Describing the Prevalence and Awareness of Sport-Related Concussion in University Intramural and Club Sport Participants

Background: Concussion injuries are growing in number among athletes across the nation. The majority of concussion research to date focuses on collegiate and high school athletes. University athletes make up a small percentage of the student body population compared to the large number of students that participate in club and intramural sports. These students participate in the same sports, assume the same risks, and may experience the same adverse effects of concussion, often without appropriate medical oversight. Purpose: The purpose of this study was to determine if concussion is a problem among intramural and club sport participants, if these participants are experiencing academic difficulties post-concussion and if they have medical coverage during their participation. Study Design: This study used a descriptive, quantitative survey-based design. Methods: Participants included college students participating in intramural and club sports at eight universities. University recreation departments sent out a 36-item survey using their participant database. This survey assessed demographic questions (e.g., age, sport, previous concussion history), SRC knowledge, barriers to medical care for SRC and commitment level to intramural or club sports. Results: Medical coverage for club games was reported by 62.4% (542/868) and 53.7% (917/1,709) of intramural participants. Approximately 7.3% (63/863) of club sport participants reported sustaining a medically diagnosed concussion during club sport participation. Academic difficulties following concussion were reported by 61.9% (39/63) of these participants. Less than two percent (1.9%, 32/1,710) of intramural participants reported sustaining a medically diagnosed concussion during sport participation. Academic difficulties following concussion were reported by 65.6% (21/32) of intramural respondents. CONCUSSION IN INTRAMURAL AND CLUB SPORT PARTICIPANTS 3 Discussion: University and club sport participants also experience academic difficulties following concussion. Increased efforts are needed to provide academic accommodations and proper medical care for university club and recreation participants that sustain a concussion. CONCUSSION IN INTRAMURAL AND CLUB SPORT PARTICIPANTS 4 Introduction Sport-related concussion (SRC) continues to be a hot topic in sports medicine. Recent estimates indicate that approximately 1.6 to 3.0 million sport and recreation-related concussions occur every year in the U.S. (Langlois, Rutland-Brown, & Wald, 2006). Sport-related concussion is best defined as a complex pathophysiological process affecting the brain that is induced by traumatic biomechanical forces (McCrory et al., 2013). The effects of SRC are unique to each injured athlete and often result in a myriad of physical, cognitive, social, and emotional symptoms and impairments (Kontos et al., 2012). The detection and diagnosis of SRC heavily relies on the self-reporting of symptoms by the injured athlete. As a result, approximately 60% of all SRCs go unreported, due to lack of knowledge/awareness, fear of removal from participation and letting teammates down (Meehan, d'Hemecourt, Collins, & Comstock, 2011). The high rate of unreported SRC is alarming, given the negative effects of this injury on the physical, emotional, and academic functioning of the athlete. In an effort to support an on-going need for SRC education, numerous epidemiological investigations tracking concussion rates have been conducted across several National Collegiate Athletic Association (NCAA) sports (Gessel et al., 2007; Hootman et al., 2007). While this research has established current documented SRC injury rates, NCAA varsity athletes are only a small representation of a larger, college-aged intramural and club sport population that participate in the same sports, assume the same risks, and may experience the same adverse effects of SRC, often without appropriate medical oversight. Currently, there are no studies to date examining SRC in university intramural and club sport participants. There is an average of 501 athletes participating in varsity sports at each of the 346 NCAA colleges and universities (NIRSA, 2007). The rate of SRC has increased 7% over the last CONCUSSION IN INTRAMURAL AND CLUB SPORT PARTICIPANTS 5 16 years (Hootman, Dick, & Agel, 2007), making the total number of concussion in NCAA sports approximately 3,753 per year. The total number of NCAA athletes comprises approximately 6% of the entire university student body population according to the NCAA Recruiting Facts (NCAA, 2014). This is a very small percentage in comparison to the number of university students that participate in intramural and club sports. Recent estimates indicate that more than 2 million college students participate in club sports (NIRSA, 2007). The sport offerings among intramural and club sport are similar or even identical to varsity