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Xiang L, Yoon S, Low AHL, Leung YY, Fong W, Lau TC, Koh DR, Thumboo J. Approaches to improving symptom appraisal: a systematic literature review. BMJ Open 2022; 12:e064521. [PMID: 35998970 PMCID: PMC9403152 DOI: 10.1136/bmjopen-2022-064521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Poor symptom appraisal (detection, interpretation and response to symptoms) plays a major role in prolonged prediagnosis interval in various health conditions. Theories and models have been proposed to study the symptom appraisal process but how they could be employed to improve symptom appraisal remains unclear. We therefore aimed to review approaches to improving symptom appraisal in the literature and to develop a theoretical framework that could guide the development of approaches to improving symptom appraisal among individuals in the general population. DESIGN Systematic review. DATA SOURCES Medline, Web of Science, PsycINFO, Embase, CINAHL and Scopus were searched from inception to 30 March 2021. ELIGIBILITY CRITERIA We included original articles in English in which approaches to improve the detection, interpretation or response to symptoms for symptomatic individuals were described. We excluded articles in which approaches were developed to improve symptom appraisal among healthcare professionals. DATA EXTRACTION AND SYNTHESIS A predefined data extraction form was used to extract the development, characteristics and evaluation of approaches to improving symptom appraisal. This formed the basis for the narrative synthesis. RESULTS Of 19 046 publications identified from the literature search, 112 were selected for full-text review and 29 approaches comprising provision of knowledge of symptoms/signs and additional components (eg, symptom self-examination and comparison) for symptom appraisal were included in the synthesis. Less than half (41.4%) of these approaches were developed based on theories/models. Interestingly, despite the variety of theories/models adopted in developing these approaches, the components of these approaches were similar. CONCLUSION Symptom appraisal is an essential process in a patient's journey that can be targeted to facilitate early diagnosis but is largely unstudied. Building on the literature, we proposed a theoretical framework and approaches to improving symptom appraisal. This could facilitate early identification of a variety of health conditions in the general population. TRIAL REGISTRATION NUMBER CRD42021279500.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Andrea H L Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Tang Ching Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore
| | - Dow Rhoon Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
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Mallory KD, Saly L, Hickling A, Colquhoun H, Kroshus E, Reed N. Concussion Education in the School Setting: A Scoping Review. THE JOURNAL OF SCHOOL HEALTH 2022; 92:605-618. [PMID: 35259774 PMCID: PMC9311225 DOI: 10.1111/josh.13156] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Concussions are a prevalent injury among youth, and concussion education has the potential to promote positive concussion-related behaviors. Recent recommendations and legislation have increased concussion education provided in schools; however, little is known about the education context, delivery method, development, and evaluation. A scoping review was conducted to identify peer-reviewed literature on concussion education delivered in the school setting. METHODS Six databases were searched (MEDLINE, CINAHL, EMBASE, PsycINFO, SPORTDiscus, and ERIC) to identify published articles from 2002 to July 16, 2020 that delivered concussion education in the school setting. Included studies described the concussion education and were written in English. RESULTS A total of 11,373 articles were identified and screened, with 27 studies meeting eligibility criteria and therefore, included. The studies delivered education to various stakeholders including students (n = 12; 44.4%), coaches (n = 5; 18.5%), educators (n = 3; 11.1%), parents (n = 1; 3.7%), and a mixed audience (n = 6; 22.2%). The education format varied and six studies (22.2%) developed the education based on a theory, model, or framework. CONCLUSIONS This study found substantial variability in the context, delivery method, development, and evaluation of education delivered in schools and further evaluation of this education is needed to ensure it is best-suited for school-based stakeholders.
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Affiliation(s)
- Kylie D. Mallory
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, 500 University Avenue, Suite 160TorontoONCanadaM5G 1V7
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital 150 Kilgour RoadTorontoONM4G 1R8
| | - Lauren Saly
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour RoadTorontoONM4G 1R8
| | - Andrea Hickling
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital; Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto 150 Kilgour RoadTorontoONM4G 1R8
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto 160‐500 University Avenue, Room 924TorontoOntarioM5G 1V7
| | - Emily Kroshus
- Department of Pediatrics, University of Washington; Center for Health, Behavior and Development, Seattle Children's Research Institute 1920 Terry AvenueSeattleWA98101
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto; Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital 160‐500 University Avenue, Room 936TorontoOntarioM5G 1V7
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Beran KM, Scafide KN. Factors Related to Concussion Knowledge, Attitudes, and Reporting Behaviors in US High School Athletes: A Systematic Review. THE JOURNAL OF SCHOOL HEALTH 2022; 92:406-417. [PMID: 35075658 DOI: 10.1111/josh.13140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Sport-related concussions are a major public health problem with only 50% of concussed teens reporting their symptoms. The purpose of this systematic review was to identify individual and institutional factors that contribute to concussion knowledge, attitude, and reporting behaviors among US high school athletes. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol was used to direct the process of this systematic review. A search for English, peer-reviewed, quantitative studies published between 2010 and 2020 was conducted in 5 scholarly databases. The Joanna Briggs Critical Appraisal Tools were used to assess study quality. RESULTS Twenty-two studies met criteria for inclusion in this systematic review. The study designs were mostly cross-sectional (N = 18). Synthesis revealed individual factors including gender, age, race/ethnicity, grade level, and concussion history were associated with differences in concussion knowledge, attitude, and/or reporting behaviors. Institutional factors identified included school location, concussion education, access to an athletic trainer, sport played, and team climate. Six studies found concussion education had a positive impact on knowledge and reporting behaviors. CONCLUSION This systematic review identified certain populations which may be more vulnerable to underreporting concussion symptoms; therefore, a targeted approach to education and management may be more effective.
