CATT Evaluation Report - 2017 FINAL SKB Final Edits · 2017. 9. 8. ·...

1 | CATT for Team Officials | BC Hockey Evaluation 2017

BC Hockey Concussion Policy Evaluation: Concussion Awareness Training Tool for Team Officials August 2017


The BC Injury Research and Prevention Unit (BCIRPU), established in August 1997, is located at BC Children’s Hospital and is a core research program within the Evidence to Innovation theme at the research institute of BC Children's Hospital. BCIRPU also serves as a training centre, and the staff at the Unit may hold faculty appointments at the University of British Columbia. BCIRPU was established as a strategic entity, blending the need for research and evidence with best practices and the development of policies and programs to reduce injury in BC. Authors: Kyle Scoten, Kate Turcotte, Shelina Babul Acknowledgements: We would also like to extend our appreciation to Fahra Rajabali for her assistance with data analysis. Funding for the BC Hockey evaluation of the Concussion Awareness Training Tool (CATT) online course for BC Hockey team officials was provided by the Community Health Endowment Fund and the BC Injury Research and Prevention Unit. BC Injury Research and Prevention Unit F508-‐4480 Oak Street Vancouver, BC V6H 3V4 Email: [email protected] Phone: (604) 875-‐3776 Fax: (604) 875-‐3569 Website: http://www.injuryresearch.bc.ca Reproduction, in its original form, is permitted for background use for private study, education instruction and research, provided appropriate credit is given to the BC Injury Research and Prevention Unit. Citation in editorial copy, for newsprint, radio and television is permitted. The material may not be reproduced for commercial use or profit, promotion, resale, or publication in whole or in part without written permission from the BC Injury Research and Prevention Unit. August 2017 Photo Credits: Cover photo: ppc.cattonline.com; p. 5: panko971/Shutterstock; p. 6: BC Hockey. 2017 BC Hockey Annual General Meeting (AGM); p. 11: Click Images/ Shutterstock; p. 17: Ron Chapple/Dreamstime.com.


Table of Contents Overview ................................................................................................................................ 4

Introduction ........................................................................................................................... 5 Rationale..................................................................................................................................... 6 Objectives ................................................................................................................................... 6

Methods ................................................................................................................................. 7 Data Analysis .............................................................................................................................. 7

Results .................................................................................................................................... 8 Demographics ............................................................................................................................. 9 Knowledge ................................................................................................................................ 10 Attitudes ................................................................................................................................... 11 Notable Cross-‐Tabulations ....................................................................................................... 17 Participant Feedback ................................................................................................................ 26

Discussion ............................................................................................................................. 28 Limitations ................................................................................................................................ 28

Next Steps ............................................................................................................................ 29

References ............................................................................................................................ 30

Appendices ........................................................................................................................... 31

Appendix A—Email Introduction ........................................................................................... 32

Appendix B—CATT Evaluation Survey ................................................................................... 33

Appendix C—Results Tables .................................................................................................. 36 Awareness ................................................................................................................................ 36 Knowledge ................................................................................................................................ 37 Attitudes ................................................................................................................................... 38 Demographics ........................................................................................................................... 41

Appendix D—Results Tables for Notable Cross-‐Tabulations .................................................. 43


Overview A concussion is a brain injury caused by a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head. A concussion results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. When managed appropriately most concussions resolve without complications; however, symptoms may be prolonged in some cases.

The real dangers of most concussions occur when the injury is not recognized or the player is not managed properly. Returning to activities too early can put a player at increased risk for future concussions and serious complications. If a player suffers subsequent concussion before having recovered from a previous concussion, the effects can be worse and result in more serious complications.

Coaches, including community volunteer coaches, need to know the principles of concussion recognition, response, and management in order to identify high-‐risk situations and take appropriate action when a player sustains an injury that could cause a concussion.

The Canadian Paediatric Society recommends that anyone involved in child and youth sport should be educated about the signs and symptoms of concussion and the appropriate management of a child with a concussion. In June 2016, the Concussion Awareness Training Tool (CATT) [www.cattonline.com] online course for Coaches was mandated by BC Hockey to be completed by all team officials prior to the start of the 2016-‐2017 hockey season [1].

CATT for Coaches was developed to provide up-‐to-‐date educational training on the recognition, response, management, and prevention of concussions in the form of:

• Online course for coaches • The Concussion Response Tool (smartphone accessible and fillable) • The Return to Sport tool • Situational and knowledge-‐based questions • Frequently asked questions • Printable handouts, related websites, journal articles, and additional resources

The objectives of this evaluation were to determine whether the CATT training led to positive changes in knowledge around concussion recognition and management among BC Hockey team officials, as well as to explore the level of interest in mandating the CATT training for the parents of BC Hockey players. Participant feedback will also be used to enhance the CATT website.

A total of 1,735 online surveys were collected. Overall, BC Hockey team officials reported a significant increase in concussion knowledge following the CATT training; and that extending the CATT training mandate to the parents of BC Hockey players should be strongly considered.

Proper concussion management may decrease the risk of brain damage and potentially reduce long-‐term health issues. CATT is currently being updated to incorporate the 5th International Consensus Statement on Concussion in Sport. Funding for this project was provided by the Community Health Endowment Fund and the BC Injury Research and Prevention Unit.


Introduction Concussion, a mild traumatic brain injury (mTBI), has received a growing amount of attention in recent years, particularly amongst those in the sporting community, with a coinciding increase in levels of awareness and concussion-‐based research. Among children and youth in Canada who visit an emergency department for a sports-‐related head injury, 39% were diagnosed with concussions, while another 24% were possible concussions [2]. Further, rates of reported sport-‐related head injuries have increased in Canada over the past decade, as hockey, football, and soccer have all shown a greater than 40% increase in rates of reported head injury between 2004 and 2014 among children and youth [2].

A concussion is caused by a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head. It is important to note that a concussion can result in a range of clinical signs and symptoms that may or may not involve a loss of consciousness [3]. Symptoms can be somatic (ex. headache), cognitive (feeling foggy) and/or emotional (lability), while other domains include physical signs, balance impairment, behavioral changes, cognitive impairment, and sleep/wake disturbances [3]. Recommended treatment following a concussion involves a period of cognitive and physical rest during the acute stage (24-‐48 hours) after the injury, followed by gradual and progressive return to activity while staying below the cognitive and physical symptom-‐exacerbation threshold [3].

