Development of a scale to measure expected concussion reporting behavior

Abstract

Background Most concussion education aims to increase athlete self-report of concussive symptoms. Although the population burden of concussion is high, frequency with which this injury occurs on a given sports team in a given season is relatively low. This means that powering concussion education evaluation studies to measure change in post-injury symptom reporting behavior requires what is often a prohibitively large sample size. Thus, evaluation studies are typically powered to measure proximal cognitions. Expected reporting behavior, a cognition that reflects planned and reactive decision-making, is a theoretically indicated construct for inclusion in evaluation studies. However, previously no scales were available to measure this construct with demonstrated reliability and validity among youth athletes. The objective of this study was to develop and assess the validity of a brief single-factor scale to measure expected youth athlete concussion reporting behavior (CR-E) in a sample of youth athletes. Methods A mixed methods approach was used, including cognitive interviews with youth athletes, and quantitative item reduction and validation. Participants were youth athletes (aged 9–16) from the Seattle metropolitan and rural south-Georgia regions. After refining an initial pool of items using cognitive interviews with a diverse group of youth athletes (n = 20), a survey containing these items was administered to youth soccer and football players (n = 291). Item reduction statistics and sequential confirmatory factor analyses were used to reduce the initial scale using a randomly selected half of the sample. Then, a final confirmatory factor analysis and validation tests were applied to the other half of the sample of youth athletes. Predictive validation was conducted longitudinally in a separate sample of youth athletes (n = 155). Results Internal consistency was high (alpha = 0.89), model fit was excellent, validation tests were in the hypothesized directions, and the scale was feasible to use. Using the finalized 4-item scale, we observed that less than one-third of youth soccer and football athletes expect to “always” tell their coach about symptoms of a suspected concussion. Conclusions The CR-E measure should be included in future studies evaluating concussion education programming in youth athlete populations.

Concussion education for youth athletes using Pre-Game Safety Huddles: a cluster-randomised controlled trial

“…Our primary outcome was expected likelihood of reporting a concussion, and we were not powered to detect statistically significant differences in concussion reporting behavior. While expected concussion reporting is a theoretically indicated measure for evaluating concussion education interventions,18 there is nonetheless a need for a follow-up trial in a sample that is large enough to detect change in reporting behaviour. Larger sample sizes would also allow for adequately powered assessments of subgroup differences at both the individual level and the bracket level, such as the bracket’s level of competitiveness.…”

“…Our primary outcome was the athlete’s expected likelihood of reporting potential concussion symptoms to a coach, measured using the four-item expected concussion-reporting behaviour (CR-E) scale. Measure development occurred in youth athletes (aged 9–16), with evidence of high internal consistency reliability and validity in this age group 18. An example item was ‘If I felt dizzy after a bump of hit to the head, I would tell my coach right away, even if the team was counting on me to play’.…”

A comparison of public views about sports concussion recovery with current guidelines: where are the gaps and overlaps?

“…Concussion management advice is fast evolving (Schneider et al 2022), including guidance on the nature and duration of postinjury rest (Kroshus et al 2021). Early advice for concussion management emphasised sustained rest from all activities, known as cocoon therapy, encompassing physical and cognitive domains (Leddy et al 2018).…”