Ithaca College Digital Commons @ IC Ithaca College Theses 2011 Athletes' Knowledge and Perceptions of Sport Related Concussions and the Decision to Seek Treatment Olivia Jarem Ithaca College Follow this and additional works at: https://digitalcommons.ithaca.edu/ic_theses Part of the Sports Sciences Commons Recommended Citation Jarem, Olivia, "Athletes' Knowledge and Perceptions of Sport Related Concussions and the Decision to Seek Treatment" (2011). Ithaca College Theses. 349. https://digitalcommons.ithaca.edu/ic_theses/349 This Thesis is brought to you for free and open access by Digital Commons @ IC. It has been accepted for inclusion in Ithaca College Theses by an authorized administrator of Digital Commons @ IC. ATHLETES' KNOWLEDGE AND PERCEPTIONS OF SPORT RELATED CONCUSSIONS AND THE DECISION TO SEEK TREATMENT A Masters Thesis presented to the Faculty of the Graduate Program in Exercise and Sport Sciences Ithaca College In partial fulfillment of the requirements for the degree Master of Science by Olivia Jarem August 2011 Ithaca College Graduate Program in Exercise & Sport Sciences Ithaca, New York CERTIFICATE OF APPROVAL MASTER OF SCIENCE THESIS This is to certify that the thesis of Olivia Jarem submitted in partial fullillment of the requirements for the degree of Master of Science in the School of Exercise and Sport Sciences at lthaca College has been Thesis Advisor: Committee Member: Candidate: Chair, Graduate Program In Exercise & Sport Sciences Dean of Graduate Studies t?t Date: f,-b Lot\ ABSTRACT The purpose of the study was to examine specific factors (namely knowledge, perceptions, and demographic characteristics including gender differences) that may influence an athlete's decision to report a sport related concussion (SRC). Participants were Division I and [I[ soccer and lacrosse athletes (n: 618) who participated in an online assessment intended to evaluate knowledge of concussive symptoms and previous reporting behavior. Descriptive statistics were calculated to determine rates of reported (57 .lyo, 1761305) and unreported (42.3%, 1291305) concussions, as well as reasons why athletes failed to report SRCs. Athletes identified not wanting to be withheld from competition or practice (43.2%) and not thinking the injury was serious enough (40.6%) as the primary reasons for failing to report a prior SRC. Average scores on the concussion knowledge quiz were consistently high for athletes both with (90.2%) and without (87.4%) previous concussion history. Logistic regression analysis examined the main effects of the independent variables (knowledge, perceptions, and the demographic characteristics of gender, age, sport played, and division level of competition) on reporting behavior; specifically, which variables increased the prediction that an athlete would fail to report a SRC (p < .05). Significant variables that contributed to the model and the corresponding odds ratios (OR) that predicted failure to report SRC included: perceiving an expectation to play through or minimize injury in sport ('culture of risk') (OR : 2.12), an increase in age by one year (OR : 1.39), playing lacrosse (OR = 2.40), and competing at the Division III level (OR: 2.91). Chi-square tests revealed no significant overall association between the genders on failure to report a SRC, but post- hoc analysis revealed that significantly more Division tI[ male athletes failed to report concussions than females (X2 (l): 8.04, p < .01). Results from this study helps identiff iii additional factors besides knowledge of SRC symptoms that may influence an athlete's decision to report SRC, specifically the previously uninvestigated influence of culture of risk and the potential influence of athletic identity. Results also expand the literature that currently debates whether male or female athletes sustain more SRC's (Dick, 2009). This information may help sports medicine professionals and sport psychology consultants target areas of intervention and education that can improve SRC management. iv ACKNOWLEDGEMENTS I would like to thank Dr. Justine Vosloo for her guidance, statistical proficiency, and continued support throughout this project. I would also like to acknowledge Dr. Kent Scriber for his expertise and suggestions with regard to literature review and methodology. Finally, I would like to thank Dr. Miranda Kaye for her assistance in preparing and offering feedback for this project. lv DEDICATION I would like to dedicate this thesis to all the NCAA athletes and coaches who made study possible. I would also like to thank Chad, whose support throughout the past year made everything possible. TABLE OF CONTENTS INTRODUCTION. ...........1 Statement of Purpose .. .......5 Hypotheses ..........5 Scope of the Problem. ......6 Assumptions of