Abstract
Background:
Each year, between 1.1 and 1.9 million sports and recreation-related concussions occur annually in US children aged =18 years. Football has a high concussion incidence relative to other youth sports. This is particularly concerning given recent evidence suggesting sport-related concussions are associated with late-life cognitive and psychological dysfunction in former athletes. Unfortunately, there are currently few proven interventions to prevent concussion in football. The purpose of this study was to evaluate a mentored intervention program designed to teach safe play techniques and thereby reduce head impact frequency and severity in high school football players.
Methods:
In a clustered quasi-experimental study design, the player education intervention program was provided to two out of three teams in year one, two out of four teams in year two, and all four teams in year three. Head impacts were measured using in-helmet accelerometers worn by all players. Head impact data and game video were used to identify “high risk” players on intervention teams to receive individualized mentoring. Players were identified as candidates for intervention based on three criteria: 1) greater than 20% of head impacts sustained to the top of the head, 2) greater than 7% of impacts exceeded 60 g in peak linear acceleration, and 3) player sustained a concussion. High-risk players attended 3 individual or small-group education sessions over 3 weeks with a mentor who analyzed game film to teach safer playing techniques. Intervention effects were evaluated by comparing post-intervention to pre-intervention head impact data. Coach and player satisfaction were assessed to evaluate the program’s acceptability and impact.
Results:
220 athletes (143 intervention; 77 control) participated. Of these, 32 (14%) were classified “high risk” with playing techniques amenable to intervention. Overall, 21 (66%) of mentored athletes demonstrated a reduction in top-of-head impacts (considered a high-risk impact zone) and 17 (53%) of mentored athletes demonstrated a reduction in high magnitude (>60 g) hits. On average, the proportion of top-of-head impacts dropped 2.75% in mentored players, and 2.04% in non-mentored players. The proportion of head impacts classified as high-magnitude (>60 g) dropped 1.07% from pre- to post-intervention in mentored players. There was minimal (<1%) change in high magnitude impacts in non-mentored players. In post-season exit surveys, most mentored players “agreed” (n=18, 69%) that his playing behaviors improved because of the study. Most intervention team coaches thought the study was “effective” (n=31, 97%).
Conclusions/Significance:
Mentoring effects were modest; however, athletes and coaches viewed the program as effective. Behavioral interventions have potential to reduce head impact frequency and severity in football but may require more intensive mentoring than the 3-session model tested in this study.
Tables/Figures:
Participant age and primary position by year and study arm.
| Year 1 | Year 2 | Year 3 | ||||||
|---|---|---|---|---|---|---|---|---|
| Mentor | Non-Mentor | Control | Mentor | Non-Mentor | Control | Mentor | Non-Mentor | |
| Total, n (%) | 11 (8.8) | 65 (68.0) | 29 (23.2) | 5 (3.9) | 68 (53.1) | 55 (43.0) | 12 (13.8) | 75 (86.2) |
| Age, years (range) | 16.4 | 16.14 | 15.88 | 17.3 | 15.96 | 16.36 | 17.33 | 16.69 |
| (14.2-17.5) | (13.9-19.2) | (14.1-17.9) | (16.7-17.8) | (14.1-18.2) | (14.1-18.3) | (15.4-18.9) | (14.1-18.8) | |
| Primary Position, n (%) | ||||||||
| Offense | 5 (45.5) | 40 (47.1) | 19 (65.5) | 1 (20.0) | 42 (61.8) | 34 (61.8) | 7 (58.3) | 45 (60.0) |
| Defense | 6 (54.5) | 36 (42.4) | 9 (31.0) | 4 (80.0) | 20 (29.4) | 20 (36.4) | 5 (41.7) | 29 (38.7) |
| Special Teams | 0 | 3 (3.5) | 0 | 0 | 2 (2.9) | 0 | 0 | 0 |
| Uncertain | 0 | 0 | 0 | 0 | 4 (5.9) | 1 (1.8) | 0 | 0 |
| Missing | 0 | 6 (7.1) | 1 (3.4) | 0 | 0 | 0 | 0 | 1 (1.3) |
Average frequency of top-of-head impacts and head impacts greater than 60g per player across mentoring period. Percent change reflects the average percent change per player from pre- to post-mentoring session
| Average Top of Head Hits/Player | Average Hits >60g/Player | |||||||
|---|---|---|---|---|---|---|---|---|
| Pre | During | Post | % Change | Pre | During | Post | % Change | |
|
|
46.6 | 20.0 | 29.0 | 2.75 | 20.0 | 9.0 | 11.2 | 1.07 |
|
|
16.5 | 16.2 | 11.1 | 2.04 | 6.2 | 5.7 | 4.4 | 0.06 |