Western University Scholarship@Western Electronic Thesis and Dissertation Repository 11-22-2018 11:00 AM Factors that contribute to the process of reporting concussion symptoms experienced by Canadian Football League players Daryl W. H. Stephenson The University of Western Ontario Supervisor Johnson, Andrew M. The University of Western Ontario Graduate Program in Health and Rehabilitation Sciences A thesis submitted in partial fulfillment of the equirr ements for the degree in Doctor of Philosophy © Daryl W. H. Stephenson 2018 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Sports Studies Commons Recommended Citation Stephenson, Daryl W. H., "Factors that contribute to the process of reporting concussion symptoms experienced by Canadian Football League players" (2018). Electronic Thesis and Dissertation Repository. 5895. https://ir.lib.uwo.ca/etd/5895 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. Abstract Background: Concussions continue to be at the forefront of research today and are still an ongoing problem for athletes across sporting domains. Further investigation is warranted to achieve a greater understanding of concussions. Purpose: The purpose of this dissertation was to explore research related to sports-related concussions, how concussions affect athletes and those surrounding the athletes at all levels of sport, with a particular focus on Canadian Football League players and the underreporting of concussions. This dissertation also reviews qualitative research methodologies, and how they are applied within concussion research. Research Questions: a) What is my own personal relationship with concussions? In particular, what was my experience with the culture of the CFL while I was playing professional football, and later, during my transition out of professional football? b) What is the extent, range, and nature of the peer- reviewed qualitative research literature on concussions in sport? c) What factors contribute to the process of reporting concussion symptoms in Canadian Football League players? Methodology: I utilized an autoethnography to for the first question, a scoping review to address the second question, and a constructivist grounded theory study (in a sample of ten current and retired CFL players) to approach the third question. Findings: Within the autoethnography presented herein, several factors were identified as influencing the way I interpreted my experiences throughout my playing career, and my subsequent transition from professional sport. The scoping review of qualitative research in sport-related concussion suggested that qualitative research is useful for exploring all levels and types of sports. It further suggested that qualitative methodologies provide researchers with a lens that can be used to view the athletes going through the concussions, and also the other people in their lives such as physicians, parents, coaches, care- ii takers, teammates and equipment personnel. Different methodologies highlighted several different areas such as barriers to reporting concussions, lived experiences, media portrayal of concussions, coping strategies and effected relationships. Finally, the empirical data collected within the grounded theory study that formed the primary study within this dissertation suggested several factors that influenced the underreporting of concussions in the CFL, within three contexts: a) premeditated thoughts during the pre-game b) assessing the hit on the field and c) during the recovery process of a concussion. Implications: Findings show the current state of concussion research and highlights several factors that influence professionals to underreport their concussions. Implications for future research are discussed. Keywords: Concussions, qualitative research, underreporting, constructivist grounded theory iii Co-Authorship Statement This doctoral dissertation consists of three complementary manuscripts that represent the collaborative work of researchers and co-authors. The primary contributor is Daryl W. H. Stephenson, who identified and researched the topic, designed the studies, collected, analyzed and interpreted the data, and drafted the manuscripts. Chapter 2 is an autoethnography, and as such is a sole-authored publication. Chapter 3 was co-authored by Dr. Andrew M. Johnson, Dr. E. Anne Kinsella, and Dr. Jeffrey D. Holmes, and was submitted as part of my candidacy examination for this PhD. Chapter 4 represents the primary publication within this dissertation, and was co- authored Dr. Andrew M. Johnson, Dr. Anne E. Kinsella, Dr. Jeff Holmes, and Dr. Lisa K. Fischer. These co-authors supervised the research, provided insights into the research design and the findings, and will review and edit the final manuscripts prior to publication. iv Acknowledgements I would like to thank the players of the Canadian Football League (CFL) for their help in collecting data. I would also like to thank the CFL league management and the Canadian Football League Players Association (CFLPA) for their assistance and support in completing this study. To my supervisor Dr. Andrew M. Johnson, I would like to thank you for the very important role your guidance played throughout my dissertation and in my academic career. Your intelligence and positive outlook were imperative to any success I had. Committee members Dr. E. Anne Kinsella, Dr. Jeff Holmes, and Dr. Lisa K. Fischer I would like to thank you for providing the important insights you each possessed to complete my research in the most impactful and proper way possible, and with all the improvements you added to this dissertation. I would like to thank the lab members who have provided help along the way through editing rough drafts and conversations about research. I was very lucky to have such an inspiring and helpful lab. I would also like to thank Dr. Deborah L. Rudman, who provided me with many great insights and conversations throughout my research. I would finally like to thank and acknowledge my family for the support and encouragement they have given me over the years. I cannot express how happy I am to have such a wonderful support system around me. v Table of Contents Abstract ...................................................................................................................................... ii Co-Authorship Statement ......................................................................................................... iv Acknowledgements .................................................................................................................... v Table of Contents ...................................................................................................................... vi List of Tables ............................................................................................................................. x List of Figures ........................................................................................................................... xi List of Appendices ................................................................................................................... xii Chapter 1 ................................................................................................................................... 1 1.1 What is a Concussion? ............................................................................................. 1 1.1.1 What Causes Concussions? ...................................................................... 2 1.1.2 What are the Symptoms of a Concussion? ............................................... 3 1.1.3 What is the Recovery Process Like for a Concussion? ............................. 3 1.1.4 What are the Current Protection Strategies for Concussions? ................. 6 1.1.5 What are Current Return-to-Play Guidelines for Players with Concussion? ....................................................................................... 7 1.1.6 What is Chronic Traumatic Encephalopathy? ........................................ 10 1.1.7 What is Second Impact Syndrome? ........................................................ 11 1.2 Have Athletes Traditionally Been Underreporting their Concussion Symptoms? .................................................................................. 11 1.3 Reflexivity on my Constructivist Perspective and the Use of Grounded Theory as a Methodology ............................................................................... 14 1.4 Overview of Dissertation ....................................................................................... 16 1.5 References .............................................................................................................. 16 Chapter 2 ................................................................................................................................. 23 vi 2.1 Overview ................................................................................................................ 23 2.2 The Draft ................................................................................................................ 26 2.3 Rookie Life ............................................................................................................ 27 2.4 Concussion/Injury .................................................................................................