Preface to Multidisciplinary Concussion Clinics

Evaluating the Implementation of an Occupational Therapy-Led Concussion Clinic Model Into Usual Practice: A Mixed Methods Study

OBJECTIVES

(1) To evaluate the implementation of Australia's first occupational therapy-led concussion clinic model into usual practice by examining acceptability and fidelity among clinicians and service users, and (2) to explore the feasibility of embedding outcome measures into the service to facilitate longer-term clinic evaluation.

SETTING AND PARTICIPANTS

A large tertiary trauma hospital service in Melbourne, Australia. Participants were patients referred to the concussion clinic and occupational therapists working in the service.

DESIGN

Prospective, single-site, mixed methods design.

MAIN MEASURES

Acceptability outcomes were evaluated using clinician interviews and the Client Satisfaction Questionnaire-8. Clinic fidelity was assessed by service usage data. Long-term patient outcomes assessed concussion (Rivermead Post-Concussive Questionnaire), mood symptoms (Patient Health Questionnaire-9), and participation in activities of daily living (Community Integration Questionnaire-Revised).

RESULTS

Over 18 months, 73% (n = 177) of patients were referred to the clinic, and 75% attended. Adherence to protocol was achieved; however, the completion rate of post-treatment measures was low. Almost half of the patients required specialist referrals beyond the clinic model for persistent symptoms. The interviewed occupational therapists (n = 6) viewed the clinic as a "safety net for patients," believed they were "learning as we go," recognized that the "clinic had potential to grow," but admitted, "we could be doing more." High attendance rates and patient satisfaction further supported clinic acceptance at an end-user level.

CONCLUSION

An occupational therapy-led concussion clinic is accepted by patients and clinicians to capture the immediate needs of people with concussions after discharge. However, coordinated pathways to multidisciplinary care are needed to address the long-term needs of people with persistent concussion symptoms and problems returning to daily activities.

Multidisciplinary care for patients with persistent symptoms following concussion: a systematic review

PURPOSE

To systematically characterize and assess the effectiveness of multidisciplinary care for patients with persistent post-concussion symptoms (PPCS).

MATERIALS AND METHODS

Only studies describing multidisciplinary treatment, defined as intervention provided by no less than 2 healthcare disciplines, each with independent scopes of practice, for patients with PPCS were considered.

RESULTS

A total of 8 of the 1357 studies identified were included. The studies were comprised of heterogenous patient populations, care delivery systems, healthcare providers, treatment approaches, and outcomes.

CONCLUSIONS

Findings suggest multidisciplinary care, using a needs-based approach with individual- or group-based interventions, may be more beneficial than usual care to; 1) immediately reduce concussion-related symptom complaints and improve mood and quality of life in adolescents following sports-related concussion (SRC) and, 2) may produce immediate and lasting improvements in symptom complaints of young, primarily female, adults following a non-SRC. Future studies should clearly describe the decision-making processes used to deliver care through a needs-based approach and prioritize the inclusion of objective, performance-based measures to assess outcomes.

Examining the interdisciplinary approach for treatment of persistent post-concussion symptoms in adults: a systematic review

BACKGROUND

The objective of this review is to examine the evidence for the interdisciplinary approach in treatment of persistent post-concussion symptoms in adults.

METHODS

This systematic literature search was undertaken according to the Preferred Reporting Items for Systematic and Meta-Analysis (PRISMA) guidelines. Five electronic databases were searched: CINAHL, Informit, ProQuest, PubMed and Scopus. After screening and quality assessment, the review included six studies published in English and peer-reviewed journals, between 2011 and 2021 to return contemporary evidence.

RESULTS

The results revealed that there was significant variation between measures used and the timing of the pre- and post-treatment assessment. The studies found an interdisciplinary approach to be beneficial, however, the challenges of inherent heterogeneity, lack of clarity for definitions and diagnosis, and mixed results were apparent. The interdisciplinary interventions applied in all identified studies were found to reduce post-concussion symptoms across the symptom subtypes: headache/migraine, vestibular, cognitive, ocular motor and anxiety/mood.

CONCLUSIONS

The results demonstrated evidence for a reduction in persistent post-concussion symptoms following interdisciplinary intervention. This evidence will inform health services, clinicians, sports administrators and researchers with regard to concussion clinic and rehabilitation team design and service delivery.

Understanding Cognitive Communication Needs in Pediatric Traumatic Brain Injury: Issues Identified at the 2020 International Cognitive-Communication Disorders Conference

Purpose In early 2020, the second International Cognitive-Communication Disorders Conference was held to provide an opportunity for researchers and clinician-scientists to discuss the most recent advances and pressing issues in the care of individuals with cognitive-communication disorders (CCDs). Presentations and discussions resulted in the identification of four areas in need of attention: (a) terminology, (b) training, (c) interdisciplinary teams, and (d) pediatrics. We will explore the four themes identified at ICCDC, specifically expanding on how terminology, training, and teams intersect in pediatric traumatic brain injury care. Additionally, we will provide two case studies to highlight the integration of these themes and suggest ways to advance clinical service provision across medical and educational settings for persons with CCDs through the lens of pediatrics. Conclusion While speech-language pathology has come a long way since the original discussion of CCD over 30 years ago, clinicians and researchers have ongoing opportunities to help advance the ways in which speech-language pathologists offer support to persons, specifically children, with CCDs and to continue to advance the profession.