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Concussion Needs Assessment

Concussion Survey

PC-OTD Capstone Survey:                                                                                                                                        
 

Introductory Paragraph:
Occupational Therapy works with individuals whose ability to engage and pursue occupations have been interrupted by illness, disease, injury, environment, etc.  Occupations are meaningful activities pursued by an individual; they are important for accomplishment and life satisfaction.

This survey is part of an occupational therapy student capstone project.  We are seeking information to better understand the knowledge and awareness surrounding concussions.
 
If you are currently an athlete, former athlete,parent of an athlete, coach, athletic trainer or physician, your participation in this survey would be appreciated. 

Your participation is voluntary and you can skip a question or stop at any point if you need to.  No personal information is collected; there are no foreseeable risks associated with this project. Your survey responses are valued and appreciated but are strictly anonymous and confidential.  The survey will take approximately 15 minutes.
The survey was reviewed/approved by the Institutional Review Board (IRB) of Presbyterian College in Clinton, SC.  If you have any questions or concerns, please contact the IRB Board:  irb@presby.edu.

Thank you for completing our survey! 

Your implied understanding and consent are given when you select START below and begin the survey.
1.What is your gender?
2.What is your age?
3.In what role are you completing this survey? Please select all that apply.
4.Do you currently play a sport?
5.If you played a sport in the past, what sport did you play and when did you stop?
6.Do you know what a concussion is?
7.Rate your knowledge of concussions.
I don't know
Some knowledge
I know a lot
8.In your own words, describe what a concussion is:
9.Have you ever been diagnosed with a concussion?(Required.)
10.If you have been diagnosed with a concussion, please describe how it occurred:
11.As a current or former athlete, if you were diagnosed with a concussion, who assessed you?
12.How many times have you suspected that you had a concussion in your life that was not formally diagnosed? 
13.On a scale of 1-10, please rate how significant a concussion is in your opinion:
14.Please select from the list below, symptoms of concussions (even if you have never had a concussion) of which you are aware. If you do not know of any symptoms, please select ‘None’.
15.In athletics, please rate your level of agreement with the following questions:
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
All head injuries should be formally evaluated.
Mental health is impacted by concussions.
 Concussions are not as important as other sport-related injuries (dislocated shoulder, torn ligament, broken bone, etc.).
16.Please describe your experience with concussions as the athlete, coach, athletic trainer, parent/caregiver, physician, sibling or other: