athletic Association and US Department of Defense have called for educational programs to change the culture of concussion reporting, increase reporting behavior, and enhance the safety of players and service members. OBJECTIVE To evaluate the effects of a novel peer concussion-education program (PCEP) in changing knowledge, attitudes, and norms about concussion reporting among collegiate student-athletes and assess program implementation. DESIGN Randomized controlled trial and qualitative analysis of interviews. SETTING National Collegiate Athletic Association athletic teams from randomly selected colleges or universities. PATIENTS OR OTHER PARTICIPANTS A total of 1614 male and female student-athletes from 60 teams at 10 colleges and universities and 8 athletic trainers. INTERVENTION(S) The PCEP intervention trains 2 peer concussion educators to provide 2 education modules to their teammates. Knowledge, attitudes (oneself and teammates), and concussion occurrence or reporting were assessed at baseline, postintervention, and 1 month later. Eight athletic trainers were interviewed about program implementation. RESULTS Compared with the control group, the intervention group showed greater increases occurred postintervention and at 1 month in concussion knowledge (F1,2648 = 51.3, P < .0001), intention to report (oneself, F2,2633 = 82.3, P < .0001; teammates, F2,2624 = 53.9, P < .0001), return-to-play protocol knowledge, (F2,2632 = 28.4, P < .0001), direct subjective norms (oneself, F2,2625 = 51.7, P < .0001; teammates, F2,2644 = 40.6, P < .0001), direct perceived behavioral control (oneself, F2,2628 = 53.7, P < .0001; teammates, F2,2615 = 68.2, P < .0001), and indirect attitudes (oneself, F2,2626 = 47.1, P < .001; teammates, F2,2623 = 40.9, P < .0001). Peer concussion-education program participants discussed concussion more often with a teammate (F1,1396 = 13.96, P < .0001) or athletic staff (F1,1396 = 6.62, P < .001). Qualitative program analysis revealed both positive aspects of the PCEP and areas for improvement. CONCLUSIONS The PCEP showed promise in increasing concussion knowledge, intention to report concussion, reporting a teammate's concussion, and facilitating attitudinal changes that support reporting among student-athletes.
Collapse
Affiliation(s)
- Meredith E Kneavel
- School of Nursing and Health Sciences, La Salle University, Philadelphia, PA.,Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA
| | - William Ernst
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA.,Department of Professional Psychology, Chestnut Hill College, Philadelphia, PA
| | - Kevin S McCarthy
- Center for Concussion Education and Research, Chestnut Hill College, Philadelphia, PA
| |
Collapse
|
32
|
Abstract
Objective: This study aimed to determine whether collegiate women's ice hockey players are receiving pre-season concussion education and evaluate the nature and delivery of this education. Secondarily, we aimed to assess whether players who recall receiving this education have greater knowledge about concussion or are more likely to have reported suspected concussions than their peers.Methods: An anonymous survey was completed by 459 NCAA women's ice hockey players. Players self-reported receipt of pre-season concussion education, year in school, division of competition, player position, and average length of ice hockey career. Players also completed scales assessing concussion knowledge, attitudes and prior reporting behavior for suspected concussions.Results: 65.3% of athletes affirmed that they received pre-season concussion education. Lecture by an athletic trainer was the most common modality. There were no differences in concussion knowledge or attitudes by concussion education status, NCAA division of competition, or year in school. Players with higher knowledge scores were more likely than their peers to have experienced a suspected concussion and to have not reported it (p = 0.056).Conclusions: Not all NCAA women's ice hockey players are receiving (or recall receiving) mandated concussion education from their institution. The inverse association between concussion knowledge and concussion reporting behavior, while not statistically significant, is concerning and warrants further study. More work is needed to develop educational materials about concussion that are acceptable and memorable to this population, and that help increase concussion care-seeking behaviors.
Collapse
Affiliation(s)
- Lauren E Piana
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,College of Medicine, The University of Tennessee, Memphis, TN, USA
| | - Kirsten D Garvey
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily Kroshus
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Emily M Brook
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
33
|
Register-Mihalik JK, Kay MC, Kerr ZY, Peck KY, Houston MN, Gildner P, Svoboda SJ, Marshall SW, Cameron KL. Influence of Concussion Education Exposure on Concussion-Related Educational Targets and Self-Reported Concussion Disclosure among First-Year Service Academy Cadets. Mil Med 2019; 185:e403-e409. [PMID: 31789379 DOI: 10.1093/milmed/usz414] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
Concussion disclosure is often essential for military personnel to receive appropriate care following concussive injury. Concussion-related education and training may play a role in improving disclosure and recognition among peers, allowing for more timely concussion identification and treatment. The objectives of this study were to: (1) describe concussion education exposure among first-year service academy cadets and (2) examine the association between exposure to concussion education sources (multiple vs. only one) and concussion-related knowledge, attitudes, perceived social norms, intention to disclose symptoms, and disclosure behaviors.