Although symptoms experienced typically resolve within a few days or weeks following a concussion, some individuals experience persistent symptoms for several months after the injury. Research suggests that 15% of individuals with a history of mTBI suffering from deficits one year after injury [4]. For those experiencing persistent symptoms and impairments following injury, a variety of treatments may be required, with data supporting interventions including psychological, cervical, and vestibular rehabilitation [3].

Returning to sport too quickly following a concussion may also lead to recovery complications and places an athlete at increased risk of sustaining a subsequent concussion [5]. As a result, it is crucial that parents, players, and coaches be supported in becoming better educated on the recognition, response, and management of concussion, and made aware of the increased risks of returning to play too soon following a concussion [6].

The 2016 Consensus Statement on Concussion in Sport is the most up-‐to-‐date set of principal messages regarding the ever-‐evolving science of sport-‐related concussion [3]. This resource includes discussion on the 11 ‘R’s of sport-‐related concussion: Recognize; Remove; Re-‐evaluate; Rest; Rehabilitation; Refer; Recover; Return to sport; Reconsider; Residual effects and sequelae; and Risk reduction.

Despite this work, uncertainty and controversy still exists amongst the sports medicine community on the proper practices for diagnosis and management of sport-‐related concussion [7]. As a result, there is a need for a valid and standardized protocol for the recognition, response, and management of sport-‐related concussion to be widely adopted by those in the BC sporting community.


This initiative provides the opportunity to evaluate the Concussion Awareness Training Tool (CATT) [www.cattonline.com] online course for Coaches as an educational resource, in order to improve concussion awareness, management, and prevention.

Rationale

The failure to appropriately recognize sport-‐related concussion may be due to a lack of a well-‐accepted and standardized approach for the recognition of signs and symptoms of a concussion [8]. While few research studies have focused specifically on concussion in young athletes, studies have found that age and developmental factors play a role in recovery from concussive brain injury, with longer recovery times expected amongst young patients as compared to adults [9]. A valid and standardized protocol for recognizing, responding to, and managing concussion in young athletes has yet to be widely adopted by the sporting community.

The Canadian Paediatric Society recommends that anyone working with children should be educated on the signs and symptoms of concussion and the appropriate management of a child with a concussion [10]. Research has shown that children benefit from a controlled, gradual return-‐to-‐school process following a concussion. A similar stepwise return-‐to-‐sport process is recommended for children as they return to physical activity following a concussion. Not following a stepwise process when returning to normal functioning can result in a child’s symptoms being prolonged, and if a subsequent head injury is sustained, can lead to further complications.

This project aims to evaluate the effectiveness of CATT for Coaches as an educational concussion training resource for BC Hockey team officials.

Impact: Adoption of a standardized protocol for the recognition, treatment, and management of concussion has the potential to reduce adverse outcomes as a result of a concussion, and decrease risks associated with returning to sport too soon following a concussion. This initiative has the potential of reducing long-‐term health care costs among these individuals.

Objectives In partnership with BC Hockey, the objectives of the evaluation of the CATT online course for Coaches are:

1. To assess the effectiveness of the online Concussion Awareness Training Tool (CATT) course for Coaches as an educational tool for BC Hockey team officials.

2. To examine the level of support in mandating the CATT course for parents of BC Hockey players.

3. To enhance the CATT website using participant feedback.


Methods The evaluation focused on officials who had completed the CATT online course for coaches prior to the 2016-‐2017 hockey season, as mandated by BC Hockey in June 2016.

Inclusion Criteria: BC Hockey officials who completed the Concussion Awareness Training Tool (CATT) online course for coaches prior to the start of the 2016-‐2017 hockey season.

Exclusion Criteria: BC Hockey officials who did not completed the Concussion Awareness Training Tool (CATT) online course for coaches prior to the start of the 2016-‐2017 hockey season.

Recruitment: BC Hockey officials were recruited via email invitation (Appendix A) sent out by BC Hockey. Potential participants were invited to participate in the study, and directed to follow a link to an online survey (Appendix B).

Sample Size: In order to obtain a representative sample size for our population with a margin of error of 5% and a 95% confidence level, a sample size of at least 375 was required.

An online survey was administered using REDCap (https://projectredcap.org/), a secure browser-‐based software.

Participants completed the survey in June 2017, following the completion of the BC Hockey league season.

Participants who completed the study were entered into a draw for an Apple Watch, as well as prizes provided by BC Hockey.

Data Analysis

Data were analyzed to assess changes in concussion knowledge and attitudes following the CATT online training. Summary statistics are presented. A paired t-‐test was used to determine the effectiveness of the CATT training in raising levels of concussion knowledge. Additionally, the level of interest in extending the CATT training mandate to parents of BC Hockey players was studied using both quantitative and qualitative analysis. Data on differences in personal experience with concussion between demographic groups was also studied.


Results A total of 1,735 BC Hockey officials responded to the invitation to participate in this study. Of these, 93.1% had visited the CATT website and 91.7% had completed the CATT online course for Coaches prior to the 2016-‐2017 hockey season. Furthermore, 28.7% of survey respondents reporting being aware of the CATT online course prior to its mandate by BC Hockey (Table 1).

A total of 1,593 participants who completed the CATT online training qualified to participate in this evaluation, representing a greater than 10% response rate.

BC Hockey 69.8% Family/Friend 14.9% Email/Newsletter 13.2% Fellow On-‐Ice Official 12.3% Media (news, newspaper, magazine, etc.) 4.8% Internet Search 2.4% Poster/Brochure 1.5% Other 13.0%

Table 1. Where Did You Hear About CATT Prior to its Mandate by BC Hockey? (Multiple Answers Possible; N=463)


Demographics

BC Hockey officials were represented in this study by 67% self-‐identifying as male and 30% self-‐identifying as female (Table 2). Fewer than five respondents self-‐identified as non-‐binary, and 3% of respondents did not answer the question. Responses by all participants are represented in the following results, with the exception of data cross-‐tabulated by gender.

Of all participants who responded to the demographic questions, 50% were 25-‐44 years of age (Table 3), roughly one third had 2-‐4 years of experience as a hockey official (Table 4), and 76% identified as having personally dealt with or known someone who has suffered a concussion (Table 5).

Participant Demographics (N=1,593)

Table 2: Self-‐Identified Gender*

Male 66.6% Female 30.4% Non-‐Binary 2.8%

Table 3: Age of Participants

18-‐24 1.6% 25-‐44 50.0% 45-‐64 44.8% 65+ 0.8% Missing 2.8%

Table 4: Years as a Hockey Official

1 13.9% 2 to 4 32.3% 5 to 10 30.6% >10 19.8% Missing 3.5%

Table 5: Experience with Concussion

Yes 76.1% No 21.0% Missing 2.8%

*: Fewer than five respondents self-‐identified as non-‐binary, and were therefore not included in any data relating to self-‐identified gender only. Non-‐binary respondent data was included in all other results.


