Graduated Return to Learn and Play After Sport-Related Concussion: What Determines Adherence Outside Elite Settings
DOI:
https://doi.org/10.5281/zenodo.22548359Keywords:
Sport-related concussion, Return to learn, Return to play, Symptom reporting, Adherence;, Youth sportAbstract
Graduated, stepwise return-to-learn and return-to-play protocols are now standard consensus guidance
following sport-related concussion, built on a substantial body of recovery-timeline and re-injury
evidence. That guidance was developed and validated predominantly in elite and well-resourced
collegiate settings with athletic trainers, team physicians, and school-based concussion management
teams available to supervise every step. The much larger population of youth and community athletes
managing concussion outside those settings faces a different adherence problem: symptom
under-reporting at the point of injury, inconsistent school-based return-to-learn accommodation, and
limited access to the supervised step-wise monitoring the protocols assume. This review synthesises the
recovery, reporting-behaviour, and return-to-learn literature to characterise what is known about
adherence to graduated concussion protocols specifically outside elite settings, and what has been shown
to improve it. Original Research was not attempted here, since no new cohort was collected.
References
McCrory P, Meeuwisse WH, Aubry M, et al. "Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012". Br J Sports Med 47(2013):250-258.
McCrory P, Meeuwisse W, Dvorak J, et al. "Consensus statement on concussion in sport -- the 5th international conference on concussion in sport held in Berlin, October 2016". Br J Sports Med 51(2017):838-847.
Patricios JS, Schneider KJ, Dvorak J, et al. "Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport -- Amsterdam, October 2022". Br J Sports Med 57(2023):695-711.
Halstead ME, McAvoy K, Devore CD, Carl R, Lee M, Logan K. "Returning to learning following a concussion". Pediatrics 132(2013):948-957.
Master CL, Gioia GA, Leddy JJ, Grady MF. "Importance of 'return-to-learn' in pediatric and adolescent concussion". Pediatr Ann 41(2012):e1-e6.
DeMatteo C, Stazyk K, Singh SK, et al. "Development of a conceptual understanding of pediatric concussion: implications for return to school". J Head Trauma Rehabil 30(2015):375-382.
Wallace J, Covassin T, Beidler E. "Sex differences in high school athletes' knowledge of sport-related concussion symptoms and their willingness to report". J Athl Train 52(2017):682-688.
McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. "Unreported concussion in high school football players: implications for prevention". Clin J Sport Med 14(2004):13-17.
Register-Mihalik JK, Guskiewicz KM, McLeod TC, Linnan LA, Mueller FO, Marshall SW. "Knowledge, attitude, and concussion-reporting behaviors among high school athletes: a preliminary study". J Athl Train 48(2013):645-653.
Kroshus E, Garnett B, Hawrilenko M, Baugh CM, Calzo JP. "Concussion under-reporting and pressure from coaches, teammates, fans, and parents". Soc Sci Med 134(2015):66-75.
Chrisman SPD, Quitiquit C, Rivara FP. "Qualitative study of barriers to concussive symptom reporting in high school athletics". J Adolesc Health 52(2013):330-335.
Baugh CM, Kroshus E, Bourlas AP, Perry KI. "Requiring athletes to acknowledge receipt of concussion-related information and responsibility to report symptoms: a study of the prevalence, form, and use of such messaging in the United States". J Law Med Ethics 42(2014):297-313.
Kroshus E, Baugh CM, Daneshvar DH, Nowinski CJ, Cantu RC. "Concussion reporting intention: a valuable metric for predicting reporting behavior and evaluating concussion education". Clin J Sport Med 25(2015):243-247.
Register-Mihalik JK, Linnan LA, Marshall SW, Valovich McLeod TC, Mueller FO, Guskiewicz KM. "Using theory to understand high school aged athletes' intentions to report sport-related concussion: implications for concussion education initiatives". Brain Inj 27(2013):878-886.
Williams RM, Puetz TW, Giza CC, Broglio SP. "Concussion recovery time among high school and collegiate athletes: a systematic review and meta-analysis". Sports Med 45(2015):893-903.
Iverson GL, Gardner AJ, Terry DP, et al. "Predictors of clinical recovery from concussion: a systematic review". Br J Sports Med 51(2017):941-948.
Grool AM, Aglipay M, Momoli F, et al. "Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents". JAMA 316(2016):2504-2514.
Silverberg ND, Iverson GL. "Is rest after concussion 'the best medicine?': recommendations for activity resumption following concussion in athletes, civilians, and military service members". J Head Trauma Rehabil 28(2013):250-259.
Leddy JJ, Haider MN, Ellis MJ, et al. "Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial". JAMA Pediatr 173(2019):319-325.
Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. "Benefits of strict rest after acute concussion: a randomized controlled trial". Pediatrics 135(2015):213-223.
Gibson S, Nigrovic LE, O'Brien M, Meehan WP 3rd. "The effect of recommending cognitive rest on recovery from sport-related concussion". Brain Inj 27(2013):839-842.
Sady MD, Vaughan CG, Gioia GA. "School and the concussed youth: recommendations for concussion education and management". Phys Med Rehabil Clin N Am 22(2011):701-719.
Purcell L, Harvey J, Seabrook JA. "Patterns of recovery following sport-related concussion in children and adolescents". Clin Pediatr 55(2016):452-458.
Wallace J, Beidler E, Register-Mihalik JK, Hibbler T, Formeller C. "Concussion knowledge and reporting behaviors among collegiate club-sport athletes". Athl Train Sports Health Care 12(2020):e1-e9.
Kroshus E, Baugh CM. "Concussion education in U.S. collegiate sport: what is happening and what do athletes want?" Health Educ Behav 43(2016):182-190.
Bramley H, Patrick K, Lehman E, Silvis M. "High school soccer players with concussion education are more likely to notify their coach of a suspected concussion". Clin Pediatr 51(2012):332-336.
Kurowski BG, Pomerantz WJ, Schaiper C, Ho M, Gittelman MA. "Impact of preseason concussion education on knowledge, attitudes, and behaviors of high school athletes". J Trauma Acute Care Surg 79(2015):S21-S28.
Chrisman SPD, Whitlock KB, Somers E, et al. "Team-based approach to concussion care: a school-based intervention". J Adolesc Health 65(2019):482-489.
Weber ML, Welch CE, Parsons JT, Valovich McLeod TC. "School nurses' familiarity and perceptions of academic accommodations for student-athletes following sport-related concussion". J Sch Nurs 31(2015):146-154.
Master CL, Master SR, Wiebe DJ, et al. "Vision and vestibular system dysfunction predicts prolonged concussion recovery in children". Clin J Sport Med 28(2018):139-145.
