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Psychological, situational and lifestyle factors that influence the reporting of postconcussion-like symptoms
14
Abstracts / Journal of Science and Medicine in Sport 20S (2017) 13–15
assessment form, were common symptoms in the doctors’ open reports. Although some doctors reported double vision, stumbling and slight dizziness, players were cleared to continue playing. Discussion: This is the first study, to our knowledge, to report the acute (sideline) symptoms of concussion in elite Australian junior rugby league players. Concussion incidences, more concussions sustained by forwards and the most common somatic and cognitive symptoms stated are consistent with previously reported data in rugby league. Concussions were significantly higher in the younger-age competition which may be due to less experienced players, but deserves further investigation. Robust objective and quantitative cognitive testing and follow-up of acute symptoms during a recovery time-course is warranted.
Discussion: These findings highlight two potential ways to assess a player’s risk of incurring sub-concussive trauma. With emerging evidence indicating repetitive sub-concussive trauma may lead to similar long-term outcomes as concussion, it is important to identify and monitor those at greater risk to further enhance duty of care and overall player well-being.
https://doi.org/10.1016/j.jsams.2017.09.216
A. Balasundaram 2 , A. Schneiders 1,∗ , J. Athens 3 , S. Sullivan 4
28 Risking head trauma: Exploring the relationship between risk propensity, position and injury in Australian Rules Football players S. Harris 1,∗ , P. Chivers 2 , F. McIntyre 1 , B. Piggott 1 , F. Farringdon 1 1 2
University Of Notre Dame, Australia Institute for Health Research, Australia
Introduction: Australian Rules Football (ARF) is an invasion based field sport. Due to its fast paced, contact nature, players are exposed to injuries, including concussion and sub-concussive traumas. Emerging evidence suggests that concussion and repetitive sub-concussive traumas may damage the prefrontal cortex, exposing a player to long-term damage. Evidence from the American National Football League (NFL) suggests a player’s exposure to head trauma may be related to their position. Although ARF appears to have more fluid position structures, little research has explored this relationship. Additionally, young adult males potentially engage in higher levels of risk-taking behaviours, which may further expose them to head trauma. Hence the current study, investigated if relationships exist between position, risk propensity and exposure to head trauma. Method: The study was conducted over 22-weeks with one West Australian Football League (WAFL) club during the 2015 competition. Baseline risk propensity was measured using the 7-item self-report Risk Propensity Scale (RPS). Possible scores ranged from 9 to 63, with higher scores indicating higher risk propensity. Players self-reported their injuries (diagnosed concussion, head knocks, other injuries) and predominate position (forward, back, midfield, forward/ruck) fortnightly using the WAFL Injury Report Survey (WIRS). Cross-tabulation compared season predominate position (SPP) and RPS scores. A Mann–Whitney U explored associations between RPS score and total injury incidence for each injury type. A Negative Binomial Generalised Linear Model (NB-GLM) assessed the risk of incurring head trauma based on SPP and RPS scores. Results: Seventy-one players (N = 71) with an age range of 18.40–30.48 years (Mage = 21.92, SD = 2.96 years) participated in the study. Player’s mean RPS score was 32.73, (SD = 8.38). A total of 12 concussions and 194 head knocks were reported across the data collection period. A greater proportion of midfielders were classified as high risk takers, compared to the other three position categories. NB-GLM identified both RPS (p = .007) and SPP (p = .006) as significant predictors of head knocks. Additionally, high risktakers had a significantly higher incidence of head knocks than low risk-takers (p = .042). Furthermore, risk of incurring a head knock increased by 6.50% per unit increase in RPS score (p = .005).
