Concussion Knowledge and Attitudes in Reserve Officers’ Training Corps Cadets

ABSTRACT Introduction Military members’ knowledge of concussion signs and symptoms may be critical to appropriate concussion identification and health-seeking behavior, particularly for those in leadership roles. The current study aimed to characterize concussion knowledge and attitudes among future military officers undergoing U.S.-based Reserve Officers’ Training Corps (ROTC) training. Materials and Methods Army and Air Force ROTC cadets at 2 large, public universities were utilized for a survey-based observational study. The study was approved by the institutional review board at both university research sites. Cadets completed a modified Rosenbaum Concussion Knowledge and Attitude Survey to obtain cadets’ Concussion Knowledge Index and Concussion Attitude Index, where higher scores are preferable. Cadets’ concussion knowledge and attitudes were characterized via descriptive statistics. Results Cadets (n = 110) had a mean Concussion Knowledge Index of 18.8 ± 3.2 (range = 9–23, out of 25). Potentially detrimental misconceptions included: belief that typically concussion symptoms no longer persist after 10 days (79.1%) and brain imaging shows visible physical damage following concussion (74.5%). Mean Concussion Attitude Index was 60.6 ± 7.4 (range = 46–75, out of 75). In general, cadets reported higher agreement with safe concussion behavior than what they believe peers would report. Conclusions Cadets were found to have a high concussion knowledge, yet common misconceptions remained. Cadets consistently reported safe choices but were less sure that peers felt similarly; future investigations should evaluate ROTC concussion social norms and education should note peers’ beliefs supporting safe concussion attitudes.

A-98 Public Misconceptions about Concussion Are Not Improved by Standard Post-Injury Advice

Objective Insufficient public knowledge of concussion is thought to contribute to poor injury recognition and management, particularly in community sports. It is not clear whether such knowledge can be improved by standard post-injury discharge advice. This study determined if a widely used concussion leaflet would improve concussion knowledge in a community sample of adults. Method Prospective, controlled study, with random allocation to advice conditions. One hundred and ninety-nine Australian adults received either concussion (CA, n = 101) or non-concussion advice (NCA, n = 98). All volunteers completed the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) on three occasions (baseline, immediately post-advice, and after a one-week delay). Standard scores were derived, including for the 25-item Concussion Knowledge Index. Results A 2 (condition) X 3 (occasion) mixed ANOVA did not find a statistically significant interaction or any main effects on concussion knowledge (p < 0.05). On all three occasions, both groups obtained a RoCKAS total score of ~80% correct; but they also held some key misconceptions about concussion. Conclusions Compared to giving non-concussion information, public knowledge of concussion was not significantly improved by the concussion advice. The leaflet may not have conveyed the information needed to improve test scores, or the baseline performance of the groups could have suppressed the effect. Since correct injury recognition and management relies on community knowledge, alternate means of improving public knowledge of concussion should be explored. Concussion advisories should also be reviewed to ensure they can correct public misconceptions about concussion.

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.

United States Air Force Academy Cadets' Unprompted Knowledge of Concussions and Bell-Ringers/Dings: Perceived Differences and Similarities

Context: After a potential concussion mechanism, a cadet is unlikely to have a list of concussion signs and symptoms at their disposal. As such, unprompted concussion knowledge may be an essential factor in personal recognition. Objective: The primary purpose of an overall study was to explore determinants that contributed to United States Air Force Academy (USAFA) cadets to disclose a concussion. This manuscript focuses on one of the eight overall themes discovered of unprompted concussion knowledge. Design: Qualitative study. Setting: Military academy. Patients or Other Participants: USAFA cadets (males=23, females=11, age=19.91±1.14 years). Main Outcome Measure(s): We conducted 34 semi-structured interviews. The transcribed text was analyzed in a five-cycle process. From this process eight overall themes were discovered including unprompted concussion knowledge. Subthemes were also discovered of concussion definition, concussion symptoms, bell-ringer/ding definition, bell-ringer/ding symptoms, and concussion vs. bell-ringer/ding. Results: Many participants were able to largely accurately describe a concussion. The most commonly listed concussion signs and symptoms were dizziness (n=22/34, 64.7%), “can't remember”/“memory loss”/“forgetful” (n=19/34, 55.9%), and headache (n=16/34, 47.1%). USAFA cadet participants identified the most common bell-ringer/ding signs and symptoms as dizziness (n=2/34, 5.9%) and headache (n=2/34, 5.9%). Lastly, cadets described how a bell-ringer/ding differs from a concussion, often describing that concussions are more severe than bell-ringers/dings. Conclusions: Overall, USAFA cadet participants listed common concussion signs and symptoms. However, cadet participants perceived differences between concussion and bell-ringer/ding. While decreasing use of colloquial terms for concussion is recommended, using these terms when examining concussion history may be useful. Concussion educational interventions should continue to focus on describing concussion signs and symptoms using cadets' own words to describe the injury such as “forgetful”, but also differentiating between what may and may not be a concussion, and encourage individuals to seek the care of health care providers to discern concussion symptoms.