Methodological Critique of Concussive and Non-Concussive Dual Task Walking Assessments: A Scoping Review.

OBJECTIVE: To understand the methodological approaches taken by various research groups and determine the kinematic variables that could consistently and reliably differentiate between concussed and non-concussed individuals. METHODS: MEDLINE via PubMed, CINAHL Complete via EBSCO, EBSCOhost, SPORTDiscus, and Scopus were searched from inception until 31 December 2021, using key terms related to concussion, mild traumatic brain injury, gait, cognition and dual task. Studies that reported spatiotemporal kinematic outcomes were included. Data were extracted using a customised spreadsheet, including detailed information on participant characteristics, assessment protocols, equipment used, and outcomes. RESULTS: Twenty-three studies involving 1030 participants met the inclusion criteria. Ten outcome measures were reported across these articles. Some metrics such as gait velocity and stride length may be promising but are limited by the status of the current research; the majority of the reported variables were not sensitive enough across technologies to consistently differentiate between concussed and non-concussed individuals. Understanding variable sensitivity was made more difficult given the absence of any reporting of reliability of the protocols and variables in the respective studies. CONCLUSION: Given the current status of the literature and the methodologies reviewed, there would seem little consensus on which gait parameters are best to determine return to play readiness after concussion. There is potential in this area for such technologies and protocols to be utilised as a tool for identifying and monitoring concussion; however, improving understanding of the variability and validity of technologies and protocols underpins the suggested directions of future research. Inertial measurement units appear to be the most promising technology in this aspect and should guide the focus of future research. IMPACT: Results of this study may have an impact on what technology is chosen and may be utilised to assist with concussion diagnosis and return to play protocols.

Sustainable interprofessional learning on clinical placements: the value of observing others at work.

Clinical placements have the potential to offer meaningful interprofessional learning opportunities for pre-registration students. Informal, as opposed to structured interprofessional learning opportunities, may offer a sustainable solution to the challenges of scheduling formal interprofessional programs in the workplace. To investigate this concept, students on clinical placement from a range of professions were invited to observe another profession undertake a patient consultation, after which they completed a standardized reflective tool. A grounded theory research design was used to explore the educational value of the one-off interprofessional observations, through an analysis of student written reflections (n = 79) and staff perceptions collected by interview (n = 11). The qualitative data was iteratively analyzed throughout the study period. A range of learning outcomes were described post student observations, ranging from knowledge or skills that informed profession-specific practice, to how others' roles related to patient needs, and the need for collaboration in order to provide high quality care. Staff orientation and facilitated reflection contributed to student learning. Positive learning value, though varying in depth, was identified through single interprofessional observations. Informal activities offer a sustainable interprofessional learning strategy that can be embedded into clinical placements; additional informal learning activities now warrant investigation.

Interprofessional education workshops in the workplace for pre-registration learners: Aligning to National Standards.

The inclusion of formal interprofessional education activities within clinical placements aligns with the national agenda in Australia to increase the focus on collaborative practice. However, the challenge remains for health services to determine how to achieve this goal. The education team at one health service elected to align new interprofessional education initiatives to the National Standards for Quality in Healthcare, to increase student focus on the complex domains of practice that require collaborative practice. An interprofessional falls prevention workshop was created for students on clinical placement. In the pilot phase, the 2h workshops ran four times across three months. Simultaneously, a second group of students were invited to complete an online falls prevention module. Knowledge gains from the two interventions were compared using a Mann Whitney test and qualitative data was thematically coded. There was no significant difference in fall prevention knowledge between the two interventions. Thematic analysis illustrated workshops promoted an increased understanding of others roles, person-centred care, interprofessional communication and collaboration. This pilot study has demonstrated that 2h interprofessional educational workshops are a feasible, replicable and useful addition to profession-specific clinical placements. The interprofessional workshop offered the opportunity for students of different professions to come together, practice interprofessional communication, explore the roles and responsibilities of others and collaborate in the theoretical management of a clinical case.