The Study ........7 Definition of Terms. ........7 Delimitations..... ........8 Limitations ............9 2.REVIEWOFLTTERATURE. ............I1 Introduction...... ......11 SRC - The Controversy. ..........11 SRC-The Symptoms.. .........11 SRc-TheGuidelines.. ..........14 SRC - The Current Trends in Reporting. .... .. ...17 The Potential Consequences of SRC. .....20 Gender Differences ..........24 Gender Role Conflict, Athletic Identity, and Culnrre of Risk. .......27 vi Measurements ....47 vll Recommendations. .....81 REFERENCES.. ........85 APPENDICES A. Concussions in Soccer and Lacrosse Survey. ........93 B. Recruitment Statement..... ............97 C. Informed Consent ........99 viii LIST OF TABLES Table Page l. Reasons Why Athletes' Failed to Report SRC..... ...........58 2. Binary Logistic Regressions for Reporting Behavior - Model 1.. .............59 3. Binary Logistic Regressions for Reporting Behavior - Model2.. .............62 ix LIST OF FIGURES Figure Page I . Description of Participants. 46 2. Gender Differences in Division III Reporting Behaviors.. Chapter I TNTRODUCTION Sport-related concussion (SRC) has recently become a popular topic of discussion in both the medical and athletic communities. According to the Centers for Disease Control and Prevention (CDC), approximately 1.5 million Americans suffer a traumatic brain injury (TBI) each year, and ofthose injured, approximately 25yo fail to receive medical attention (Setnik & Bazaian,2007). Following motor vehicle accidents, sports are the second leading cause ofconcussions in the l5-24 years old age bracket (Sosin, Sniezek, & Thurman, 1996), and they are currently on the rise in all sports, including ttrose traditionally refened to as 'non-contact' (Bloom, Loughead, Shapcott, Johnston, & Delaney, 2008). The most recent incidence estimate ofSRC has increased from 300,000 in 1998 to between 1.6 and 3.8 million per year in 2006 (Langlois, Rutland-Brown, & Wald, 2006). The wide range present in this statistic calls to attention the discrepancy that exists between the number ofSRCs occurring in athletics each year versus the number that are acrually reported. Additionally, there is a shared consensus among researchers and sports medicine professionals that this statistic is an underestimate and that a significant proportion of SRCs go unreported and undiagnosed (Broglio, Yagnozzi, Sabin, Signoretti, Tavazzi, & Lazzaion,20l0; Langlois et a1.,2006; McCrea, Hammeke, Olsen, Leo, & Guskiewicz, 2004). The discrepancy between the occurrence ofconcussions in athletics and the acrual reporting ofsuch is not unfathomable considering the current lack ofa universal means for measuring the severity ofconcussions (Guskiewicz, 2001 ; Lovell,2009). As attention regarding the identification and management ofSRC has grown over the past two 2 decades, so has the controversy over how to properly define and treat this type of injury. Currently, there is no unanimously accepted definition ofa concussion or ofa universal management system for treating SRC (Lovell, 2009). The most recent definition proposed by the CDC (2010) defines a concussion as a bump, blow, orjolt to the head that alters the normal functioning of the brain. These alterations to the brain can be physiological, biomechanical, and/or psychological in nature. Diagnosing a SRC is additionally complicated by the fact that both physical and cognitive symptoms may not appear immediately after injury (Putukian & Echemendia, 2003). Symptoms can occur two to three days after the initial blow to the head and may last upward ofseveral weeks or months (Kontos, Collins, & Russo, 2004; Lovell, 2009). SRCs are known as the'invisible injury'because there are no completely objective, extemal markers (such as a crutch or a sling) that mark an athlete as concussed (Johnston et al., 2004). Unlike an anterior cruciate ligament (ACL) injury or broken bone, SRCs require more subjective means for determining whether or not an athlete has sustained this injury or is ready to retum to play (RTP). Because relying on an athlete's honest self-report ofSRC symptoms is an inherent part ofthe diagnosis and perceived progress of this particular injury, understanding what factors influence reporting behaviors is an essential component for improving diagnosis and treatment. Continuing to play while experiencing concussive symptoms places an athlete at an increased risk for sustaining more severe short and long term neurologic, physiologic, and psychological consequences. RTP before an athlete's SRC symptoms are fully resolved increases the risk ofsecond impact syndrome (SIS), a devastating and potentially fatal swelling of the brain that can lead to seizures, subdural hematomas, a 3 coma, and death (Cantu, 2003; Logan, Bell, & Leonard, 2001).