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Fetta J, Starkweather A, Huggins R, Van Hoof T, Casa D, Gill J. Systematic Review and Critical Appraisal of Role Definition and Responsibility Within the Concussion Management Team for Secondary Schools. J Neurosci Nurs 2024; 56:33-41. [PMID: 38198638 DOI: 10.1097/jnn.0000000000000744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
ABSTRACT BACKGROUND: Sports- and recreation-related concussions impact the cognitive function of secondary school students during the recovery process. They can cause symptoms such as headache, difficulty concentrating, and memory impairment, which pose a challenge for students during the return to learn (RTL) after injury. Concussion management teams (CMTs) assist the student in managing symptoms and develop an individualized RTL process; however, the ideal composition of professionals involved in the CMT has not been fully evaluated. METHODS: A systematic review was conducted to assess current research on CMTs in secondary schools. A search of the databases CINAHL, MEDLINE, and PsycINFO was conducted using the search terms "concussion management team" AND "school" OR "return to learn." RESULTS: Twenty-four articles were included for review. The CMT structure was highly variable in all studies. Identified themes from the literature were confusion of role definition and function, and communication gaps among interdisciplinary team members. Half of the articles viewed the school nurse as the leader in coordinating the CMT and RTL process. CONCLUSION: Evidence from this review suggests further consensus in this field is needed to clarify the school nurse's role and standardize the CMT structure.
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Salmon DM, Chua J, Brown JC, Clacy A, Kerr ZY, Walters S, Keung S, Sullivan SJ, Register-Mihalik J, Whatman C, Sole G, Badenhorst M. Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System. BMJ Open Sport Exerc Med 2023; 9:e001722. [PMID: 37860152 PMCID: PMC10582854 DOI: 10.1136/bmjsem-2023-001722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
There is a growing concern around concussions in rugby union, at all levels of the game. These concerns highlight the need to better manage and care for players. However, consistency around concussion-related responsibilities of stakeholders across the community rugby system remains challenging. Taking a systems thinking approach, this pragmatic, qualitative descriptive study explored key stakeholder groups within New Zealand's community rugby system's perceptions of their own and others' concussion-related responsibilities. Participants included players from schools and clubs, coaches, parents, team leads and representatives from four provincial unions. A total of 155 participants (67 females and 88 males) were included in the study. Focus groups and individual interviews were conducted. Thematic content analysis was used to analyse data. Thirty concussion-related responsibilities were identified. These responsibilities were contained within four themes: (1) policies and support (responsibilities which influence policy, infrastructure, human or financial resources); (2) rugby culture and general management (responsibilities impacting players' welfare and safety, attitudes and behaviour, including education, injury reporting and communication); (3) individual capabilities (responsibilities demonstrating knowledge and confidence managing concussion, leadership or role/task shifting) and (4) intervention following a suspected concussion (immediate responsibilities as a consequence of a suspected concussion). The need for role clarity was a prominent finding across themes. Additionally, injury management initiatives should prioritise communication between stakeholders and consider task-shifting opportunities for stakeholders with multiple responsibilities. How concussions will realistically be managed in a real-world sports setting and by whom needs to be clearly defined and accepted by each stakeholder group. A 'framework of responsibilities' may act as a starting point for discussion within different individual community rugby contexts on how these responsibilities translate to their context and how these responsibilities can be approached and assigned among available stakeholders.
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Affiliation(s)
- Danielle M Salmon
- Safety and Welfare, New Zealand Rugby, Wellington, New Zealand
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Jason Chua
- Safety and Welfare, New Zealand Rugby, Wellington, New Zealand
- Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
| | - James C Brown
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
- Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amanda Clacy
- School of Law & Society, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Simon Walters
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Sierra Keung
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - S John Sullivan
- Safety and Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Johna Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Chris Whatman
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
| | - Gisela Sole
- School of Physiotherapy, University of Otago - Dunedin Campus, Dunedin, New Zealand
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, Auckland University of Technology, Auckland, New Zealand
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Fetta J, Starkweather A, Huggins R, Van Hoof T, Casa D, Gill J. Implementation of Return to Learn Protocols for Student Athletes with Sport and Recreation Related Concussion: An Integrative Review of Perceptions, Challenges and Successes. J Sch Nurs 2023; 39:18-36. [PMID: 34816759 DOI: 10.1177/10598405211056646] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Concussion or mild traumatic brain injury (mTBI) is a common phenomenon in the United States, with up to 3.6 million sport-related mTBIs diagnosed annually. Return to learn protocols have been developed to facilitate the reintegration of students into school after mTBI, however, the implementation of return to learn protocols varies significantly across geographic regions and school districts. An integrative review of the literature was performed using Whittemore and Knalf's methodology. A search of published literature was conducted using the PRISMA checklist. Database searches were conducted from March 2,019 to October 2,021 using the terms "mild traumatic brain injury" and "return to learn." Twenty-eight publications were included. Three themes were derived from this review: lack of policy, poor staff education on concussion symptoms and stakeholder communication breakdown. The development of communication patterns and use of a return to learn protocol could facilitate a gradual return to full academic workload after concussion.