https://doi.org/10.1016/j.jsams.2017.09.217 29 Psychological, situational and lifestyle factors that influence the reporting of postconcussion-like symptoms
1
CQUniversity, Australia Department of Health Sciences, Institute of Health & Society, Norway 3 Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand 4 Center for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Oatgo, New Zealand 2
Background: The assessment and management of sportsrelated concussion relies on self-reporting of symptoms (SRS) by the concussed athlete. However, symptoms associated with concussion are non-specific in nature and symptom scores might not accurately reflect an athlete’s neurological status as psychological, situational and lifestyle factors are thought to influence symptom reporting. In order to better understand whether symptoms associated with a concussion are a true reflection of the underlying pathology or a normal response to daily stressors and health status it is important to evaluate postconcussion-like symptoms in non-concussed populations to determine normal day-to-day variability, serial reporting of symptoms, as well as the effect of lifestyle and psychological factors. Understanding these influences will lead to a better understanding of the assessment and management of concussion in athletes. Methods: University students (603) with no recent history of concussion were recruited and participated in a series of studies that evaluated the point prevalence, diurnal variability, and the serial (7-day) reporting of concussion-like symptoms. The Sport Concussion Assessment Tool (SCAT) was used to assess the Total Symptom Score (TSS, max 22) and the Symptom Severity Score (SSS, max 132) for each participant. Statistical analyses included stepwise multivariate linear mixed-effects modelling to determine the influence of psychological and lifestyle factors on symptom reporting. Results: Six modifiers were identified contributing to TSS with the strongest being alcohol consumption (estimate 2.75, p < .001) and trouble sleeping (estimate 2.27, p < .001), followed by mental fatigue, stress, anxiety and depression (p < .001). Hybrid cluster analysis of symptom similarity for diurnal variability identified two specific clusters; one where the symptoms (TSS & SSS) were stable over the day and one where they decreased. Over the seven-day period, predictors of location at the time of reporting, physical fatigue and mental fatigue (p < .001) contributed to TSS change. Discussion: Non-concussed individuals exhibit considerable individual variability in symptom scores over time. Multiple factors associated with the normal context of daily life influence postconcussion-like symptoms in university students. Clinicians
Abstracts / Journal of Science and Medicine in Sport 20S (2017) 13–15
should exercise caution when interpreting symptom scores in concussed athletes in regard to management and return to play. https://doi.org/10.1016/j.jsams.2017.09.218 30 Early warning signs? Recent head trauma linked to depressive symptoms in Australian Rules football players S. Harris 1,∗ , P. Chivers 2 , F. McIntyre 1 , B. Piggott 1 , F. Farringdon 1 1
School of Health Science, University Of Notre Dame, Australia 2 Institute for Health Research, Australia Background: Australian Rules Football (ARF) players are frequently exposed to the risk of head trauma (concussion or head knocks) due to the fast paced, contact nature of the game. Research into other football codes indicates repeated exposure to this head trauma, in particular concussion, may increase a player’s risk of long term consequences, including neurodegeneration and negative emotional changes (e.g. depression). However little research has considered the short-term impact of concussive or sub-concussive traumas on emotional wellbeing, specifically the presence of depressive symptoms. The purpose of this study was to investigate the relationship between recent head trauma and the presence of depressive symptoms in senior West Australian Football League (WAFL) players. Method: The study was conducted over the first 22 weeks of the 2015 WAFL season (n = 69, Mage = 21.81, SD = 2.91 years), with data collected fortnightly. Injury including head trauma was anonymously self-reported using the WAFL Injury Report
15
Survey (WIRS). Depressive symptoms were measured using the Centre for Epidemiological Studies Depression Scale (CESD-20) with a score over 16 indicating presence of depressive symptoms. Univariate Linear Mixed Models (ULMM) assessed the relationship between head trauma and depressive symptoms over time. Generalized Estimating Equations (GEE) assessed the risk of depressive symptoms occurring when a head trauma was experienced. Results: Within a fortnight of experiencing a concussion, 40 percent of concussed players reported depressive symptoms above the cut off (CESD20 score ≥16). ULMM indicated a significant relationship existed between concussion and an increase in depressive symptoms (p = .002) and head knocks and depressive symptoms (p = .007). When investigating risk, a GEE model identified a player was almost 8 times more likely to experience symptoms of depression (CESD20 score ≥16), when a concussion was reported. Discussion: Despite increased recognition of the importance of emotional wellbeing, there is limited evidence regarding the impact of head trauma on the mental health of ARF players at the semi-professional level. Findings that a significant proportion of players reported experiencing depressive symptoms within the two week period following head trauma, suggests that coaches and medical staff need to monitor not only the physical, but also the emotional wellbeing of their players, especially after a concussion or head knock has occurred. Players may also benefit from more education regarding identifying depressive symptoms post head trauma, encouraging them to seek medical advice especially if they notice a change in their emotional wellbeing. https://doi.org/10.1016/j.jsams.2017.09.219
Abstracts / Journal of Science and Medicine in Sport 20S (2017) 13–15
assessment form, were common symptoms in the doctors’ open reports. Although some doctors reported double vision, stumbling and slight dizziness, players were cleared to continue playing. Discussion: This is the first study, to our knowledge, to report the acute (sideline) symptoms of concussion in elite Australian junior rugby league players. Concussion incidences, more concussions sustained by forwards and the most common somatic and cognitive symptoms stated are consistent with previously reported data in rugby league. Concussions were significantly higher in the younger-age competition which may be due to less experienced players, but deserves further investigation. Robust objective and quantitative cognitive testing and follow-up of acute symptoms during a recovery time-course is warranted.