Knowledge

The following section presents self-‐reported concussion knowledge score results before and after completing the CATT online course for Coaches, as captured by question K1 (Appendix C).

When asked to rate their level of concussion knowledge on a scale from 1 to 5, where 1 is “Minimal Knowledge” and 5 is “Very Knowledgeable”, before and after completing the CATT training, concussion knowledge scores were found to be statistically significantly higher after completing the CATT training (p<0.001). Before completing the CATT training, only 34.3% of officials were scoring their concussion knowledge at a 4 or higher, whereas after completing the training, 92.9% of officials rated their concussion knowledge at a 4 or higher (Figure 1, Table 6).

Concussion Knowledge Pre-‐CATT Median Score

Post-‐CATT Median Score

P-‐value

Knowledge Change (N=1,593) 3.14 4.3 p<0.001

Figure 1. Comparison of self-‐reported concussion knowledge scores before and after completing the CATT training.

Table 6. Median concussion knowledge scores before and after completing the CATT training, and p-‐value for paired t-‐test change in concussion knowledge.

How much did you know about concussions (a) prior to, and (b) after completing the CATT online course? (N=1,593)


Attitudes

The following section presents participant attitudes towards different aspects of the CATT training (Appendix C).

Responses to questions A1-‐A4 were given on a scale from 1 to 5, where 1 was “Not at all” and 5 was “Very”.

A1-‐A4: When examining results for the relevance (Figure 2), organization (Figure 3), and overall satisfaction regarding the CATT material (Figure 4), as well as likelihood of recommending the CATT training to others (Figure 5), satisfaction scores were high for all categories, with all categories having greater than 84% of respondents scoring a satisfaction score of at least 4.

A1. How relevant is the material included in the CATT online course? (N=1,575)

Figure 2. Level of satisfaction regarding the relevance of material included in the CATT course.


A2. How well organized is the information covered in the CATT online course? (N=1,575)

A3. How satisfied are you with the CATT online course overall? (N=1,575)

Figure 3. Level of satisfaction regarding the organization of information in the CATT course.

Figure 4. Level of overall satisfaction with the CATT course.


A4. How likely are you to recommend the CATT online concussion training to others? (N=1,575)

Figure 5. Likelihood of recommending the CATT course to others.


A5: When judging the amount of information included in the CATT training, most respondents were in agreement that an appropriate amount of information is included in the course. A similar proportion of respondents felt that the course included ‘too little’ (7%) or ‘too much’ (5%) information (Figure 6).

A6: The amount of time spent completing the CATT training was found to be appropriate for a large portion of respondents, as the online course requires a minimum

of 30 minutes to 1 hour to complete (Figure 7). Furthermore, a considerable number of respondents reported spending more than an hour on the CATT website, which may indicate further exploration of the CATT resources, while only a small number of respondents reported spending less time than the minimum time required. Many respondents commented that they did not remember the amount of time they spent completing the concussion training, as this training had taken place several months prior to the survey.

A5. How would you rate the amount of information covered in the CATT online course? (N=1,565)

A6. How much time did you spend completing the CATT online course? (N=1,565)

Figure 6. Evaluation of the amount of information covered in the CATT course.

Figure 7. Amount of time spent completing the CATT training.


A7: Participants were asked whether they experienced a situation during the 2016-‐2017 hockey season where a player sustained a possible concussion. The majority of officials did report experiencing a possible concussion situation this past season (Figure 8).

A8: For those who had experienced a possible concussion situation during the 2016-‐2017 season, a large majority stated that the CATT prepared them to handle the situation appropriately (85%), while a very small proportion of participants felt that the CATT training did not at all prepare them to handle the situation (2%) (Figure 9). Many of those who reported feeling only somewhat prepared to handle such a situation appropriately suggested that a quick reference guide to the protocol would have been beneficial.

A9: When respondents were asked whether the CATT training raised awareness and knowledge on concussion, 91% of participants answered “Yes”, while 7% answered “I don’t know” (Figure 10).

A10: When asked whether a BC Hockey should mandate the CATT training for the parents of players, 68% were in favour, with 15% against a potential mandate (Figure 11). Many of those who were against a CATT mandate for parents stated that the burden of the time commitment to complete the course, and administrative challenges surrounding such a requirement as reasons against a mandate for parents. Comments were made both in favour of parents understanding more about the mandated response to potential concussion situations (e.g. why their child is being taken off the ice), as well as against increasing parents’ knowledge in this area (e.g. parents may try to have other children taken off the ice to give their own child an advantage).

A7. During the 2016-‐2017 season, did you

experience a situation where a player sustained a possible concussion? (N=1,565)

A8. Did the CATT online course prepare you to handle the situation appropriately? (N=891)

Figure 8. Proportion of officials who dealt with a possible concussion situation during the 2016-‐2017 hockey season.

Figure 9. Level of preparedness for handling a possible concussion situation acquired through completing the CATT training.


A10. Do you think that BC Hockey should mandate concussion training for the parents of players registered with BC Hockey? (N=1,553)

Figure 10. Attitude regarding whether the BC Hockey mandated concussion training resulted in an increase of concussion awareness and knowledge.

Figure 11. Attitude regarding mandating the CATT training for parents of BC Hockey players.

A9. Do you think that the concussion training mandated by BC Hockey has raised awareness and knowledge on concussion recognition and management? (N=1,553)


Notable Cross-‐Tabulations

The following section presents some of the notable results obtained from cross-‐tabulations of the data collected (Appendix D). Cross-‐tabulations were performed comparing response rates for all survey questions by the following:

• Age • Self-‐identified gender* • Years involved as a hockey official • Experience with concussion (self or other) • Time spent completing the CATT online course • Awareness of the CATT online course prior to the mandate by BC Hockey

*: Fewer than five respondents self-‐identified as non-‐binary, and were therefore not included in any data relating to self-‐identified gender only. Non-‐binary respondent data was included in all other results.

CT1: Comparing the likelihood of recommending the CATT training to others by age or respondents, participants in the 65+ age group were most likely to recommend the CATT concussion training to others, as compared to other age groups. It should be noted that the number of respondents in the 65+ age group was small (n=12) compared to the other age groups (Figure 12).

