Personality Predictors of Time to Return to Play Following Sports-Related Concussion: Analysis of Survey Data from an Undergraduate Sample

Abstract

Objective:

This study aimed to address a gap in concussion literature by investigating the relation between personality and return-to-play. It is important to know that earlier return-to-play places individuals at higher risk of sustaining a new concussion after an initial concussion.

Design:

Participants were undergraduate students recruited from psychology courses in 2019 who reported medically confirmed sports-related concussion and medically advised return-to-play (N = 202). Participants completed an online battery in a supervised lab setting that included self-report survey measures, concussion history items, and behavioral impulsivity tasks. Kaplan Meier analysis and Cox Proportional Hazards models were used to analyze time to return-to-play following participants’ first reported sports-related concussion.

Results:

Results showed that one subdimension of sensation seeking, experience seeking, and two subdimensions of self-reported impulsivity, attentional and motor impulsivity, were positively associated with earlier return-to-play following a sports-related concussion. In contrast, higher levels of conscientiousness were associated with later return-to-play.

Conclusion:

Despite a heterogeneous sample, significant relations were found between timing of return-to-play and sensation seeking, impulsivity, and conscientiousness. As earlier return-to-play can heighten the risk of sustaining a new concussion after an initial concussion, it is important to identify characteristics – such as personality traits – that influence individuals’ return-to-play behaviors.

Over the past several decades, sports-related concussion (SRC) has become a growing public health concern,¹ especially as an estimated 1.8 to 3.6 million SRCs occur every year in the United States. Concussion, a form of mild traumatic brain injury, is a complex pathophysiological event that results in altered mental status.^2–6 Concussions occur when external forces to the head or the body cause the brain to move rapidly within skull. SRCs are those that occur during competitive or recreational sports participation.⁵

In addition to the growing number of diagnosed concussions, Asken and colleagues¹ reported that 30–50% of SRCs go undiagnosed, as some athletes fail to report concussion-causing incidents and their subsequent symptoms. Further, some athletes delay reporting concussion-cause incidents and symptoms. Notably, those who do not report symptoms immediately after the “concussion-causing event” and continue playing are 2.2 times more likely to have longer recovery periods once they do report their symptoms and stop playing than those who report symptoms immediately after the “concussion-causing event” and refrain from play immediately. The likelihood of reporting symptoms and the duration of time that passes before reporting are influenced by multiple factors. These factors include: the drive to continue playing, influence from coaches and parents, altered or intact self-awareness, an understanding or misunderstanding of symptom severity, and the ability or inability to remember an injury-inducing event.^1,5,6 Importantly, failing to report symptoms often elicits premature return-to-play,^1,2 which can increase risk of multiple concussions and adverse effects of injury. This effect is particularly salient during the 7–10 day period of post-concussive vulnerability.^1,2,5,7 Still, it remains unclear why some athletes have, for example, a drive to return to play that supersedes safety concerns and why other athletes are more likely to adhere to guidance from their coaches, training staff, or physicians.

Personality constructs, including sensation seeking, impulsivity, and the Big Five factors of personality have been associated with other health risk behaviors, like substance use, risky sex, and crime, to inform prevention and intervention efforts.^8,9 These findings have been translated to predict high risk sport participation and injury.^10–12 Sensation seeking, a personality construct that has been found to have a positive relation with risky sport participation and injury, is defined as the tendency to seek out novel experiences and the willingness to take risks for these experiences.¹³ Big Five factors like low levels of conscientiousness and high levels of extraversion are also positively associated with risky sports participation.¹¹ These studies have the potential to inform prevention and intervention efforts for SRC. Yet, a recent systematic review by Trinh and colleagues¹⁴ highlights the paucity of studies in this area, as well as the relatively new idea of investigating personality predictors of SRC outcomes and behaviors.