Materials and Methods
First-year service academy cadets completed a cross-sectional survey to assess perceptions of concussion disclosure during preseason concussion baseline testing sessions. Associations between key cadet characteristics and exposure to multiple concussion education sources were examined using odds ratios and 95% confidence intervals. Linear regression was used to model the continuous measures of concussion-related knowledge, attitudes, and perceived social norms. Log-binomial regression was used to model the categorical outcomes of high perceived control over concussion disclosure (higher vs. lower), intention to disclose (higher vs. lower), and disclosure of all possible concussive events at the time of injury (yes vs. no). The primary predictor for all models was exposure to multiple sources of concussion education (video, coach, medical professional, or other) vs. exposure to only one educational source. All models were adjusted for gender, high school contact sport participation, and previous concussion history.
Results
Of the 972 first-year cadets (85% response; age = 18.4 ± 0.9 years; 21.7% female, 29.0% NCAA student-athlete), 695 (71.5%) reported receiving some type of previous concussion education and 229 (23.6%) reported a previous concussion history (206/229 reported the actual number they experienced). Of those reporting previous concussion-related education (n = 695), 542 (78.0%) watched a video, 514 (74.0%) talked with a coach about concussion, 433 (62.3%) talked with a medical professional, and 61 (8.8%) reported other sources of education ranging from anatomy teachers to brochures. Overall, 527 (75.8%) reported receiving more than one source of concussion education. Having played a contact sport in high school and having a history of concussion were associated with having multiple concussion education exposures. Being female was associated with lower odds of multiple exposures. Exposure to multiple sources of concussion education was not associated with knowledge, attitudes, perceived norms, or higher intention to disclose concussion symptoms. However, among those with a concussion history, exposure to multiple sources of concussion education was associated with a nearly 40% higher prevalence of disclosing all concussions at the time of injury compared to only one source of educational exposure (67.1% vs. 48.3%; prevalence ratio = 1.4; 95% confidence interval: 0.9, 2.1). Thus, although multiple sources of education may not influence intermediate variables of knowledge, attitudes, perceived norms and intentions, exposure to multiple sources of concussion education may influence actual decision-making around concussion disclosure among first-year service academy cadets.
Conclusion
These data suggest disparities in concussion education exposure that can be addressed in first-year cadets. Additionally, findings support the importance and use of multiple sources of concussion education in improving cadet’s concussion-related decision-making.
Collapse
Affiliation(s)
- Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, CB# 8700, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
- Injury Prevention Research Center, CB#7505, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Melissa C Kay
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, CB# 8700, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
- School of Health Professions, University of Southern Mississippi, 118 college Dr. #5122, Hattiesburg, MS, 39406
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, CB# 8700, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
- Injury Prevention Research Center, CB#7505, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Karen Y Peck
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 990 Washington Road, West Point, NY, 10996
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 990 Washington Road, West Point, NY, 10996
| | - Paula Gildner
- Injury Prevention Research Center, CB#7505, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Steven J Svoboda
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 990 Washington Road, West Point, NY, 10996
| | - Stephen W Marshall
- Injury Prevention Research Center, CB#7505, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
- Department of Epidemiology, CB#7400, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, 990 Washington Road, West Point, NY, 10996
- Department of Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
34
|
Abstract
BACKGROUND Extant literature suggests that a substantial portion of athletes may not report a possible concussion and that concussion knowledge is insufficient to predict concussion reporting behavior. One area that has not been explored is reporting skill; that is, mastery of the actions required to report a concussion. This study evaluated the relationship between reporting skill and reporting intention, introducing a measure of the reporting skill construct. HYPOTHESES Reporting intentions will be more closely associated with reporting skill than with concussion/symptom knowledge. The relationship between concussion (or symptom) knowledge and reporting intentions will differ by level of reporting skill. STUDY DESIGN Repeated cross-sectional study. LEVEL OF EVIDENCE Level 2. METHODS A set of items was administered to young adults aged 18 to 24 years from the Survey Sampling International panel. Exploratory/confirmatory factor analyses were conducted on 2 waves of data to develop the scale (n = 899). Hypotheses were tested using structural equation modeling on the responses from the third wave of participants (n = 406). RESULTS Knowing the actions to take in reporting was more important than having knowledge of concussions or concussion symptoms. Reporting skill, not concussion or concussion symptom knowledge, was associated with higher intentions to report symptoms. Among those with higher levels of reporting skill, concussion symptom knowledge (but not general concussion knowledge) was associated with higher intentions to report symptoms. CONCLUSION Reporting skill is an important and, until now, missing ingredient in the concussion literature and practice. CLINICAL RELEVANCE Incorporating reporting skill development in concussion education and team activities to teach athletes how to report is likely to improve actual reporting intentions. While further study is needed with particular sports and additional age groups, reporting skill holds promise as a new avenue for increased concussion reporting.