CT1. How likely are you to recommend the CATT online concussion training to others? * What is your age? Cross-‐tabulation (N=1,549)

Figure 12. Comparison of the likelihood of recommending the CATT course to others, by age of team official.


CT2: Concussion knowledge scores were virtually identical between males and females before completing the CATT training (Figure 13a). After the training was completed, however, female participants scored their concussion knowledge higher as compared to males (Figure 13b). A chi-‐square test found that although there was no significant difference in concussion knowledge scores between genders prior to completing the CATT training, female officials had significantly higher scores after completing the concussion training (p<0.02).

CT2. How much did you know about concussions (a) prior to, and (b) after completing the CATT online course? * How do you self-‐identify? Cross-‐tabulation (N=1,548)

Figure 13a. Comparison of self-‐reported concussion knowledge scores before completing the CATT training, by gender of team official.*

Figure 13b. Comparison of self-‐reported concussion knowledge scores after completing the CATT training, by gender of team official.*

CT2. How much did you know about concussions (a) prior to, and (b) after completing the CATT online course? * How do you self-‐identify? Cross-‐tabulation (N=1,548)


CT3: Female participants were more likely to recommend the CATT training to others as compared to males, although both gender groups are likely to recommend the training, with greater than 83% of respondents in both groups scoring a 4 or higher for this question (Figure 14).

Figure 14. Comparison of the likelihood of recommending the CATT course to others, by gender of team official.*

CT3. How likely are you to recommend the CATT online concussion training to others? * How do you self-‐identify? Crosstabulation (N=1,548)


CT4: Comparing the level of interest in mandating the CATT training for parents by gender of respondents, female participants were notably more in favour of a mandate for parents of BC Hockey players than males (Figure 15). A chi-‐square text found that female participants were significantly more in favour of extending the CATT training mandate to parents, as compared to males (p<0.002).

CT4. Do you think that BC Hockey should mandate concussion training for the parents of players registered with BC Hockey? * How do you self-‐identify? Crosstabulation (N=1,548)

Figure 15. Comparison of interest in mandating the CATT training for parents of BC Hockey players, by gender of team official.*


CT5: A notably higher proportion of male respondents reported experiencing concussion, whether it be themselves or someone close to them having dealt with a concussion, as compared to females (83% compared to 68%) (Figure 16). A chi-‐square test found this difference in personal experience with concussion by self-‐identified gender to be significant (p<0.001).

CT5. Have you or someone close to you ever suffered from concussion? * How do you self-‐identify? Cross-‐tabulation (N=1,545)

Figure 16. Comparison of experience with concussion, by gender of team official.*


CT6: Concussion knowledge scores compared by years involved as a hockey official show that respondents with less experience as hockey officials reported significantly lower concussion knowledge scores as compared to more experienced officials before taking the CATT training (p<0.001) (Figure 17a). Meanwhile, no significant difference was observed between groups after completing the training (Figure 17b).

CT7: A steady increase was observed in the proportion of respondents who have experienced concussion (themselves or someone close to them) as the years of involvement as a hockey official increases (Figure 18). Participants in the 5 to 10 year experience group showed a greater than 20% higher proportion of respondents who had experienced concussion than those in the 1 year experience group (90% compared to 70%). Statistical analysis determined that a significantly higher proportion of more experienced participants have dealt with a concussion first hand, as compared to those with fewer years involved in hockey (p<0.001).

CT6. How much did you know about concussions (a) prior to, and (b) after completing the CATT online course? * How many years have you been involved as a hockey official? Cross-‐tabulation (N=1,538)

Figure 17a. Comparison of self-‐reported concussion knowledge scores before completing the CATT training, by team official’s years involved as a hockey official.


Figure 17b. Comparison of self-‐reported concussion knowledge scores after completing the CATT training, by team official’s years involved as a hockey official.

Figure 18. Comparison of experience with concussion, by team official’s years involved as a hockey official.

CT7. Have you or someone close to you ever suffered from concussion? * How many years have you been involved as a hockey official? Cross-‐tabulation (N=1,535)

CT6. How much did you know about concussions (a) prior to, and (b) after completing the CATT online course? * How many years have you been involved as a hockey official? Cross-‐tabulation (N=1,538)


CT8: Those participants who spent more time completing the CATT training reported that they felt that the CATT prepared them to appropriately handle a potential concussion experienced during the 2016-‐2017 hockey season (Figure 19). Over 84% of respondents who spent 30 minutes or longer completing the training felt that the CATT prepared them to handle situation, while less than 72% of those who spent under 30 minutes completing the training felt that they were prepared.

CT8. Did the CATT online course prepare you to handle the situation appropriately? * How much time did you spend completing the CATT online course? Cross-‐tabulation (N=891)

Figure 19. Comparison of level of preparedness for handling a possible concussion situation acquired through completing the CATT training, by amount of time spent completing the CATT training.


CT9: Comparing the level of interest in mandating the CATT training for the parents of BC Hockey players by whether a respondent was aware of the CATT prior to the BC Hockey mandate, those who were aware of the training prior to its mandate had a higher level of interest in extending the CATT mandate to parents (74% compared to 66%; Figure 20). Statistical analysis determined that this difference in interest in mandating the CATT training for parents by awareness of CATT prior to the BC Hockey mandate for team officials was significant (p<0.001).

CT9. Do you think that BC Hockey should mandate concussion training for the parents of players registered with BC Hockey? * Were you aware of the CATT online course prior to its mandate by BC Hockey? Cross-‐tabulation (N=1,553) *: Fewer than five respondents self-‐identified as non-‐binary, and were therefore not included in any data relating to self-‐identified gender only. Non-‐binary respondent data was included in all other results.

Figure 20. Comparison of interest in mandating the CATT training for parents of BC Hockey players, by awareness of CATT prior to BC Hockey mandate for team officials.


Participant Feedback

Common themes gathered from participant feedback include:

1) General Suggestions/Feedback

• Access to a quick reference sheet, checklist, or other form of printed material summarizing the concussion protocol would be valuable, as it could be easily carried on the bench.

• Include a downloadable package of resources such as on Return to Sport and Return to School tool after the course has been completed.

• Create a system that notifies the minor hockey association once the mandated CATT training has been completed by an official.

• An annual refresher course to ensure that the information covered in the CATT remains fresh and easy to recall in case they need to be applied during the season.

• Creating a course that is required to be taken by players above a certain age (e.g., those 12 years and older) would allow them the opportunity to understand the importance of following concussion protocol properly for recovery.

• Concussion training should be implemented as a requirement for officials from other sports organizations in British Columbia (soccer, football, figure skating, etc).

