The Athletic Training Practice-Based Research Network: A National Model for Point-of-Care Sports Injury and Outcomes Documentation to Improve Athlete Health and Wellness

There is mounting evidence to suggest that sport-related injuries can negatively impact an individual’s well-being and quality of life on a long-term basis. As a result, there has been increased interest in the medical community to gain a better understanding of effective treatment interventions to ensure optimal short- and long-term health. Despite the growing problem of sport-related injuries and the need to identify effective treatment interventions, there is surprisingly little data to describe the types of treatments provided for common sport-related injuries at the point-of-care and how those treatments can potentially impact short- and long-term patient outcomes. In this paper, we aim to (1) introduce the Athletic Training Practice-Based Research Network (AT-PBRN) as an infrastructure for collecting the requisite data to address current gaps in sports medicine literature, (2) summarize findings from the AT-PBRN, and (3) describe future directions of the AT-PBRN

Supporting Students after a Concussion: School Administrators’ Perspectives

Students with a concussion may experience challenges when returning to school and completing schoolwork. Therefore, students may require temporary academic support throughout the recovery process. The purpose of this study was to examine school administrators’ perceptions of the return to school process and provision of academic adjustments (AA) after concussion. Online surveys were analyzed using a series of descriptive, chi-square, and Mann Whitney tests. School administrators strongly agreed a concussion can affect school performance and were supportive of providing AA for symptomatic students. More school administrators with access to an athletic trainer and who completed concussion training had an established team to monitor concussions and reported students had received AA after concussion. To better prepare school professionals and enhance the support for students after a concussion, school administrators can develop a school-based concussion team, organize in-service training on concussion, and identify pertinent school and district-based resources to facilitate this care

Adolescent Athletes’ Perspectives on the Social Implications of Sport-Related Concussion

Purpose: Sport-related concussion can affect many domains of a patient’s health status. Social functioning is an important consideration, especially for adolescent athletes. Our purpose was to explore adolescent athletes’ social perspectives regarding sport and concussion. Methods: Using a qualitative study design we interviewed 12 interscholastic athletes who had sustained a sport-related concussion. The interviews focused on injury details, and explored the physical, psychosocial, emotional, and spiritual components of sport and health. Themes and categories were identified using the consensual qualitative research process by a three-person research team. A comprehensive codebook that captured the main themes and categories resulted. Results: Following concussion, participants discussed two primary themes: perceptions regarding the social aspects of sport and social perspectives regarding their concussion. Specific categories related to the social aspects of sport included: friendships and family and decision to participate based on peers. Specific categories regarding the social perspectives of the concussion included uncertainty of the diagnosis, perceptions of others regarding their injury, being ashamed of the concussion, parent and peer roles, and communication and expectation about their concussion. Conclusions: Participation in sport and removal from sport following a concussion have significant social implications for adolescent athletes. Specifically, the perceptions of peers, parents/guardians, and others regarding the injury can influence reporting of symptoms and recovery following concussion. Limited communication regarding recovery and expectations post-concussion may cause undue social pressures to return to activity prematurely. Providing a supportive environment in which patients can recover from concussion while engaging with peers and teammates is important. Anticipatory guidance, with education regarding the possible signs and symptoms, risk factors pre- and post-injury, and recovery expectations following a concussion are important to include in post-injury management and should be known to all stakeholders

Reliability and Concurrent Validity of Select C3 Logix Test Components

We sought to investigate the one-week and within-session reliability of the instrumented balance error scoring system test and the concurrent validity/one-week reliability of two neurocognitive assessments available through C3 Logix. (n = 37) Participants completed two balance error scoring system tests separated by the Trails A, Trails B, and Symbol Digit Modality test available through C3 Logix, and with paper and pencil. We found that the instrumented balance error scoring system test demonstrated strong one-week reliability and that neuropsychological tests available through C3 Logix show acceptable concurrent validity with standard (comparable) paper and pencil measures

A Multifactorial Approach to Sport-Related Concussion Prevention and Education: Application of the Socioecological Framework

To offer an overview of sport-related concussion (SRC) prevention and education strategies in the context of the socioecological framework (SEF). Athletic trainers (ATs) will understand the many factors that interact to influence SRC prevention and the implications of these interactions for effective SRC education

Comprehensive Coach Education Reduces Head Impact Exposure in American Youth Football

