Skip to main content

Advertisement

SpringerLink
Log in

Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study

  • Original Research Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this study was to determine sex differences in recovery trajectories of assessments for sport-related concussion using Concussion Assessment, Research and Education (CARE) Consortium data.

Methods

National Collegiate Athletic Association athletes (N = 906; 61% female) from sex-comparable sports completed a pre-season baseline assessment and post-sport-related concussion assessments within 6 h of injury, 24–48 h, when they initiated their return to play progression, when they were cleared for unrestricted return to play, and 6 months post-injury. Assessments included the Standardized Assessment of Concussion, Balance Error Scoring System, Brief Symptom Inventory-18, Immediate Post-concussion Assessment and Cognitive Testing (ImPACT), Sport Concussion Assessment Tool-3 symptom evaluation, Clinical Reaction Time, King–Devick test, Vestibular Ocular Motor Screen, 12-item Short-Form Health Survey, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale.

Results

Only the Vestibular Ocular Motor Screen Total Symptom Score at the 24–48 h timepoint (p = 0.005) was statistically significantly different between sexes. Specifically, female athletes (mean = 60.2, 95% confidence interval [CI] 51.5–70.4) had higher Vestibular Ocular Motor Screen Total Symptom Scores than male athletes (mean = 36.9, 95% CI 27.6–49.3), but this difference resolved by the time of return-to-play initiation (female athletes, mean = 1.8, 95% CI 1.1–2.9; male athletes, mean = 4.1, 95% CI 1.5–10.9).

Conclusions

Sport-related concussion recovery trajectories for most assessments were similar for female and male National Collegiate Athletic Association athletes except for Vestibular Ocular Motor Screen symptoms within 48 h of sport-related concussion, which was greater in female athletes. Female athletes had a greater symptom burden across all timepoints, suggesting that cross-sectional observations may indicate sex differences despite similar recovery trajectories.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Pierpoint LA, Collins C. Epidemiology of sport-related concussion. Clin Sports Med. 2021;40:1–18.

    Article  PubMed  Google Scholar 

  2. Lin CY, Casey E, Herman DC, et al. Sex differences in common sports injuries. PM R. 2018;10:1073–82.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cheng J, Ammerman B, Santiago K, et al. Sex-based differences in the incidence of sports-related concussion: systematic review and meta-analysis. Sports Health. 2019;11:486–91.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Master CL, Katz BP, Arbogast KB, et al. Differences in sport-related concussion for female and male athletes in comparable collegiate sports: a study from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. Br J Sports Med. 2021;55:1387–94.

    Article  PubMed  Google Scholar 

  5. Henry LC, Elbin RJ, Collins MW, et al. Examining recovery trajectories after sport-related concussion with a multimodal clinical assessment approach. Neurosurgery. 2016;78:232–41.

    Article  PubMed  Google Scholar 

  6. Baker JG, Leddy JJ, Darling SR, et al. Gender differences in recovery from sports-related concussion in adolescents. Clin Pediatr. 2016;55:771–5.

    Article  Google Scholar 

  7. Covassin T, Elbin RJ, Bleecker A, et al. Are there differences in neurocognitive function and symptoms between male and female soccer players after concussions? Am J Sports Med. 2013;41:2890–5.

    Article  PubMed  Google Scholar 

  8. Covassin T, Swanik CB, Sachs ML. Epidemiological considerations of concussions among intercollegiate athletes. Appl Neuropsychol. 2003;10:12–22.

    Article  PubMed  Google Scholar 

  9. Kerr ZY, Zuckerman SL, Wasserman EB, et al. Factors associated with post-concussion syndrome in high school student-athletes. J Sci Med Sport. 2018;21:447–52.

    Article  PubMed  Google Scholar 

  10. Black AM, Sergio LE, Macpherson AK. The epidemiology of concussions: number and nature of concussions and time to recovery among female and male Canadian varsity athletes 2008 to 2011. Clin J Sport Med. 2017;27:52–6.

    Article  PubMed  Google Scholar 

  11. Mihalik JP, Ondrak KS, Guskiewicz KM, et al. The effects of menstrual cycle phase on clinical measures of concussion in healthy college-aged females. J Sci Med Sport. 2009;12:383–7.