“I had an understanding of what to look for…a quick reference easy access guide would be really helpful. Or a quick access checklist.”

—Survey Participant

2) Opinions on CATT online course

• Situational questions included in the course were very helpful. Including more would further help understanding how to handle different types of in-‐game situations.

• Shortening the course by reducing repetitive and unnecessarily content could support the officials in remaining focused throughout the training.

• There is some level of uncertainty as to who has authority to decide to sit out a player when there is a disagreement between another coach or parent.

• Information included in the protocol remains unclear for situations when a concussion is not evident. In these cases, it is unclear what to do, and the protocol appears overly cautious.

“I feel that this is an extremely eye opening and informative training tool.”

-‐Survey Participant

“Very informative and empowering. Concussion protocol is keeping kids safe and improving quality of hockey and future enjoyment of players.”



3) Opinions on a CATT Mandate for Parents

• A mandate for parents would be valuable in ensuring that they have an understanding of the existing protocol that has been implemented for officials.

• Requiring the parents of BC Hockey players to complete the CATT training would place a burden on the parents and may results in fewer players involved with BC Hockey.

• Requiring the parents of BC Hockey players to complete the CATT training would involve administrative challenges in ensuring that it is being completed by all parents.

• Mandating the training for parents would cause the parents to become overly involved in the decisions of officials when following concussion protocol.

• Creating a course for parents that is largely centered around the management of concussion at home would be beneficial.

• Making the course widely available and recommended to parents is sufficient; a mandate for all parents is not necessary.

“I would like to see parents take the course so they understand the decision of the Safety person.”


“We want more kids to play. Adding more requirements and time commitments is just another barrier to entry regardless of content.”



Discussion Concussion has become a widely discussed health issue in recent years, particularly within the sporting community, as the level of awareness and amount of concussion-‐based research has increased over the past several years. With the rates of reported head injuries increasing over the past decade, there is a need for a valid and standardized protocol for the recognition, response, and management of sport-‐related concussion.

Based on established evidence-‐based research principles, the aim of the CATT is to standardize the protocol for the recognition, response, management, and prevention of concussion. The CATT for Coaches provides up-‐to-‐date education concussion training in the form of:

• Online course for coaches • The Concussion Response Tool (smartphone accessible and fillable) • The Return to Sport tool • Situational and knowledge-‐based questions • Frequently asked questions • Printable handouts, related websites, journal articles, and additional resources

The CATT for Parents, Players and Coaches was originally launched in 2014 (www.cattonline.com), and was actively disseminated provincially and nationally via presentations to committees and sports organizations; newsletters and websites; cards distributed to private clinics; posters distributed to sporting organizations, regional health authorities, community centres and other locations in the Lower Mainland and through regional health authorities; and posters presented at conference presentations.

On June 27, 2016, at the BC Hockey AGM, the CATT for Coaches training was approved and mandated as a training resource to be completed by all team officials prior to their participation in the 2016-‐2017 season.

This evaluation of the CATT online course for Coaches found that the training led to a significant increase in self-‐reported concussion knowledge amongst BC Hockey team officials. A large majority of BC Hockey officials felt that the CATT training prepared them to handle a potential concussion situation experienced during the 2016-‐2017 season appropriately. Overall, officials reported being in favour of extending the CATT mandate to the parents of BC Hockey players.

Policy supporting the adoption of the CATT amongst other sporting organizations throughout BC will allow for a more widespread understanding of proper protocol for concussion recognition, treatment, management, and prevention. This, in turn, may reduce related short and long-‐term health problems, lowering total health care costs among these individuals.

Limitations

This was a questionnaire-‐based study collecting self-‐reported data from BC Hockey team officials who self-‐selected to participate. Self-‐reported data may be biased for knowledge and attitude questions, as these questions may be affected by socials bias, with participants answering questions how they believe they should be answered rather than their personal reality.

Furthermore, the concepts of ‘knowledge’ and ‘attitude’ are difficult to objectively measure. Particularly for those questions where participants were asked to answer using a Likert-‐scale (from 1 to 5. This survey tool was not tested beyond face validity due to limited resources and the expectation that the questionnaire would not be used beyond the purposes of this evaluation.


Next Steps

• Update CATT resources to incorporate the 5th International Consensus Statement on Concussion in Sport.

• Further explore the value of mandating concussion training for parents of players with BC Hockey

• Continue to engage in social marketing to raise awareness and knowledge among British Columbians of the severity and consequences of concussion.

• Integrate survey feedback into CATT website to enhance the training tool.


References [1] BC Hockey. Concussion Awareness Training Tool. Posted June 27, 2016.

[2] Government of Canada. Concussions. Posted June 21, 2017.

[3] McCory, P, Meeuwisse, WH, Dvořák, J, et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine 2017;51(11):838-‐847.

[4] Daneshvar, DH, Riley, DO, Nowinski, CJ, McKee, AC, Stern, RA, Cantu, RC. Long-‐Term Consequences: Effects on Normal Development Profile After Concussion. Physical Medicine and Rehabilitation Clinics of North America 2011;22(4):683-‐700.

[5] Yard, EE, Comstock, RD. Compliance with return to play guidelines following concussion in US high school athletes, 2005-‐2008. Brain Injury 2009;23(11):888-‐898.

[6] Echlin P. Concussion education, identification, and treatment within a prospective study of physician observed junior ice hockey concussions: social context of this scientific intervention. Neurosurgical Focus 2010;29(5):E7.1-‐13.

[7] Ghajar, J. Commentary: Statements of Agreement from the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-‐16, 2015. Neurosurgery 2016;79(6):930.

[8] Echlin PS, Johnson AM, Riverin S, Tator CH, Cantu RC, Cusimano MD, Taunton JE, Upshur RE, Hall CR, Forwell LA, Skopelja EN. A prospective study of concussion education in 2 junior ice hockey teams: implications for sports concussion education. Neurosurgical Focus, 2010;29(5):E6.1-‐4.

[9] Meehan, WP, Taylor, AM, Proctor, M. The Pediatric Athlete: Younger Athletes with Sport-‐Related Concussion. Clinics in Sports Medicine 2011:30(1):133-‐144.

[10] Purcell LK, CPS Healthy Active Living and Sports Medicine Committee, Abridged version: Paediatric Child Health 2012;17(1):31.