sports. Football, basketball, and soccer are among the NCAA sports with the highest incidence rates of SRC, with football having 55% of all concussions collected in a study done by Hootman and colleagues where they surveyed over 15 different sports (Hootman et al., 2007). Many schools have identical or similar (e.g., flag football) intramural and club sport offerings. In addition, other potentially high-risk sports are unique to many intramural and club university programs such as rugby, hockey, boxing, and martial arts. Given the disparity in the number of participants and the similarity of sports being played by both varsity NCAA athletes and intramural and club sport participants, it is hypothesized that SRC is likely a problem in intramural and club sports. Furthermore, the rates of SRC may be higher due to the variability of skill level and physical attributes among intramural and club participants. Participation among intramural and club sports provide an ideal opportunity for college students to maintain a physically healthy lifestyle (Cooper, Schuett, & Phillips, 2012). Regular physical activity is the number one preventative health measure that adults can take against disease. Universities encourage the participation in fitness activities of their students via their recreation programs. These programs influence students to attend their university as well as increase their likeliness to return to school the following year (Henchy, 2013.). Henchy (2013) CONCUSSION IN INTRAMURAL AND CLUB SPORT PARTICIPANTS 6 conducted a study where a 143-item survey was sent out to 2,500 students at a southeastern university via email. The survey consisted of questions about recruitment, retention, satisfaction, involvement, and the benefits students have received from participating in university recreational programs. They found that 38% of undergraduate students said that campus recreation programs influenced their decision to continue at the university. Studies have shown that students report they enjoy participating in campus recreation and that it improves quality of life at the university in many ways including: expanded their interest in staying fit, positively influenced their overall health, fitness level, well-being, stress management, and academic performance. (Henchy, 2013.) Additional research estimating the incidence and effects of SRC in intramural and club participants is needed. While the benefits of participating in sport and recreational activity offers satisfaction, enjoyment, exercise, fellowship, achievement, stress release, and acquisition of lifelong leisure skills (Artinger, Clapham, Hunt, Meigs, & Milord, 2006; Eime, Harvey, Brown, & Payne, 2010), these participants are still at risk for injury. Musculoskeletal injuries are often visible making it easier for university wellness centers to provide care for those who seek treatment. However, SRC is an “invisible” injury that may have delayed signs and symptoms that last for days, weeks, or even months making this injury one of the most intangible diagnoses for university wellness centers (McCrea et al., 2004). These symptoms often interfere with academic performance and can impair physical, social, and emotional functioning (McGrath, 2010). Varsity NCAA athletes receive daily care for their concussion from clinicians trained in SRC management and may receive academic accommodations to aid them in their recovery and preserve academic standing. However, intramural and club participants are often left to seek medical attention on their own and may struggle though their academic work without proper accommodations. Therefore, a mismanaged SRC can negatively influence short-term health and CONCUSSION IN INTRAMURAL AND CLUB SPORT PARTICIPANTS 7 academic performance resulting in long-term academic and occupational and/or professional consequences. Research on SRC in this understudied population of college students is necessary to support increased need for medical oversight, SRC education, and academic accommodations for intramural and club participants. The current study describes the prevalence and awareness of concussion in university intramural and club sport participants, and programs will be able to better estimate the impact that concussion may have on their participants and justify additional medical coverage, participant concussion education, and academic support when needed. CONCUSSION IN INTRAMURAL AND CLUB SPORT PARTICIPANTS 8 Literature Review Definition of Concussion In current years, public awareness about the consequences of concussion has risen considerably causing an increase in attention from researchers on the biomechanics of this injury (Dashnaw, Petraglia, Bailes, 2012). Concussion is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces (McCroy, et. al., 2012). Concussion occurs when a force is transmitted to the head following a direct hit to the head, face, neck or somewhere else on the body. There are no structural markers of concussion that show up on neuroimag