    Article  PubMed  Google Scholar 

  12. Snook ML, Henry LC, Sanfilippo JS, et al. Association of concussion with abnormal menstrual patterns in adolescent and young women. JAMA Pediatr. 2017;171:879–86.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wallace J, Covassin T, Beidler E. Sex differences in high school athletes’ knowledge of sport-related concussion symptoms and reporting behaviors. J Athl Train. 2017;52:682–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Brown DA, Elsass JA, Miller AJ, et al. Differences in symptom reporting between males and females at baseline and after a sports-related concussion: a systematic review and meta-analysis. Sports Med. 2015;45:1027–40.

    Article  PubMed  Google Scholar 

  15. Caccese JB, Buckley TA, Tierney RT, et al. Head and neck size and neck strength predict linear and rotational acceleration during purposeful soccer heading. Sports Biomech. 2018;17:462–76.

    PubMed  Google Scholar 

  16. Putukian M, Riegler K, Amalfe S, et al. Preinjury and postinjury factors that predict sports-related concussion and clinical recovery time. Clin J Sport Med. 2021;31:15–22.

    Article  PubMed  Google Scholar 

  17. McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport: the 5th International Conference on Concussion in Sport held in Berlin, October 2016. Br J Sports Med. 2017;51:838–47.

  18. Broglio SP, Cantu RC, Gioia GA, et al. National Athletic Trainers’ Association position statement: management of sport concussion. J Athl Train. 2014;49:245–65.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Harmon KG, Clugston JR, Dec K, et al. American Medical Society for Sports Medicine position statement on concussion in sport. Br J Sports Med. 2019;53:213–25.

    Article  PubMed  Google Scholar 

  20. D’Lauro C, Jones ER, Swope LM, et al. Under-representation of female athletes in research informing influential concussion consensus and position statements: an evidence review and synthesis. Br J Sports Med. 2022;56:981–7.

    Article  Google Scholar 

  21. Broglio SP, McCrea M, McAllister T, et al. A national study on the effects of concussion in collegiate athletes and US Military Service Academy members: the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium structure and methods. Sports Med. 2017;47:1437–51.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Putukian M, D’Alonzo BA, Campbell-McGovern CS, et al. The Ivy League-Big Ten Epidemiology of Concussion Study: a report on methods and first findings. Am J Sports Med. 2019;47:1236–47.

    Article  PubMed  Google Scholar 

  23. Carney N, Ghajar J, Jagoda A, et al. Concussion guidelines step 1: systematic review of prevalent indicators. Neurosurgery. 2014;75:S3-15.

    Article  PubMed  Google Scholar 

  24. McCrea M. Standardized mental status assessment of sports concussion. Clin J Sport Med. 2001;11:176–81.

    Article  CAS  PubMed  Google Scholar 

  25. Finnoff JT, Peterson VJ, Hollman JH, et al. Intrarater and interrater reliability of the Balance Error Scoring System (BESS). PM R. 2009;1:50–4.

    Article  PubMed  Google Scholar 

  26. Caccese JB, Iverson GL, Hunzinger KJ, et al. Factors associated with symptom reporting in US Service Academy cadets and NCAA student athletes without concussion: findings from the CARE Consortium. Sports Med. 2021;51:1087–105.

    Article  PubMed  Google Scholar 

  27. Meachen S, Hanks RA, Millis SR, et al. The reliability and validity of the brief symptom inventory-18 in persons with traumatic brain injury. Arch Phys Med Rehabil. 2008;89:958–65.

    Article  PubMed  Google Scholar 

  28. Houck ZM, Asken BM, Bauer RM, et al. Multivariate base rates of low scores and reliable decline on ImPACT in healthy collegiate athletes using Care Consortium norms. J Int Neuropsychol Soc. 2019;25:961–71.

