Feasibility of an Interactive Coaching App to Enhance Post-concussion Outpatient Care.

Dorothyann Curran,Shawn Marshall,Julia Lauzon,Deanna Quon

doi:10.3389/fmedt.2021.660540

Dorothyann Curran, Shawn Marshall + Show 2 more

Open Access

https://doi.org/10.3389/fmedt.2021.660540

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Abstract

Objectives: To determine the feasibility of patients to use a web-based health app for management of post-concussion (mTBI) symptoms in an out-patient setting.Participants: Seven (7) patients who were referred to an outpatient specialist clinic (physiatry) with persisting symptoms following a concussion. Participants had to be 18 years of age or older and more than 3 months post injury.Design: This was a prospective cohort study using a web-based platform for chronic disease management to guide patients in managing symptoms based on individual clinical recommendations. Each patient received weekly Symptom Management Plans created by a health coach and a physician specialist, designed to reinforce positive progress with clinical recommendations.Main Measures: Adherence to tracking daily recommendations and symptoms (data collected through the web-interface), The Rivermead Post-Concussion Questionnaire (self report) and a Satisfaction Questionnaire (self report).Results: Adherence to assigned clinical recommendations was close to 100%. Pre-post results on the patient reported outcome measure (Rivermead Post Concussion Tool) showed improvement for most patients in their experience of symptoms. The Satisfaction Questionnaire showed high rates of satisfaction with the App and the intervention in general.Conclusions: Use of a web-based health app with a health coach is feasible in this patient population from both the patient and clinician perspective based on high adherence. There is also some evidence of improvement of symptoms with this intervention over time. Further exploration of the use of this type of intervention with post-concussion patients could potentially impact long-term outcomes.

Highlights

Concussion, known as mild traumatic brain injury accounts for between 70 and 90% of all adult TBI cases treated at hospital Emergency Rooms and/or admitted to hospitals worldwide [1, 2]
The Guidelines for Concussion/mild traumatic brain injury (mTBI) and Persistent Symptoms: 3rd Ed defines persisting symptoms following concussion as; A variety of physical, cognitive, emotional and behavioral symptoms that may endure for weeks or months following a concussion [4]
Access to the App was provided by the Champlain Local Health Integration Network (LHIN) Home Care Innovation Center which provides health services and options for patient care in the community within a set geographic area

Summary

Introduction

Concussion, known as mild traumatic brain injury (mTBI) accounts for between 70 and 90% of all adult TBI cases treated at hospital Emergency Rooms and/or admitted to hospitals worldwide [1, 2]. While most people do recover from a concussion, many experience symptoms that persist beyond the usual 2–4 week timeframe. The Guidelines for Concussion/mTBI and Persistent Symptoms: 3rd Ed (hereafter referred to as The Guidelines) defines persisting symptoms following concussion as; A variety of physical, cognitive, emotional and behavioral symptoms that may endure for weeks or months following a concussion [4]. People with persisting symptoms usually exhibit multiple symptoms including cognitive fatigue, headaches, visual problems (including intolerance to screens), memory problems and sleep disorders, which can make it difficult to focus treatment. These persisting symptoms can become a potentially serious chronic health issue for previously active people, with various negative physical, social and economic impacts

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