Abstract

This is the first study to assess sport concussion knowledge and the effect of sport concussion self-report on knowledge in the UK general public. In the online survey, participants (n = 227) stated personal sport concussion history, injury indicators, and rated 26 injury statements for truthfulness using definite (true, false) or non-definite (probably true, probably false) response options. As anticipated, knowledge was limited. Few statement ratings were definite, and misconceptions prevailed. The injury's seriousness was systematically underestimated, suggesting that knowledge may not be sufficient for injury self-diagnosis and self-recovery measures. Sport concussion self-report was associated with more definite than non-definite statement ratings. However, response accuracy did not differ. This suggested that personal injury experience may yield a false sense of security. The use of accessible, easy-to-use tools needs to be promoted to improve sport practice safety.

Introduction

Current guidelines recommend a multifaceted interdisciplinary approach to recognize and diagnose sport concussion (Guskiewicz et al., 2006; McCrory et al., 2009). However, access to this approach is unlikely for most general public sport players (Ferrara, McCrea, Peterson, & Guskiewicz, 2001). Therefore, sufficient and accurate knowledge is needed by individuals to recognize concussion injury and take appropriate action. Currently, no data are available on sport concussion knowledge in the UK general public. The present study aimed to address this limitation using an online survey.

In the literature (Chapman & Hudson, 2010; Gouvier, Prestholt, & Warner, 1988; Guilmette & Paglia, 2004; Hux, Schram, & Goeken, 2006; O'Jile et al., 1997; Weber & Edwards, 2010), knowledge of concussion has been assessed using statements where the participant has to rate them for their truthfulness (e.g., “It is good advice to rest and remain inactive during recovery”). A choice of four responses is typically provided (true, probably true, probably false, and false). Findings generally reveal that knowledge is poor, with participants making many misconception (incorrect) responses (Chapman & Hudson, 2010; Gouvier et al., 1988; Hux et al., 2006; O'Jile et al., 1997). For example, Gouvier and colleagues (1988) reported that brain injury misconceptions were particularly dominant regarding knowledge about the loss of consciousness, memory, and recovery profiles. Follow-up surveys suggested that selected misconceptions appeared at least partially to diminish with time (Chapman & Hudson, 2010; Hux et al., 2006; O'Jile et al., 1997).

In the papers cited above, the original four response categories have typically been collapsed into two categories (i.e., false: combining false and probably false, and true: combining probably true and true). This means that, for example, responding “true” and “probably true” to the statement “once a recovering sports person feels ‘back to normal,’ the recovery process is complete” has been treated as equal in meaning to the participant. We think that this might not be appropriate. For example, (falsely) rating the above statement as “true” might reflect a clear misconception that is well anchored in the way in which the individual perceives sport concussion, affiliated symptoms, their recovery course, and assessment. On the other hand, a less definitive “probably true” rating might rather reflect an unsure guess and lacking knowledge, but not necessarily a clear misconception of which the individual is convinced of. By analyzing all four categories instead of two collapsed-from-four response options, additional knowledge could be gained regarding the extent to which misconceptions are clear versus based on guesses. Furthermore, this separation might inform how general public knowledge might be possible to change through education. On the basis of this, here, we treat response definiteness as an indicator of participants' certainty of the expressed knowledge. Resilience to change might be particularly relevant for the UK, as research into sport concussion (knowledge) has not received as much attention as, for example, in North America.

