Identifying factors that relate to recovery among collegiate athletes with sport-related concussion

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Degree type
Doctor of Philosophy (PhD)
Graduate group
Epidemiology and Biostatistics
Discipline
Life Sciences
Medicine and Health Sciences
Public Health
Subject
Athletes
Injury
Recovery
Sport concussion
Symptoms
Traumatic brain injury
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Copyright date
01/01/2024
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Author
D'Alonzo, Bernadette
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Abstract

Sport-related concussion is common, accounting for 6.2% of injuries in the National Collegiate Athletic Association (NCAA). Concussion symptoms can be debilitating, may vary dramatically, and require costly treatments. There is growing interest in improving targeted concussion treatment by examining recovery differences by sex, and types of symptoms. However, heterogeneity in study design, participants, and recovery outcomes has led to mixed findings that are difficult to interpret and uniformly apply to student-athletes. To address these issues, we leveraged surveillance data from the Ivy League-Big Ten Epidemiology of Concussion Study (N=3,000+), and combined multiple epidemiologic (Aims 1 and 2) and qualitative (Aim 3) methods to characterize how collegiate athletes experience concussion and recovery. Aim 1. We used Cox proportional hazards regressions to estimate associations between sex and recovery timelines. Time from injury to symptom resolution, and return to academics and sport was similar between males and females, adjusting for measured confounders. Findings also suggest previously apparent differences in recovery timelines by sex and contact-level may be driven by differences in men’s/women’s team-only sports. Aim 2. We compared symptom structures of the Sport Concussion Assessment Tool (SCAT) using confirmatory factor analysis and examined associations between symptom groups and recovery timelines. SCAT symptoms were best represented through six domains: headache, vestibulo-ocular, sensory, cognitive, sleep, and affective. SCAT measures represented symptom domains similarly by sex. Using latent class analysis, we identified four classes/symptom profiles representing how symptom domains co-occur. We found differences in the timelines to recovery outcomes among these symptom-profile groups, but not by sex. Aim 3. We conducted semi-structured interviews with University of Pennsylvania student-athletes with a concussion. We identified the importance of managing expectations, previous concussions, and emotions on recovery and return-to-academics and sport decision-making. We also found these experiences were shaped by the social environment and key actors. Findings will aid sports medicine clinicians and researchers to better assess and manage collegiate athletes with concussion. Findings also inform and underscore the need for the development of targeted, individualized, symptom-specific interventions to manage concussion.

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Wiebe, Douglas, J
Date of degree
2024
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