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Affiliation(s)
- Krista M Beran
- Doctoral Candidate, , College of Health and Human Services, George Mason University, 4400 University Dr., Fairfax, VA 22030
| | - Katherine N Scafide
- Associate Professor, , College of Health and Human Services, George Mason University, 4400 University Dr., Fairfax, VA 22030
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McCarthy KS, Kneavel M, Ernst W. Psychometric properties of concussion knowledge and cognitive mediators of reporting measures. Brain Inj 2021; 35:1210-1217. [PMID: 34347541 DOI: 10.1080/02699052.2021.1959064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Context: Concussion education and prevention programs require reliable and valid instruments to evaluate the theory, mechanisms, and outcome of these interventions Objective: To assess the psychometric properties of measures evaluating concussion education and prevention programsDesign: Descriptive epidemiological Setting: 10 NCAA-member universities Patients or Other Participants: 841 student-athletes in an RCT control group testing an ecological, peer-led concussion education program Main Outcome Measures: Instruments adapted for assessing concussion knowledge and Theory of Planned Behavior/Theory of Reasoned Action (TPB/TRA) cognitive mediators of reporting behavior (attitudes, subjective norms, perceived control, and intentions to report concussion). Participants completed measures at baseline, after one hour, and after one month Results: Internal consistency and test-retest reliability were moderate for both the concussion knowledge and cognitive mediator measures. TPB/TRA was supported subscale intercorrelation and item factor analysis in the cognitive mediator scale. Factor analysis of the concussion knowledge measure revealed subscales for physical/cognitive, psychological/affective, and non-symptoms. The intermediate TPB/TRA mediators of attitudes, norms, and perceived control predicted greater intention-to-report, which predicted increased likelihood of reporting concussion one month later.Conclusions: Measures of concussion knowledge and cognitive mediators of reporting adapted from the literature show adequate psychometric properties and support TPB/TRA application for concussion reporting behaviors.
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Affiliation(s)
- Kevin S McCarthy
- , Chestnut Hill College, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meredith Kneavel
- School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania, USA.,Center for Concussion Education and Research of Chestnut Hill College
| | - William Ernst
- , Chestnut Hill College, Philadelphia, Pennsylvania, USA
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O'Reilly M, Mahon S, Reid D, Hume P, Hardaker N, Theadom A. Knowledge, attitudes, and behavior toward concussion in adult cyclists. Brain Inj 2020; 34:1175-1182. [PMID: 32683900 DOI: 10.1080/02699052.2020.1793386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine knowledge, attitudes, and behavior toward concussion in cyclists and to identify predictors of concussion knowledge. METHODS Cycling organizations sent members a web link to online information about the study and a questionnaire. Anyone aged >16 years, living in New Zealand and engaged in a cycling activity was invited to participate. The 36-item questionnaire included sociodemographics, knowledge about concussion, helmet use, and personal concussion history. Data were collected between 15/05/19 and 30/06/19. A multiple linear regression model identified factors associated with levels of concussion knowledge. RESULTS The questionnaire was completed by 672 participants aged between 16 and 82 years (x̄ = 48.6 years). Knowledge of concussion was high. However, knowledge that helmets are not able to prevent concussion was low and time to return to sport after injury was variable. Knowledge did not always translate to seeking of medical attention or replacement of helmet behavior. Younger age and having sustained at least one prior concussion were associated with higher levels of concussion knowledge F(df = 3) = 8.81, p < .001. CONCLUSIONS Knowledge and attitudes toward concussion were positive. However, knowledge gaps and discrepancies between attitudes and behavior were identified. Consistent, clear messages are needed around return to sport timeframes.