In the paper presented here, we aim to replicate and extend the literature. We are the first to test UK general public sport concussion knowledge and we are also the first to identify misconceptions responses using all four response options. Consistent with the literature from mainly the North American general public (Chapman & Hudson, 2010; Gouvier et al., 1988; Hux et al., 2006; O'Jile et al., 1997), we anticipate misconceptions and lacking knowledge to be prevalent in the UK general public sample (Hypothesis 1). An additional analysis explored the effect of sport concussion self-report on knowledge; a factor currently unclear in the literature (Guilmette & Paglia, 2004; Hux et al., 2006; O'Jile et al., 1997). Outside of the sporting context, injury experience has been shown to be promotive (Hux et al., 2006), detrimental (O'Jile et al., 1997), and without any influence at all (Guilmette & Paglia, 2004) on knowledge. Given the nature of the injury, it might be that personal injury experience might unlikely influence correct knowledge as a variety of sport concussion effects are not easily accessible to introspection, or it is possible that players have experienced inappropriate injury management (i.e., being allowed to continue to play) causing incorrect beliefs. Alternatively, personal injury experience might be advantageous, as an injured player might have actively sought or passively been provided with correct injury-related information. In Hypothesis 2, we suggest that sport concussion history might influence statement rating response patterns. Personal injury experience might lead the individual to more likely choose definite statement ratings (i.e., true, false), though it remains unclear whether the ratings will be more correct than the responses made by self-reported uninjured individuals.

Method

Participants

The survey was completed by 227 members of the UK general public aged between 18 and 76 (Table 1). The University of Birmingham Ethics Committee approved the study in accordance with the 1964 Declaration of Helsinki. Each participant gave informed consent before providing any data.

Table 1.

Demographics for Hypotheses 1 and 2

  Hypothesis 2 (sport concussion history)
 
Demographic measure Hypothesis 1 Self-report No self-report 
N 227 85 142 
Age (M [SD]) 25.3 (11.2) 25.7 (10.8) 25.1 (11.5) 
Gender (women; %) 60.8 49.4 67.6 
  Hypothesis 2 (sport concussion history)
 
Demographic measure Hypothesis 1 Self-report No self-report 
N 227 85 142 
Age (M [SD]) 25.3 (11.2) 25.7 (10.8) 25.1 (11.5) 
Gender (women; %) 60.8 49.4 67.6 

Note: In Hypothesis 2, women were underrepresented χ2(1, N = 227) = 7.38, p < .01.

Material and procedure

SurveyMonkey was used to create the survey and collect the data. The study was advertised in the university's community outreach newsletter, and in addition, invitations to take part were sent to local and university sport clubs. The questionnaire's main section inquired familiarity with the term sport concussion and given familiarity and measured sport concussion knowledge using two elements: (i) the nomination of the “the most important injury indicator,” and (ii) the truthfulness rating of 26 statements by choice of one of four response categories (true, probably true, probably false, and false). We deliberately did not provide a sport concussion definition so not to influence participant responses. Separate survey sections inquired about sport concussion history and basic demographics.

Statistical analysis

SPSS was used for data analysis (significance p < .05). First, term familiarity was analyzed. Only data of participants confirming familiarity with the term sport concussion were entered into the analyses of Hypotheses 1 and 2. Hypothesis 1 was analyzed by calculating the response frequencies for the knowledge elements (i) injury indicators and (ii) statement ratings as the dependent measures. Injury indicators had to be nominated by at least five participants to be considered in further analyses. Finally, for each statement, odds ratios with 95% confidence intervals determined whether the proportion of misconceptions differed in definite (i.e., true, false) and non-definite (i.e., probably true, probably false) responses. In addition, we provided misconception rates for collapsed response categories for comparative reference. Hypothesis 2 included sport concussion history as an independent variable, but tested the same dependent measures as Hypothesis 1. Chi-squared tests examined whether participants with and without sport concussion self-report differed in the proportion of definite (i.e., true, false) and non-definite (i.e., probably true, probably false) responses for misconceptions, and whether sport concussion history had any influence on the data. For all comparisons, violated test assumptions were met with calculations of the coefficient of association φ (phi).

Results

Hypothesis 1: UK public knowledge

The most frequent cumulative injury indicators nominated were dizziness (16.3%), disorientation and confusion (15.4%), loss of consciousness (13.7%), head trauma (8.8%), headache (7.0%), memory loss (4.0%), and altered consciousness (3.1%).

