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Mind Matters Research Challenge findings

In January 2016, nine schools selected from a field of 22 finalists, each received $400,000 research grants to fund projects designed to improve the understanding of how to spur changes in the culture surrounding concussion in target communities, including student-athletes and military populations.

The schools have used those funds to produce dozens of research papers that, taken together, mark an important step toward that goal. A brief review of the research and their findings to date, and links to the abstracts or full study articles, follow. The page will be updated regularly with links to new study publications.  

Arizona State University

Chestnut Hill College

  • Development of a peer-education program to improve concussion knowledge and reporting in collegiate athletes (Abstract 2020) Brief Summary: A novel peer concussion-education program (PCEP) was developed to enhance concussion knowledge and reporting among collegiate student-athletes. The PCEP was developed based on the Theory of Reasoned Action and Planned Behavior. Following a focus-group discussion and pilot implementation, the investigators revised the PCEP and its education modules and developed an online manual to facilitate broad dissemination.
  • Randomized controlled trial of a novel peer concussion-education program for collegiate athletes (Abstract 2020) Brief Summary: The objective of this study was to evaluate the effects of a novel peer concussion-education program (PCEP). Compared with a control group, participation in a peer concussion-education program increased discussion of concussions with peers, coaches and athletic trainers. Athletic trainers who implemented the peer concussion-education program reported positive experiences using well-organized and engaging materials and guidelines for peer selection.  In conclusion, the PCEP showed promise in increasing concussion knowledge, intention to report concussion, reporting a teammate’s concussion, and facilitating attitudinal changes that support reporting among student-athletes.

Colorado State University

  • Three research manuscripts currently under peer review

Northern Arizona University

  • A simple field-based tool to assess concussion reporting behavior (Abstract 2019) Brief Summary: Study evaluated concussion symptom reporting behavior and measures that capture key features of concussion symptom reporting behavior. Data were collected from a small number of Division I football programs over the span of two seasons. Investigators found that concussion symptom reporting behavior was most often initiated by athletes in practice contexts, followed by athletic trainers in game contexts. Results led to development of a brief concussion symptom reporting behavior recording tool that can be used in practice, game, and athletic training room settings.
  • Investigation of strategies to improve concussion reporting in American football (Abstract 2019) Brief Summary: Investigators used a multi-site, repeated measures design to assess concussion reporting at a small number of Division I football programs and to subsequently work with stakeholders to develop and assess strategies to improve reporting. In all programs studied, concussion knowledge was unrelated to reporting intentions. For programs that implemented the intervention strategies, there was evidence that the interventions were effective.  Authors believe the study demonstrates that working with stakeholders to develop site-specific strategies to improve concussion reporting is an effective approach to help improve reporting behaviors.
  • Improving concussion-reporting behavior in Division I football: evidence for the applicability of the socio ecological model for athletic trainers (Article 2019) Brief Summary: This quantitative study of a small number of Division I football players examined the extent to which stakeholders' beliefs about what influences concussion reporting behavior reflect system-level influences that go beyond individual-level factors. Participants largely identified individual-level factors (attitudes), followed by exosystem-level factors (university policies and support for athletic trainers), with fewer microsystem- and mesosystem-level factors (coach influence and communication between coaches and ATs, respectively) and almost no macrosystem-level factors (media influence, cultural norms about aggression and toughness in football). The authors believe results  indicate growing stakeholder awareness of the importance of exosystem-level factors (e.g. medical personnel and concussion-reporting behavior policies) in influencing concussion reporting rates; but also think that frontline stakeholders and policy makers may benefit from practices that bridge these influences (e.g. coach involvement and communication) in a way that allows for a more integrated approach to influence student-athletes' willingness to improve their concussion-reporting behaviors.
  • Concussion reporting behaviors of athletes: a systematic review (Abstract 2019) Brief Summary: Authors mined data from twenty PubMed and Web of Science studies to summarize current evidence related to barriers pertaining to and strategies implemented to improve concussion reporting behaviors. General findings demonstrated that some barriers to reporting were still present, although there were numerous education interventions being implemented, but with little evidence regarding the effectiveness of these educational efforts. The authors believe that athletic trainers should include intention to report and norms adjustment as part of their knowledge of sport-related concussion.
  • An exploratory study on the culture of concussion reporting from the athletes’ perspective (Abstract 2017) Brief Summary: The study evaluated the concussion-reporting behaviors of a very small number of collegiate football student athletes, using interviews and focus groups, in order to gain insight into reasons contributing to the underreporting of concussion signs and symptoms. Six major themes emerged from the data: minimization of risk, misconceptions about lasting effects, diagnostic uncertainty, pressure from coaches, athletic identity, and social identity. The authors concluded that the participants appeared to have a strong knowledge of the signs and symptoms of concussions, but it did not necessarily translate into reporting. While they were aware of the lasting effects, the identity of being a football player and possibly letting their team down motivated them to continue playing.

