Bridging the Gap Between Medical and Academic Stakeholders Who Assist University Students Returning to Learn after Concussion

Abstract

Concussions affect millions of young adults annually, many of whom are enrolled in post-secondary education. To date, concussion research has yet to establish evidence-based protocols to assist university students in returning to the classroom (i.e., return to learn [RTL]) after concussion. Without clear guidelines, students are left to independently navigate the complex medical and university systems. In order to understand and address barriers to receiving and implementing post-concussion academic supports within higher education, this dissertation was conducted using an exploratory-sequential mixed methods approach comprised of three main aims: (1) to collate the experiences of academic stakeholders and previously concussed university students; (2) to develop the Post-Concussion Collegiate RTL Protocol and additional concussion management recommendations for higher education through a multidisciplinary Delphi procedure; and (3) to assess perceptions surrounding implementation of the novel RTL Protocol among clinicians and academic stakeholders across the Power 5 Conferences.

The first investigation was conducted using semi-structured interviews among previously concussed undergraduate students (n=21) and university academic stakeholders (n=7). Using a Grounded Theory approach, several emerging themes arose among the two cohorts. Specifically, students recalled empathetic interactions with their instructors; however, academic stakeholders indicated they lacked sufficient information and/or resources on how to appropriately develop academic supports to facilitate the RTL process for students recovering from concussion.

The second study sought to mediate the discrepancies in post-concussion RTL support within higher education by developing concussion management guidelines through a modified Delphi procedure. The Delphi panel was comprised of twenty-two multidisciplinary professionals (n=9 clinicians, n=8 researchers, n=5 university academic stakeholders). The iterative process resulted in consensus across four main categories including: recommendations for medical discharge documentation, procedures for developing and maintaining a multidisciplinary RTL approach within post-secondary institutions, processes for university students to obtain academic supports following concussion, as well as the development of the novel Post-Concussion Collegiate RTL Protocol.

The third project explored perceptions of prospective utility of the Post-Concussion Collegiate RTL Protocol among clinicians and university faculty/staff within the Power 5 Conferences (Atlantic Coast Conference, Southeastern Conference, Big 10 Conference, Big 12 Conference, and the Pacific 12 Conference). Participants (N=49; n=25 clinicians, n=24 university faculty/staff) completed an electronic survey comprised of four validated implementation outcome measures including the Acceptability of Implementation Measure (AIM), Implementation Appropriateness Measure (IAM), Feasibility of Implementation Measure (FIM), and Organizational Readiness for Implementing Change (ORIC). Mann-Whitney U analyses yielded no significant between-group differences on the protocol’s acceptability, appropriateness, and feasibility in their setting. However, group differences within the change commitment and change efficacy subscales of the ORIC were noted, with university faculty/staff indicating lower organizational readiness for change in contrast to clinicians within the Power 5 Conferences.

Collectively, these findings serve as a framework for future university policy to standardize the RTL process for students who require academic support after concussion. Additional research is warranted to investigate university infrastructure to develop implementation pathways to support the Post-Concussion Collegiate RTL Protocol across all institutions of higher learning.