Discussion: These findings highlight two potential ways to assess a player’s risk of incurring sub-concussive trauma. With emerging evidence indicating repetitive sub-concussive trauma may lead to similar long-term outcomes as concussion, it is important to identify and monitor those at greater risk to further enhance duty of care and overall player well-being.
https://doi.org/10.1016/j.jsams.2017.09.216
A. Balasundaram 2 , A. Schneiders 1,∗ , J. Athens 3 , S. Sullivan 4
28 Risking head trauma: Exploring the relationship between risk propensity, position and injury in Australian Rules Football players S. Harris 1,∗ , P. Chivers 2 , F. McIntyre 1 , B. Piggott 1 , F. Farringdon 1 1 2
University Of Notre Dame, Australia Institute for Health Research, Australia
Introduction: Australian Rules Football (ARF) is an invasion based field sport. Due to its fast paced, contact nature, players are exposed to injuries, including concussion and sub-concussive traumas. Emerging evidence suggests that concussion and repetitive sub-concussive traumas may damage the prefrontal cortex, exposing a player to long-term damage. Evidence from the American National Football League (NFL) suggests a player’s exposure to head trauma may be related to their position. Although ARF appears to have more fluid position structures, little research has explored this relationship. Additionally, young adult males potentially engage in higher levels of risk-taking behaviours, which may further expose them to head trauma. Hence the current study, investigated if relationships exist between position, risk propensity and exposure to head trauma. Method: The study was conducted over 22-weeks with one West Australian Football League (WAFL) club during the 2015 competition. Baseline risk propensity was measured using the 7-item self-report Risk Propensity Scale (RPS). Possible scores ranged from 9 to 63, with higher scores indicating higher risk propensity. Players self-reported their injuries (diagnosed concussion, head knocks, other injuries) and predominate position (forward, back, midfield, forward/ruck) fortnightly using the WAFL Injury Report Survey (WIRS). Cross-tabulation compared season predominate position (SPP) and RPS scores. A Mann–Whitney U explored associations between RPS score and total injury incidence for each injury type. A Negative Binomial Generalised Linear Model (NB-GLM) assessed the risk of incurring head trauma based on SPP and RPS scores. Results: Seventy-one players (N = 71) with an age range of 18.40–30.48 years (Mage = 21.92, SD = 2.96 years) participated in the study. Player’s mean RPS score was 32.73, (SD = 8.38). A total of 12 concussions and 194 head knocks were reported across the data collection period. A greater proportion of midfielders were classified as high risk takers, compared to the other three position categories. NB-GLM identified both RPS (p = .007) and SPP (p = .006) as significant predictors of head knocks. Additionally, high risktakers had a significantly higher incidence of head knocks than low risk-takers (p = .042). Furthermore, risk of incurring a head knock increased by 6.50% per unit increase in RPS score (p = .005).
