concussion: prevention through education by tamara valovich mcleod
TRANSCRIPT
Concussion:Prevention Through Education
Tamara Valovich McLeod, PhD, ATC, FNATAProfessor and Director, Athletic Training Programs
Research Professor, School of Osteopathic Medicine in ArizonaDirector, Athletic Training Practice-Based Research Network
Objectives
• Discuss the need for concussion education• Discuss the effectiveness of concussion
educational interventions• Describe concussion education within a public
health framework• Describe the need for knowledge translation• Future directions for prevention through
education
The Problem
Lack of Awareness
Unrecognized concussion
Catastrophic injury
Concussion Recognition ProblemsMedical Professionals• Hospital discharge (Genuardi & King, 1995)• MDs, NPs (Bazarian, 2001; Zonfillo, 2012; White 2013; Stoller, 2014, Carl, 2014)• Primary Care (Pleacher & Dexter, 2006; Lebrun, 2013)
Coaches• High school (O’Donoghue, 2009)• Youth (Valovich McLeod, 2007, Mrazik, 2011)
Athletes• College (Kaut, 2003; LaBotz, 2004)• High school (McCrea, 2004; Valovich McLeod, 2006; Sye, 2006; Register-Mihalik, 2013; Cournoyer,
2015; Delahunty, 2015Kurowski, 2014)• Youth (Williamson, 2006; Gourley, 2010)
Parents• Youth (Sullivan, 2009; Gourley, 2010; Stevens 2010; Lin, 2015)
Education• State Laws
– All require some form of education– Varies as to whom and how often
• Interscholastic Association: Parent/Athlete– Majority (n=30) use information handouts– 2 require online training (AZ, OR)– 2 refer to CDC web training (GA, IL)– 3 encourage NFHS training (RI, VA, WI)
• Interscholastic Association: Coach– Most require NFHS training for head coaches
Impact of State Laws
• More recent studies indicate knowledge is improving– Physician (Chrisman, 2011)
– Youth athletes (Bloodgood, 2013; Chrisman, 2014)
– Youth parents (Bloodgood, 2013; Chrisman, 2014)
– Coaches (Chrisman, 2014)
Education for Prevention
• Primary prevention– Protect from concussion for occurring in the first
place– Pre-season
• Secondary prevention– Limiting long term disability and preventing re-
injury– Post-injury education– Appropriate management
Education
Valovich McLeod, Kinesiology Reviews, 2015
Effect of Educational Intervention• Improved immediate
knowledge– Cook, 2003– Goodman, 2006– Glang, 2010– Koh, 2011– Bagley, 2012– Miyashita, 2013– Manasse-Cohick, 2014– Cusimano, 2014– Hunt, 2015
• No effect on knowledge– Echlin, 2010– Kroshus, 2013– Cusimano, 2014– Manasse-Cohick, 2014– Register-Mihalik, 2015 – Register-Mihalik, 2015
Increase in immediate knowledge in some studies but the long-term effects of interventions on retention and reporting behaviors are unclear (Caron, 2015)
Reporting Intention
• Soccer athletes more likely to report to coach following education (Bramley, 2012)
• Increased knowledge not associated with self-reporting (Kurowski, 2014; Kroshus, 2013, 2014)
• Intention to report was associated with in-season reporting (Kroshus, 2014)
• Parental attitudes more predictive of care-seeking behaviors (Register-Mihalik, 2015)
Public Health Framework
Surveillance
Risk Factors
Interventions
Evaluate Outcomes
(Binder, 2005)
Public Health Framework: Concussion Education
Concussion reporting
What makes people
report a concussion?
Develop concussion education programs
Has reporting
increased?
(Binder, 2005)
Theory of Planned Behavior (TPB)• Expectancy value theory• “The most important predictor of behavior is
the intention to perform that behavior”
Intention
Attitudes
Subjective Norms
Perceived Behavioral Control
(Kroshus, 2014; Register-Mihalik, 2013)
Theory of Reasoned Action• Behavior intention• Attitude (direct and indirect)• Subjective norm (direct and indirect)
Theory of Planned Behavior• Perceived behavioral control (direct
and indirect)
(Kroshus, 2014; Register-Mihalik, 2013)
Socio-ecological Framework
• Broad perspective that evaluates multiple levels of influences on health behaviors– To understand behavior need to consider all levels
of the ecological system– Also consider the inter-relations and interactions
among these levels– Examines the cumulative impact of multiple levels
of influence,• Individual behaviors, peer networks, physical and social
environments and relevant policies
Kerr, 2014
Kerr, 2014
Policy
Environment
Interpersonal
Intrapersonal
Knowledge Translation• Key component to the success of any concussion
education• “the exchange, synthesis, and ethically sound
application of knowledge within a complex system of interactions among researchers and users” (Canadian Institute of Health Research: http://www.cihr-irsc.gc.ca/e/29418.html)
• Ensuring that sound educational programs are successful in modifying reporting behavior and ensuring proper post-injury management processes
Knowledge Translation
Define target audience
Determine message to be delivered
Identify the messenger
Decide on mode of delivery
Evaluate impact on outcome(s)
Provvidenza, 2009
Developing Effective Education:Concussion Reporting Barriers
• Athletes know concussions are dangerous• Most would still play with symptoms• Athletes want to keep playing• It’s hard to tell if you are injured• You’re supposed to play injured• Don’t want to let team down• Hesitant to report to coach
Chrisman, 2012
Developing Effective Education: What Do Athletes Want?
• Content– Symptoms– Proper management– Long-term issues– Impact on athletic
performance– Impact on academics– Importance of self-
reporting
• Mode of Delivery– Lecture (57%)– Video (54%)– Handout (28%)
• 40% want education provided by coach
Kroshus, 2015
Future Directions for Education
• Awareness education should be targeted – Appropriate modalities– Culturally relevant tools– Community medical providers– Academic accommodations
• Shift from awareness education to other areas– Behavior modification– Technique training
BAKPAC Studies
• Beliefs, Attitudes, and Knowledge of Pediatric Athletes with Concussion – Athletic Trainers– Primary Care Providers (MD/DO, PA-C)– School Nurses– School Counselors– Principals– Superintendents– Teachers
Medical: Welch, Williams, Weber, Kay, Erickson, Sleight , McLeod , Valovich McLeod School: Welch , Register-Mihalik Kasamatsu, Johnson, Shumaker, Valovich McLeod
Valovich McLeod, Kinesiology Reviews, 2015
• HUF, NHUF, HUF+PW• Practice injury rate: HUF & HUF+PW < NHUF• Game injury rate: HUF+PW < NHUF• Practice concussion rate: HUF+PW < NHUF in 11-15 y/o• Head impacts in practices: HUF < NHUF (Kerr, OJSM, In Press)
OJSM, 2015; 3(7)
Helmetless Tackling Technique
Medical Professional
Education
Medical Professional
Presence
Parent Education
Coach Education
Athlete Education
Culture of Sport
Proper Technique
Athlete Reporting
Coach Identification
Medical Professional Identification
in injuries indentified
Proper Management
Concussive Injuries
Outcomes
Developing a Prevention Model
Appropriate Tools and
Plan
Slide Courtesy of Johna Register-Mihalik, PhD, ATC
Summary
• Public health approach is very useful for concussion
• Need to determine intended outcomes for interventions
• Need to determine most effective manner in which to educate
• Evaluate other potential prevention mechanisms
SPORT CONCUSSION SUMMIT
September 24, 2015 #uminjuryctr