The limited literature available shows that extraversion is positively associated with frequency of heading the ball in soccer;¹⁵ agreeableness is positively linked to reports of undiagnosed SRC;¹⁶ neuroticism is positively associated with post-concussive symptoms;^14,17 finally, there is a positive relationship between history of SRC and sensation seeking and impulsivity.¹⁸ These findings support that personality is associated with SRC behaviors and highlight gaps in current literature. Thus, it is necessary to continue investigating personality predictors in a wide variety of SRC behaviors, including return-to-play timing. A study conducted by Beidler and colleagues¹⁸ found significant associations between history of SRC and sensation seeking and impulsivity. Yet, these researchers did not describe how dimensions of impulsivity, like attentional, motor, and non-planning impulsivity, may differentially predict history of SRC.¹⁹ This current study evaluates potential relations between the dimensions of sensation seeking, impulsivity, and the Big Five factors of personality and return-to-play behaviors following SRC using a retrospective, online assessment battery with self-report survey measures and objective behavioral measures.

Method

Participants and Procedures

The initial sample of participants in this data collection included a total sample size of 1,141 participants (with and without a history of SRC) before filtering reduced the sample size for this particular study. Figure 1 includes information about how the sample was reduced from 1,141 participants to 202 participants. Participants were undergraduate students recruited from introductory psychology courses between March 2019 and December 2019 (N = 202; M_age = 19.58, SD = 1.57, female = 56.2%). All participants in the final sample reported experiencing at least one medically confirmed SRC and reported that they were eventually cleared to return to play by a medical professional. Self-reported demographic information for this sample is included in Table 1. This study conforms to all STROBE guidelines and reports the required information (see Supplementary Checklist). All data were collected following institutional review board approval. All participants consented to participation in written format and received academic course credit for 1 hour of survey completion. Following participation, all participants received debriefing information.

Figure 1.

Filtering process from complete participant sample to participants included in statistical analyses. Data were exclusively used from participants who had a medically confirmed SRC and medical guidance for return to play (RTP).

*Data indicated that all participants with a medical diagnosis of concussion also had medical guidance for return-to-play.

Table 1:

Self-Reported Participant Demographics

	N	%
Sex
Female	113	56.2
Male	88	43.8
Not Specified	2	-
Gender
Woman	113	55.7
Man	90	44.3
Non-binary/Non-conforming	0	0.0
Another Identity	0	0.0
Not specified	0	-
Race
American Indian	8	3.8
Asian	7	3.3
African American	12	5.6
Hawaiian/ Pacific Islander	1	0.5
White	185	86.8
Not Specified	6	-
Ethnicity
Hispanic or Latino	34	17.1
Not Hispanic or Latino	165	82.9
Not Specified	4	-

Data collection occurred in a university laboratory via an online platform using individual, private computer stations monitored by trained research assistants. Following instruction, participants first completed two objective behavioral impulsivity tasks (~15 minutes). Next, participants completed the self-report survey measures (~20–45 minutes). All participants received a random participant ID number, which was used to link objective behavioral data to self-report survey data. To ensure participant confidentiality, no document was created linking participants’ performance or survey responses to their name.

Previous studies have used similar methodology in order to attain a large and representative sample that offers enhanced external validity.^20–23 Cross-sectional survey methods have many advantages including: the ability to attain a larger, more diverse sample, an ease of replicability with other studies, the ability to acquire data on a variety of outcomes and risk factors,^24,25 and the capacity to answer public health questions.²⁵ By including cross-sectional survey methods in the online assessment battery, this study was able to include participants from a wide variety of sports and with injury histories from a range of competition levels.

Measures

Objective Behavioral Tasks

Behavioral impulsivity was assessed using two of four tasks from the Laboratory Measures of Behavioral Impulsivity – Impulsivity Bundle paradigms.²⁶ The two included tasks assess ability to inhibit a prepotent response (GoStop Paradigm) and time perception (Time Paradigm). The GoStop Paradigm is a stop signal task that includes three trial types: no stop trials, stop trials, and novel trials. The variable used to represent this task in this study, “percent inhibited”, was the percent of these trials successfully inhibited when the stop signal was presented at 350ms in the stop trials (M = 39.60%, SD = 27.47). The Time Paradigm assesses time perception. Individuals high in the construct of impulsivity are more likely to have a skewed perception of time such that they feel like time is moving more slowly.¹³ This task asks participants to estimate 1 minute by holding down the left mouse button, five times in a row. This study used the average of these five trials to create a “mean time estimation” variable (M = 56.06 seconds, SD = 8.15).