    Article  PubMed  Google Scholar 

  29. Caccese JB, Eckner JT, Franco-MacKendrick L, et al. Clinical reaction-time performance factors in healthy collegiate athletes. J Athl Train. 2020;55:601–7.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Caccese JB, Eckner JT, Franco-MacKendrick L, et al. Interpreting clinical reaction time change and recovery after concussion: a baseline versus norm-based cutoff score comparison. J Athl Train. 2021;56(8):851–9.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Chrisman S, Harmon KG, Schmidt JD, et al. Impact of factors that affect reading skill level on King–Devick baseline performance time. Ann Biomed Eng. 2019;47:2122–7.

    Article  CAS  PubMed  Google Scholar 

  32. Clugston JR, Houck ZM, Asken BM, et al. Relationship between the King–Devick test and commonly used concussion tests at baseline. J Athl Train. 2019;54:1247–53.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ferris LM, Kontos AP, Eagle SR, et al. Utility of VOMS, SCAT3, and ImPACT baseline evaluations for acute concussion identification in collegiate athletes: findings from the NCAA-DoD Concussion Assessment, Research and Education (CARE) Consortium. Am J Sports Med. 2022;50:1106–19.

    Article  PubMed  Google Scholar 

  34. Ware JE Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–33.

    Article  PubMed  Google Scholar 

  35. Sigurdardottir S, Andelic N, Roe C, et al. Post-concussion symptoms after traumatic brain injury at 3 and 12 months post-injury: a prospective study. Brain Inj. 2009;23:489–97.

    Article  PubMed  Google Scholar 

  36. Pavot W, Diener ED, Colvin CR, et al. Further validation of the Satisfaction with Life Scale: evidence for the cross-method convergence of well-being measures. J Pers Assess. 1991;57:149–61.

    Article  CAS  PubMed  Google Scholar 

  37. Bretzin AC, Esopenko C, D’Alonzo BA, et al. Clinical recovery timelines after sport-related concussion in men’s and women’s collegiate sports. J Athl Train. 2022;57:678–87.

    Article  PubMed  Google Scholar 

  38. D’Alonzo BA, Bretzin AC, Wiebe DJ. The role of reported affective symptoms and anxiety in recovery trajectories after sport-related concussion. Am J Sports Med. 2022;50:2258–70.

    Article  PubMed  Google Scholar 

  39. Broshek DK, Kaushik T, Freeman JR, et al. Sex differences in outcome following sports-related concussion. J Neurosurg. 2005;102:856–63.

    Article  PubMed  Google Scholar 

  40. Schneider KJ, Emery CA, Kang J, et al. Examining Sport Concussion Assessment Tool ratings for male and female youth hockey players with and without a history of concussion. Br J Sports Med. 2010;44:1112–7.

    Article  PubMed  Google Scholar 

  41. Covassin T, Savage JL, Bretzin AC, et al. Sex differences in sport-related concussion long-term outcomes. Int J Psychophysiol. 2018;132:9–13.

    Article  PubMed  Google Scholar 

  42. Covassin T, Elbin RJ, Harris W, et al. The role of age and sex in symptoms, neurocognitive performance, and postural stability in athletes after concussion. Am J Sports Med. 2012;40:1303–12.

    Article  PubMed  Google Scholar 

  43. Chiang Colvin A, Mullen J, Lovell MR, et al. The role of concussion history and gender in recovery from soccer-related concussion. Am J Sports Med. 2009;37:1699–704.

    Article  Google Scholar 

  44. Zuckerman SL, Solomon GS, Forbes JA, et al. Response to acute concussive injury in soccer players: is gender a modifying factor? J Neurosurg Pediatr. 2012;10:504–10.

    Article  PubMed  Google Scholar 

  45. Sufrinko AM, Mucha A, Covassin T, et al. Sex differences in vestibular/ocular and neurocognitive outcomes following sport-related concussion. Clin J Sport Med. 2017;27:133.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Pearce KL, Sufrinko A, Lau BC, et al. Near point of convergence after a sport-related concussion: measurement reliability and relationship to neurocognitive impairment and symptoms. Am J Sports Med. 2015;43:3055–61.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Patricios JS, Davis GA, Ahmed OH, et al. Introducing the sport concussion office assessment tool 6 (SCOAT6). Br J Sports Med. 2023;57(11):648–50.

    Article  PubMed  Google Scholar 

  48. Covassin T, Elbin RJ III, Larson E, et al. Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms. Clin J Sport Med. 2012;22:98–104.

