Physiotherapist involvement in concussion services in New Zealand: A national survey

Maxtone, Sophie; Bishop, Megan; Chapple, Cathy; Tumilty, Steve; Quinn, Dusty; Kennedy, Ewan

doi:10.15619/nzjp/48.2.03

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…PU representatives also perceived their responsibilities spanned from a collation of region-level injury surveillance data to direct follow-up with injured players and seeking confirmation of their medical clearance. Although not specifically interviewed as part of this study, physiotherapists have multiple responsibilities in the immediate management and recovery of players with concussion,26 27 and this was also evident in the expectations of physiotherapists from the participants in this study. These findings demonstrate these stakeholders' broad influence on concussion care and its direct impact on players.…”

Section: Discussionmentioning

confidence: 99%

Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System

Salmon,

Chua,

Brown

et al. 2023

BMJ Open Sport Exerc Med

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There is a growing concern around concussions in rugby union, at all levels of the game. These concerns highlight the need to better manage and care for players. However, consistency around concussion-related responsibilities of stakeholders across the community rugby system remains challenging. Taking a systems thinking approach, this pragmatic, qualitative descriptive study explored key stakeholder groups within New Zealand’s community rugby system’s perceptions of their own and others’ concussion-related responsibilities. Participants included players from schools and clubs, coaches, parents, team leads and representatives from four provincial unions. A total of 155 participants (67 females and 88 males) were included in the study. Focus groups and individual interviews were conducted. Thematic content analysis was used to analyse data. Thirty concussion-related responsibilities were identified. These responsibilities were contained within four themes: (1) policies and support (responsibilities which influence policy, infrastructure, human or financial resources); (2) rugby culture and general management (responsibilities impacting players’ welfare and safety, attitudes and behaviour, including education, injury reporting and communication); (3) individual capabilities (responsibilities demonstrating knowledge and confidence managing concussion, leadership or role/task shifting) and (4) intervention following a suspected concussion (immediate responsibilities as a consequence of a suspected concussion). The need for role clarity was a prominent finding across themes. Additionally, injury management initiatives should prioritise communication between stakeholders and consider task-shifting opportunities for stakeholders with multiple responsibilities. How concussions will realistically be managed in a real-world sports setting and by whom needs to be clearly defined and accepted by each stakeholder group. A ‘framework of responsibilities’ may act as a starting point for discussion within different individual community rugby contexts on how these responsibilities translate to their context and how these responsibilities can be approached and assigned among available stakeholders.

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Section: Discussionmentioning

confidence: 99%

Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System

Salmon,

Chua,

Brown

et al. 2023

BMJ Open Sport Exerc Med

View full text Add to dashboard Cite

show abstract

“…In reality, physiotherapists are often involved and confident to identify and manage individuals with suspected concussions while waiting for a medical doctor appointment (Frémont et al, 2022;Maxtone et al, 2020;McGrann & Keating, 2012;Salmon, Chua, et al, 2023). To initiate care under the current ACC restrictions, physiotherapists use other read codes that are within their scope, such as neck sprains or head contusions (Kennedy et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Aotearoa New Zealand physiotherapists’ perspectives of potential expanded roles for sports-related concussion management: A qualitative study

Dalton,

Galea,

Blyth

et al. 2024

NZJP

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Concussions (mild traumatic head injury) have received increasing attention in clinical practice, research, and the public press. A range of healthcare providers engage with patients presenting with concussion, and physiotherapists are often at the front line of these consultations, especially on the sports field. We explored physiotherapists’ perspectives of their scope of practice and actual clinical practice within the sports-related concussion diagnosis and return-to-sport context. A qualitative approach with interviews and focus groups was used, including 18 physiotherapists. Three themes were derived: (a) delayed access to concussiontrained general practitioners; (b) navigating concussion care in a strained healthcare system; and (c) proposed expanded role for physiotherapists. Delayed patient access to medical doctors often delayed a formal concussion diagnosis, initiation of specific concussion care, or medical sports clearance. Yet the participants were regularly identifying and managing concussions, and most felt confident to do so. Some participants, particularly those working with high-performance athletes or in multidisciplinary teams, suggested that concussion diagnosis and clearance for return to work or play should remain the medical doctors’ responsibilities. Yet participants working at community level suggested that, with relevant training and mentored experience, diagnosis, triaging, and clearance for sport could be within their scope of practice.

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“…42 Physiotherapists play a key role in concussion management. 59 Future work should consider how this profession could be optimally involved and supported in this process. 60,61 Active engagement of currently under-utilized stakeholders such as school nurses, or other opportunities for task-shifting among stakeholders must be considered.…”

Section: Discussionmentioning

confidence: 99%

Managing concussion in the real world: Stakeholder perspectives of New Zealand Rugby's concussion management pathway

Salmon,

Walters,

Brown

et al. 2023

International Journal of Sports Science & Coaching

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The potential adverse consequences associated with poor concussion management highlights the need to improve the translation of concussion guidelines into consistent use in real-world sport settings. To facilitate this process, New Zealand Rugby developed a community concussion management pathway to support concussion recognition, diagnosis, and management. This study adopted a pragmatic, descriptive qualitative approach to explore key stakeholders’ perceptions of the concussion management pathway, with the aim to inform policy and practice. Interviews were conducted with 123 participants, including players, parents, coaches, healthcare professionals, and school and provincial union representatives. The framework method was used to analyze data. Themes were organized according to the principles of realist process evaluation that considers contextual factors and mechanisms influencing a program's operation to produce specific outcomes. Contextual factors influencing the concussion management pathway's implementation included governing bodies’ support, existing local resources, general concussion attitudes, or concussion severity. The optimal functioning of the concussion management pathway ( mechanism) was influenced by (i) pathway resources, (ii) roles and relationships, (iii) buy-in and support towards the concussion management pathway, and (iv) diligence and communication. Outcomes identified included (i) hitting the target (optimally managed and enhanced awareness) or (ii) missing the mark (dissatisfaction or management gaps). Overall, participants found the concussion management pathway valuable. However, the acceptability of certain policy-related aspects and the underlying attitudes associated with these perceptions, are some areas requiring further investigation and support. Tailoring programs according to end-users’ perceptions is crucial in developing context-sensitive interventions appropriate for a specific setting. These findings may act as a foundation for investigations of concussion management in other settings.

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Physiotherapist involvement in concussion services in New Zealand: A national survey

Cited by 5 publications

References 22 publications

Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System

Quest for clarity: investigating concussion-related responsibilities across the New Zealand Rugby Community System

Aotearoa New Zealand physiotherapists’ perspectives of potential expanded roles for sports-related concussion management: A qualitative study

Managing concussion in the real world: Stakeholder perspectives of New Zealand Rugby's concussion management pathway

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