Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada (Drs van Ierssel and Zemek); School of Rehabilitation Sciences, University of Ottawa, Ottawa, Canada (Drs O'Neil, King, and Sveistrup); Bruyère Research Institute, Ottawa, Canada (Drs O'Neil and Sveistrup); and Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada (Dr Zemek).
J Head Trauma Rehabil. 2023;38(3):E233-E243. doi: 10.1097/HTR.0000000000000827. Epub 2022 Oct 14.
To examine clinician perspectives regarding the use of telehealth for concussion assessment and management.
A Pan-Canadian survey.
Twenty-five purposively sampled multidisciplinary clinician-researchers with concussion expertise (female, n = 21; physician, n = 11; and other health professional, n = 14).
Sequential mixed-method design: (1) electronic survey and (2) semistructured interviews with focus groups via videoconference. Qualitative descriptive design.
Survey : A 59-item questionnaire regarding the suitability of telehealth to perform recommended best practice components of concussion assessment and management. Focus groups : 10 open-ended questions explored survey results in more detail.
Clinicians strongly agreed that telehealth could be utilized to obtain a clinical history (96%), assess mental status (88%), and convey a diagnosis (83%) on initial assessment; to take a focused clinical history (80%); to monitor functional status (80%) on follow-up; and to manage symptoms using education on rest (92%), planning and pacing (92%), and sleep recommendations (91%); and to refer to a specialist (80%). Conversely, many clinicians believed telehealth was unsuitable to perform a complete neurologic examination (48%), cervical spine (38%) or vestibular assessment (61%), or to provide vestibular therapy (21%) or vision therapy (13%). Key benefits included convenience, provision of care, and patient-centered approach. General and concussion-specific challenges included technology, quality of care, patient and clinician characteristics, and logistics. Strategies to overcome identified challenges are presented.
From the perspective of experienced clinicians, telehealth is suited to manage symptomatic concussion patients presenting without red flags or following an initial in-person assessment, but may have limitations in ruling out serious pathology or providing return-to-sport clearance without an in-person physical examination.
探讨临床医生对使用远程医疗进行脑震荡评估和管理的看法。
一项泛加拿大调查。
25 名具有脑震荡专业知识的多学科临床医生-研究人员（女性，n=21；医生，n=11；其他健康专业人员，n=14），采用有针对性的抽样方法。
顺序混合方法设计：（1）电子调查，（2）通过视频会议进行焦点小组的半结构性访谈。定性描述性设计。
调查：一份 59 项的问卷，涉及远程医疗在执行脑震荡评估和管理推荐最佳实践方面的适宜性。焦点小组：10 个开放式问题更详细地探讨了调查结果。
临床医生强烈同意可以利用远程医疗在初始评估时获取临床病史（96%）、评估精神状态（88%）和传达诊断（83%）；进行有针对性的临床病史采集（80%）；在随访时监测功能状态（80%）；通过休息（92%）、计划和调整（92%）和睡眠建议（91%）进行症状管理；并向专家转介（80%）。相反，许多临床医生认为远程医疗不适合进行完整的神经系统检查（48%）、颈椎（38%）或前庭评估（61%），也不适合提供前庭治疗（21%）或视觉治疗（13%）。主要优点包括方便、提供护理以及以患者为中心的方法。一般和脑震荡特定的挑战包括技术、护理质量、患者和临床医生的特征以及后勤。提出了克服已识别挑战的策略。
从经验丰富的临床医生的角度来看，远程医疗适用于管理无明显症状或初始体检后出现的症状性脑震荡患者，但在排除严重病理或在无体检的情况下提供重返运动许可方面可能存在局限性。
