What can family medicine providers learn about concussion non-disclosure from former collegiate athletes?

Abstract

BackgroundDespite the risks, concussion symptoms often go underreported by athletes, leading to delayed or forgone treatment and increased potential for concussion recurrence. One of the most serious long-term consequences of sports-related concussions is Chronic Traumatic Encephelopathy (CTE), a disorder associated with progressive neurological deterioration. The purpose of this study was to explore former collegiate athletes’ understanding of concussions and motivations behind concussion non-disclosure in order to better assist family medicine providers in screening for and managing a history of concussions.MethodsInformed by the theoretical framework Social Cognitive Theory, we conducted focus groups with former collegiate athletes using a field-tested discussion guide. Discussions were transcribed, coded, and analyzed via content and thematic analyses using NVivo 10 software.ResultsThirty-two former collegiate athletes (24.5 ± 2.9 years old, 59.4% female, 87.5% white) participated in 7 focus groups. Three predominant themes emerged: 1) Concussions are Part of the Game: Participants believed that concussions were part of sports, and that by agreeing to play a sport they were accepting the inherent risk of concussions. Importantly, many were not familiar with concussion symptoms and what constituted a concussion; 2) Hiding Concussion Symptoms: Participants said they often hid concussion symptoms from coaches and trainers in order to avoid being taken out of or missing games. Participants were able to hide their concussions because most symptoms were indiscernible to others; and 3) Misconceptions about Concussions in Low Contact Sports: Several participants did not understand that concussions could occur in all sports including low contact or noncontact sports. The former athletes who participated in low contact sports and experienced concussions attributed their concussions to personal clumsiness rather than their sport.ConclusionsFamily medicine providers as well as coaches, athletic trainers, teachers, and parents/guardians should reinforce the message that concussions can occur in all sports and inform patients about the signs and symptoms of concussions. Further, providers should ask all patients if they engaged in high school or collegiate athletics; and if yes, to describe their hardest hit to their head in order to obtain a complete medical history.

Concussions in Collegiate Club Sports: Investigating Concussion Education, Knowledge, and Attitudes

“…al., 2021). Some of these barriers include players believing concussions are an inherent part of the game, a player's passion/competitiveness, withholding information from trainers and coaches, being embarrassed by receiving a concussion in a low-impact sport, team culture, and not understanding that concussions can occur in any/all sports (Beverly et. al., 2018).…”

The Delayed Presentation and Diagnosis of Youth Wrestling Injuries: A 20-Year Analysis of National Injury Data

“…Self-reported symptoms are an important component of injury diagnosis, and previous studies have demonstrated that athletes may hide or underreport symptoms to avoid missing play time, especially with concussions. [19][20][21][22] Previous literature has demonstrated factors associated with nondisclosure as male sex, participation in a high-risk sport, and pressure from a coach to play after sustaining a hit. 23 Given that common motivations for nondisclosure are not wanting to leave the game or practice and not wanting to let the team down, the greater burden of responsibility to identify wrestling injuries may be borne by coaches, trainers, and parents.…”

Making Headway for Discussions About Concussions: Experiences of Former High School and Collegiate Student-Athletes

“…Prior qualitative studies have explored student-athletes' education regarding concussion, past or present personal experiences of concussion, and support of concussed individuals as they return to school. From this work, it becomes very apparent that healthcare providers, coaches, athletic trainers, teachers, and parents should learn more about concussions, understand that they can occur in all sports, and recognize signs or symptoms of injury (18). The current study is consistent with, but adds to, this prior literature.…”