A systematic review of concussion education, knowledge, and attitudes in football

Detecting concussion during football games is difficult due to the complexity of the condition. Medical staff may only enter the field to assess players when the injury is recognised by the referee. With no temporary concussion substitutions available, pitch-side testing often depends on medics recognising, or players self-reporting, symptoms. The aim of this review is to provide a summary of the literature examining the concussion education, knowledge and attitudes of players, coaches, medics, and officials in association football. A literature search based on PRISMA guidelines was conducted using PubMed, SPORTDiscus and Web of Science up to 12 January 2024. Papers were ineligible if the outcome of the survey or questionnaire was concussion incidence or over 50% of participants did not play football. A total of 21 studies were included. Of these studies 14 evaluated concussion education,11 evaluated concussion knowledge and 14 evaluated attitudes towards concussion. Study quality was assessed using the appropriate Joanna Briggs Critical Appraisal Tool. Results show that participants who have previously undergone concussion education have greater concussion knowledge. However, concussion attitudes do not appear to improve with increased concussion knowledge. Players are still likely to continue playing while injured in important games. Coaches, and officials have safer attitudes towards concussion than players. Consistency in participant groups and methods used to test knowledge and attitudes was low. All papers included suffer from medium to high risks of bias, therefore the strength of evidence is weak. Published research examining concussion knowledge, attitudes and education in football is limited.