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Affiliation(s)
- Joseph Fetta
- School of Nursing, 7712University of Connecticut, Storrs, CT, USA
| | | | - Robert Huggins
- Korey Stringer Institute, 7712University of Connecticut, Storrs, CT, USA
| | - Thomas Van Hoof
- School of Nursing, 7712University of Connecticut, Storrs, CT, USA
| | - Douglas Casa
- School of Nursing, 7712University of Connecticut, Storrs, CT, USA
| | - Jessica Gill
- National Institute for Nursing Research, Bethesda, MD, USA
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DePadilla L, Miller GF, Jones SE, Breiding MJ. Substance Use and Sports- or Physical Activity-Related Concussions Among High School Students. J Sch Nurs 2022; 38:511-518. [PMID: 33267719 PMCID: PMC9514098 DOI: 10.1177/1059840520977319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
History of concussion is associated with substance use. Data from the 2017 National Youth Risk Behavior Survey (N = 14,765) were used in this study to examine associations between sports- or physical activity-related concussions and current cigarette, alcohol, and marijuana use among high school students, and whether other factors moderate those associations. In addition to having played on a sports team, potential moderators examined included persistent feelings of sadness or hopelessness, hours of sleep, and serious difficulty concentrating, remembering, or making decisions. The association between sports- or physical activity-related concussions and current cigarette, alcohol, and marijuana use was significant when controlling for sex, grade, and race/ethnicity and the potential moderators with the exception of cigarette smoking while controlling for hours of sleep. Those involved in the care of high school students after a concussion may consider assessing current cigarette, alcohol, and marijuana use.
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Affiliation(s)
- Lara DePadilla
- Division of Overdose Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, USA
| | - Gabrielle F. Miller
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, USA
| | - Sherry Everett Jones
- Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, GA, USA
| | - Matthew J. Breiding
- Division of Injury Prevention, National Center for Injury Prevention and Control, CDC, Atlanta, GA, USA
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Salmon DM, Badenhorst M, Falvey É, Kerr ZY, Brown J, Walters S, Sole G, Sullivan SJ, Whatman C, Register-Mihalik J, Murphy I. Time to expand the circle of care - General practitioners' experiences of managing concussion in the community. J Sports Sci 2022; 40:2102-2117. [PMID: 36399490 DOI: 10.1080/02640414.2022.2130586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
New Zealand Rugby (NZR) implemented a concussion management pathway (CMP), aimed at improving management at community level. General Practitioners (GPs) played a large role in the design of this process. The objective of this study was to explore GPs' perceptions of barriers and facilitators of the CMP and rugby-related concussion management in the community. A descriptive qualitative approach using interviews and focus groups was employed. Four themes were derived: i) GPs' existing knowledge and confidence around concussion management; ii) Operational resources: time, remuneration and pathway guidance; iii) Standardising concussion care and iv) Expanding the circle of care - the need for multi-disciplinary healthcare team. These themes described how GP's concussion knowledge, and the efficiency and availability of operational resources affected their experience and ability to fulfil their tasks within the CMP. GPs found NZR's CMP especially valuable, as it provided guidance and structure. Expanding the role of other healthcare providers was seen as critical to reduce the burden on GPs, while also delivering a more holistic experience to improve clinical outcomes. Addressing the identified barriers and expanding the network of care will help to improve the ongoing development of NZR's CMP, while supporting continued engagement with all stakeholders.
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Affiliation(s)
- Danielle M Salmon
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Marelise Badenhorst
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Éanna Falvey
- World Rugby House, Pembroke Street Lower, Dublin.,College of Medicine & Health, University College Cork, Cork, Ireland
| | - Zachary Y Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James Brown
- The Institute of Sport and Exercise Medicine, Stellenbosch University, Cape Town, South Africa
| | - Simon Walters
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Gisela Sole
- Centre of Health, Activity, Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, Newzeland
| | - S John Sullivan
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
| | - Chris Whatman
- Sports Performance Research Institute New Zealand, School of Sport and Recreation, Auckland University of Technology, Auckland, New Zealand
| | - Johna Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ian Murphy
- Injury Prevention and Player Welfare, New Zealand Rugby, Wellington, New Zealand
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Miller D, Snyder R, Manos A. Understanding Baseline Concussion Testing: A Resource for School Nurses as Members of Concussion Management Teams. NASN Sch Nurse 2022; 37:245-249. [PMID: 35264037 DOI: 10.1177/1942602x221082329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sports-related concussions (SRCs) are not uncommon among teen athletes. School nurses are in an ideal position to care for athletes affected with SRCs. However, evidence suggests there is a lack of knowledge regarding concussion management, use of baseline concussion testing, and active involvement on concussion management teams among school nurses. This article briefly examines the use of baseline concussion testing as a tool for assessing and managing the student athlete suffering from an SRC. The role of the school nurse on concussion management teams will also be explored. As active members of concussion management teams, working closely with athletic trainers, coaches, school administration, and local medical providers, school nurses have the opportunity to evaluate for return to learn and play, ultimately improving outcomes of student athletes suffering from SRCs.
