Investigating the Student in Returning to Learn After Concussion: A Systematic Review and Meta‐Analysis

Abstract

PURPOSE:Examine concussion effects on academic outcomes, including student perspectives. METHODS:This study included a systematic review and meta-analysis examining post-concussion school attendance, academic performance, perceptions of academic difficulty, and accommodations for students in elementary through college settings. The analysis considered pre-and post-injury factors, along with injury factors that contribute to post-concussion academic outcomes. RESULTS:The systematic review showed that students with concussion miss more school days and perceive higher levels of academic difficulty, but results about academic performance varied. Meta-analysis yielded small concussion effects on school absence and academic performance and moderate effects on perceptions of academic difficulty. Female sex, older age, history of migraine, prior concussions, severe or persistent symptoms, vestibular-ocular motor, and cognitive disruptions are risk factors, but these moderators were not identified in the meta-analysis due to lack of effect sizes. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:This study confirmed negative concussion effects on academic absences, performance, and perceptions of academic difficulty. Identified contributing factors will guide future practices to support students returning to learn after concussion. CONCLUSIONS:Negative impacts to academics from concussion may be amplified by complicating factors. Future investigations are needed to confirm risk factors and mitigating effects of early identification and post-injury supports.

The SUCCESS Peer Mentoring Program for College Students with Concussion: Preliminary Results of a Mobile Technology Delivered Intervention

“…Current models of concussion describe a neurobiopsychosocial injury [ 36 , 37 , 38 ] with baseline student characteristics interacting with the injury, systems of care, and the student’s psycho-emotional processing of their experiences. As depicted in gray boxes in Figure 1 , many elements of this model are not modifiable at the point of injury.…”

Applying the Common-Sense Self-Regulation Model to Understand Illness Representations of Mild Traumatic Brain Injury in College Students

“…31,33,61,62 In addition, the majority of mTBIs do not result in complicated recoveries 1,2 ; therefore, prior experience with health education and treatment of mTBI may lead someone to have high confidence in their illness representation (ie, self-treatment), 60 even as subsequent injuries may be more likely to result in complicated or prolonged recoveries. 28,60,63,64 In addition, there was a clear trend of college students discussing health with their friends and significant others first, followed by family (parents or siblings) before talking to a doctor. The pattern found here corresponds to other studies examining social contexts in college, where peers have a significant influence on overall decision-making and identity formation, 65,66 which may extend to care for mTBI.…”

“…One explanation for this somewhat counterintuitive finding from the sports-related mTBI literature could be that multiple pressures and barriers influence injury disclosure 31,33,61,62. In addition, the majority of mTBIs do not result in complicated recoveries1,2; therefore, prior experience with health education and treatment of mTBI may lead someone to have high confidence in their illness representation (ie, self-treatment),60 even as subsequent injuries may be more likely to result in complicated or prolonged recoveries 28,60,63,64…”

“…Specifically, illness perceptions contribute to health outcomes related to recovery from mTBI, such as return to work,21 psychological health,22 and activity restrictions 23. Most importantly, the evaluation of health perceptions aligns with the current neurobiopsychosocial understanding of mTBI, including consideration of personal, psychological, and social factors that contribute to recovery and long-term outcomes 24–29…”

“…23 Most importantly, the evaluation of health perceptions aligns with the current neurobiopsychosocial understanding of mTBI, including consideration of personal, psychological, and social factors that contribute to recovery and long-term outcomes. [24][25][26][27][28][29] The present study investigates how college students formed illness representations (CSM constructs) of mTBI in 7 different common mTBI vignettes. We focus on differences in illness representations and actions based on injury to oneself (Self) as compared with injury sustained by a friend (Other) when provided varying causes of the injury (ie, across common mTBI mechanisms).…”