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Navigating the evidence-practice gap in concussion care


Despite a growing body of research and clinical guidelines, a significant evidence-practice gap persists in the management of concussions. This gap represents a challenge that health care professionals and researchers are working diligently to bridge. Here are the basics of how the gap plays out in concussion care and how telemedicine is providing a promising solution to the problem.

What is the evidence-practice gap?

The evidence-practice gap refers to the disparity between what scientific research and clinical evidence suggest is the best course of action for patient care and what is actually implemented in real-world clinical practice. This gap can be up to 17 years by some estimates. It’s not unique to concussion care; it exists in various areas of medicine.

In the context of concussions, this gap manifests in several ways:

Over-reliance on rest. Historically, rest has been the cornerstone of concussion management, sometimes referred to as “cocooning.” While it is undoubtedly a vital component of recovery, emerging evidence suggests that prolonged rest may not always be the best approach. The evidence-practice gap here lies in clinicians continuing to prescribe extended rest periods without adjusting management based on the patient’s individual needs and recovery progress.

Lack of consistent follow-up. Many individuals with concussions do not receive adequate follow-up care to monitor their progress. Despite recommendations for post-concussion evaluations, patients often receive minimal follow-up. This gap results in missed opportunities to address ongoing symptoms and complications.

Improper return-to-play decisions. The evidence supports a gradual and individualized return-to-play protocol after a concussion, yet many sports organizations, schools, and clinicians may not follow these guidelines. This inconsistency can put athletes at risk for re-injury.

Underutilization of advanced neurocognitive testing. While neurocognitive testing can provide valuable insights into a patient’s cognitive function, it is often underutilized in clinical practice. In many cases, clinicians rely solely on symptom reports and basic assessments, missing subtle cognitive deficits that may persist.

Limited integration of multidisciplinary teams. Concussion management benefits from a multidisciplinary approach. However, in many health care settings, a lack of coordination among these experts contributes to the evidence-practice gap.

Why does the gap exist?

Several factors contribute to the evidence-practice gap in concussion care. Many clinicians and patients may not be aware of the latest research and guidelines for concussion management. Medical practices often evolve slowly, and traditional approaches can be hard to change, especially when they have been widely accepted for years. Emergency facilities see many concussions on a primary basis, but their top priority is to rule out severe diseases such as brain bleeding, not to implement a successful care plan. Finally, care for concussions is fragmented, leading to disjointed and inconsistent approaches to diagnosis and management.

Bridging the gap

Efforts to bridge the evidence-practice gap in concussion care are underway. Key strategies include promoting the latest evidence-based guidelines and research to clinicians, patients, and the public. Implementing standardized concussion management protocols can ensure consistent care. Finally, state legislation on mandatory minimum care has also prompted the need for both improved education and mandatory medical care.

The telemedicine revolution

Telemedicine offers the potential to enhance access to specialized concussion care. This is especially important for patients in remote or underserved areas. Importantly, the advent of remote neurocognitive testing has made telemedicine concussion care a viable solution in this space.

Conclusion

The evidence-practice gap in concussion care represents an ongoing challenge. However, with increased awareness, education, and a concerted effort to integrate evidence-based guidelines into clinical practice, we can minimize this gap. Bridging the divide between research and real-world care is essential to provide the best possible outcomes for those who have suffered concussions, ensuring their well-being and quality of life. The telehealth revolution has offered a simple solution to bring specialist-level concussion care to the broad population, essentially bridging the gap.

Sohaib Kureshi is a neurosurgeon.


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