title: Concussion-Management Practice Patterns of National Collegiate Athletic Association Division II and III Athletic Trainers: How the Other Half Lives.
abstract: BACKGROUND
  The National Collegiate Athletic Association (NCAA) has published concussion-management practice guidelines consistent with recent position and consensus statements. Whereas NCAA Division I athletic trainers appear highly compliant, little is known about the concussion-management practice patterns of athletic trainers at smaller institutions where staffing and resources may be limited.
  
  
  OBJECTIVE
  To descriptively define the concussion-management practice patterns of NCAA Division II and III athletic trainers.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Web-based questionnaire.
  
  
  METHODS
  A total of 755 respondents (response rate = 40.2%) from NCAA Division II and Division III institutions.
  
  
  METHODS
  The primary outcome measures were the rate of multifaceted concussion-assessment techniques, defined as 3 or more assessments; the specific practice patterns of each assessment battery; and tests used during a clinical examination.
  
  
  RESULTS
  Most respondents indicated using a multifaceted assessment during acute assessment (Division II = 76.9%, n = 473; Division III = 76.0%, n = 467) and determination of recovery (Division II = 65.0%, n = 194; Division III = 63.1%, n = 288) but not at baseline (Division II = 43.1%, n = 122; Division III = 41.0%, n = 176). Typically, when a postconcussion assessment was initiated, testing occurred daily until baseline values were achieved, and most respondents (80.6% [244/278]) reported using a graded exercise protocol before return to participation.
  
  
  CONCLUSIONS
  We found limited use of the multifaceted assessment battery at baseline but higher rates at both acute assessment and return-to-participation time points. A primary reason cited for not using test-battery components was a lack of staffing or funding for the assessments. We observed limited use of neuropsychologists to interpret neuropsychological testing. Otherwise, most respondents reported concussion-management protocols consistent with recommendations, including a high level of use of objective measures and incorporation of a progressive return-to-participation protocol.
authors.affiliation: Department of Kinesiology and Applied Physiology, University of Delaware, Newark.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Buckley
authors.affiliation: School of Health and Kinesiology, Georgia Southern University, Statesboro.
authors.forename: Glenn
authors.initials: G
authors.lastname: Burdette
authors.affiliation: Department of Intercollegiate Athletics, Georgia Southern University, Statesboro.
authors.forename: Kassandra
authors.initials: K
authors.lastname: Kelly
mesh_terms: D001265:Athletic Injuries / Q000175:diagnosis / Q000628:therapy*; D001924:Brain Concussion / Q000175:diagnosis / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D000068958:Return to Sport / Q000502:physiology; D013177:Sports / Q000502:physiology*; D013178:Sports Medicine / Q000379:methods; D011795:Surveys and Questionnaires
keywords: baseline testing; mild traumatic brain injury; return to play