Department of Speech, Language, and Hearing Sciences, University of Colorado Boulder.
School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.
Am J Speech Lang Pathol. 2021 Jul 14;30(4):1625-1655. doi: 10.1044/2021_AJSLP-20-00311. Epub 2021 May 26.
Purpose The study purpose was to capture the clinical practice patterns of speech-language pathologists (SLPs) treating mild traumatic brain injury (mTBI; concussion). Study aims were to (a) characterize expert SLP practice patterns for the management of mTBI and (b) use qualitative content analysis to explore areas of quantitative variability within participants' responses. Method Using a modified Delphi approach, SLPs completed an online survey, with Round 1 responses shaping questions for Round 2. Round 2 results were analyzed using a concurrent partially mixed-methods approach with quantitative and qualitative items. Quantitative consensus agreement levels were set prestudy at 75% agreement or higher. Topic-level items that did not reach consensus were analyzed using qualitative content analysis. Participants SLPs engaging in a specialty mTBI-SLP networking group were invited to participate. Round 1 had nine participants (United States: 4, Canada: 5). Round 2 had 18 participants (United States: 12, Canada: 6), with a mean of 15.7 years of experience in mTBI (range: 3-33) and a mean of 7.6 clients with mTBI seen weekly (range: 1-25). Results Nearly all topic-level practice items met quantitative consensus (42/45). Consensus areas included using conceptual frameworks, interprofessional teaming, assessment and intervention practices, goal setting, and outcomes. Functional, collaborative, and client-centered care anchored clinical practice. Areas lacking consensus included SLP roles in mTBI mental and somatic health symptoms, specific measurement tools, and intervention dosages. Qualitative themes that emerged included limited interprofessional awareness for the role of SLPs in mTBI and challenges in measurement selection. Conclusions Study aims were met with clear consensus on clinical patterns implemented by SLPs specializing in mTBI. Results will inform both current clinical practices and future practice guidelines. High-level guidance and advocacy are needed to clarify SLP practice concerns and advance interprofessional education. Future work should address identified gaps, including targeted assessment tools and consensus on intervention methods.
研究目的是捕捉治疗轻度创伤性脑损伤（mTBI；脑震荡）的言语语言病理学家（SLP）的临床实践模式。研究目的是：（a）描述 SLP 管理 mTBI 的专家实践模式；（b）使用定性内容分析探索参与者反应中定量变异性的领域。方法：使用改良 Delphi 方法，SLP 完成了一项在线调查，第一轮的回复为第二轮的问题提供了依据。第二轮的结果使用同时进行的部分混合方法进行分析，包括定量和定性项目。研究前设定了 75%或更高的一致性水平作为定量共识协议水平。未达到共识的主题项目使用定性内容分析进行分析。参与者：受邀参加专门从事 mTBI-SLP 网络小组的 SLP。第一轮有 9 名参与者（美国：4 名，加拿大：5 名）。第二轮有 18 名参与者（美国：12 名，加拿大：6 名），mTBI 患者的平均治疗经验为 15.7 年（范围：3-33 年），每周平均有 7.6 名 mTBI 患者（范围：1-25 名）。结果：几乎所有主题级别的实践项目都达到了定量共识（45 项中的 42 项）。达成共识的领域包括使用概念框架、跨专业团队合作、评估和干预实践、目标设定和结果。功能、协作和以客户为中心的护理是临床实践的基础。没有达成共识的领域包括 SLP 在 mTBI 心理和躯体健康症状、特定测量工具和干预剂量方面的角色。出现的定性主题包括对 SLP 在 mTBI 中的角色的跨专业意识有限，以及在测量选择方面的挑战。结论：研究目的是明确 SLP 专门治疗 mTBI 的临床模式的共识。结果将为当前的临床实践和未来的实践指南提供信息。需要高级别的指导和倡导，以澄清 SLP 的实践关注点，并推进跨专业教育。未来的工作应解决已确定的差距，包括有针对性的评估工具和干预方法的共识。