    Article  PubMed  Google Scholar 

  49. Cottle JE, Hall EE, Patel K, et al. Concussion baseline testing: preexisting factors, symptoms, and neurocognitive performance. J Athl Train. 2017;52:77–81.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Covassin T, Swanik CB, Sachs M, et al. Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes. Br J Sports Med. 2006;40:923–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Lewis RS, Kamptner NL. Sex differences in spatial task performance of patients with and without unilateral cerebral lesions. Brain Cogn. 1987;6:142–52.

    Article  CAS  PubMed  Google Scholar 

  52. Beatty WW, Mold JW, Gontkovsky ST. RBANS performance: influences of sex and education. J Clin Exp Neuropsychol. 2003;25:1065–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

CARE Consortium Investigators Include: April Hoy, MS, ATC, CSCS (Azusa Pacific University); Justus D. Ortega, PhD (California State Polytechnic University, Humboldt); Nicholas Port, PhD (Indiana University); Patrick G. O’Donnell, MHA, MBA (UMass Memorial Health); Christopher D’Lauro, PhD (United States Air Force Academy); Kenneth L. Cameron, PhD, MPH, ATC (US Military Academy); Joshua T. Goldman, MD, MBA (University of California, Los Angeles); Holly J. Benjamin, MD (University of Chicago); Thomas W. Kaminski, PhD, ATC (University of Delaware); Julianne Schmidt, PhD, ATC (University of Georgia); Michael Collins, PhD (University of Pittsburgh Medical Center); Jeffrey J. Bazarian, MD, MPH (University of Rochester); Stefan Duma, PhD (Virginia Tech).

Author information

Authors and Affiliations

  1. School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, 453 W. 10th Avenue, Columbus, OH, 43210, USA

    Jaclyn B. Caccese

  2. Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Christina L. Master, Anne E. Mozel & Patricia R. Roby

  3. University of Delaware, Newark, DE, USA

    Thomas A. Buckley

  4. Seattle Children’s Hospital, Seattle, WA, USA

    Sara P. D. Chrisman

  5. University of Florida, Gainesville, FL, USA

    James R. Clugston

  6. University of Michigan, Ann Arbor, MI, USA

    James T. Eckner, Landon B. Lempke & Steven P. Broglio

  7. Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Elsa Ermer & Stacey Harcum

  8. Georgia Southern University, Statesboro, GA, USA

    Tamerah N. Hunt

  9. Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Divya Jain & Carrie Esopenko

  10. California Lutheran University, Thousand Oaks, CA, USA

    Louise A. Kelly

  11. Temple University, Philadelphia, PA, USA

    T. Dianne Langford & Jane McDevitt

  12. University of New Mexico, Albuquerque, NM, USA

    Allyssa K. Memmini

  13. Indiana University School of Medicine, Indianapolis, IN, USA

    Susan M. Perkins & Thomas W. McAllister

  14. Major League Soccer, New York, NY, USA

    Margot Putukian

  15. Loras College, Dubuque, IA, USA

    Adam Susmarski

  16. Medical College of Wisconsin, Milwaukee, WI, USA

    Michael McCrea

  17. Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, USA

    Paul F. Pasquina

Authors
  1. Jaclyn B. Caccese
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina L. Master
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas A. Buckley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sara P. D. Chrisman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James R. Clugston
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. James T. Eckner
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elsa Ermer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stacey Harcum
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tamerah N. Hunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Divya Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Louise A. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. T. Dianne Langford
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Landon B. Lempke
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Jane McDevitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Allyssa K. Memmini
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Anne E. Mozel
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Susan M. Perkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Margot Putukian
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Patricia R. Roby
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Adam Susmarski
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Steven P. Broglio
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Thomas W. McAllister
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Michael McCrea
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Paul F. Pasquina
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Carrie Esopenko
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

CARE Consortium Investigators

  • April Hoy
  • , Justus D. Ortega
  • , Nicholas Port
  • , Patrick G. O’Donnell
  • , Christopher D’Lauro
  • , Kenneth L. Cameron
  • , Joshua T. Goldman
  • , Holly J. Benjamin
  • , Thomas W. Kaminski
  • , Julianne Schmidt
  • , Michael Collins
  • , Jeffrey J. Bazarian
  •  & Stefan Duma

Corresponding author

Correspondence to Jaclyn B. Caccese.

