Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA.
Department of Neurology, Stanford University, CA.
J Athl Train. 2021 Nov 1;56(11):1197-1208. doi: 10.4085/509-20.
Concussion underreporting leads to delays in diagnosis and treatment, prolonging recovery time. Athletes' self-reporting of concussion symptoms, therefore, reduces risk.
To evaluate the effectiveness of 3 concussion-education programs in improving concussion-reporting intention.
Randomized controlled clinical trial.
Three high schools in California.
A total of 118 male football players (age = 14.88 ± 1.19 years).
INTERVENTION(S): Participants were randomly assigned to receive concussion education via CrashCourse (CC), Centers for Disease Control and Prevention (CDC) video education materials (CDC-Vi), or CDC written education materials (CDC-Wr).
MAIN OUTCOME MEASURE(S): The primary outcome was concussion-reporting intention, which was assessed at baseline, immediately after education, and at 1-month follow-up. Secondary outcomes were concussion knowledge, concussion-reporting attitudes, perceived concussion-reporting norms, and perceived behavioral control.
Across all education formats, a total sample of athletes improved in concussion-reporting intention at immediate and 1-month follow-ups (mean improvements = 6.8% and 11.4%, respectively; F4,224 = 11.1, P < .001). Similar findings were observed across all education formats in secondary analyses examining knowledge, attitudes, and perceived behavioral control. However, we noted differences in concussion-reporting intention by education format and time (F4,224 = 2.8, P = .03). Post hoc analysis showed that athletes who received CC had increased concussion-reporting intentions at immediate and 1-month follow-ups (baseline = 4.7, immediate follow-up = 6.1, 1-month follow-up = 6.0; F16,61.1 = 6.1, P = .007) compared with increases only at 1-month follow-up for CDC-Vi (baseline = 4.3, immediate follow-up = 5.2, 1-month follow-up = 5.8; F1.6,61.6 = 8.4, P = .001) and no improvement for CDC-Wr (P = .10). Secondary analyses indicated differences between CC and both CDC interventions in concussion knowledge and attitudes at immediate and 1-month follow-ups. We identified no differences in perceived behavioral control among interventions (F4,216 = 0.2, P = .93) or perceived concussion-reporting norms across (F4,224 = 0.3, P = .73) or among (F4,224 = 1.7, P = .15) interventions.
All athletes exhibited an improved intent to report concussions, increased concussion knowledge, better concussion attitudes, and more perceived behavioral control at both immediate and 1-month follow-ups. However, athletes randomized to receive CC reported a greater intent to report concussion, more knowledge, and improved concussion-reporting attitudes when compared with those who received CDC-Vi and CDC-Wr.
脑震荡漏报会导致诊断和治疗延误，延长康复时间。因此，运动员自我报告脑震荡症状可降低风险。
评估 3 种脑震荡教育计划在提高脑震荡报告意向方面的效果。
随机对照临床试验。
加利福尼亚州的 3 所高中。
共 118 名男性足球运动员（年龄=14.88±1.19 岁）。
参与者被随机分配接受脑震荡教育，分别通过 CrashCourse（CC）、疾病预防控制中心（CDC）视频教育材料（CDC-Vi）或 CDC 书面教育材料（CDC-Wr）。
主要结局是脑震荡报告意向，在基线、教育后即刻和 1 个月随访时进行评估。次要结局是脑震荡知识、脑震荡报告态度、感知脑震荡报告规范和感知行为控制。
所有教育形式的运动员在教育后即刻和 1 个月随访时脑震荡报告意向均有改善（平均改善分别为 6.8%和 11.4%；F4,224=11.1，P<.001）。在对知识、态度和感知行为控制进行的二次分析中，也观察到了类似的结果。然而，我们注意到教育形式和时间对脑震荡报告意向的影响存在差异（F4,224=2.8，P=0.03）。事后分析显示，接受 CC 的运动员在即刻和 1 个月随访时脑震荡报告意向增加（基线=4.7，即刻随访=6.1，1 个月随访=6.0；F16,61.1=6.1，P=0.007），而仅在 1 个月随访时 CDC-Vi 增加（基线=4.3，即刻随访=5.2，1 个月随访=5.8；F1.6,61.6=8.4，P=0.001），而 CDC-Wr 则无改善（P=0.10）。二次分析表明，在即刻和 1 个月随访时，CC 与 CDC 干预措施在脑震荡知识和态度方面存在差异。我们没有发现干预措施之间（F4,216=0.2，P=0.93）或感知脑震荡报告规范之间（F4,224=0.3，P=0.73）存在差异。
所有运动员在即刻和 1 个月随访时都表现出更强的脑震荡报告意向、增加的脑震荡知识、更好的脑震荡态度和更强的感知行为控制。然而，与接受 CDC-Vi 和 CDC-Wr 的运动员相比，接受 CC 的运动员报告脑震荡的意向更强、知识更多、脑震荡报告态度改善。