Misconception rates differed between definite and non-definite responses for 18 of the 26 statements (Table 2; in bold). For three statements concerning post-traumatic amnesia, gender differences, and increased re-injury likelihood (Table 2; statements 23, 25, and 26), the misconception was significantly “higher” for definite than non-definite respondents. This means that for a subset of statements, the definite responders tended to express knowledge that was actually incorrect. However, the misconception for the non-definite response for the same three statements was around 50% suggesting that non-definite responders appeared to have guessed rather than based their response on a true belief. Overall, on 6 of the 26 statements only (Table 2; statements 1–4, 6, and 10), the majority of participants (i.e., more than 50%) chose a definite response (i.e., true, false), suggesting that on this small subset of statements, knowledge was expressed with greater certainty than for the other statements.

Table 2.

Statement responses

   Misconception (%)
 
   
Statement Misconception in collapsed responses (%) Definite responses (%) Definite only Non-definite only OR 95% CI p-value 
1. An SC is harmless and never results in long-term problems or brain damage (F) 1.8 74.4 0.0 6.9 −0.23a  .004 
2. A little brain damage does not matter, as people use a small portion of their brains anyway (F) 2.6 82.4 0.0 15.0 −0.16a  .03 
3. An SC can cause brain damage even if the sports person is not knocked out (T) 5.7 50.2 2.6 8.9 0.28 [0.08, 1.04] .05 
4. In sport, SC almost never happens (F) 8.4 61.7 2.1 18.4 0.10 [0.03, 0.35] <.0001 
5. Most sports persons with SC are not fully aware of its effect on their behavior and performance (T) 9.3 36.1 11.0 8.3 1.37 [0.55, 3.40] .63 
6. Sometimes a second blow to the head can help a sports person remember things that were forgotten (F) 9.7 59.0 0.8 22.6 0.03 [0.01, 0.20] <.0001 
7. Once a recovering sports person feels “back to normal,” the recovery process is complete (F) 10.6 38.8 2.3 15.8 0.12 [0.03, 0.54] .001 
8. Complete recovery from an SC is not possible, no matter how badly the person wants to recover (F) 12.8 48.0 4.6 20.3 0.19 [0.07, 0.51] .0005 
9. Drinking alcohol may affect a sports person differently after an SC (T) 18.1 34.8 15.2 19.6 0.74 [0.35, 1.54] .47 
10. How quickly a sports person recovers from an SC depends mainly on how hard they work on recovery (F) 19.4 55.1 7.2 34.3 0.15 [0.07, 0.33] <.0001 
11. It is easy to tell if a sports person has brain damage from an SC by the way the person looks or acts (F) 23.8 49.3 11.6 35.7 0.24 [0.12, 0.47] <.0001 
12. Whiplash injuries to the neck can cause brain damage even if there is no direct blow to the head (T) 26.0 30.4 14.5 31.0 0.38 [0.18, 0.80] .01 
13. It is good advice to rest and remain inactive during recovery (F) 26.4 38.7 10.2 36.6 0.20 [0.09, 0.43] <.001 
14. In sports, an SC can have positive and negative effects on the sports person (F) 28.6 41.0 15.1 38.1 0.29 [0.15, 0.56] .0002 
15. Concussed sports persons usually show good understanding of their problems because they experience them every day (F) 28.6 23.8 14.8 32.9 0.35 [0.16, 0.80] .02 
16. An SC may cause one to feel depressed, hopeless, and sad (T) 37.4 18.5 45.2 35.7 1.49 [0.76, 2.93] .29 
17. Emotional problems after SC are usually not related to brain damage (F) 40.1 18.1 51.2 37.6 1.70 [0.88, 3.44] .12 
18. Recovery from an SC is usually complete in about a week (F) 42.3 27.3 27.4 47.9 0.41 [0.22, 0.78] <.007 
19. The only sure way to tell if someone has suffered brain damage from an SC is by an X-ray of the brain (F) 48.0 39.2 37.1 55.1 0.48 [0.28, 0.83] .01 
20. A sports person who has recovered from an SC is less able to withstand a second blow to the head (T) 48.0 31.7 38.9 52.3 0.58 [0.33, 1.03] .07 
21. Asking sports persons who were concussed about their recovery is the most accurate, informative way to find out how they have progressed (F) 48.5 25.1 33.3 53.5 0.43 [0.23, 0.81] .009 
22. When a sports person is knocked unconscious, most wake up quickly with no lasting effects (F) 60.4 29.9 51.5 64.2 0.59 [0.33, 1.05] .08 
23. Sports persons usually have more trouble remembering things that happen after an SC that remembering things from before (T) 60.8 27.8 73.0 56.1 2.20 [1.12, 4.00] .02 
24. A concussed sports person may have trouble remembering events from before the concussion, but usually does not have trouble learning new things (F) 65.6 20.7 63.8 66.1 0.90 [0.46, 1.77] .86 
25. An SC affects men's and women's brains differently (T) 68.7 30.4 81.2 63.3 2.50 [1.26, 4.96] .008 
26. Sports people who have had one SC are more likely to have another (T) 70.1 44.5 80.2 61.9 2.50 [1.36, 4.58] .003 
   Misconception (%)
 
