Concussion education in medical students studying in Scotland: an assessment of knowledge and future needs.

BACKGROUND: Physicians play a key role in ensuring athletes with concussion safely return to sport. Research has shown deficiencies in concussion education amongst physicians and medical students. However, studies have not previously been conducted in UK medical schools. OBJECTIVES: To assess students' concussion knowledge and learning in Scottish Medical Schools. DESIGN: A survey with 23 questions was distributed to Year 3-6 medical students studying in Scotland in October 2020. The survey included the following: (1) demographics, (2) concussion knowledge, e.g. 'What is the role of headgear in preventing concussion?' (3) concussion learning, 'In which part of the curriculum should concussion be taught?.' Frequencies of responses were calculated for each question. RESULTS: 200 students responded (response rate 8%). The average symptoms and management score were 87.3% and 31% respectively. 15% of participants knew that headgear has no role in preventing concussions and one participant identified the minimum "return to sport" timeframes for adults and children. 15% had learnt about concussion at medical school with 92.5% interested in receiving concussion teaching at medical school. CONCLUSION: Knowledge gaps exist in managing and preventing sports-related concussion. There is a discrepancy between levels of concussion teaching and the desire and importance placed on concussion education.

Validity of the Fitbit Ace and Moki Devices for Assessing Steps During Different Walking Conditions in Young Adolescents.

PURPOSE: Using wearable monitoring devices is increasingly ubiquitous, including among young people. However, there is limited evidence of the validity of devices which are aimed at children and adolescents. The purpose of this study was to evaluate the validity of Fitbit Ace and Moki monitors in healthy young adolescents. METHODS: This cross-sectional study included 17 young adolescents (ages 11-13 y) ambulating between 3 different walking conditions (incidental [∼6 min], controlled, and treadmill [each 3 min], while wearing wrist-worn devices [Fitbit Ace, Moki] on each wrist [left and right, respectively]). Data from the devices were compared with observer counts (criterion). Bland-Altman plots and mean absolute percentage errors were computed. RESULTS: Analyses identified that the Fitbit Ace showed higher levels of bias across conditions compared with the Moki device: (mean difference [SD]; Fitbit Ace: 30.0 [38.0], 3.0 [13.0], and 13.0 [23.0] steps and Moki: 1.0 [19.0], 4.0 [16.0], and 6.0 [14.0] steps, incidental, controlled, and treadmill, respectively). Mean absolute percentage errors ranged from 3.1% to 9.5% for the Fitbit Ace and 3.0% to 4.0% for the Moki device. CONCLUSION: The Fitbit Ace and Moki devices might not provide acceptable validity under all walking conditions, but the Moki provides more accurate estimates of incidental walking and might therefore be a good choice for free-living research or school-based interventions.

A Concussion Education Programme for Motorsport Drivers: A Field-Based Exploratory Pilot Study.

OBJECTIVE: Concussion education strategies that improve knowledge and attitudes long term are needed. This exploratory study piloted an interactive concussion education program, adopting concepts from the learning sciences and attitude change literature, for the underserved and high-risk population of motorsports. METHOD: Forty UK motorsport drivers (ages 16-20 years) participated. The workshop group received a two-phased workshop-based program. The comparison group received a concussion leaflet. Participants completed an adapted version of the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS-ST) at pre-, post- and 2-month follow-up. Within-group analysis for the workshop group explored the differential effect of the individual difference variable, Need for Cognition (NfC), and effectiveness was explored through post-workshop questionnaires and interviews. RESULTS: Unlike the comparison group, the workshop group showed a significant improvement in knowledge over time (F(2,58) = 45.49, p < .001, η2p = .61). Qualitative data indicated workshop-program participants developed safer attitudes toward concussion following programming. Preliminary evidence suggested individuals' responses to concussion education aligned with differences in NfC. CONCLUSION: This study piloted the first concussion education program for motorsport drivers and explored whether aligning educational provision with the NfC construct may help to improve program effectiveness. Findings are relevant to addressing the public health issue of concussion through educational approaches.

The Impact of COVID-19 on High School Student-Athlete Experiences with Physical Activity, Mental Health, and Social Connection.

