Understanding the Sociocognitive Determinants Underlying Intentions to Exercise for Postconcussion Symptom Relief: An Application of the Theory of Planned Behavior.

CONTEXT: This study investigated individual sociocognitive factors from the theory of planned behavior and their relationship to exercise for postconcussion recovery. DESIGN AND METHODS: Four hundred and fifty-nine Australian adults, two-thirds of whom had no concussion history (66%), completed an online survey of their beliefs and attitudes toward exercise for postconcussion recovery. Secondary questions evaluated program design features that could affect engagement (eg, session frequency). RESULTS: Structured equation modeling found that subjective norms were the strongest significant predictor of intention to participate in exercise for postconcussion recovery. Perceived behavioral control was also a significant predictor of intention to participate but to a lesser extent. Attitude did not predict participation intention. The design features identified as key were personalization and being supervised during the program. CONCLUSIONS: This study found that people's intention to participate in a program of exercise postconcussion recovery is shaped by individual psychological factors and identified program design features that could be adjusted for increased engagement. Program success could be maximized through strategies such as supporting individuals to have a stronger sense of control over their participation through the choice of session timing or frequency and harnessing the influence of significant others via supportive messaging from key professionals.

Exercise Parameters for Postconcussion Symptom Rehabilitation: A Systematic Review.

CONTEXT: Exercise rehabilitation for postconcussion symptoms (PCS) has shown some benefits in adolescent athletes; but a synthesis of evidence on exercise per se has been lacking. OBJECTIVE: This systematic review aimed to determine if unimodal exercise interventions are useful to treat PCS and if so, to identify a set of clearly defined and effective exercise parameters for further research. EVIDENCE ACQUISITION: Relevant health databases and clinical trial registries were searched from inception to June 2022. The searches used a combination of subject headings and keywords related to mild traumatic brain injury (mTBI), PCSs, and exercise. Two independent reviewers screened and appraised the literature. The Cochrane Collaboration's Risk of Bias-2 tool for randomized controlled trials was used to assess methodological quality of studies. EVIDENCE SYNTHESIS: Seven studies were included in the review. Four studies were assessed to have a low overall risk of bias, 2 with low risk and 1 with some concerns. Participants in the studies comprised mostly adolescents with sports-related concussion. The review found exercise to be more beneficial than control conditions in 2 studies investigating acute PCS and 2 studies investigating persistent PCS. Within-group differences showing symptom improvement over time were observed in all 7 studies. In general, the review found support for programmatic exercise that commences after an initial period of rest for 24 to 48 hours. Recommendations for exercise parameters that can be explored in subsequent research include progressive aerobic exercise starting from 10 to 15 minutes at least 4 times a week, at a starting intensity of 50% HR of the subsymptom threshold, with length of program depending on recovery. CONCLUSION: The evidence in support of exercise rehabilitation for PCSs is moderate based on the small pool of eligible studies. Further research can be guided by the exercise parameters identified in this review.

Research Letter: Concussion Knowledge Is Difficult to Predict From Self-Reported Exposure, Sports Participation, and Education.

OBJECTIVES: Increasing concussion knowledge could contribute to improving injury outcomes. Understanding the predictors of concussion knowledge could determine the areas of educational need. This study examined whether individual factors, prior brain injury, prior concussion education, and contact-sports participation predicted concussion knowledge. DESIGN AND SETTING: Cross-sectional study with recruitment of community volunteers. PARTICIPANTS: An online survey was completed by 525 adults, 443 of whom provided useable responses. MAIN MEASURES: The respondents provided background information and completed the Concussion Knowledge Index from the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS). RESULTS: On average, the participants answered 19.8 out of 25 items correctly. A multiple regression model with demographic, injury, and sport-related variables did not significantly predict concussion knowledge. CONCLUSION: This community sample had higher than expected concussion knowledge (restricted range), but some important misconceptions were still present. The model reflecting a combination of self-reported factors did not predict concussion knowledge. The implications for concussion education are discussed, including the need for targeted education to address specific misconceptions.

A comparison of public views about sports concussion recovery with current guidelines: where are the gaps and overlaps?

Background Sports concussion (SC) management guidelines have recently been updated. A key focus is the emphasis on rest (immediately postinjury) followed by gradual resumption of activity (active recovery). This study aimed to explore community views on SC management and compared these with the guidelines. Methods A total of 157 volunteers completed an online SC survey, including listing three pieces of advice for a concussed person immediately postinjury, and after 2weeks (subacute). Quantitative data were statistically compared, and qualitative data underwent content analysis. Results Almost all participants offered different immediate versus subacute advice; however, rest featured highly at both timepoints. Commonly expressed themes, consistent with guidelines were immediate rest; safety and reinjury prevention; and symptom monitoring. Two themes were identified in the community advice with limited emphasis in the guidelines: general health advice and psychological and social support. Expert clinical assessment was not always identified in community advice. Conclusion Community members hold some views that align with expert advice for SC, particularly the importance of immediate postinjury rest. However, there is scope to grow public awareness of some recommended practices, including expert clinical assessment following injury and when to engage in active recovery.

Sports fans, wagering, and concussion knowledge: implications for injury nondisclosure.

OBJECTIVE: Athletes perceive sports fans as a source of concussion nondisclosure pressure. Sports fans are exposed to injury depictions from the media that could lead them to underestimate its seriousness. This study examined the concussion knowledge of non-sports fans, sports fans, and wagering sports fans, as knowledge is a modifiable factor that can influence injury disclosure. SETTING AND PARTICIPANTS: A convenience sample of 443 Australian adults completed an online survey. DESIGN: Cross-sectional. MAIN MEASURES: Self-rated and actual concussion knowledge (the Rosenbaum Concussion Knowledge and Attitudes Survey; RoCKAS). RESULTS: There was no significant difference in the concussion knowledge of self-identified sports (n = 157) and non-sports (n = 286) fans; but sports fans rated their knowledge as significantly higher than non-sports fans (p < .05). Wagering sports fans (n = 24) had significantly less concussion knowledge than non-wagering sports fans (η2 = .03, small effect). DISCUSSION: Athletes who feel nondisclosure pressure from sports fans may be influenced by people with incomplete concussion knowledge, particularly wagering sports fans. Sports fans over-estimated their knowledge, and this could contribute to the nondisclosure pressure felt by athletes. Programmes to increase injury disclosure by athletes should take these factors into consideration.