Collapse
Affiliation(s)
- Dee Warmath
- Department of Financial Planning, Housing, and Consumer Economics, College of Family and Consumer Sciences, University of Georgia, Athens, Georgia
| | - Andrew P Winterstein
- Department of Kinesiology, School of Education, University of Wisconsin-Madison, Wisconsin
| |
Collapse
|
35
|
Abstract
While research on sport-related concussion has increased dramatically over the past decade, research investigating concussion reporting is in its early stages. The purpose of this project was to assess concussion reporting and work with stakeholders to develop and assess strategies to improve reporting. We used a multi-site, repeated measures design with three NCAA Division I football programs, including 223 athlete participants. A modified community-based participatory research (CBPR) approach was used to develop intervention strategies (Fall 2017 season) with stakeholders designed to increase concussion reporting intentions. Preseason and postseason surveys were administered to determine effectiveness. Main outcome measures included concussion knowledge, intervention effectiveness, and reporting intention measures. For all three programs, concussion knowledge was unrelated to reporting intentions. Two of the three programs implemented the intervention strategies and for these programs there was evidence that the interventions were effective. Specifically, athletes from these two programs perceived more support from coaches about reporting (P< 0.05; t= 2.83), received education more frequently (P< 0.05; t= 2.67), and reported being more likely to report concussion symptoms (P< 0.05; t= 2.14). Our study demonstrates that working with stakeholders to develop site-specific strategies to improve concussion reporting is an effective approach to help improve reporting behaviours.
Collapse
Affiliation(s)
- Debbie I Craig
- Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, Arizona
| | - Monica R Lininger
- Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, Arizona
| | - Heidi A Wayment
- Psychological Sciences, W.A. Franke College of Business, Northern Arizona University
| | - Ann H Huffman
- Psychological Sciences, W.A. Franke College of Business, Northern Arizona University
| |
Collapse
|
36
|
Putukian M, Echemendia RJ, Chiampas G, Dvorak J, Mandelbaum B, Lemak LJ, Kirkendall D. Head Injury in Soccer: From Science to the Field; summary of the head injury summit held in April 2017 in New York City, New York. Br J Sports Med 2019; 53:1332. [DOI: 10.1136/bjsports-2018-100232] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 12/15/2022]
Abstract
There has been an increased focus and awareness of head injury and sport-related concussion (SRC) across all sports from the medical and scientific communities, sports organisations, legislators, the media and the general population. Soccer, in particular, has been a focus of attention due to the popularity of the game, the frequency of SRC and the hypothesised effects of repetitive heading of the ball. Major League Soccer, US Soccer and the National Women’s Soccer League jointly hosted a conference entitled, ‘Head Injury in Soccer: From Science to the Field’, on 21–22 April 2017 in New York City, New York. The mission of this conference was to identify, discuss and disseminate evidence-based science related to the findings and conclusions of the fifth International Conference on Concussion in Sport held by the Concussion in Sport Group and apply them to the sport of soccer. In addition, we reviewed information regarding the epidemiology and mechanism of head injuries in soccer at all levels of play, data regarding the biomechanics and effects of repetitive head impacts and other soccer-specific considerations. We discussed how to release the information raised during the summit to key stakeholders including athletes, parents, coaches and healthcare providers. We identified future areas for research and collaboration to enhance the health and safety of soccer (football) players.
Collapse
|
37
|
Abstract
Beginning in 2009 with the passage of the Zackery Lystedt law in the state of Washington, all 50 states have passed concussion laws that implement a mandatory framework of care for high school and youth athletes. The structure of these laws generally shares the three primary components of the Lystedt law: (1) preseason concussion education; (2) mandatory removal from play with suspected concussion; and (3) clearance from a healthcare professional prior to return to play. These same three policy components are also found at the collegiate and professional levels of sport, either through established policy or labor contracts. This chapter explores concussion-specific legal and policy developments that currently inform concussion management practices across multiple levels of the US athletic system.
Collapse
|
38
|
Register-Mihalik JK, Cameron KL, Kay MC, Kerr ZY, Peck KY, Houston MN, Linnan LA, Hennink-Kaminski H, Gildner P, Svoboda SJ, Marshall SW. Determinants of intention to disclose concussion symptoms in a population of U.S. military cadets. J Sci Med Sport 2018; 22:509-515. [PMID: 30551922 DOI: 10.1016/j.jsams.2018.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Non-disclosure of concussion complicates concussion management, but almost nothing is known about non-disclosure in military settings. This study describes concussion disclosure-related knowledge, attitudes, perceived social norms, perceived control, and intention. Additionally, the study identifies determinants of high intention to disclose concussion symptoms. DESIGN Cross sectional survey. METHODS First-year service academy cadets completed a cross-sectional survey to assess perceptions of concussion disclosure. Independent variables included: gender, race, ethnicity, high school athlete status, NCAA athlete status, previous concussion history, previous concussion education, socioeconomic proxy, concussion-related knowledge, attitudes about concussion, perceived social norms (perceived peer/organizational support and actions), and perceived control over disclosure. Log-binomial regression was used to identify determinants of high intention to disclose concussion symptoms. RESULTS A total of 972 first-year military service academy cadets completed the survey [85% response; age=18.4±0.9y]. In the simple models, previous concussion history was associated with lower intention to disclose concussion symptoms. High perceived control over disclosure, higher concussion knowledge, more favorable attitudes and social norms about concussion were associated with high intention to disclose. In the multivariable model, a 10% shift towards more favorable perceived social norms (PR=1.28; p<0.001) and attitudes (PR=1.07; p=0.05) about concussion were associated with high intention to disclose concussion symptoms. High perceived control over disclosure was associated with high intention to disclose concussion symptoms (PR=1.39; p=0.08). CONCLUSIONS Concussion-related perceived social norms, attitudes, and perceived control are associated with intention to disclose. Organizationally appropriate intervention strategies can be developed from these data.