U.S. Air Force Academy

  • Pilots and athletes: different concerns, similar concussion non-disclosure (Article 2019) Brief Summary: Dozens of research studies have demonstrated that concussion non-disclosure is a pervasive problem in athletic populations and have identified several important contributors to concussion non-disclosure. Investigators hypothesized that non-athlete populations might experience this same type of dilemma, but for different reasons. The study examined concussion disclosure in cadets at the United States Air Force Academy using anonymous surveys to assess intention to self-disclose undiagnosed concussions as well as several variables potentially related to concussion self-disclosure: perceived cost, perceived reward, personal identity, attitudes, normative behavior, social support, and self-efficacy. Results demonstrated that concussion non-disclosure developed when disclosure was perceived as more costly (i.e. directly or emotionally) and less rewarding. Authors believe that the results suggest that cultures of concussion non-disclosure can develop in any population where disclosure is perceived as having undesirable consequences, not just athletic populations.
  • Reconsidering return-to-play: a broader perspective on concussion recovery (Article 2018) Brief Summary: The study retrospectively assessed probable recovery and return to play time for understudied populations, such as women and nonelite athletes, after concussion. Sex and athletic status both affected return-to-play time with understudied groups, such as women and nonelite athletes, demonstrating notably longer recovery times; however, it is unclear how other population-specific factors may have contributed.
  • Predictive power of head impact intensity measures for recognition memory performance (Abstract 2019) Brief Summary: Authors studied cadets at the US Air Force Academy engaged in boxing and physical development, measuring head impact motions during exercise with accelerometers to understand what types of subconcussive impacts might prove detrimental to cognition. When head impact measures were compared with post-exercise memory performance, boxers were found to receive more head impacts and achieve lower performance in post-exercise memory than non-boxers and impact intensity appeared to set an upper bound on post-exercise memory performance with stronger impacts leading to lower expected memory performance. Investigators also explored multiple techniques for characterizing the magnitude of head impacts and found that the novel technique of principal component analysis captured more distinct impact information than seven traditional impact measures also tested.
  • Return-to-learn: a post-concussion academic recovery program at the U.S. Air Force Academy (Article 2018) Brief Summary: The U.S. Air Force Academy created a return-to-learn program that is specific to the cadet learning environment by reviewing available NCAA return-to-learn resources and other available return-to learn programs and then selecting and modifying the best practices for their institution.  The article describes the resulting program. The Academy is in the process of institutionalizing the program at the Air Force Academy and intend to measure whether the program increases the likelihood of concussion self-report, improves academic performance, and ultimately benefits retention at the Air Force Academy.
  • The prevalence of concussion within the military academies: findings from the Concussion Assessment, Research, and Education Consortium (Abstract 2017) Key takeaway: This prospective study evaluated data from a significant number of NCAA and non-NCAA athlete cadets enrolled in the CARE Consortium at three different U.S. service academies with hopes of understanding prevalence and risk factors for concussion among USA Service Academy cadets. When examining NCAA status, contact-sport, gender, and brief sensation seeking scale (BSSS) as risk factors for previous concussion and Poisson regression modelling, the number of previous concussions revealed significant main effects for contact-sport and BSSS. Controlling for BSSS, contact-sport cadets had higher rates of previous concussion compared to non-contact sport athletes and, controlling for contact-sport, higher BSSS scores increased prevalence of previous concussions. While overall concussion prevalence among all service academy cadets was similar to prevalence of concussion previously reported for NCAA athletes, within the academies, cadets who are also NCAA athletes had greater odds of concussion, likely due to increased risk exposure.