   
Statement Misconception in collapsed responses (%) Definite responses (%) Definite only Non-definite only OR 95% CI p-value 
1. An SC is harmless and never results in long-term problems or brain damage (F) 1.8 74.4 0.0 6.9 −0.23a  .004 
2. A little brain damage does not matter, as people use a small portion of their brains anyway (F) 2.6 82.4 0.0 15.0 −0.16a  .03 
3. An SC can cause brain damage even if the sports person is not knocked out (T) 5.7 50.2 2.6 8.9 0.28 [0.08, 1.04] .05 
4. In sport, SC almost never happens (F) 8.4 61.7 2.1 18.4 0.10 [0.03, 0.35] <.0001 
5. Most sports persons with SC are not fully aware of its effect on their behavior and performance (T) 9.3 36.1 11.0 8.3 1.37 [0.55, 3.40] .63 
6. Sometimes a second blow to the head can help a sports person remember things that were forgotten (F) 9.7 59.0 0.8 22.6 0.03 [0.01, 0.20] <.0001 
7. Once a recovering sports person feels “back to normal,” the recovery process is complete (F) 10.6 38.8 2.3 15.8 0.12 [0.03, 0.54] .001 
8. Complete recovery from an SC is not possible, no matter how badly the person wants to recover (F) 12.8 48.0 4.6 20.3 0.19 [0.07, 0.51] .0005 
9. Drinking alcohol may affect a sports person differently after an SC (T) 18.1 34.8 15.2 19.6 0.74 [0.35, 1.54] .47 
10. How quickly a sports person recovers from an SC depends mainly on how hard they work on recovery (F) 19.4 55.1 7.2 34.3 0.15 [0.07, 0.33] <.0001 
11. It is easy to tell if a sports person has brain damage from an SC by the way the person looks or acts (F) 23.8 49.3 11.6 35.7 0.24 [0.12, 0.47] <.0001 
12. Whiplash injuries to the neck can cause brain damage even if there is no direct blow to the head (T) 26.0 30.4 14.5 31.0 0.38 [0.18, 0.80] .01 
13. It is good advice to rest and remain inactive during recovery (F) 26.4 38.7 10.2 36.6 0.20 [0.09, 0.43] <.001 
14. In sports, an SC can have positive and negative effects on the sports person (F) 28.6 41.0 15.1 38.1 0.29 [0.15, 0.56] .0002 
15. Concussed sports persons usually show good understanding of their problems because they experience them every day (F) 28.6 23.8 14.8 32.9 0.35 [0.16, 0.80] .02 
16. An SC may cause one to feel depressed, hopeless, and sad (T) 37.4 18.5 45.2 35.7 1.49 [0.76, 2.93] .29 
17. Emotional problems after SC are usually not related to brain damage (F) 40.1 18.1 51.2 37.6 1.70 [0.88, 3.44] .12 
18. Recovery from an SC is usually complete in about a week (F) 42.3 27.3 27.4 47.9 0.41 [0.22, 0.78] <.007 
19. The only sure way to tell if someone has suffered brain damage from an SC is by an X-ray of the brain (F) 48.0 39.2 37.1 55.1 0.48 [0.28, 0.83] .01 
20. A sports person who has recovered from an SC is less able to withstand a second blow to the head (T) 48.0 31.7 38.9 52.3 0.58 [0.33, 1.03] .07 
21. Asking sports persons who were concussed about their recovery is the most accurate, informative way to find out how they have progressed (F) 48.5 25.1 33.3 53.5 0.43 [0.23, 0.81] .009 
22. When a sports person is knocked unconscious, most wake up quickly with no lasting effects (F) 60.4 29.9 51.5 64.2 0.59 [0.33, 1.05] .08 
23. Sports persons usually have more trouble remembering things that happen after an SC that remembering things from before (T) 60.8 27.8 73.0 56.1 2.20 [1.12, 4.00] .02 
24. A concussed sports person may have trouble remembering events from before the concussion, but usually does not have trouble learning new things (F) 65.6 20.7 63.8 66.1 0.90 [0.46, 1.77] .86 
25. An SC affects men's and women's brains differently (T) 68.7 30.4 81.2 63.3 2.50 [1.26, 4.96] .008 
26. Sports people who have had one SC are more likely to have another (T) 70.1 44.5 80.2 61.9 2.50 [1.36, 4.58] .003 

