Knowledge, attitudes, and behaviours of New Zealand physiotherapists to sports-related concussion
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Abstract:
Sports-related concussion (SRC) is a risk across all sports. New Zealand physiotherapists are more frequently in attendance at sporting events than medical doctors. The aim of this study was to determine the knowledge, attitudes, and behaviours of physiotherapists working with SRC, using a 35-item, multi-choice questionnaire. The survey was completed by 122 physiotherapists (response rate 10%). Physiotherapists were knowledgeable regarding SRC and showed positive attitudes towards correct management of the injury. Of the respondents, 98% recognised the key signs and symptoms of SRC, and 88% would refer to a medical practitioner for further assessment of SRC. Physiotherapists indicated a strong desire to be more involved in sideline management and testing, and would like to see a more multidisciplinary approach to return-to-play decision-making after SRC. Given that the knowledge, attitudes, and behaviours of New Zealand physiotherapists to SRC were very good, it is suggested that the processes in New Zealand be reviewed to enable physiotherapists to be more involved in the assessment and management of concussion.Keywords:
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OBJECTIVE Concussion is a common topic of research as a result of the short- and long-term effects it can have on the affected individual. Of particular interest is whether previous concussions can lead to a biomechanical susceptibility, or vulnerability, to incurring further head injuries, particularly for youth populations. The purpose of this research was to compare the impact biomechanics of a concussive event in terms of acceleration and brain strains of 2 groups of youths: those who had incurred a previous concussion and those who had not. It was hypothesized that the youths with a history of concussion would have lower-magnitude biomechanical impact measures than those who had never suffered a previous concussion. METHODS Youths who had suffered a concussion were recruited from emergency departments across Canada. This pool of patients was then separated into 2 categories based on their history of concussion: those who had incurred 1 or more previous concussions, and those who had never suffered a concussion. The impact event that resulted in the brain injury was reconstructed biomechanically using computational, physical, and finite element modeling techniques. The output of the events was measured in biomechanical parameters such as energy, force, acceleration, and brain tissue strain to determine if those patients who had a previous concussion sustained a brain injury at lower magnitudes than those who had no previously reported concussion. RESULTS The results demonstrated that there was no biomechanical variable that could distinguish between the concussion groups with a history of concussion versus no history of concussion. CONCLUSIONS The results suggest that there is no measureable biomechanical vulnerability to head impact related to a history of concussions in this youth population. This may be a reflection of the long time between the previous concussion and the one reconstructed in the laboratory, where such a long period has been associated with recovery from injury.
Biomechanics
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Purpose : Assess whether athletes with a prior concussion diagnosis are more likely to continue play with a possible concussion. Additionally, explore whether reasons for concussion under-reporting are different among athletes with a prior concussion when compared to other athletes. Methods : Cross-sectional survey of 328 collegiate athletes. Results : Athletes with a prior concussion diagnosis had significantly greater relative risk of continuing play while symptomatic of a possible concussion during their most recent season compared to athletes without prior concussion diagnosis. Significant differences exist in the reasons that athletes provided for not reporting by history of concussion. Conclusions : Findings suggest that learning may have occurred as a result of the prior diagnosis; however, this learning did not appear to result in safer reporting behavior. Additional research is necessary to clarify why athletes who have been previously diagnosed with a concussion are more likely to continue playing while experiencing concussion symptoms.
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Objective To evaluate brain adaptation following concussion. Do youth with a history of previous or acute concussion require more ball throws to land on or near a target, when wearing prism glasses (bend light to the left by 15˚), than youth with none? Design Cross-sectional study. Setting Sport Injury Prevention Research Centre, Alberta, Canada. Participants Ice hockey players: 21 with acute concussion [(17 males), mean age 13.8 (95% CI: 13.4, 14.2), median number of days since concussion 4 (range 2–11)], 40 reporting previous concussion(s) [(33 males), mean age 13.4 (95% CI: 13.1, 13.7), median number of days since last concussion 620 (range 90–1560)], and 40 with no concussion history [(36 males), mean age 12.9 (95% CI: 12.5, 13.2)]. Independent variable Lifetime concussion history (yes/no) or acute concussion (<10 days). Dependent variable Number of throws for brain adaptation. Main results A significant concussion effect was identified across groups [F(2,98)=26.17, p<0.001]. Post-hoc analyses showed a difference in the number of throws in players with no concussion history versus players reporting previous concussions [−4.700 (95% CI: −8.44, −0.96)] and acute concussions [−13.440 (95% CI: −17.89, −8.99)], as well as between previous history versus acute concussion groups [−8.740 (95% CI: −13.19, −4.29)]. Conclusions Concussion history and acute concussion appears to negatively impact brain plasticity in youth. They do not adapt as well as individuals with no concussion history. Our results support the use of a prism adaptation paradigm for identifying/quantifying short and long-term neurologic impairments in youth following concussion. Competing interests None.