Appendices Appendix A—Email Introduction ........................................................................................... 32

Appendix B—CATT Evaluation Survey ................................................................................... 33

Appendix C—Results Tables .................................................................................................. 36 Awareness ................................................................................................................................ 36 Attitudes ................................................................................................................................... 38 Demographics .......................................................................................................................... 41

Appendix D—Results Tables for Notable Cross-‐Tabulations .................................................. 43


Appendix A—Email Introduction Dr. Shelina Babul at the University of British Columbia, in partnership with BC Hockey, is evaluating the concussion educational training mandated by BC Hockey last year. BC Hockey announced in June, 2016, at their AGM held in Sun Peaks, BC, that all BC Hockey team officials are required to complete the Concussion Awareness Training Tool (CATT) prior to their participation in any practice or games starting the 2016–2017 hockey season.

We are requesting that any individuals who have completed this concussion training complete a short online questionnaire with a time commitment of approximately 5-‐10 minutes.

All participants who qualify and complete the questionnaire will be entered into a draw for an Apple Watch, as well as various clothing items from BC Hockey.

All responses will be anonymous.

Your email address will be kept confidential and used only to enter you in the prize draw.

Please follow this link to complete the questionnaire: Evaluation of BC Hockey Mandated Concussion Training.

If the link above does not work, try copying the link below into your web browser:

https://rc.cfri.ca/redcap/surveys/?s=D7CEJAYPFD

If you have any questions about this study, or require further information, please contact the project co-‐ordinator Kate Turcotte at [email protected].

Thank you very much for your time and consideration. Your feedback will allow us to improve concussion education and awareness in British Columbia.


Appendix B—CATT Evaluation Survey 1. Have you visited the website for the Concussion Awareness Training Tool (CATT) for Parents, Players & Coaches (www.cattonline.com)?

• Yes • No

[If “No” for Q1: survey is terminated and no further information will be collected: “Thank you for taking the time and responding to our survey.”]

2. Did you complete the CATT for Coaches online course prior to the 2016-‐2017 season?

• Yes • No

[If “No” for Q2: survey is terminated and no further information will be collected: “Thank you for taking the time and responding to our survey.”]

3. Were you aware of the CATT online course prior to its mandate by BC Hockey?

• Yes • No

[If “Yes” to Q3:]

4. How did you hear about the CATT? (Select all that apply) • BC Hockey • Fellow On-‐Ice Official • Poster/Brochure • Email/Newsletter • Media (News, Newspaper, Magazine, etc.) • Family/Friend • Internet Search • Other (Text box)

Please respond to the following questions (Questions 5 & 6) using a scale of 1 to 5, where 1 is “Minimal” and 5 is “Very Knowledgeable” 5. How much did you know about concussions prior to completing the CATT online course? 1/2/3/4/5 6. How much do you now know about concussions after completing the CATT online course? 1/2/3/4/5 Please respond to the following questions (Questions 7 to 10) using a scale of 1 to 5, where 1 is “Not at all” and 5 is “Very” 7. How relevant is the material included in the CATT online course? 1/2/3/4/5


8. How well organized is the information covered in the CATT online course? 1/2/3/4/5 9. How satisfied are you with the CATT online course overall?

1/2/3/4/5 10. How likely are you to recommend the CATT online concussion training to others?

1/2/3/4/5 11. How would you rate the amount of information covered in the CATT online course?

• Too little • Too much • The right amount

12. How much time did you spend completing the CATT online course?

• 15-‐30 minutes • 30 minutes-‐1 hour • 1-‐2 hours • 2+ hours • I don’t remember

13. During the 2016-‐2017 season, did you experience a situation where a player sustained a possible concussion?

• Yes • No

[If “Yes” to Q13:]

14. Did the CATT online course prepare you to handle the situation appropriately? • Yes • Somewhat • No

[If “Somewhat/No” to Q14:]

15. How did the CATT online course not prepare you to handle the situation appropriately? [Open ended]

16. Do you think that the concussion training mandated by BC Hockey has raised awareness and knowledge on concussion recognition and management?

[If “No” to Q16:] 17. If no, why not?

[Open ended] 18. Do you think that BC Hockey should mandate concussion training for the parents of players registered with BC Hockey?

[If “No” to Q18:]


19. If no, why not? [Open ended]

20. What suggestions do you have to improve the CATT online course?

[Open ended] 21. Please share any additional comments regarding the CATT online course.

[Open ended] Please complete the demographic information below: What is your age?

• 18-‐24 • 25-‐44 • 45-‐64 • 65+

How do you self-‐identify?

• Male • Female • Non-‐binary

How many years have you been involved as a Hockey official?

• 1 • 2-‐4 • 5-‐10 • >10

Have you or someone close to you ever suffered from concussion?

• Yes • No


Appendix C—Results Tables

Awareness

Have you visited the website for the Concussion Awareness Training Tool (CATT) for Parents, Players & Coaches (www.cattonline.com)?

Frequency Percent Valid Percent Cumulative Percent

Valid No 120 6.9 6.9 6.9

Yes 1615 93.0 93.1 100.0 Total 1735 99.9 100.0

Missing System 2 0.1

Total 1737 100.0

Did you complete the CATT for Coaches online course prior to the 2016-‐2017 season?

Frequency Percent Valid Percent

Cumulative Percent

Valid No 144 8.3 8.3 8.3

Yes 1593 91.7 91.7 100.0 Total 1737 100.0 100.0

Were you aware of the CATT online course prior to its mandate by BC Hockey?


Valid No 1152 66.3 71.3 71.3

Yes 463 26.7 28.7 100.0 Total 1615 93.0 100.0

Missing System 122 7.0

Total 1737 100.0


How did you hear about the CATT? (Select all that apply) Option Response Rate (%) Other 13

Internet search 2.4 Family/friend 14.9

Media (news, newspaper, magazine, etc.) 4.8 Email/Newsletter 13.2 Poster/Brochure 1.5

Fellow on-‐ice official 12.3 BC Hockey 69.8

Knowledge

How much did you know about concussions prior to completing the CATT online course?


Valid 1 (Minimal) 81 4.7 5.1 5.1

2 295 17.0 18.5 23.6 3 671 38.6 42.1 65.7 4 412 23.7 25.9 91.6

5 (Very Knowledgeable)

134 7.7 8.4 100.0

Total 1593 91.7 100.0 Missing System 144 8.3

Total 1737 100.0

How much do you now know about concussions after completing the CATT online course?


