Identification of Clinical Measures to Use in a Virtual Concussion Assessment: Protocol for a Mixed Methods Study

Abstract

Background Workplace concussions can have a significant impact on workers. The impact of concussion symptoms, combined with challenges associated with clinical environments that are loud, bright, and busy, create barriers to conducting effective in-person assessments. Although the opportunity for remote care in rural communities has long been recognized, the COVID-19 pandemic has catalyzed the transition to virtual assessments and care into the mainstream. With this rapid shift, many clinicians have been completing remote assessments. However, the approaches and measures used in these assessments have not yet been standardized. Furthermore, the psychometric properties of the assessments when completed remotely using videoconference have not yet been documented. Objective Through this mixed methods study, we aim to (1) identify the concussion assessment measures clinicians are currently using in person and are most relevant to the following 5 physical domains: neurological examination (ie, cranial nerve, coordination, motor, and sensory skills), cervical spine, vestibular, oculomotor, and effort assessment; (2) document the psychometric properties of the measures identified; (3) identify measures that appear feasible in a virtual context; and (4) identify practical and technical barriers or challenges, facilitators, and benefits to conducting or engaging in virtual concussion assessments. Methods This study will follow a sequential mixed methods design using a survey and Delphi approach, working groups with expert clinicians, and focus groups with experienced clinicians and people living with concussions. Our target sample sizes are 50 clinicians for the Delphi surveys, 4 clinician-participants for the working group, and 5-7 participants for each focus group (roughly 6-10 total groups being planned with at least two groups consisting of people living with concussions). The results from this study will inform the decision regarding the measures that should be included in a virtual assessment tool kit to be tested in a future planned prospective evaluation study. Results The study is expected to be completed by January 2023. Conclusions This mixed methods study will document the clinical measures that are currently used in person and will identify those that are most relevant to assessing the physical domains impacted by concussions. Potential feasibility of using these measures in a virtual context will be explored. International Registered Report Identifier (IRRID) DERR1-10.2196/40446

Reliability and Sensitivity of a Virtual Assessment Developed for Workplace Concussions: Protocol for a Method-Comparison Study

“…There is an identified gap in the current knowledge with limited research conducted on the reliability and comparability of virtual concussion assessments in comparison to inperson assessments. While virtual care has demonstrated to be a valuable approach to concussion assessment and management [19,44], there is a need for additional information regarding the psychometric properties of outcome measures. This information is essential for instilling confidence in the administration of these measures in a practical setting.…”

“…Clinician surveys were used to identify relevant measures for assessing the physical domains of concussion [19]. A working group refined the measures feasible for virtual administration based on expert opinion.…”