Collapse
Affiliation(s)
- Johna K Register-Mihalik
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA.
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, USA
| | - Melissa C Kay
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA; Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, USA
| | - Zachary Y Kerr
- Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA
| | - Karen Y Peck
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, USA
| | - Megan N Houston
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, USA
| | - Laura A Linnan
- Department of Health Behavior, Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, USA
| | - Heidi Hennink-Kaminski
- School of Media and Journalism, Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA
| | - Steven J Svoboda
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Hospital, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, USA; Department of Epidemiology, Curriculum in Human Movement Science, University of North Carolina at Chapel Hill, USA
| |
Collapse
|
39
|
Cusimano MD, Zhang S, Topolovec-Vranic J, Grosso A, Jing R, Ilie G. Pros and Cons of 19 Sport-Related Concussion Educational Resources in Canada: Avenues for Better Care and Prevention. Front Neurol 2018; 9:872. [PMID: 30450073 PMCID: PMC6224516 DOI: 10.3389/fneur.2018.00872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 09/27/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: The goal of this research was to assess the effectiveness of available concussion educational resources in Canada, the means used to disseminate this knowledge and the impact of these educational resources on players' concussion prevention knowledge. Methods: We assessed concussion knowledge before and after exposure to one or more of 19 resources introduced through a national program aimed to increase awareness and knowledge of concussion. The effectiveness of the mode of delivery was measured by changes in concussion knowledge scores (CKS) between pre and pro scores. Measures: Concussion knowledge scores (CKS) were calculated for pre- and post- exposure to concussion educational resources and used as a measure of both, the effectiveness of each resource as well as the effectiveness of the delivery method. The effectiveness of each educational resource was also measured by the respondents' rating of each concussion educational resource. Results: Respondents in post-survey had higher CKS than those in pre-survey. Two out of the 19 newly developed concussion educational resources were effective in improving the resource users' CKS. Linear regression showed that using more resources further increased CKS. Four out of six modes of delivery enhanced respondents' concussion knowledge. Conclusion: Our findings demonstrate that the newly developed Canadian concussion educational resources were effective at improving users' concussion knowledge. Our data demonstrates that using three or more resources further enhanced the users' concussion knowledge. Future research, however, is critical to assess whether concussion prevention knowledge is sufficient to reduce injuries and factors influencing it.
Collapse
Affiliation(s)
- Michael D Cusimano
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stanley Zhang
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Jane Topolovec-Vranic
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Ashley Grosso
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Rowan Jing
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Gabriela Ilie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
40
|
Kroshus E, Baugh CM, Meehan WP 3rd, Viswanath K. Personal subjectivity in clinician discussion about retirement from sport post-concussion. Soc Sci Med 2018; 218:37-44. [PMID: 30336393 DOI: 10.1016/j.socscimed.2018.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 07/19/2018] [Accepted: 07/29/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is increasing focus on the number of concussions after which an athlete should discontinue participating in contact or collision sports. This is a clinically subjective and, in some cases, a preference-sensitive decision. PURPOSE Our goal was to assess whether there is personal subjectivity in when athletic trainers (ATs) discuss the possibility of sport retirement post-concussion with athletes. METHODS A national sample of ATs who provide clinical care to college athletes completed a questionnaire (n = 677, 34% response rate). Structural equation modeling was used to assess the association between risk perceptions, risk tolerance, social influences (beliefs about athlete, coach and parent preferences), expectancies about athlete success (on and off field), and the number of concussions after which retirement would be discussed. RESULTS There was a significant direct effect of AT risk tolerance on the number of concussions after which sport retirement would be discussed, among both male and female ATs (male B = 0.54, p < 0.001; female B = 0.31, p < 0.001). ATs who more strongly prioritized athletes' on-field achievements indicated that they would discuss sport retirement after a larger number of concussions compared to their peers who less strongly valued athletic achievement. CONCLUSIONS The results suggest the potential utility of standardized approaches to communicating concussion risk consistently to athletes. This can help ensure that all athletes are uniformly able to make informed decisions about continued exposure to concussion risk that are based on their values and preferences.