Valid 1 (Minimal) 1 0.1 0.1 0.1 2 6 0.3 0.4 0.4 3 106 6.1 6.7 7.1 4 879 50.6 55.2 62.3


601 34.6 37.7 100.0


Total 1737 100.0


Attitudes

How relevant is the material included in the CATT online course? Frequency Percent Valid Percent Cumulative

Percent Valid 1 (Not at

all) 3 0.2 0.2 0.2

2 12 0.7 0.8 1.0 3 122 7.0 7.7 8.7 4 656 37.8 41.7 50.3

5 (Very) 782 45.0 49.7 100.0 Total 1575 90.7 100.0

Missing System 162 9.3 Total 1737 100.0

How well organized is the information covered in the CATT online course?


Valid 1 (Not at all)

3 0.2 0.2 0.2

2 10 0.6 0.6 0.8 3 109 6.3 6.9 7.7 4 756 43.5 48.0 55.7

5 (Very) 697 40.1 44.3 100.0


Total 1737 100.0

How satisfied are you with the CATT online course overall? Frequency Percent Valid Percent Cumulative

Percent Valid 1 (Not at

all) 6 0.3 0.4 0.4

2 32 1.8 2.0 2.4 3 143 8.2 9.1 11.5 4 704 40.5 44.7 56.2

5 (Very) 690 39.7 43.8 100.0 Total 1575 90.7 100.0



How likely are you to recommend the CATT online concussion training to others?


Valid 1 (Not at all)

18 1.0 1.1 1.1

2 42 2.4 2.7 3.8 3 186 10.7 11.8 15.6 4 548 31.5 34.8 50.4

5 (Very) 781 45.0 49.6 100.0


Total 1737 100.0

How would you rate the amount of information covered in the CATT online course? Frequency Percent Valid Percent Cumulative

Percent

Valid Too little 114 6.6 7.3 7.3

Too much 73 4.2 4.7 11.9 The right amount

1378 79.3 88.1 100.0


Total 1737 100.0

How much time did you spend completing the CATT online course? Frequency Percent Valid

Percent Cumulative Percent

Valid 15-‐30 minutes 141 8.1 9.0 9.0

30 minutes-‐1 hour

553 31.8 35.3 44.3

1-‐2 hours 257 14.8 16.4 60.8

2+ hours 64 3.7 4.1 64.9 I dont

remember 550 31.7 35.1 100.0


Total 1737 100.0


During the 2016-‐2017 season, did you experience a situation where a player sustained a possible concussion?


Valid No 674 38.8 43.1 43.1 Yes 891 51.3 56.9 100.0 Total 1565 90.1 100.0


Did the CATT online course prepare you to handle the situation appropriately?


Valid Yes 755 43.5 84.7 84.7 Somewhat 123 7.1 13.8 98.5

No 13 0.7 1.5 100.0 Total 891 51.3 100.0


Do you think that the concussion training mandated by BC Hockey has raised awareness

and knowledge on concussion recognition and management?


Valid Yes 1420 81.8 91.4 91.4

No 23 1.3 1.5 92.9 I dont know

110 6.3 7.1 100.0


Total 1737 100.0

Do you think that BC Hockey should mandate concussion training for the parents of players registered with BC Hockey?


Cumulative Percent

Valid Yes 1063 61.2 68.4 68.4 No 230 13.2 14.8 83.3

I dont know

260 15.0 16.7 100.0


Total 1737 100.0


Demographics

How do you self-‐identify?**


Cumulative Percent

Valid Male 1061 68.6 68.6 68.6 Female 485 31.4 31.4 100.0 Total 1546 100.0 100.0

How many years have you been involved as a hockey official?


Valid 1 221 12.7 14.4 14.4

2 to 4 514 29.6 33.4 47.8 5 to 10 488 28.1 31.7 79.5 >10 315 18.1 20.5 100.0 Total 1538 88.5 100.0


What is your age? Frequency Percent Valid Percent Cumulative

Percent Valid 18-‐24 26 1.5 1.7 1.7

25-‐44 798 45.9 51.5 53.2 45-‐64 713 41.0 46.0 99.2 65+ 12 0.7 0.8 100.0 Total 1549 89.2 100.0



Have you or someone close to you ever suffered from concussion? Frequency Percent Valid Percent Cumulative

Percent Valid No 335 19.3 21.6 21.6

Yes 1213 69.8 78.4 100.0 Total 1548 89.1 100.0


*: For options with fewer than five respondents, these frequencies were removed from results tables to ensure that no participants are identifiable. **: Fewer than five respondents self-‐identified as non-‐binary, and were therefore not included in any data relating to self-‐identified gender only. Non-‐binary respondent data was included in all other results.


Appendix D—Results Tables for Notable Cross-‐Tabulations Only those cross-‐tabulation results that were reported in the “Notable Cross-‐Tabulations” section of “Results” are included in the appendix below. How likely are you to recommend the CATT online concussion training to others? * What is

your age? Cross-‐tabulation What is your age? Total

18-‐24 25-‐44 45-‐64 65+ How likely are you to recommend the CATT online

concussion training to others?

1 (Not at all)

Count 0 11 6 0 17 % within What is

your age? 0.0% 1.4% 0.8% 0.0% 1.1%

2 Count * 22 17 0 % within What is

your age? 2.8% 2.4% 0.0%

3 Count * 100 79 0 % within What is

your age? 12.5% 11.1% 0.0%

4 Count 8 297 231 * % within What is

your age? 30.8% 37.2% 32.4%

5 (Very)

Count 13 368 380 9 770 % within What is

your age? 50.0% 46.1% 53.3% 75.0% 49.7%

Total Count 26 798 713 12 1549 % within What is

your age? 100.0% 100.0

% 100.0%

100.0%

100.0%


How much did you know about concussions prior to completing the CATT online course? *

How do you self-‐identify**? Cross-‐tabulation How do you self-‐

identify? Total

Male Female How much did you know about concussions prior to

completing the CATT online course?

1 (Minimal)

Count 42 35 77 % within How do you self-‐

identify? 4.0% 7.2% 5.0%

2 Count 199 85 284 % within How do you self-‐

identify? 18.8% 17.5% 18.4%


identify? 43.4% 39.8% 42.3%


identify? 25.7% 26.2% 25.9%



identify? 8.1% 9.3% 8.5%

Total Count 1061 485 1546 % within How do you self-‐

identify? 100.0% 100.0% 100.0

%

How much do you now know about concussions after completing the CATT online course? * How do you self-‐identify**? Cross-‐tabulation


Total

Male Female How

much do you now know about

concussions after completing the CATT online course?

