Abstract
This descriptive, qualitative study describes the OT process used by expert practitioners for adults with persistent mild traumatic brain injury symptoms in outpatient concussion clinics. OTs are uniquely trained to return persons to their everyday activities, without requiring a military or sport background. This evidence empowers practitioners to advocate for the client and for the professional to be part of the rehabilitation team and raise the perceived value of the profession.
Primary Author and Speaker: Mary Ann B. Roelke
Contributing Authors: Vanessa Jewell
Traumatic brain injuries (TBIs) are a public health issue; 90% are considered mild (mTBI), or concussion, and up to 30% have persistent symptoms lasting more than three months (Centers for Disease Control & Prevention, 2020). Current concussion rehabilitation recommendations are based on symptom profiles with suggestion to address the whole person, but with little guidance on how to move toward return to activity and life roles. Occupational therapy practitioners are trained to help a person return to their everyday activities. The study purpose was to describe the occupational therapy process used by expert practitioners for adults with persistent mTBI symptoms in outpatient concussion clinics across practice settings. Research questions were: How do expert occupational therapy practitioners describe philosophy of care and care plans used with concussed adults receiving care in outpatient neurologic programs? The inclusion criterion for this descriptive, qualitative study were: Occupational therapy practitioners with contributing work toward concussion rehabilitation including first author, interventionist in a study, or national presenter; 3+ years of experience; 1+ year in concussion rehab, part of an interdisciplinary outpatient (OP) neurologic concussion (NC) rehabilitation clinic; and proficient in English. Exclusion criterion: Non-English speaking, employed outside of adult OP NC rehabilitation. Data collection instruments included pilot-tested demographic questionnaire and semi-structured interview guide. Email contact was made to obtain consent and schedule. The one-hour virtual focus group used round-robin method and open discussion. Content analysis with a deductive strategy, open coding, and unconstrained matrix were used for the video- and audio-recorded interview data corpus verbatim transcriptions (Elo & Kyngas, 2007; Creswell & Poth, 2018). Categories were hand coded into Excel based on pre-determined symptom profiles, new codes emerged, all were reviewed for final themes, concept maps and outline were created. Trustworthiness of data is assured via triangulation of space, person, researcher; member-checking; transferability; and credibility. Thirteen expert occupational therapy practitioners enrolled, eight clinical and five academicians, with backgrounds in neurology (7), military (5), sport (5), and mental health (2). Analysis of data corpus determined concepts using a deductive approach of content analysis (Elo & Kyngas, 2008). The overarching concepts include dynamic interplay with sub-concepts of education, modification, and rehabilitation; use of a strengths-based approach; and concussion rehabilitation progression with sub-concepts progression of care and individualized session example. In summary, occupational therapy practitioners deliver care plans for people with persistent concussion symptoms through a dynamic interplay of education, modification, and rehabilitation, and a strengths-based approach through the progression of care, to return a person to their everyday activities and life roles. The philosophy of care is consistent across practice settings and follows the Occupational Therapy Practice Framework (AOTA, 2014). This study is important to practice because it demonstrates that practitioners are uniquely trained in activity analysis and graded activity progression to return a person to their everyday activities including work, school, recreational activities, and their sport. Providing evidence of occupational therapy process for concussion rehabilitation empowers practitioners to advocate for the client, advocate for the occupational therapy practitioner to be part of the rehabilitation team, and raises the perceived value of the profession.
American Occupational Therapy Association (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48. https://doi.org/10.5014/ajot.2014.68s1
Centers for Disease Control and Prevention (CDC), National Institute of Health (NIH), Department of Defense (DoD), and Veterans Administration (VA) Leadership Panel (2013). Report to Congress on Traumatic Brain Injury in the United States: Understanding the Public Health Problem among Current and Former Military Personnel. Retrieved from https://www.cdc.gov/traumaticbraininjury/pdf/Report_to_Congress_on_Traumatic_Brain_Injury_2013-a.pdf
Creswell, J.W. & Poth, C.N. (2018). Qualitative inquiry and research design Choosing among five approaches (4th ed.). Thousand Oaks, CA: SAGE Publications.
Elo, S. & Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62(1), 107-115. https://doi.org/10.1111/j.1365-2648.2007.04569.x