Research priorities for diagnosis, prognosis, and rehabilitation following concussion: results from a national survey of Australian health professionals

Recently, the Concussion James Lind Alliance Priority Setting Partnership (JLAPSP) (Canada) identified serious research gaps regarding diagnosis, management, and access to effective rehabilitation for concussion/mild traumatic brain injury (mTBI). Our aim was to determine if the same research priorities are important to Australian health professionals working in the concussion/mTBI field. A survey was distributed <i>via</i> professional networks, social media, professional group listservs, a research project noticeboard, and at conferences. It comprised of 25 of the highest ranked concussion research questions from the JLAPSP. We examined how professionals ranked the research questions and analyzed variation in ranking by clinical role and concussion/mTBI work experience. Our sample of 187 participants included medical and allied health professionals. Most participants were occupational therapists (22%), physiotherapists (18%), neuropsychologists (17%), and worked in Victoria (47%), New South Whales (18%), or Queensland (15%) in metropolitan areas. Health professionals ranked three research questions highest: identifying methods to predict prolonged recovery; effectiveness of early referral and treatment by a specialized concussion/mTBI team; and implementation studies on upskilling healthcare workers. The research priorities identified can guide research efforts to improve the assessment, management, and rehabilitation of individuals with concussion/mTBI in Australia. Health professionals with experience in the assessment and rehabilitation of adults with concussions overwhelmingly agree that there is a need for further research to understand the prognosis and the effectiveness of specialized rehabilitation clinics.The role of healthcare providers in supporting recovery and the long-term health implications of suffering a concussion was identified as a priority.Both pre-clinical and clinical research are identified priorities to determine the effectiveness of biomarkers for concussion and return to activity.Health professionals also call for clinical trials testing management protocols, and implementation trials to support translation of clinical guidelines into practice to understand the role of healthcare providers in rehabilitation. Health professionals with experience in the assessment and rehabilitation of adults with concussions overwhelmingly agree that there is a need for further research to understand the prognosis and the effectiveness of specialized rehabilitation clinics. The role of healthcare providers in supporting recovery and the long-term health implications of suffering a concussion was identified as a priority. Both pre-clinical and clinical research are identified priorities to determine the effectiveness of biomarkers for concussion and return to activity. Health professionals also call for clinical trials testing management protocols, and implementation trials to support translation of clinical guidelines into practice to understand the role of healthcare providers in rehabilitation.

近日，加拿大脑震荡詹姆斯·林德联盟优先级设定合作项目（Concussion James Lind Alliance Priority Setting Partnership, JLAPSP）明确了脑震荡/轻度创伤性脑损伤（mild traumatic brain injury, mTBI）在诊断、管理以及获取有效康复服务方面存在的重大研究空白。
本研究旨在探究该项目提出的研究优先级，对于澳大利亚脑震荡/mTBI领域的医疗专业人员是否同样具有重要意义。
研究通过专业网络、社交媒体、专业群组邮件列表、研究项目公告板以及学术会议发放问卷。本次问卷涵盖了JLAPSP评选出的25个优先级最高的脑震荡研究问题。我们分析了专业人员对这些研究问题的排序情况，并依据其临床岗位与脑震荡/mTBI工作年限，探究了排序结果的差异。
本次研究的187名参与者涵盖了医师与辅助医疗专业人员（allied health professionals）。其中占比最高的职业为作业治疗师（22%）、物理治疗师（18%）与神经心理学家（17%）；47%的参与者位于维多利亚州、18%位于新南威尔士州、15%位于昆士兰州的都会区。
医疗专业人员将三项研究问题列为最高优先级：一是明确可预测恢复延迟的方法；二是脑震荡/mTBI专科团队早期转诊与治疗的有效性；三是针对提升医疗人员专业技能的实施性研究。
本研究明确的研究优先级，可为澳大利亚脑震荡/mTBI患者的评估、管理与康复相关研究提供指引。有成人脑震荡评估与康复经验的医疗专业人员普遍认为，亟需开展进一步研究以明确预后情况以及专科康复门诊的治疗有效性。医疗服务提供者在支持康复过程中所扮演的角色，以及脑震荡所带来的长期健康影响，均被列为优先研究方向。此外，明确脑震荡生物标志物与恢复活动有效性的临床前与临床研究，也被纳入优先研究范畴。医疗专业人员还呼吁开展针对管理方案的临床试验，以及支持临床指南转化为实践的实施性研究，以明确医疗服务提供者在康复过程中的作用。
有成人脑震荡评估与康复经验的医疗专业人员普遍认为，亟需开展进一步研究以明确预后情况以及专科康复门诊的治疗有效性。医疗服务提供者在支持康复过程中所扮演的角色，以及脑震荡所带来的长期健康影响，均被列为优先研究方向。此外，明确脑震荡生物标志物与恢复活动有效性的临床前与临床研究，也被纳入优先研究范畴。医疗专业人员还呼吁开展针对管理方案的临床试验，以及支持临床指南转化为实践的实施性研究，以明确医疗服务提供者在康复过程中的作用。