Abstract
Background: Early concussion diagnosis is critical for initiating rehabilitation, and delayed diagnosis can lead to delayed recovery. Physiotherapists are at the front-line of identifying potential concussions and ensuring that sportspeople are ready to return to training. Yet only medical doctors can diagnose and provide clearance for return-to-sports.
Purpose: To explore physiotherapists' perspectives of their scope of practice and current actual clinical practice within sports-related concussion diagnosis and return to sports.
Methods: We recruited 18 physiotherapists working in sports physiotherapy for this qualitative study, using semi-structured individual interviews and focus groups, and Interpretive Description.
Results: Three themes were derived: (i) Delayed access to concussion-trained medical doctors; (ii) Navigating concussion care in a strained healthcare system, and (iii) Proposed expanded role for physiotherapists. Delayed access to medical doctors often delayed formal concussion diagnosis, initiation of concussion care, or medical sports clearance. Yet participants were regularly identifying and managing concussions, feeling confident to do so. Participants working with high-performance athletes or in multidisciplinary teams suggested that concussion diagnosis and clearance for return-to-work or -play should remain the medical doctors’ responsibilities. Yet participants working at community level suggested that, with relevant training and mentored experience, diagnosis, triaging, and clearance for sport could be within their scope of practice.
Conclusion: Participants suggested that current constraints about timely access to medical doctors impeded initiation of concussion care for many individuals. At high-performance sport level, medical doctor consultation appears to be considered critical. At community level, many participants were already providing interim diagnoses and clearance for return to sports, advising GPs thereof for formal coding or sign-off.
Implications: The scope of practice for physiotherapists for concussion diagnosis, triaging, and return to sports clearance should be reconsidered. Physiotherapists could decrease the burden of medical doctors yet improve efficient and effective initiation of concussion care in the community.