Sports Medicine Research: In the Lab & In the Field: Concussion Knowledge Does Not Translate into Healthy Reporting Habits (Sports Med Res)


Monday, January 29, 2018

Concussion Knowledge Does Not Translate into Healthy Reporting Habits

Why professional football players chose not to reveal their concussion symptoms during a game or practice  

Mouzon BC, Bachmeier C, Ojo JO, Acker CM, Ferguson S, Paris D, Ait-Ghezala G, Crynen G, Davies P, Mullan M, Stewart W, Crawford F. 2017. Annals of Clinical and Translational Neurology: ahead of print.

Take Home Message: Many professional football players whom believed they suffered a concussion failed to disclose this information to a medical professional – many reported that they did not believe the injury was serious enough.
Despite increased concussion knowledge and understanding of concussion policies, some athletes still fail to report that they may have suffered a concussion to a medical professional and continue to play. Several researchers have investigated why athletes fail to report his/her concussion; however, little is known about professional Canadian football players. Therefore, the authors mailed 100 questionnaires to each of the 9-team’s head athletic trainer/therapist to identify reasons why athletes believed they suffered a concussion and failed to seek medical attention, how often this occurred, and how important these reasons were in the decision process. During the 2016 preseason physicals, athletes who consented completed the anonymous survey. This survey consisted of 17 questions that assessed the player’s football participation history, lifetime and recent (past 12 months) concussion injury history, and 13 different scenarios where players re-counted how many times each scenario happened to them and rated how important it was in their decision to disclose or not. A total of 454 athletes completed the survey, of which 309 athletes played in the Canadian Football League in the 2015 season. Among 446 players, 188 (42%) had a history of concussion. However, of the 309 players that participated in the 2015 season only 21% stated they would always share their symptoms and 62% reported that they would never volunteer their symptoms. The most common reason a player failed to report a concussion was because they did not feel the concussion was serious/severe enough and felt they could continue to play with little danger (49%). Forty-two percent felt that they would be removed from the game, and they did not want this to happen, and 41% reported they thought they would let the team down if they reported a concussion.

Similar to the National Football League, the Canadian Football League has a concussion policy, concussion spotters, and targeted concussion education programs for their players. However, the authors of this study found that the minority of athletes sought medical attention for a concussion, and most athletes would not volunteer concussion injury information to medical personnel. Additionally, like previous research, the authors found the most frequent reasons for why an athlete failed to disclose a potential concussion was because they did not deem it serious enough, they do not want to let the teammates down, or they do not want to be taken out of the game. This underscores an important but sad reality that too often education does not lead to a change in behavior. It would be interesting to see if a broad cohort of athletes have similar attitudes and reporting behaviors regarding concussions across different sports, ages, and skill levels. Within this Canadian Football League cohort it would be noteworthy to determine if they are failing to disclose due potential financial loss.  We need further research to identify how we can better educate athletes, so we can encourage healthy injury reporting behaviors. At this time, medical professionals need to be aware of the reasons why athletes may not disclose a potential concussion.

Questions for Discussion: How do you educate your athletes so it translates into healthy reporting behaviors? Do you feel like your approaches to concussion education have been successful?

Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban

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Kevin said...

Hi Jane,

I think there is an important discussion to be had regarding under-reporting of injuries, especially concussion. Seeing as how the landscape of concussion research has really begun to grow, I guess it is not all too surprising that nearly half of the volunteers think concussion is not a serious enough injury to disclose. Unfortunately, if I am not mistaken, it takes on average 16 years for research to fully transform clinical practice.

Until then I think this is where the clinician can help influence the athlete to be open and honest about their symptoms. In my experience, athletes are much more willing to disclose an injury when they have a great rapport with their clinician.

What are your thoughts?

Jane said...

I agree education is the key and like you stated I think athletic trainers are great at gaining a rapport with the athlete; however, obviously it takes something more because these findings are not unique to professional I am not discounting the struggles athletic trainers in the professional field have due to the fact I am sure the struggle is even greater due to the amount of money involved. However, we need to ascertain how we can quickly translate (16 years does sound correct for research to translate into clinical practice) these findings into clinical practice. We have known for years that underreporting is a problem and that they do not want to report because they do not think it is serious enough, loose his/her spot on the team, or let his/her coach/teammates down. How can we get this message across to the coaches, parents, and athletes to make a large enough impact to get them to change their behavior? Maybe it will take something like commercials or advertisements to get the word out to the general population to make this behavioral shift much like they did with healthy eating habits and not doing drugs. This is certainly a grand idea. How do you conduct your concussion education?

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