Exploring challenges and opportunities related to the identification of mild traumatic brain injury and concussion in rehabilitation trauma inpatients: a qualitative study

To examine the perspectives of healthcare providers regarding missed mild traumatic brain injury and concussion (mTBI/C) diagnosis in trauma populations in rehabilitative and other post-acute settings. An inductive qualitative study design was undertaken to obtain insights from healthcare providers across care settings (e.g. acute care, rehabilitation) about mTBI/C. A total of 20 healthcare providers took part in semi-structured interviews. Data were analyzed using codebook thematic analysis. Four main themes were identified from the data: (1) the prevalence of missed mTBI/C; (2) the challenges of identifying and managing mTBI/C; (3) current approaches to identifying and managing mTBI/C, and; (4) recommendations for improving mTBI/C identification and management. Our qualitative research sheds light on the complexities encountered by healthcare providers with regard to identifying and managing mTBI/C at a patient, practice and system-level. The findings from this work highlighted the variability in diagnostic methods and approaches across care settings and disciplines, emphasizing the need for standardized approaches and enhanced interdisciplinary communication to optimize mTBI/C care. There is a need to raise awareness about missed mild traumatic brain injury and concussion (mTBI/C) in rehabilitation settings, which may lead to more patients receiving appropriate care.There is a need to standardize diagnostic criteria and screening tools to facilitate early identification of mTBI/C in rehabilitation settings as some of the more commonly used tools used in rehabilitation, such as the Montreal Cognitive Assessment (MoCA) and the Rivermead Post-concussion Symptoms Questionnaire (RPQ), were not specifically designed to capture the subtle cognitive and physical signs of mTBI/C.A multidisciplinary approach is required to identify missed mTBI/C in rehabilitation settings, with occupational therapists being ideal as the potential first line of screening for this issue. There is a need to raise awareness about missed mild traumatic brain injury and concussion (mTBI/C) in rehabilitation settings, which may lead to more patients receiving appropriate care. There is a need to standardize diagnostic criteria and screening tools to facilitate early identification of mTBI/C in rehabilitation settings as some of the more commonly used tools used in rehabilitation, such as the Montreal Cognitive Assessment (MoCA) and the Rivermead Post-concussion Symptoms Questionnaire (RPQ), were not specifically designed to capture the subtle cognitive and physical signs of mTBI/C. A multidisciplinary approach is required to identify missed mTBI/C in rehabilitation settings, with occupational therapists being ideal as the potential first line of screening for this issue.