PATIENT REPORTED OUTCOME SCORES DIFFER IN ADOLESCENTS WHO DISCONTINUE ATHLETIC PARTICIPATION FOLLOWING CONCUSSION

Abstract

Background: Clinical knowledge of concussion injuries and subsequent recovery has grown significantly in recent years. However, an area that has not been well investigated is a patient’s psychological readiness to return to their sport following their concussion and the potential impact the injury may have on their athletic participation. A recent preliminary study on the Concussion Return to Sport After Injury questionnaire showed the outcome to be valid and reliable. Further investigations to determine clinical relevance are warranted to specifically understand the ability of the outcome to correctly identify athletes who are fearful or lack confidence to return back to their main sport. Therefore, the purpose of this study was to investigate if C-RSI scores were different in adolescent athletes who made the decision to discontinue participating in their main sport against those who were remaining in their main sport following a concussion. Methods: As part of clinical care, all concussion patients seen at an outpatient adolescent sports medicine concussion clinic complete a series of patient reported outcomes, which includes the Concussion Return to Sport After Injury Questionnaire (C-RSI), at their initial evaluation and release visit. The C-RSI is a 12-question patient reported outcome designed to measure readiness to return to sport after an injury. Patients who decided not to return to their main sports following their concussion were identified from a prospectively collected database, based on a “no” response to the question “are you planning on returning back to your main sport” (Group 1). A group of gender, age, previous concussion history, main sport and outcome time point (initial visit or final visit) matched patients who answered “yes” to this same question were collected as a control group (Group 2). Description statistics were computer for all patient demographics and C-RSI scores. Student T-tests were completed to determine if differences existed between groups for patient demographics and C-RSI scores. Results: A total of 126 patients were included in this study, with 28 females and 35 males in each group. There were no differences between groups for age (Group 1 - 14.9±2.4 years, Group 2 - 14.9±2.1 years; p=0.938), previous concussion history (Group 1 – 33 patients, Group 2 – 31 patients; p=0.596), or length of recovery (Group 1 – 86±68 days, Group 2 – 69±53 days; p=0.142). Group 1 had an average C-RSI score of 56.2±20.4 at initial evaluation (n=33) and 73.9±20.8 at final visit (n=30), compared to Group 2’s average C-RSI score of 68.1±22.7 (n=33) and 83.1±12.9 (n=30). Group 1 had statistically lower C-RSI scores compared to Group 2 at both initial visit (p=0.011) and final visit (p=0.044). Two thirds of the patients in Group 1 cited fear of getting another concussion (38.1%), family encouraged discontinuation of main sport (33.3%), physician encouraged discontinuation of main sport (8.0%) as the reasons for not continuing. Conclusion: Concussions are challenging injuries that can result in a significant psychological response in patients. Patient reported outcomes have been shown to be beneficial in providing clarifying information regarding how the patient perceives their recovery and overall health. The results from this study demonstrate that C-RSI scores were statistically lower in adolescent patients who decided to discontinue their main sport following a concussion. The use of the C-RSI in clinical practice may help identify patients who are at risk of not returning back to their main sport due to internal and external psychological factors such as fear or lack of confidence. Further investigation is warranted to understand the length of time adolescent patients remain away from their main sport and if they choose to pursue a secondary sport.