What is the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS)?
The Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS) is a validated questionnaire tool designed to assess an individual's knowledge about concussions and their attitudes toward concussion safety and reporting behaviors.
Structure and Components
The RoCKAS consists of two primary indices:
- Concussion Knowledge Index (CKI): Scored from 0-24 (or 0-25 in some versions), measuring factual understanding of concussion mechanisms, symptoms, and management 1, 2
- Concussion Attitude Index (CAI): Scored from 15-75 (or up to 65 in some versions), evaluating attitudes toward concussion safety, reporting behaviors, and return-to-play decisions 1, 2
- Signs and Symptoms Recognition (SS): An additional component assessing ability to identify specific concussion symptoms 3
Higher scores on both indices reflect better knowledge and safer attitudes toward concussion management.
Validation and Reliability
The CKI has been validated as a reliable measure in collegiate student-athletes 1. However, the CAI has demonstrated poor model fit and improper correlations between attitude items in confirmatory factor analysis, suggesting it may not be a sound outcome measure for assessing attitudes in collegiate athletes 1. Despite this limitation, the tool continues to be widely used across various populations.
Clinical Applications
The RoCKAS is primarily used to:
- Assess baseline concussion knowledge in athletes, coaches, parents, and support staff before educational interventions
- Evaluate effectiveness of concussion education programs by comparing pre- and post-intervention scores 3
- Identify knowledge gaps and misconceptions that require targeted education 2, 4
- Compare concussion awareness across different populations, sports levels, and time periods 2, 5
Key Findings from Recent Studies
Recent research using RoCKAS has revealed:
- Knowledge improvements over time: Collegiate athletes showed modest increases in CKI scores (18.5 to 19.4) but substantial improvements in CAI scores (52.9 to 62.2) over a decade (2010-2023) 2
- Persistent risky behaviors: Despite good knowledge scores (mean 21.0/25), nearly half of British American Football participants indicated they would continue playing with a concussion 4
- Educational tool effectiveness: The PitchSafe intervention increased parental CKI scores from 68% to 76% and SS scores from 46% to 62%, with improvements sustained at one-year follow-up 3
Important Caveats
Knowledge does not always translate to safe behavior. Athletes may score well on knowledge assessments but still demonstrate unsafe reporting practices and return-to-play decisions 4, 5. This disconnect highlights that education alone is insufficient—systemic changes in sports culture and enforcement of concussion protocols are essential.
The tool has limitations in measuring attitudes reliably 1, so results should be interpreted alongside behavioral observations and actual reporting patterns rather than relying solely on self-reported attitudes.