Background:

Post-concussion care or treatments must be evidence-based, or if evidence is not available, recommended through the consensus of recognized leaders in concussion, and be within the scope of practice of the treating care provider.

A research-to-practice gap exists such that some practices shown to be effective by scientific research may not be used in clinical practice, but some therapies are not empirically validated and may be ineffective or even harmful. Because scientific research, especially when synthesized across multiple, high-quality, experimental studies, is generally recognized as the most valid source of evidence for determining what is effective, prioritizing such evidence-based practices over other ineffective approaches should result in better patient outcomes.

What this standard means:

The evidence is continually evolving in the area of clinical research in post-concussion care and healthcare providers need to keep current regarding the latest evidence. This can be done through consultation of clinical practice guidelines. Regulating bodies also have an obligation to summarize the latest research, update practice guidelines and disseminate these changes to their membership.

In the absence of a solid body of scientific evidence, regulating bodies for healthcare providers have a role in disseminating consensus-based updates to clinical practices based on the experience of leaders in their profession in collaboration with leaders of other healthcare professions (i.e. consensus statement from Berlin).

Concussion clinics need to justify the appropriateness of therapies and whether there is strong evidence to support them; patients must know that therapies being recommended are appropriate or whether they are evidence-based. This is necessary for patients and families to be able to informed decisions about their care.

There are some new therapies being offered for which there is no research or consensus of recognized clinical experts to support their use. While these may be anecdotally helpful there is no strong support for these practices. Providers need to be upfront when there is not an evidence base to support the use of a suggested therapy, especially when there is no payment coverage for those therapies.

Tools and Resources:

Concussion Clinical Practice Guidelines: Adult, Pediatric, Sport