CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(06): 469-477
DOI: 10.1590/0004-282X-ANP-2019-0436
Article

Level of knowledge and misconceptions about brain concussion in Brazilian adults

Nível de conhecimento e de equívocos sobre concussão cerebral em adultos brasileiros
1   Universidade de São Paulo, Ambulatório de Reabilitação Cognitiva Pós-Trauma Cranioencefálico, São Paulo, SP, Brazil.
,
1   Universidade de São Paulo, Ambulatório de Reabilitação Cognitiva Pós-Trauma Cranioencefálico, São Paulo, SP, Brazil.
,
1   Universidade de São Paulo, Ambulatório de Reabilitação Cognitiva Pós-Trauma Cranioencefálico, São Paulo, SP, Brazil.
,
1   Universidade de São Paulo, Ambulatório de Reabilitação Cognitiva Pós-Trauma Cranioencefálico, São Paulo, SP, Brazil.
,
2   Universidade de São Paulo, Centro Dr. Jair Minoto Abe, São Paulo SP, Brazil.
,
2   Universidade de São Paulo, Centro Dr. Jair Minoto Abe, São Paulo SP, Brazil.
,
1   Universidade de São Paulo, Ambulatório de Reabilitação Cognitiva Pós-Trauma Cranioencefálico, São Paulo, SP, Brazil.
,
1   Universidade de São Paulo, Ambulatório de Reabilitação Cognitiva Pós-Trauma Cranioencefálico, São Paulo, SP, Brazil.
› Author Affiliations

Abstract

Background: Brain concussion (BC) is seen as a public health priority due to its high incidence and morbidity rate, among thousands of people around the world. There are needs for fast identification, accurate diagnosis and correct management in order to reduce the short and long-term problems relating to BC. Proper knowledge of BC in the population and among clinicians is a critical factor in achieving this. Objectives: To evaluate the level of self-reported BC knowledge and gaps/misconceptions, and to identify variables correlated with this level. Methods: A cross-sectional descriptive survey was performed. A Brain Concussion Knowledge Questionnaire (BCKQ) that had been created to capture data was widely distributed. Total scores, domain partial scores and percentages of correct and incorrect answers were calculated to ascertain the level of knowledge relating to BC. Results: The sample was formed by 1,247 Brazilian adults (age: 41.7±11.8 years). Partial scores of the BCKQ revealed the existence of poor knowledge and misconceptions in all domains of the questionnaire, especially regarding questions about recovery from and management of BC. Moderate correlations between BCKQ scores and professions (p=0.312; P=0.00) or previous brain concussion knowledge (p=0.489; P=0.00) were observed. In a multiple linear regression model, age, profession and sports practice were predictors of BC knowledge. Conclusion: This first study to analyze the level of BC knowledge in a sample of Brazilian adults suggests that poor knowledge and misconceptions are present. Thus, meaningful and useful information was provided by this study for developing health education programs about BC for the population in order to improve fast diagnosis and correct BC management.

RESUMO

Introdução: A concussão cerebral (CC) é considerada prioridade em saúde pública devido à sua alta incidência e taxa de morbidade. Há necessidade de identificação rápida, diagnóstico acurado e manejo correto após essas lesões, com objetivo de reduzir problemas de curto e longo prazo. O conhecimento apropriado da população, atletas e de clínicos é primordial para que isto seja alcançado. Objetivos: Avaliar o nível de conhecimento autorrelatado sobre CC, descrever lacunas/equívocos e identificar variáveis correlacionadas com este nível. Métodos: Foi realizada uma pesquisa descritiva transversal. O Questionário de Conhecimento sobre Concussão Cerebral (QCCC) criado foi amplamente distribuído. Pontuações totais e parciais em domínios e porcentagens de respostas corretas e incorretas foram calculadas para obter o nível de conhecimento sobre CC. Resultados: A amostra foi formada por 1.247 brasileiros adultos (41,7±11,8 anos). Pontuações parciais do QCCC revelaram baixo nível de conhecimento, principalmente em questões sobre recuperação e manejo. Observou-se correlações moderadas entre a pontuação no QCCC e a profissão dos participantes (p=0,312, P=0,00) ou conhecimento prévio sobre CC (p=0,489, P=0,00). A regressão linear múltipla mostrou que a idade, profissão e prática de esportes podem ser preditoras do conhecimento sobre CC. Conclusão: Esse primeiro estudo a analisar o nível de conhecimento sobre CC em uma amostra de adultos brasileiros sugere baixo conhecimento e equívocos sobre esta condição. Assim, informações úteis e significantes foram fornecidas para o desenvolvimento de programas de educação em saúde sobre CC para o público, com objetivo de melhorar a identificação rápida e o manejo correto de concussões.

Authors’ contributions:

AVLA, RAF, CCG, and RW were responsible for designing the study and constructing the questionnaire. AVLA, RA, and RAF wrote the study and critically assessed the methodological quality. JNI interpreted the results, updated reference lists and created tables and figures. RMB and JLCD were responsible for statistical analysis.




