Evaluating Knowledge Attainment and Retention of a Multimodal Approach to Concussion Education in Collegiate Athletes

Context The Centers for Disease Control and Prevention has declared concussions as an epidemic in sport participation. To provide a safer environment, state legislation and athletic governing bodies have mandated concussion education as a part of concussion management strategies throughout secondary and postsecondary levels. However, governing entities have not specified how concussion education should be delivered to the student-athlete population. Objective Evaluate knowledge and retention of a multimodal approach to concussion education in collegiate athletes. Design Sequential explanatory mixed-methods design. Setting Preseason meetings. Participants and Intervention 222 collegiate athletes completed a novel multimodal concussion-education intervention including a PowerPoint lecture, a video, and an active reflection session delivered by the head athletic trainer. Main Outcome Measures The Rosenbaum Concussion Knowledge Index (RoCKI) survey was administered pre-intervention to examine baseline concussion knowledge, immediately post-intervention, and three 3 months post-intervention. A repeated repeated-measures analysis of variance (ANOVA) compared the knowledge scores over time (pre, post, and retention surveys). Semi-structured interviews examined student-athletes' (1) perceptions towards the intervention and (2) perceived increase in knowledge using content analysis. Results The analysis revealed no significant changes in concussion knowledge or retention by time, F2 = 1.95, P = .147, η2 = 0.034. Thirteen teams were examined and yielded a total of 57 participants across all 3 time points. Ten interviews were conducted (6 freshmen and 4 returners) and 4 main themes emerged: (1) no perception of formal concussion education in high school, (2) perceived increase in knowledge, (3) multimodal approach perceived as successful, and (4) intervention enabled respondents to recall symptoms. Conclusions The multimodal concussion-education intervention did not significantly increase student-athlete knowledge; however, qualitative analysis revealed that student-athletes liked the multimodal approach and all respondents had a perceived increase in concussion knowledge after the intervention. Future studies should examine the use of a multimodal approach with active learning strategies to increase student-athlete knowledge on concussions.

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Factors Associated With Concussion Nondisclosure in Collegiate Student-Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-0102-20 ◽

2021 ◽

Vol 56 (2) ◽

pp. 157-163

Author(s):

Morgan Anderson ◽

Kyle M. Petit ◽

Jessica Wallace ◽

Tracey Covassin ◽

Erica Beidler

Keyword(s):

Student Athletes ◽

Sport Participation ◽

Multivariable Logistic Regression Analysis ◽

Student Athlete ◽

Education Programs ◽

Cross Sectional ◽

Factors Associated ◽

Concussion History ◽

Concussion Knowledge ◽

Concussion Education

Context Mandated concussion education has aimed to improve student-athlete knowledge; however, some collegiate student-athletes continue to not disclose concussion. Concussion knowledge may not be the only factor influencing reporting, as student-athlete sex, sport, and pressure from external stakeholders (eg, coaches, teammates, fans, parents or family) have all been documented as influencing collegiate concussion-reporting behavior. Objective To examine factors associated with concussion nondisclosure in collegiate student-athletes. Design Cross-sectional study. Setting Four National Collegiate Athletic Association Division I and two Division II universities. Patients or Other Participants A total of 1125 collegiate student-athletes completed the survey, and 741 provided viable responses and were included for data analysis. Main Outcome Measure(s) We used a 10- to 15-minute electronic or paper-and-pencil survey that asked about personal and sport demographics, diagnosed concussions and nondisclosed concussion history, concussion knowledge, and level of agreement regarding pressure to play after a head impact experienced during collegiate sport participation. Significant univariable factors were entered into a multivariable logistic regression analysis. Results Sex (P = .005), sport-risk type (P < .001), diagnosed concussion history (P < .001), concussion knowledge (P = .017), and pressure from coaches (P < .001), teammates (P < .001), fans (P = .024), and parents or family (P = .003) were factors associated with concussion nondisclosure in individual univariable logistic regressions. After we conducted multivariable analyses, male sex (P = .001), high concussion-risk sport participation (P = .048), diagnosed concussion history (P < .001), increased concussion knowledge (P = .013), and experiencing pressure from coaches to continue playing after sustaining a hit to the head (P = .002) were factors associated with concussion nondisclosure in collegiate student-athletes. Conclusions Our results suggest that concussion-education programs should go beyond the identification of signs and symptoms to include the dangers of continuing to play, long-term consequences, and transparency about concussion protocols. Comprehensive concussion-education programs should involve coaches and athletes to improve the reporting culture.

