The underreporting of self-reported symptoms following sports-related concussion

Meier, Timothy B.; Brummel, Bradley J.; Singh, Rashmi; Nerio, Christopher J.; Polanski, David; Bellgowan, Patrick S.F.

doi:10.1016/j.jsams.2014.07.008

Cited by 175 publications

(104 citation statements)

References 26 publications

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“…Prospective studies have found that athletes significantly under-report concussive symptoms to their ATCs as compared with symptoms reported in a confidential setting 48. Furthermore, several studies suggested report of symptoms is not consistent with performance on cognitive testing 49 50.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, several studies suggested report of symptoms is not consistent with performance on cognitive testing 49 50. Surveys that included tests of athlete's knowledge identified gaps in their knowledge base 9 17 18 42 48 51–57. A majority of athletes recognise some, but not all symptoms associated with concussion, and often do not attempt to discriminate between concussion and non-related symptoms.…”

Section: Methodsmentioning

confidence: 99%

“…A majority of athletes recognise some, but not all symptoms associated with concussion, and often do not attempt to discriminate between concussion and non-related symptoms. An interesting trend was that athletes who had a history of concussions were more likely to correctly identify symptoms than those with no previous history of concussion 17 18 42 48 51 55–57. Moreover, select studies suggested that athletes who had received concussion education were more likely to state it was not okay to keep playing after concussion 51.…”

Section: Methodsmentioning

confidence: 99%

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A qualitative review of sports concussion education: prime time for evidence-based knowledge translation

et al. 2015

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A qualitative review of sports concussion education: prime time for evidence-based knowledge translation

et al. 2015

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“…If patients are concerned that their history of TBI may limit their immediate or long-term career opportunities, they may be motivated to not report their TBI or minimize their symptoms. Underreporting of TBI and postconcussive symptoms is a particular concern in athletes [6][7][8][9][10]. In contrast, overreporting symptoms is often found in patients who are involved in litigation or otherwise have potential for secondary gain [11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Utility of the Validity-10 scale across the recovery trajectory following traumatic brain injury

Lange¹,

Bailie

Kennedy

et al. 2016

J Rehabil Res Dev

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Abstract-The Validity-10 scale was recently developed to screen for symptom exaggeration in patients following traumatic brain injury (TBI). However, it has only been validated on patients with TBI largely in the chronic phase of recovery. The influence of time since injury on the Validity-10 scale was investigated in 2,661 male servicemembers with TBI presenting to six U.S. Defense and Veterans Brain Injury Centers. Participants completed the Neurobehavioral Symptom Inventory (NSI). The Validity-10 scale and NSI total score were both weakly statistically significantly (1) positively correlated with time since injury, (2) negatively correlated with bodily injury severity, and (3) higher in participants undergoing medical board evaluations than in participants who returned to duty or were still hospitalized. Participants were statistically more likely to screen positive for possible symptom exaggeration on the Validity-10 scale as time since injury increased. However, the Validity-10 scale was only weakly related to time since injury, TBI severity, bodily injury severity, disposition, age, and return to duty status. That false positives are not increased in the acute phase of recovery and that the Validity-10 scale is not strongly related to clinical factors support the use of the Validity-10 scale in the acute recovery phase and across the TBI recovery trajectory.

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“…32 Attributing worse-than-expected performance to suboptimal effort versus purposeful malingering is a challenge, and as such, many authors have had to rely on predetermined cutoff scores to identify potential instances without being able to definitively say the reason for low scores. From 6% to 11% of baseline scores may reflect poor effort or malingering.…”

mentioning

confidence: 99%

Baseline Neurocognitive Performance and Clearance for Athletes to Return to Contact

Asken

Clugston

Snyder

et al. 2017

Journal of Athletic Training

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Context: Computerized neurocognitive assessments are commonly used to manage sport-related concussion. Variations in baseline performance may influence neurocognitive performance after injury as well as the amount of time needed for an athlete to be cleared for return to sport participation.Objective: To investigate the relationship between mean baseline Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) scores and postconcussion reliable decline as well as the association between postconcussion cognitive decline and days missed after injury.Design: Cross-sectional study. Setting: University concussion databank. Patients or Other Participants: A total of 84 collegiate athletes who sustained a concussion between 2008 and 2015 were studied. For each ImPACT composite score (verbal memory, visual memory, visual motor speed, reaction time), athletes were grouped based on the presence or absence of reliable decline and on the presence of reliable decline in 0, 1, 2, 3, or 4 cognitive domains.Main Outcome Measure(s): Outcome measures were baseline ImPACT composite scores and days missed due to concussion.Results: Athletes with a reliable decline in visual memory scored higher on baseline visual memory than did athletes with no decline or an improvement (t 82 ¼À2.348, P ¼ .021, d ¼ 0.65). When comparing athletes who displayed a reliable decline with those who showed no change or an improvement in any composite score, days missed did not differ. The number of composite scores with a reliable decline demonstrated no main effect on days missed (P ¼ .530).Conclusions: Athletes who exhibited cognitive decline in most or all of the composite scores did not miss more days after injury than athletes with a decline in fewer or none of the composite scores. Athletes should be educated regarding the lack of association between baseline neurocognitive scores and the presence or absence of a reliable decline after concussion, as well as the fact that, on average, individuals with a reliable decline across multiple domains did not miss more time after concussion.

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The underreporting of self-reported symptoms following sports-related concussion

Cited by 175 publications

References 26 publications

A qualitative review of sports concussion education: prime time for evidence-based knowledge translation

A qualitative review of sports concussion education: prime time for evidence-based knowledge translation

Utility of the Validity-10 scale across the recovery trajectory following traumatic brain injury

Baseline Neurocognitive Performance and Clearance for Athletes to Return to Contact

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