Collapse
|
41
|
Kerr ZY, Register-Mihalik JK, Haarbauer-Krupa J, Kroshus E, Go V, Gildner P, Byrd KH, Marshall SW. Using opinion leaders to address intervention gaps in concussion prevention in youth sports: key concepts and foundational theory. Inj Epidemiol 2018; 5:28. [PMID: 29984386 PMCID: PMC6035905 DOI: 10.1186/s40621-018-0158-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/30/2018] [Indexed: 12/04/2022] Open
Abstract
Behavioral interventions to increase disclosure and proper management of concussion in youth sports have unrealized potential when it comes to preventing concussion. Interventions have focused on changing individual athlete behavior and have fallen short of the potential for sustained systemic behavioral change. One potentially critical reason for this shortfall is that other key determinants of risk behaviors at all levels of the socio-ecological model (e.g. interpersonal, community, policy) are not addressed in extant programming. There is a critical need for theory-driven interventions that address concussion prevention and education at the community level and target sustainable culture change. The Popular Opinion Leader (POL) intervention, a multi-level intervention model previously successfully employed in multiple public health contexts, is theoretically well positioned to affect such change. POL is based on the Diffusion of Innovations framework and involves identifying, recruiting, and training well-respected and trusted individuals to personally endorse prevention and risk-reduction within their social networks. Critical behavioral changes related to concussion disclosure and management have been shown to diffuse to others if enough opinion leaders endorse and support the behaviors. This article summarizes the concepts and principles of POL and describes how it could be adapted for and implemented in youth sport settings. For optimal impact, POL needs to adapt to several factors unique to youth sports settings and culture. First, adult involvement may be important, given their direct involvement in the athlete's medical care. However, parents and coaches' opinions on injury care-seeking, competition, and safety may affect their perceptions of POL. Second, youth sports are structured settings both physically and socioculturally. Games and practices may provide opportunities for the informal interactions that are critical to the success of POL. However, youth sport setting membership is transient as players get older and move to other sport settings; POL approaches need to be self-sustaining despite this turnover. Moreover, stakeholder value placed on athlete development and competition, alongside safety, must be considered. Formative research is needed to ensure that POL principles are translated into the youth sport setting while maintaining fidelity to the concepts and principles that have made POL successful for other health outcomes.
Collapse
Affiliation(s)
- Zachary Y. Kerr
- Department of Exercise and Sport Science, University of North Carolina, 313 Woollen Gym CB#8700, Chapel Hill, NC 27599-8700 USA
- Injury Prevention Research Center, University of North Carolina, CVS Plaza, Suite 500, 137 East Franklin Street, CB#7505, Chapel Hill, NC 27599-7505 USA
| | - Johna K. Register-Mihalik
- Injury Prevention Research Center, University of North Carolina, CVS Plaza, Suite 500, 137 East Franklin Street, CB#7505, Chapel Hill, NC 27599-7505 USA
- Department of Exercise and Sport Science, University of North Carolina, 125 Fetzer Hall CB#8700, Chapel Hill, NC 27599-8700 USA
| | - Juliet Haarbauer-Krupa
- Division of Unintentional Injury, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4700 Buford Highway, MS F-62, Atlanta, GA 30341 USA
| | - Emily Kroshus
- Department of Pediatrics, University of Washington, 2001 Eighth Ave, Seattle, WA 98121 USA
- Seattle Children’s Research Institute; Child Health, Behavior and Development, 2001 Eighth Ave, Suite 400, Seattle, WA 98121 USA
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, 361 Rosenau Hall CB#7440, Chapel Hill, NC 27599-7440 USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina, CVS Plaza, Suite 500, 137 East Franklin Street, CB#7505, Chapel Hill, NC 27599-7505 USA
| | - K. Hunter Byrd
- Injury Prevention Research Center, University of North Carolina, CVS Plaza, Suite 500, 137 East Franklin Street, CB#7505, Chapel Hill, NC 27599-7505 USA
| | - Stephen W. Marshall
- Injury Prevention Research Center, University of North Carolina, CVS Plaza, Suite 500, 137 East Franklin Street, CB#7505, Chapel Hill, NC 27599-7505 USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, CVS Plaza, Suite 500, 137 East Franklin Street, CB#7505, Chapel Hill, NC 27599-7505 USA
| |
Collapse
|
42
|
Sullivan L, Molcho M. What do coaches want to know about sports-related concussion? A needs assessment study. J Sport Health Sci 2018; 7:102-108. [PMID: 30356480 PMCID: PMC6180547 DOI: 10.1016/j.jshs.2017.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/01/2017] [Accepted: 03/08/2017] [Indexed: 05/09/2023]
Abstract
PURPOSE This study aims to identify the concussion-related training and education needs of Gaelic Athletic Association (GAA) coaches in Ireland, as well as the preferred method of concussion education delivery. METHODS We used a self-report questionnaire to collect data from a convenience sample of 108 GAA coaches in Ireland. Data were captured on (1) informational needs and desires, (2) preferred methods of delivery, and (3) concussion practices and procedures. Questionnaires were completed electronically from June 3rd-September 29th, 2015. RESULTS Coaches indicated that they were most interested in receiving information about the (1) signs and symptoms of concussion, (2) assessment of concussion, and (3) return-to-play guidelines. Over two-thirds of participants indicated that in-person training would be the most effective mode of delivery of concussion education for this population. Additionally, only 10% coaches reported that before the start of the season they talked to their athletes about concussion management and safety, and this was more common among coaches who reported being formally educated about concussion. CONCLUSION Our findings reveal a disconnect between the concussion education needs and the education that is currently provided to GAA coaches, in terms of content and delivery modality. Our results suggest a need for a multifaceted approach to concussion education, tailored to the needs and learning preferences of the target population.