COVID-19 restrictions led to reduced levels of physical activity, increased screen usage, and declines in mental health in youth; however, in-depth understandings of the experiences of high school student-athletes have yet to be explored. To describe the experiences of the COVID-19 pandemic on student-athletes' physical activity, social connection, and mental health, 20 high school student-athletes living in Calgary, Alberta participated in semi-structured interviews, designed using phenomenography. Participants reported variations in physical activity, social connections, and mental health which were influenced by stay-at-home restrictions and weather. Access to resources, changes to routines, online classes, and social support all influenced engagement in physical activity. School and sports provided opportunities for in-person social connections, impacted by the onset of the pandemic. Participants reported their mental health was influenced by social connections, online classes, and physical activity. Findings from this study will inform the development of resources for high school student-athletes amidst COVID-19.

Advancing our understanding of cognitive development and motor vehicle crash risk: A multiverse representation analysis.

Neurobiological and cognitive maturational models are the dominant theoretical account of adolescents' risk-taking behavior. Both the protracted development of working memory (WM) through adolescence, as well as individual differences in WM capacity have been theorized to be related to risk-taking behavior, including reckless driving. In a cohort study of 84 adolescent drivers Walshe et al. (2019) found adolescents who crashed had an attenuated trajectory of WM growth compared to adolescent drivers who never reported being in a crash, but observed no difference in WM capacity at baseline. The objectives of this report were to attempt to replicate these associations and to evaluate their robustness using a hybrid multiverse - specification curve analysis approach, henceforth called multiverse representation analysis (MRA). The authors of the original report provided their data: 84 adolescent drivers with annual evaluations of WM and other risk factors from 2005 to 2013, and of driving experiences in 2015. The original analysis was implemented as described in the original report. An MRA approach was used to evaluate the robustness of the association between developmental trajectories of WM and adolescents' risk-taking (indexed by motor vehicle crash involvement) to different reasonable methodological choices. We enumerated 6 reasonable choice points in data processing-analysis configurations: (1) model type: latent growth or multi-level regression, (2) treatment of WM data; (3) which waves are included; (4) covariate treatment; (5) how time is coded; and (6) link function/estimation method: weighted least squares means and variance estimation (WLSMV) with a linear link versus logistic regression with maximum likelihood estimation. This multiverse consists of 96 latent growth models and 18 multi-level regression models.

Concussion in Motorsport? Experience, Knowledge, Attitudes, and Priorities of Medical Personnel and Drivers.

OBJECTIVE: To assess concussion experiences, knowledge, and attitudes of motorsport medical personnel and drivers and to determine priority areas regarding concussion within the sport. DESIGN: Sequential mixed-method design. Part 1: stakeholder interviews; part 2: cross-sectional online survey. SETTING: United Kingdom. PARTICIPANTS: Part 1: key motorsport stakeholders (N = 8); part 2: motorsport medical personnel and drivers (N = 209) representing amateur and/or professional 4-wheeled motorsport. MAIN OUTCOME MEASURES: Concussion experience, knowledge, attitudes, and perceived priority areas. RESULTS: Thirty-one percent of surveyed drivers (age = 37.91 ± 13.49 years: 89% male) reported suffering from concussion in motorsport. Eighty-seven percent of surveyed medical personnel (age = 48.60 ± 10.68 years: 74% male) reported experience with concussed drivers, and 34% reported feeling pressured to clear a driver with concussion. Gaps in knowledge and misperceptions about concussion were reported in both groups, and disparity between concussion attitudes emerged between drivers and medical personnel. Application of assessment and management procedures varied between medical personnel and there was evidence motorsport policy and concussion guidelines may not be directly followed. According to both medical personnel (77%) and drivers (85%), "education and training" is the top priority area for the sport. CONCLUSIONS: There is clear evidence of concussions in motorsport, but accurate knowledge about this injury is missing. Concussion education and training for all drivers and medical personnel is required. Additional investigations into concussion attitudes are advised to complement and advance simple educational initiatives. Further investigation is also required to determine how to best support motorsport medical personnel, and general practitioners, who hold significant responsibility in guiding drivers from diagnosis to return to racing, and to support the effective implementation of policy.