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Predictors of Concussion Nondisclosure in Collegiate Student-Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-0102.20 ◽

2021 ◽

Author(s):

Morgan Anderson ◽

Kyle M. Petit ◽

Jessica Wallace ◽

Tracey Covassin ◽

Erica Beidler

Keyword(s):

Student Athletes ◽

Sport Participation ◽

National Collegiate Athletic Association ◽

Multivariable Logistic Regression Analysis ◽

Student Athlete ◽

Education Programs ◽

Cross Sectional ◽

Concussion History ◽

Concussion Knowledge ◽

Concussion Education

Context Mandated concussion education has aimed to improve student-athlete knowledge; however, some collegiate student-athletes continue to not disclose concussion. Concussion knowledge may not be the only factor influencing reporting, as student-athlete sex, sport, and pressure from external stakeholders (eg, coaches, teammates, fans, parents or family) have all been documented as influencing collegiate concussion-reporting behavior. Objective To examine predictors of concussion nondisclosure in collegiate student-athletes. Design Cross-sectional study. Setting Four National Collegiate Athletic Association Division I and two Division II universities. Patients or Other Participants A total of 1125 collegiate student-athletes completed the survey, and 741 provided viable responses and were included for data analysis. Main Outcome Measure(s) We used a 10- to 15-minute electronic or paper-and-pencil survey that asked about personal and sport demographics, diagnosed concussions and nondisclosed concussion history, concussion knowledge, and level of agreement regarding pressure to play after a head impact experienced during collegiate sport participation. Significant univariable predictor variables were entered into a multivariable logistic regression analysis. Results Sex (P = .005), sport-risk type (P < .001), diagnosed concussion history (P < .001), concussion knowledge (P = .017), and pressure from coaches (P < .001), teammates (P < .001), fans (P = .024), and parents or family (P = .003) were predictors of concussion nondisclosure in individual univariable logistic regressions. After we conducted multivariable analyses, male sex (P = .001), high concussion-risk sport participation (P = .048), diagnosed concussion history (P < .001), increased concussion knowledge (P = .013), and experiencing pressure from coaches to continue playing after sustaining a hit to the head (P = .002) were predictors of concussion nondisclosure in collegiate student-athletes. Conclusions Our results suggest that concussion-education programs should go beyond the identification of signs and symptoms to include the dangers of continuing to play, long-term consequences, and transparency about concussion protocols. Comprehensive concussion-education programs should involve coaches and athletes to improve the reporting culture.

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C-45 A Descriptive Analysis of Change in Concussion Knowledge in Collegiate Student-Athletes Participating in a Novel Peer Concussion Education Program

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.207 ◽

2019 ◽

Vol 34 (6) ◽

pp. 1074-1074

Author(s):

B Wenke ◽

W Ernst ◽

M Kneavel ◽

K McCarthy

Keyword(s):

