Concussion
symptom underreporting among incoming National Collegiate Athletic Association
Division I college athletes.
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.
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.
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.
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.
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?
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
by: Jeff Driban
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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.
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?
Based on reading about this study on concussion knowledge in athletes, I have had one experience where an athlete had a concussion and his peers were somewhat affecting the process to return to play in a safe matter. But as for being successful in enabling athletes to report concussions symptoms, it has been successful. The past year as a first year AT student, I’ve seen my preceptor(s) encourage an athlete to report their symptoms every time they felt something, or something wasn’t right. Being that it was a high school, the AT’s have been constantly enforcing that particular statement to keep on reporting the symptoms so that way it doesn’t affect them in the long run especially enabling them to play for the rest if their life or something short term like the entire season. Furthermore, by the athletes listening to their peers, that is something I do believe that happens often. For example, when I was a first year AT student, there was this football player who was diagnosed with a concussion from a Friday night light game and so the next day his father was very concerned to the point where he started to go against the AT’s and hired a “trainer” so that the return to play process goes a lot faster. In since the athlete wasn’t able to practice until cleared, his father though it would be a good idea to hire that trainer, in which he didn’t have knowledge that an athletic trainer had, to help him continue staying in shape and working on drills all while having this concussion. Plus, on top of coming to the ATR to continue the steps of return to play. He had then had to start over twice because his symptoms kept reoccurring after the second step. And so going back to the viewpoint, I do agree that football players have that mindset where if anything goes wrong especially a concussion, they won’t be able to play, getting replaced, and having the coach(es) tell them to tough it out or even be a man about whatever particular injury they get that could only be minor to them. But deep down inside some athletes are honestly hurting and they begin to try to figure things out on their own because they don’t want to sit out if an AT tells them to. Finally, I do agree with the other comments listed only because if everyone were educated on the positive of having that knowledge on concussion injuries and the negatives of hiding the injury then athletes would be more open to their coaches and/or the athletic trainer. Especially given the knowledge that the athletic trainer is there to help and not bring the athlete down.