An Investigation of the awareness and knowledge of concussion in equestrian athletes

Introduction: Concussion has become more apparent in sporting activities (McCrory et al. 2017) across the world. There has been attempts to increase awareness of concussion in sports such as football and rugby. Whereas, in equestrian sport there has been no attempt despite the injuries reported. It has been reported that 48% of participants with an equestrian trauma in a study from Ball et al. (2009) suffered head injuries. Concussion was 18% of the injuries reported in point to point racing between 1993 and 2006 in Great Britain (Balendra et al., 2006). This study aimed to investigate the following: (1) Do athletes know what concussion is? (2) Do athletes know how to recognise concussion? (3) Do national governing bodies provide information on concussion?
Methods: Fifty-four equestrian athletes were recruited from advertisement of the study at equestrian venues, on social media and Hartpury email distribution to staff and students. The questionnaire was carried out online in which the survey was open for six weeks. The inclusion criteria for participants was that all subjects were equestrian athletes or working in the equestrian industry. Participants had to have a minimum of 3 years’ experience of riding or working in the equine industry, had to have competed their horse(s) in unaffiliated or affiliated competitions within the last six months or/and have been active within their coaching or volunteering and be actively involved in care or management of horses on a regular basis. Subjects had to be aged 18 years or older. Participants were excluded if they have had concussion 23 days prior to taking part or they were a medical professional. This questionnaire consisted of two sections; section one gathering personal information and the participant’s background on concussion. Section two gathering information on the participant’s knowledge of concussion. These questions consisted of both multiple choice and open-ended questions. Results were coded then analysed for correlations between answers in section two and personal variables in section one.
Results: In this study, 70% of participants were aged 18-35 years old, 19% 35 – 50 years old and the remaining over 50 years old. Fifty six percent of participants compete at affiliated level, 46% at unaffiliated level and the remaining 2% did not compete. Participants participated in multiple disciplines. Eighty-nine percent of participants were part of a National Governing Body. Eighty three percent of participants had never received information on concussion from a national governing body. Only 17% of participants had ever had training on concussion. None of the variables mentioned above were able to directly correlate with participants ability to correctly define concussion or answer all the multiple-choice questions correctly. Spearman’s Rho correlation test was used to test for correlation due to data being non-normally distributed. Participants of a higher level were able to state more signs and symptoms than those who compete in a lower level. Number of signs and symptoms listed and having a personal experience of concussion was present.
Discussion & Conclusion: The percentage of correct answers for the majority of each multiple-choice question in this study were over 70%. This shows that athletes had good knowledge. However, questions on concussion definition and the onset of concussion were 40.7% and 11%, which shows that these are areas for education. The correct definition of concussion, ‘a traumatic brain injury’ (McCrory et al., 2017) was given by less than half of the participants (40.7%). This shows that riders are unaware that concussion can affect the brain. It was a common answer that participants gave signs and symptoms instead of a definition as the answer. This can mean that people can recognise a concussion from the symptoms but not know what impact this has had on the body. Eleven percent of participants knew that symptoms can occur up to 10 days post trauma (McCrory et al., 2012). This shows that 89% participants are unaware of the delayed onset of concussion, again a lack of education and awareness. The average number of signs and symptoms listed by participants was 4.7 (SD 2.05). Higher-level athletes were able to provide more signs and symptoms. This can show that the higher-level competitors may have a better knowledge or have seen more concussions in which to learn from (Baker et al., 2012). The experience of having a concussion and the number of signs and symptoms given was also a positive correlation. This shows that athletes learn from their experiences and could recognise when they had a concussion. The lack of education regarding


the consequences of returning to riding after concussion was also highlighted in this study. No participant mentioned the return to play protocol following a concussion as recommended by McCrory et al. (2017). However, participants were aware of the consequences of continuing to ride with a concussion. Eighty three percent of participants had never received information on concussion from a national governing body. An expected result due to the lack of concussion information on the public domain from equestrian national governing bodies. For equestrian athletes, this means that they may not recognise a concussion, or what to do if someone has one, allowing for further consequences as their current knowledge may not come from a reliable source. There was no correlation between receiving information and age, level or being able to provide the correct definition. Despite this, 17% of participants had received training on concussion however this did not impact their ability to define concussion therefore this questions who supplied the training and was information retained. Further educational interventions are needed from National Governing Bodies to improve participant’s knowledge and awareness of concussion.