Provider Perceptions of Current Concussion Care Practices for Active Duty Service Members

The traumatic brain injury (TBI) and concussion management landscape changes with rapidly evolving evidence and clinical guidance. This evolution presents challenges in implementing current and best evidence. The purpose of this study was to explore provider perceptions of current concussion care practices and the Department of Defense/Defense Health Agency's Progressive Return to Activity Clinical Recommendation (PRA) to inform future research and concussion care.

This study was a qualitative, cross-sectional, survey study. Qualitative data were analyzed using a Consensual Qualitative Research (CQR) tradition.

Seventeen healthcare providers actively engaged in caring for active duty service members with a concussion participated in the qualitative survey (11 primary care providers [MD/DO/PA/NP], 1 occupational therapist, 1 cognitive coach, and 4 medics). Fourteen of 17 (82.4%) agreed or somewhat agreed that current practices aid in their patients' recovery; 12/17 (70.5%) agreed or somewhat agreed that current practices under the PRA meet the needs of their patients. The CQR processes identified 3 themes concerning factors related to implementation of current concussion care practices. These were (1) roles, (2) treatment, and (3) education. Roles were attributed to the service member (e.g., accurate reporting, varying motivation to comply, and differing accountability to follow protocols), provider (e.g., variability following protocols, provision of educational materials), and organization/command (e.g., updating protocols, pushing out updates/education, support for treatment/protocols) in the context of the pathway of care. The second theme was treatment where protocols (e.g., conventional and holistic), recommended improvements (e.g., chronic considerations, follow-up guidelines, specificity on limitations), and symptoms (e.g., assessments, guiding treatment, and subjectivity) were discussed as drivers and challenges in treatment. The third theme was education, where both service member (e.g., pre-/post-concussion education, clinical information delivery as handouts and paper materials) and provider (e.g., continuing education, delivery of provider education through handouts, online, and in-person trainings) education were discussed.

Future research and clinical practice guidelines can consider these findings as new studies and guidelines are developed to preserve brain health among service members.