Methods

The Concussion Advisory Committee was formed by the Ontario Neurotrauma Foundation (ONF) ABI Advisory Committee to advance the work completed at the April 2016 Concussion Summit, with the mandate to move forward on developing the Standards for Post-Concussion Care in Ontario. Following the Summit it was clear that there were four key areas that needed to be addressed:

  1. Define the multiple competences and scopes of practice of different healthcare providers that deliver post-concussion services, in order to support collective competence for post-concussion care.
  2. Develop a pathway or system for ensuring that patients were connected to the appropriate healthcare professional at the right time.
  3. Develop information for patients and family members to help them navigate what has become a complex and often disjointed system of post-concussion care.
  4. Develop a strategy to educate the public and healthcare providers on the Standards for Post-Concussion Care in Ontario.

To effectively address these key areas, four working groups were developed. Each working group had an identified Chairperson who led the sessions of their group during the Fall of 2016. Staff from the ONF oversaw the activities of the four working groups to maintain continuity in process, support complementarity, ensure that there were no major gaps in content, and to reduce any overlap in content between working groups. Each of the working groups was tasked to provide a rationale and practical leadership directions for the draft Standards based upon the consensus outcomes from the Concussion Summit.

The goals of the four working groups are outlined below:

Collective Competence

Goals/Accomplishments:

  • Developed a profile of service that various healthcare practitioners working with concussions contribute based upon their defined scope of practice (within Ontario), and the training required to work with concussed patients.
  • Drafted a profile of typical concussion related symptom clusters and map this onto the scopes of practice of various healthcare professionals.
  • Defined the service functions that a concussion clinic should offer and draft a model for concussion symptom management.
Improving the System for Management and Referrals

Goals/Accomplishments:

  • Created a pathway to standardize the flow of service from the point of injury to diagnosis, follow-up, and longer term referrals.
  • Developed an evidence-based list of risk factors related to the development of persistent concussion symptoms to allow for earlier and more effective management.
  • Coordinated common concussive symptoms as indicators for referrals to healthcare providers with management of specific symptoms in their scope of practice.
  • Examined the regionalism of current concussion services to create a provincial network of centres of excellence to enhance links between health care professionals/clinics.
Developing Patient Information

Goals/Accomplishments:

  • Developed information package for patients synthesizing key information from current evidence-based resources.
  • Identified questions that patients should ask their service provider, and information that providers should be prepared to answer regarding concussive injuries, management and expected outcomes.
  • Identified methods of disseminating information packages to providers, networks and appropriate channels.
Education on the Standards

Goals/Accomplishments:

  • Identified primary and secondary audiences and delivery mechanisms for short term education of the Standards for Concussion Clinics. Primary audiences are those who should be addressed in the first effort and involve those directly involved in the treatment, planning and funding of service provision for individuals post-concussion. Secondary audiences are those one step removed from direct service provision, but are important nonetheless. Identified delivery mechanisms involved print-based, electronic and in-person methods, with variations by audience.
  • Developed a preliminary strategy to disseminate and educate professionals and the general public on the Standards for Concussion Clinics.
  • Identified common knowledge gaps in relation to the Standards for Concussion Clinics in order to set priorities for the education on the Standards. These gaps are in relation to understanding the type of interdisciplinary care that is required, the scopes of practice of different healthcare professionals, the trajectory of care and the need for the Standards for Concussion Clinics, and how standards could be clinically helpful.

The ONF Concussion Advisory Committee and ONF Acquired Brain Injury Committee then reviewed a report created from the working groups and provided feedback and further editing. The information was then compiled by ONF staff into a formal standards document and sent for external review and feedback from participants from the original 2016 Summit, as well as professional associations and select stakeholder organizations.

Feedback was obtained from three external reviewers. The document was also sent for feedback to the following:

  • All participants of the 2016 Summit on Concussion Standards
  • Ministry of Health and Long-Term Care
  • Health Quality Ontario
  • WSIB Medical Director and Team
  • Ontario Brain Injury Association
  • Ontario College of Family Physicians
  • Ontario Association of Family Health Teams
  • College of Nurses of Ontario
  • Ontario Chiropractic Association
  • College of Occupational Therapists of Ontario
  • College of Physiotherapists of Ontario
  • College of Psychologists of Ontario
  • College of Audiologists and Speech Language Pathologists of Ontario
  • Ontario Athletic Therapist Association
  • Ontario College of Social Workers
  • College of Massage Therapists of Ontario
  • College of Optometrists of Ontario
  • Various Professional Associations
  • Ontario Provincial Lead for Emergency Medicine

The Concussion Advisory Committee reviewed feedback and approved final changes.

The ONF Concussion Advisory Committee and ONF Acquired Brain Injury Committee then reviewed a report created from the working groups and provided feedback and further editing. The information was then compiled by ONF staff into a formal standards document and sent for external review and feedback from participants from the original 2016 Summit, as well as professional associations and select stakeholder organizations.

Feedback was obtained from four external reviewers. The document was also sent for feedback to the following:

  • All participants of the 2016 Summit on Concussion Standards
  • Ministry of Health and Long-Term Care
  • Health Quality Ontario
  • WSIB Medical Director and Team
  • Ontario Brain Injury Association
  • Ontario College of Family Physicians
  • Ontario Association of Family Health Teams
  • College of Nurses of Ontario
  • Ontario Chiropractic Association
  • College of Occupational Therapists of Ontario
  • College of Physiotherapists of Ontario
  • College of Psychologists of Ontario
  • College of Audiologists and Speech Language Pathologists of Ontario
  • Ontario Athletic Therapist Association
  • Ontario College of Social Workers
  • College of Massage Therapists of Ontario
  • College of Optometrists of Ontario
  • Various Professional Associations
  • Ontario Provincial Lead for Emergency Medicine

The Concussion Advisory Committee reviewed feedback and approved final changes.