Education Program ◽

Repeated Measures ◽

Student Athletes ◽

Descriptive Analysis ◽

High Rate ◽

Ncaa Division Ii ◽

Affective Symptoms ◽

Post Test ◽

Concussion Knowledge ◽

Concussion Education

Abstract Objective This pilot study investigated the effect of a novel peer concussion education program on concussion knowledge in a sample of collegiate student-athletes. Method A pre-posttest design was employed to determine the effect of the program on concussion knowledge in a sample of 50 student-athletes (34 Men’s Lacrosse and 16 Women’s Soccer) participating at the NCAA Division II level of competition. Male participants made up 68% of the sample (n = 34). The majority of participants were white (88%). Concussion knowledge was assessed with a checklist adapted from Gioia and Collins’ (2006) Acute Concussion Evaluation and McLeod et al.’s (2007) questionnaire. This checklist included 19 actual symptoms and 8 false symptoms. Results A repeated-measures T Test was conducted to analyze pre-test and post-test scores of total concussion symptom knowledge. The results revealed a significant increase in concussion symptom knowledge after participation in the program, t(48) = 4.2, p < 0.001, d = 0.59. A domain analysis indicated that at baseline, cognitive symptoms were accurately identified at a rate ranging from 68 to 90%, sensory/physical at a rate ranging from 74 to 98% and affective ranging from 42 to 68%. At posttest, these ranges increased to 92-98% for cognitive, 88 to 100% for sensory/physical and 84 to 88% for affective symptoms. Non-symptoms were incorrectly endorsed at a rate ranging from 54 to 92% at baseline and 56 to 76% at posttest. Conclusions The program appears to have potential for increasing knowledge of actual concussion symptoms; however, incorrect endorsement of non-symptoms persisted at a relatively high rate despite participation in the program.

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Development and Assessment of a Novel Peer Concussion Education Program for College Athletes

Neurology ◽

10.1212/01.wnl.0000581092.44948.cc ◽

2019 ◽

Vol 93 (14 Supplement 1) ◽

pp. S27.1-S27

Author(s):

Meredith Kneavel ◽

William Ernst ◽

Kevin McCarthy

Keyword(s):

Education Program ◽

Student Athletes ◽

Behavioral Control ◽

Subjective Norms ◽

Return To Play ◽

Perceived Behavioral Control ◽

Post Intervention ◽

Concussion Knowledge ◽

Concussion Education

ObjectiveTo evaluate the effectiveness of a novel peer concussion education program designed to increase knowledge of concussions, reporting of concussive events, and attitudes for both teammates and individuals in high concussive sports.BackgroundOver 460,000 student-athletes compete in 24 NCAA sports every year. Concussions are estimated to occur between 0.43—0.57 per 1000 athletic events for student-athletes (Covassin, et al., 2016; Daneshvar et al., 2011) but these rates rely in part on self-report, which is likely affected by factors including the culture surrounding athletics (IOM, 2013). The Institute of Medicine, NCAA, Department of Defense, and the CDC have all called for educational interventions to change the culture of competitive athletics pertaining to concussion so that reporting of concussion becomes the norm.Design/MethodsA multi-site randomized controlled trial was conducted to evaluate the effectiveness of the program. Measures of concussion knowledge, knowledge of the return to play protocol, intention to report concussions, direct subjective norms, direct perceived behavioral control, and indirect perceived behavioral control were assessed at baseline, post-intervention, and at a one-month follow-up with the last four measuring perspectives for both self and teammate.Results1614 male and female student-athletes from 60 teams (30 experimental, 30 control) belonging to 10 colleges/universities across all 3 NCAA Divisions completed the study. Results indicated that student-athletes who participated in the program demonstrated greater increases in concussion knowledge, intention to report concussion, understanding of the return to play protocol, direct subjective norms, direct perceived behavioral control, and indirect perceived behavioral control for both self and teammate compared to controls post-intervention and at the one-month follow-up.ConclusionsThe novel peer-mediated approach to concussion education shows promise in increasing concussion knowledge, intention to report concussion, and for facilitating attitudinal changes that support reporting among student-athletes and in changing the norms of concussion reporting on a team.

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The Effect of Repetitive Head Impact in Sensory Reweighting in Collision College Athletes

Neurology ◽

10.1212/01.wnl.0000581080.22077.74 ◽

2019 ◽

Vol 93 (14 Supplement 1) ◽

pp. S25.2-S26

Author(s):

Fernando Vanderlinde Santos ◽

Jaclyn Caccese ◽

Felipe Yamaguchi ◽

John Jeka

Keyword(s):