Notes: The correct answer is indicated at the end of each statement (T = true; F = false). Misconceptions in collapsed responses (true/probably true; false/probably false), the percentage of participants that made definite and non-definite responses (and the percentage of these that were misconceptions—in round brackets) are presented. Odds ratio analyses indicate the significant effects (in bold) (and 95% confidence intervals in square brackets). SC = sport concussion; OR = odds ratio; CI = confidence interval.

aCoefficient of association φ (phi).

Hypothesis 2: Effect of sport concussion self-report on knowledge

Analysis of the data taking into account participants' sport concussion self-report showed that overall injury indicator nomination did not vary by sport concussion self-report (Table 3). Knowledge of loss of consciousness approached significance, suggesting the possibility of a trend by which this particular indicator may be nominated by more participants with sport concussion self-report than without. However, these data indicate that participant experience of sport concussion had no influence on their knowledge.

Table 3.

Injury indicators by sport concussion self-report

 Sport concussion history
 
   
 Indicator Self-report No self-report    OR 95% CI p-value 
Cumulative 57.2 74.7 0.77 [0.50, 1.19] .28 
Loss of consciousness 8.2 16.9 0.44 [0.18, 1.07] .07 
Confusion, disorientation 12.9 16.9 0.73 [0.34, 1.58] .46 
Dizziness 11.8 19.1 0.57 [0.26, 1.24] .19 
Headache 4.7 8.5 0.54 [0.17, 1.72] .42 
Head trauma 9.4 8.5 0.59 [0.44, 2.88] .81 
Altered consciousness 5.9 1.4 4.38 [0.83, 23.07] .11 
Memory loss 4.7 3.5 1.35 [0.35, 5.18] .73 
 Sport concussion history
 
   
 Indicator Self-report No self-report    OR 95% CI p-value 
Cumulative 57.2 74.7 0.77 [0.50, 1.19] .28 
Loss of consciousness 8.2 16.9 0.44 [0.18, 1.07] .07 
Confusion, disorientation 12.9 16.9 0.73 [0.34, 1.58] .46 
Dizziness 11.8 19.1 0.57 [0.26, 1.24] .19 
Headache 4.7 8.5 0.54 [0.17, 1.72] .42 
Head trauma 9.4 8.5 0.59 [0.44, 2.88] .81 
Altered consciousness 5.9 1.4 4.38 [0.83, 23.07] .11 
Memory loss 4.7 3.5 1.35 [0.35, 5.18] .73 

Notes: OR = odds ratio; CI = confidence interval.

