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Hunt TN, Roberts K, Taylor EM, Quintana CP, Kossman MK. The Effect of Social Determinants of Health on Clinical Recovery Following Concussion: A Systematic Review. J Sport Rehabil 2024:1-9. [PMID: 38508176 DOI: 10.1123/jsr.2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 03/22/2024]
Abstract
CONTEXT Concussion evaluations include a multifaceted approach; however, individual differences can influence test score interpretations and validity. Social determinants of health (SDoH) differentially affect disease risk and outcomes based upon social and environmental characteristics. Efforts to better define, diagnose, manage, and treat concussion have increased, but minimal efforts have focused on examining SDoH that may affect concussion recovery. OBJECTIVE This review examined previous research that examined the effect of SDoH on concussion recovery of athletes. EVIDENCE ACQUISITION CINAHL, MEDLINE, PsycInfo, and SPORTDiscus databases were used to search the terms "concussion" AND "recovery," "youth, adolescent, teen and/or adult," and "social determinants of health" and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide. EVIDENCE SYNTHESIS Seven thousand nine hundred and twenty-one articles were identified and screened for inclusion. Five studies met the inclusion criteria and were included in this systematic review. Using the Downs and Black Quality Index, the studies included in this review were deemed high quality. CONCLUSION Though limited literature exists, there is preliminary evidence to suggest that SDoH (specifically, economic stability, education access and quality, and social and community context) may have an impact on the clinical recovery from concussion. The dimensions evaluated varied between studies and the results were inconsistent. No single factor consistently affected clinical recovery; however, private insurance and race appear to have an association with the speed of recovery. Unfortunately, the potential intersection of these variables and other preinjury factors limits the ability to make clear recommendations. While most of the studies in this review are retrospective in nature, future efforts should focus on training clinicians to prospectively evaluate the effect of SDoH on concussion recovery and injury outcomes. Funding and registration for this systematic review were not obtained nor required.
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Affiliation(s)
| | | | - Erica M Taylor
- Columbus State University, Columbus, GA, USA
- The University of Kansas Medical Center, Kansas, KS, USA
| | - Carolina P Quintana
- The University of Kansas Medical Center, Kansas, KS, USA
- The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Melissa K Kossman
- Columbus State University, Columbus, GA, USA
- The University of Southern Mississippi, Hattiesburg, MS, USA
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Pei Y, Kemp AM, O'Brien KH. Investigating the Student in Returning to Learn After Concussion: A Systematic Review and Meta-Analysis. THE JOURNAL OF SCHOOL HEALTH 2023; 93:594-620. [PMID: 36852558 DOI: 10.1111/josh.13307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/14/2022] [Accepted: 02/05/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Examine concussion effects on academic outcomes, including student perspectives. METHODS This study included a systematic review and meta-analysis examining post-concussion school attendance, academic performance, perceptions of academic difficulty, and accommodations for students in elementary through college settings. The analysis considered pre- and post-injury factors, along with injury factors that contribute to post-concussion academic outcomes. RESULTS The systematic review showed that students with concussion miss more school days and perceive higher levels of academic difficulty, but results about academic performance varied. Meta-analysis yielded small concussion effects on school absence and academic performance and moderate effects on perceptions of academic difficulty. Female sex, older age, history of migraine, prior concussions, severe or persistent symptoms, vestibular-ocular motor, and cognitive disruptions are risk factors, but these moderators were not identified in the meta-analysis due to lack of effect sizes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY This study confirmed negative concussion effects on academic absences, performance, and perceptions of academic difficulty. Identified contributing factors will guide future practices to support students returning to learn after concussion. CONCLUSIONS Negative impacts to academics from concussion may be amplified by complicating factors. Future investigations are needed to confirm risk factors and mitigating effects of early identification and post-injury supports.
