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Updated: Dec 9, 2025
Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
Published on: January 20, 2019
De-implementing Prolonged Rest Advice for Concussion in Primary Care Settings: A Pilot Stepped Wedge Cluster
Noah D Silverberg1, Thalia Otamendi, William J Panenka
1Division of Physical Medicine & Rehabilitation (Dr Silverberg), Rehabilitation Sciences (Ms Otamendi), and Departments of Psychiatry (Dr Panenka), Pediatrics (Dr Babul), and Physical Therapy (Dr Li), The University of British Columbia, Vancouver, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada (Dr Silverberg and Ms MacLellan); BC Mental Health & Substance Use Services Research Institute, Vancouver, British Columbia, Canada (Dr Panenka); British Columbia Provincial Neuropsychiatry Program, Vancouver, British Columbia, Canada (Dr Panenka); Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Quebec, Canada (Dr Archambault); Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, Ontario, Canada (Dr Archambault); Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Lévis, Quebec, Canada (Dr Archambault); Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec City, Quebec, Canada (Dr Archambault); Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec, Canada (Dr Archambault); BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, British Columbia, Canada (Dr Babul); and Arthritis Research Canada, Richmond, British Columbia, Canada (Dr Li); on behalf of the Canadian TBI Research Consortium.
A pilot study found that while physician training improved concussion return-to-activity guideline adherence, recruitment and retention challenges need addressing for future research on de-implementing prolonged rest advice.
Area of Science:
- Sports Medicine
- Public Health
- Clinical Practice Improvement
Background:
- Concussion management guidelines recommend a structured return to activity.
- Prolonged rest is often overprescribed, hindering recovery.
- De-implementation strategies are needed to align practice with evidence-based guidelines.
Purpose of the Study:
- To assess the feasibility and preliminary effectiveness of a de-implementation intervention.
- To support the use of return-to-activity guidelines after concussion.
- To reduce prolonged rest recommendations in clinical practice.
Main Methods:
- Pilot stepped wedge cluster randomized trial involving 21 family physicians across 5 clinics.
- Intervention involved education outreach visits on new return-to-activity guidelines.
- Feasibility assessed via recruitment, retention, and form completion; efficacy via knowledge tests and guideline adherence; qualitative interviews explored barriers and facilitators.
Main Results:
- Feasibility benchmarks for recruitment, retention, and form completion were not met.
- Physician knowledge of guidelines increased significantly (6.3 to 8.8/10 correct).
- Guideline adherence improved dramatically (25% to 86%).
- Qualitative data identified key barriers (e.g., beliefs) and facilitators (e.g., patient materials).
Conclusions:
- Education outreach shows potential for de-implementing prolonged rest advice post-concussion.
- Methodological adjustments are crucial for the feasibility of larger trials.
- Qualitative insights offer valuable avenues for intervention refinement.
