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

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.