Aotearoa New Zealand physiotherapists’ perspectives of potential expanded roles for sports-related concussion management: A qualitative study

Abstract

Concussions (mild traumatic head injury) have received increasing attention in clinical practice, research, and the public press. A range of healthcare providers engage with patients presenting with concussion, and physiotherapists are often at the front line of these consultations, especially on the sports field. We explored physiotherapists’ perspectives of their scope of practice and actual clinical practice within the sports-related concussion diagnosis and return-to-sport context. A qualitative approach with interviews and focus groups was used, including 18 physiotherapists. Three themes were derived: (a) delayed access to concussiontrained general practitioners; (b) navigating concussion care in a strained healthcare system; and (c) proposed expanded role for physiotherapists. Delayed patient access to medical doctors often delayed a formal concussion diagnosis, initiation of specific concussion care, or medical sports clearance. Yet the participants were regularly identifying and managing concussions, and most felt confident to do so. Some participants, particularly those working with high-performance athletes or in multidisciplinary teams, suggested that concussion diagnosis and clearance for return to work or play should remain the medical doctors’ responsibilities. Yet participants working at community level suggested that, with relevant training and mentored experience, diagnosis, triaging, and clearance for sport could be within their scope of practice.