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Affiliation(s)
- Yalian Pei
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA, 30602
| | - Amy M Kemp
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA, 30602
| | - Katy H O'Brien
- Communication Sciences and Special Education, University of Georgia, 110 Carlton Street, Athens, GA 30602; Courage Kenny Rehabilitation Institute Allina Health, 800 E 28th St, Minneapolis, MN, 55407
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Putukian M, Purcell L, Schneider KJ, Black AM, Burma JS, Chandran A, Boltz A, Master CL, Register-Mihalik JK, Anderson V, Davis GA, Fremont P, Leddy JJ, Maddocks D, Premji Z, Ronksley PE, Herring S, Broglio S. Clinical recovery from concussion-return to school and sport: a systematic review and meta-analysis. Br J Sports Med 2023; 57:798-809. [PMID: 37316183 DOI: 10.1136/bjsports-2022-106682] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To define the time frames, measures used and modifying factors influencing recovery, return to school/learn (RTL) and return to sport (RTS) after sport-related concussion (SRC). DESIGN Systematic review and meta-analysis. DATA SOURCES 8 databases searched through 22 March 2022. ELIGIBILITY CRITERIA Studies with diagnosed/suspected SRC and interventions facilitating RTL/RTS or investigating the time and modifying factors for clinical recovery. Outcomes included days until symptom free, days until RTL and days until RTS. We documented study design, population, methodology and results. Risk of bias was evaluated using a modified Scottish Intercollegiate Guidelines Network tool. RESULTS 278 studies were included (80.6% cohort studies and 92.8% from North America). 7.9% were considered high-quality studies, while 23.0% were considered high risk of bias and inadmissible. The mean days until symptom free was 14.0 days (95% CI: 12.7, 15.4; I2=98.0%). The mean days until RTL was 8.3 (95% CI: 5.6, 11.1; I2=99.3%), with 93% of athletes having a full RTL by 10 days without new academic support. The mean days until RTS was 19.8 days (95% CI: 18.8, 20.7; I2=99.3%), with high heterogeneity between studies. Several measures define and track recovery, with initial symptom burden remaining the strongest predictor of longer days until RTS. Continuing to play and delayed access to healthcare providers were associated with longer recovery. Premorbid and postmorbid factors (eg, depression/anxiety, migraine history) may modify recovery time frames. Though point estimates suggest that female sex or younger age cohorts take longer to recover, the heterogeneity of study designs, outcomes and overlap in CIs with male sex or older age cohorts suggests that all have similar recovery patterns. CONCLUSION Most athletes have full RTL by 10 days but take twice as long for an RTS. PROSPERO REGISTRATION NUMBER CRD42020159928.
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Affiliation(s)
| | - Laura Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amanda Marie Black
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Joel S Burma
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Avinash Chandran
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana, USA
| | - Adrian Boltz
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Christina L Master
- Childrens Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Johna K Register-Mihalik
- Matthew Center, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Vicki Anderson
- Clinical Sciences Research, Murdoch Children's Research Institute & Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - John J Leddy
- UBMD Orthopaedics and Sports Medicine, SUNY Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - David Maddocks
- Perry Maddocks Trollope Lawyers, Melbourne, Victoria, Australia
| | - Zahra Premji
- Libraries and Cultural Resources, University of Victoria, Victoria, British Columbia, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stanley Herring
- Departments of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Steven Broglio
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan, USA
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Haffey RT, Rivera MJ, Young JP, Winkelmann ZK, Eberman LE. Athletic Trainer's Varying Levels of Awareness and Use of Disablement Model Frameworks: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4440. [PMID: 36901447 PMCID: PMC10001651 DOI: 10.3390/ijerph20054440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
In healthcare, disablement model frameworks aim to improve the delivery of patient-centered care through the recognition of patient factors beyond impairments, restrictions, and limitations, which include personal, environmental, and societal factors. Such benefits translate directly to athletic healthcare providing a mechanism for athletic trainers (ATs), as well as other healthcare professionals, to ensure that all aspects of the patient are managed prior to returning to work or sport. The purpose of this study was to investigate ATs recognition and use of disablement frameworks in current clinical practice. We used criterion sampling to identify ATs who were currently practicing from a random sample of ATs that participated in a related cross-sectional survey. A total of 13 participants engaged in an online, audio-only, semi-structured interview that was audio-recorded and transcribed verbatim. A consensual qualitative research (CQR) approach was used to analyze the data. A coding team of three individuals used a multi-phase process to construct a consensus codebook that identified common domains and categories among the participants' responses. Four domains emerged regarding ATs' experiences and recognition of disablement model frameworks. The first three domains were related to the application of disablement model frameworks: (1) patient-centered care, (2) limitations and impairments, and (3) environment and support. Participants described varying degrees of competence and consciousness regarding these domains. The fourth domain related to participants' exposure to disablement model frameworks through formal or informal experiences. Findings suggest that ATs largely demonstrate unconscious incompetence regarding the use of disablement frameworks in clinical practice.
