CONTEXT: The sequelae of concussion may have psychological consequences that affect an athlete's ability to return to play (RTP). However, confidence of RTP readiness is rarely monitored after a concussion. DESIGN: This study examined the acute and longitudinal implications of concussion on an athlete's confidence to RTP, the relationship between self-reported symptoms and athlete confidence to RTP, and interactions between concussion symptoms, sex, sport type (contact vs noncontact), and confidence to RTP. METHODS: Forty-six college athletes (65% female) sustained a concussion and completed the Injury Psychological Readiness to Return to Sport (I-PRRS) scale at 3 timepoints: within 72 hours of injury (acute), within 72 hours of beginning the RTP protocol (pre-RTP), and within 72 hours of being fully cleared to RTP (post-RTP). RESULTS: Athletes reported acute low confidence after concussion (I-PRRS mean [SD] = 32.59 [18.45]), which improved over time (pre-RTP mean [SD] = 52.11 [9.60]
post-RTP mean [SD] = 57.45 [5.96]). Some athletes returned to competition (post-RTP) with lingering confidence concerns (ie, I-PRRS <
50
95% CI = 0.03-0.26). Acute symptom severity was associated with worse confidence (P <
.001). Sex and sport type (contact vs noncontact) had no relationship with confidence (P = .406, P = .3314, respectively). These results indicate that athletes lack confidence acutely (within 72 h) following concussion. CONCLUSIONS: Although confidence improves over time, those who report greater acute symptoms also exhibit decreased confidence, and some athletes are returning to play with lingering concerns about their confidence (I-PRRS <
50). This preliminary evidence of heterogeneous confidence following concussion encourages the assessment and monitoring of confidence throughout concussion rehabilitation.