Characteristics and main findings from studies that met inclusion criteria
| Studies | Methodology | Participants | Programme | Instruments | Main outcomes |
|---|---|---|---|---|---|
| Bagley et al31 | Non-randomised, pre-post study without a control group. | 599 male (n=309) and female (n=290) students were grouped into three age categories: 9–12 (n=104), 13–15 (n=310) and 16–18 (n=148) (n=37 age unknown) | Content: signs and symptoms, short-term and long-term consequences, and strategies for responding to concussions Delivery: 40–60 min audiovisual presentation that contained video segments, demonstrations, case studies of professional and high school athletes, personal testimonies and question/answer period | Identical pre- and post-programme quizzes containing free-response, T/F, and multiple-choice questions | Improvements in absolute pre- and post-quiz scores were observed across all participants (p<0.0001). More athletes 13 and older passed the post-presentation quiz (p<0.0001). Women showed greater improvement than men (p<0.0001) |
| Cook et al25 | Randomised controlled, post-only study. Two groups: experimental (n=45) and control (n=30) | 75 male ice hockey players 11–12 years old | Content: medical information, training lessons and personal statements Delivery: experimental group watched ‘Smart Hockey’ video. Control group received no intervention | Two methods of assessment: two ‘player questions’ assessed concussion knowledge and game-by-game penalty analysis to determine video's effect on behaviour | Experimental group showed improvements in knowledge and reduction in aggressive penalties that were each maintained at 3 months (p<0.05) |
| Cusimano et al26 | Cluster randomised controlled, pre-post study. Two groups: video (n=61) and no-video (n=74) | 135 youth ice hockey players 10 years old (n=89) and 14 years old, (n=46). Gender was not reported | Content: mechanisms of concussion, in-game tactics to reduce high-risk manoeuvres, and return to play guidelines Delivery: Video group watched the ThinkFirst's ‘Smart Hockey: More Safety, More Fun’ | Two questionnaires were developed to assess athletes’ knowledge, and attitudes and behaviours. They were administered at three time points: immediately before and after video, and 2 months later | Increase in players’ knowledge immediately following the video (p<0.001). 10-year old group showed post-video improvement but decreased average scores at 2 months (measure of significance were not provided). The 14-year-old group showed concussion knowledge retention at 2 months (measure of significance were not provided). No differences in players’ attitudes and behaviours (p=0.507) |
| Echlin et al27 | Randomised controlled, pre-post study. Three groups: DVD (n=16), interactive computer module (ICM) (n=20), and control (n=22) | 58 male ice hockey players 16–21 years old | Content: not explicitly stated Delivery: experimental groups received either the ThinkFirst DVD or ICM intervention. Control group received no intervention | 26 multiple-choice and T/F questions on injury knowledge and treatment protocol. Questions were readministered immediately after intervention, and at 2 and 4 months | No significant differences in knowledge acquisition between groups, across the times measured (p>0.05) |
| Glang et al33 | Randomised controlled, post-only study. Two groups: experimental (n=40) and control (n=35) | 75 male (n=52) and female (n=23) youth sport coaches. 75% self-identified as being between 30 and 49 years old | Content: prevention, recognition, and management based on expert guidelines34 35 Delivery: experimental group completed computer modules designed to deliver concussion education. Control spent 15–20 min reviewing CDC materials | Questionnaire assessed general knowledge, symptoms, misconceptions, self-efficacy and behaviour intention, and programme satisfaction and acceptability | Experimental group scored higher in general knowledge (η2 =0.37), symptoms (η2=0.46), misconceptions (η2=0.12), self-efficacy (η2=0.29) and intention to take appropriate actions (η2=0.17) |
| Goodman et al28 | Study 1 Randomised controlled, post-only study. Two groups: experimental (n=65) and control (n=65) Study 2 Randomised controlled, post-only study. Two groups: experimental (n=16) and control (n=17) | Study 1 130 ice hockey players aged 11–12 (n=44), 13–14 (n=38) and 15–17 years old (n=48). Gender was not reported Study 2 39 ice hockey players 13–14 years old. Gender was not reported | Content: concussion symptoms Delivery: experimental group played a computer game where they stacked icons that represented concussion symptoms and non-symptoms. Control group played the same game but icons were not related to concussion | A 36-item questionnaire was developed and administered after playing the game. Time to complete the questionnaire was also recorded. Computerised feedback questionnaire provided to assess game attributes | Study 1 Experimental group answered more questions correctly (p<0.05) and faster than control (p<0.05). The game ‘held the interest’ of 90% of 11–12 year olds, 75% of 13–14 year olds and 60% of 15–17 year olds Study 2 Experimental group completed questionnaire faster than control group (p=0.015). Compared to study 1, 13–14 year olds thought the game was easier to play. No differences found in symptom recognition (p=0.055) |
| Koh32 | Incidence cohort, pre-post study without a control group | 208 male (n=136) and female (n=72) university students from 18 to 32 years old registered in a snowboarding class | Content: concussion definition, mechanism of injury, signs and symptoms, post-concussion management and return-to-play Delivery: 30 min concussion safety session using slides, videos and oral presentation | A 20-item quiz was developed. Identical quizzes were administered pre- and post-educational intervention | Significant increase in snowboard-related concussion knowledge and awareness after being exposed to the concussion safety session (p=0.00) |
| Manasse-Cohick and Shapley29 | Non-randomised pre-post study without a control group | 160 high school football players. Information on athletes’ age and gender was not provided | Content: general information about concussions, causes and symptoms, management, short-term and long-term, and underreporting. Based on Rosenbaum and Arnett's36 survey. Delivery: a 5 min modified video of CDC's 'Heads Up: Concussion in High School Sports—Information for Coaches' followed by a 20 min PowerPoint presentation, and a question and answer period | Participants answered identical pre- and post-questionnaires. The Rosenbaum Concussion Knowledge and Attitudes Survey was used. Developed for students aged 13–20 years, it contains three indices: concussion knowledge index, concussion attitude index, and validity scale | Significant increase found in post-intervention concussion knowledge index (p<0.000) (Cohen's d=1.05) but not with respect to the concussion attitude index (p=0.508) |
| Miyashita et al30 | Cross-sectional, pre-post study without a control group. Pre-intervention surveys were completed during pre-participation physical tests. Post-intervention surveys were completed 5 months (soccer) and 7 months (basketball) months after the intervention | 50 male (n=27) and female (n=23) National Collegiate Athletic Association division II basketball and soccer players average 19.68 years old | Content: definition of concussion, signs and symptoms, reporting process, ‘take-home guide’, return-to-play protocol, and long-term sequelae. Based on ‘athletic Training Education’ courses taught by lead investigator Delivery: 20 min PowerPoint presentation with 10 slides | Pre- and post-intervention surveys contained four quantitative questions to obtain athletes’ previous medical history and six qualitative questions to ascertain athletes’ concussion knowledge | Athletes scored significantly fewer incorrect scores on the post-intervention surveys (p<0.0001) |