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
: 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.
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
by: Jeff Driban
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