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Affiliation(s)
- Dawn Miller
- School of Nursing and Health Sciences, Malone University, Canton, OH
| | - Renae Snyder
- School of Nursing and Health Sciences, Malone University, Canton, OH
| | - Alexa Manos
- School of Nursing and Health Sciences, Malone University, Canton, OH
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Berz K, Rhine T, Pomerantz WJ, Zhang Y, Loftus K, Lyons S, Logan K. An intervention to improve knowledge and increase comfort of concussion management among school medical staff. NURSE EDUCATION TODAY 2022; 109:105247. [PMID: 34968933 DOI: 10.1016/j.nedt.2021.105247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 11/03/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Concussion can negatively impact a child's ability to learn. School-based health professional staff have a unique opportunity to monitor students during recovery and mitigate the potential negative impact. Little is known about school health professional staff's knowledge and comfort with concussion diagnosis and management. OBJECTIVES We aimed to evaluate whether a tailored concussion education session could improve school health professional staff's knowledge about pediatric concussions. A secondary aim was to determine their knowledge retention and comfort with concussion management over the following year, including the impact of periodic follow-up education. We hypothesized that there would be sustained improvement in concussion knowledge and self-reported comfort in concussion management. STUDY DESIGN This study was a pre/post-intervention assessment with longitudinal follow-up. The study investigators provided a three-hour educational presentation about concussions in school-aged children. A survey on knowledge and management of pediatric concussions was administered immediately before and after this educational intervention. Knowledge retention and comfort with management was assessed at six months and at one year post-intervention. PARTICIPANTS AND SETTING Participants included Cincinnati Health Department school health professional staff in attendance at their Back to School in-service, prior to the start of the 2017-2018 school year. RESULTS Sixty school health professional staff from thirty-three schools completed the baseline knowledge survey, and forty completed all four assessments. Among the 40 participants with complete data, on average, the correct response rate (mean number correct, SD) was 82.3% (18.1/22, 11.0) pre-education, 91.8% (20.2/22, 10.3) immediate post-education, 86.4% (19.0/22, 10.8) 6-month follow-up, and 87.3% (19.2/22, 10.9) one-year follow-up. CONCLUSIONS A brief didactic educational intervention improved pediatric concussion knowledge and management skills among school health care providers. Periodic and in-person education is likely necessary to optimize knowledge retention.
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Affiliation(s)
- Kate Berz
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America.
| | - Tara Rhine
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America
| | - Wendy J Pomerantz
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, United States of America
| | - Yin Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, United States of America
| | - Kirsten Loftus
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, United States of America; Division of Pediatric Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, United States of America
| | - Stephanie Lyons
- Comprehensive Children's Injury Center, Division of Trauma Services, Cincinnati Children's Hospital Medical Center, United States of America
| | - Kelsey Logan
- Department of Pediatrics, University of Cincinnati College of Medicine, United States of America; Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, United States of America; Department of Internal Medicine, University of Cincinnati College of Medicine, United States of America
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Critical Elements of Return to Learn for Students With Concussion: A Scoping Review. J Head Trauma Rehabil 2021; 37:E113-E128. [PMID: 34145156 DOI: 10.1097/htr.0000000000000695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify critical elements of return to learn (RTL) for students with concussion and examine the state of the peer-reviewed published literature through a scoping review. METHODS Three electronic databases were systematically searched, and reference lists screened for articles addressing components of RTL protocols and accommodations for students with concussion. In total, 100 articles met inclusion criteria, including 56 empirical studies and 44 expert articles. RESULTS Four key components to RTL protocols were identified: RTL teams, management approaches, outcome measurement, and accommodations. Both bodies of literature agree on the importance of RTL teams, but evidence for specific monitoring tools and management approaches is less robust. Accommodations have been better addressed by experts than empirical evaluation. Empirical studies are largely cross-sectional, and many are survey based. Just 24 include student perspectives. Publication of expert literature has declined in frequency, as empirical studies have become more common. CONCLUSION This scoping review describes the current landscape of RTL and provides guidance toward expanding the empirical literature to systematically determine best practices to serve students with concussion.
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