Self-Report Survey Measures

Sensation seeking was measured using the Sensation Seeking Personality Trait Scale (SSPT; Conner, unpublished data, 2020). This 10-item scale assesses sensation seeking through 2 sub-dimensions: experience seeking, or the tendency to seek out novel or stimulating experiences (i.e. “I love challenging myself with new and interesting tasks”), and risk seeking, or the willingness to take risks for these experiences (i.e. “I have the most fun when I am doing risky or dangerous things”). Responses were recorded using a 5-point Likert scale ranging from “strongly disagree” to “strongly agree”. Cronbach’s alpha values were acceptable to good in the current sample (experience seeking: Cronbach’s α = 0.70, risk seeking: Cronbach’s α = 0.86). Both experience seeking and risk seeking were continuous and normally distributed variables.

Self-report impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11).¹⁹ This 30-item scale includes items assessing for impulsive or non-impulsive behaviors and preferences measured on a 4-point Likert scale ranging from “rarely/never” to “almost always/always”. Analysis and interpretation of this scale is supported at the total score level, the second order factor level, and the first order factor level. In the interest of both the multidimensionality of the construct of impulsivity and parsimony, analyses were conducted in this study on the second order factors of this scale. Second order factors included: attentional impulsivity, or the tendency to lack focus (i.e. “I don’t ‘pay attention’”), motor impulsivity, or the tendency to act without thinking (i.e. “I do things without thinking”), and non-planning impulsivity, or the tendency to lack forethought (i.e. “I say things without thinking”). Cronbach’s alpha values for these factors were acceptable in this sample (attentional impulsivity: Cronbach’s α = .72, motor impulsivity: Cronbach’s α = .67, non-planning impulsivity: Cronbach’s α = .62). All three variables were continuous and normally distributed.

The Big Five personality factors of openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism were assessed using the Ten Item Personality Inventory (TIPI).²⁷ This 10-item questionnaire includes 5, 2-item pairs of statements that each correspond to one Big Five personality trait. Participants responded using a 7-point Likert scale ranging from “disagree strongly” to “agree strongly”. Because this scale includes 2-item measures of individual constructs, internal consistency reliability is not reported. However, this scale typically has good test-retest reliability (r = .80). All five variables were continuous and normally distributed in this sample.

Time to return-to-play was assessed via a self-report question asking, “How long did it take you to return to play following this concussion?” Participants reported return-to-play in the metric of days, weeks, or months. Self-reported time to return-to-play was converted to weeks for analysis. Return to play following SRC in this study was analyzed following participants’ reported first concussive injury that occurred when they were 12 years of age or older.

Analysis Plan

All analyses were conducted using the R version 3.5.3.²⁸ Survival analysis was used to assess the time to return-to-play following an SRC for those that re-engage in the same sport following injury. This analysis included two parts: Kaplan Meier analysis and Cox Proportional Hazards modeling, a form of multivariate regression analysis for investigating predictors of time to an event of interest (i.e. return-to-play). For both types of analysis, the dependent variable remained the same. The dependent variable consisted of two parts: an event indicator and the length of time between concussion occurrence and return to play. The event indicator was a binary variable with “1” representing return-to-play at some point before the study occurred, and “0” corresponding to not yet returning-to-play at the time the survey was completed. The second part of the dependent variable was defined as the number of weeks between SRC occurrence and return-to-play. Individuals who had not returned-to-play by the time the study was conducted (event = 0) were considered censored.

