To explore physiotherapists' perspectives of their scope of practice and current actual clinical practice within sports-related concussion diagnosis and return to sports.
We recruited 18 physiotherapists (12 women) with a range of clinical experience and working in sports physiotherapy across the country for this qualitative study. Two members were present at each semi-structured focus group/interview, held via Zoom. Relativist ontological and emic epistemological approaches were used to analyse viewpoints and opinions of the participants. Interpretive Description was used to analyse the data. One team member coded all transcripts and a second member coded one interview and two focus groups. The research team met to discuss interpretations and establishment of the themes using an iterative approach.
Three themes were derived: i) Delayed access to concussion-trained medical doctors; ii) Navigating concussion care in a strained healthcare system, and iii) Proposed expanded role for physiotherapists. Due to the national general burden on medical doctors, concussion diagnoses were often delayed at community level, and formal medical sports clearance was seldom sought. Without the formal diagnosis, patients could not access the fully funded ACC Concussion Services, if needed, creating further financial tension for the patient. The ACC requirements of a diagnosis by medical doctors placed the participants in a quandary as they were regularly identifying and managing concussions, feeling confident to do so. They often used other diagnoses, such as cervical sprain, to initiate rehabilitation to minimise the risk delayed post-concussion recovery. Participants monitored the return to activity and sport programmes, and suggested that their report commonly guided the medial doctor’s return-to-play decision, if the patient could get such appoinment. Those participants working with high performance athletes or in multidisciplinary teams suggested that concussion diagnosis and clearance for return-to-work or -play should remain the medical doctors’ responsibilities. Their views thus contrasted starkly to those working mainly at the community level and in smaller urban and rural areas of the country. Participants working at community level suggested that, with relevant training and mentored experience, diagnosis, triaging, and clearance for sport could be within their formal scope of practice.
Participants suggested that current constraints about timely access to medical doctors impeded initiation of concussion care for many individuals. At high performance sport level, medical doctor consultation appears to be considered critical. At community level, many participants were already providing interim diagnoses and clearance for return to sports, advising GPs thereof for formal coding or sign-off.
The scope of practice for physiotherapists for concussion diagnosis, triaging and return to sports clearance should be reconsidered. Physiotherapists could decrease burden of medical doctors yet improve efficient and effective initiation of concussion care in the community.
Diagnosis
Sports Clearance
