Question Format Matters: Do Athletes Really Know the Signs and Symptoms of a Sport-Related Concussion?

Previous studies commonly utilized a multi-select checklist method to assess an athlete's ability to recognize true sports-related concussion (SRC) signs and symptoms (S&S) amongst incorrect distractor options. However, this may overinflate the evaluation of participants' knowledge since the multi-select method does not test athletes' ability to retrieve knowledge from their long-term memory. To test this hypothesis, an online survey was sent to registered members of the Japan Lacrosse Association (n=8,530) to examine differences in reported SRC S&S by an open-ended question and multi-select formats. We also examined whether previous exposure to SRC education and a history of SRC influenced athletes' SRC S&S knowledge. The number and proportions of responses by participants were calculated using descriptive statistics. Pearson's correlation was used to analyze the relationship between scores from two question formats. Unpaired sample t-tests were used to compare mean scores of each question format by previous SRC education and history of diagnosed SRC. Odds ratio was calculated to express the relationship between the proportion of correct answers by question format per symptom. The response rate of the survey was 35.9% (n=3,065) and revealed that scores from two question formats were correlated (r=0.34, 95%CI=0.31, 0.37; p<0.001). For both question formats, athletes with previous exposure to SRC education and a history of SRC reported a greater number of correct answers; however, the mean differences were trivial. In conclusion, researchers and clinicians should acknowledge the difference between multi-select (recognition) and open-ended (free recall) when assessing one's understanding of SRC and managing athletes with a suspected SRC.