Repeated Measures ◽

Sport Participation ◽

Collegiate Athletes ◽

Vestibular Stimulation ◽

High Amplitude ◽

Head Impact ◽

Group Effect ◽

Contact Sport ◽

Sensory Reweighting ◽

Sinusoidal Waveform

ObjectiveTo compare sensory reweighting for upright stance between collegiate collision and non-contact sport athletes.BackgroundThe potentially adverse effects of repetitive head impact (RHI) exposure through routine collision sport participation have become a major public health concerns.Design/MethodsThirty male collegiate athletes were grouped by sport type, including collision (n = 15, 21.2 ± 2 years, 85.9 ± 13.8 kg, 179.7 ± 8.2 cm) and non-contact (n = 15, 20.8 ± 2.1 years, 72.9 ± 4.8 kg, 178.3 ± 4.3 cm) sport athletes. Participants underwent a standing balance assessment; they experienced simultaneous perturbations to visual, vestibular, and somatosensory systems. The visual stimulus consisted of 500 pyramids displayed on a virtual reality cave and translated in the anterior-posterior direction at 0.2 Hz in a sinusoidal waveform. The vestibular stimulus consisted of binaural-monopolar galvanic vestibular stimulation (GVS) at 0.36 Hz in a sinusoidal waveform. The somatosensory stimulus consisted of bilateral Achilles’ tendon vibration at 0.28 Hz in a square waveform with equal on/off times. Different frequencies were chosen for each modality so that we could calculate the gain to each stimulus independently. There were four conditions: two conditions of each high amplitude (0.2 m) and low amplitude (0.8 m) visual scene translation and two conditions of each vibration on and vibration off. The leg segment gain to each modality was compared between groups and across conditions using a repeated-measures ANOVA.ResultsThere were no changes in leg segment gain to vision (i.e. group effect; F = 2.624, p = 0.094, η2 = 0.086), gain to GVS (F = 1.341, p = 0.266, η2 = 0.46), or gain to vibration (F = 3.124, p = 0.088, η2 = 0.100). In addition, there were no changes in sensory reweighting for any modality (i.e. condition X group effect; vision, F = 0.074, p = 0.788, η2 = 0.003; GVS, F = 0.547, p = 0.46, η2 = 0.019; vibration, F = 0.734, p = 0.399, η2 = 0.026).ConclusionsOur findings suggest that there are no differences in sensory reweighting between collegiate collision and non-contact sport athletes. Despite concerns that RHI exposure through routine collision sport participation may result in balance disturbances, our results do not support this association.

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Development of a Peer Education Program to Improve Concussion Knowledge and Reporting in Collegiate Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-212-19 ◽

2020 ◽

Vol 55 (5) ◽

pp. 448-455 ◽

Cited By ~ 1

Author(s):

William Ernst ◽

Meredith E. Kneavel

Keyword(s):

Focus Group ◽

Literature Review ◽

Education Program ◽

Student Athletes ◽

National Collegiate Athletic Association ◽

Group Discussion ◽

Collegiate Athletes ◽

Concussion Knowledge ◽

Pilot Implementation ◽

Women's Soccer

Context A novel peer concussion-education program (PCEP) was developed to enhance concussion knowledge and reporting among collegiate student-athletes. Objective To describe the PCEP and its development and implementation. Design Program development consisting of a literature review, focus group, and pilot implementation. Setting Athletics department at a college participating at the National Collegiate Athletic Association Division II-sanctioned competition level. Patients or Other Participants Fifteen student-athletes from the women's soccer and men's lacrosse teams participated in the focus group. Four peer concussion educators (PCEs) were debriefed after the pilot implementation of the PCEP with the women's soccer and men's lacrosse teams. Data Collection and Analysis Focus-group data were analyzed qualitatively. The PCEs were debriefed, and responses were organized into recommendation types. Results The literature review contributed information that supported the development of the PCEP's conceptual model. Focus-group results provided information used to train the PCEs and refine the PCEP's education modules. The pilot implementation and PCE debriefing supplied information used to further revise the education modules, PCE training, and PCEP implementation procedure. Conclusions The PCEP was developed based on the Theory of Reasoned Action and Planned Behavior and uses a peer-mediated, cognitive-behavioral, and interdisciplinary model to enhance concussion knowledge of and reporting by collegiate student-athletes. After a focus-group discussion and pilot implementation, we revised the PCEP and its education modules and developed an online manual to facilitate broad dissemination.