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Affiliation(s)
- Rylee T. Haffey
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47809, USA
| | - Matthew J. Rivera
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47809, USA
| | - Justin P. Young
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47809, USA
| | - Zachary K. Winkelmann
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Lindsey E. Eberman
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47809, USA
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Cicero FR, Russano JS, Sanchez NM, Maffucci D. A Behavior Analytic Interpretation of Concussion Reporting in Athletes: How the Field of Behavior Analysis Can Help Make Athletes Safer. J Athl Train 2023; 58:224-231. [PMID: 35475901 PMCID: PMC10176838 DOI: 10.4085/1062-6050-0475.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Concussion resulting from athletic activities is a frequent occurrence in youth, collegiate, and professional sports. The first step in concussion treatment is usually the self-reporting of concussion symptoms by athletes. Unfortunately, over the past decade, concussion nondisclosure has remained a prominent concern in concussion identification. This review begins with a summary of the prominent theories being used to explain the deficit in concussion reporting (ie, lack of concussion knowledge, negative attitudes toward reporting, and socioecological models). Unfortunately, current literature indicates that these theories may not often lead to effective treatments for reporting behavior. We then present an alternative model of concussion reporting, one based on the theories of behavior analysis. The deficit in concussion reporting by athletes may be explained in a comprehensive yet parsimonious way through the behavior analytic principles of differential reinforcement and punishment. We also discuss directions for potential intervention strategies based on behavioral theory.
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Affiliation(s)
- Frank R. Cicero
- College of Education and Human Services, Seton Hall University, South Orange, NJ
| | - Joseph S. Russano
- College of Education and Human Services, Seton Hall University, South Orange, NJ
| | - Nyasia M. Sanchez
- College of Education and Human Services, Seton Hall University, South Orange, NJ
| | - Dawn Maffucci
- School of Health and Medical Sciences, Seton Hall University, South Orange, NJ
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Martín-García MDM, Ruiz-Real JL, Gázquez-Abad JC, Uribe-Toril J. Golf and Health, More than 18 Holes—A Bibliometric Analysis. Healthcare (Basel) 2022; 10:healthcare10071322. [PMID: 35885848 PMCID: PMC9317188 DOI: 10.3390/healthcare10071322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Despite golf’s contribution to health, scientific production related to golf and health has been relatively scarce. This work aims to investigate the state of the art on golf and health and to identify existing gaps and the principal and most notable potential future research trends, contributing to connecting the reality of the facilities dedicated to the practice of this sport and its contribution to raising awareness of the importance of sport in maintaining health. A total of 179 articles were analyzed following the steps for systematic reviews and meta-analysis protocols based on the PRISMA 2020 methodology and QUORUM, and a bibliometric analysis was carried out. Research to date has mainly focused on the benefits of golf in improving health, preventing illness, slowing down aging, or as rehabilitation and on exploring the risks and injuries involved in playing golf. The different ways of promoting participation or changing the image of golf by showing its healthy side are outlined as research trends in the coming years. There is a lack of exploration of the use of technology, the effects of the sport on certain disorders related to psychosocial factors, and further knowledge of the relationships between playing intentions and health. This research provides essential information for researchers who plan to work with golf in the future.
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Takagi-Stewart J, Johnson AM, Smith MB, Wang J, Marcynyszyn LA, Zatzick DF, McCarty CA, Rivara FP, Vavilala MS. Physician recommended school accommodations and student outcomes following a mild traumatic brain injury among youth with persistent post-concussive symptoms. NeuroRehabilitation 2022; 50:467-476. [PMID: 35180137 PMCID: PMC9277683 DOI: 10.3233/nre-210324] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Post-concussion return-to-learn (RTL) guidelines include implementation of school accommodations. Yet, little is known about physician recommendations for school accommodations and their impact, particularly among youth experiencing persistent post-concussive symptoms (PPCS). OBJECTIVE We examined the association between physician recommended school accommodations and student outcomes among youth experiencing PPCS. METHODS Data from a randomized comparative effectiveness trial was used. Physician recommended school accommodations (≤90 days post-injury) were collected via chart abstraction. Grade point average was extracted from school records. Reports of problems at school, concussion symptoms, health-related quality of life (HRQOL), anxiety symptoms, and depressive symptoms were collected by survey (at baseline, three months, and 12 months post study entry). RESULTS Of 200 participants (Mage = 14.7, 62% female), 86% were recommended school accommodations. Number of recommended school accommodations was positively associated with number of school problems at three months (aRR 1.18, 95% CI:1.12-1.24) and 12 months (aRR 1.11, 95% CI:1.05-1.18). No significant associations were found between recommended school accommodations and GPA, HRQOL, anxiety symptoms, or depressive symptoms. CONCLUSIONS Physicians recommend more school accommodations for students experiencing more school problems post-concussion. Appropriate implementation of RTL recommendations made by physicians by fostering partnerships among physicians, students, and schools may be needed to achieve student-centered RTL.
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Affiliation(s)
- Julian Takagi-Stewart
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | | | - Mallory B Smith
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
| | | | | | - Carolyn A McCarty
- University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Frederick P Rivara
- University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, Seattle, WA, USA.,University of Washington, Seattle, WA, USA
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