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Concussion Care Pathway

Date of last update: May, 2024

Outcome Measures

Clinical Cornerstone:

  • By incorporating a meaningful set of outcome measures before treatment begins and reviewing them at regular intervals, clinicians can help ensure that care remains patient-centered and evidence-driven. The plan of management can be responsive and adapted as needed to achieve the best possible results. Selected outcome measures should be congruent with the patient’s goals and expectations of treatment.

Common outcome measures for patients with headache associated with or without neck pain include:

  • Concussion Symptoms: Concussion Assessment Tool (SCAT6) (SCOAT6)(to discriminate concussion from non-concussion, Rivermead (RPCS) for severity, Post-concussion Symptom Scale (PCCS).

  • Pain: Pain scales (e.g., NRS), pain diagram.

  • Impact: Impact of pain on daily activities and life situation, e.g. Headache Impact (HIT-6), Sleep Quality (PSQI)

  • Goal Attainment: Help the patient to set SMART Goals: Specific, Measurable, Achievable, Relevant, Timely.

  • Return to Work/School/Activities: PSFS (Patient specific functional scale).

  • Function and participation: e.g., MYMOP, WHODAS 2.0 (12item).

  • Mental Health: Patient Health Questionnaire for Depression (PHQ-9), or Generalized Anxiety Scale (GAD-7)

  • Psychosocial Assessment: Assess any psychosocial factors that may impact recovery e.g., FABQ (Fear Avoidance Behaviour Questionnaire), ORT (Opioid Risk Tool).

  • Quality of Life: e.g., SF-20.

  • Self-perceived General Health: Excellent, very good, good, poor.

  • Patient Feedback: Patient experience and satisfaction with care.

Conduct patient assessment

Red flags or Orange flags present

Red flags or Orange flags present

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Refer to appropriate emergency or healthcare provider

No

Yes

Acute mTBI

  • Structured patient education

  • Self Care

  • Return to work / school

  • Return to driving

  • Return to sport / activity

Persistent mTBI

  • Monitoring and Reassessment

  • Tailored clinical management of symptoms:

    • Headache
    • Neck Pain
    • Sleep Disturbance
    • Fatigue
    • Emotional / Behavioural
    • Cognitive Disorders
    • Vestibular Disorders

Differential Diagnosis

Diagnosis

 

Diagnosis

Follow-up

Follow-up

(Align with patient goals, Criteria for discharge)

Major symptom/sign change

Goals not achieved

Discharge

No

Yes

Re-evaluate

Adjust treatment and management plan or refer

References or links to primary sources

  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. CDC Heads Up [Internet]. CDC February 2022. Available from: https://www.cdc.gov/headsup/index.html.

  • David L. MacIntosh Sports Medicine Clinic, University of Toronto. Post-Concussion Return to Activity Guidelines. EMPWR Our Toolkit [Internet]. EMPWR Foundation 2019. Available from: https://empwr.ca/our-toolkit.

 

Contact information for further inquiries or feedback

carolina.cancelliere@ontariotechu.ca

Disclaimer:

These care pathways are intended to provide information to practitioners who provide care to people with musculoskeletal conditions. The care pathways on this website are 'living' documents, reflecting the state of clinical practice and research evidence to our best knowledge at the time of development. As knowledge and healthcare practices evolve, these pathways may be updated to ensure they remain current and evidence driven. These pathways are not intended to replace advice from a qualified healthcare provider.

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