Question Format Matters: Do Athletes Really Know the Signs and Symptoms of a Sport-Related Concussion?

Authors of previous studies commonly used a multiselect checklist method to assess an athlete's ability to recognize true sport-related concussion (SRC) signs and symptoms (S&S) among incorrect distractor options. However, this may overinflate the evaluation of participants' knowledge because the multiselect method does not test athletes' ability to retrieve knowledge from their long-term memory. To examine this hypothesis, we sent an online survey to registered members of the Japan Lacrosse Association (n = 8530) to assess differences in reported SRC S&S by open-ended-question and multiselect formats. We also evaluated whether previous exposure to SRC education and a history of SRC influenced athletes' SRC S&S knowledge. The numbers and proportions of responses were calculated using descriptive statistics. The Pearson correlation was calculated to analyze the relationship between scores from the 2 question formats. Unpaired-samples t tests were conducted to compare the mean scores for each question format by previous SRC education and history of diagnosed SRC. Odds ratios were computed to express the relationship between the proportion of correct answers by question format per symptom. The response rate of the survey was 35.9% (n = 3065), and scores from the 2 question formats were correlated (r = 0.34, 95% CI = 0.31, 0.37; P < .001). For both question formats, athletes with previous exposure to SRC education and a history of SRC had a greater number of correct answers; however, the mean differences were trivial. Researchers and clinicians should acknowledge the difference between multiselect (recognition) and open-ended (free recall) formats when assessing one's understanding of SRC and managing athletes with a suspected SRC.