Concussion Assessment and Management Practices Among Irish and Canadian Athletic Therapists: An International Perspective.

CONTEXT: Certified athletic therapists in Ireland and Canada serve essential concussion assessment and management roles, but their health care practices and concussion knowledge have not been established. OBJECTIVE: To examine Irish and Canadian athletic therapist cohorts' (1) concussion knowledge, (2) current concussion assessment and management techniques across all job settings, and (3) the association of concussion assessment and management practices with years of clinical experience and highest degree attained. DESIGN: Cross-sectional cohort study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Licensed Irish (49.7%, n = 91/183) and Canadian (10.1%, n = 211/2090) athletic therapists. MAIN OUTCOME MEASURE(S): Athletic therapists completed an online survey assessing their demographics, concussion knowledge (symptom recognition, patient-clinician scenarios), frequency of concussions assessed annually, and assessment and return-to-play (RTP) measures using a modified, previously validated survey. Symptom recognition consisted of 20 (8 true, 12 false) items on recognition of signs and symptoms that were scored as total correct. Descriptive statistics and odds ratios were used to examine survey responses where appropriate. RESULTS: Irish (86.8%, n = 46/53) and Canadian (93.4%, n = 155/166) athletic therapists indicated RTP guidelines were the most common method for determining RTP. Symptom recognition scores were 72.8% ± 17.0% among Irish and 76.6% ± 17.0% among Canadian athletic therapists. Irish (91.2%, n = 52/57) and Canadian (90.4%, n = 161/178) athletic therapists reported standardized sideline assessments as the most used concussion assessment method. Irish and Canadian athletic therapists' use of 2-domain (Irish: 38.6% [n = 22/57]; Canadian: 73.6% [n = 131/178]) and 3-domain (Irish: 3.5% [n = 2/57]; Canadian: 19.7% [n = 35/178]) minimum assessments (ie, symptoms, balance, or neurocognitive) was not associated with education or clinical experience (P ≥ .07), except for Canadian athletic therapists with master's degrees having greater odds of completing 2-domain assessments at initial evaluation than those with bachelor's degrees (odds ratio = 1.80; 95% CI = 1.41, 1.95). CONCLUSIONS: Irish and Canadian athletic therapists demonstrated similar concussion knowledge; however, most did not fully adhere to international consensus guidelines for concussion assessment as evidenced by low 2- and 3-domain assessment use. Athletic therapists should aim to implement multidimensional concussion assessments to ensure optimal health care practices and patient safety.

Incidence, Awareness, and Reporting of Sport-Related Concussions in Manitoba High Schools.

BACKGROUND AND OBJECTIVES: Federal and provincial governments in Canada are promoting provincial legislation to prevent and manage sport-related concussions (SRCs). The objective of this research was to determine the incidence of concussions in high school sport, the knowledge of the signs, symptoms, and consequences of SRC, and how likely student athletes are to report a concussion. METHODS: A cross-sectional survey of athletes (N = 225) from multiple sports in five high schools in one Manitoba school division was conducted. RESULTS: Participants in this study were well aware of the signs, symptoms, and consequences of SRC. Cognitive and emotional symptoms were the least recognized consequences. SRC is prevalent in high schools in both males and females across all sports. Of the 225 respondents, 35.3% reported having sustained an SRC. Less than half (45.5%) reported their concussion. Athletes purposely chose not to report a concussion in games (38.4%) and practices (33.8%). Two major barriers to reporting were feeling embarrassed (3.4/7) and finding it difficult (3.5/7) to report. There was, however, strong agreement (Mean 5.91/7, SD 0.09) when asked if they intend to report a concussion should they experience one in the future. CONCLUSIONS: The results suggest that high school athletes would benefit from more SRC education. Coaches and team medical staff must be trained to be vigilant for the mechanism, signs, and symptoms of injury in both game and practice situations. This study will also inform the implementation of pending legislation in Manitoba and perhaps other provinces in Canada.

