Sports Medicine Research: In the Lab & In the Field: Concussion Knowledge Getting Better But is Reporting Getting Worse? (Sports Med Res)


Wednesday, February 21, 2018

Concussion Knowledge Getting Better But is Reporting Getting Worse?

Concussion symptom underreporting among incoming National Collegiate Athletic Association Division I college athletes.

Conway FN, Domingues M, Monaco R, Lesnewich LM, Ray AE, Alderman BL, Todaro SM, Buckman JF. 2018. Clin J Sport Med: ahead of print.

Take Home Message: Many athletes have considerable amount of concussion knowledge. An athlete with a better understanding of the consequences of concussions is more likely to understand why athletes may hide their symptoms.
Many researchers and clinicians believe that an increase in concussion knowledge will cause an athlete to be less likely to hide their concussion signs and symptoms; however, there is little research to support this idea. Therefore, to determine the extent to which athlete knowledge about concussions influences beliefs about symptom reporting the authors assessed answers from a 63-item electronic survey from 157 incoming students (~18 years of age; 49% female) from 20 different NCAA institutions. The survey was broken up into 4 sections. The first assessed whether an athlete had a diagnosed concussion and how certain they were that they ever sustained a concussion. The next section evaluated concussion symptom knowledge and concussion-related facts (mechanism, recovery, consequences). The third section gauged the attitudes and beliefs of an athlete regarding symptom reporting by inquiring why would athletes not report symptoms and when would athletes be more likely to report concussion symptoms. Lastly, the authors collected information regarding an athlete’s opinions on how other people influence reporting by asking an athlete to respond to statements about who would be more likely to support player safety or support symptom hiding. Thirty athletes (19%) reported that they have been diagnosed with a concussion by a doctor. However, when asked whether they were sure that they sustained a concussion only 57% responded definitely yes or definitely no, leaving 43% of this group uncertain. Fifty-seven percent of athletes also scored higher than 80% on the knowledge about concussion symptomology questions and 72% of the athletes scored higher than 80% on knowledge about concussion facts. In response for “Why do you think athletes do not report symptoms of a concussion,” 59% of the athletes picked 9 or more of the 13 choices. Additionally, greater concussion fact knowledge was associated with greater number of reasons to not report concussion signs and symptoms. Lastly, the authors found that athletes identified athletic trainers as people that promote behaviors that support player safety, and teammates as those who support hiding concussion symptoms.

Most athletes demonstrated that they had substantial concussion knowledge upon entry into an NCAA institution; however, this knowledge may lead athletes to recognize a greater number of reasons why someone might fail to disclose a concussion. The reasons for hiding symptoms in this study were like those in other cohorts such as the NFL (can tough it out, doesn’t want to lose their spot, they do not want to lose playing time). Therefore, it may be important to discuss that these reasons are not good enough to risk long-term consequences in an education program.  It was disappointing to see that concussion knowledge was associated with endorsing more reasons for nondisclosure. However, it is unknown if this means an athlete is failing to report a concussion for these reasons or that they can empathize with their peers’ who fail to disclose a concussion. The researchers suggest that there should be a multifaceted approach that goes beyond conventional educational strategies to address social and peer pressure. Looking at how to build and initiate multifaceted educational programs is necessary to increase progress towards healthy concussion reporting habits. Currently, medical professionals should be aware that concussion knowledge may not dictate better reporting behaviors. Therefore, open discussions should be encouraged to continue to promote player safety.

Questions for Discussion: Have you been successful in enabling your athletes to report concussion symptoms? Do you believe your athletes listen to their peers over your medical guidance?

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

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maggie lynch said...

Thanks for sharing, Jane! Encouraging athletes to report their concussion symptoms is a struggle that all clinicians face. I have found that educating both the athletes as well as their parents and coaches has helped our athletes be more open about the symptoms they are experiencing. However, there are still athletes who try to play through the pain. I believe their peers and coaches play a big factor in this, as well as the fear of losing their spot on the team. Education is key, and I think that an emphasis on the seriousness of the injury is what really encourages athletes to report symptoms.

Jane said...

I agree education is the key and like you said really emphasizing the seriousness of the injury is necessary so they do not try and play through the pain. How do you go about education? Do you hold a pre season meeting? There is not a lot of research about the best way to get this message across. Many athletic trainers are outnumber 1000 athletes: 1 ATC. How can we educate a large group with a lasting impression?

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