A Prospective Evaluation of the Influence of an Electronic Clinical Practice Guidelines on Concussion Patients’ Future Activities and Outcomes

Rowe, Brian H.; Eliyahu, Leeor; Lowes, Justin; Gaudet, L.; Beach, Jeremy; Mrázik, Martin; Cummings, Garnet; Voaklander, Donald C.

doi:10.1016/j.jemermed.2018.02.013

Cited by 10 publications

(4 citation statements)

References 30 publications

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“…This may support that early assessment of concussion and symptoms and, when needed, an individualized and progressive exercise plan delivered by trained staff, may prove beneficial in decreasing PCS. Furthermore, it is essential that educational interventions in the acute phase are systematic and consistent with evidence, as supported by Rowe et al ( 56 ) who discovered that most physicians in the ED did not follow the consensus guidelines when providing structured return to activity recommendations to patients. Nurse shortage and busyness in the ED and lack of standardized evidence-based material and procedures also hinder effective intervention of acute concussion ( 57 ).…”

Section: Discussionmentioning

confidence: 99%

“…A brief search on studies aiming at interventions in the acute phase of concussion reveals that early interventions are delivered primarily by professionals other than OTs and PTs (34,(54)(55)(56)(57). In a study by Moore (54), people attending an ED after experiencing acute concussion were met by a social worker whose intervention contained education about concussion-related symptoms, symptom management and coping.…”

Section: Discussionmentioning

confidence: 99%

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Occupational and Physiotherapy modalities used to support interdisciplinary rehabilitation after concussion: A Scoping Review

Marwaa

Egebæk

Guldager

2023

JRM

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Objective: To identify and describe occupational and physiotherapy rehabilitation modalities used to support an interdisciplinary rehabilitation in adults (aged 16 + years) with concussion.Methods: A scoping review methodology was used. Included studies were categorized according to Wade’s elements of rehabilitation and the Danish White Paper definition of rehabilitation.Results: Ten studies were included in this review, addressing: “assessment” (n = 9), “goal-setting” (n = 4), “training” (n = 10), and “social participation and discharge support” (n = 4). Interventions were delivered mainly by physiotherapists or an interdisciplinary team. In two studies occupational therapists were part of the interdisciplinary team. Randomized controlled trials more often addressed several of the rehabilitation elements using interdisciplinary intervention delivery. No studies specifically aimed their intervention at patients with acute or subacute concussion.Conclusion: The therapeutic modalities identified were: (i) manual and sensory motor interventions; (ii) physical exercises; and (iii) management of, or coping with, symptoms. More research is needed on how to better support social participation and discharge or return to work in the rehabilitation process. In addition, interventions delivered in the acute phases of concussion need further exploration.LAY ABSTRACTIndividuals with prolonged or persisting symptoms from a concussion often struggle to participate in activities of daily living, and their quality of life and work ability is affected. Interdisciplinary rehabilitation is recommended, and it is recognized that occupational and physiotherapy is important to support the interdisciplinary rehabilitation and promote recovery. However, this scoping review found that occupational therapists were seldom part of the interdisciplinary rehabilitation team. Furthermore, the physiotherapy and occupational rehabilitation modalities used consisted of manual or sensory motor interventions, physical exercise interventions, and management and coping. Only a few studies included social participation and discharge support as a part of the rehabilitation. No studies specifically aimed their intervention at preventing prolonged symptoms in patients with acute or subacute concussion. There is a need for more research into how to better support social participation and discharge in the rehabilitation process. Also, interventions delivered in the acute phases of concussion need further exploration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Occupational and Physiotherapy modalities used to support interdisciplinary rehabilitation after concussion: A Scoping Review

Marwaa

Egebæk

Guldager

2023

JRM

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“…In addition, the attending physician for each patient completed a standardized questionnaire about the verbal and written advice provided to the patient, discharge instructions, and the use of a concussion-specific electronic clinical practice guideline that was available at the study sites. 17 Importantly, physicians were blinded to the outcome and subgroup comparisons planned for this study.…”

Section: Methodsmentioning

confidence: 99%

“…Fifth, although we attempted to standardize discharge instructions through electronic handouts, variations in patient instructions occurred. 17 At the time of the study, most guidelines recommended 24 to 48 hours of cognitive and physical rest 26 ; however, recent research has suggested that early light exercise may not be harmful. 31 Finally, although it is possible that physicians may have provided more treatment advice than their standard care, at the time of the study, they were not aware of the specific research question.…”

Section: Limitationsmentioning

confidence: 99%

Sports-Related Concussions in Adults Presenting to Canadian Emergency Departments

Rowe

Yang

Gaudet

et al. 2022

Clinical Journal of Sport Medicine

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Clinical Work-Integrating Care in Current Practice: A Scoping Review

Kluit,

van Bennekom,

Beumer

et al. 2023

J Occup Rehabil

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Purpose Clinical work-integrating care (CWIC) refers to paying attention to work participation in a clinical setting. Working patients may benefit from CWIC. The purpose of this study is to explore the extent and nature to which medical specialists provide CWIC and what policies and guidelines oblige or recommend specialists to do. Methods A scoping review was conducted. The databases MEDLINE, EMBASE, Psychinfo, CINAHL, and Web of Science were searched for studies on the extent and nature of CWIC and supplemented by gray literature on policies and guidelines. Six main categories were defined a priori. Applying a meta-aggregative approach, subcategories were subsequently defined using qualitative data. Next, quantitative findings were integrated into these subcategories. A separate narrative of policies and guidelines using the same main categories was constructed. Results In total, 70 studies and 55 gray literature documents were included. The main findings per category were as follows: (1) collecting data on the occupation of patients varied widely; (2) most specialists did not routinely discuss work, but recent studies showed an increasing tendency to do so, which corresponds to recent policies and guidelines; (3) work-related advice ranged from general advice to patient–physician collaboration about work-related decisions; (4) CWIC was driven by legislation in many countries; (5) specialists sometimes collaborated in multidisciplinary teams to provide CWIC; and (6) medical guidelines regarding CWIC were generally not available. Conclusion Medical specialists provide a wide variety of CWIC ranging from assessing a patient’s occupation to extensive collaboration with patients and other professionals to support work participation. Lack of medical guidelines could explain the variety of these practices.

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A Prospective Evaluation of the Influence of an Electronic Clinical Practice Guidelines on Concussion Patients’ Future Activities and Outcomes

Cited by 10 publications

References 30 publications

Occupational and Physiotherapy modalities used to support interdisciplinary rehabilitation after concussion: A Scoping Review

Occupational and Physiotherapy modalities used to support interdisciplinary rehabilitation after concussion: A Scoping Review

Sports-Related Concussions in Adults Presenting to Canadian Emergency Departments

Clinical Work-Integrating Care in Current Practice: A Scoping Review

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