For descriptive Kaplan Meier analyses, all personality factors of interest were used as binary independent variables to assess for significant differences between personality groups (i.e. low and high). The low personality group for each construct was defined as those possessing that trait as the 49^th percentile or below; the high personality group for each construct was defined as those possessing that trait at the 50^th percentile or above. These personality predictors were considered time-invariant (i.e. constant over the study duration).

These Kaplan Meier analyses fit models of the effects of the binary personality predictors on time to return-to-play such that survival curves, or time to return-to-play curves, were plotted for low and high personality groups to assess for significant differences in return to play between these two groups. Subsequent log rank tests were conducted to determine the chi-square statistic for the difference in survival between high and low personality groups. Each personality construct was assessed in a separate plot to investigate differing effects of each individual personality construct on return-to-play behavior. Significance was established as p values < .05.

Before personality variables could be evaluated with return-to-play timing, assumptions were checked to determine an appropriate model for these analyses. Assumptions for Cox Proportional Hazards modeling were met, including proportionality of hazards. Cox Proportional Hazards models were used to analyze the continuous forms of each personality variable as predictors of time to return-to-play. In developing these models, we first evaluated variables that previous research has shown to affect SRC outcomes, as they could influence our primary outcome variable of weeks to return-to-play. These included: 1) severity of injury³ – as measured by presence/absence of loss of consciousness, 2) participant characteristics – sex^3,5 and number of past concussions, either 1 or 2+,^2,3 and 3) environmental/external factors – setting of play (i.e. recreational, club, college),³ adherence to medical guidelines for return to play, and presence/absence of external pressure for return to play.²¹ Variables that were significantly predictive of number of weeks to return-to-play at p <.05 or those at a statistical trend of p = .05 - .10 were subsequently controlled for in the models. As a result, all Cox Proportional Hazards models controlled for setting of play (recreational, club, college).

First, individual models were run such that return-to-play timing was regressed on each personality variable in a separate model to investigate independent effects of each personality construct on return-to-play, controlling for setting of play, as well as to assist in identifying which variables should be included in a final model. Significant personality predictors in these independent models were used in one final model, which was intended to assess for the effects of these personality predictors, holding constant all other significant personality predictors as well as setting of play.

Cox Proportional Hazards analysis results in parameter estimates that are in the metric of log. As a result, these estimates were exponentiated to find a hazard ratio (HR), or the risk of outcome occurrence given a specific interval of time.²⁹ HRs, or the “risk of return-to-play” in this study, were interpreted here as relative risk (RR) estimates. These estimates were interpreted as the percent change in risk of earlier return to play for every one unit increase in each personality construct. These estimates are presented with relevant confidence intervals.

Results

Descriptive statistics

Analyses were conducted on the 202 participants who met study criteria (see Figure 1). The mean number of weeks to return to play was 21.3, with a median return to play of 3 weeks. Time to return to play varied, with a minimum of 0 weeks (immediately) and a maximum of 260 weeks, or 5 years (SE = 3.76). Survival data for the whole sample are included in Table 2.

Table 2:

Survival Data

time	n.risk	n.event	survival	SE	95% CI
0.0	202	10	0.9505	0.01526	0.9099–0.9731
0.5	192	7	0.9158	0.01953	0.8681–0.9468
1.0	185	28	0.7772	0.02928	0.7133–0.8286
1.5	157	5	0.7525	0.03037	0.6869–0.8063
2.0	152	38	0.5644	0.03489	0.4931–0.6295
2.5	114	4	0.5446	0.03504	0.4733–0.6102
3.0	110	23	0.4307	0.03484	0.3618–0.4977
3.5	87	1	0.4257	0.03479	0.3570–0.4927
4.0	86	29	0.2822	0.03167	0.2219–0.3453
5.0	56	2	0.2721	0.03133	0.2127–0.3347
6.0	54	5	0.2469	0.03038	0.1898–0.3081
8.0	49	14	0.1764	0.02692	0.1272–0.2321
12.0	35	4	0.1562	0.02566	0.1099–0.2099
14.0	31	1	0.1512	0.02533	0.1056–0.2043
16.0	30	1	0.1461	0.02498	0.1013–0.1987
24.0	29	2	0.1361	0.02425	0.0929–0.1874
36.0	27	2	0.1260	0.02348	0.0845–0.1761
52.0	25	5	0.1008	0.02132	0.0640–0.1473
56.0	20	1	0.0957	0.02084	0.0600–0.1414
78.0	19	1	0.0907	0.02034	0.0560–0.1355
104.0	18	5	0.0655	0.01754	0.0367–0.1056
156.0	13	5	0.0403	0.01395	0.0189–0.0743
208.0	8	4	0.0202	0.00997	0.0067–0.0476
260.0	4	4	0.0000	-	-

