1. Progressive Return to Activity After Concussion: The Evolution of Training to Primary Care Providers in a Mixed Method Study
Keith A. Stuessi M.D. 1,2,3, Therese A. West NP 4, Emma Gregory PhD1,2, Karen Trimmer M.A., M. DE 1,2, Mike Fischer B.A. 1,2, Marianna Jolly B.A.1,3, Amy Cecchini M.S. 1,6, Taylor R. Andrews B.A. 1,8 , Rose Braue B.A. 1,2, Scott Livingston, PhD, PT, ATC1, Wesley R. Cole PhD 1,7, Karen L. McCulloch PT, PhD 5,6, Felicia Qashu PhD 1 , Ida Babakhanyan PhD 1,2 , LCDR Lynita Mullins MC, USN1,8
1Defense and Veterans Brain Injury Center, Silver Spring, MD; 2General Dynamics Health Solutions, Silver Spring, MD; 3Naval Hospital Camp Pendleton, Camp Pendleton, CA; 4 US Army Medical Research and Material Command, Fort Detrick, MD; 5 The University of North Carolina at Chapel Hill; 6 Venesco LLC, Chantilly, VA;7 Womack Army Medical Center, Fort Bragg, NC;8 Naval Medical Center San Diego, San Diego, CA
RESULTS
In total, 25 providers enrolled in the PRA Study attended the educational training at three separate sites: Fort Bragg, Marine Corps Base Camp Pendleton and Naval Medical Center San Diego.
Breakdown of participants by is as follows:
In addition to the study participants, 125 non-study participants attended one of the sessions.
The makeup of this group was more diverse and included 20 Physicians, 2 NPs, 1 IDC, 85 Corpsman/Medics, 4 Nurses, and 5 “Others” (DVBIC Staff and a Medical Operations Officer).
Themes that emerged from the educational intervention:
BACKGROUND & PURPOSE
Concussions, also known as mild traumatic brain injury (mTBI), are a common medical condition impacting military personnel.
In 2012, the Defense and Veterans Brain Injury Center (DVBIC) developed clinical recommendations (CR) for primary care managers that define a standardized step-wise return to unrestricted activity, or progressive return to activity (PRA).
The PRA study is a DVBIC initiative looking at awareness and utilization of these recommendations and their impact on recovery of acutely concussed patients.
This abstract focuses on the study’s intervention: an educational program targeting the CR, developed for primary care providers who treat active duty service members with acute concussions.
Medical Profession
# of Participants
Residency Trained Doctor of Medicine (MD) 5
General Medical Officer (GMO) 3
Physician Assistant (PA) 7
Nurse Practitioner (NP) 4
Independent Duty Corpsman (IDC) 6
METHODS
A mixed-method multi-level lesson plan based on best practices in adult learning (anagogical) theory was used to develop the educational curriculum.
This method advocates that adults benefit most with immediate application of content and draw on accumulated knowledge while interacting with a motivated (self-directed) peer group.
Understanding that the study participants had varying degrees of experience, a targeted survey to identify each provider’s experience with concussion management was used to construct an enhanced learning environment.
The two-hour interactive, problem-based educational intervention included PowerPoint slides, an instructor’s guide and a trainee workbook.
All problem-based questions were specifically designed to provoke discussion between peers, and to reinforce steps needed for understanding the CR and integrating the guidance into existing practice.
Common Themes
Problem Based nature of talk instrumental in learning
Proven benefit based on ↑ use of educational material, NSI, Exertion test
Large variance in provider experience
Noted difficulties in actual implementation in clinic setting
CONCLUSIONS
Although preliminary, we are able to demonstrate the utility of a standardized approach to education that is interactive and can be implemented across various clinical settings to providers of various degrees of experience with concussions.
Planned analysis of the impact of the educational component, as part of the larger PRA study, is anticipated to provide insight regarding the effectiveness of this educational intervention on patient outcomes and provider utilization of and adherence to the guidance.
* The views expressed herein are those of the author(s) and do not reflect the official policy of the Department of the Army, Department of Defense, or the U.S. Government.