Table 1

Characteristics and main findings from studies that met inclusion criteria

StudiesMethodologyParticipantsProgrammeInstrumentsMain outcomes
Bagley et al31Non-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 questionsImprovements 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 al25Randomised controlled, post-only study. Two groups: experimental (n=45) and control (n=30)75 male ice hockey players 11–12 years oldContent: 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 behaviourExperimental group showed improvements in knowledge and reduction in aggressive penalties that were each maintained at 3 months (p<0.05)
Cusimano et al26Cluster 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 reportedContent: 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 laterIncrease 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 al27Randomised 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 oldContent: 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 monthsNo significant differences in knowledge acquisition between groups, across the times measured (p>0.05)
Glang et al33Randomised 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 oldContent: 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 acceptabilityExperimental 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 al28Study 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 attributesStudy 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)
Koh32Incidence cohort, pre-post study without a control group208 male (n=136) and female (n=72) university students from 18 to 32 years old registered in a snowboarding classContent: 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 interventionSignificant increase in snowboard-related concussion knowledge and awareness after being exposed to the concussion safety session (p=0.00)
Manasse-Cohick and Shapley29Non-randomised pre-post study without a control group160 high school football players. Information on athletes’ age and gender was not providedContent: 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 scaleSignificant 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 al30Cross-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 intervention50 male (n=27) and female (n=23) National Collegiate Athletic Association division II basketball and soccer players average 19.68 years oldContent: 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 knowledgeAthletes scored significantly fewer incorrect scores on the post-intervention surveys (p<0.0001)