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Affiliation(s)
- Maureen O'Reilly
- TBI Network, Auckland University of Technology , Auckland, New Zealand
| | - Susan Mahon
- TBI Network, Auckland University of Technology , Auckland, New Zealand
| | - Duncan Reid
- Sports Performance Research Institute New Zealand, Faculty of Health and Environmental Science, Auckland University of Technology , Auckland, New Zealand
| | - Patria Hume
- TBI Network, Auckland University of Technology , Auckland, New Zealand.,Sports Performance Research Institute New Zealand, Faculty of Health and Environmental Science, Auckland University of Technology , Auckland, New Zealand
| | - Natalie Hardaker
- Injury Prevention, Accident and Compensation Corporation , Wellington, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology , Auckland, New Zealand
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Schmidt JD, Weber ML, Suggs DW, Bierema L, Miller LS, Reifsteck F, Courson R, Hoff R, Dill K, Dunham J. Improving Concussion Reporting across National College Athletic Association Divisions Using a Theory-Based, Data-Driven, Multimedia Concussion Education Intervention. J Neurotrauma 2020; 37:593-599. [DOI: 10.1089/neu.2019.6637] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - Laura Bierema
- Department of Lifelong Education, Administration, & Policy, and University of Georgia, Athens, Georgia
| | | | - Fred Reifsteck
- Department of University Health Center, University of Georgia, Athens, Georgia
| | - Ron Courson
- University of Georgia Athletics Association, Sports Medicine, Athens, Georgia
| | - Russel Hoff
- College of Nursing and Health Sciences, Valdosta State University, Valdosta, Georgia
| | - Karli Dill
- Emory University Sports Medicine, Atlanta, Georgia
| | - John Dunham
- Emory University Sports Medicine, Atlanta, Georgia
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Cusimano MD, Zhang S, Topolovec-Vranic J, Grosso A, Jing R, Ilie G. Pros and Cons of 19 Sport-Related Concussion Educational Resources in Canada: Avenues for Better Care and Prevention. Front Neurol 2018; 9:872. [PMID: 30450073 PMCID: PMC6224516 DOI: 10.3389/fneur.2018.00872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 09/27/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: The goal of this research was to assess the effectiveness of available concussion educational resources in Canada, the means used to disseminate this knowledge and the impact of these educational resources on players' concussion prevention knowledge. Methods: We assessed concussion knowledge before and after exposure to one or more of 19 resources introduced through a national program aimed to increase awareness and knowledge of concussion. The effectiveness of the mode of delivery was measured by changes in concussion knowledge scores (CKS) between pre and pro scores. Measures: Concussion knowledge scores (CKS) were calculated for pre- and post- exposure to concussion educational resources and used as a measure of both, the effectiveness of each resource as well as the effectiveness of the delivery method. The effectiveness of each educational resource was also measured by the respondents' rating of each concussion educational resource. Results: Respondents in post-survey had higher CKS than those in pre-survey. Two out of the 19 newly developed concussion educational resources were effective in improving the resource users' CKS. Linear regression showed that using more resources further increased CKS. Four out of six modes of delivery enhanced respondents' concussion knowledge. Conclusion: Our findings demonstrate that the newly developed Canadian concussion educational resources were effective at improving users' concussion knowledge. Our data demonstrates that using three or more resources further enhanced the users' concussion knowledge. Future research, however, is critical to assess whether concussion prevention knowledge is sufficient to reduce injuries and factors influencing it.
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Affiliation(s)
- Michael D Cusimano
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine and the Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stanley Zhang
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Jane Topolovec-Vranic
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Ashley Grosso
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Rowan Jing
- Division of Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Gabriela Ilie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Sarmiento K, Donnell Z, Hoffman R. A Scoping Review to Address the Culture of Concussion in Youth and High School Sports. THE JOURNAL OF SCHOOL HEALTH 2017; 87:790-804. [PMID: 28876477 PMCID: PMC6211168 DOI: 10.1111/josh.12552] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 02/02/2017] [Accepted: 04/10/2017] [Indexed: 05/28/2023]
Abstract
BACKGROUND In 2013, the National Academy of Sciences emphasized the need to develop, implement, and evaluate effective large-scale educational strategies to improve the culture of concussion in youth and high school sports. In support of this recommendation, in this article we summarize research on factors that contribute to the culture of concussion. METHODS We conducted the literature search using 7 electronic databases. We used a scoping review method to identify studies that addressed knowledge, attitudes, behaviors, use of educational resources, and interventions related to concussion among young athletes, coaches, and parents. RESULTS Of the 33 articles identified, most focused on concussion education (N = 15), followed by knowledge (N = 13), behaviors (N = 13), and attitudes (N = 5). Three studies addressed multiple study populations. CONCLUSIONS The rapid spread of concussion education and awareness efforts has outpaced research on effective strategies to improve knowledge, attitudes, and behaviors that contribute to the culture of concussion. Further research is critical to inform the development and implementation of large-scale educational efforts. This research should incorporate rigorous study designs; be inclusive of diverse ages, socioeconomic status, and racial/ethnic groups; and examine opportunities to improve behavioral outcomes around concussion prevention, reporting, and management.
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Affiliation(s)
- Kelly Sarmiento
- Health Communications Specialist, (), US Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 4770 Buford Hwy NE, Building 106,8th floor, Atlanta, GA30341
| | - Zoe Donnell
- Manager, (), Health Communications Team, ICF, 100 Cambridgepark Drive, Suite 501, Cambridge, MA 02140
| | - Rosanne Hoffman
- Senior Manager, (), Health Communications Team, ICF, 530 Gaither Road, Rockville, MD 20895
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