Note: 1 Observation deleted due to missingness

Kaplan Meier

Kaplan Meier and log rank analyses indicated that those low in experience seeking (ESgroup=1) had a higher probability than those high in experience seeking (Esgroup=2) of not returning to play, χ² = 4.2, df = 1, p = .04, and those low in risk seeking had a higher probability of not returning to play than those high in risk seeking, χ² = 6.1, df = 1, p = .01. Those low in motor impulsivity had a higher probability of not returning to play than those high in motor impulsivity, χ² = 4.3, df = 1, p = .04. Those high in conscientiousness had a higher probability of not returning to play than those low in conscientiousness, χ² = 5.4, df = 1, p = .02. These plots are shown in Figure 2.

Figure 2.

Survival probability curve for participants with higher levels of each personality construct (group=2) and lower levels of each personality construct (group=1). ES = experience seeking, RS = risk seeking, Motorgroup = motor impulsivity, Concgroup = Conscientiousness.

Cox Proportional Hazards Models

None of the following variables was significantly associated with weeks to return-to-play: presence/absence of loss of consciousness (p = .99), sex (p = .65), number of past concussions (p =.52), adherence to medical guidelines for return-to-play (p = .25), and presence/absence of external pressure for return to play (p = .65). However, there was a statistical trend, such that competition level was marginally associated with number of weeks to return-to-play, p = .07; thus, we controlled for this variable in all Cox regression models.

Experience seeking, attentional impulsivity, motor impulsivity, and conscientiousness, all emerged as significant predictors of time to return-to-play in separate models. Parameter estimates, relative risk estimates (RR), standard errors (SE), and 95% confidence intervals for both significant and non-significant results are included in Table 3. Significant associations are below:

Table 3:

Cox Proportional Hazard Model Relative Risk

	b	RR	CI	SE	p
Experience Seeking	0.078	1.081	[1.021 – 1.145]	0.029	0.01*
Risk Seeking	0.040	1.041	[0.999 – 1.084]	0.021	0.05
Attentional Impulsivity	0.040	1.040	[1.002 – 1.080]	0.019	0.04*
Motor Impulsivity	0.039	1.040	[1.006 – 1.074]	0.017	0.02*
Non-planning Impulsivity	0.010	1.010	[0.981 – 1.040]	0.015	0.51
Openness to Experience	0.040	1.040	[0.975 – 1.110]	0.033	0.23
Conscientiousness	−0.070	0.932	[0.874 – 0.994]	0.033	0.03*
Extraversion	0.009	1.010	[0.964 – 1.058]	0.024	0.69
Agreeableness	0.042	1.042	[0.971 – 1.120]	0.036	0.25
Neuroticism	0.008	1.008	[0.956 – 1.063]	0.027	0.77
Mean Time Estimation	0.003	1.003	[0.983 – 1.023]	0.010	0.78
Percent Inhibited	0.004	1.004	[0.998 – 1.009]	0.003	0.19

Note:

^*indicates significant results at the .05 significance level

• Hazard of earlier return to play is 8.1% higher for every one unit increase in experience seeking (b = 0.078, SE = 0.029, p =.01, RR = 1.081, CI [1.021 – 1.145]).

• Hazard of earlier return to play is 4.1% higher for every one unit increase in attentional impulsivity (b = 0.040, SE = 0.019, p =.04, RR = 1.041, CI [1.002 – 1.080]).