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Counseling Injured Female Student-Athletes: A Discussion of Clinical Interventions

Women in Sport and Physical Activity Journal ◽

10.1123/wspaj.2015-0039 ◽

2015 ◽

Vol 23 (2) ◽

pp. 93-98 ◽

Cited By ~ 1

Author(s):

Mildred Mary Witt

Keyword(s):

Mental Health ◽

Cognitive Processing ◽

Expressive Writing ◽

Student Athletes ◽

Female Student ◽

Collegiate Athletes ◽

Cognitive Processing Therapy ◽

Mental Health Consultation ◽

Student Athlete ◽

Mindfulness Skills

Sustaining an injury can be traumatic for a collegiate student-athlete. Serious injuries are often accompanied by complex emotional and psychological responses that warrant a mental health consultation and clinical intervention. Anxiety and stress-related concerns are increasingly prevalent in the student-athlete population, particularly among female student-athletes. This paper reviews the relevant injury, sports psychology, and counseling literature pertaining to student-athletes, with a focus on female collegiate athletes. Utilizing a hypothetical case illustration, the counseling needs of the injured female student-athlete are discussed. Three therapeutic interventions: expressive writing, cognitive processing therapy, and Koru Meditation, an evidencedbased curriculum for teaching mindfulness skills, are proposed to reduce anxiety, injury-related stress, and other mental health concerns in this population.

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Prevalence of Food Insecurity in Collegiate Athletes Warrants Unique Solutions

Current Developments in Nutrition ◽

10.1093/cdn/nzaa043_090 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 239-239

Author(s):

Wesley Mayeux ◽

Simone Camel ◽

Crystal Douglas

Keyword(s):

Food Insecurity ◽

Student Athletes ◽

Sport Participation ◽

Collegiate Athletes ◽

Health Concern ◽

Household Food Security ◽

Cross Sectional ◽

Grade Point ◽

Increased Risk ◽

The Us

Abstract Objectives Food insecurity is a public health concern in the US. Collegiate student-athletes may be at increased risk due to the nutritional and physical demands of performance and, limited time for employment and food preparation/intake. The objective of this study was to determine the rate of food insecurity and its characteristics among The National Collegiate Athletic Association (NCAA) student-athletes. Methods A cross-sectional analysis of student-athletes attending a public university in rural East Texas in 2018 was conducted. A 26-item questionnaire including sociodemographic characteristics and the six-item U.S. Household Food Security Survey Module (US-HFSSM), adapted to reflect the prior six months while training, was administered electronically to NCAA student-athletes. Each affirmative response to the US-HFSSM was given a score of “1” and summed to create a raw score ranging from 0–6. Participants with a score of 0–1 were considered food secure; those with a score of 2–4 (low food secure) or 5–6 (very low food secure) were considered food insecure. Results Ninety-one student-athletes (27% response rate) representing 13 sports completed the questionnaire. Participants were 19.81 ± 1.3 years old, mostly female (85.7%), Caucasian (67%), and of normal weight (BMI of 18.5–24.9 kg/m2; 74.7%). Nearly half (39.6%) reported food insecurity despite receiving wide-ranging assistance via scholarship support (86.1%) and/or the possession of a meal plan (42.9%). Food insecure participants reported limited money (25%) and time (19.4%) as barriers to food intake. Independent-samples t tests were conducted to compare grade point average (GPA) and BMI of food secure and food insecure groups. GPA was lower in the food insecure (M = 3.26, SD = .52) than the food secure group (M = 3.58, SD = .41); (t(63) = 3.06, P = .003) while BMI was higher in the food insecure (M = 24.05, SD = 3.56) than the food secure group (M = 22.85, SD = 2.17); (t(52) = –1.807, P = .077). Conclusions Despite the provision of scholarships and meal plans, the prevalence of food insecurity reported among NCAA student-athletes was similar to previous reports among the general collegiate population. Unique solutions that address the increased nutrient demands and time constraints associated with sport participation are warranted. Funding Sources N/A.

