Comparing Interventions For Sport Related Concussions

Concussions should be on the top of the list of potential injuries for anyone playing sports. Over the past several years, sport related concussions have been recognized as a major health concern in young athletes. A concussion is defined as a traumatic brain injury that results in temporary loss of normal brain function because of the brain moving back and forth in the skull. The primary sources of concussions are from sports activities, such as hockey, lacrosse, soccer, rugby and football. However, concussions can also outcome from non-sport related injuries, such a car accident, a fall, a hit to the head, and even being hit forcefully with a moving object.

Having a concussion does not always mean that the person is unconscious. Although there maybe instances of no external indicators there are, signs and symptoms that can help diagnose if a person has a concussion. According to Coronado et al. (2015), approximately 329,290 children under the age of 19 were seen in the emergency room and diagnosed with concussion or traumatic brain injury from sports and recreational activities. Additionally, from 2001-2012 the rate of concussion visits doubled for youths. Traumatic brain injuries are the leading cause of disability and mortality in youth aged 0-4 and 15-19 years old.

Annually, more than 62,000 concussions occur in high school sport activities. Estimates show that the risk of repeat concussions is three to six times higher in football with soccer being comparable with four to six times. The importance of safety cannot be stressed enough when it comes to concussions. Concussions can have lasting effects throughout one’s life. Many youths have cognitive, physical, and even behavioral effects of concussions such as, depression and memory loss.

Studies have shown that exposure to contact sports at younger age, long-term exposure to repeated head trauma, and consequences of the immediate effect on a young athlete’s life are continued concerns. Thus, why making education about concussions essential for coaches, youth athletes, sports officials, health care professionals and parents alike. All must be prepared to act as soon as concussions symptoms are apparent because recovery can take longer for youths. Additionally, being knowledgeable on the incidence of concussions and the associated risks will be influential in reviewing and improving rules, regulations, safety, and guiding future changes in various sports. The consensus is that the concussion incidence rate is steadily rising.

With everything considered educational campaigns and initiatives are great ways to improve prevention, recognition, and response efforts. Two health promotion initiatives reviewed are the HEADS UP: Concussion in High School Sports and the Sports Legacy Institute Community Educators (SLICE) program. Both programs focus on increasing recognition and concussion response.

HEADS UP: Concussion in High School Sports

The HEADS UP initiative was established by the Center for Disease Control as a means to protect the health and safety of young athletes. HEADS UP also strives to increase the awareness of anyone involved in youth sports, particularly, the athletes, health care professionals, teachers, parents, and coaches. A study was conducted to evaluate the outcome and effectiveness of the HEADS UP initiative. The evaluation participants were based on those who received the HEADS UP: Concussion in High School Sports tool kit between September 2005 to July 2006. Out of the 13,199 tool kits ordered and the participants were narrowed down to only 1,009 coaches.

A mixed method evaluation was conducted that included the use of a mail survey and six focus groups. The purpose of mail survey was to gather qualitative data and assess their awareness of concussion prevention. The survey used a combination of multiple choice, Likert-scale, and open-ended questions. All prospective respondents received a pre-notification letter, an initial survey, a thank-you or reminder postcard, a replacement survey, and a final survey. The focus groups used open-ended questions to increase understanding of the qualitative data.

Prior to beginning the focus groups, verbal consent was obtained and the participants were informed that their session would be audio recorded. Data analysis was a representation of descriptive statistics and segmentation. The focus group data analysis included the recordings, document coding, summary opinions and experiences. The data was reviewed with the research team with a goal to achieve an agreement of understanding.

Sports Legacy Institute Community Educators (SLICE) Program

SLICE is an interactive concussion education program that uses video, discussion and games to educate young athletes about concussions. The SLICE curriculum aimed to examine the effectiveness of the recognition and response to concussions in effort to determine awareness. The SLICE curriculum proposed that an uptake in concussion awareness among student athletes would benefit overall public health and promote the importance of sport safety within the United States. To analyze the effectiveness of SLICE, a prospective cohort study was conducted. The study included evaluation of 636 students aged 9-18 years old who took part in the SLICE program.