Collapse
Affiliation(s)
- Lindsay Sullivan
- School of Health Sciences, Discipline of Health Promotion, NUI Galway, Galway, Ireland
| | - Michal Molcho
- School of Arts, Social Sciences, and Celtic Studies, Children's Studies Programme, NUI Galway, Galway, Ireland
| |
Collapse
|
43
|
Baugh CM, Kroshus E, Perry KI, Bourlas AP. Concussion management plans' compliance with NCAA requirements: Preliminary evidence suggesting possible improvement. J Law Med Ethics 2017; 45:231-237. [PMID: 31695299 PMCID: PMC6833948 DOI: 10.1177/1073110517720652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examined the extent to which concussion management plans at National Collegiate Athletic Association (NCAA) member schools were in line with NCAA Concussion Policy and best practice recommendations in absence of any process to ensure compliance. Most schools' concussion management plans were in compliance with 3 (60%) or 4 (25.6%) of the NCAA's 4 required components. Annual athlete education and acknowledgement was the requirement least often included, representing an area for improvement. Further, schools tended to more often include best practices that were more medically-oriented (e.g., including baseline examination), compared to best practices that were less medical in nature (e.g., avoiding flagrant head hits).
Collapse
Affiliation(s)
- Christine M Baugh
- Christine is a Ph.D. candidate in Health Policy at Harvard University (Cambridge, MA) and a graduate researcher at Boston Children's Hospital Division of Sports Medicine (Boston, MA). Christine received her BA from Harvard College (Cambridge, MA) and her MPH from Boston University School of Public Health (Boston, MA)
| | - Emily Kroshus
- Emily is an Assistant Professor at University of Washington in the Department of Pediatrics and at Seattle Children's Research Institute in the Center for Child Health, Behavior and Development. She received her doctoral degree in public health from Harvard University's T.H. Chang School of Public Health (Boston, MA)
| | - Kaitlyn I Perry
- Kaitlyn is a Health Promotion Specialist at the Lawrence-Douglas County Health Department. She received her BS from the University of Kansas (Lawrence, KS) and her MPH from Boston University School of Public Health (Boston, MA)
| | - Alexandra P Bourlas
- Alexandra is a medical student at Ohio University Heritage College of Osteopathic Medicine (Athens, OH). She received her BA from Johns Hopkins University (Baltimore, MD) and her MA from Boston University School of Medicine (Boston, MA)
| |
Collapse
|
44
|
Register-Mihalik J, Baugh C, Kroshus E, Y Kerr Z, Valovich McLeod TC. A Multifactorial Approach to Sport-Related Concussion Prevention and Education: Application of the Socioecological Framework. J Athl Train 2017; 52:195-205. [PMID: 28387550 DOI: 10.4085/1062-6050-51.12.02] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To offer an overview of sport-related concussion (SRC) prevention and education strategies in the context of the socioecological framework (SEF). Athletic trainers (ATs) will understand the many factors that interact to influence SRC prevention and the implications of these interactions for effective SRC education. BACKGROUND Concussion is a complex injury that is challenging to identify and manage, particularly when athletes fail to disclose symptoms to their health care providers. Education is 1 strategy for increasing disclosure. However, limited information addresses how ATs can integrate the many factors that may influence the effectiveness of SRC education into their specific settings. Public health models provide an example through the SEF, which highlights the interplay among various levels of society and sport that can facilitate SRC prevention strategies, including education. DESCRIPTION For ATs to develop appropriate SRC prevention strategies, a framework for application is needed. A growing body of information concerning SRC prevention indicates that knowledge alone is insufficient to change concussion-related behaviors. The SEF allows this information to be considered at levels such as policy and societal, community, interpersonal (relationships), and intrapersonal (athlete). The use of such a framework will facilitate more comprehensive SRC prevention efforts that can be applied in all athletic training practice settings. Clinical Applications: Athletic trainers can use this information as they plan SRC prevention strategies in their specific settings. This approach will aid in addressing the layers of complexity that exist when developing a concussion-management policy and plan.
