Beyond Publications: A Focus on Clinical Implications and Implementing Concussion Research in Clinical Practice within the U.S. Military Health System

Presenters:

  • Saafan Malik
  • Emma Gregory
  • Rachel Lazarus

Objectives:

  • Define knowledge translation (KT) and state the importance of KT in concussion care, including care for Service Members and Veterans.
  • Summarize completed and ongoing research studies, to include those focused on devices or technology for assisting in concussion assessment and management, that have the potential to directly inform concussion care.
  • Describe KT research supporting concussion care, and highlight important methodological, recruitment, and feasibility considerations in conducting research to evaluate clinical guideline use in a real-world setting.

Description:

Every year concussion/mild traumatic brain injury (mTBI) affects thousands of individuals, including Service Members (SMs) in the U.S. military. While research continues to emerge describing best practices for diagnosing, assessing, and managing concussion, clinical implications of research findings are often not the focus of publications or presentations, and moreover, are often not implemented into practice or only implemented in piecemeal over the course of many years. Overcoming these dissemination and implementation challenges will require prioritizing and reorganizing research efforts in order to produce findings that are clinically relevant and readily translatable into practice. The Defense and Veterans Brain Injury Center (DVBIC), the TBI Center of Excellence component of the Defense Health Agency, has a mission to serve SMs, their beneficiaries and veterans with TBI through clinical care, innovative clinical research initiatives, and educational programs. The DVBIC coordinates the review of current evidence for the development of state of the science clinical recommendations and tools supporting diagnosis, assessment, and treatment of TBI. Furthermore, through its research mission, the DVBIC supports studies focused on yielding findings with translatable relevance as well as studies that examine the utility of treatments and clinical guidance in ecologically valid settings.

This symposium will describe the importance of knowledge translation research including: a) Allocating resources and efforts to studies with clinical relevance; b) Prioritizing the extraction of clinical implications from research; c) Conducting research on treatments and guidance in real world settings to produce findings that are generalizable, such that findings are readily implementable into practice; and, d) Collaborating with the civilian sector, particularly on sports concussion-related projects, to make tangible improvements to concussion screening and treatment tools. A selection of research studies will be highlighted that directly inform concussion assessment and management and currently have findings being considered for incorporation into care algorithms. The discussion will include an overview of ongoing research on devices or technology aimed at assisting in concussion assessment. Finally, several knowledge translation research studies evaluating and validating DVBIC clinical recommendations will be presented, along with a description of challenges and considerations for conducting this type of research.

Research and research support must emphasize the need for studies that have the potential to directly inform best practices and support the adoption of such best practices into clinical care. Moreover, publication and presentation are insufficient modes of dissemination for moving findings to practice. Instead, attention should be directed on how to incorporate findings into clinical guidelines, as well as proactive evaluation of guidelines to ensure the adoption of these standards in non-idealized settings. This practical focus is critical to ensure force readiness in SMs, as well as implementation of safe return-to-play protocols following sports concussion.

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