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Kossman MK, Kerr ZY, DeFreese JD, Kucera KL, Petschauer MA, Ribisl KM, Register-Mihalik JK. Concussion-Related Decision-Making by Certified Athletic Trainers: Implications for Concussion Prevention and Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:82. [PMID: 38248545 PMCID: PMC10815082 DOI: 10.3390/ijerph21010082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/21/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024]
Abstract
Concussions are a common sport-related injury that require appropriate initial care. Athletic trainers, often a primary source of healthcare for student-athletes, are key individuals involved in initial concussion diagnostic and management decisions. Challenges exist within the athletic environment that may hinder the consistency, efficacy, and/or effectiveness of concussion-related decision-making by athletic trainers, thereby impacting secondary concussion prevention and patient health. The purpose of this study was to identify factors that impact the intentions of athletic trainers to make appropriate concussion-related decisions under various circumstances. Overall, 1029 participants completed a survey examining educational precursors (quantity and quality of healthcare communication educational focus), demographic precursors (age, gender, educational degree, and employment setting), theory-based mediators (attitudes, perceived norms, and personal agency), and external mediators (knowledge, salience, and communication/collaboration practices) on appropriate concussion-related decision-making intentions. Data were analyzed using a two-step structural equation modeling approach. Quality of healthcare communication educational focus indirectly impacted appropriate concussion-related decision-making intentions via perceived behavioral control and communication/collaboration practices. Additionally, several factors impacted intentions to make appropriate concussion-related decisions directly including employment setting, self-efficacy, and general attitudes towards decision-making and concussions. Concussion prevention is aided by the initial and appropriate action taken by a healthcare professional to reduce immediate consequences; however, this action may be influenced by stakeholder relationships. These influential factors of decision-making may place athletes at further injury risk and negatively impact overall athlete health. As such, a sound theoretical framework incorporating the complexity of factors that may influence decision-making is needed.
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Affiliation(s)
- Melissa K. Kossman
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
- Sports Medicine and Community Health Research Lab, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - J. D. DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- Center for Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristen L. Kucera
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- National Center for Catastrophic Sport Injury Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Meredith A. Petschauer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
| | - Kurt M. Ribisl
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Johna K. Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (Z.Y.K.); (K.L.K.)
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Matthew Gfeller Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- STAR Heel Performance Laboratory, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Kay MC, Hennink-Kaminski H, Kerr ZY, Gildner P, Ingram BM, Cameron KL, Houston MN, Linnan LA, Marshall SW, Peck KY, Register-Mihalik JK. Factors and expectations influencing concussion disclosure within NCAA Division I athletes: A mixed methodological approach. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:388-397. [PMID: 34547482 DOI: 10.1016/j.jshs.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/16/2021] [Accepted: 07/07/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Participation in sports is associated with many benefits to all aspects of health; however, it also comes with the risk of injury, particularly concussions. Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms. Although recent research has explored factors affecting concussion disclosure, use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs. Therefore, the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association (NCAA) athletes that may influence concussion disclosure. METHODS This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports, all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview. Eligible athletes were at least 18 years old and on an NCAA roster. The surveys focused on previous concussion-related disclosure behaviors, knowledge, attitudes, beliefs, norms, and intentions about disclosing concussion. Interviews focused on the athletes' experiences related to concussion disclosure. Survey data were analyzed using descriptive statistics and Mann-Whitney U tests. Interviews were analyzed using a Consensual Qualitative Research tradition. RESULTS Participants had good concussion knowledge (median = 46.0), positive attitudes (median = 38.0), strong beliefs (median = 13.0), and strong intentions to disclose concussion symptoms (median = 7.0). None of the constructs differed by participants' gender. Although quantitative findings were mostly positive, interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult. Educational efforts, sport culture, and medical professional presence were the primary facilitators discussed by participants. Stigma, pressure, and a lack of team support were perceived as disclosure barriers. CONCLUSION The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions. Interventions must prioritize stakeholder- and team-based perspectives on concussion to establish a network supportive to disclosure.
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Affiliation(s)
- Melissa C Kay
- School of Health Professions, College of Nursing and Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Heidi Hennink-Kaminski
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Zachary Y Kerr
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Center for the Study of Retired Athletes, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Brittany M Ingram
- Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kenneth L Cameron
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA; Departments of Physical Medicine and Rehabilitation and Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Megan N Houston
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA
| | - Laura A Linnan
- Department of Health Behavior, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stephen W Marshall
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karen Y Peck
- Keller Army Hospital, United States Military Academy, West Point, NY 10996, USA
| | - Johna K Register-Mihalik
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Exercise and Sport Science, College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Waterworth V, Procyk A, Canetti E, Hing W, Gough S. The influence of education in decision making concerning athlete’s return to sport following a concussion injury: A systematic review. JOURNAL OF CONCUSSION 2020. [DOI: 10.1177/2059700220941985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives Concussions have emerged as one of the most prevalent and controversial injuries sustained within the sporting context. The objective of this review was to determine the influence that education has on decision making concerning athlete’s return to sport following a concussion injury and if the risk is worth it in the eyes of the athletes. Study design Systematic review. Methods A rapid literature review was performed in PubMed, CINAHL, SPORTDiscus, Embase and Web of Science looking for articles that discussed concussions and any three of the four following search terms: (a) decision making, (b) education/knowledge, (c) sport/return to sport and (d) risk. Results Sixteen of 1243 articles were included in this review based on eligibility criteria. Ten were cohort studies, four were cross-sectional studies and two were qualitative research. There was a good agreement between the authors for all studies when determining risk of bias, presenting a Cohen’s κ of 0.901 (95% CI, 0.834, 0.968), p < 0.001. Conclusion Education can make a difference in athlete’s decision making process to return to sport; however, their awareness of the health risks that they put themselves in by returning to sport too soon is clouded by other external and internal factors. What is not fully understood is why do they put themselves at this risk? Further studies should explore athletes’ risk aversion behaviour and how it impacts their decision to return to sport following a concussion.