Publication History

Received: 17 December 2019

Accepted: 04 August 2020

Article published online:
04 July 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • References

  • 1 Kutcher JS, Giza CC. Sports concussion diagnosis and management. Continuum (Minneap Minn). 2014 Dec;20(6 Sports Neurology):1552-69. https://doi.org/10.1212/01.CON.0000458974.78766.58
  • 2 Jackson WT, Starling AJ. Concussion evaluation and management. Med Clin North Am. 2019 Mar;103(2):251-61. https://doi.org/10.1016/j.mcna.2018.10.005
  • 3 Weber M, Edwards MG. Sports concussion knowledge in the UK general public. Arch Clin Neuropsychol. 2012 May;27(3):355-61. https://doi.org/10.1093/arclin/acs029
  • 4 Finch CF, McCrory P, Ewing MT, Sullivan SJ. Concussion guidelines need to move from only expert content to also include implementation and dissemination strategies. Br J Sports Med. 2013 Jan;47(1):12-4. https://doi.org/10.1136/bjsports-2012-091796
  • 5 Voss JD, Connolly J, Schwab KA, Scher AI. Update on the epidemiology of concussion/mild traumatic brain injury. Curr Pain Headache Rep. 2015 Jul;19(7):32. https://doi.org/10.1007/s11916-015-0506-z
  • 6 Roozenbeek B, Maas AI, Menon DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013 Apr;9(4):231-6. https://doi.org/10.1038/nrneurol.2013.22
  • 7 Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic brain injury: an overview of epidemiology, pathophysiology, and medical management. Med Clin North Am. 2020 Mar;104(2):213-8. https://doi.org/10.1016/j.mcna.2019.11.001
  • 8 Junge A, Dvorak J, Graf-Baumann T. Football injuries during the World Cup 2002. Am J Sports Med. 2004 Jan-Feb;32(1 Suppl):23S-7S. https://doi.org/10.1177/0363546503261246
  • 9 McCrory P, Meeuwisse WH, Aubry M, Cantu RC, Dvořák J, Echemendia RJ, et al. Consensus statement on concussion in sport: the 4th international conference on concussion in sport, Zurich, November 2012. J Athl Train. 2013 Jul-Aug;48(4):554-75. https://doi.org/10.4085/1062-6050-48.4.05
  • 10 Kerr ZY, Zuckerman SL, Wasserman EB, Vegt CBV, Yengo-Kahn A, Buckley TA, et al. Factors associated with post-concussion syndrome in high school student-athletes. J Sci Med Sport. 2018 May;21(5):447-52. https://doi.org/10.1016/j.jsams.2017.08.025
  • 11 Ahman S, Saveman BI, Styrke J, Björnstig U, Stålnacke BM. Long-term follow-up of patients with mild traumatic brain injury: a mixed-methods study. J Rehabil Med. 2013 Sep;45(8):758-64. https://doi.org/10.2340/16501977-1182
  • 12 Silverberg ND, Iverson GL. Etiology of the post‑concussion syndrome: physiogenesis and psychogenesis revisited. NeuroRehabilitation. 2011;29(4):317-29. https://doi.org/10.3233/NRE-2011-0708
  • 13 van Eijck MM, Schoonman GG, Naalt JVD, Vries J, Roks G. Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis. Brain Inj. 2018;32(4):395-402. https://doi.org/10.1080/02699052.2018.1429018
  • 14 Concannon LG, Kaufman MS, Herring SA. The million-dollar question: when should an athlete retire after concussion? Curr Sports Med Rep. Nov-Dec 2014;13(6):365-9. https://doi.org/10.1249/JSR.20190436201904360098
  • 15 Ling H, Morris HR, Neal JW, Lees AJ, Hardy J, Holton JL, et al. Mixed pathologies including chronic traumatic encephalopathy account for dementia in retired association football (soccer) players. Acta Neuropathol. 2017 Mar;133(3):337-52. https://doi.org/10.1007/s00401-017-1680-3
  • 16 McLendon LA, Kralik SF, Grayson PA, Golomb MR. The controversial second impact syndrome: a review of the literature. Pediatr Neurol. 2016 Sep;62:9-17. https://doi.org/10.1016/j.pediatrneurol.2016.03.009
  • 17 Schellinger SK, Munson B, Kennedy MRT. Public perceptions of traumatic brain injury: predictors of knowledge and the effects of education. Brain Inj. 2018;32(11):1377-85. https://doi.org/10.1080/02699052.2018.1492737
  • 18 Costa B, Sousa Filho JL, Dourado JC, Gontijo JAM, Dellaretti MA, Costa BS. Traumatic Brain Injury Epidemiology in Brazil. World Neurosurg. 2016 Mar;87:540-7. https://doi.org/10.1016/j.wneu.2015.10.020
  • 19 Taylor ME, Sanner JE. The relationship between concussion knowledge and the high school athlete's intention to report traumatic brain injury symptoms. J Sch Nurs. 2017 Feb;33(1):73-81. https://doi.org/10.1177/1059840515619683