Ethics declarations

Funding

Data collection and sharing for this project was conducted with support from the National Collegiate Athletic Association (NCAA) and the Department of Defense (DOD). The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014, USA is the awarding and administering acquisition office. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Combat Casualty Care Research Program, endorsed by the Department of Defense, through the Joint Program Committee 6/Combat Casualty Care Research Program—Psychological Health and Traumatic Brain Injury Program under Award No. W81XWH1420151. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense.

Conflict of interest

James R. Clugston receives research support from the National Football League. Margot Putukian is the Chief Medical Officer for Major League Soccer, Senior Advisor National Football League Head, Neck & Spine Committee, Football Association Research Task Force, Concussion in Sport Group Expert Group, and the National Operating Committee on Standards for Athletic Equipment Scientific Advisory Committee. Steven P. Broglio has current or past research funding from the National Institutes of Health, Centers for Disease Control and Prevention, Department of Defense—USA Medical Research Acquisition Activity, NCAA, National Athletic Trainers’ Association Foundation, National Football League, Under Armour, GE, Simbex, and ElmindA. He has consulted for US Soccer, US Cycling, University of Calgary SHRed Concussions external advisory board, and medico-legal litigation. He is a co-author of “Biomechanics of Injury (3rd edition)” and has a patent on “Brain Metabolism Monitoring Through CCO Measurements Using All-Fiber-Integrated Super-Continuum Source” (U.S. 11,529,091 B2). Thomas W. McAllister receives grant support for concussion research studies from the NCAA, the US DOD, and the National Institutes of Health. He also receives royalties for a traumatic brain injury textbook from American Psychiatric Association Publishing, Inc. Michael McCrea receives research funding to the Medical College of Wisconsin from the National Institutes of Health, Department of Veterans Affairs, Centers for Disease Control and Prevention, DOD, NCAA, National Football League, and Abbott Laboratories. He receives book royalties from Oxford University Press. He serves as a clinical consultant to Milwaukee Bucks, Milwaukee Brewers, and Green Bay Packers, and is Co-Director of the NFL Neuropsychology Consultants without compensation. He serves as a consultant for Neurotrauma Sciences, Inc.

Ethics approval

The local institutional review board at each of the performance sites and the US Army Medical Research and Materiel Command Human Research Protection Office reviewed and approved all study procedures.

Consent to participate

Participants provided written informed consent prior to participation.

Consent for publication

See Consent to participate.

Author contributions

JBC designed and conceptualized the secondary analyses, analyzed the data, and drafted and revised the manuscript for intellectual content. CLM led the CARE sex differences working group, designed and conceptualized these secondary analyses, and revised the manuscript for intellectual content. TAB, SPDC, JRC, JTE, EE, SH, TNH, DJ, LAK, TDL, LBL, JMc, AKM AEM, SMP, MP, PRR, and AS designed and conceptualized the secondary analyses and revised the manuscript for intellectual content. SPB, TWMc, MMc, and PFP designed and conceptualized the overall CARE Consortium study and revised the manuscript for intellectual content. CE designed and conceptualized the secondary analyses, and drafted and revised the manuscript for intellectual content. All CARE Consortium Investigators played a major role in the acquisition of the data and revised the manuscript for intellectual content. All authors approved the manuscript.

Availability of data and material

The CARE Consortium datasets generated and analyzed during the current study are available in the FITBIR repository (https://fitbir.nih.gov/).

Code availability

Not applicable.

Additional information

The members of the “CARE Consortium Investigators” are processed under Acknowledgements section.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 631 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Caccese, J.B., Master, C.L., Buckley, T.A. et al. Sex Differences in Recovery Trajectories of Assessments for Sport-Related Concussion Among NCAA Athletes: A CARE Consortium Study. Sports Med (2023). https://doi.org/10.1007/s40279-023-01982-2

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40279-023-01982-2

Search

Navigation