Ice hockey
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PURPOSE: To determine if female athletes with a prior history of concussion have a longer recovery period when compared with their male counterparts with a similar history of prior concussion. METHODS: We reviewed male and female youth, high school, collegiate and professional athletes (10-35 years old) seen by one provider for post-concussive symptoms at an outpatient sports medicine clinic. RESULTS: When comparing males and females with a prior history of concussion, there were no differences found (p = 0.4006) in recovery time following a concussion. Without regard to gender, those with no history of prior concussion are more likely to recover from post-concussive symptoms than those with a prior concussion history, although the difference was not statistically significant (p = 0.1027). When assessing whether gender alone influenced recovery rates, findings suggest that males are more likely to recover at any time point when compared to their female counterparts (p = 0.0019). CONCLUSIONS: History of at least one prior concussion in young athletes results in a higher initial symptom score and extended duration of post-concussive symptoms, thereby prolonging recovery time. According to our study, there are no gender-based differences in recovery time for those who sustain multiple concussions.
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Background: Concussion affects almost 4 million individuals annually. There are many sideline screening tools available to assist in the detection of sports-related concussion. The King-Devick (K-D) test in association with Mayo Clinic utilizes rapid number naming to test saccadic eye movements in order to screen for concussion. An ideal screening tool for concussion would correctly identify all athletes with active concussion. The accuracy of K-D testing compared with other sideline screening tools is undetermined. Objective: To critically assess current evidence regarding the utility of K-D testing as a sideline screening tool for acute concussion and compare K-D testing to other sideline concussion assessments. Methods: The objective was addressed through the development of a critically appraised topic that included a clinical scenario, structured question, literature search strategy, critical appraisal, assessment of results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the field of concussion neurology and neuro-ophthalmology. Results: A recent meta-analysis was selected for critical appraisal. Cohorts analyzing athletes with sports-related concussion were selected, and utilized K-D testing as the main baseline and sideline assessment of concussion. K-D testing was found to have a high sensitivity and specificity for detecting concussion when there was worsening from baseline. Conclusion: K-D testing has high sensitivity and specificity for detecting sideline concussion. Compared with other sideline screening tools that do not include vision testing, it has greater accuracy. Screening for concussion is optimized when multiple testing modalities are used in conjunction.
Post-concussion syndrome
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Objective Immediate removal from activity after sport-related concussion is associated with less time missed from sport, a shorter symptomatic period, and better outcomes on acute clinical measures than delayed removal from activity. However, the effects of undiagnosed concussion on clinical outcomes have not been studied. In the case of an undiagnosed concussion, when the athlete is not removed from play, he/she may undergo subsequent repetitive head impacts. Subsequent head impacts may prevent complete recovery and make the athlete more sensitive to even mild mechanical head impact. The purpose of this study was to determine if soccer players with a history of undiagnosed concussion are more likely to report concussion-like symptoms following typical soccer heading than those without a history of undiagnosed concussion. Methods Thirty-one adult amateur soccer players (17 males and 14 females, 22.3 ± 4.5 years, 171.0 ± 9.2 cm, 71.9 ± 11.4 kg) completed a self-reported concussion/sport history questionnaire as part of a larger study aimed to identify behavioral and biomarkers of subconcussion. Participants were asked to report diagnosed and undiagnosed concussions. Undiagnosed concussions consisted of unreported and unrecognized concussions. Participants also indicated concussion-like symptoms typically experienced after soccer heading. A χ2 analysis was used to determine if a history of undiagnosed concussion was associated with prolonged concussion-like symptoms following subconcussive head impacts. Results Individuals with a history of undiagnosed concussion were more likely to report concussion-like symptoms following soccer heading (χ2 = 5.114, p = 0.024; Likelihood Ratio = 4.693, p = 0.030). Conclusions The results of this study suggest that individuals who experience unreported or unrecognized concussions may be more likely to experience concussion-like symptoms following repetitive subconcussive head impacts and highlight the importance for athletes in immediately reporting concussion signs and symptoms. We speculate that these individuals may not fully recover and may remain sensitive to mild mechanical head impact even years following their concussion.