As part of the evaluation, the participants were required to complete a quiz assessing their knowledge about concussions before and after partaking in the SLICE program. Medical-related or health-related volunteers who received training on concussions, the SLICE program and CDC guidelines taught the curriculum by use of presentations lasting up to 60 minutes each session. The presentation included information on the signs, symptoms, consequences and the various ways to respond to concussions. The quiz design, distribution, and scoring took it a step farther. The questions were a combination of true/false, multiple choice and open ended.

Non-identifiable information such as age, gender, ethnicity, and sport of choice was gathered without revealing the participants identity. These variations are important because they can determine the effect of the participant’s knowledge about concussions. Pre presentation quizzes were collected by the SLICE volunteers and graded by two people to minimize variations. The statistical analysis included the mean scores of both the pre and post presentation quizzes. Additional analysis encompassed paired t tests, the pass percentage rate and multivariable logistic regression.

Impact and Outcome Comparison of both Intervention Programs

The HEADS UP evaluation revealed a positive change in relation to concussion awareness, prevention, and management. Even though the coaches had experience with concussions, some reported they still gained insight. Additionally, the coaches felt a responsibility to continue to educate themselves, ensure safety equipment is used correctly, implement training techniques, and engage with health professionals prior to an injured athlete returning to play. In comparison, the SLICE program revealed significant learning improvements among the participants based on the quizzes and the SLICE presentations.

The quiz scores showed that the SLICE curriculum was effective for the participants over 13 years old. The study also discovered that female students had a better understanding, which was shown by the quiz scores. Another factor that identified alignment for the SLICE program was that the portion of participants who passed the quiz increased by 46% after the presentation. Lastly, the multivariable logistic regression, identified age and gender as the most significant factors.

Critique

The HEADS UP program has made a positive impact on coaches, yet, that is only one element to improve upon. More engagement is needed on all levels, especially with the parents. The limitations of HEADS UP program included lack of support from athletes and their parents. Some disregarded the seriousness of concussions and injury policies. A suggestion would be coming up with alternatives to engage with the parents for a better understanding.

The SLICE program was deemed effective; however, it also suggests that the program had limited short-term implications. It would be beneficial if the program used a multiple sessions and involved more information to gain long-term implications. A suggestion would be to provide continuous education throughout the year prior to participating in sports. A better understanding as to why female participants have a significantly higher awareness of concussions should be researched. Limitations of the SLICE program included possible bias since the quizzes were conducted in an open testing environment, a larger sample size would have produced more evidence, and there was lack of long-term behavioral understanding.

Overall, it may prove beneficial to reassess both the HEADS UP and SLICE concussion education programs. A collaborative approach among athletes, coaches, parents, health care providers, and school professionals should be maintained to decrease chances of concussions.

References

1. American Association of Neurological Surgeons. (n.d). Neurosurgical Conditions and Treatments: Concussions. Retrieved from: https://www.aans.org/Patients/Neurosurgical: Conditions-and-Treatments/Concussion
2. Bagley, A., Danshvar, D, Schanker, B., Zurakowski, D., d’Hemecourt, C., Nowinski, C.,  Goulet, K. (2012). Effectiveness of the SLICE Program for Youth Concussion Education. Clinical Journal of Sport Medicine, 22(5), 385-389.
3. Center for Disease Control and Prevention. (2015). HEADS UP to School Sports. Retrieved from: https://www.cdc.gov/headsup/highschoolsports/index.html
4. Clay, M., Glover, K., Lowe, D. (2013). Epidemiology of Concussion in Sport: A Literature Review. Journal of Chiropractic Medicine, 12(4), 230-51
5. Coronado, V., Haileyesus, T., Cheng, T., Bell, J., Haarbauer-Krupa, J., Lionbarger, M., Flores- Herrara, J., McGuire, L., Gilchrist, J. (2015). Trends in Sports and Recreation Related Traumatic Brain Injuries Treated in US Emergency Departments: 185-197.
6. Fishman, M., Taranto, E., Perlman, M., Quinlan, K., Benjamin, H., Ross, L. (2017). Attitudes and Counseling Practices of Pediatrics Regarding Youth Sports Participation and Concussion Risk. Journal of Pediatrics, 184: 19-25.
7. Sarmiento, K., Mitchko, J., Klein, C., Wong, S. (2010). Evaluation of the Center’s for Disease Control and Prevention’s Concussion Initiative for High School Coaches: “Heads Up: Concussion in High School Sports”. Journal of School Health, 80(3), 112-118.