BACKGROUND: Despite little evidence that defines a threshold of head impact exposure or that participation in youth sports leads to long-term cognitive impairments, it is prudent to identify methods of reducing the frequency of head impacts. PURPOSE: To compare the mean number of head impacts between youth football players in practice and games between leagues that implemented the Heads Up Football (HUF) educational program and those that did not (NHUF). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: During the 2014 season, head impact exposure was measured using xPatch accelerometers from 70 youth football players aged 8 to 15 years from 5 leagues. Data were collected during both games and practices. The NHUF group comprised 32 players from 8 teams within 3 leagues. The HUF group comprised 38 players from 7 teams within 2 leagues. Independent-sample t tests evaluated differences in head impact exposure across groups (ie, HUF and NHUF). RESULTS: Players (mean ± SD: age, 11.7 ± 1.4 years; height, 152.2 ± 10.5 cm; weight, 51.6 ± 9.6 kg) experienced a total of 7478 impacts over 10g, of which 4250 (56.8%) and 3228 (43.2%) occurred in practices and games, respectively. The majority of impacts occurred within the NHUF group (62.0%), followed by the HUF group (38.0%). With a 10g impact threshold, the mean number of impacts during practice per individual event was lower in the HUF group (mean ± SD, 5.6 ± 2.9) than in the NHUF group (mean ± SD, 8.9 ± 3.1; difference, 3.4; 95% CI, 2.9-3.9). This difference was attenuated when the threshold was changed to 20g but remained significant (difference, 1.0; 95% CI, 0.7-1.3). At both the 10g and 20g impact thresholds, no differences were found in games. CONCLUSION: Players who participated in HUF leagues accumulated fewer head impacts per practice at both the 10g and 20g thresholds. Youth football leagues should consider the HUF educational program, while exploring additional interventions, to help reduce the number of head impacts in players

Relationship between concussion history and concussion knowledge, attitudes, and disclosure behavior in high school athletes

Objective: Examine the association between self-reported concussion history and measures of concussion knowledge, attitude, and disclosure behavior. Design: Cross-sectional survey. Setting: Classroom. Participants: A convenience sample of high school athletes (n = 167; mean age = 15.7 years) from multiple sports completed a validated survey. Independent Variables: Concussion history (main predictor) was defined as the number of self-recalled concussions during participants' high school career. Main Outcome Measures: The outcomes were recalled concussion disclosure behavior (3 measures) and scales assessing both concussion knowledge and concussion attitude. Results: 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). Conclusions: 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

Demographic, parental, and personal factors and youth athletes' concussion-related knowledge and beliefs

Context: Currently, significant attention is focused on improving care for patients with concussions through legislative mandates that include educational interventions. Few researchers have examined young athletes' concussion knowledge and the factors that may influence their knowledge. Objective: To use the socioecological model to examine demographic, parental, and personal factors associated with youth athletes' knowledge of concussion. Our ultimate goal is to inform the planning and implementation of youth sport concussion-related interventions. Design: Cross-sectional survey. Setting: Gymnasium and classroom. Patients or Other Participants: North Carolina and Arizona youth athletes (n ¼ 225; age ¼ 8 to 15 years) active in football, boys' or girls' soccer, boys' or girls' ice hockey, or boys' or girls' lacrosse in 2012-2013. Main Outcome Measure(s): Participants completed a validated, self-administered survey. The intention and belief measures were guided by the theory of planned behavior. Perceptions of concussion and intention to seek care were examined using descriptive statistics. Athletes' concussion knowledge was modeled using linear regressions and generalized estimating equations, with child demographic and personal factors and parental knowledge and attitudes about concussion as predictors. Results: Geography, sport, parental attitudes toward concussion, and athlete age were associated with athlete knowledge in the univariable analyses (P, .10). In the multivariable model, geographic location (North Carolina versus Arizona, mean difference [MD] ¼ 2.2, 95% confidence interval [CI] ¼ 1.1, 3.2), sport (girls' soccer versus girls' lacrosse, MD ¼ 2.2, 95% CI ¼ 0.7, 3.6), more favorable parental attitudes toward concussion (MD ¼ 1.2 for a 2-standard deviation shift; 95% CI ¼ 0.3, 2.1), and older age (.12 years, MD ¼ 1.6; 95% CI ¼ 0.5, 2.6) were associated with better knowledge about concussion. Conclusions: Geographic location, sport, parental attitudes about concussion, and athlete's age influenced athletes' concussion-related perceptions, indicating the need to address multiple levels of the socioecological model when targeting youth sport interventions. Parental interventions that translate to an improved culture of youth sport by improving youth athletes' perceptions and experiences are key areas for future work

Estimating Concussion Incidence Using Sports Injury Surveillance Systems: Complexities and Potential Pitfalls

Numerous sports injury surveillance systems exist with the capability of tracking concussion incidence data. It is important for the consumers of sport-related concussion data, be they researchers or the public, to have a comprehensive understanding of the strengths and limitations of sports injury surveillance systems. This article discusses issues of system design and analysis that affect the interpretation and understanding of sport-related concussion incidence data from sports injury surveillance systems. Such understanding will help inform the design of sports injury surveillance systems and research studies that aim to identify risk factors, develop prevention strategies, and evaluate prevention mechanisms