Projects

Implementing concussion return to activity guidelines into primary care

THE PROBLEM

Recent practice guidelines have downplayed the role of rest in concussion management and instead encouraged early progressive return to pre-injury activities as tolerated. This has created is a critical gap between evidence and practice, especially in primary care.

STUDY HYPOTHESES AND OBJECTIVES

The primary objective of this project is to implement new evidence-based return to activity guidelines for concussion into primary care and study how effective this knowledge translation (KT) effort is. We hypothesize that our multifaceted KT intervention will be associated with greater family physician (FP) adherence to the practice guideline and better patient outcomes (fewer symptoms and less disability). The objectives of the current (pilot) study phase is to establish feasibility, validate our novel data collection tool (post-encounter form), and collect information that is essential to planning a larger-scale study (e.g., estimating intracluster correlation coefficients).

METHODS

Pilot stepped wedge cluster randomized trial. FP at enrolled clinics report the clinical actions they took with each concussion patient in a brief web-based post-encounter form. Following a pre-intervention observation period, FP clinics are crossed over to receive a multifaceted KT intervention (education outreach + audit/feedback). Patient-level outcomes are assessed 3-5 days after the FP visit and again one month later, by telephone.

EXPECTED RESULTS AND POTENTIAL SIGNIFICANCE

We expect to generate preliminary data on current FP practice with regard to concussion management and demonstrate feasibility for a KT intervention that can alter their practice. These findings can guide KT efforts for the wide-spread uptake of concussion return to activity guidelines.This study was presented at the Winter 2017 CTRC meeting. We will provide updates on the study progress, methodological changes, sample characteristics, and preliminary feasibility data. We will also highlight the implementation challenges we encountered and lessons learned.

TIMELINES

The pilot phase (October 2016-2018) is in progress, with support from a Vancouver Coastal Health Research Institute Innovation and Translational Research Award.