Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This descriptive study examined OT referrals in an interdisciplinary concussion clinic. Data analyzed show that patients referred to OT presented to clinic evaluation further out from injury; had missed more days from school, work, and physical activity; were lacking a routine; and were not socially active. These results provide variables that indicate the need for OT assessment, guide clinicians in the referral process, and advance the role of OT in concussion management.
Primary Author and Speaker: Shannon S. Westerberg
Additional Authors and Speakers: Madison Harris
Contributing Authors: Samia Rafeedie, David McArthur, and Christopher Giza
PURPOSE: Concussion management is an emerging field for occupational therapy (OT). Literature pertaining to OT's role and efficacy in this setting is limited (Finn, 2019). The aim of this study is to highlight the role of OT by identifying whether patients referred to OT in an interdisciplinary specialty concussion clinic have a unique clinical presentation when compared to patients not referred. It was hypothesized that patients referred to OT would present to clinic with more days elapsed since their initial injury and would have missed more days or would not be currently participating in school, work or physical activity. Additionally, it was postulated that these patients would have impacted sleep, lack a structured daily routine, and not currently be participating in social or leisure activities.
DESIGN: This is a retrospective descriptive study using a cohort from an interdisciplinary concussion clinic at a single academic institution. Inclusion criteria were patients between the ages of 8-75 years with a diagnosis of possible, probable or definite concussion, and complete records with no missing data. Patients with moderate or severe traumatic brain injury (TBI) were excluded.
METHOD: Data were obtained from patient medical records by a single researcher. From January-April 2020, an occupational therapist was present at initial neurology visits for suspected concussion. Records from these visits were included for review along with records from neurology visits during which the OT was not present, but the patient was referred to OT services. Decision for referral was made by the staff physician of each visit. Patient information was collected following initial visit to clinic, de-identified and compiled in a sole location. Data analyzed included demographics, therapist's presence at visit, information regarding school, work, physical, social, and leisure activity, routine, and sleep.
RESULTS: R Version 3.6.3 was used to analyze all data. 48 records were reviewed, 42 records met inclusion criteria. 16 were referred (REF) to OT and 26 were not referred (NOT). The REF group was 81% female and the mean age was 21.9 years. The NOT group was 46% female and the mean age was 26.4 years. Comparison between the two groups showed that REF differed significantly from NOT in five out of nine hypothesized domains. Conventional t-tests showed no significance but the robust Yuen test, which appropriately down-weighs statistical outliers, showed that REF were further post-initial injury (204.9 days vs 90.44 days; p = 0.043), missed more days from school or work (35.9 days vs 7.5 days, p = 0.015) and from physical activity (58.6 days vs 16.81 days; p = 0.022) due to symptoms following concussion. REF also did not have a daily routine (p = 0.029) and were not socially active (p < 0.001). There were no statistically significant differences between REF and NOT in current participation in school or work, physical activity, leisure, or sleep at the time of evaluation.
CONCLUSION: Patients referred to occupational therapy services after being evaluated in an interdisciplinary concussion clinic present with clinically different needs from those who are not referred. This research impacts future OT practice as it serves to highlight the unique presentation of patients who might benefit from an OT evaluation after sustaining a concussion, and to guide healthcare professionals in this referral process. In the future, referring physicians may use variables such as days since injury, days missed from school, work and physical activity, or lack of routine and social participation as indicators for occupational therapy assessment. Further research is required to address the efficacy and impact of specific OT intervention in these domains.
References
Finn, C. (2019). Occupational Therapists’ Perceived Confidence in the Management of Concussion: Implications for Occupational Therapy Education. Occupational Therapy International. 2019: 1-5. https://doi.org/10.1155/2019/9245153
R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/.
