Factors Affecting Concussion Management and Return to Activity Decision Making By Clinicians
Purpose/Hypothesis:
What factors influence physical therapists’ decisions to determine safe return to activity following concussion? Do PTs feel prepared to deal with the psycho-social aspects of concussion?
Number of Subjects:
58
Materials and Methods:
A systematic literature search was performed. Two researchers screened the references using pre-defined inclusion-exclusion criteria. Twenty references met the inclusion criteria and were reviewed in full. The researchers created a 29-question survey with Qualtrics software broken out into 5 sections: 1) Demographics, 2) Clinical practice, 3) Legislation, 4) Attitudes and beliefs towards concussion management, and 5) Concussion management. The survey was distributed online through American Physical Therapy Association sections and through personal contacts with licensed physical therapists who treat concussions. Descriptive statistics applied for analysis of the mean and distribution of responses.
Results:
Fifty-eight clinicians completed the survey. Fifty-three percent of the respondents (n=30) had obtained a doctorate degree in physical therapy and 70.7% reported having received formal training in sports medicine (n=41 and 69% reported formal training in concussion management (n=40). Eighty-three percent of respondents (n=40) slightly agreed or strongly agreed that they were confident in recognizing and treating concussions, but only 72.9% (n=35) slightly agreed or strongly agreed in their ability to determine return to activity which is in line with findings of Yorke et al, 2016. Thirty-two respondents reported always or very often in regard to their use of return to plan (RTP) protocols. Two respondents rarely or never using RTP protocols. Seventy-one percent of respondents (n=32) reported there was not enough concussion specific training available pre or post-graduation and 77.3% (n=34) would be interested in formal concussion management certification for physical therapists (PTs). PTs reported receiving the least training in school in the areas of cognitive/fatigue management (22.73%, n=10) and anxiety/mood management (29.55%, n=13). PTs reported the least confidence in treating anxiety/mood (36.36%, n=16) and post-traumatic migraine (25%, n=11) which are common side effects of concussion.
Conclusions:
Results of this survey identified key factors that influenced PTs management of patients with concussions. The study determined that more PTs utilized established return to play protocols to guide decision making as compared to best practice identified in the literature. This study also provided insight on clinician perceived gaps in concussion specific education and training. Physical therapists reported lower levels of training and confidence in dealing with anxiety, mood, cognitive deficits, fatigue and post-traumatic migraine as compared to other aspects of concussion management. Respondents to the survey also expressed a desire for more concussion specific continuing education and certification programs.
Clinical Relevance:
This information can be used by Doctor of Physical Therapy Programs, the APTA and continuing education providers as they plan concussion specific curriculum and training programs.