A qualitative study of persons with persistent postconcussion symptoms and clinicians with concussion expertise to inform the development of a concussion-specific questionnaire.

PURPOSE: To explore the experiences of adults with persistent postconcussion symptoms and clinicians to inform the development of a concussion-specific questionnaire. METHODS: Using a qualitative descriptive design, we conducted 10 focus groups with persons with persistent post-concussion symptoms (n = 35; female 66%; age range 19.0-65.1 years) and semi-structured interviews with clinicians with concussion expertise (n = 16; female 81%). Thematic analysis was used to identify themes within their narratives. The International Classification of Functioning, Disability and Health (ICF) provided a standardized language for coding. RESULTS: Three overarching themes emerged from the data: Functioning, Environmental and Personal Factors, and Capacity. Functioning mapped closely onto Activities and Participation within the ICF. Contextual factors, both Environmental and Personal, had a significant influence on functioning following concussion. Capacity was a unique finding that described how long a person is able to engage in a task before the onset or worsening of symptoms. CONCLUSIONS: Capacity is fundamental to measuring limitations in functioning based on symptom threshold and time to recovery. The impact of contextual factors on functioning needs to be considered on a continuum from barrier to facilitator. These findings provide the basis for the development of a concussion-specific questionnaire.Implications for RehabilitationClinicians should explore with their patients limitations across all areas of functioning.Clinicians should explore and address support and relationships, attitudes of others, access to affordable and high-quality healthcare, coping strategies, and a patient's own knowledge of concussion as these influence functioning.Current guidelines recommend a symptom-based approach to concussion management, whereas persons with concussion emphasize the importance of measuring functional capacity.Capacity is defined as the length of time one can perform a task before symptom onset, primarily fatigue.Currently, no concussion-specific measure of functioning exists.

Symptom Burden, School Function, and Physical Activity One Year Following Pediatric Concussion.

OBJECTIVES: To characterize symptom burden, school function, and physical activity in youth 1 year following acute concussion and those with subsequent repeat concussion. STUDY DESIGN: Secondary analysis of Predicting Persistent Postconcussive Problems in Pediatrics prospective, multicenter cohort study conducted in 9 Canadian emergency departments. Participants were children between ages 5 and 18 years who presented consecutively ≤48 hours of concussion and agreed to participate in a post hoc electronic survey 1 year after injury. Outcomes were assessed using a standardized 25-question symptom scale derived from the Post-Concussion Symptom Inventory-Parent; school function and physical activity outcomes were queried. The primary outcome was total symptom score 1 year following concussion, defined as the number of symptoms experienced more than before injury. RESULTS: Of 3052 youth enrolled in the Predicting Persistent Postconcussive Problems in Pediatrics study, 432 (median [IQR] age, 11.5 [9,14] years; 266 [62%] male) completed the 1-year survey; 34 respondents reported a repeat concussion. Following acute concussion, youth were more likely to be symptom-free than following repeat concussion (75% vs 50%; difference = 25% [95% CI 8-41]; P = .002) and to have recovered fully (90% vs 74%; difference = 17% [95% CI 5-34]; P = .002) after 1 year. Although physical symptoms were less 1 year after initial emergency department presentation for both groups (P < .001), youth with a repeat concussion reported greater headache persistence (26% vs 13%; difference = 13% [95% CI 1,31]; P = .024). Both groups returned to their normal school routine (100% vs 95%; difference = 5% [95% CI -5 to 8; P = .618). Youth without repeat concussion more frequently returned to normal physical activities (98% vs 85%; difference = 13% [95% CI 4-28]; P < .0001) and sport (95% vs 82%; difference = 13% [95% CI 3-29]; P = .009). CONCLUSIONS: Most youth are symptom-free and fully recovered 1 year following concussion. Some children with repeat concussion have worse outcomes and have delays in returning to normal school routines and sport.

The concussion recovery questionnaire (CORE-Q): conceptual model development and item generation of a concussion-specific measure of functional status.

