Disclosures: Sean Schowalter: No financial relationships or conflicts of interest

Background and/or Objectives: Due to difficulties with measuring changes in concussion-reporting behavior, studies typically evaluate effectiveness of concussion education programs through surrogate survey outcomes such as intention to report concussion or other proxies related to concussion beliefs. This study clarifies the relationship between these concussion-reporting proxies and concussion-reporting behavior through use of a simulated in-game experience.

Design: High school football players were randomized to receive concussion education (n=167) or no education (n=146), after which all participants completed a questionnaire assessing concussion-reporting intention and related beliefs. Subsequently, all participants watched a first-person, two-minute video in which a simulated concussion occurred. Athletes were then asked whether they would like to seek evaluation or stay in the game. Neither participants, nor study staff, knew that this decision was being tracked.

Setting: Seven Colorado high schools.

Participants: 313 high school football players

Interventions: Simulated concussion. Concussion education vs. no education.

Main Outcome Measures: Concussion-reporting intention, attitudes, subjective norms, and enjoyment of prior concussion education were assessed using a five-point Likert scale, from 1=“strongly disagree,” to 5=“strongly agree.” Perceived behavioral control was assessed using a 100-point scale from 1=“cannot do” to 100 =“definitely can do.” Logistic regression assessed the relationship between these questions and concussion-reporting behavior during the simulated game experience.

Results: Athletes who reported their concussion in the simulated game had higher baseline concussion-reporting intention (mean difference = 0.50, 95%CI: 0.34-0.67; p < 0.001), concussion-reporting attitudes (mean difference = 0.35, 95%CI: 0.20-0.49; p < 0.001), subjective norms (mean difference = 0.19, 95%CI: 0.06-0.31; p=0.003), perceived behavioral control (mean difference = 6.46, 95%CI: 2.28-10.63; p=0.003), and enjoyment (mean difference = 0.51, 95%CI: 0.34-0.69; p < 0.001). Each one-point higher score on baseline concussion-reporting intention was associated with a 63% increased odds of reporting concussion in the simulated setting (OR=0.37, 95%CI: 0.26-0.52; p < 0.001).

Conclusions: Using a novel, first-person simulated in-game experience, this study provides direct evidence that concussion-reporting intention predicts behavior.

Level of Evidence: Level II

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/association-between-concussion-reporting-intention-and-reporting-behavior-in-a-simulated-game-setting/