Concussion management in Occupational Therapy: A systematic Review

• Introduction
Concussion (mTBI) for over 80% of the 1 to 4 million annual head injuries, with children and adolescents often experience prolonged symptoms and occupational disruptions. While occupational therapists (OTs) address these issues, the optimal assessments and treatments remain uncertain. This systematic review seeks consensus on OT assessments and treatments.
• Methods
In line with the PRISMA guidelines, we validated search strings and searched across multiple databases. Using Covidence software, two reviewers evaluated articles. Inclusion criteria encompassed articles focusing on OT assessment and treatment, published between 2013 and May 2023.
Data was extracted from a subset of 15 articles, categorized into theoretical frameworks (n=5), intervention studies (n=9), and OT perspectives (n=1). Despite limited data, valuable insights into OT assessment and treatment were found. Due to insufficient intervention effectiveness data, a narrative synthesis was undertaken as meta-analysis was unfeasible.
• Results and Discussion.
The limited articles included highlight the need for research, especially from the global south as 14 articles originated from the USA and Canada.
None of the 39 assessments discussed were universally recommended in all categories. The Canadian Occupational Performance Measure appeared most regularly together with the Rivermead Post-Concussion Symptoms Questionnaire and Occupational profile in two of the three groups.
Treatment ranged from specific symptom management, e.g., vision treatment to more general education and skill development. The favoured treatments encompassed graded return to activity, school reintegration, relaxation techniques, vision-specific treatment, and education. Notably, there was greater consensus on treatments than assessments.
• Conclusions
Concussions vary in presentation, necessitating a standardized assessment and treatment protocol for OTs. A systematic review reveals a lack of consensus in assessments and treatments, compounded by a global north bias that may hinder access for therapists in the global south. Future research should aim to establish an OT consensus paper for both regions.