  • 20 Mckinlay A, Bishop A. Mclellan T. Public knowledge of ‘concussion’ and the different terminology used to communicate about mild traumatic brain injury (MTBI). Brain Inj. 2011;25(7-8):761-6. https://doi.org/10.3109/02699052.2011.579935
  • 21 Melo JRT, Silva RA, Moreira-Junior ED. Characteristics of patients with traumatic brain injury in the city of Salvador, Bahia, Brazil. Arq Neuro-Psiquiatr. 2004;62(3A):711-5. https://doi.org/10.1590/S0004-282X2004000400027
  • 22 Melo JRT, Oliveira-Filho J, Silva RA, Moreira-Junior ED. Prognostic factors about mortality and lethality in head injury. Arq Neuro-Psiquiatr. 2006;63(4):1054-7. https://doi.org/10.1590/S0004-282X2005000600026
  • 23 Rosenbaum AM, Arnett PA. The development of a survey to examine knowledge about and attitudes toward concussion in high-school students. J Clin Exp Neuropsychol. 2010 Jan;32(1):44-55. https://doi.org/10.1080/13803390902806535
  • 24 Wright KB. Researching internet-based populations: Advantages and disadvantages of online survey research, online questionnaire authoring software packages, and web survey services. J Comput-Mediat Comm. 2005;10(3):00. https://doi.org/10.1111/j.1083-6101.2005.tb00259.x
  • 25 Buchanan EA, Hvizdak EE. Online survey tools: Ethical and methodological concerns of human research ethics committees. J Empir Res Hum Res Ethics. 2009 Jun;4(2):37-48. https://doi.org/10.1525/jer.2009.4.2.37
  • 26 Makdissi M, Darby D, Maruff P, Ugoni A, Brukner P, McCrory PR. Natural history of concussion in sport: markers of severity and implications for management. Am J Sports Med. 2010 Mar;38(3):464-71. https://doi.org/10.1177/0363546509349491
  • 27 Meehan WP, D'Hemecourt P, Comstock RD. High school concussions in the 2008–2009 academic year: mechanism, symptoms, and management. Am J Sports Med. 2010 Dec;38(12): 2405-9. https://doi.org/10.1177/0363546510376737
  • 28 Griffin AS, Ranson C, Moore I, Mathema P. Concussion knowledge and experience among Welsh amateur rugby union coaches and referees. BMJ OpenSport Exerc Med. 2017 Sep;3(1):e000174. https://doi.org/10.1136/bmjsem-2016-000174
  • 29 Mulhern S, McMillan TM. Knowledge and expectation of postconcussion symptoms in the general population. J Psychosom Res. 2006 Oct;61(4):439-45. https://doi.org/10.1016/j.jpsychores.2006.03.004
  • 30 King D, Brughelli M, Hume P, Gissane C. Assessment, management and knowledge of sport-related concussion: systematic review. Sports Med. 2014 Apr;44(4):449-71. https://doi.org/10.1007/s40279-013-0134-x
  • 31 Knollman-Porter K, Brown J, Flynn M. A preliminary examination of concussion knowledge by collegiate athletes and non-athletes. Am J Speech Lang Pathol. 2018 May;27(2):778-95. https://doi.org/10.1044/2018_AJSLP-17-0108
  • 32 Waltzman D, Daugherty J. Concussion knowledge and experience among a sample of American adults. J Concussion. 2018 Jan;2:1-11. https://doi.org/10.1177/2059700218769218
  • 33 Cournoyer J, Tripp BL. Concussion knowledge in high school football players. J Athl Train. 2014 Sep-Oct;49(5):654-8. https://doi.org/10.4085/1062-6050-49.3.34
  • 34 Mannings C, Kalynych C, Joseph MM, Smotherman C, Kraemer DF. Knowledge assessment of sports-related concussion among parents of children aged 5 years to 15 years enrolled in recreational tackle football. J Trauma Acute Care Surg. 2014 Sep;77(3 Suppl 1):S18-22. https://doi.org/10.1097/TA.20190436201904360371
  • 35 Chow R, Hollenberg D, Ng W, Pinto D. High incidence of concussion, but low knowledge levels among young adults. Int J Adolesc Med Health. 2018 Sep;32(6). https://doi.org/10.1515/ijamh-2018-0003
  • 36 Gouvier WD, Prestholdt PH, Warner MS. A survey of common misconceptions about head injury and recovery. Arch Clin Neuropsychol. 1988;3(4):331-43.
  • 37 Sullivan L, Pursell L, Molcho M. Evaluation of a theory-based concussion education program for secondary school student-athletes in Ireland. Health Educ Res. 2018 Dec;33(6):492-504. https://doi.org/10.1093/her/cyy034
  • 38 Eagles ME, Bradbury-Squires DJ, Powell MF, Maroun FB. The Impact of a Concussion-U Educational Program on Knowledge of and Attitudes about Concussion. Can J Neurol Sci. 2016 Sep;43(5):659-64. https://doi.org/10.1017/cjn.2016.263
  • 39 Register-Mihalik JK, Williams RM, Marshall SW, Murphy JR, Campbell GC, Guskiewicz KM, et al. Demographic, Parental, and Personal Factors and Youth Aug;53(8):768-75. https://doi.org/10.4085/1062-6050-223-17