For the comparison of response and sport concussion self-report, significantly more participants with self-report sport concussion than without chose definite responses on six statements (Table 4). On these statements, participants with sport concussion self-report expressed knowledge with greater certainty than participants without sport concussion self-report. However, accuracy did not differ according to sport concussion self-report suggesting that personal injury experience exerted influence on the certainty with which knowledge was expressed, yet not accuracy itself.

Table 4.

Effects of sport concussion self-report on definite and non-definite responses (and of these, the percentage of statement misconceptions—in round brackets)

 Responses (%) by sport concussion history
 
  
 Self-report
 
No self-report
 
  
Statement Definite Non-definite Definite Non-definite χ2(1) p-value 
71.8 (3.3) 28.2 (8.3) 55.6 (1.3) 44.4 (22.2) 5.85 .01 
10 70.6 (6.7) 29.4 (40.0) 45.8 (7.7) 54.2 (32.5) 13.20 .000 
17 35.3 (50.0) 64.7 (36.5) 23.2 (52.6) 76.8 (38.2) 3.85 .04 
18 25.9 (25.8) 74.1 (57.4) 13.4 (29.0) 86.6 (43.2) 5.62 .02 
23 36.5 (75.8) 63.5 (54.5) 21.8 (70.0) 78.2 (56.9) 5.74 .01 
24 28.2 (66.7) 71.8 (68.9) 16.2 (60.9) 83.8 (64.7) 5.85 .01 
 Responses (%) by sport concussion history
 
  
 Self-report
 
No self-report
 
  
Statement Definite Non-definite Definite Non-definite χ2(1) p-value 
71.8 (3.3) 28.2 (8.3) 55.6 (1.3) 44.4 (22.2) 5.85 .01 
10 70.6 (6.7) 29.4 (40.0) 45.8 (7.7) 54.2 (32.5) 13.20 .000 
17 35.3 (50.0) 64.7 (36.5) 23.2 (52.6) 76.8 (38.2) 3.85 .04 
18 25.9 (25.8) 74.1 (57.4) 13.4 (29.0) 86.6 (43.2) 5.62 .02 
23 36.5 (75.8) 63.5 (54.5) 21.8 (70.0) 78.2 (56.9) 5.74 .01 
24 28.2 (66.7) 71.8 (68.9) 16.2 (60.9) 83.8 (64.7) 5.85 .01 

Notes: See Table 2 for the statements. Chi-square analyses indicate the significant effects (in bold).

Discussion

We present an online study that surveyed members of the UK general public and assessed sport concussion knowledge. The data showed a reasonable knowledge base on basic aspects of the injury and brain injury in general. Sport concussion was considered a frequent injury with a usually benign outcome that nevertheless requires attention, as a long-term problem and/or brain damage may arise. For the latter, loss of consciousness was not considered a decisive factor. Participants also correctly stated that injury effects were not necessarily accessible to the injured individual and that recovery progress cannot be assessed by introspection. Furthermore, participants accurately recognized the malign effect of any brain damage and repeated trauma, respectively. This knowledge base was also reflected in the nomination of sport concussion indicators.

However, sport concussion understanding also showed some limitation in knowledge, and misconceptions prevailed. The seriousness of sport concussion was clearly underestimated. For example, most participants rejected the idea of increased vulnerability to and likelihood of re-injury following a sport concussion. Similar to past research (Chapman & Hudson, 2010; Gouvier et al., 1988; Guilmette & Paglia, 2004; Hux et al., 2006; O'Jile et al., 1997), knowledge was particularly poor concerning loss of consciousness, memory, and recovery. The UK general public also lacked knowledge on injury mechanisms and recovery assessment. For example, head trauma was one of the most frequently named injury indicators and statement ratings suggested that many participants did not know that a direct head impact may be sufficient, but not necessary to cause brain damage. Furthermore, a substantial proportion considered the injured individual herself/himself as the best source to evaluate recovery progress, even though it was acknowledged that awareness of injury effects might be limited and that the subjective feeling of recovery was not to be equated with objective recovery.