Collapse
|
45
|
Alosco ML, Jarnagin J, Tripodis Y, Martin B, Chaisson C, Baugh CM, Torres A, Nowinski CJ, Cantu RC, Stern RA. Utility of providing a concussion definition in the assessment of concussion history in former NFL players. Brain Inj 2017; 31:1116-1123. [PMID: 28471243 DOI: 10.1080/02699052.2017.1294709] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Former National Football League (NFL) players' working knowledge of concussion has not yet been evaluated, despite this population being a major clinical research target due to the association between repetitive head impacts (RHI) and long-term clinical impairments. This study examined former NFL players' understanding of the current concussion definition, and the association between number of concussions with clinical function. METHODS 95 former NFL players (mean age = 55.29; mean NFL year = 8.10) self-reported number of concussions before being provided with a concussion definition and after being read a modern definition of concussion. Subjects reported number of concussions with loss of consciousness (LOC). Principal Component Analysis of a battery of tests generated behaviour/mood, psychomotor speed/executive function, and verbal and visual memory factor scores. RESULTS Post-definition number of concussions (median = 50) was five times the pre-definition (median = 10; p < 0.001). Greater pre- (p = 0.019) and post-definition concussions (p = 0.036) correlated with worse behaviour/mood scores, after controlling for years of football played, with specific effects for depressive symptoms and impulsivity. LOC did not account for variance beyond number of concussions. CONCLUSIONS Practitioners and clinical researchers should provide a definition of concussion in the assessment of concussion history in former football players to facilitate accuracy and standardization.
Collapse
Affiliation(s)
- Michael L Alosco
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,b Department of Neurology , Boston University School of Medicine , Boston , MA , USA
| | - Johnny Jarnagin
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,b Department of Neurology , Boston University School of Medicine , Boston , MA , USA
| | - Yorghos Tripodis
- c Department of Biostatistics , Boston University School of Public Health , Boston , MA , USA
| | - Brett Martin
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,d Data Coordinating Center , Boston University School of Public Health , Boston , MA , USA
| | - Christine Chaisson
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,c Department of Biostatistics , Boston University School of Public Health , Boston , MA , USA.,d Data Coordinating Center , Boston University School of Public Health , Boston , MA , USA
| | - Christine M Baugh
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,b Department of Neurology , Boston University School of Medicine , Boston , MA , USA.,e Interfaculty Initiative in Health Policy , Harvard University , Cambridge , MA , USA
| | - Alcy Torres
- f Pediatric Neurology , Boston University School of Medicine , Boston , MA , USA.,g Pediatric Neurology , Boston Medical Center , Boston , MA , USA
| | | | - Robert C Cantu
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,b Department of Neurology , Boston University School of Medicine , Boston , MA , USA.,h Concussion Legacy Foundation , Waltham , MA , USA.,i Department of Neurosurgery , Boston University School of Medicine , Boston , MA , USA
| | - Robert A Stern
- a Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine , Boston , MA , USA.,b Department of Neurology , Boston University School of Medicine , Boston , MA , USA.,i Department of Neurosurgery , Boston University School of Medicine , Boston , MA , USA.,j Department of Anatomy & Neurobiology , Boston University School of Medicine , Boston , MA , USA
| |
Collapse
|
46
|
Abstract
Although football is one of the most popular sports in America, its high injury incidence places concern on the injury prevention and safety of its players. This article investigates the perspectives of two National Collegiate Athletic Association Division 1 football coaches on promoting injury management and player safety while maintaining a highly competitive team. Through obtaining their coaching philosophy team management topics, effective strategies that contribute to a team culture prioritizing player well-being were identified. Interactions of football coaches with physicians and medical specialists are explored to highlight strengths that can optimize the care and treatment of football athletes.
Collapse
Affiliation(s)
- Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School, Ann Arbor, Michigan
| | - Meghan E. Lark
- Research Associate, Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Paul S. Cederna
- Professor of Surgery, Section of Plastic Surgery, Section Head, University of Michigan Medical School, Ann Arbor, Michigan
| |
Collapse
|
47
|
Abstract
AIM There has been considerable increase in concussion awareness and risks; however, extreme sports such as motocross have received scant attention. The purpose of this study was to assess concussion knowledge among motocross riders and determine differences based on demographic factors. METHODOLOGY & RESULTS 782 motocross riders responded to an Internet-based questionnaire, and participant's knowledge score was 14.3 ± 2.7 out of 20 and symptom recognition was 6.8 ± 1.4 out of 8. Riders who had performed baseline concussion testing or received formal concussion education demonstrated higher knowledge scores. Rider's demographics did not predict outcome measures. CONCLUSIONS Considerable misconceptions and lack of symptom knowledge persist among motocross riders and these results can be used for future interventions to improve concussion reporting.
