Informing athletes about concussions may not change behavior

Educating athletes about the risk of concussion may do little to change long-term behavior, a new qualitative research review has found.

Based on 89 peer-reviewed articles, two books and two Web sites, researchers say the most successful approaches included interactivity and varied kinds of presentations and were part of mandated training or legislation, according to their report online August 25 in the British Journal of Sports Medicine.

"We recommend that everyone involved with the athlete (coaches, parents, athletic trainers, physicians) be involved. It's not just the athlete," the paper's lead author, Dr. Martin Mrazik from the University of Alberta in Edmonton, Canada, told Reuters Health by email.

Educational efforts should be informed by updated guidelines such as those published in 2013 in the same journal, Dr. Mrazik said (available here: http://bit.ly/1JTmuGx). He also recommended caution in using online guidelines that have not been internationally approved.

Few studies reported on the efficacy of educational campaigns, and that may be a problem, the researchers write. There are more Web sites, social media and mobile device applications than reviews of those sources of information, and there is a danger that they might be propagating misconceptions, the researchers write.

Surveys show between 25% and 60% of hockey players continue to play even when they have symptoms of concussion, the researchers note.

Athletes may also tend not to report concussions when they happen. When anonymously surveyed, hockey players said they had suffered concussions 30 times more often than the official injury reports indicated. Unreported concussions ranged from 20% to 50% among college football, hockey, soccer and rugby players.

"Their conclusion is consistent with my work evaluating existing concussion education programs," Dr. Emily Kroshus, an assistant professor at University of Washington in Seattle, said of the new work.

"This does not mean that concussion education itself is an ineffective concept, but that current approaches have tended to be designed in a way that they are not targeting and changing attitudes/beliefs that are actually driving concussion reporting behavior," she told Reuters Health by email.

More research on the efficacy of different educational programs is needed and the programs themselves should be improved, the researchers write.

"Education is not just informing, it's changing behavior. Understanding athlete behavior (the hesitancy to report injury, peer pressure, times in the year when they are less likely to report) is a key component of improving athletes perceptions and reporting behaviors when it comes to concussions," Dr. Mrazik said.