Concussion clinic guidance to focus on the right care, at the right time by the right provider

Inconsistencies targeted, application of concussion guidelines supported  

It should be straightforward. Someone who experiences a concussion regardless of the cause should have confidence that they will be able to able to access appropriate care by choosing or being referred to a clinic that says it specializes in “concussion care”. Unfortunately this is not the case.

There has been a proliferation of such clinics in the province over the past decade due to the increased profile of concussions. The Ontario Neurotrauma Foundation initiated the development of Concussion Clinic Standards at a spring 2016 summit to reduce inconsistent approaches to care, the need to have individualized requirements addressed and to further encourage the use of known and effective therapies. The first version of the standards will be released this spring.

“The goal is to provide guidance to clinicians that will help support them to work within their scope of practice providing the care that is required,” says Corinne Kagan, Senior Director Acquired Brain Injury at ONF. “It’s important that there is a common understanding across the system regarding the processes around concussion care, including timing of treatment and strong connections to primary care clinicians.”

Finding care is a maze

Katelin Sims felt like she was in a maze when looking for a clinic able to address her post-concussion treatment. “I found out that any clinic can call itself a concussion clinic, regardless of the level of expertise in providing care specific to concussions,” says Katelin. “While most provide adequate care, these clinics are not all the same and it took some time to find one that was right for me. Health care professionals there provided the navigation through the healing process and I could focus on getting better, not figuring out if an appropriate treatment plan was in place.”

Neuropsychologist Dr. Diana Velikonja is a member of the ONF Acquired Brain Injury Committee and is helping lead this effort. “Clinics have developed their own approaches to concussion care – some of this based on the available evidence-based guidelines and some is not”, she says.

“There continues to be a need to evaluate the evidence supporting the treatment options and the care pathways providers follow in providing concussion treatment,” she says. “People looking for concussion treatment must have confidence that the clinic they choose will have those standard processes in place.”

In an ideal world each person with a concussion would be properly diagnosed then educated about their symptoms and recover. If symptoms persist they would be followed by an interdisciplinary group of professionals who have specialized training in concussion and work within their scope of practice to provide evidence-based care. Their family physician would be part of the care process.

Ruth Wilcock of the Ontario Brain Injury Association (OBIA) says Katelin’s experience is all too common.

“Many people have knowledge of other types of injuries but concussion isn’t that well understood, so it’s difficult to know if you have found a clinic to provide the best care,” she says. “We often hear ‘where can I get help and when am I going to get better?’ They desperately try to find treatment in any form so that they can recover as quickly as possible.”

Standard approach will help patient, health care providers

Ruth wants patients to be able to determine if the clinic they are choosing adheres to evidence-based standards. They are then able to make better informed decisions about the care they receive. “The goal of setting these standards is both to help the patient and the clinician,” she says.

“We would like to see private practitioners such as physiotherapists or chiropractors feel they can work effectively with physicians and other health care providers in the interdisciplinary team,” she says. Concussion clinic standards will provide guidance with respect to the various roles in the care process across the health system.

“People should know that this is a journey and that it may take more time than you realize to find the best clinic and health care team,” says Katelin. “By establishing standards for the operation of clinics, over time the public can feel confident that the care practiced at a clinic follows the standard processes and care guidelines that reflect the most current research. This can help them with their recovery.”

“The challenge will be to keep these standards practical and ensure they are easy to implement,” says Corinne. “This should help reduce the overall burden on the system, the clinicians and patients while supporting the right health care provider to deliver the right care at the right time.”

ONF will release the first version of Standards for Concussion Clinics in the spring of 2017. The third (updated) version of the Adult Concussion Guidelines is also expected to be published in 2017.