Unversity of Georgia

  • Collegiate student-athlete gender, years of sport eligibility completed, and sport contact level influence on concussion reporting intentions and behaviours (Abstract 2019) Brief Summary: A cross-sectional population of student-athletes were asked to reported their sex, years of sport eligibility completed, sport, and completed concussion reporting intentions and behaviours via survey. Nonparametric statistics were conducted to compare intentions and behaviours between groups and to determine whether the reported variables influenced those reporting intentions and behaviours. Data suggests that female and limited/non-contact sport student-athletes intended to report more concussions, however differences did not translate to reporting behaviours.
  • Post-concussion driving behaviors and opinions: a survey of collegiate student-athletes (Abstract 2018) Brief Summary: Authors surveyed a small number of student-athletes regarding their post-concussion driving behaviors and opinions. Data indicated that, despite generally believing that driving immediately following a concussion is unsafe, a majority of student-athletes did not refrain from driving at any point following their previous concussions. The authors believe that post-concussion driving restrictions may have had some influence on student-athletes' decisions to report the injury to a health care provider and that, while health care providers played a critical role in post-concussion driving restriction, they lacked standardized recommendations to guide their care.
  • Immediate removal from activity after sport-related concussion associated with shorter clinical recovery and less severe symptoms in collegiate student-athletes (Abstract 2018) Brief Summary: Authors reviewed data from a small cross-sectional subset of participants in the CARE Consortium study for the purpose of evaluating the effect of timing of removal from play after concussion on clinical outcomes and determining whether immediate removal from activity after sport-related concussion (SRC) might be associated with less time missed from sport, a shorter symptomatic period, and better outcomes on acute clinical measures. Diagnosed SRC events were classified as either immediate removal from activity (I-RFA) or delayed removal from activity (D-RFA). Outcomes of interest included time missed from sport attributed to their SRC, symptom duration, and clinical assessment scores. I-RFA status was associated with significantly less time missed from sport and shorter symptom duration while controlling for other SRC recovery modifiers and I-RFA athletes had significantly less severe acute SRC symptoms and were at lower risk of delayed recovery. Authors believe that I-RFA was a protective factor associated with less severe acute symptoms and shorter recovery after sport-related concussion.
  • The influence of concussion knowledge on reporting intentions in collegiate student-athletes (Abstract 2019) Brief Summary: The purpose of the study was to examine if concussion knowledge predicts reporting intentions and identify concussion knowledge differences based on demographics (sex, age and years of eligibility) in collegiate student-athletes. 105 student-athletes from three universities completed three surveys over a 4-month period. The results showed small differences in concussion knowledge between sexes, but these differences may not be clinically meaningful. Neither age nor years of eligibility affected concussion knowledge outcome measures. Overall, concussion knowledge was shown to play a role, albeit minor, in influencing student-athletes’ concussion reporting intentions such that authors propose that clinicians should understand that concussion knowledge is valuable and needed for student-athletes to have basic comprehension of concussions but should also be cautious of relying on improving concussion knowledge alone to influence a student-athlete’s reporting intentions or behaviors.
  • Improving concussion reporting across national college athletic association division using a theory-based, data-driven, multi-media concussion education intervention (Abstract 2020) Brief Summary: In this study, the investigators used survey data to compare student-athlete concussion reporting intentions and behaviors prior to and one year after exposure using a theory-based, data-driven, multimedia, simulated concussion reporting intervention for one group and a control treatment for the other. The results showed a modest, but significant rise in concussion reporting intentions among the intervention group relative to the control group, with the effect retained for an entire calendar year. The survey results showed that the intervention was more effective at targeting elements of the overall sport culture in a way that substantively improved concussion reporting in that group. The investigators propose there may be value in using this type of intervention in combination with other evidence-based educational materials.
  • Examination of collegiate student-athlete concussion reporting intentions and behavior (Abstract 2020) Brief Summary: The purpose of this study was to determine whether knowledge, attitudes, subjective norms, self-efficacy social identity and athletic identity explain variability in student-athlete concussion reporting intentions and behavior. The results showed that a student-athlete’s confidence, or self-efficacy was a frequent predictor of concussion reporting intentions and behavior. Based on the findings, authors propose that clinicians should aim to increase student-athlete knowledge attitudes and subjective norms, but most importantly their confidence in reporting concussions.