Fréquence, prise de conscience et signalement des commotions cérébrales liées au sport dans les écoles secondaires du Manitoba. Contexte et objectifs: Au Canada, tant le gouvernement fédéral que les gouvernements des provinces cherchent à encourager l'adoption de lois provinciales visant à prévenir et à prendre en charge les commotions cérébrales liées au sport. L'objectif de cette étude a été de déterminer la fréquence de commotions cérébrales en lien avec la pratique sportive dans les écoles secondaires, de dresser un état des connaissances en lien avec les signes, les symptômes et les conséquences de ce type de traumatisme et de calculer la probabilité que des athlètes étudiants le signalent. Méthodes : Pour ce faire, nous avons effectué un sondage transversal auquel ont participé des athlètes (n = 225) pratiquant plusieurs sports différents. Fait à noter, ces athlètes étaient issus de cinq écoles secondaires du Manitoba faisant partie de la même division. Résultats : Les participants à cette étude étaient bien conscients des signes, des symptômes et des conséquences des commotions cérébrales liées au sport. Les symptômes d'ordre cognitif et émotionnel sont toutefois apparus comme les conséquences les moins mentionnées. Rappelons que les commotions cérébrales liées au sport sont répandues dans tous les sports des écoles secondaires, et ce, peu importe que les athlètes soient des garçons ou des filles. Sur 225 répondants, 35,3 % d'entre eux ont affirmé avoir subi une commotion cérébrale dans le cadre de la pratique d'un sport ; de plus, moins de la moitié (45,5 %) de ces jeunes ont fini par en signaler une. Lors de compétitions, 38,4 % d'entre eux ont délibérément choisi de ne rien signaler ; dans le cas de pratiques, ils ont été 33,8 % à le faire. Deux obstacles importants à un signalement ont émergé de cette étude : éprouver de la gêne (3,4/7) et trouver qu'il est difficile d'en faire un (3,5/7). Nos répondants se sont néanmoins largement rejoints (moyenne : 5,91/7 ; écart-type : 0,09) dans leur intention de signaler une commotion cérébrale s'ils devaient en être victimes dans le futur. Conclusions : Ces résultats suggèrent donc que les athlètes des écoles secondaires pourraient tirer parti de programmes d'éducation ciblant les commotions cérébrales subies dans le cadre d'un sport. Les entraîneurs et le personnel médical des équipes doivent ainsi être formés afin d'être à l'affût, tant lors de compétitions que de pratiques, des signes et des symptômes liés à ces traumatismes. Enfin, cette étude entend aussi se pencher sur la mise en œuvre d'une loi en cours de préparation au Manitoba et peut-être aussi sur d'autres lois ailleurs au Canada.

A Survey of Injuries Affecting Pre-Professional Ballet Dancers.

A cross-sectional design was employed retrospectively to evaluate injuries self-reported by 71 pre-professional ballet dancers over one season. Some of the descriptive findings of this survey were consistent with those of previous research and suggest particular demographic and injury trends in pre-professional ballet. These results include gender distribution, mean age and age range of participants, training hours, injury location, acute versus overuse injuries, as well as average number of physiotherapy treatments per dancer. Other results provide information that was heretofore unreported or inconsistent with previous investigations. These findings involved proportion of dancers injured, average number of injuries per dancer, overall injury incidence during an 8.5 month period, incidence rate by technique level, mean time loss per injury, proportion of recurrent injury, and activity practiced at time of injury. The results of univariate analyses revealed several significant findings, including a decrease in incidence rate of injury with increased months of experience in the pre-professional program, dancers having lower injury risk in rehearsal and performance than in class, and a reduced risk of injury for dancers at certain technique levels. However, only this latter finding remained significant in multivariate analysis. The results of this study underscore the importance of determining injury rates by gender, technique level, and activity setting in addition to overall injury rates. They also point to the necessity of looking at both overall and individual dancer-based injury risks.

Epidemiological Review of Injury in Pre-Professional Ballet Dancers.

The objective of this study was to provide an epidemiological review of the literature concerning ballet injuries affecting pre-professional ballet dancers. The literature search was limited to published peer-reviewed reports and involved an extensive examination of Scopus, SPORTDiscus, and CINAHL. The following search terms were used in various combinations: ballet, injury, epidemiology, risk factor, pre-professional, and intervention. Additional citations were located using the ancestry approach. Unlike some other athletic activities that have been the focus of recent intervention research, there is a paucity of intervention and translational research in pre-professional ballet, and sample sizes have often been small and have not accounted for the multivariate nature of ballet injury. Exposure-based injury rates in this population appear similar to those reported for professional ballet dancers and female gymnasts. A preponderance of injuries affect the lower extremity of these dancers, with sprains and strains being the most frequent type of injury reported. The majority of injuries appear to be overuse in nature. Injury risk factors have been tested in multiple studies and indicate a variety of potential injury predictors that may provide useful guidance for future research.