The comparison of misconception rates in definite (true, false) and non-definite (probably true, probably false) statement ratings showed that in a subset of statements, misconception was greater in definite than non-definite responses. For example, on the statement “sports people who have had one sport concussion are more likely to have another,” more than 80% of participants expressed a misconception with great certainty as indicated by the choice of a definite response category (i.e., false). This suggests that selected misconceptions might be well established in the subjective injury constructs, reflecting the way in which the participants perceive the injury, associated symptoms, assessment, and recovery. Thus, the extended analysis approach (i.e., looking at all four response categories instead of collapsing four categories into two) allowed for the discovery that misconceptions differed according to definite and guess responses providing additional understanding about the areas that might need more or more persistent attention to yield changes or corrections in the public's knowledge. For example, a misconception rate of around 10% (collapsed) on the statement “sometimes a second blow to the head can help a sports person remember things that were forgotten” might prompt one to consider this secure knowledge that does not need educational attention. However, the non-definite responses (Table 2) would prove otherwise.

The analysis into the effect of sport concussion self-report on statement rating showed that the participant's experience of sport concussion had no influence on their knowledge. However, the analyses did reveal an effect on the certainty with which (a subset of) statements were rated (as indicated by the choice of definite response options). The finding suggests that personal sport concussion experience might yield a false sense of security, yet the highly individualized nature of the injury might prevent injured persons to deduct knowledge that is valid beyond the personal level. For example, if no emotional symptoms were experienced post-concussion, the survey respondent might have falsely rejected the statement “a sport concussion may cause one to feel depressed, hopeless and sad.” This further emphasizes the need to education.

The study had some limitations. First, we decided to use an online survey to access a wider geographical range of participants from the UK general public rather than using conventional paper methods and testing a sample of participants from the local region. A potential consequence of this decision was that the mean age of the participants was mostly that of young adults; a finding that could have been caused by the younger participants more frequently accessing the Internet. We propose that future studies should aim to assess a balanced aged sample of participants. A second potential limitation concerns Question 18 of the survey (“recovery from SC is usually complete in about a week”). We considered that the statement was false because of recent studies that have mapped abnormalities in symptoms, cognition, and brain function at the chronic recovery stage following sport concussion (e.g., Chen, Kareken, Fastenau, Trexler, & Hutchins, 2003; Chen et al., 2004; De Beaumont et al., 2009; Di Russo & Spinelli, 2010; McAllister et al., 2001; Shehata et al., 2009). However, some participants might have believed that the statement was true. For example, previous studies have found that a majority of participants assessed reported full symptom recovery within 1 week (e.g., McCrea, Kelly, Randolph, Cisler, & Berger, 2002; McCrea et al., 2003). These latter findings may have led to the belief that symptom recovery is the same as cognitive or neural recovery. We suggest that future studies might aim to evaluate whether participants understand or have knowledge about the differences between symptom and cognition or neural recovery following sport concussion.

This is the first study to examine sport concussion knowledge in the UK general public. Our data support other literature and show that the UK general public had limited knowledge or had misconceptions about sport concussion brain injury (Chapman & Hudson, 2010; Weber & Edwards, 2010). Furthermore, our data also suggest that injury experience exerted little influence on knowledge (Hux et al., 2006; Guilmette & Paglia, 2004; O'Jile et al., 1997). These data clearly imply that amateur sport players do not possess the sufficient amount of correct knowledge to self-diagnose sport concussion and take appropriate action (e.g., refrain from sport, seek medical advice). As the recommended multifaceted sport concussion recognition and treatment approach (McCrory et al., 2009) might not be available to the majority of amateur sport players (in the UK), the access to and distribution of easy-to-use tools that assist amateur sport players in self-diagnosing the injury need to be promoted and improved so that greater safety in sport practice can be achieved.

Funding

This work was supported by a University of Birmingham PhD scholarship.

Conflict of Interest

None declared.

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