Collapse
Affiliation(s)
- Kristina O Miller
- Department of Intercollegiate Athletics, University of Maryland Baltimore County, Baltimore, MD 21250, USA
| | - Jody L Langdon
- School of Health & Kinesiology, Georgia Southern University, Statesboro, GA 30460, USA
| | - Glenn P Burdette
- School of Health & Kinesiology, Georgia Southern University, Statesboro, GA 30460, USA
| | - Thomas A Buckley
- Department of Kinesiology & Applied Physiology, University of Delaware, Newark, DE 19716, USA
| |
Collapse
|
48
|
Chinn NR, Porter P. Concussion reporting behaviours of community college student-athletes and limits of transferring concussion knowledge during the stress of competition. BMJ Open Sport Exerc Med 2016; 2:e000118. [PMID: 27900182 PMCID: PMC5117077 DOI: 10.1136/bmjsem-2016-000118] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 11/05/2022] Open
Abstract
Concussion education for student-athletes is mandated by several states and is becoming an integral component of concussion management programmes; however, little is known about student-athlete concussion knowledge and self-reporting of suspected concussion. This study explored to what extent collegiate student-athletes are knowledgeable on the topic of concussion, the relationship between having concussion knowledge and reporting behaviours, and factors contributing to not reporting when education has been provided.
Collapse
Affiliation(s)
- Nancy Resendes Chinn
- Disability Resources Department, Santa Rosa Junior College, Santa Rosa, California, USA
| | - Paul Porter
- Department of Education, Sonoma State University, Rohnert Park, California, USA
| |
Collapse
|
49
|
Stern RA, Seichepine D, Tschoe C, Fritts NG, Alosco ML, Berkowitz O, Burke P, Howland J, Olshaker J, Cantu RC, Baugh CM, Holsapple JW. Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A Survey of New England Emergency Departments. J Neurotrauma 2016; 34:861-868. [PMID: 27112592 DOI: 10.1089/neu.2016.4475] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. In 2013, a 32-item online survey was e-mailed to 149/168 EDs throughout New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine). Respondents included senior administrators asked to report on their EDs use of clinical practice guidelines, neuroimaging decision-making, and discharge instructions for concussion management. Of the 72/78 respondents included, 35% reported absence of clinical practice guidelines, and 57% reported inconsistency in the type of guidelines used. Practitioner preference guided neuroimaging decision-making for 57%. Although 94% provided written discharge instructions, there was inconsistency in the recommended time frame for follow-up care (13% provided no specific time frame), the referral specialist to be seen (25% did not recommend any specialist), and return to activity instructions were inconsistent. There is much variability in concussion care practices and application of evidence-based clinical practice guidelines in the evaluation and management of concussions in New England EDs. Knowledge translational efforts will be critical to improve concussion management in the ED setting.
Collapse
Affiliation(s)
- Robert A Stern
- 1 Boston University Alzheimer's Disease and CTE Center; Departments of Neurology, Neurosurgery, and Anatomy and Neurobiology, Boston University School of Medicine , Boston, Massachusetts
| | - Daniel Seichepine
- 2 Boston University Alzheimer's Disease and CTE Center , Boston, Massachusetts
| | - Christine Tschoe
- 3 Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts
| | - Nathan G Fritts
- 2 Boston University Alzheimer's Disease and CTE Center , Boston, Massachusetts
| | - Michael L Alosco
- 4 Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine , Boston, Massachusetts
| | - Oren Berkowitz
- 5 Departments of Neurosurgery and Medicine, Boston University School of Medicine , Boston, Massachusetts
| | - Peter Burke
- 6 Section of Acute Care & Trauma Surgery, Division of General Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine , Boston, Massachusetts
| | - Jonathan Howland
- 7 Injury Prevention Center, Boston Medical Center; Department of Emergency Medicine, Boston University School of Medicine , Boston, Massachusetts
| | - Jonathan Olshaker
- 8 Department of Emergency Medicine, Boston University School of Medicine; Department of Emergency Medicine , Boston Medical Center, Boston, Massachusetts
| | - Robert C Cantu
- 9 Boston University Alzheimer's Disease and CTE Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine , Boston, Massachusetts
| | - Christine M Baugh
- 10 Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; Interfaculty Initiative in Health Policy, Harvard University , Cambridge, Massachusetts
| | - James W Holsapple
- 3 Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts
| |
Collapse
|
50
|
Abstract
Reducing the frequency and severity of concussions from sport is an important issue in public health currently addressed by a multifaceted approach. Given the large number of participants and the comparatively high risk of injury, American football is an important sport to consider when examining concussion management practices. Focusing on American football at the collegiate level, this manuscript describes current research regarding concussion epidemiology, policy, implementation of clinical diagnosis, management and return-to-play standards and athlete concussion education. Although American collegiate sports leagues have put forth concussion-related policies in recent years, the implementation of these policies and related effects on athlete concussion education, clinical management of concussion and ultimately athlete health outcomes are not well understood. Additional research is needed.
Collapse
Affiliation(s)
- Christine M Baugh
- Interfaculty Initiative in Health Policy, Harvard University, 14 Story Street, Fourth Floor, Cambridge, MA 02138, USA
- Division of Sports Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA 02115, USA
| | - Emily Kroshus
- Harvard School of Public Health, Department of Social & Behavioral Sciences, 677 Huntington Avenue, Kresge 7th Floor, Boston, MA 02116, USA
| |
Collapse
|