Introduction: Defining and measuring limitations in functional status post-concussion has been challenging, as generic measures do not accurately reflect issues most relevant to adults with persistent post-concussion symptoms.Purpose: To develop a new concussion-specific measure of functional status for use in clinical practice and intervention trials.Method: We developed a conceptual model of functioning based on concepts identified from a previous qualitative study with persons with concussion and clinicians. An initial set of questionnaire items was generated from the concepts, codes, and conceptual model. Items were refined using cognitive interviews elicit feedback on their relevance and acceptability.Results: We developed an initial set of 145 items categorized by concepts that were reduced to 50. Our final item set resulted in the COncussion REcovery Questionnaire, which contains a total of 53 items split into 3 separate scales: the Post-Concussion Functional Scale, Concussion Modifiers Scale, and Global Functional Recovery Scale.Conclusion: The new Concussion Recovery Questionnaire is a self-reported measure of functional status for monitoring outcomes in clinical practice and in clinical intervention trials following concussion. Further studies are necessary to provide evidence of the measure's psychometric properties and to determine the questionnaire's ability to facilitate clinical decision-making.

Remote supervision of rehabilitation interventions for survivors of moderate or severe traumatic brain injury: A scoping review.

INTRODUCTION: Individuals with moderate or severe traumatic brain injury (TBI) often have persistent impairments upon discharge home. In rural communities, specialized rehabilitation services to address impairments can be difficult to access. The purpose of this scoping review is to examine how remote supervision is currently being used in TBI rehabilitation to identify gaps in knowledge that need to be addressed to facilitate access to and implementation of these services. METHODS: The main objective for this review is to identify the methods being used to deliver remote supervision for rehabilitation in a moderate or severe TBI population. The aim of this review was to document the implementation characteristics of remote supervision used including: (1) type of supervision such as synchronous, asynchronous supervision or mixed; (2) frequency and intensity of remote supervision; and (3) outcomes used to measure intervention delivery as well as effectiveness within this population. This scoping review follows EQUATOR Network recommendations for screening and extracting data. RESULTS: Twenty-six studies using a variety of remote supervision technology and outcome measures were included. Supervision frequency and intensity are poorly reported with no standardization. One hundred and six outcome measures were reported in this review showing large diversity in the areas being explored. DISCUSSION: Different types of remote supervision have been used with this population; however, there are no clear guidelines on clinical implementation. Future studies must better define implementation parameters of remote supervision. Benefit on physical activity, balance and mobility outcomes also need to be further explored.

Identifying the concepts contained within health-related quality of life outcome measures in concussion research using the International Classification of Functioning, Disability, and Health as a reference: a systematic review.

PURPOSE: To identify the concepts contained within health-related quality of life (HRQOL) outcome measures used in concussion-specific research using the International Classification of Functioning, Disability, and Health (ICF) as a reference. METHODS: Eight electronic databases were searched from January 1, 1992 to March 12, 2017. Gray literature was searched, reference lists scanned, and relevant journals hand-searched. Agreement for inclusion was reached by consensus by two reviewers. A standardized data extraction tool was used to document study design, population, and key findings. Questionnaire items were linked as concepts to the corresponding second-level category of the ICF. Quality of studies was not assessed, as review was exploratory. RESULTS: Five outcome measures met the inclusion criteria, including the Perceived Quality of Life Scale, EuroQoL-5 dimensions, Quality of Life after Brain Injury, WHOQOL-100, and WHOQOL-BREF. A total of 373 concepts were extracted. 34 questions were linked to activities and participation (50.7%), 16 questions (23.9%) referred to body functions, and 17 questions (25.4%) were related to the environment. CONCLUSIONS: The wide range of concepts covered by different outcome measures demonstrates the complexity of recovery post-concussion and a lack of universal agreement in terms of what should be measured in this population. A working conceptual model of HRQOL post-concussion is proposed. Registration Prospero #CRD42017068241 (June 15, 2017).