Evaluating the Implementation of an Occupational Therapy-Led Concussion Clinic Model Into Usual Practice: A Mixed Methods Study.

IF 2.4 3区 医学 Q2 CLINICAL NEUROLOGY
Adrianne Natoli, Ethan Hunt, Emma Hays, Eloise Thompson, Samantha Ioannidis, David J Read, Toni D Withiel, Celia Marston
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Abstract

Objectives: (1) To evaluate the implementation of Australia's first occupational therapy-led concussion clinic model into usual practice by examining acceptability and fidelity among clinicians and service users, and (2) to explore the feasibility of embedding outcome measures into the service to facilitate longer-term clinic evaluation.

Setting and participants: A large tertiary trauma hospital service in Melbourne, Australia. Participants were patients referred to the concussion clinic and occupational therapists working in the service.

Design: Prospective, single-site, mixed methods design.

Main measures: Acceptability outcomes were evaluated using clinician interviews and the Client Satisfaction Questionnaire-8. Clinic fidelity was assessed by service usage data. Long-term patient outcomes assessed concussion (Rivermead Post-Concussive Questionnaire), mood symptoms (Patient Health Questionnaire-9), and participation in activities of daily living (Community Integration Questionnaire-Revised).

Results: Over 18 months, 73% (n = 177) of patients were referred to the clinic, and 75% attended. Adherence to protocol was achieved; however, the completion rate of post-treatment measures was low. Almost half of the patients required specialist referrals beyond the clinic model for persistent symptoms. The interviewed occupational therapists (n = 6) viewed the clinic as a "safety net for patients," believed they were "learning as we go," recognized that the "clinic had potential to grow," but admitted, "we could be doing more." High attendance rates and patient satisfaction further supported clinic acceptance at an end-user level.

Conclusion: An occupational therapy-led concussion clinic is accepted by patients and clinicians to capture the immediate needs of people with concussions after discharge. However, coordinated pathways to multidisciplinary care are needed to address the long-term needs of people with persistent concussion symptoms and problems returning to daily activities.

评估职业治疗主导的脑震荡临床模型在日常实践中的实施:一项混合方法研究。
目的:(1)通过检验临床医生和服务使用者的可接受性和保真度,评估澳大利亚首个以职业治疗为主导的脑震荡临床模式在常规实践中的实施情况;(2)探索将结果测量纳入服务的可行性,以促进长期临床评估。环境和参与者:澳大利亚墨尔本一家大型三级创伤医院。参与者是转介到脑震荡诊所的病人和在该诊所工作的职业治疗师。设计:前瞻性、单场地、混合方法设计。主要测量方法:通过临床医生访谈和客户满意度问卷-8来评估可接受性结果。通过服务使用数据评估临床保真度。评估脑震荡患者的长期预后(Rivermead脑震荡后问卷)、情绪症状(患者健康问卷-9)和日常生活活动的参与(社区融入问卷-修订版)。结果:超过18个月,73% (n = 177)的患者转诊到诊所,75%的患者就诊。遵守了协议;然而,后处理措施完成率较低。几乎一半的患者需要专科转诊,而不是诊所模式的持续症状。接受采访的职业治疗师(n = 6)将诊所视为“患者的安全网”,相信他们“在我们前进的过程中学习”,认识到“诊所有发展的潜力”,但承认“我们可以做得更多”。高出勤率和患者满意度进一步支持了最终用户对诊所的接受度。结论:以职业治疗为主导的脑震荡门诊能够满足脑震荡患者出院后的迫切需求,为患者和临床医生所接受。然而,需要协调的多学科护理途径来解决持续脑震荡症状和恢复日常活动问题的人的长期需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.80
自引率
4.20%
发文量
153
审稿时长
6-12 weeks
期刊介绍: The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of “knowledge informing care” and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America (BIAA).
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