The Development of a Facebook Concussion Management Intervention for Young Persons with a Sports Concussion

Abstract

Background: A concussion is a brain injury caused by direct or indirect forces to the head, and is common in contact and collision sports. The high proportion of younger individuals who participate in contact and collision sports means that a considerable number of concussions involve persons in this demographic group. Medical management of concussion centres on physical and cognitive rest during the early stages post-injury, with the provision of accurate information important in order to facilitate a safe return to sport, education or employment, and recreational activities. The recent advent and continued use of social networking sites (in particular Facebook) amongst the younger population has led this thesis to explore the potential of Facebook to provide best-practice concussion information to individuals recovering from a sports concussion.

Aims: Given the absence of any prior examination of the use of social networking sites to assist the recovery from sports concussion, this thesis explored the use of a Facebook concussion management intervention as an adjunct to traditional medical care. The overall aim of this thesis was:

- To develop a concussion management intervention to be delivered via Facebook.

To achieve this aim, a number of preliminary studies were conducted in order to inform the development of the Facebook concussion management intervention.

Methods: A multi-stage approach was used in the development of the interactive concussive management intervention (termed “iCon”). Following a comprehensive review of the related literature, existing concussion-related websites and Facebook groups were evaluated. The subsequent consultation with key stakeholder groups (young persons with a concussion and doctors whose caseload includes persons with a concussion) assisted in identifying the needs of this cohort and further aided the development of iCon. As well as containing best-practice concussion information, key features of iCon include the provision of real-time feedback from a sports physiotherapist and a doctor, links to high-quality concussion-related websites, and the opportunity to share concussion-related experiences with other users.

Once iCon had been developed it was necessary to trial this intervention under controlled conditions, and a pilot study was used for this purpose. iCon was evaluated using programme evaluation methodology, with the primary focus of the evaluation being measured by the satisfaction of the individuals using iCon. A participant questionnaire was conducted prior to entering the group and upon exiting the group, and objective symptom measurements were taken prior to and following iCon. Data relating to the participants’ use of iCon and their interactions was also sought during this pilot study.

Results: The evaluation of concussion-related websites indicated a variety in the quality, content and readability of the information posted online, whilst the analysis of existing concussion-related Facebook groups showed these to be primarily used by individuals to share experiences relating to their concussion. The stakeholder consultation demonstrated support for the development of iCon, from both young persons who had sustained a concussion (via focus groups), and the doctors responsible for their care after a concussion (via semi-structured interviews).

Eleven participants were enrolled into the pilot study, and all of the participants who were symptomatic upon entering iCon (N=9) saw a reduction in their symptom scores. The primary measure of evaluating iCon was the satisfaction of the individuals using it, with the satisfaction scores and accompanying quotes indicating that the participants were satisfied with iCon. All of the participants (N=11) stated that they would recommend iCon to others, and that they felt comfortable in sharing information within iCon. The majority of participants (N=8) also reported their concussion knowledge had increased as a result of iCon and that iCon influenced their return to play decisions.

Conclusions: The innovative approach taken in this thesis using a Facebook concussion management intervention to assist the recovery from concussion showed promise, and indicated that iCon has a potential role to play as an adjunct to traditional management strategies for concussion. The pilot study of iCon demonstrated that the use of Facebook in this manner showed acceptability within this cohort, and suggests that a larger trial of iCon is warranted.