Family Hardship Following Youth Concussion: Beyond the Medical Bills

Graves, Janessa M.; Moore, Megan; Kehoe, Leanne; Li, Matthew; Chan, Anissa; Conrick, Kelsey M.; Williams-Gilbert, Wendy; Vavilala, Monica S.

doi:10.1016/j.pedn.2019.11.016

Cited by 15 publications

(7 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Access to specialized concussion care is also limited in Canada, especially among individuals in remote communities who may experience significant geographic or socioeconomic barriers and youth who are reliant on caregiver accompaniment. Studies from the United States reveal barriers to accessing pediatric concussion care among families in rural communities, including higher health care expenses [ 78 ] and indirect costs related to transportation and lost productivity [ 79 ]. Delayed access to care is problematic because it increases the risk of premature return to activity and potential reinjury or development of persistent symptoms and functional limitation.…”

Section: Resultsmentioning

confidence: 99%

Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development

Shore¹,

Nalder²,

Hutchison³

et al. 2022

JMIR Pediatr Parent

View full text Add to dashboard Cite

Background Active rehabilitation involving subsymptom threshold exercise combined with education and support promotes recovery in youth with concussion but is typically delivered in person, which may limit accessibility for families because of a lack of services in their communities or logistical challenges to attending in-person sessions. Objective This paper describes the evidence-based and theory-informed development of the Tele-Active Rehabilitation (Tele-AR) intervention for pediatric concussion, which was specifically designed for remote service delivery. Methods The intervention was designed by clinician-researchers with experience in pediatric concussion rehabilitation following the Medical Research Council guidance for developing complex interventions. Development involved a critical review of the literature to identify existing evidence, the expansion of the theoretical basis for active rehabilitation, and the modeling of the intervention process and outcomes. Results Tele-AR is a 6-week home exercise and education and support program facilitated through weekly videoconferencing appointments with a clinician. Exercise consists of low- to moderate-intensity subsymptom threshold aerobic activity and coordination drills that are individualized to participant needs and interests (prescribed for 3 days per week). Education includes the evidence-supported Concussion & You self-management program, which covers topics related to energy management, nutrition, hydration, sleep hygiene, and return to activity. Elements of self-determination theory are incorporated to support motivation and engagement. We present a logic model describing predicted intervention effects using a biopsychosocial conceptualization of outcomes after concussion. Conclusions The Tele-AR intervention may help to increase access to care that improves recovery and promotes a timely return to activity in youth with concussion. Future research is needed to evaluate the feasibility and efficacy of this approach.

show abstract

Section: Resultsmentioning

confidence: 99%

Tele-Active Rehabilitation for Youth With Concussion: Evidence-Based and Theory-Informed Intervention Development

Shore¹,

Nalder²,

Hutchison³

et al. 2022

JMIR Pediatr Parent

View full text Add to dashboard Cite

show abstract

“…Families in rural communities face higher healthcare costs for paediatric concussion, 18 including indirect costs related to transportation and lost productivity. 19 Adolescents living close to care may also have difficulty attending in-person sessions due to financial or logistical challenges preventing parental accompaniment. Telehealth delivery of a multimodal active rehabilitation programme may help address these barriers and improve access to care but has not been explored among adolescents with concussion.…”

Section: Introductionmentioning

confidence: 99%

“…Although concussion is more common in rural communities,17 active rehabilitation services are often location in urban areas. Families in rural communities face higher healthcare costs for paediatric concussion,18 including indirect costs related to transportation and lost productivity 19. Adolescents living close to care may also have difficulty attending in-person sessions due to financial or logistical challenges preventing parental accompaniment.…”

Section: Introductionmentioning

confidence: 99%

Tele-Active Rehabilitation for adolescents with concussion: a feasibility study

Shore

Hutchison

Nalder

et al. 2022

BMJ Open Sport Exerc Med

View full text Add to dashboard Cite

ObjectivesActive rehabilitation involving subsymptom threshold exercise and education/support promotes recovery among adolescents with concussion, but is typically delivered in-person, which limits accessibility. This study explored the feasibility of a remotely delivered Tele-Active Rehabilitation (Tele-AR) intervention for adolescents with concussion.MethodsA precase–postcase series design was used. Three adolescents (ages 14–17 years) experiencing postconcussion symptoms ≥2 weeks postinjury participated with a parent. The Tele-AR intervention was a 6-week programme supervised by a rehabilitation clinician through weekly videoconferencing appointments and included (1) aerobic exercise, (2) coordination drills and (3) comprehensive education and support. Feasibility indicators included rates of recruitment, retention, adherence, as well as adolescent and parent ratings of technology usability using an adapted Telehealth Usability Questionnaire and satisfaction using the Client Satisfaction Questionnaire-8. Prechanges to postchanges in postconcussion symptoms, illness perceptions, and occupational performance and satisfaction were also assessed.ResultsRates of recruitment (n=3/4) and retention (n=3/3) achieved success criteria. Adherence was high among all participants (77%–100%), and there were no adverse events. Participant ratings of technology usability and satisfaction approached 90%. All participants reported improvements in postconcussion symptoms and illness perception. Clinically significant positive changes were also observed in occupational performance and satisfaction.ConclusionsThe Tele-AR intervention appears feasible in a small group of adolescents with concussion, and positive changes were observed in postconcussion symptoms, illness perception and occupational performance. Further study is warranted to evaluate the efficacy of this approach, which may enable access to care that supports recovery in adolescents with concussion.

show abstract

“…The prevalence and severity in which children experience concussions, coupled with the personal and societal impacts of concussions is concerning (Government of Canada, 2018). Recovering from a concussion can be emotionally draining for children and their families (Graves et al, 2020). To fully understand the impact of this common injury we conducted a qualitative study to explore the experiences and information needs of children who have had a concussion, and their parents.…”

Section: Introductionmentioning

confidence: 99%