Identifying Occupational Therapy Referral Patterns in an Interdisciplinary Concussion Clinic

Abstract

ObjectiveTo identify whether patients referred to occupational therapy (OT) in a specialty concussion clinic differ clinically from those not referred.BackgroundLiterature pertaining to OTs role in concussion management is limited (Finn, 2019) and research primarily explores moderate to severe traumatic brain injury (TBI) (Cogan 2014).Design/MethodsUsing a cohort from an interdisciplinary concussion clinic at an academic institution, demographics, injury characteristics, patient/family history, and neurologic exam results were obtained from complete medical records of patients 8–75 years with mild TBI. Patients with moderate or severe TBI were excluded. Records were reviewed from initial neurology visits between January and April 2020 if OT was present or patient was referred to OT. Outcomes included days since initial injury, days missed/current participation in school, work, exercise, social and leisure activity, impacted sleep and routine. Referrals were decided by visit physician. R Version 3.6.3 was used to analyze data.Results42 of 48 records met inclusion criteria. 16 were referred (REF) to OT, 26 not referred (NOT). REF were 81% female, mean age 21.9 years. NOT were 46% female, mean age 26.4 years. The robust Yuen test showed REF were further post-initial injury (204.9 days vs 90.44 days; p = 0.043), missed more school or work (35.9 days vs 7.5 days, p = 0.015) and exercise (58.6 days vs 16.81 days; p = 0.022) following concussion. REF also lacked a daily routine (p = 0.029) and were not socially active (p < 0.001). Current participation in school, work, exercise, or leisure, as well as impacted sleep showed no statistically significant group differences.ConclusionsPatients referred to OT after evaluation in an interdisciplinary concussion clinic experienced prolonged recovery with protracted durations of inactivity, lack of daily routine and absence of social activity. Future research should explore whether factors like symptom burden, pain, or comorbidities may account for these differences and provide clinicians with earlier indication for OT referral.