US physical therapist practice patterns evaluating concussion and clinical practice guideline adherence

OBJECTIVES

To assess the influence of contemporary physical therapy clinical practice guidelines (CPG) on concussion evaluation practice patterns and barriers/facilitators for CPG adherence.

DESIGN

Electronic cross-sectional survey.

SETTING

Online survey platform.

PARTICIPANTS

US licensed physical therapists that manage concussion.

MAIN OUTCOME MEASURES

1) practice patterns 2) knowledge/use of CPG 3) barriers/facilitations to CPG adherence.

RESULTS

Knowledge/use of CPG categories significantly predicted the model (χ²(1) = 10.966, p < .001) of total vignette scores/practice patterns with a statistically significant effect. A Kruskal-Wallis test indicated significant differences in total vignette score means based on knowledge/use between "not aware of the concussion CPG" and "integrated concussion CPG into practice" groups (p < .001, ES = .21). Knowledge/use of the CPG predicted the perceived barriers/facilitators model for three questions: investment in specialized concussion training (χ²(1) = 39.52, p < .001), necessary equipment to complete concussion evaluation (χ²(1) = 16.01, p < .001), and confidence around concussion evaluation knowledge (χ²(1) = 27.46, p < .001) with a significant effect.

CONCLUSION

The results of this study provide support for guiding documents like the CPG to positively influence concussion practice patterns and insight into facilitators for guideline adherence.

The School-Based Speech-Language Pathologist and Students With Concussion: An Examination of Evolving Knowledge and Confidence

PURPOSE

This study examines school-based speech-language pathologists' (SLPs') experience, knowledge, and confidence in supporting students as they return to the classroom following concussion, with a particular focus on knowledge of new management guidelines over the last decade.

METHOD

Participants were 74 school-based SLPs who completed an electronic survey about their knowledge and experiences serving students with concussion. We examined participants' accuracy and confidence across knowledge questions using Kruskal-Wallis tests. We also conducted linear regression to explore the relationships between training, work experiences, knowledge, and confidence.

RESULTS

Nearly half of participants who are currently working with students with concussion reported having no clinical or training experiences related to concussion. Participants who had more concussion-related training or working experiences reported higher confidence. Participants were confident about general concussion knowledge but less confident about providing assessment and supporting students with concussion as they returned to school. Participants had the lowest confidence and accuracy for the most recent guidelines around rest and activity, as well as the differential impact of concussion on children as compared to adults.

CONCLUSIONS

Many school-based SLPs have limited training around concussion management and are often not specifically consulted to work with students following concussion. Despite this, SLPs have good awareness of their knowledge about concussion, but show gaps in knowledge surrounding more recent evidence-based guidelines. Additional investigation is needed to determine better ways to move research into clinical practice and to increase the involvement of SLPs in school-based concussion teams.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20361969.

Cognitive-Communication Complaints and Referrals for Speech-Language Pathology Services Following Concussion

PURPOSE

Speech-language pathologists are increasingly being recognized as key members of concussion management teams. This study investigates whether self-report of communication problems postconcussion may be useful in identifying clients who could benefit from speech-language pathology services.

METHOD

Participants included 41 adolescents and adults from an outpatient specialty concussion clinic. All completed the La Trobe Communication Questionnaire (LCQ) at admission, and 23 repeated this measure at discharge. Participants were prospectively enrolled, with chart reviews providing demographic, injury, and medical factors. The analysis considered (a) communication complaints and resolution over time, including comparison to two previously published LCQ studies of typical adults and adults with and without traumatic brain injury (TBI); (b) the relationship between communication complaints, participant factors, and common concussion assessments; and (c) factors related to speech-language pathology service referral for rehabilitation.

RESULTS

At first visit, 12 of 41 participants (29%) reported communication problems, although 19 (46%) reported difficulty with greater than half of LCQ items. At a group level, compared to published reference data of both people with chronic mixed severity TBI and controls, participants in this study reported more problems at first visit with communication overall, as well as greater difficulty with the LCQ Initiation/Conversation Flow subscale. Partner Sensitivity subscale scores at first visit were also greater than published control data. LCQ subscale scores of Initiation/Conversation Flow and Partner Sensitivity decreased from first visit to last visit, demonstrating resolution over time. Only concussion symptom scales and not demographic, injury, or cognitive screenings were related to LCQ scores. The same two LCQ subscales, Initiation/Conversation Flow and Partner Sensitivity, predicted referral for speech-language pathology services, along with symptom scales and being injured due to motor vehicle crash.

DISCUSSION

A subset of people recovering from concussion report experiencing communication problems. Reporting of particular communication problems was related to referral for speech-language pathology rehabilitation services and may be useful in directing care after concussion.

First-Line Health Care Providers' Reported Knowledge of and Referrals to Speech-Language Pathologists for Clients With Mild Traumatic Brain Injury

Purpose People with mild traumatic brain injury (mTBI) may experience deficits in cognition or communication that go unnoticed by first-line health care providers (FHPs). Speech-language pathologists (SLPs) assess and treat these domains yet are often underrepresented on mTBI multidisciplinary teams. This study's aim was to evaluate FHPs' reported knowledge of and referral practices to SLPs for individuals across the life span with mTBI. Method Physicians, physician assistants, nurse practitioners, nurses, and athletic trainers (n = 126) completed an online survey, including two Likert scale questions and one free response question relating to SLPs' role in mTBI. Results More than half of FHPs rate their knowledge of the SLP's role in mTBI management as low (somewhat knowledgeable, 29%; not very knowledgeable, 23%). Similarly, nearly two thirds of FHPs indicated rarely (19%) or never (44%), referring to SLPs for management of patients with mTBI. The majority of FHPs' open responses on the role of the SLP in mTBI management were incomplete, with many including domains that were not relevant to an SLP's role in the management of mTBI (e.g., dysphagia). Within the article, we provide results overall and according to individual profession. Conclusions Results suggest a majority of FHPs lack knowledge in the role of the SLP in the management of mTBI, which may underpin the low referral patterns reported by FHPs for SLP services. Future educational efforts for FHPs regarding the role of SLPs in mTBI care are necessary.

The role of AT-SLP collaborations in return to academics following mTBI: A scoping review

Return-to-academics (RTA) for student-athletes with mild traumatic brain injury (mTBI) is crucial, but relatively understudied compared to return-to-play (RTP). The transient and unpredictable nature of symptoms surrounding mTBI often results in underreporting of neurocognitive symptoms, leading to a greater susceptibility for repeated TBIs, as well as posing impediments to the process of RTA. Athletic Trainers (ATs) and Speech-Language Pathologists (SLPs) are in a unique position to help student-athletes achieve a safe, timely, and effective RTA following mTBI. They typically work in middle/high schools and collegiate-level academic settings and often serve as members of concussion management teams. Compared to other allied health professions, ATs and SLPs are relatively new professions with evolving scopes of practice. Despite established guidelines and recommendations for their scope of practice in treating student-athletes with mTBI, there is a lacuna in research regarding their individual and collaborative roles in achieving RTA. The current scoping review was conducted with the main goal of exploring published literature pertaining to the roles of ATs and SLPs in achieving RTA for student-athletes with mTBI. Current implications, recommendations for integrating pre-service interprofessional education (IPE) experiences, and future directions for AT-SLP collaborations are discussed.