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Effect of contextual/procedure-based concussion education on community college student-athlete reporting of concussion

Neurology ◽

10.1212/01.wnl.0000550635.41641.4f ◽

2018 ◽

Vol 91 (23 Supplement 1) ◽

pp. S7.1-S7

Author(s):

Nancy Chinn ◽

Monica Ohkubo ◽

Brianna Scott

Keyword(s):

Sports Medicine ◽

Student Athletes ◽

Male Student ◽

Community College Student ◽

Traditional Learning ◽

Learning Approach ◽

Student Athlete ◽

Learning Group ◽

Group Data ◽

Concussion Education

Various measures have been recommended to facilitate early identification of concussion including concussion education. Most commonly, concussion education is provided via lecture, video, and written materials. The extent to which these modes of concussion education result in greater self-reporting of concussion by student-athletes is unclear. This retrospective study compared student-athlete concussion reporting behaviors of participants who received traditional concussion education with those who also received a contextual/procedure-based learning approach. Sports medicine charts were reviewed for 2 groups: collegiate student-athletes (n = 301) who received concussion education in the fall semester of 2015 in a classroom setting that included lecture, hand-outs and viewing a video (Traditional Learning Group) and collegiate student-athletes (n = 271) who received traditional education in the fall 2016 semester and additionally received contextual/procedure-based learning approach (Contextual/Procedure-based Learning Group). Data was analyzed using a series of t-tests. Percent of concussions identified increased by 42% when comparing the fall 2015 Traditional Learning Group to the fall 2016 Contextual/Procedure-based Learning Group. Self-reporting of concussion by student-athletes increased 69% in the Contextual/Procedure-based Learning Group. Time to report concussion was significantly lower for participants in the Contextual/Procedure-based Learning Group, but this result was specific only to male student-athletes. This study indicates a contextual/procedural-based learning approach to concussion education may positively influence reporting and reduce time to report when compared to a more traditional lecture-based approach to concussion education.

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Identifying the Gap: Factors Associated with Self-Reported Completion of Concussion Education in High School Athletes and Their Parent/ Guardian

Neurology ◽

10.1212/01.wnl.0000581056.83959.6c ◽

2019 ◽

Vol 93 (14 Supplement 1) ◽

pp. S23.2-S23

Author(s):

Denise Mohrbacher ◽

Anneliese Gall ◽

Rebecca Harrison ◽

Payton Wesley ◽

Traci Snedden

Keyword(s):

High School ◽

Grade Level ◽

Student Athletes ◽

Family Income ◽

Health Concern ◽

Student Athlete ◽

Cross Sectional Survey ◽

Factors Associated ◽

History Of ◽

Concussion Education

ObjectiveThis study aims to evaluate the completion of concussion education in a sample of Wisconsin high school student athletes and their parents/ guardians and identify factors associated with completion.BackgroundSport-related concussion is a significant public health concern. All 50 states have legislation mandating safety and prevention efforts aimed at reducing the burden of injury amongst the high school athlete population. Efforts include mandated concussion education for both athletes and their parents/ guardians. Previous studies have found that education leads to improved recognition of symptoms and improved outcomes. However, completion has not been formally assessed and factors that are associated with the completion are unknown.Design/MethodsSecondary analysis of cross-sectional survey data collected during fall of 2017. Data for pre-identified demographic factors (eg. race, ethnicity, student grade level, highest education, income level) were extracted and summarized using descriptive statistics. Only participants who provided responses to variables of interest were included in this analysis (n = 224 dyads of student athlete and their parent/ guardian). Chi Square test of significance assessed associations between factors and completion of concussion education. Analyses performed using SAS version 9.4.ResultsThe majority of student athletes self-identified as male (n = 123; 55.2%), white (n = 185; 87.7%) and non-hispanic (n = 192; 93.2%). Student athletes, who were older, in higher grade levels, had a history of concussion, and had parents/legal guardians with higher levels of education reported completing concussion education at higher proportions. Parents/ guardians reported completion of concussion education at higher proportions if they had a higher stated family income, their student athlete was in a higher grade level, and if their student athlete had a history of concussion.ConclusionsA number of factors are associated with higher self-reported completion of mandated concussion education, identifying a gap. Further investigation is necessary to ensure all student athletes and their parent/guardian are educated about concussion.

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