Use of a multi-level mixed methods approach to study the effectiveness of a primary care progressive return to activity protocol after acute mild traumatic brain injury/concussion in the military

详细信息    查看全文

• 作者：Emma Gregory^a ; ^b ; ^{emma.d.gregory2.ctr@mail.mil} ; Therese A. West^c ; Wesley R. Cole^a ; ^b ; ^d ; Jason M. Bailie^a ; ^b ; ^e ; Karen L. McCulloch^f ; ^g ; Mark L. Ettenhofer^a ; ^h ; ⁱ ; Amy Cecchini^a ; ^g ; Felicia M. Qashu^a
• 关键词：CPG ; clinical practice guideline ; CR ; clinical recommendation ; DVBIC ; defense and veterans brain injury center ; DoD ; department of defense ; mBIAS ; mild brain injury atypical symptoms scale ; mTBI ; mild traumatic brain injury ; NSI ; neurobehavioral symptom inventory ; PCMs ; primary care managers ; PRA CR ; progressive return to activity ; RCTs ; randomized controlled trials ; SSI ; semi-structured interview ; SMs ; service members ; TAU ; treatment as usual ; VA ; veterans affairs
• 刊名：Contemporary Clinical Trials
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：52
• 期：Complete
• 页码：95-100
• 全文大小：326 K
• 卷排序：52

文摘

The large number of U.S. service members diagnosed with concussion/mild traumatic brain injury each year underscores the necessity for clear and effective clinical guidance for managing concussion. Relevant research continues to emerge supporting a gradual return to pre-injury activity levels without aggravating symptoms; however, available guidance does not provide detailed standards for this return to activity process. To fill this gap, the Defense and Veterans Brain Injury Center released a recommendation for primary care providers detailing a step-wise return to unrestricted activity during the acute phase of concussion. This guidance was developed in collaboration with an interdisciplinary group of clinical, military, and academic subject matter experts using an evidence-based approach. Systematic evaluation of the guidance is critical to ensure positive patient outcomes, to discover barriers to implementation by providers, and to identify ways to improve the recommendation. Here we describe a multi-level, mixed-methods approach to evaluate the recommendation incorporating outcomes from both patients and providers. Procedures were developed to implement the study within complex but ecologically-valid settings at multiple military treatment facilities and operational medical units. Special consideration was given to anticipated challenges such as the frequent movement of military personnel, selection of appropriate design and measures, study implementation at multiple sites, and involvement of multiple service branches (Army, Navy, and Marine Corps). We conclude by emphasizing the need to consider contemporary approaches for evaluating the effectiveness of clinical guidance.