• Hazard of earlier return to play is 4.0% higher for every one unit increase in motor impulsivity (b = 0.039, SE = 0.017, p = .02, RR = 1.040, CI [1.006 – 1.074]).

• Hazard of earlier return to play is 6.8% lower for every one unit increase in conscientiousness (b = −0.070, SE = 0.033, p = .03, RR = 0.932, CI [0.874 – 0.994]).

These four significant personality constructs (experience seeking, attentional impulsivity, motor impulsivity, and conscientiousness) were included together in one final model to assess for the effects of personality on time to return-to-play, holding constant other significant personality predictors and setting of play. Experience seeking emerged as the only significant predictor of return to play in this model.

• Hazard of earlier return to play is 8.1% higher for every one unit increase in experience seeking (b = 0.077, SE = 0.041, p = .01, RR = 1.081, CI [1.019 – 1.146]).

Discussion

The current study found significant differences in return-to-play timing depending upon personality traits. Typical return to play after SRC occurs within 7–10 days post-injury,^5,7 and the median reported return to play timeline was 3 weeks in this sample. Thus, most of our participants followed a slightly longer than typical return-to-play trajectory. However, the range of reported time to return-to-play was highly variable. Participants reported return-to-play timeframes spanning from the same day of the injury to 260 weeks, or 5 years. As noted earlier, return-to-play timeframes of greater than 5 years were identified as outliers excluded from analyses (see Figure 1).

Our results show that experience seeking, attentional impulsivity, and motor impulsivity are significant predictors of early return-to-play, while conscientiousness is strongly associated with later return-to-play. After an SRC, those high in experience seeking likely find the recovery process less novel and stimulating than participating in sports, and thus return-to-play sooner than others. Those high in attentional impulsivity may attend less effectively to their symptoms or return-to-play guidelines and, as a result, may return to play more quickly. Additionally, those high in motor impulsivity likely act without thinking and thus may return-to-play more quickly without considering potential consequences. A core aspect of high levels of conscientiousness is a drive to be diligent, follow rules, and to take obligations seriously.³⁰ As a result, those high in conscientiousness are probably most likely to adhere to recovery recommendations after an SRC.

The above findings were expected given past research. Future research should continue investigating the differential associations of behavioral and self-report measures of impulsivity on short-term and long-term sports-related injury behaviors. Although there were no significant findings for behavioral impulsivity, agreeableness, extraversion, openness to experience, or neuroticism, all other findings were consistent with past literature. In the final model, experience seeking emerged as the most salient predictor of return-to-play behavior. Specifically, those high in experience seeking were significantly more likely to return-to-play more quickly than those lower in impulsivity. Additionally, because all significant personality predictors (experience seeking, attentional impulsivity, motor impulsivity, and conscientiousness) were included in the model (along with the setting of play as a control variable), the results of the final model underscore that experience seeking is likely a more salient predictor of return-to-play behavior than all other personality traits assessed in this study. Interestingly, two subdimensions of self-reported impulsivity emerged as significant predictors, while behavioral impulsivity measures did not emerge as significantly predictive of return-to-play.

The results of this study align with previous research that has found that sensation seeking is positively associated with risky sports behavior,¹² and, specifically, with SRC.^15,18 The emergence of one subdimension of sensation seeking and two subdimensions of impulsivity as significant predictors of early return-to-play highlights the importance of considering the nuance that may be present in personality subdimensions. It has been established that sensation seeking and impulsivity have distinct developmental trajectories, differing neurological underpinnings, and have varied implications for outcomes in several domains; this also appears to be the case for return-to-play timing following SRC such that some subdimensions of these personality traits were significant while some were not, including behavioral impulsivity.^31,32

Limitations and Future Directions

One limitation of the current study is that personality is just one of many factors that influences SRC behaviors. Previous research has established that a host of psychosocial and environmental factors play an influential role in risk taking in sport,^4,33,34 concussion recovery and rehabilitation,^35,36 and return-to-play.^1,5,6 It is important to recognize that while personality likely influences return-to-play decision-making, it is not the only important contributing factor.