1 (Minimal)

Count * 0 % within How do you self-‐identify? 0.0%

2 Count * * % within How do you self-‐identify?

3 Count 80 22 102 % within How do you self-‐identify? 7.5% 4.5% 6.6%

4 Count 605 242 847 % within How do you self-‐identify? 57.0% 49.9% 54.8%


Count 371 220 591 % within How do you self-‐identify? 35.0% 45.4% 38.2%

Total Count 1061 485 1546 % within How do you self-‐identify? 100.0% 100.0% 100.0

%


How likely are you to recommend the CATT online concussion training to others? * How do you self-‐identify**? Cross-‐tabulation


Total

Male Female How likely are

you to recommend the CATT online concussion training to others?

1 (Not at all)


identify? 0.9% 1.4% 1.1%


identify? 2.7% 2.3% 2.6%


identify? 12.6% 10.1% 11.8%


identify? 36.9% 30.1% 34.7%

5 (Very) Count 497 272 769 % within How do you self-‐

identify? 46.8% 56.1% 49.7%


identify? 100.0% 100.0% 100.0%

Do you think that BC Hockey should mandate concussion training for the parents of players registered with BC Hockey? * How do you self-‐identify**? Cross-‐tabulation


Total

Male Female Do you think that BC Hockey should

mandate concussion

training for the parents of players registered with BC Hockey?

Yes Count 706 352 1058 % within How do you self-‐

identify? 66.5% 72.6% 68.4%

No Count 164 64 228 % within How do you self-‐

identify? 15.5% 13.2% 14.7%

I don’t know


identify? 18.0% 14.2% 16.8%


identify? 100.0% 100.0% 100.0%


How much did you know about concussions prior to completing the CATT online course? * How many years have you been involved as a hockey official? Cross-‐tabulation


Total

1 2-‐4 5-‐10 >10 How much did you know about concussions

prior to completing the CATT online course

?

1 (Minimal

)

Count 23 27 24 * % within How many years have you been involved as a hockey

official?

10.4% 5.3% 4.9%

2 Count 60 116 76 29 281 % within How many years have you been involved as a hockey

official?

27.1% 22.6% 15.6% 9.2% 18.3%


official?

36.7% 44.9%

42.0% 43.2%

42.5%


official?

21.7% 21.4% 28.3% 32.4%

25.9%


Count 9 30 45 45 129 % within How many years have you been involved as a hockey

official?

4.1% 5.8% 9.2% 14.3%

8.4%

Total Count 221 514 488 315 1538 % within How many years have you been involved as a hockey

official?

100.0% 100.0%

100.0%

100.0%

100.0%


How much do you now know about concussions after completing the CATT online course? * How many years have you been involved as a hockey official? Cross-‐tabulation


Total

1 2-‐4 5-‐10 >10 How

much do you now know about

concussions after completing the CATT online course?

1 (Minimal)

Count * 0 0 0 % within How many years have you been involved as a

hockey official?

0.0% 0.0% 0.0%

2 Count 0 * * * % within How many years have you been involved as a

hockey official?

0.0%

3 Count 17 32 34 19 102 % within How many years have you been involved as a

hockey official?

7.7% 6.2% 7.0% 6.0% 6.6%

4 Count 119 273 291 164 847 % within How many years have you been involved as a

hockey official?

53.8% 53.1%

59.6%

52.1% 55.1%


Count 84 207 161 131 583 % within How many years have you been involved as a

hockey official?

38.0% 40.3%

33.0%

41.6% 37.9%

Total Count 221 514 488 315 1538 % within How many years have you been involved as a

hockey official?

100.0% 100.0%

100.0%

100.0%

100.0%


Have you or someone close to you ever suffered from concussion? * How do you self-‐identify**? Cross-‐tabulation


Total

Male Female Have you or

someone close to you ever suffered from concussion?

No Count 178 156 334 % within How do you self-‐

identify? 16.8% 32.2% 21.6%

Yes Count 880 329 1209 % within How do you self-‐

identify? 83.2% 67.8% 78.4%


identify? 100.0% 100.0% 100.0%

Have you or someone close to you ever suffered from concussion? * How many years have

you been involved as a hockey official? Cross-‐tabulation How many years have you

been involved as a hockey official?

Total

1 2-‐4 5-‐10 >10 Have you

or someone close to you ever suffered from

concussion?

No Count 67 129 105 31 332 % within How many years have you been involved as a hockey official?

30.3%

25.2% 21.5% 9.9% 21.6%

Yes Count 154 383 383 283 1203 % within How many years have you been involved as a hockey official?

69.7%

74.8% 78.5% 90.1% 78.4%

Total Count 221 512 488 314 1535 % within How many years have you been involved as a hockey official?

100.0%

100.0%

100.0%

100.0%

100.0%


Did the CATT online course prepare you to handle the situation appropriately? * How much time did you spend completing the CATT online course? Cross-‐tabulation

How much time did you spend completing the CATT online course?

Total

15-‐30 mins

30 mins-‐1 hr

1-‐2 hrs

2+ hrs

Don’t remember

Did the CATT online course prepare you to handle the

situation appropria

tely?

Yes Count 60 284 130 30 251 755 % within How much time did you

spend completing the CATT online course?

71.4% 84.5% 89.7% 88.2%

86.0% 84.7%

Somewhat Count 19 50 14 * 36 % within How much time did you


22.6% 14.9% 9.7% 12.3%

No Count 5 * * * 5 % within How much time did you


6.0% 1.7%

Total Count 84 336 145 34 292 891 % within How much time did you


100.0%

100.0%

100.0%

100.0%

100.0%

100.0%


Do you think that BC Hockey should mandate concussion training for the parents of players registered with BC Hockey? * Were you aware of the CATT online course prior to

its mandate by BC Hockey? Cross-‐tabulation Were you aware of the

CATT online course prior to its mandate by BC Hockey?

Total

No Yes Do you

think that BC Hockey should mandate concussion training for the

parents of players

registered with BC Hockey?

Yes Count 731 332 1063 % within Were you aware of the CATT online course prior

to its mandate by BC Hockey?

66.1% 74.3% 68.4%

No Count 182 48 230 % within Were you aware of the CATT online course prior


16.5% 10.7% 14.8%

I don’t know

Count 193 67 260 % within Were you aware of the CATT online course prior


17.5% 15.0% 16.7%

Total Count 1106 447 1553 % within Were you aware of the CATT online course prior


100.0% 100.0% 100.0%

*: For options with fewer than five respondents, these frequencies were removed from results tables to ensure that no participants are identifiable. **: Fewer than five respondents self-‐identified as non-‐binary, and were therefore not included in any data relating to self-‐identified gender only. Non-‐binary respondent data was included in all other results.

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