An Inside Look at Para Sport Concussion Care: Para Sport Healthcare Providers Perspectives

Context: Para sport athletes experience concussions at a similar rate to athletes without disabilities; however, published concussion tools have limited applicability to diverse athlete populations. Objective: Understand healthcare provider (HCP) concussion management across different para sports and athlete classifications to identify facilitators and barriers influencing the delivery of concussion care. Design: Explanatory sequential mixed-method. Setting: Online survey and virtual interviews. Patients or Other Participants: Para sport HCPs completed online surveys (n=21) and voluntary follow-up interviews (n=11). Data Collection and Analysis: Researchers designed a survey from an established line of healthcare evaluation surveys and distributed it via chain-referral sampling following expert review (n=3) and pilot testing (n=4). We conducted follow-up interviews via Google Meet using automatic transcription technology and reviewed for accuracy. We used phenomenology to analyze the qualitative data with multi-analyst triangulation and peer review as credibility strategies. Results: HCPs most often used the Sport Concussion Assessment Tool 6 (SCAT6; 85.7%) to guide examinations, the modified Balance Error Scoring System (mBESS; 66.7%) for balance testing, and the Vestibular/Ocular-Motor Screening (VOMS; 81.0%) for vestibular ocular-motor testing. HCPs noted three themes: 1) the importance of developing purposefully flexible classification- and para sport-specific frameworks to promote individualized concussion care, while 2) building personal HCP-athlete relationships to understand individual needs and improve concussion diagnostics, and emphasizing 3) a multidisciplinary, team-based approach to care. HCPs emphasized these themes as critical for successful management across para sports to overcome limited education and resource allocation available to often volunteer-based HCPs. Conclusions: Para sport HCPs used current concussion assessment tools but reported a lack of effective adaptive guidelines exemplified by variable athlete-specific modifications for concussion care. Our findings emphasize the need to develop flexible frameworks for para sport concussion management while emphasizing a multidisciplinary team-based approach to care and HCP-athlete relationships to implement effective para sport concussion care.