Abstract：
BACKGROUND: Concussion evaluations include a multifaceted approach; however, individual differences can influence test score interpretations and validity. Social determinants of health (SDoH) differentially affect disease risk and outcomes based upon social and environmental characteristics. Efforts to better define, diagnose, manage, and treat concussion have increased, but minimal efforts have focused on examining SDoH that may affect concussion recovery.
OBJECTIVE: This review examined previous research that examined the effect of SDoH on concussion recovery of athletes.
METHODS: CINAHL, MEDLINE, PsycInfo, and SPORTDiscus databases were used to search the terms \"concussion\" AND \"recovery,\" \"youth, adolescent, teen and/or adult,\" and \"social determinants of health\" and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide.
RESULTS: Seven thousand nine hundred and twenty-one articles were identified and screened for inclusion. Five studies met the inclusion criteria and were included in this systematic review. Using the Downs and Black Quality Index, the studies included in this review were deemed high quality.
CONCLUSIONS: Though limited literature exists, there is preliminary evidence to suggest that SDoH (specifically, economic stability, education access and quality, and social and community context) may have an impact on the clinical recovery from concussion. The dimensions evaluated varied between studies and the results were inconsistent. No single factor consistently affected clinical recovery; however, private insurance and race appear to have an association with the speed of recovery. Unfortunately, the potential intersection of these variables and other preinjury factors limits the ability to make clear recommendations. While most of the studies in this review are retrospective in nature, future efforts should focus on training clinicians to prospectively evaluate the effect of SDoH on concussion recovery and injury outcomes. Funding and registration for this systematic review were not obtained nor required.
OBJECTIVE: This review examined previous research that examined the effect of SDoH on concussion recovery of athletes.
METHODS: CINAHL, MEDLINE, PsycInfo, and SPORTDiscus databases were used to search the terms \"concussion\" AND \"recovery,\" \"youth, adolescent, teen and/or adult,\" and \"social determinants of health\" and variations of these terms. The evidence level for each study was evaluated using the 2011 Oxford Center for Evidence-Based Medicine Guide.
RESULTS: Seven thousand nine hundred and twenty-one articles were identified and screened for inclusion. Five studies met the inclusion criteria and were included in this systematic review. Using the Downs and Black Quality Index, the studies included in this review were deemed high quality.
CONCLUSIONS: Though limited literature exists, there is preliminary evidence to suggest that SDoH (specifically, economic stability, education access and quality, and social and community context) may have an impact on the clinical recovery from concussion. The dimensions evaluated varied between studies and the results were inconsistent. No single factor consistently affected clinical recovery; however, private insurance and race appear to have an association with the speed of recovery. Unfortunately, the potential intersection of these variables and other preinjury factors limits the ability to make clear recommendations. While most of the studies in this review are retrospective in nature, future efforts should focus on training clinicians to prospectively evaluate the effect of SDoH on concussion recovery and injury outcomes. Funding and registration for this systematic review were not obtained nor required.
摘要：
背景：脑震荡评估包括多方面的方法；但是，个体差异会影响考试成绩的解释和有效性。健康的社会决定因素（SDoH）根据社会和环境特征不同地影响疾病风险和结果。努力更好地定义，诊断,管理,治疗脑震荡增加了，但很少的努力集中在检查可能影响脑震荡恢复的SDoH。
目的：本综述调查了以往研究中研究了SDoH对运动员脑震荡恢复的影响。
方法：CINAHL，MEDLINE,PsycInfo,和SPORTDiscus数据库用于搜索术语“脑震荡”和“恢复”，\"\"青春,青春期,青少年和/或成人，“”和“健康的社会决定因素”以及这些术语的变体。使用2011年牛津循证医学指南中心对每项研究的证据水平进行评估。
结果：确定并筛选了七千九百二十篇文章。5项研究符合纳入标准，纳入本系统评价。使用唐斯和黑色质量指数，纳入本综述的研究被认为是高质量的.
结论：尽管文献有限，有初步证据表明，SDoH(特别是，经济稳定,教育机会和质量，以及社会和社区环境）可能会对脑震荡的临床恢复产生影响。评估的维度在研究之间有所不同，结果不一致。没有单一因素持续影响临床恢复；然而，私人保险和种族似乎与复苏的速度有关。不幸的是,这些变量与其他损伤前因素的潜在交叉限制了提出明确建议的能力.虽然这篇综述中的大多数研究都是回顾性的，未来的工作重点应该是培训临床医师,以前瞻性评估SDoH对脑震荡恢复和损伤结局的影响.这项系统审查的资金和登记既没有获得，也没有要求。
目的：本综述调查了以往研究中研究了SDoH对运动员脑震荡恢复的影响。
方法：CINAHL，MEDLINE,PsycInfo,和SPORTDiscus数据库用于搜索术语“脑震荡”和“恢复”，\"\"青春,青春期,青少年和/或成人，“”和“健康的社会决定因素”以及这些术语的变体。使用2011年牛津循证医学指南中心对每项研究的证据水平进行评估。
结果：确定并筛选了七千九百二十篇文章。5项研究符合纳入标准，纳入本系统评价。使用唐斯和黑色质量指数，纳入本综述的研究被认为是高质量的.
结论：尽管文献有限，有初步证据表明，SDoH(特别是，经济稳定,教育机会和质量，以及社会和社区环境）可能会对脑震荡的临床恢复产生影响。评估的维度在研究之间有所不同，结果不一致。没有单一因素持续影响临床恢复；然而，私人保险和种族似乎与复苏的速度有关。不幸的是,这些变量与其他损伤前因素的潜在交叉限制了提出明确建议的能力.虽然这篇综述中的大多数研究都是回顾性的，未来的工作重点应该是培训临床医师,以前瞻性评估SDoH对脑震荡恢复和损伤结局的影响.这项系统审查的资金和登记既没有获得，也没有要求。