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Examine the association between self-reported concussion history and measures of concussion knowledge, attitude, and disclosure behavior.Cross-sectional survey.Classroom.A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey.Concussion history (main predictor) was defined as the number of self-recalled concussions during participants' high school career.The outcomes were recalled concussion disclosure behavior (3 measures) and scales assessing both concussion knowledge and concussion attitude.A greater number of previous concussions was associated with worse attitude to concussion and negative concussion disclosure behavior. For every 3 additional self-recalled concussions, there was a mean decrease of 7.2 points (range of possible scores = 14-98) in concussion attitude score (P = 0.002), a 48% decrease in the self-reported proportion of concussion events disclosed (P = 0.013), and an increased prevalence of self-reported participation in games (67%) and practices (125%) while experiencing signs and symptoms of concussion (P < 0.001). Increased concussion history did not affect concussion knowledge score (P = 0.333).Negative trends in concussion disclosure behavior were identified in youth athletes with a positive history of concussion. Improving disclosure in this subgroup will require targeted efforts addressing negative attitude to concussion.
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Objective Determine if youth athletes with a history of concussion had more symptoms, higher symptom score, longer recovery, or were more likely to be diagnosed with Post-Concussion Syndrome (PCS) than those with no history of concussion. Design Retrospective chart review. Setting Paediatric, multi-disciplinary concussion. Participants 306 youth (mean 14.0 years, SD 2.3; 65.5% male) with an acute sport-related concussion. Intervention (or assessment of risk factors) Self-reported concussion history. Outcome measures Recovery days were days between concussion and medical clearance by the neurosurgeon. Medical clearance occurred after tolerating full-time school, completing return-to-play protocol, and absence of vestibulo-ocular dysfunction. Initial symptoms were reported on the Post Concussion Symptom Severity score (PCSS); symptom severity was the total PCSS score. The neurosurgeon diagnosed Post-Concussion Syndrome (PCS) using ICD-10 criteria of symptoms for at least 30 days. Main results Median number of initial symptoms was 5.5 (IQR: 1–10) for youth with no concussion history and 7.0 (IQR: 2–14) with a concussion history (p=0.04). Initial median PCSS score was 9 (IQR: 1–22) for youth with no concussion history and 13 (IQR: 3–34) with a concussion history (p=0.03). Median recovery days was 22 (IQR: 15–43) for those with no concussion history compared to 23 (IQR: 16–39) with a concussion history (p=0.41). There was no significant difference in subsequently being diagnosed with PCS (no concussion history: 40.1%, ?concussion history: 41.7%, p=0.73). Conclusions Despite a significantly higher initial symptom burden among those with a concussion history, there was no increased risk of protracted recovery or subsequent diagnosis of PCS. Competing interests None.
Post-concussion syndrome
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Previously published studies have found that concussion symptoms are underreported in youth athletics. This study evaluated the likelihood high school soccer players would identify themselves as having concussion related symptoms during game situations. A questionnaire inquiring about past concussion education and the likelihood of notifying their coach of concussion symptoms was administered to 183 high school soccer players. Of the 60 (33%) who completed the survey, 18 (72%) athletes who had acknowledged receiving concussion training responded that they would always notify their coach of concussion symptoms, as compared with 12 (36%) of the players who reported having no such training (P = .01). The results of this study suggest that athletes with past concussion training are more likely to notify their coach of concussion symptoms, potentially reducing their risk for further injury. Concussion education should be considered for all high school soccer players.
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