Exploring clinical decision-making in pediatric concussion and the impact of the COVID-19 pandemic
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2020-09-08
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Abstract
Concussions are a significant public health concern in Canada. The effective development and implementation of a pan-Canadian concussion strategy requires an understanding of the current state of concussion policies across the country. Given the recent COVID-19 pandemic, there is also an interest in the impact on clinicians, as well as facilitators and barriers to the remote management of concussion. This project focuses on Ontario, British Columbia, and Alberta. These three provinces have taken different approaches to concussion management. Ontario is the only province in Canada with concussion specific legislation. British Columbia’s approach to concussion policy involves the development of clinical guidelines to assist in awareness and management of concussion. Alberta’s approach involves the development of a provincial concussion strategy to support families, children, and clinicians managing concussion. At the onset of the COVID-19 pandemic, Ontario had a provincial telehealth network, while Alberta initially did not allow for virtual care. British Columbia had a hybrid model, with limited telehealth services. These initial differences impacted how clinicians’ managed concussion during the COVID-19 pandemic. The purpose of this project is to explore factors that guide how healthcare professionals manage pediatric concussion, understand perspectives of recent clinical practice guidelines and resulting changes in practice, and to explore the impact of the COVID-19 pandemic on healthcare practices, including the provision of remote telehealth/telerehab services. Eighteen interviews were conducted with physiotherapists, occupational therapists, and physicians from Ontario, Alberta, and British Columbia. Interviews were thematically analyzed and organized to identify common challenges. This study identified multiple key findings. Clinicians are playing a more active role in managing patients’ concussions, however there is a lack of harmonization in concussion management both across Canada and provincially. Although clinicians were unaware if a pan-Canadian concussion strategy current exists, the 5th Consensus Statement on Concussion in Sport, the Ontario Neurotrauma Foundation Living Guidelines, and Parachute resources, were identified as the most used resources, respectively. Concussion awareness has increased over recent years due to the Internet, media, and movies, but in some instances, this awareness is excessive and may result in hyperawareness of concussion. Waitlists and outdated or incorrect advice have been identified as challenges to effective and timely concussion care. Barriers to remote care include a lack of existing remote care infrastructure and poor technology and internet connection. Facilitators to remote care include changes to billing practices and better virtual platforms. Participants with pre-existing remote care experienced less disruption during the COVID-19 pandemic.
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Grewal, A. S. (2020). Exploring clinical decision-making in pediatric concussion and the impact of the COVID-19 pandemic (Unpublished master's project). University of Calgary, Calgary, AB.