Certified Athletic Trainers' Use of Cervical Clinical Testing in the Diagnosis and Management of Sports-Related Concussion.

Abstract

CONTEXT:

Despite evidence implicating cervicogenic symptoms in the development of persistent postconcussion symptoms, factors that influence utilization of cervical clinical tests to identify cervicogenic symptoms following concussion are poorly understood.

OBJECTIVE:

Explore barriers to the utilization of cervical clinical testing in multifaceted concussion evaluation.

DESIGN:

Cross-sectional.

SETTING:

Online survey.

PATIENTS OR OTHER PARTICIPANTS:

A total of 122 athletic trainers (AT) (age = 42.6 [6.4] y; female = 51.6%; 52% >10 y of clinical practice; 68% master's degree or greater; 35% treated a minimum of 15 concussions/y).

MAIN OUTCOME MEASURE(S):

Perceived importance, clinical experience, number of concussions treated, utilization of cervical clinical tests following nonspecific cervical pathology and following concussion, comfort with cervical treatment modalities following a concussion, and recommendation for cervical-specific therapy to treat persistent postconcussion symptoms.

RESULTS:

Ordinal logistic regression revealed perceived importance had the strongest positive impact on AT's likelihood of high utilization of cervical clinical testing following concussion (95% CI, .17 to .99; P = .005), while clinical experience (95% CI, -.43 to .29; P = .71) and number of concussions treated/y (95% CI, -.21 to .31; P = .71) had no bearing. Moreover, low comfort with cervical treatments following a concussion (95% CI, -2.86 to -.26; P = .018) and low utilization of cervical clinical testing following nonspecific cervical pathology (95% CI, -7.01 to -3.39; P ≤ .001) had a strong positive impact on high utilization of cervical clinical testing following concussion. Two logistic regression models demonstrated how recommendations for cervical-specific therapy in persistent post-concussion symptom patients could be predicted based on (1) cervical test utilization and (2) perceptions and clinical experience with 79% and 78%, respectively.

CONCLUSIONS:

Perceived importance played a major role in utilization of cervical clinical test following concussion. ATs who utilized common cervical treatments when dealing with non-concussive injuries were more likely to utilize those same treatments to treat comorbid cervical pathology following a concussion.

• Authors: Kelly Cheever, Melissa Kay
• Journal: Journal of sport rehabilitation (J Sport Rehabil) Vol. 30 Issue 6 Pg. 926-934 (Mar 25 2021) ISSN: 1543-3072 [Electronic] United States
• PMID: 33771946 (Publication Type: Journal Article)

Topics

• Adult
• Athletic Injuries (diagnosis)
• Brain Concussion (diagnosis, therapy)
• Cross-Sectional Studies
• Female
• Humans
• Post-Concussion Syndrome
• Sports