https://doi.org/10.1016/j.jsams.2017.09.217 29 Psychological, situational and lifestyle factors that influence the reporting of postconcussion-like symptoms
1
CQUniversity, Australia Department of Health Sciences, Institute of Health & Society, Norway 3 Department of Preventive & Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand 4 Center for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Oatgo, New Zealand 2
Background: The assessment and management of sportsrelated concussion relies on self-reporting of symptoms (SRS) by the concussed athlete. However, symptoms associated with concussion are non-specific in nature and symptom scores might not accurately reflect an athlete’s neurological status as psychological, situational and lifestyle factors are thought to influence symptom reporting. In order to better understand whether symptoms associated with a concussion are a true reflection of the underlying pathology or a normal response to daily stressors and health status it is important to evaluate postconcussion-like symptoms in non-concussed populations to determine normal day-to-day variability, serial reporting of symptoms, as well as the effect of lifestyle and psychological factors. Understanding these influences will lead to a better understanding of the assessment and management of concussion in athletes. Methods: University students (603) with no recent history of concussion were recruited and participated in a series of studies that evaluated the point prevalence, diurnal variability, and the serial (7-day) reporting of concussion-like symptoms. The Sport Concussion Assessment Tool (SCAT) was used to assess the Total Symptom Score (TSS, max 22) and the Symptom Severity Score (SSS, max 132) for each participant. Statistical analyses included stepwise multivariate linear mixed-effects modelling to determine the influence of psychological and lifestyle factors on symptom reporting. Results: Six modifiers were identified contributing to TSS with the strongest being alcohol consumption (estimate 2.75, p < .001) and trouble sleeping (estimate 2.27, p < .001), followed by mental fatigue, stress, anxiety and depression (p < .001). Hybrid cluster analysis of symptom similarity for diurnal variability identified two specific clusters; one where the symptoms (TSS & SSS) were stable over the day and one where they decreased. Over the seven-day period, predictors of location at the time of reporting, physical fatigue and mental fatigue (p < .001) contributed to TSS change. Discussion: Non-concussed individuals exhibit considerable individual variability in symptom scores over time. Multiple factors associated with the normal context of daily life influence postconcussion-like symptoms in university students. Clinicians
Abstracts / Journal of Science and Medicine in Sport 20S (2017) 13–15
should exercise caution when interpreting symptom scores in concussed athletes in regard to management and return to play. https://doi.org/10.1016/j.jsams.2017.09.218 30 Early warning signs? Recent head trauma linked to depressive symptoms in Australian Rules football players S. Harris 1,∗ , P. Chivers 2 , F. McIntyre 1 , B. Piggott 1 , F. Farringdon 1 1
School of Health Science, University Of Notre Dame, Australia 2 Institute for Health Research, Australia Background: Australian Rules Football (ARF) players are frequently exposed to the risk of head trauma (concussion or head knocks) due to the fast paced, contact nature of the game. Research into other football codes indicates repeated exposure to this head trauma, in particular concussion, may increase a player’s risk of long term consequences, including neurodegeneration and negative emotional changes (e.g. depression). However little research has considered the short-term impact of concussive or sub-concussive traumas on emotional wellbeing, specifically the presence of depressive symptoms. The purpose of this study was to investigate the relationship between recent head trauma and the presence of depressive symptoms in senior West Australian Football League (WAFL) players. Method: The study was conducted over the first 22 weeks of the 2015 WAFL season (n = 69, Mage = 21.81, SD = 2.91 years), with data collected fortnightly. Injury including head trauma was anonymously self-reported using the WAFL Injury Report
15
Survey (WIRS). Depressive symptoms were measured using the Centre for Epidemiological Studies Depression Scale (CESD-20) with a score over 16 indicating presence of depressive symptoms. Univariate Linear Mixed Models (ULMM) assessed the relationship between head trauma and depressive symptoms over time. Generalized Estimating Equations (GEE) assessed the risk of depressive symptoms occurring when a head trauma was experienced. Results: Within a fortnight of experiencing a concussion, 40 percent of concussed players reported depressive symptoms above the cut off (CESD20 score ≥16). ULMM indicated a significant relationship existed between concussion and an increase in depressive symptoms (p = .002) and head knocks and depressive symptoms (p = .007). When investigating risk, a GEE model identified a player was almost 8 times more likely to experience symptoms of depression (CESD20 score ≥16), when a concussion was reported. Discussion: Despite increased recognition of the importance of emotional wellbeing, there is limited evidence regarding the impact of head trauma on the mental health of ARF players at the semi-professional level. Findings that a significant proportion of players reported experiencing depressive symptoms within the two week period following head trauma, suggests that coaches and medical staff need to monitor not only the physical, but also the emotional wellbeing of their players, especially after a concussion or head knock has occurred. Players may also benefit from more education regarding identifying depressive symptoms post head trauma, encouraging them to seek medical advice especially if they notice a change in their emotional wellbeing. https://doi.org/10.1016/j.jsams.2017.09.219