Context

Medical disqualification (MDQ) following concussion is a challenging decision clinicians may encounter with little evidence-based guidance.

Objective

We aimed to 1) describe the MDQ following concussion cases athletic trainers (ATs) have been involved in, 2) describe beliefs about MDQ following concussion, and 3) explore factors that ATs believed should be involved in the MDQ following concussion process.

Design

Mixed methods

Setting

Online cross-sectional survey with follow-up semi-structured interviews.

Participants

ATs (n=502) employed at the collegiate setting completed a survey (completion rate=82.3%, n=413/502; male=175, 34.9%; female=235, 46.8%, prefer not to answer=4, 0.8%; no response=88, 17.5%; age=35.3±10.8 years). Twenty participants were also interviewed (males=13, 65.0%; females=7, 35.0%; average age=40.7±11.0years).

Data Collection and Analysis

Participants completed a cross-sectional survey comprised of three sections of MDQ experience and specific case information, MDQ beliefs, and demographic items. We also interviewed participants that completed the survey and indicated involvement in at least one MDQ following concussion case. We addressed aims 1 and 2 using descriptive statistics and aim 3 with a five-cycle content analysis.

Results

Nearly half of respondents had been involved in an MDQ case following concussion (49.0% n=246; not involved=51.0%, n=256). ATs who had been involved in at least one MDQ case had involvement in an average of 2.3±1.9 cases (n=241). Participants often described many factors they believed should influence the MDQ decision including sport type, concussion history and recovery, health-related quality of life, and academic performance.

Conclusions

Our findings highlight that nearly half of participants were involved in an MDQ case following concussion and navigated this process without guidelines. Given this, multiple factors were considered to evaluate the patient’s well-being holistically. The number of ATs involved in MDQ cases following concussion and factors that guided this process warrant further research to develop evidence-based recommendations that assist clinicians in these difficult decisions.

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Author notes

Tamara C. Valovich McLeod, PhD, ATC, FNATA, FNAK, FNAP John P. Wood, D.O., Endowed Chair for Sports Medicine Chair, Department of Athletic Training Professor and Director, Athletic Training Programs Research Professor, School of Osteopathic Medicine in Arizona A.T. Still University 5850 E. Still Circle, Mesa, AZ 85206 [email protected]

Kimberly Detwiler, DAT, ATC Lecturer, Coordinator of Clinical Education School of Exercise and Nutritional Sciences San Diego State University 5500 Campanile Drive, San Diego, CA 92182 [email protected]

Julianne D. Schmidt, PhD, ATC Associate Professor Department of Kinesiology University of Georgia 330 River Road, Athens, GA 30605, USA [email protected]

Conflict of interest: None