University of North Carolina, Chapel Hill

  • Determinants of intention to disclose concussion symptoms in a population of us military cadets (Abstract 2018) Brief Summary: Investigators reviewed cross-sectional survey responses from a significant number of first-year service academy cadets to assess perceptions of concussion disclosure (and non-disclosure) in a military setting. Independent variables included: gender, race, ethnicity, high school athlete status, NCAA athlete status, previous concussion history, previous concussion education, socioeconomic proxy, concussion-related knowledge, attitudes about concussion, perceived social norms (perceived peer/organizational support and actions), and perceived control over disclosure. Log-binomial regression was used to identify determinants of high intention to disclose concussion symptoms. Data indicated that concussion-related perceived social norms, attitudes, and perceived control were associated with intention to disclose in this military setting. More specifically, in the simple models, previous concussion history was associated with lower intention to disclose concussion symptoms while high perceived control over disclosure, higher concussion knowledge, more favorable attitudes and social norms about concussion were associated with high intention to disclose. In the multivariable model, a shift towards more favorable perceived social norms about concussion were associated with high intention to disclose concussion symptoms and high perceived control over disclosure was associated with high intention to disclose concussion symptoms. The authors believe that organizationally appropriate (e.g.; military-specific) intervention strategies can be developed from these data.
  • Influence of concussion education exposure on concussion-related educational targets and self-reported concussion disclosure among first-year service academy cadets (Abstract 2020) Brief Summary: The objectives of this study were to 1.) describe concussion education exposure among first-year service academy cadets and 2.) examine the association between exposure to concussion education sources and concussion-related knowledge, attitudes, perceived social norms, intention to disclose symptoms and disclosure behaviors. The survey data from first year service academy cadets suggest disparities in concussion education exposure that can be addressed in first-year cadets. Additionally, authors propose that the findings support the importance and use of multiple sources of concussion education in improving cadet’s concussion-related decision-making.
  • Perceived social norms and concussion-disclosure behaviours among first-year NCAA student-athletes: implications for concussion prevention and education (Abstract 2020) Brief Summary: The purpose of this study was to describe concussion disclosure behaviours and identify the association between perceived social norms and these disclosure behaviours. Survey results from first-year NCAA student-athletes demonstrated that a supportive social environment that models and supports appropriate concussion disclosure behaviours was associated with improved concussion disclosure. Authors propose that concussion disclosure should be addressed at multiple levels of the college/university environment to provide an optimal social environment and to promote improved concussion identification and disclosure among student-athletes and that education and environmental support concerning disclosure are key to optimizing identification of concussion and concussion symptoms among NCAA student-athletes.

University of North Carolina, Greensboro

  • Using the Integrated Behavioral Model to Determine Sport-Related Concussion Reporting Intentions Among Collegiate Athletes (Abstract 2020) Brief Summary: The purpose of this study was to test factors associated with collegiate athletes' intentions to (1) self-report concussion symptoms; (2) report another athlete's concussion symptoms; and (3) encourage others to report. Drawing on the Integrated Behavioral Model, results from a survey of collegiate athletes indicated that Bystander descriptive norms, positive reporting expectancies, concussion reporting attitudes, self-efficacy to communicate about a concussion, and athletes' perceptions of their coach's communication were positively associated with all three outcomes, while subjective norms were only positively associated with intentions to self-report and bystander reporting intentions, negative reporting expectancies were only associated with intentions to self-report, and positive and negative expectancies for playing through a concussion were only associated with intentions to self-report and bystander encouragement. Authors propose that multiple factors within the Integrated Behavioral Model may be predictive of reporting intentions and underscore the complexity of athletes' concussion reporting behaviors and offer guidance for the development of prevention strategies.

University of Wisconsin

  • Reporting skill: the missing ingredient in concussion reporting intention assessment (Abstract 2019) Brief Summary: Investigators administered a set of items to a significant number of young adults aged 18 to 24 years and analyzed the data in three separate waves to evaluate the relationship between reporting skill and reporting intention and whether reporting intentions will be more closely associated with reporting skill than with concussion/symptom knowledge of if the relationship between concussion (or symptom) knowledge and reporting intentions may differ by level of reporting skill. Exploratory/confirmatory factor analyses were conducted on 2 waves of data to develop the scale and hypotheses were tested using structural equation modeling on the responses from the third wave of participants. Data indicated that reporting skill, not concussion or concussion symptom knowledge, was associated with higher intentions to report symptoms and that, among those with higher levels of reporting skill, concussion symptom knowledge (but not general concussion knowledge) was associated with higher intentions to report symptoms.