Abstract
Background: Concussion is a common injury both in New Zealand (NZ) and globally. Although many people recover from concussion within a few months, a proportion can go on to experience persistent symptoms which have a significant impact on their lives. A tool for clinicians to use when assessing and treating people with concussion are clinical practice guidelines (CPGs). The purpose of CPGs are to synthesise evidence-based research recommendations to guide clinical practice. However, despite concussion CPGs being useful tools, they are not always used. There is a need for the development and use of strategies to improve uptake and implementation of CPGs.
Aim: The aim of this research project was to survey NZ clinicians on their use of concussion CPGs and identify facilitators and barriers to their use. The research objectives were to, investigate clinician awareness and use of concussion CPGs, identify facilitators and barriers to use, find out if CPGs had helped to improve clinical practice and to identify the main reasons clinicians used CPGs.
Methods: This study was a quantitative, non-experimental study with an observational research design. An online survey was developed and piloted. The survey included demographic information, questions on awareness and use of concussion CPGs, questions on facilitators and barriers to use and questions on the reasons for use of CPGs. The survey was disseminated using a snowballing approach, by emailing a link to the survey around networks available to the research team.
Results: Eighty-six clinician respondents completed the survey and were included in the analyses. Clinicians were aware of and did use concussion CPGs. However, there were aspects of the CPGs themselves and workplace factors which were identified as barriers (time constraints, client variability and unclear information) or facilitators (level of evidence, clear information and being easy to find) to CPG use. Some clinicians reported strategies and supports were provided by their workplace to facilitate CPG use, but many clinicians reported that supports were not provided. While there was a statistically significant association between years of experience in the concussion field and concussion CPG use, this study did not find any associations between discipline and CPG use.
Conclusions: Clinicians were generally positive about the value added to their clinical practice by concussion CPGs. This study identified aspects of the CPGs themselves and workplace factors which were barriers to CPG use. There is an opportunity for more strategies and supports to be provided to facilitate CPG use. Future research should explore implementation strategies, using knowledge translation models to improve uptake of CPGs. In addition, specific aspects of CPGs which were identified as weaknesses could be further investigated, such as insufficient detail about managing the complex psychological factors which impact concussion recovery.