Back to Top Skip to main content

Improving training of healthcare providers boosts post-concussion care

Elizabeth Fuentes (left), physical therapist assistant, Fort Bliss Traumatic Brain Injury Clinic, William Beaumont Army Medical Center, provides information and educates medical professionals about TBI symptoms, treatments and assessments, during the TBI Clinic’s open house event, in observance of Brain Injury Awareness Month. (U.S. Army photo by Marcy Sanchez) Elizabeth Fuentes (left), physical therapist assistant, Fort Bliss Traumatic Brain Injury Clinic, William Beaumont Army Medical Center, provides information and educates medical professionals about TBI symptoms, treatments and assessments, during the TBI Clinic’s open house event, in observance of Brain Injury Awareness Month. (U.S. Army photo by Marcy Sanchez)

Recommended Content:

Traumatic Brain Injury

What happens when the Defense and Veterans Brain Injury Center disseminates a new clinical recommendation? Is it adopted by practitioners? Does training health care providers lead to improved patient outcomes?

DVBIC scans the latest research about TBI findings, and then recruits TBI experts from the scientific community who meet regularly to develop clinical guidelines to inform health care decisions. This specialized function supports the Military Health System’s objectives of improving warfighter care and readiness. DVBIC is a division of the Defense Health Agency Research and Development Directorate.

These questions are at the heart of a recent study by DVBIC who asked whether teaching providers about state-of-the-science tools for concussion treatment improves patient care and rehabilitation. A concussion is a blow or jolt to the head that disrupts the normal function of the brain. Most traumatic brain injuries in the military are mild and most service members return to duty after recovering from their injuries.

The study compared two groups of TBI patients: those treated after primary care managers at various military hospitals received an interactive two-hour training, and those treated before providers received instruction. At the end of the study, patients completed a questionnaire that asked how soon they began to engage in physical and mental activity.

DVBIC found that patients in the group cared for by providers who had received the intensive training reported an overall reduction in symptoms after one week, one month and at three months, when compared to patients who were treated by the providers who had not yet received the intensive training.

This study highlights the importance of integrating research, clinical affairs, and education activities at DVBIC.

“One of the things that DVBIC has done, of late, is take many of our clinical tools . . . and actually study them,” Navy Captain Scott Pyne, DVBIC division chief. “The tools are based on the state-of-the-science, which is current research. Not only do we create the tool, but we throw it out there for the providers to use, and then we evaluate the effectiveness of its use. That's been very helpful.”

The “Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury” clinical recommendation is focused on a six-stage approach to manage recovery.

The first stage involves rest, followed by light routine activity, light work-related activity, moderate activity, intensive activity, and finally unrestricted activity.

Each stage lasts a minimum of 24 hours and the service member should be re-evaluated each day. Patients with a mild TBI, often described as a concussion, should begin with less physical and mental activity and gradually move from one stage to the next.

“We have been able to show two critical things for military medicine,” said Jason Bailie, DVBIC’s senior clinical research director at Camp Pendleton. “Our frontline medical practitioners need to be taught how to treat concussed patients with a progressive return to activity approach” and “we can enhance our force readiness by helping our warfighters get better faster following a concussion.”

In addition to improved health among patients, the study finds more consistent treatment options offered by the trained physicians – including giving their patients special brochures focused on different parts of their rehabilitation. As one physician said in a post-study survey, “It’s been a pretty big difference, not only in my comfort with treating these patients, but educating them as well.”

Dr. Keith Stuessi, a DVBIC subject matter expert who provided the two-hour training sessions, underscored the implications of these findings for DVBIC’s future training efforts. “By doing this study, in this way,” Stuessi said, “we showed the effectiveness of this educational intervention.”

These findings could not be timelier. In June 2019, the U.S. Army directed medical personnel who would be treating patients with concussions use updated management tools designed by DVBIC, including the progressive return to activity process.

The progressive return to activity clinical suite is designed to help primary care managers, rehabilitation providers, and service members.

You also may be interested in...

Diagnoses of Traumatic Brain Injury Not Clearly Associated with Deployment, Active Component, U.S. Armed Forces, 2001 – 2016

Infographic
4/4/2017
Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force.  TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment). Categorization of person time during surveillance period included four categories: Group 1 (Never deployed/TBI before first-ever deployment), Group 2 (Currently deployed or within 30 days of return), Group 3 (previously deployed but not currently deployed nor within 30 days of return) and Censored after Diagnosis of TBI. From 2001-2016, 276,858 active component service members received first-time diagnoses of TBI. The crude overall incidence rate of TBI among deployed service members was 1.5 times that of service members assigned to Group 1 and 1.2 times that of service members in Group 3 during the surveillance period.  Total TBI cases by group were Group 1 42.8%, Group 2 13.2% and Group 3 44.0%. Incidence rates by group (per 100,000 person-years) were Group 1 1,141.3, Group 2 1,690.5, and Group 3 1,451.2. Learn more at www.Health.mil/MSMR and see fact sheets at www.Health.mil/AFHSB

Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force. TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment).

Recommended Content:

Traumatic Brain Injury
Showing results 1 - 1 Page 1 of 1

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.