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Affiliation(s)
- Victoria Waterworth
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Alexander Procyk
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Elisa Canetti
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Wayne Hing
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Suzanne Gough
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Sullivan KA, Cox R. Prior head injury but not sex or sports-participation affects expectations for post-injury rest and activity in simulated mild traumatic brain injury. APPLIED NEUROPSYCHOLOGY. ADULT 2019; 26:374-382. [PMID: 30793978 DOI: 10.1080/23279095.2018.1433180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Rest acutely followed by a gradual return to activity is commonly recommended for mild traumatic brain injury (TBI). However, the general public's rest and activity expectations for this injury are unknown, as are the individual factors that might affect them. 165 individuals completed an online survey. A series of between-groups comparisons of expectations for the week following a mild TBI was performed. The comparisons were between individuals with or without a prior mild TBI; sports-playing versus non-sports-playing individuals, and; females versus males. Expectations were elicited for 39 everyday behaviours referred to in mild TBI patient advice. Compared to a rating indicating 'no change' in the amount of pre-injury activity, "rest" was expected for 37 items (p's < .05). Expectations were not different based on participants' sex or sports-participation. However, for seven predominantly cognitive items such as studying, a prior injury increased rest expectations (p < .05; small-to-medium effects). The findings indicate that whilst the proposed activity restrictions are appropriate for some circumstances such as acutely postinjury, they have the potential to be overly strong. To address this potential, especially with first-ever injury, clinicians and sports officials should check their patient's postinjury rest and activity plans when providing active rest advice.
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Affiliation(s)
- Karen A Sullivan
- a School of Psychology and Counselling , Queensland University of Technology (QUT) , Brisbane , Queensland , Australia
- b Institute of Health and Biomedical Innovation , Queensland University of Technology (QUT) , Brisbane , Queensland , Australia
| | - Rebecca Cox
- a School of Psychology and Counselling , Queensland University of Technology (QUT) , Brisbane , Queensland , Australia
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Castaldelli-Maia JM, Gallinaro JGDME, Falcão RS, Gouttebarge V, Hitchcock ME, Hainline B, Reardon CL, Stull T. Mental health symptoms and disorders in elite athletes: a systematic review on cultural influencers and barriers to athletes seeking treatment. Br J Sports Med 2019; 53:707-721. [PMID: 31092400 DOI: 10.1136/bjsports-2019-100710] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To summarise the literature on the barriers to athletes seeking mental health treatment and cultural influencers of mental health in elite athletes. DESIGN Systematic review DATA SOURCES: PubMed, Cochrane, Scopus, SportDiscus (Ebsco), and PsycINFO (ProQuest) up to November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Qualitative and quantitative original studies of elite athletes (those who competed at the professional, Olympic, or collegiate/university levels), published in any language. RESULTS Stigma, low mental health literacy, negative past experiences with mental health treatment-seeking, busy schedules, and hypermasculinity are barriers to elite athletes seeking mental health treatment. Cultural influencers of mental health in elite athletes include: (1) the lack of acceptance of women as athletes; (2) lower acceptability of mental health symptoms and disorders among non-white athletes; (3) non-disclosure of religious beliefs; and (4) higher dependence on economic benefits. Coaches have an important role in supporting elite athletes in obtaining treatment for mental illness. Brief anti-stigma interventions in elite athletes decrease stigma and improve literary about mental health. CONCLUSION There is a need for various actors to provide more effective strategies to overcome the stigma that surrounds mental illness, increase mental health literacy in the athlete/coach community, and address athlete-specific barriers to seeking treatment for mental illness. In this systematic review, we identified strategies that, if implemented, can overcome the cultural factors that may otherwise limit athletes seeking treatment. Coaches are critical for promoting a culture within elite athletes' environments that encourages athletes to seek treatment.
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Affiliation(s)
- João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo Andre, SP, Brazil .,Department of Psychiatry, Medical School, University of São Paulo, Sao Paulo, SP, Brazil.,ABC Center for Mental Health Studies, Santo André, SP, Brazil
| | | | | | - Vincent Gouttebarge
- Amsterdam UMC, Univ of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Mary E Hitchcock
- Ebling Library for the Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Brian Hainline
- National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA
| | - Claudia L Reardon
- Department of Psychiatry, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Todd Stull
- Athletic Department, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
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Navarro SM, Pettit RW, Haeberle HS, Frangiamore SJ, Rahman NM, Farrow LD, Schickendantz MS, Ramkumar PN. Short-Term Impact of Concussion in the NHL: An Analysis of Player Longevity, Performance, and Financial Loss. J Neurotrauma 2018; 35:2391-2399. [DOI: 10.1089/neu.2017.5611] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Sergio M. Navarro
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Rowland W. Pettit
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Heather S. Haeberle
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
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