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Updated: Feb 3, 2026

A Neuroscientific Approach to the Examination of Concussions in Student-Athletes
Published on: December 8, 2014
Use of the stepwise progression return-to-play protocol following concussion among practicing athletic trainers
Jessica Wallace1,2, Tracey Covassin1, Meghan Lafevor1
1Department of Kinesiology, Michigan State University, East Lansing, MI 48824, USA.
Purpose:
The purpose of this study was to determine whether practicing athletic trainers (ATs) were using the stepwise progression to make return-to-play (RTP) decisions after concussion and to determine what factors influenced their decision to use the stepwise progression.
Methods:
A total of 166 ATs (response rate = 16.6%) completed a 21-item questionnaire that evaluated participant demographics, methods of concussion management, and RTP decision-making using the stepwise progression. Descriptive statistics and a logistic regression were completed to analyze data.
Results:
Factors such as education level (p = 0.05) and number of concussions treated (p = 0.05) predicted use of the stepwise progression, whereas sex (p = 0.17), employment setting (p = 0.17), state law (p = 0.86), and years practicing (p = 0.17) did not predict whether ATs were following the stepwise progression.
Conclusion:
The majority of the ATs from this study are employing the stepwise progression to safely return athletes to play after sustaining a concussion. This demonstrates that ATs are providing a standard of care for concussed athletes across various athletic training settings; however, having a graduate degree and treating more concussions per year are predictors of whether an AT follows all steps of the stepwise progression.
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