Further, this study’s findings relied upon self-report measures and included retrospective reporting of SRC incidence and return-to-play timing. Thus, some data may be inaccurate, due to unintentional misreporting or misremembering. There also may have been data inaccuracies, as return-to-play estimates were included in the survival analysis in terms of weeks; timing would have been more accurate with specific time metrics of days or hours. However, the retrospective nature of this study required estimates, rather than precise reporting of days or hours.

Nonetheless, the retrospective and self-report limitations of this study are offset by strengths of this methodology. Notably, this methodology permitted data collection from a large, undergraduate sample, and has precedence from past SRC studies.^20–23 Several of these studies have also asked participants to recall sports-related concussions from several years prior including concussion history from high school, college, and professional sports participation.²⁰ The retrospective, self-report nature of this study allowed for inclusion of participants from various sports at a range of competition levels, enhancing its external validity. This study also allowed for participants to report when they actually returned to play, rather than when they were medically cleared to return-to-play as all participants included in analyses reported that they had been cleared to return to play by a medical professional. Interestingly, adherence to medical guidelines was not predictive of return-to-play timeline – thus, it is likely that another mechanism was at play. It is possible that most athletes do adhere to medically advised guidance; however, these athletes may not be reporting symptoms accurately. Individuals may over- or under-report details of their injuries for a variety of reasons. It is important to note that the effects of personality on reported behaviors may reflect the tendency to engage in certain behaviors, as well as a tendency to report such behaviors. In addition to prospectively investigating SRC behaviors longitudinally, future work should consider investigating relationships between reporting accuracy and personality traits.

A final limitation is that the current study did not assess age at time of injury. Age at time of injury has been found to be significantly related to several SRC behaviors like symptom reporting and recovery timeline.² Although this study only included SRCs that were sustained after the age of 12, the exact age at time of injury was unknown. Future research should investigate age to determine if this variable is influential in return to play timeline in models that include personality. Future studies may also benefit from the inclusion of more detailed variables regarding specific symptom duration, SRC complexity, and experiences with SRC sustained prior to the SRC of interest in the study.

Conclusions

Earlier, or premature, return-to-play increases the likelihood of sustaining a new concussion after an initial SRC.⁷ Khurana and Kaye⁵ underscore the importance of following evidence-based return-to-play protocols to prevent incidence of repeat SRCs. The results from this study highlight an important relationship between personality traits and return-to-play timing. It is possible, even likely, that athletes who are high in experience seeking, attentional impulsivity, and motor impulsivity traits may engage in behaviors (e.g. withholding symptom status from medical providers) that allow them to return-to-play more quickly. These athletes may require objective performance assessment, rather than self-report assessment, to determine return-to-play readiness. In contrast, athletes who are high in conscientiousness are more likely to adhere to return-to-play protocols with little to no-additional monitoring. Therefore, it may also be beneficial for medical professionals to include measures of personality as part of their intake paperwork for sports-related injury patients to determine which athletes may be at increased or decreased risk of certain SRC outcomes. This could be one way to reduce new SRC incidence due to premature return-to-play. As more research elucidates the relationship between personality and specific SRC outcomes, medical professionals and athletic trainers may be better equipped to tailor educational, prevention, and interventions efforts based on individualized athlete personality profiles.

Highlights/Summary.

What is known:

It has been established that sports-related concussion is a public health concern, highlighting the imperative to develop more individualized prevention and intervention efforts. Recently, specific personality traits have been significantly associated with sports-related concussion behaviors such as increased likelihood of heading the ball in soccer. A recent review highlights the importance of this research and the paucity of studies in this area.

What is new:

The current study investigated the association between personality traits and return-to-play following sports-related concussion. Sensation seeking, impulsivity, and conscientiousness show differential relations with time to return to play in a large undergraduate sample.